Hematolojik ve immünolojik fonksiyonlarý olan dalak travmadan sonra korunmasý gereken önemli bir organdýr. Bu sebepten dolayý, Perisplenik Packing yönteminin etkinliði sýçanlarda oluþturulan splenik lezyonlarda gösterildi. 45 sýçan, 4 grupta incelendi. Ýlk grupta, perisplenic packing grade IV splenik lezyonlardan sonra vicryl mesh ile gerçekleþtirildi. Ýkinci grupta splenektomi, üçüncü grupta ise laparotomi yapýldý. Sonuçlar sintigrafik, hematolojik ve histopatolojik olarak deðerlendirildi. Ýlk grupta sintigrafik sonuçlar sadece 2 sýçanda intrasplenik hematom gösterdi. 8 hafta sonra yapýlan kontrol sintigrafilerinde bu hematomlarýn kaybolduðu gözlendi. Hematolojik incelemelerde, grup 1'deki trombosit sayýsýnýn kontrol grubuna göre daha yüksek olduðu bulundu. Ýkinci grupta da trombosit sayýsý daha yüksekti ve target hücreler görüldü. Ýkinci haftada yapýlan histopatolojik incelemelerde dalaklarýn anatomik olarak intakt olduðu, fibroblast ve fibrositlerden zengin bir bað dokunun varlýðý gösterildi. Sekizinci haftada yapýlan incelemelerde de mesh 'in tamamen absorbe olduðu ve kapsülün tamir edilmiþ olduðu gözlendi. Elde edilen sintigrafik, histopatolojik, bulgular bu yöntemin hiler yaralanma dýþýnda splenektomi gerektiren dalak yaralanmalarýnda güvenle kullanýlabileceðini göstermektedir.

The spleen, which possesses hematologic and immunologic functions, is an important organ to be protected after trauma. For this purpose, the reliability of the perisplenic packing method was investigated on rats with induced splenic lesions. Fourty five rats were divided into three main groups. In the first group, perisplenic packing was performed with vicryl mesh after grade IV splenic lesions. Splenectomy was performed on the second group and laparotomy for ones in the third group. The specimens were evaluated by sintigraphic hematologic and histopatologic means. In the first group, sintigraphic results revaluated intrasplenic hematomas in only two rats. Control sintigraphy studies on the eight week revaluated total resolution of these hematomas. With hematologic evaluation, thrombocyte count was found to be much higher in group I than in the control group. In the second group the thrombocyte count was even higher and target cells were observed. Histiopathologic evaluation performed during the second week revealed that the spleens anatomical structure was intact with an increased amount of connective tissue rich in fibrocytes and fibroblast, while findings during the eighth week revealed that the mesh had been totally absorbed and the capsule repaired.

1985-1995 tarihleri arasýnda 10 yýllýk süre içinde, Dicle Üniversitesi Týp Fakültesi Genel Cerrahi Kliniðinde, 18 künt diafragma yaralanmalý hasta tedavi edildi. Travma sebebi 14 olguda trafik kazasý, 4 hastada yüksekten düþmeydi. Tüm hastalar akut dönemde görüldü. En sýk rastlanan þikayetler ve fizik bulgular dispne, göðüs aðrýsý, abdominal distansiyon ve solunum seslerinin alýnamamasýydý. AÇ grafiðinde ise, en sýk diafragma gölgesinin kaybolmasý, diafragmanýn elevasyonu ve toraksa visseral herniasyon bulgularýyla karþýlaþýldý. Bu bulgulara göre, olgularýn 11 'inde doðru taný preoperatif dönemde kondu. Tüm hastalar baþvurduklarý gün operasyona alýndýlar. Laparotomide 13 olguda sol, 5 olguda sað diafragma rüptürü saptandý. Dört olguda toraksa herniasyon vardý, ancak strangülasyon yoktu. On olguda diafragma yaralanmasýna intraabdominal organ yaralanmalarý da eslik ediyordu. Sekiz olguda ise, izole diafragma rüptürü saptandý. Kunt diafragma yaralanmasýna en sýk eþlik eden organ dalak idi. Tüm olgularda, diafragma nonabsorbabl sütürlerle iki kat üzerinden tamir edildi. Mortalite oranýmýz eþlik eden travmalara baðlý olarak %16.6 idi. Bu çalýþma bize kunt diafragma yaralanmalarýnýn ender görüldüðü için, tanýda güçlük çekilebilen bir yaralanma olduðunu göstermiþtir. Üst batýna ve göðüse ait künt travmalarda, taný genellikle akut dönemde hastanýn deðerlendirilmesi sýrasýnda, bir künt diafragma yaralanmasý olabileceði þüphesi, operasyonda diafragmatik yüzeyin iyi bir þekilde eksplorasyonu ve posttravmatik dönemde çekilen seri göðüs grafilerin incelenmesiyle konur. Kunt diafragma yaralanmalarýnda prognoz, eþlik eden yaralanmalarýn ciddiyeti ve geç baþvurudan doðan bir takým problemlere baðlýdýr.

