Amaç: Ýntraabdominal yapýþýklýklar halen ciddi bir problemdir. Geçmiþte septik batýnda adezyon formasyonunu önlemek için sadece rifamisin lavajý denenmistir. Bu çalýþmanýn amacý abdominal sepsis modelinde farklý antibiyotiklerin intraperitoneal uygulamasýnýn etkinliðini deðerlendirmektir.
Gereç ve Yöntem: 60 adet Wistar-albino sýçan rastgele olacak þekilde 6 eþit gruba ayrýlmýþtýr. Tüm gruplara çekal ligasyon ve puncture modeli uygulanarak bakteriyel peritonit oluþturulmuþtur. Grup 1 kontrol grubudur. Grup 2’ye izotonik salinle, grup 3’e imipenemle, grup 4’e seftriaksonla, grup 5’e sefazolinle ve grup 6’ya metronidazolle periton lavajý yapýlmýþtýr. Cerrahiden 4 hafta sonra intraabdominal adezyonlar deðerlendirilmiþ, adezyonlarýn gerginlik kuvveti ölçülmüþ ve histopatolojik deðerlendirme yapýlmýþtýr.
Bulgular: Ýmipenem, seftriakson ve sefazolin ile adezyon formasyonu anlamlý derecede azalmýþ (p<0,001) ve fibrozis skorlarý anlamlý derecede düþük olarak bulunmuþtur (p=0,013). En kötü adezyon metronidazol grubunda izlenmiþtir. Adezyon kopma kuvveti grup 4 ve 5’te anlamlý olarak düþüktür (p<0,001). Ýnflamasyon daðýlým skorlarý benzer olmasýna raðmen (p=0,058) grade 3 inflamasyon skorlarý sadece kontrol, salin ve metronidazol grubunda gözlemlenmiþtir.
Sonuç: Bu veriler ýþýðýnda septik karýnda sefalosporinle peritoneal lavajýn adezyon formasyonunu önlenmede etkin olduðu ve sonuçlarýn bir klinik çalýþmada deðerlendirilmesi gerektiði söylenebilir.

Background: Intraabdominal adhesions are still a major problem. Previously, only rifamycin lavage was tried to prevent adhesion formation in septic abdomen. The aim of our study was to test the effectiveness of intraperitoneal application of different antibiotics in an abdominal sepsis model.
Materials and methods: 60 Wistar-albino rats were randomly divided into 6 equal groups. Bacterial peritonitis was induced using caecal ligation and puncture model in all groups. Group 1 was control. Peritoneum was lavaged with isotonic saline in group 2, with imipenem in group 3, with ceftriaxone in group 4, with cefazolin in group 5 and with metronidazole in group 6. Four weeks after the surgery, intraabdominal adhesions were graded, tensile strength of the adhesions was measured and histopathological examinations were performed.
Results: Imipenem, ceftriaxone and cefazolin significantly reduced adhesion formation (p<0.001) with significantly low fibrosis scores (p=0.013). Worst adhesions were in metronidazole group. Breaking force of adhesions was significantly low in group 4 and 5 (p<0.001). Although, the distribution of inflammation scores were similar (p= 0.058), grade 3 inflammation scores were only seen in control, saline and metronidazole groups.
Conclusion: According to these data, cephalosporins seem effective to prevent adhesion formation in septic abdomens and need to be evaluated in a clinical trial.

INTRODUCTION: We evaluated the effect of calcium alginate as a hemostatic agent in

splenic injury model.
MATERIAL AND METHOD: Experimental rats were divided into four groups. Group I:

Laparotomy was not performed. Only blood samples for bleeding time and hemogram was

taken. Group II: After laparotomy, the abdomen was closed without any splenic injury.

Group III: After laparotomy, splenic injury about 0.5 cm in depth and 0.3 cm in lenght was

created by standart Rochester pean forceps. Gauze dressing with serum physiologic about 2x2

cm in size was applied to the injured splenic tissue for 3 minutes Group IV: After laparotomy,

standart splenic injury about 0.5 cm in lenght and 0.3 cm in depth was also created in this

group. Calcium alginate wound dressing 1x1 cm in size was applied to the splenic

wound.Peroperative blood loss, pre and postoperative hemoglobulin and hematocrit values were calculated.

RESULTS: When comparing decline in hematorit values and peroperative bleeding amount

in between Group III and Group IV, Group IV has lower decline in hematocrit values and

peroperative bleeding amount (Table II,III). CONCLUSION: In conclusion, Calcium alginate has hemostatic capacity. It may be used in

splenic injuries specially for Grade I and II.

