Yanýk yaralanmalarý diðer pek çok ülkede olduðu gibi Türkiye’de de üzerinde durulmasý gereken bir saðlýk problemidir. Bu hastalarýn erken dönem yönetimleri sonraki dönem morbiditesi ve mortalitesi için çok önemlidir. Bu nedenle Saðlýk Bakanlýðý, Yanýk Bilim Komisyonu katkýlarýyla hazýrlanan “Ulusal Yanýk Tedavi Algoritmasý”ný hazýrladý. Bu algoritmanýn temel amacý, yanýk kazazedeleri deneyimli yanýk merkezlerine ulaþana deðin klinisyenlere kýlavuzluk yapmaktý. Bu algoritmanýn içeriði ilk yardým, baþlangýç yönetimi, resüsitasyon ve transfer politikasýdýr. Konsey, algoritma üzerindeki çalýþmalarýna 2011 yýlýnda baþladý. Genel cerrahlarýn, çocuk cerrahlarýnýn, estetik plastik ve rekonstrüktif cerrahlarýn, anestezistlerin ve yoðun bakým klinisyenlerini içeren çok sayýda konsültanlar ilk taslaðý hazýrladý ve bu sekiz Saðlýk Bakanlýðý eðitim ve araþtýrma hastanesine, dört üniversiteye ve yedi sivil toplum kuruluþuna iletildi. 2012 yýlýnýn son çeyreðinde, algoritmaya son þekli verildi ve Bilim Komisyonu tarafýndan onaylandý. Sonrasýnda Saðlýk Bakanlýðý tarafýndan onaylanarak yayýnlandý.

As in many other countries, burn injuries are a challenging healthcare problem in Turkey. Initial management of burn patients is very important for future morbidity and mortality. Therefore, the Turkish Ministry of Health prepared “National Burns Treatment Algorithm” aided by the Scientific Burns Council. The basic aim of this algorithm is to guide physicians in the treatment of burn victims until they reach an experienced burns center. The content of this algorithm is first aid, initial management, resuscitation, and transfer policy. The Council started to work on this algorithm in 2011. Various consultants, including general surgeons, pediatric surgeons, aesthetic, plastic and reconstructive surgeons, anesthesiologists, and intensive care physicians, revised the first draft and it was sent to eight education and research hospitals of the Ministry of Health, four universities, and seven non-governmental organizations. In the last quarter of 2012, the algorithm was finalized and approved by the Scientific Council, after which, it was approved by the Ministry of Health and published.

AMAÇ: Bu çalýþmanýn amacý duruþ fazýnda aksiyel yüklenme altýnda insan ayak bileðinin anterior inferior tibiofibularis ligamanýnýn (AITFL) biyomekanik davranýþýný deðerlendirmektir. Duruþ fazýnda ayak bileði stabilitesine AITFL’nin etkisini araþtýrmak için in vitro ardaþýk deneysel bir düzenek simüle edildi.
GEREÇ VE YÖNTEM: Aksiyel kompresyon gerçekleþirken nötral posizyonda ayaðýn anterior yerdeðiþimi ve distal tibianýn posterior yerdeðiþimi ölçümü iki non-kontakt vidyo ekstansiyometre ile gerçekleþtirildi. Sekiz taze donmuþ ve anatomik olarak saðlam insan kadavra ayak bileði örnekleri test edildi. Aksiyel kompresyon test makinesi, duruþ fazýnda aksiyel ayak bileði yüklenmesini simüle etmek için 0’dan 800 Newton’a kadar yüklenme ile ve 5 mm/dk yükleme hýzýnda kullanýldý.
BULGULAR: AITFL-saðlam ve AITFL-kesilmiþ örneklerde anteroposterior yerdeðiþtirme arasýnda istatistiksel olarak anlamlý fark gözlendi. Ortalama AITFL-saðlam ayak bileði anteroposterior yerdeðiþimi 1.28±0.47 mm idi. Ortalama AITFL-kesik ayakbileði anteroposterior yerdeðiþimi 2.06±0.7 mm idi.
TARTIÞMA: Sonuç olarak, ayak bileði nötral pozisyondayke AITFL’nin biyomekanik özellikleri hakkýnda bazý nümerik ve kantitatif bilgi vermektedir. Acil serviste ayak bileði distorsiyon sonrasý AITFL yaralanmasý teþhisi ve tedavisi önemlidir. Ayak bileði biyomekaniði AITFL yaralanmalarý sonrasý etkilenmekte ve instabilite geliþmektedir.