In a 10 year period, between 1985 to 1995, 18 patients with blunt traumatic rupture of diaphragm were treated in Dicle University General Surgery Department. Causes of trauma were motor vehicle accident in 14 and falling down in 4 cases. All patients were seen within in acute stage. The most frequent complaints and physical findings were dyspnea, chest pain, abdominal distention and absent breath sounds. The most frequent radiographic findings were obscuration of the diaphragmatic shadow, elevation of the diaphragm and visceral herniation to the chest. On the basis of these findings, correct diagnosis was made on 11 patients preoperatively. All patients were treated by laparotomi on the day of admission. At laparotomi, left hemidiaphragm was involved in 13 and the right in 5 patients. There were visceral herniation in 4 patients but not strangulation. Significant intraabdominal injury requiring repair was found in 10 and, isolated injuries of diaphragm was detected in 8 patients. The most frequently injured abdominal viscus was spleen. Repair was always carried out with interrupted sutures with nonabsorbable suture material. The mortality was 16.6%, all attributable to associated injuries or their sequelae. This study suggest that blunt traumatic rupture of diaphragm is an uncommon injury which may be difficult to diagnose. Most cases with severe blunt injuries to the upper abdomen and/or chest will be diagnosed by maintaining a high index of suspicion during the initial assesment and operative exploration of diaphragmatic surface and by performing serial chest radiographs during post-traumatic period. Prognosis of blunt diaphragmatic injuries are due to severity of accompanial injuries and due to the delay between time of injury and administration of patient to the hospital.

Ocak 1989 ve Aralýk 1993 tarihleri arasýnda, 184 künt karýn travmalý hastada tanýda Ultrasonografi (USG) kullanýldý. USG deneyimli bir radyolog tarafýndan yapýldý. 110 hastada herhangi bir patolojiyle karþýlaþýlmadý. 74 hasta ameliyata alýndý. 70 hastada (%38) periton içi serbest sývý tanýmlandý. USG'nin duyarlýlýðý %94.5, özgüllüðü ise %100 olarak saptandý. Sonuç olarak USG'nin hemodinamik olarak stabil künt batýn travmalý hastalarda ilk tanýsal seçenek olmasý gerektiði kanaatine varýldý.

Between January 1989 and December 1993, 184 patients with blunt abdominal injuries were examined prospectively. Sonographic examinations were performed by an experienced radiologist. 110 patients were no abdominal pathology. Seventy-four of this patients were operated. In 70 cases (38%), free intraperitoneal fluid was demonstrated ultrasonographically. Ultrasonography in terms of detecting free intra-abdominal fluid 94.5% and 100% sensivity and specifity respectively. Ultrasonography must be the first diagnostic tool for evaluation of the hemodynamically stable patients with blunt abdominal trauma.

Kliniðimizde Ocak 1987 ve Ocak 1995 tarihleri arasýnda künt travma sonucu diafragma rüptürü nedeniyle tedavi edilen sekiz hasta retrospektif olarak incelendi. Hastalarýn beþi kýz, üçü erkek olup ortalama yaþlarý 9.3 yaþ (4-13) idi. Beþ hastada trafik kazasý, üç hastada ise yüksekten düþme sonucu diafragma rüptürünün geliþtiði tesbit edildi. Taný tüm hastalarda toraks grafisi ile konuldu. Rüptür yedi hastada sol, bir hastada ise sað tarafta idi. Fizik muayenede üç hastada solunum sýkýntýsý tesbit edildi ve hastalarýn hepsinde rüptüre olan tarafta solunum sesleri azalmýþtý. Multipl travmalý bu hastada ek organ yaralanmasý olarak en sýk ekstremite yaralanmasýnýn bulunduðu (5 hasta) saptandý. Bütün hastalar abdominal yaklaþýmla ameliyat edildi ve bu hastalarda defekt primer onarýldý. Rüptür sonucu en çok midenin (7 hasta) toraksa herniye olduðu tesbit edildi. Ameliyat sonrasý dönemde bir hastada atelektazi ve bir hastada yara enfeksiyonu geliþti. Ortalama hastanede kalýþ süresinin 16 gün (6-30 gün) olarak tesbit edildiði bu seride ölen hasta olmadý.

In this study eight children who were treated with diaphragmatic rupture following nonpenetrating trauma between January 1987 and January 1995 were analyzed. There were five girls and three boys, ranging in age from 4 to 13 years (average 9.3 years). Road trauma was the cause in 5 cases and fall from height in 3 patients. The diagnosis of diaphragmatic injury was made radiologically in all patients. The left hemidiaphragm was injured in 7 patients and right hemidiaphragm in one. Clinical examination revealed respiratory distress in 3 patients and diminished breath sounds on the side of the lesion. The most common associated injuries were the extremity fractures. All patients underwent laparotomy with primary repair of the diaphragm. The most frequently herniated organ was the stomach (7 patients). Atelectasis developed in one patient and infection occurred in one patient postoperatively. The mean hospital stay was 16 days (6 to 30 days). There were no deaths in this series.

Clay Shoveler's fracture is an avulsion type fracture of one or more spinous processes of the lower cervical or upper thoracal vertebra. Most commonly C7 or T1 are affected. The usual presenting symptom is pain. Plain radiographic examination establishes the diagnosis. The treatment of isolated spinous process fracture is conservative. In this study, 4 Clay Shoveler's fracture (3 after traffic accident, 1 after falling) are presented in the review of literature.