BACKGROUND
In the treatment of a subset of patients with uncomplicated appendicitis, no surgical method has been clearly estab- lished as superior.
METHODS
The present study was a prospective randomized clinical trial. Patients diagnosed with acute appendicitis were recruit- ed for the study. Patients with a preoperative diagnosis of complicated appendicitis were excluded. The patients were randomly divided into two groups: a laparoscopic appendec- tomy group and an open appendectomy group. The primary outcome measure was the rate of postoperative septic compli- cations. Secondary outcome measures were the length of hos- pital stay, postoperative pain score, and quality of life score.
RESULTS
Ninety-six patients were included in the study, 50 in the laparoscopic appendectomy group and 46 in the open ap- pendectomy group. There were no signi cant differences between the two groups in terms of the rates of postopera- tive septic complications, hospital stay lengths, postopera- tive pain scores, or quality of life scores.
CONCLUSION
The laparoscopic approach to appendectomy in patients with uncomplicated appendicitis does not offer a signi cant advan- tage over the open approach in terms of length of hospital stay, postoperative pain score, or quality of life, which are consid- ered the major advantages of minimally invasive surgery.

AMAÇ
Ülkemizdeki kalabalýk aciller için geliþtirdiðimiz þikayet temelli 5-düzeyli Hacettepe Acil Triyaj Sistemi’ni ESI 5-düzeyli triyaj sistemiyle karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM
Altý gün süresince hergün baþka bir görevli tarafýndan HATS ile deðerlendirilen hastalar, bir Acil Týp Uzmaný tarafýndan HATS ile kör olarak tekrar deðerlendirildiler. Her iki deðerlendirme kararýný bilmeyen ve ESI konusunda uzman olan baþka bir Acil Týp Uzmaný tarafýndan baðýmsýz ve kör olarak ESI ile deðerlendirildiler.
BULGULAR
Araþtýrmadaki 308 hastanýn 133’ü erkek, 175’i kadýn ve yaþ ortalamasý 44,41 ± 18,033 bulunmuþtur. HATS ile HATS-Kör karþýlaþtýrýldýðýnda gözlemler arasý tutarlýlýk %97,40 (Kappa=0,963), ESI-Kör ile karþýlaþtýrýldýðýnda gözlemler arasý tutarlýlýk %74,35 (Kappa=0,646) saptanmýþtýr. HATS-Kör ile ESI-Kör karþýlaþtýrýldýðýnda gözlemler arasý tutarlýlýk %74,67 (Kappa=0,652) saptanmýþtýr. Birinci Acil Týp Uzmaný, Acil Týp Asistaný, ve Acil Hemþiresi ile HATS-Kör uygulayan Ýkinci Acil Týp Uzmaný arasýndaki tutarlýlýðýn en yüksek olduðu (Kappa=1,0), Ýntern Doktor, týbbi olmayan Acil Sekreteri ve Paramedik’in de çok iyi olduðu (Kappa= sýrasýyla 0,971; 0,935; 0,864) saptanmýþtýr. HATS ile deðerlendirilen hastalarda %7,25 yanlýþ yüksek triyaj, %1,08 yanlýþ düþük triyaj bulunmuþtur.
SONUÇ
Aþýrý kalabalýk acil servisler için geliþtirlmiþ olan þikayet temelli HATS, gözlemler ve gözlemciler arasý tutarlýðý yüksek, yanlýþ triyaj oranlarý düþük, týbbi olmayan sekreterden acil týp uzmanýna kadar herkesin kolaylýkla uygulayabileceði bir triyaj sistemidir.

BACKGROUND
To compare ESI Five-Level Triage System with 5-Level Hacettepe Emergency Triage System, which was developed for Overcrowded EDs’ in our country.
METHODS
During 6 days, patients were assessed by a different ED staff everyday using HETS and they were re-evaluated blindly by an Emergency Physican using HETS. Then patients were evaluated blindly for a third time by an independent, ESI using Emergency Physican.
RESULTS
Of the patients in the study, 133 were men, 175 were women and the average age was 44.41 ± 18.033. Interrater agreement was found 97.40% (Kappa=0.963) between HETS and HETS-Blind, 74.35% (Kappa=0.646) between HETS and ESI-Blind, 74,67% (Kappa=0.652) between HETS-Blind and ESI-Blind. Interobserver agreement between the second Emergency Physician who is performing HETS-Blind and the first Emergency Physician, Resident, Nurse was found very good (Kappa=1.0). Intern Doctor, Non-Medical Secretary and Paramedic was found almost very good agreement (respectively; Kappa= 0.971; 0.935; 0.864). Overtraige 7.25% and undertraige 1.08% were found in HETS.
CONCLUSION
Complaint-based HEST developed for Overcrowded EDs’ is a triage system which has a very good agreement between observations and observers, provided with low undertrige and overtriage ratios and can be easily applied by all staff from non-medical secretary to the Emergency Physican.

Background: In these first reported series we observed the outcomes of skin take and wound healing using 2-octyl-cyanoacrylate glue which was used as tissue glue in the reconstruction of complex genital skin loss due to fournier gangrene.
Material and Methods: Fifteen patients with Fournier’s gangrene were treated in this study. After initial surgical debridement, all defects were repaired using STSG. In this method a thin layer of 2 octyl-cyanoacrylate was dripped on the recipient site immediately before graft application. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Patient and physician satisfaction were also determined.
Results: Grafts were completely accepted in all fifteen patients. None of the patients had wound infection, seroma, hematoma, or other complications.
Conclusions: Use of 2 octyl-cyanoacrylate glue (Glueseal) for STSG fixation in complex genital skin defects after fournier gangrene may be an acceptable alternative to conventional surgical closure with a good cosmetic outcome. Further studies are needed to confirm our initial success with this approach.
Key words: cyanoacrylate, skin graft, fournier gangrene.

Amaç: Çalýþmamýzýn amacý amatör oyuncularda futbol topu ile oluþan arka segment kapalý göz yaralanmalarýnýn anatomik ve fonksiyonel sonuçlarýný, uygulanan tedavileri incelemektir.
Gereç Ve Yöntem: 2004-2008 yýllarý arasýnda futbol oynarken kapalý göz yaralanmasý geçiren 22 hastanýn kayýtlarý geriye dönük olarak incelendi. Yaralanmalar okuler travma sýnýflamasýna göre deðerlendirildi.
Bulgular: 22 hastanýn tümü erkekti ve yaralanmalarýn tümü futbol topu çarpmasýna baðlýydý. 16 (%72) hastaya herhangi bir tedavi uygulanmadý. 5 (%22) hastaya cerrahi tedavi uygulandý. 20 (%91) hastanýn baþvuru anýndaki görme keskinliði 5/200 ve üzerindeyken 2 (%9) hastanýn ise el hareketi ve altýndaydý. Son kontrol muayenesinde 22 hastanýn tümünde 5/200 ve üzeri görme keskinlik düzeyi elde edildi (p<0.01).
Sonuç: Futbol topu ciddi arka segment travmasýna neden olabilmektedir ve koruyucu ekipman kullanýmý uygun bir çözüm olabilir.

Backround: The aim of this study to report the characteristics, treatment, and anatomical and functional outcomes of outdoor amateur soccer players with soccer ball-related posterior segment ocular trauma
Methods: We conducted a retrospective chart review of 22 patients with diagnoses of closed-globe ocular trauma caused by soccer play activity from 2004 through 2008. Injuries were classified according to Ocular Trauma Classification.
Results: All patients (n=22) were male and all injuries were due to contact with the soccer ball itself. Sixteen (72%) patients did not require any treatment. Surgery was performed in 5 (22%) patients. Twenty (91%) eyes had 5/200 or better VA at presentation and 2 (9%) eyes had hand movements or worse VA. At the final visit all of the 22 eyes had 5/200 or better VA (p<0.01).
Conclusion: We have identified that soccer ball can cause significant posterior segment trauma and using an eye protection equipment might be an appropriate solution.

Amaç:
Mezenter ven trombozu, akut mezenter iskemi olgularýnýn yaklaþýk %5-15’inden sorumlu olan ve nadir görülen bir durumdur. Bu çalýþmanýn amacý, 34 hastalýk tecrübemizi paylaþmak ve mezenter ven trombozuna yaklaþýmý tartýþmaktýr.

Gereç ve Yöntem:
Ocak 2007 ve Ocak 2010 tarihleri arasýnda, acil cerrahi servisimize mezenter iskemi tanýsý ile baþvuran 34 hasta retrospektif olarak incelendi.Peritonit bulgusu mevcut olan hastalara, baþvurularýnda tanýsal laparokopi uygulandý. Ameliyatýn bitirilmesine yakýn, karýn sol alt kadrana 10mm laparoskopi trokarý yerleþtirildi. Anastomoz yapýlan olgularda ameliyat sonrasý ilk 72 saatlik dönemde laparoskopik ikincil baký yapýldý.Tüm hastalar günde iki kez subkutan 100mg/kg enoxaparin uygulandý. Ven rekanalizasyonu deðerlendirilmesi amacýyla tüm hastalara, 6. ve 12. aylarda BT anjiografi görüntüleme yapýldý.

Bulgular:
BT anjiografi ile 25(%73) hastada superior mezenterik ven trombozu, 24(%70) hastada portal ven trombozu ve 12 (%35) hastada splenik ven trombozu saptandý. Peritonit bulgusu olan 11 hastaya tanýsal laparoskopi yapýldý. Bu hastalarýn 8 tanesine ince baðýrsak rezeksiyonu ve anastomozu yapýlarak ikincil baký için trokar yerleþtirildi. Ýkincil baký yapýlan hastalardan 2 tanesinde ince baðýrsak iskemisi saptanarak re-rezeksiyon gerçekleþtirildi.

Sonuç:
Mezenterik ven trombozunun tedavisinde BT anjiografi ile erken taný, cerrahi ya da cerrahi dýþý yöntemlerle kan akýmýnýn saðlanmasý, uygun antikoagulan kullanýmý ve yoðun bakým destek tedavileri, hastalýðýn baþarýlý bir þekilde yönetilmesinde hayati rol oynamaktadýrlar.

Background:
Mesenteric vein thrombosis is a rare occurrence that is responsible for approximately 5–15% of all cases of acute mesenteric ischemia.The aim of this presentation is to discuss the management of mesenteric vein thrombosis with our experience of 34 patients.