Bel aðrýsý ile travma arasýnda bir iliþki olduðu eskiden beri düþünülmüþtür. Çalýþmamýzýn amacý, bu iliþkinin var olup olmadýðýný ortaya koymaktýr. 1654 bel ve/veya bacak aðrýlý hasta, yaþ, cinsiyet, meslek, aðrýnýn süresi, travma olup olmadýðý, travmanýn þekli, süresi, konan taný açýsýndan incelendi. 1028 (%62.2) kadýn, 626 (%37.8) hasta erkekti. Yaþ ortalamasý 42,6 ± 15.4 idi. Bel ve/veya bacak aðrýsý olan hastalarýn 453'ünde (%27.4) bel aðrýsýný baþlatan faktör olarak travma saptandý. Bunlarýn 212'si (%46.8) erkek, 241'i (%53.2) kadýndý. Yaþ ortalamasý genel olarak 38.06 ± 14.1, kadýnlarda 39.7±14.2, erkeklerde 36.5±13.9 idi. Olgularýn 400'ü (%24,2) ev hanýmý, 345'i (%20,9) masabasý iþ yapanlar, 98'i (%5,9) emekli, 77'si (%4,7) isçi, 58'i (%3,5) öðrenci, 16'sý (%1) yardýmcý saðlýk meslek grubundaydý. Sadece öðrenci, iþçi ve yardýmcý saðlýk meslek grubunda travmanýn risk faktörü olduðu saptandý (p<0.05). Hastalýk olarak yapýlan sýnýflandýrmada travma sadece lomber disk hernisinde ve lomber strainde risk faktörü olarak saptandý (p<0.05). Sonuç olarak, travmanýn, bel ve/veya bacak aðrýlarýný ortaya çýkaran hastalýklarýn oluþumunda önemli bir neden olmadýðý ancak lomber disk hernisinde ve lomber strain olgularýnda risk faktörü olarak karþýmýza çýktýðý söylenebilir.

A relationship between low-back pain and trauma has been considered to be important. The aim of our study was to find out whether such a relationship exists or not. 1654 subjects with low back and/or leg pain were included in the study. All subjects were evaluated with respect to age, gender, occupation, duration of pain, presence of trauma, form and duration of trauma and clinical diagnosis. 1028 (62.2%) of 1654 patients were female and 626 (37.8) were male. Mean age was 42.6±15.4. 453 (27.4%) patients with low-back and/or leg pain had a trauma as an initiating factor. Of these patients, 212 (46.8%) were male, 241 (53.2%) were female. Four hundred (24.2%) of the subjects were housewives, 345 (20.9%) bureau-staff, 77 (4.7%) workers, 98 (5.9%) retired and 16 (1%) paramedicals. The most common trauma was weight lifting. Trauma had appeared as a risk factor in workers, students and paramedicals (p<0.05). Trauma had been evaluated as a risk factor for lumbar disk herniation and lumbar strain (p<0.05). In conclusion, trauma did not appear to have a major role in most of low-back and/or leg pain while it could be evaluated as a risk factor for lumbar disc herniation and lumbar strain.

Yapýlan anatomik disseksiyonlarda ve radyografik incelemelerde coraco clavicular eklemin mevcudiyeti bulunmuþtur. Bu eklem humerusun cerrahi boyun kýrýklarý sonucunda oluþabildiði ve torasik çýkýþ sendromuna (thoracic outlet syndrom) neden olduðu gibi, çoðunlukla asemptomatik bir varyasyon þeklinde görülür. Coracoclavicular eklem, claviculanýn tuberculum conoideum'u ile scapulanýn processus coracoideus'u arasýnda görülen diartroz grubu bir eklemdir. Bu ekleme ait yüzeyler proceccus coracodieus 'un üst yüzünde ve tuberculum conoideum 'u ile scapulanýn processus coracodieus 'u arasýnda görülen diartroz grubu bir eklemdir. Bu ekleme ait yüzeyler processus coracoideus'un üst yüzünde ve tuberculum conoideum'un altýnda bulunur. Bu çalýþmada 102 scapula ve 130 clavicula üzerinde Coracoclavicular ekleme ait eklem yüzleri araþtýrýldý. Bu örneklerde, 9 clavicula ve 7 scapula üzerinde eklem yüzlerinin mevcut olduðu görüldü. Bulunan eklem yüzleri sað ve sol olarak kaydedildi. Sonuçlarýn istatistiksel deðerlendirilmesi yapýldý. Bulgular takdim edildi. Literatür gözden geçirildi.

The presence of the coracocclavicular joint has occacionally been detected, their radiologically or by anatomical dissection. This joint may develop as a result of the surgical neck fracture of the humerus and may result in thoracic outlet syndrome. Coraco clavicular joint is mostly an asemptomatic variation. It is a diarthrotic joint between the coracoid process of the spacula and conoid tubercle of the clavicle. An articular facet on the conoid tubercul of the clavicle and on the superior surface of the coracoid process of the spacula will indicate the existence of this joint. In this study, the presence of the articular facets of the coracoclavicular joint on 102 spacula and 130 clavicle presented at the laboratories of the anatomy department of the medical faculty, Atatürk University was investigated. The presence of the articular facet was determined on 9 clavicle and 7 scapula. The articular facets were recorded as either unilateral left or unilateral right. The assesment of the results were made statistically. Findings were presented and literature was reviewed.

1991-1995 yýllarý arasýnda Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Ýlk ve Acil Yardým Anabilim Dalý'na baþvuran ve opere edilen 84 ürolojik yaralanma olgusu retrospektif olarak incelenmiþtir. Olgularýn ilk baþvuru muayenesinde 57 (% 68) hastada hematüri saptanmýþtýr. En sýk yaralanan organ böbrek (%48), en az yaralanan organ ise ürelerdir (%1). Olgularýn tanýsýnda ÝVP, USG, BT, asendan sistografi taný aracý olarak kullanýlmýþtýr. 29(%35) hastaya nefrektomi, 8 (%10) hastaya nefrorafi, 3 (%4) hastaya parsiyel nefrektomi, 17 (%20) hastaya sistotomi + sistorafi + sistostomi, 1'er (%1) hastaya da üretero-üreterostomi ve corpus cavernozum onarýmý uygulanmýþtýr. Multitravmalý hastada hematüri iyi deðerlendirilmelidir.