Methods:
Between January 2007 and January 2010, 34 patients who admitted to our emergency surgery department with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively.Patients with peritoneal signs were initially underwent diagnostic laparoscopy to rule out the perforation or bowel gangrene.We performed a second-look laparoscopy within 72h following the first operation.All patients anticoagulated with enoxaparin 100mg/kg/twice-daily.In 6th and 12th months of controls a CT-angiography was carried out to determine recanalization of the veins.

Results:
CT-angiography revealed superior mesenteric vein thrombosis in 25(73%) patients, portal vein thrombosis in 24(70%) patiens, and splenic vein thorombosis in 12(35%) patients. Eleven patients with peritoneal sign had underwent diagnostic laparoscopy. Among them, in 8 patients small bowel resection and anastomosis was performed and in a trocar was inserted.During the second look laparoscopy in 2 patients small bowel ischemia was found and re-resection was performed.

Conclusion:
Early diagnosis with CT angiography, surgical and non-surgical blood flow restoration, proper anticoagulation, and supportive intensive care are the cornerstones of successful treatment of mesenteric vein thrombosis.

AMAÇ
Özofagus yabancý cisimleri her yaþ grubunda sýk görülür ve acil týpta önemli yer tutar.Tedavinin yeterli olmamasý halinde özofagus’ta obstrüksiyon, submukozal laserasyon ve kanama,basýnç nekrozu, alkali yanýklar ve perforasyon görülebilmektedir.Bu çalýþmanýn amaçlarý özofagus yabancý cisimlerinin klinik özelliklerini belirlemek, giriþimsel ve cerrahi yaklaþýmýmýzý ve sonuçlarýný analiz etmektir.
GEREÇ VE YÖNTEM
Bu çalýþmada; 20 yýlý aþkýn sürede Siyami Ersek Hastanesine baþvurmuþ ve özofagus yabancý cisim tanýsý ile takip ve bir giriþimsel iþlem veya cerrahi yapýlarak tedavi edilen 512 hastanýn kayýtlarý incelenmiþtir.
BULGULAR
Çocuklarda yabancý cisim týkacý en sýk 2-5 yaþ(%34.4) grubunda,eriþkinlerde ise 55 yaþ(%38.7) ve üzerinde saptanmýþtýr. Çocuklarda özofagus’ta en sýk saptanan yabancý cisim madeni paralar 232(%68.8) iken eriþkinlerde ise en sýk et parçasý 153(%87.4) saptanmýþtýr.Yabancý cisimler çocuklarda en sýk servikal özofagus’a(%78.2) yerleþmiþken eriþkinlerde ise torasik özofagus’a(%66.4) yerleþmiþtir. Eriþkinlerin 54(%30.8)' unda eþlik eden özofagus veya baþka bir sistem hastalýðý tespit edilmiþtir.Yabancý cisimler çocuklarýn %48.3' ünde entübasyon laringoskopisinde Magill pensiyle baþarýyla çýkarýlmýþken; eriþkinlerin tamamýna rijid özofagoskopi yapýlmýþtýr. Çocuklarda mortalite görülmezken; eriþkinlerde rijit özofagoskopi sýrasýnda meydana gelen perforasyona baðlý mediastinit ve sepsisten 3 olguda ölüm meydana gelmiþtir.
SONUÇ
Altta yatan özofagus hastalýklarý veya eþlik eden sistemik hastalýklar eriþkinlerde özofagus yabancý cisimlerine eðilimi artýrmaktadýr.Göðüs cerrahlarýnýn klinik ve endoskopik tecrübelerinin artmasýyla son yýllarda özofagus yabancý cisimlerine baðlý morbidite ve mortalite azalmýþtýr.

BACKGROUND
Esophageal foreign object ingestion is frequently seen in all ages.Failure to treat them can cause serious complications such as esophageal perforation.The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results for their removal.

METHODS
The records of 512 cases of foreign objects enlodged in the esophagus, treated at Siyami Ersek Hospital,Ýstanbul over a period 20 years were analyzed.
RESULTS
Patients aged between 2-5 years were majority (34.4%) in children, above 55 years (38.7%) in adults.Coins were the commonest type foreign object detected in 68.8% of children,whereas meat impaction in 87.4% of adults.Location of the foreign object was at the cervical esophagus in 78.2% of children, whereas thoracic esophagus in 66.4% of adults.There were esophageal or systemic disease in 30.8% of adults. Objects were removed with Magill clamp in 48.3% of children.Rigid endoscopy was the main treatment in adult patients.Perforation due to endoscopy developed in three patients.Surgical repair was performed on these patients but all died owing to mediastinitis.
CONCLUSION
Underlying esophageal or systemic diseases may predispose to foreign object ingestion in the esophagus in adults.Improving endoscopic experience and clinical management of thoracic surgeons led to reduce morbidity and mortality in recent years.

Amaç: Bu retrospektif çalýþmada, kliniðimizde 8 yýlý kapsayan süre zarfýnda 28 ateþli silah yaralanmasýna baðlý opere ettiðimiz periferik sinir lezyonlu hastada uyguladýðýmýz cerrahi tedavi ve sonuçlarý sunulmaktadýr.
Yöntem ve gereç: Çalýþmaya Ocak 2002 – Þubat 2010 tarihleri arasýnda kliniðimize baþvuran, etyolojide ateþli silah yaralanmasý olan, yaralanmadan 1-6 ay süre sonra baþvurmuþ ve periferik sinir lezyonu tanýsý ile opere edilen olgular dahil edildi. Tüm hastalara preoperatif ve postoperatif elektromiyografik inceleme (EMG) ve motor güç derecelendirmesi yapýldý. Olgularýn tümüne cerrahi tedavi uygulanarak, operasyon sonrasý 1, 6, 12. ayda kontrole çaðrýldý.
Bulgular: Hastalarýn ortalama baþvuru süreleri 3,6 aydý (1gün- 6ay). En sýk yaralanan sinir; 14 olgu (%50) ile siyatik sinirdi. Olgularýn 23’ ü kurþun yaralanmasý (9’u tabanca ile sivil yaralanma, 14’ ü tüfek ile askeri yaralanma), 5’ i ise þarapnel yaralanmasýna baðlý olarak meydana gelmiþti. Olgularýmýzýn tümünde sinir dokusu bütünlüðü tam olduðundan cerrahide sinir grefti ihtiyacý olmadý. Cerrahi sonrasý eksternal epinöroliz + dekompresyon yapýlan olgularda, EMG sonuçlarýnýn ve motor fonksiyonlardaki düzelmenin daha iyi olduðu saptandý.
Sonuç: Biz cerrahi teknik kurallara uyulmasý þartýyla (enfeksiyon, cilt defekti, vasküler yaralanma ve kemik kýrýðý varlýðý dýþýnda) ateþli silah yaralanmasýna baðlý sinir lezyonlarýnda ilk altý ay içinde cerrahi tedaviyi önermekteyiz.

Objective: Surgical treatment, which we applied in 28 patients with peripheral lesion, we operated within 8 years in our clinic because of gunshot injury, and its outcomes are presented in this retrospective study.
Material and Method: The cases, who applied to our clinic between January 2002 and February 2010, had gunshot injury in etiology, applied 1-6 months after the injury, and was operated due to the diagnosis of peripheral nerve lesion, were included into the study. Preoperative and postoperative electromyographic analysis (EMG) and motor strength rating were performed on all patients. After all patients were surgically treated, they were called for control at the postoperative 1st, 6th, and 12th months.
Findings: The mean application period of the patients was 3.6 months (1 day - 6 months). The most injured nerve was the sciatic nerve by 14 cases (50%). Of the patients, 23 came depending on bullet injury (9 were civilian injury with a gun, 14 were military injury with a rifle) and 5 came due to shrapnel injury.
Conclusion: We recommend the surgical treatment within the first six months in neural lesions depending on gunshot injury on condition that surgical technique rules are obeyed (except infection, skin defect, vascular injury, and the presence of bone fracture).

Objective: Our aim is to study the accuracy of emergency medicine (EM) physician-performed, bedside ultrasonography (BUS) in patients with clinical suspicion of scaphoid fracture and normal radiographs.
Methods: From January to December 2011, an EM physician used BUS to prospectively evaluate patients presenting to the emergency department (ED) with clinical suspicion of scaphoid fracture and normal radiographs. BUS examination of the scaphoid prior to a wrist MRI scan, within 24 hours of wrist trauma. The outcome was determined by official radiology reports of the MRI. The results were statistically compared using the Chi-square test.
Results: Of the 63 enrolled patients, 12 Patients were BUS-positive. Of these, MRI results agreed with the BUS findings in 12 patients, who had cortical damage of the scaphoid with hematoma. In 35 instances, hematoma with no cortical damage was detected with BUS, and corroborated by MRI. A scaphoid fracture was demonstrated by MRI in two patients from this group. The sensitivity, specificity, positive predictive value, negative predictive value, negative likelihood ratio for BUS were 85.7%, 100%, 100%, 100% and 0.14, respectively. Accuracy of BUS was not statistically different from MRI.
Conclusion: The diagnosis of scaphoid fractures is another BUS application in the ED. EM physicians can diagnose scaphoid fractures using BUS in emergency department.

Objectives: The aim of this study is to determine the type and cause of traumatic orofacial injuries in children up to 18 years of age.
Methods: This retrospective study involved data collected from 12055 patient that applied to Istanbul University, Medical Faculty, Department of Emergency in 2011.The patients data were evaluated with regard to age, gender, etiologic factor of the trauma, type and localization of the injury and time interval between injury and treatment.
Results: A total of 1296 children in 12055 patients with orofacial trauma were evaluated.Trauma incidence was higher in boys (65%). The major etiologic factor of injury was falls (56%) and primary localization was in frontal region (41%).The most frequent types of injury were laceration (30,1%) and hematoma (18,6%).4% of the injuries were found in orodental region including lips, teeth, tongue and oral mucosa of the mouth.38% of the patients applied to emergency department between 30-60 minutes after the injury and 68% were sent home with symptomatic treatment.
Conclusion: Considering the high percentage of orofacial traumas, effective education is necessary regarding the appropriate diagnostic approach, emergency management and prevention of traumatic dental injuries.