Approach to Urologic Traumas: Analysis of 84 urological trauma patients who presented to and were operated at Istanbul University, Istanbul Medical Faculty Emergency Department between 1991-1995. Hematuria was the first presenting symptom in 57 (%68) of the patients. Diagnosis was made preoperatively in 42 (50%) of the patients using intravenous pyelography, Ultrasonography, Computerized Tomography. Nephrectomy was performed for 29 (35%) patients, nephroraphy for 8 (10%) patients, partial nephrectomy for 3 (4%) patients, cystotomy + cystomphy + cystostomy (20%) for 17 patients, uretero-ureterostomy for 1 (1%) patient, and corpus cavernosus repair vas performed for 1 patient (1%). Hematuria should be well evaluated in patients with multitraumas.

Penetrating foreign body injuries of the skull, may progress uncomplicated or may cause considerable morbidity and mortality. If foreign body penetrates orbital region, visional loss on different degrees or enucleation may occur. We reported an orbitocranial penetration case, caused by a perforating foreign body, means "mil". The body was extracted under CT control. Postoperative ll. day the patient discharged to home without any complication.

1986-1993 yýllarý arasýnda Uludað Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý'nda displase intrakapsüler femur kýrýðý nedeniyle hemiartroplasti uygulanan 37 hasta gözden geçirildi. Hastalarýn yaþ ortalamasý 65.5 (41-86) olup, 25'i (%67.6) kadýn, 12'si (%32.4) erkekti. Hastalarýn ameliyat öncesi ve sonrasý radyografileri incelendi ve ameliyatlarýn teknik yeterliliðini deðerlendirmek için protez basýnýn büyüklüðü, femur boyun uzunluðu, protezin pozisyonu, protez steminin kalkara yerleþimi deðerlendirildi ve çok iyi-iyi sonuç %81 olmak saptandý. Harris sýnýflamasýna göre çok iyi ve klinik sonuç %81 olarak belirlendi. Bir (%2.7) hastada dislokasyon meydana geldi. Ýki (%5.4) hastada yüzeyel, 1 (%2.7) hastada derin yara enfeksiyonu oluþtu. Üç (%8.1) hastaya gevþeme, 2 (%5.4) hastaya da protruzyo nedeniyle TKP uygulandý. Yaþlý, orta derecede aktif hastalarýn displase unstabil intrakapsüler femur boyun kýrýklarýnýn tedavisinde hemiartroplasti yapýlmasý güncelliðini korurken, bu hastalarýn 1-2 yýldan fazla yaþam beklentisi olanlarýnda bipolar protez kullanýlmasý uygun olacaktýr.

Thirty seven patients who underwent hemiartroplasty due to displaced intracapsular femoral neck fracture were studied in Orthopaedics and Traumatology department, Medical Faculty, Uludað University in 1993. The mean age of the patients 65.5 (41-86), 25 (67.66%) female and 12 (%32.4%) male. Roentgenograms of all patients were assessed preoperative and postoperative and in order to evaluate technical efficiency of operations, head sizes, neck length, position of prothesis, calcar seating were assessed. The excellent and good results were 81%. According to Harris clasification the excellent and good clinical results in our patients were 81%. Dislocation occurred in I (2.7%) patient. Superficial infection occurred in 2 (5.4%) patients and there was deep infection in I (2.7%) patient. THA was applied to 3 (8.1%) due to loosening and to 2 (5.4%) due to protrusion. We haw the opinion that it would be proper to perform hemiartroplasty in the treatment of displaced unstable intracapsular fractures of the femoral neck in elderly and moderately active patients and that the use of bipolar prosthesis will be convenient in the patients who are likely to have a 1 or 2 year life expectancy.

Lesion of the Plexus Brakialis has increased due to traffic accidents. In our hospital we operated three cases which had Plexus Brachialis injuries. Neurotization has been performed in one of two found positive tinel test and sensitivity at the upper arm. At second case which has been applied nerve greft, no change has been found during 10 months follow up by clinical and electromiographical evaluation. At third case which has been injured by gun, as a result of 10 months follow-up we determined sensitivity at the upper arm and flexion at the elbow about 2/5 of the normal arm in comparison. In this text surgical indication, surgical technique and results have been discussed under the appraise of literatures.

Drinking corrosive substances accidentally or for suicide causes acute or chronic damage in upper G.I.S. because liquid cleansing materials have been increasingly used frequency of burns depend on corrosive substances has been increased. Damage most commonly occurs in oropharynx, esophagus and stomach, respectively. Corrosive burns in stomach are manifested by bleeding, necrosis and perforation at early period and obstruction symptoms a late period. There is no agreement on surgical approach of corrosive burns in stomach which has high mortality and morbidity risks. In this article we introduce two cases of corrosive burns in stomach and review literature.

1977-1995 yýllarý arasýnda 27 hastaya akut süpüratif kolanjit tanýsýyla acil cerrahi giriþim uygulanmýþtýr. Hastalarýn 15'i erkek, 12'si kadýndý. Medyan yaþ 53 idi (30-83). Tabloya sebep olan birincil patoloji; 15 hastada toledokolüyaz, 9 hastada safra yollarýna açýlmýþ kist hidatik, bir hastada biliyer striktür, bir hastada Caroli hastalýðý zemininde geliþmiþ kolanjiokarsinom, bir hastada iatrojenik safra yollarý yaralanmasýydý. Taný; Charcot kriterlerine ek olarak, þoka eðilim, þuur bozukluðu ve medikal tedaviye yanýtsýzlýk ile kondu. Safra yollarýnýn kompresyonu için 16 hastada koledokoduodenostomi, 6 hastada T-drenaj, iki hastada T-drenaj + sfinkteroplasti, bir hastada koledokojejunostomi, bir hastada hepatikojejunostomi, bir hastada eksternal drenaj uygulandý. Ameliyat sonrasýnda kaybedilen dört hastanýn ikisi kliniðe septik þok tablosunda baþvurmuþ, diðer iki hastada ise sýrasýyla safra yollarýndaki pürülan materyalin taþlaþmýþ olmasý ve yaygýn kolanjiokarsinom sebebiyle etkin drenaj yapýlamamýþtýr (mortalite: %15). Dört hastada yara enfeksiyonu, iki hastada subhepatik abse, bir hastada böbrek yetmezliði, bir hastada T-dreni kaçaðý, bir hastada karaciðer absesi saptandý. Akut süpüratif kolanjit, nadir görülen ancak mortalitesi yüksek olan bir tablodur. Erken taný ile hýzlý ve etkin safra yollarý drenajý vakalarýn büyük çoðunluðunda hayat kurtarýcýdýr.