AMAÇ
Van’da yaþanan deprem sonrasýnda yanýk nedeniyle baþvuran ve hastanede tedavi edilen olgularýn epidemiyolojik özelliklerini belirlemek, bir önceki yýlýn ayný aylarýnda baþvuran yanýk olgularýyla karþýlaþtýrarak, mortaliteye etkili olan faktörleri saptamak için planlandý.
GEREÇ VE YÖNTEM
Van Bölge Eðitim ve Araþtýrma Hastanesine depremden sonra 3 aylýk periyotta baþvuran hastalar grup1,bir yýl önce ayný tarih aralýðýnda baþvuran hastalar grup 2 olarak belirlendi.
BULGULAR
Grup 1’de 121 hasta bulunmaktaydý. Grup II’de ise 89 olgu vardý. Grup 1deki yanýk olgularýnýn %35,95 oranýnda arttðý saptandý. Alev yanýklarý grup 1’de grup 2’ye nazaran 4.8 kat daha fazla gözlendi (p=0,002). Grup I’de olgularýn %25,4’ünde, grup II’de %7’sinde exitus görüldü (p=0,0069).
SONUÇ
Deprem sonrasýnda baþvuran yanýk olgularý sayýsý, alev yanýklarýnýn sayýsý, yanýk yüzdesi ve mortalite oranýný, deprem öncesine göre yüksek olduðu saptandý.

BACKGROUND
This study was planned to determine the epidemiological features of cases that were registered for burns and treated at a hospital after the Van earthquake to compare burn cases from the previous year and to determine the factors that influenced mortality.
METHODS
Patients who were admitted to the Van Region Education and Research Hospital within the 3-month period after earthquake were categorized as group 1; patients who were admitted within same time interval in the previous year were categorized as group 2.
RESULTS
There were 121 patients in Group 1 and 89 patients in Group II. It was determined that there were 35,95% more burn cases in Group 1. Flame burns were observed 4.8 times more often in Group 1 compared to Group II (p=0,002). Exitus was observed in 25,4% of the cases in Group 1 and in 7% of the cases in Group II (p=0,0069).
CONCLUSION
It was determined that the number of burn cases registered after the earthquake, the number of flame burns, the percentage of burns and the rate of mortality were higher than these data before the earthquake.

Amaç: Karbonatlý içecek þiþeleri göz için potansiyel tehlike oluþtururlar. Bu çalýþmada, fýrlayan metal soda þiþe kapaklarý nedeniyle göz yaralanmasý oluþan hastalarýn klinik özelliklerini ve oluþan görsel sonuçlarý deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Metal soda kapaklarýna baðlý oküler travma teþhis edilen hastalarýn týbbi kayýtlarýnýn geriye dönük olarak gözden geçirilmesi.
Bulgular: On altý hastanýn 16 gözü çalýþmaya dâhil edildi. Hastalarýn tümü erkek ve ortalama yaþ 24 yýldý. On hastada þiþe kapaðýný uygun olmayan bir aletle açma öyküsü mevcuttu. On iki olguda sol göz, 4 olguda sað göz etkilenmiþti. Tüm olgularda kontüzyon tipinde kapalý göz yaralanmasý oluþmuþtu. Deðiþik derecelerde hifema olgularýn tümünde mevcuttu ve dördünde vitreus hemorajisi ile birlikteydi. Son yapýlan muayenede görme keskinliði hastalarýn 15’inde 20/20 düzeyindeydi.
Sonuç: Sýkýþtýrýlmýþ metal soda kapaklarýna baðlý oluþan göz yaralanmalarýnýn önlenmesinde açacak kullanýlmasý önemlidir. Vidalý çevir-aç kapaklarýn kullanýmýnýn yaygýnlaþtýrýlmasýna ilave olarak, sýkýþtýrýlýþ metal kapaklý karbonatlý içecek þiþelerinin üzerine tüketicileri olasý göz yaralanmalarý konusunda uyaran etiketler yerleþtirilmelidir.

Background: Bottles containing carbonated drinks are potentially hazardous to the eye. In this study, we aimed to document the clinical characteristics and visual outcomes in a series of patients with ocular injury from flying metal caps of carbonated mineral water bottles.
Methods: Retrospective chart review of patients diagnosed with ocular injury from metal caps of carbonated mineral water bottles.
Results: Sixteen eyes of the 16 patients included in the study. All of the cases were male with a mean age of 24 years. Ten of the patients had a history of using improper tools for bottle cap removal. The left eye was involved in 12 cases and the right eye in four cases. All patients had contusion type closed-globe injury. Varying degrees of hyphema was observed in all patients, and vitreous hemorrhage was present in four. The visual acuity at the last follow-up was 20/20 in 15 of the patients.
Conclusion: The use of a bottle cap opener is essential for preventing ocular damage from pressed metal caps of carbonated drinks. In addition to popularising the use of screw cap bottles, warning labels that alert consumers about the possibility of eye injury should be placed on carbonated drinks with pressed metal caps.