Between 1977 and 1995, 27 patients with acute suppurative cholangitis were treated by emergency surgery. Fifteen patients were male and 12 were female. Median age was 53(30-83). The primary pathology was choledocholithiasis in 15 patients, intrabiliary rupture of a hydatid cyts in 9, biliary stricture in one, cholangiocarcinoma associated with Caroil's disease in one, iatrogenic injury in one. The diagnosis was based on Charcot's criteria as well as the presence of hypotension, mental confusion and unresponsiveness to medical therapy. Decompression of the biliary system was achieved by choledochoduodenostomy in 16 patients, T-drainage in 6, T-drainage + sphincteroplasty in two, choledochojejunostomy in one, hepaticojejunostomy in one and external iminage in one. Four patients died in the early postoperative period (mortality: 15%) two were in septic shock at admission; effective drainage could not be achieved in the other two patients due diffuse cholangiocarcinoma in one ad the presence of extremely organized purulent material in the biliary tree in the other. Wound infection developed in four patients, subhepatic abcess in two, renal failure in one, T-drain leakage in one, liver abcess in one. Acute suppurative cholangitis is a rare entity with high mortality. Early diagnosis, rapid and effective biliary lecompression are life-saving in the majority of the cases.

1990-1995 yýllarý arasýnda Kartal Eðitim ve Araþtýrma Hastanesi Cerrahi Kliniðinde tedavi edilen 11 popliteal damar yaralanmasý retrospektif olarak incelendi. Yedi olguda arter ve ven yaralanmasý birlikte idi. Dört olguda izole arter yaralanmasý mevcuttu. Sekiz arter ve 1 ven yaralanmasý olgusunda otojen saf en ve ven interpozisyonu, 2 olguda rezeksiyon + uç uca anastomoz, bir olguda primer onarým uygulandý. Arter ve ven yaralanmasý birlikte olan 2 olguda erken sürede arter onarýmý ve ven ligasyonu yapýldý. Kompartman sendromu geliþen bu olgularda ve iki gecikmiþ olguda fasiyotomi uygulandý. Morbidite %36.6, mortalite %9.1, amputasyon oraný %20 bulundu. Popliteal bölgenin vasküler yaralanmalarýnda arter ve ven birlikte yaralanmýþça mümkün olduðunca ven ligasyonundan kaçýnýlmalý, eðer ligasyon uygulanmýþsa fasiotomi ilave edilmelidir.

Eleven popliteal vascular injuries repaired at surgery Kartal Training and Research Hospital, department in between 1990-1995 were investigated retrospectively. In seven patients vein and artery injuries were together, meanwhile, arterial injury was the single problem in 4 patients. Surgical interventions performed in these patients were; autogen sapheneous vein interpositon in 8 arterial and 1 venous injuries, limited resection (debridment) end to end anastomosis in 2 patients and primary repair in 1 patients. Early arterial repair and vena ligation was performed in two patients who suffered both arterial and venous injury. Compartment syndrome (entrapment) was seen in two other patients due to delay in treatment and fasciotomy was performed in all four patients. In our series morbiditiy was 36.6%, mortality 91% and amputation rate was 20%. In vascular injuries of popliteal region; if both artery and vein are injuried, surgeon must avoid vein ligations as much as possible and if it is ligated than faciotomy must be added to the surgical procedure.

Çalýþmamýzda, travma ile oluþan hifemada tedavi yaklaþýmý ve sonuç görmeye etkili faktörler araþtýrýldý. 1992-1995 yýllarý arasýnda, ayaktan ve yatýrýlarak tedavisi yapýlan 100 travmatik hifema olgusu çalýþmaya alýndý. 16 olguya týbbi tedavinin yanýsýra cerrahi tedavi de uygulandý. Cerrahi giriþim olarak parasentez, ön kamara lavajý ve pýhtý çýkarýmý yapýlýrken, ek olarak ayný seansta 1 olguya ön vitrektomi, 1 olguya ise lens aspirasyonu yapýldý. Cerrahi giriþim endikasyonlarý kontrol altýna alýnamayan göz içi basýnç artýþý, disk hematik geliþimi ve gerilemeyen hifema idi. Sonuç görmesi 0.1'in altýnda olan olgu sayýsý 8 olup, tümü baþlangýçta grade 4 hifemaya sahipti. Az görme sebepleri; katarakt, retina dekolmaný, optik atrofi, makula deliði, disk hematik ve'ftizis bulbi idi. Sonuç olarak; travmatik hifemaya baðlý komplikasyonlar týbbi ve carrahi tedavi ile önlenebilirken, görme prognozunu hifemaya eþlik edebilen ön ve arka segment patolojileri belirlemektedir.

In our study, we evaluated treatment of traumatic hyphema and prognostic factors in visual outcomes. Between the years of 1992-1995, 100 traumatic hyphema patients which have been treated in outpatient or inpatient, have been included in this study. In 16 of 100 patients, in addition to medical therapy, surgical management was aso applied. Surgical management was paracentesis with anterior chamber washout and clot extraction. At the same session, anterior vitrectomy in one patients and lens aspiration in one patients were applied. Indications for surgical management were uncontrolled elevated intraocular pressure, corneal bloodstaining and prolonged clot. Final vision was worse than 1/10 in eight patients. All of those eight patients initially had total hyphema. Causes of reduced final vision were cataract, retinal detachment, optic atrophy, macular hole, corneal blood staining and phtisis bulbi. In conclusion, while complications of traumatic hyphema can be prevented with medical and surgical treatment, anterior and posterior segment problems determine visual prognosis.

1975-1995 yýllarý arasýndaki 20 sene içine de, Askaris ileusu nedeniyle toplam 17 hasta cerrahi olarak tedavi edildi. Bu hastalarýn 12'si çocuk, 5'i eriþkindi. En sýk görülen semptom ve fizik muayene bulgularý; karýn aðrýsý, distansiyon, bulantý, kusma ve konstipasyondu. On olguda enterotomi, 2 olguda barsak rezeksiyonu yapýldý. 5 olguda askaris yumaðý kolona geçirilebildi. En sýk görülen morbidite ve mortalite sebebi sepsis idi. Morbidite ve mortalite oranlarýmýz sýrasýyla %29 ve %17'dir. Askariasisin endemik olduðu bölgelerde özellikle okul öncesi ve okul çaðýnda karþýlaþýlan intestinal obstrüksiyonlarýn parazite baðlý olabileceði akla gelmelidir.

Over the past 20 years, between 1975-1995, a total of 17 patients with intestinal obstruction caused by Ascaris lumbricoides were operated in Dicle University Medical Faculty. Five of them were adult and 12 were children. The most frequently symptoms and physical findings were abdominal pain, distention, nausea, vomiting and constipation. We performed enterotomi in 10 patients and resection in 2 patients. We attempt to manually aperss and advance the parasitic bundle toward to colon in 5 patients. The most cause of morbidity and mortality was sepsis. Morbidity and mortality rates were delected 29% and 17% respectively. This study suggest that simple bowel obstruction is a rare but fatal complication of ascaris infestation, which is seen particularly pre-school and young school-age in unhgienic conditions.

Coming out from the alveol (Avulsion) is the worst result of the trauma which affects to tooth. In these cases important factors which affect the success of treatment are the extraoral time of the tooth and the medium in which the tooth is stored. In this study avulsed maxillary right central incisor which was treated in our clinic is presented.

Diyarbakýr Asker Hastanesi KBB ve Plastik Cerrahi servislerinde 1993-1994 yýllarý arasýnda tedavi edilen 39 yüksek hýzlý, 28 yavaþ hýzlý baþ ve boyun ateþli silah yaralanmak hastalarýn tedavi sonuçlarý deðerlendirildi. Eksplorasyonun özellikle II. Bölge yaralanmalarýnýn taný ve tedavisinde en deðerli yöntem olduðu, ayrýca 1. ve III. Bölge yaralanmalarýnda eksplorasyon yetersizse diðer taný yöntemlerine ihtiyaç duyulabileceði tesbit edildi.

Treatment results of 39 high velocity and 28 low velocity gunshot wound cases were looked over during 1993-1994 at E.N.T. and Plastic Surgery Departments of Diyarbakýr Military Hospital. It was proved that, exploration is the most valuable method for diagnosis and treatment especially at second zone wounds, also at first and third zone wounds, if exploration is insufficient then other diagnostic methods can be necessary.

Kliniðimize 1990-1994 yýllarý arasýnda 1023 kafa travmalý olgu yatýrýlarak tedavi edilmiþtir. Bu çalýþmaya 426 pediatrik hasta alýnmýþtýr. Hastalar (0-1), (1-3), (3-7), (7-16) olmak üzere dört yaþ grubuna ayrýlmýþtýr. Klinik tablolarý Glasgow Koma Skalasýna (GKS) göre deðerlendirilmiþtir. Buna göre hastalar; Hafif Travma (GKS: 13-15), Orta Þiddette Travma (GKS: 9-12), Þiddetli Travma (GKS: 3-8) olmak üzere üç gruba ayrýlmýþtýr. Hastalarýn %83.3'ü hafif travmaya uðramýþlardýr. Direkt kraniografi ve Bilgisayarlý Beyin Tomografisine (BBT) göre en sýk karþýlaþýlan patoloji kafatasý kýrýðýdýr. 325 olgu konservatif olarak tedavi edilirken 101 olguya cerrahi giriþim uygulanmýþtýr. Hastalar tedavi sonrasýnda Glasgow Sonuç Skalasýna (GSS) göre deðerlendirilmiþlerdir. Tüm olgularýn, 355 (%83.3)'inde tam iyileþme saðlanýrken, 29 (%6.7)'u kaybedilmiþtir. Travma komplikasyonu olarak en fazla pnömosefalus, beyin omurilik sývýsý (BOS) fistülü, epilepsi ve enfeksiyona rastlanmýþtýr.

1023 patients with head trauma had been treated between the years 1990 and 1994 in our clinic. 426 pediatric patients were included in this study. These patients were divided into four groups; (0-1), (1-3), (3-7) and (7-16) according to their ages. The clinical assessment of head injury was defined as Glasgow Coma Scale (GCS) and 426 consecutive patients were divided into three groups; Mild Head Injury (GCS: 13-15), Moderate Head Injury (GCS: 9-12), Severe Head Injury (GKS: 3-8) when they were admitted. Of 83 percent of patients had mild head injury. The skull X-rays and computerized tomography were revealed the skull fracture as the most encountered lesion in the patients. Surgical intervention was performed to 101 patients while the rest was treated conservatively. The pediatric patients with head trauma were evaluated with Glasgow Outcome Scale (GOS) after the treatment has been completed. Good recovery was obtained in 355 patients while 29 died. Pneumocephalus, cerebro spinal fluid (CFK) leakage, epilepsy and the infection were the most encountered complications after head trauma.