Ýstismara baðlý kafa travmasýnýn bir formu, süt çocuðu veya küçük bir çocuðun istismarcý tarafýndan siddetle sarsýlmasý ile ortaya çýkan, çeþitli intrakraniyal yapýlarýn zedelenmesi ile sonuçlanan, tarihi adýyla “sarsýlmýþ bebek sendromu (SBS)” dur. Burada farklý klinik özellikleri olan 3 istismara baðlý kafa travmasý olgusu sunulmaktadýr.

Olgu-1:
Üç aylýk kýz bebek tekrarlayan nöbetler, uyuklama ve düþük derecede ateþ yakýnmalarý ile kabul edildi. Oftalmolojik muayenede sol gözde retinal hemoraji (RH) saptandý. Kraniyal bilgisayarlý tomografi ile sol frontal bölgede intraparankimal subakut subdural hematom (SDH) gösterildi.

Olgu-2:
12 aylýk erkek bebek sol bacaðýnýn üzerine basamama yakýnmasý ile kabul edildi. Oftalmolojik muayenede sað gözde RH saptandý. Kraniyal manyetik rezonans görüntüleme (MRG) ile sað frontoparyetal bölgede subakut SDH gösterildi.

Olgu-3:
Üç aylýk erkek bebek irritabilte ve nöbet geçirme yakýnmalarý ile kabul edildi. Oftalmolojik muayenede bilateral yaygýn RH saptandý. Kraniyal MRG ile bilateral frontoparyetal bölgede subakut SDH gösterildi.

Olgularýn tümü, Çocuk Koruma Servisi’ne bildirildi ki bu servis psikososyal riskleri deðerlendirerek ev ziyaretleri ve aile eðitimini içeren güvenli bir plan yaparak çocuklarý ailelerinden ayýrmamaya karar verdi. Hekimler sinsi veya aþikar nörolojik semptomlarla baþvuran süt çocuklarýnda istismara baðlý kafa travmasý olasýðýnýn farkýnda olmalýdýrlar. Bu olgularýn yönetiminde rol alan tüm personele istismara baðlý kafa travmasý konusunda eðitim verilmesi önemlidir.

One form of abusive head trauma (AHT) is perpetrated when an infant or young child is shaken violently by an abuser, results with injuries to various intracranial structures, historically called “shaken baby syndrome (SBS)”. Three cases of AHT with different constellations of clinical symptoms are presented here.

Case-1:
Three month-old female infant was admitted with recurrent seizures, drowsiness, and low grade fever. Ophthalmologic examination revealed retinal hemorrhages (RH) in the left eye. Computed tomography of cranium showed left frontal intra-parenchymal, subdural hematoma (SDH).

Case-2:
Twelve month-old male infant was admitted with a history of favoring left leg. Ophthalmologic examination revealed RH in the right eye. Cranial magnetic resonance imaging (MRI) revealed subacute SDH in the right fronto-parietal region.

Case- 3. Three month-old male infant was admitted with irritability and seizures. Ophthalmologic examination revealed bilateral disseminated RH. Craniyal MRI scan showed bilateral fronto-parietal subacute SDH.

All cases were reported to the Child Protective Services who decided not to remove children but evaluated the psychosocial risks and developed a safety plan, including home visits and family education. Physicians must be aware of possibility of AHT in infants presenting both subtle and overt neurologic symptoms. It’s important to provide training on AHT to staff involved in the management of these cases.

Ýntrakranyal epidural hematomlar hemen her zaman kafa travmasýna sekonder geliþir ve sýklýkla unilateral olarak izlenir. Bilateral intrakranyal epidural hematomlar nadir olmakla birlikte mortalitesi oldukça yüksektir. Olgumuzda; araç dýþý trafik kazasý sonucu kafa travmasý nedeniyle acil servise getirilen 32 yaþýnda, HIV infeksiyonlu, erkek hastada saptanan bilateral epidural hematom bildirilmektedir. Kafa travmasý tek yönlü ve lateral planda olmasýna raðmen HIV infeksiyonlu bir hastada bilateral epidural hematom ile sonuçlanmasý nadir bir durumdur. HIV infeksiyonunun komplikasyonlarý olan vaskülopati ve koagülopati sonucunda serebral damarlar frajil bir yapý alýr ve bu komplikasyonlar birlikte kontrlateral intrakranyal epidural hematom geliþmesini kolaylaþtýrýr.

Intracranial epidural haematomas are almost always secondary to head traumas and usually occur unilaterally. Bilateral intracranial epidural haematomas are rare, but the mortality is very high. In our case, we report a bilateral epidural haematoma in a 32 years old, HIV infected, male patient who reached the emergency service with a head trauma because of a motor vehicle-pedestrian accident. The occurance of bilateral epidural haematoma in a HIV infected patient is a rare condition as a result of head trauma in lateral direction by one side. As the result of vasculopathy and coagulopathy, which are complications of HIV infection, cerebral vessels have a fragile structure and these complications facilitate the development of contrlateral intracranial epidural haematoma together.