Kliniðimizde 1.6.1994-1.6.1995 tarihleri arasýnda, nontravmatik akut karýn ön tanýsý ile yatýrýlýp tedavi edilen toplam 107 hastada preoperatif ve postoperatif 24, 48, 72'ci saatlerde plazma CRP (C-Reaktif Protein) düzeyleri incelendi. Opere edilen 89 hastada akut karýna yol açan cerrahi bir patoloji vardý. Bunlar çalýþma grubunu oluþturdu. Akut karýn ön tanýsý ile yatýrýlýp yapýlan gözlem sonucu rahatlayan ve akut karýn ön tanýsýyla operasyona alýnýp cerrahi bir patoloji tesbit edilemeyen 18 hasta ise kontrol grubunu oluþturdu. CRP deðerleri 6 mg/L'den yüksek ise anlamlý olarak kabul edildi. Çalýþma grubunda 89 hastanýn 80'inde (%89.8); kontrol grubunda ise 18 hastanýn 4'ünde (%22.2) CRP deðerleri 6 mg/L'den yüksek olarak bulundu. Çalýþma grubunda preoperatif CRP deðerleri 6 mg/L'den yüksek olarak bulundu. Çalýþma grubunda preoperatif CRP deðerleri kontrol grubuna göre çok anlamlý derecede yüksekti. Akut karýn hastalýklarý içinde de en yüksek preoperatif CRP deðerleri akut apandisitti hastalarda tesbit edildi. Çalýþma grubunda 48'ci saatteki postoperatif CRP deðerlerinin preoperatif ve diðer postoperatif deðerlerden daha yüksek olduðu, kontrol grubunda ise preoperatif ve postoperatif CRP deðerleri arasýnda önemli fark olmadýðý görüldü. Yaptýðýmýz çalýþma sonucunda cerrahi akut karýn hastalarýnda preoperatif dönemde CRP'nin yükseldiðini ve postoperatif erken dönemde bu yüksekliðin devam ettiðini tesbit ettik.

Serum C-reactive protein was measured preoperatively and postoperatively 24, 48 and 72nd hours in 107 patients hospitalized with the diagnosis of nontraumatic acute abdomen in our clinic between 1.6.1994 and 1.6.1995. Eighty-nine of the patients formed the study group. Eighteen patients who did not have a surgical pathology in the operation or who recovered after the observation period formed the control group. CRP values higher than 6mg/L were regarded as significant. In the study group, 80 patients (89.8%) and in the control group, 4 patients (22.2: ) had CRP values higher than 6mg/L. Preoperative CRP value of the study group was significantly higher than that of the control group. The highest preoperative CRP value was found in the patients with acute appendicitis in the study group. In the study group, CRP value measured at the 48th hour postoperatively was higher than those measured preoperatively and 24th and 72nd hours postoperatively. In the control group, there was not a difference between CRP values measured preoperatively and postoperatively. We concluded that CRP values are high in the preoperative and early postoperative period in the patients with acute abdomen.

Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý'nda tedavi edilen 41 karaciðer travmalý olgu Moore klasifikasyonuna göre karaciðer yaralanmasýnýn derecesi, mortalite, preoperatif çalýþýlan ALT (Alanine aminotransferaz) ve AST (Aspartate aminotransferaz) deðerleri açýsýndan retrospektif olarak incelendi. Olgularýn 35'i erkek (Yaþlarý ort: 34.48±15.62), 6'sý kadýn (yaþlarý ort: 26.16±12.01) idi. Bu olgulardan 32'si künt (%78.05), 9'u penetran (%21.95) travmalýydý. Bu çalýþma sonunda, grade III-V karaciðer yaralanmalarý ile grade I-II yaralanmalar arasýnda AST ve ALT deðerleri açýsýndan istatistiksel anlamlý farklýlýk saptandý (p<0.005). Bu nedenle preoperatif dönemde ALT ve AST deðerlerindeki normalden 4 kat artýþ saptandýðýnda karaciðerdeki yaralanmanýn ciddi nitelikte olabileceðinin düþünülmesi gerektiði kanýsýna varýldý.

Fortyone patients with liver trauma, who were admitted to the General Surgery Department of Akdeniz University Medical Faculty, were evaluated for the severity of liver injury according to the Moore classification, mechanism of trauma, Injury severity score (ISS), mortality and alanine aminotransferase (ALT) values and aspartate aminotransferase (AST) values retrospectively. Among the 41 patients, 32 (78.05%) had a blunt and 9 (21.95%) had a penetrating trauma. The difference between the ALT and AST values of patients with grade I-II injury and grade III-V injury was statistically significant (p<0.005). Our results show that, a four fold rise than normal in the preoperative AST and ALT values should suggest a severe liver injury in these patients.

Trachea-bronchial ruptures sterning from blunt thorax traumas are patologies that scarcely occur. The media end publications began to work more on this subject recently as a result of increasing traffic accidents and blunt traumas caused by falling down from high places (1,2,3). Also, in out cauntry increasing volume of traffic accidents results in serious thorax traumas and trachea-bronchial injuries. Major respiratory ruptures that follow blunt thorax traumas are deadly injuries. In such cases, it's very, important to diagnose the bronchial injury, determine the type (whether it's complete/incomplete rupture, opening to the pleura), it's clinical eridence and give surgical assistance at early stage in order to save pulmonary functions with this punpose, two cases were presented under our treatment in our clinic in the last two mounths.