Eosophageal and larengealand laryngeal injuries due to the blastic injuries are seldom encountered. External neck traumas genereally result in death. Incidience of external penetran neck injuries may vary between 1/5000 – 137000 patients among emergency servis referrals. Vascular injuries, eosophagus – hypopharynx perforations, larnygotracheal injuries, bony fractures and segmentations may be encountered in external neck traumas.

Here we report a 27 year old male patient who referred our emergency department and represented wtih hyoid bone fracture, multiple mandibula fractures, hypopharynx perforation due to a blastic external neck injury.

Velpeau bandajý omuz bölgesindeki kýrýk ve çýkýklarda kolu gövdeye tespit eden bir tedavi yöntemidir. Velpeau bandajý çok nadiren komplikasyonlara yol açar.
Kýrkbeþ yaþýnda erkek hasta travma sonrasý acil servise baþvurdu. Radyolojik tetkiklerde glenoid ve multipl kaburga kýrýðý tespit edildi. Cerrahi düzeltme öncesinde geçici Velpeau bandajý uygulandý. Bandaj uygulamasýndan 1 gün sonra hastada nefes darlýðý ve göðüs aðrýsý þikayetleri baþladý. Göðüs grafisinde kaburga kýrýk bölgelerinde belirgin bir ayrýþma ve hemopnömotoraks olduðu görüldü. Hastaya göðüs tüpü yerleþtirildi. Glenoid kýrýk cerrahi olarak düzeltildi. Hasta 6. Gün taburcu edildi. Bir ay sonraki muayenesinde sorunsuzdu.

Velpeau bandage is a treatment method fixing the arm to the body in fractures and dislocations at the region of shoulder. Velpeau bandage very rarely leads to complications.
Forty five years old male admitted to the emergency service after trauma. Glenoid and multiple rib fractures were detected in radiological examinations. A transient Velpeau bandage was performed before surgical correction. Patient had dyspnoea and chest pain 24 hours after bandage application. An obvious deplacement at the rib fracture sites and hemopneumothorax were seen at chest X-ray. A chest tube was inserted to the patient. Glenoid fracture was corrected surgically. Patient was discharged at the 6th day. He has no problem at the first month readmission.

Skalp amputasyonlarýnda mikrovasküler replantasyon teknik zorluklarýna raðmen üstün estetik sonuçlarý, sosyal ve psikolojik avantajlarý nedeni ile ilk tercih olarak deðerlendirilmesi gereken seçkin tedavi yöntemidir. Biz bu olguda saçlý derinin tamamýna yakýnýnýn ayrýca sol kulak, tüm alýn bölgesi, her iki kaþ ile üst göz kapaklarýný içeren tam bir amputasyonun baþarýlý replantasyonunu ve olgunun ameliyat sonrasý 6. yýldaki fonksiyonel deðerlendirmesini sunmaktayýz.

Despite the technical difficulties, microvascular replantation is the oustanding method of treatment for avulsed scalps because of the superior aesthetic results, social and psychological benefits. We presented a successful replantation of the almost whole of the scalp also the left ear, the entire forehead, eyebrows and upper eyelids in this case, also functional assessment of the case in the postoperative sixth year was reported.

Ozet
Giriþ: Hiyoid kemik kýrýklarý nadir görülür. Hiyoid kemik kýrýðýnýn teþhisi zor olup; yüksek þüphe ile tanýsý konulabilir. Burada künt travmaya baðlý geliþen izole hiyoid kýrýðý vakasý sunulmaktadýr.
Olgu sunumu: 26 yaþýnda bayan hasta araç içi trafik kazasý sonucu acil servisimize baþvurdu. Hasta yutma güçlüðü ve boyunda aðrý ve rahatsýzlýk hissinden þikayetçiydi. Fizik muayenede boyunda hiperemi ve hassasiyet mevcuttu. Boyun tomografisi çekilen hastada hiyoid fraktürü gözlendi. Hasta medikal tedavi uygulanarak 24 saat gözlendi. Poliklinik kontrolü önerilerek taburcu edildi.
Sonuç: Acil hekimi künt travmalarda hiyoid kýrýðý oluþma riskini dikkate almalýdýr. Hiyoid kýrýklý hastalar 24 saat gözlenmelidir. Genellikle bu hastalar için medikal tedavi yeterli sonuçlarý vermektedir.

Introduction: Fractures of the hyoid bone are very rare. Diagnosis of hyoid fracture is difficult and can be made only with a strong degree of suspicion. We report a case of isolated hyoid bone fracture due to blunt trauma to the neck.
Case report: A 26 year old woman was admitted to emergency department for motor vehicle accident. She complained of disphagia and anterior neck discomfort. Physical examination showed hiperemia and tenderness of neck. A tomographic scan of neck was performed. The findings demonstrated hyoid fracture. Patient was observed with medical therapy for 24 hours and discharged with recommendation of outpatient control.
Conclusion: Emergency physician has to be aware of the possibility of hyoid fractures in blunt traumas. Patients with hyoid fracture should be observed for 24 hours. Generally, medical treatment is satisfactory in isolated hyoid fractures.