Tibia plato kýrýklarýnýn tedavisinde amaç stabil güçlü ve hareketli bir diz eklemi elde etmektir. Elde edilecek stabil bir fiksasyon, postop artroz riskiyle direkt iliþkili olduðundan, tedavi planlamasý ayrýca önem arz etmektedir. Çalýþmamýzda, Ýstanbul Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji ABD'da Mart 1980-Haziran 1992 tarihleri arasýnda cerrahi tedavi uygulanan 72 hastadan, çaðrýmýza uyarak son kontrollerine gelen 30 vaka materyalimizi oluþturmuþtur. Vakalarýmýzýn 18'i erkek (%60), 12'si kadýn (%40) olup ortalama yaþ (en küçük 30 en büyük 77) 51.6, takip süreleri ortalama (en az. 6 ay-en çok 12 yýl) 5.9 yýl idi. Vakalarýmýzýn preop sýnýflamasýnda Hohl klasifikasyonu kullanýlmýþtýr. Ýnternal tesbit olarak 11 vakada plak-vida, 10 vakada kortikal ve spongiöz vida, 4 vakada bolt vidasý kullanýlmýþ, 5 vakada internal tesbit uygulanmamýþtýr. 11 vakada platodaki çökme plato distalinden açýlan bir pencereden iliak-spongiöz greftler kullanýlarak yükseltilmiþ, 1 vakada aþýrý parçalanma gösteren iç kondile kristadan blok greft alýnarak yeni bir plato oluþturulmuþtur. Sonuçlar Delamarter ve Hohl'ün önerdikleri kriterlere göre deðerlendirilmiþ, buna göre, 5 vaka (%16) çok iyi, 12 vakada (%36.6) iyi, 11 vaka (%36.6) orta ve 2 vaka (%10) kötü olarak deðerlendirilmiþtir.

The purpose of the surgical treatment of tibial plateau fractures is to get a stable, powerfull and mobile joint. The importance of surgical planning is that a stable post operative fixation is directly proportional to postoperative arthrosis. The material of this study consists of thirty out of 72 patients who responded to our call for control examination, treated surgically at the Department of Orthopaedics and Traumatology, Istanbul Medical Faculty between March 1980 and June 1992. 18 patients were male (%60) and 12 female (%40), mean age was 51.6 (min. 30-max. 77) and the mean follow-up 5.9 years (inin. 6 mounths-max. 12 years). The cases have been classified according to Hohl's system. As an internal fixation device, we used plate and screws in 11 patients, cortical and spongios screws in 10 patients, Bolt screw in 4 patients and no device in 5 patients. The plateau depression has been reconstructed with elevation through a window in the bone distal to the plate with a corticospongios iliac crest graft and a crashed medial tibial condile has been reconstructed with an iliac crest graft in one patient. The results are evaluated according to Hohl's and Delamarter's clasification systems; 5 patients have scored excellent (16%), 12 patients good (36.6%), 11 patients fair (36.6%) and 2 patients poor (10%).

1980-1994 yýllarý arasýnda Atatürk Üniversitesi Týp Fakültesi Acil servisine baþvuran ve Genel Cerrahi Anabilim Dalý'na yatýrýlarak tedavi gören batýna nafiz kesici-delici alet yaralanmasý olan 119 hastanýn kayýtlarý retrospektif olarak incelendi. Hastalarýn 107'si erkek (%89.9), 12'si kadýn (%10.1) idi. En genç hasta 5, en yaþlý hasta 70 yaþýnda olup yaþ ortalamasý 27.6±11.9 idi. Yaralanma sýklýðýna göre organlar incelendiðinde 33 vaka ile(%27.8) ince barsaklar, 22 vaka (%18.4) ile kolon, 20 vaka ile (%16.8) karaciðer,14 vaka ile (%11.8) mide, 14 vaka ile (%11.8) omentum, 12 vaka ile (%10.8) dalak, 10 vaka (%8.4) diyafragma, 2 vaka ile (%1.7) rektum, 2 vaka ile (%1.7) gastrokolik ligament, 2 vaka ile (%1.7) gastroepiploik damarlar, 1 vaka ile (%0.8) falsiform ligament,1 vaka ile (%0.8) v.cava, 1 vaka ile (0.8)(%0.8) v.porta, 1 vaka ile (%0.8) ile üreter, 1 vaka ile (%0.8) v.iliaka yaralanmasý izlemektedir. 5 vakaya (%4.2) operasyon gerekmemiþ ve 6 vakaya (%5.0) negatif explorasyon yapýlmýþtýr. Ortalama hospitalizasyon süresi 10.4(4.5 gün olup, mortalite oraný %8.4 (10 vaka)'tür. sonuç olarak kesici-delici alet yaralanmalarýnda morbidite ve mortalite riski artýrýlmadan negatif laparotomi oranlarýnýn azaltýlmasý için genel konsensüse ihtiyaç vardýr.

From 1980 through 1994,119 patients' records with penetrating stab wounds of the abdomen causing visceral or vascular injuries were reviewed retrospectively. In this series there were 107 man (89.9%) and 12 women (10.1%). The patient's ages ranged from 5 to 70 years (average, 27.6±11.9 years). The most commonly injuried organs were small bowel (27.8%), colon (10.8%), live (16.8), stomach (11.8), amentum (11.8), spleen (10.8%) and diaphragm (8.4%). In addition, there were injuries to the rectum, gastrocolic ligament, falciform ligament, ureter and vasculer structures. The negative laporotomy rate was 5%. The average hospitalization period was 10.4±4.5 day. Overall mortality rate was 8.4% (10 patients). In conclusion to decrease the rate of negative laparotomy rate in patients with penetrating abdominal traumas a concensus necessary.