BACKGROUND: The aim of this study was to evaluate the biomechanical behavior of anterior inferior tibiofibularis ligament (AITFL) deficient human ankle under axial loading of ankle at stance phase of gait. In order to investigate the contribution of AITFL to ankle stability, an in vitro sequential experimental setup was simulated.
METHODS: The measurement of posterior displacement of distal tibia and anterior displacement of the foot, in neutral position, secondary to axial compression, was performed by two non-contact video extensometers. Eight freshly frozen, anatomically intact, cadaveric human ankle specimens were included and tested. An axial compression test machine was utilized from 0 to 800 Newtonswith a loading speed of 5 mm/min in order to simulate the axial weight-bearing sequence of the ankle at stance phase of human gait.
RESULTS: There was a statistically significant difference between anteroposterior displacement values for AITFL-Intact and AITFLDissected specimens (p≤0.05). Mean AITFL-Intact and mean AITFL-Dissected ankle anteroposterior displacement was 1.28±0.47 mm
and 2.06±0.7 mm, respectively.
CONCLUSION: This study determined some numerical and quantitative data about the biomechanical properties of AITFL in neutral foot position. In the emergency department, diagnosis and treatment of AITFL injury, due to ankle distortion, is important. In AITFL injuries, ankle biomechanics is affected, and ankle instability occurs.

AMAÇ: Bu çalýþmada, akut spinal kord hasarý sonrasý erken dönemde kafeik asit fenetil esterin (KAFE) enflamatuvar sitokinlerden interlökin 1 beta (IL-1β) ve tümör nekrotizan faktor alfa (TNF-α) üzerine etkisini ve histopatolojik olarak KAFE’nin olasý iyileþtirici etkisini araþtýrmak amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmada aðýrlýklarý 250-300 gram arasýnda deðiþen 48 Wistar-Albino cinsi sýçan kullanýldý. Denekler üç gruba ayrýldý. Her grup kendi altýnda iki alt gruba ayrýldý. 1a grubu kontrol grubu olup bu grupta yalnýzca laminektomi yapýldý. Grup 1b’de laminektomi sonrasý anevrizma klibi ile travma oluþturuldu. Ýkinci gruptaki deneklerde travma oluþturulduktan yarým saat sonra serum fizyolojik sistemik olarak verilip birinci ve altýncý saatte denekler sakrifiye edildi. Üçüncü grupta travma oluþturulmuþ deneklere yarým saat sonra sistemik yoldan KAFE verildi ve bu denekler birinci ve altýncý saatte sakrifiye edildi. Sakrifikasyon öncesi kalpten alýnan kanda ELÝSA kitleri ile serum IL-1β ve TNF-α düzeyleri ölçüldü. Hasarlanmýþ kordan alýnan doku örneklerinde histopatolojik deðerlendirme yapýldý.
BULGULAR: Kafeik asit fenetil esterin verilen grupta TNF-α ve IL-1β düzeylerinin azaldýðý tespit edildi. Histopatolojik deðerlendirmede KAFE verilen grupta hemoraji ve nekroz oranýnda azalma tespit edildi.
TARTIÞMA: Akut spinal kord hasarý sonrasý erken dönemde KAFE enflamatuvar sitokinlerden TNF-α ve IL-1β düzeylerini baskýlamaktadýr ve hasar sonrasý iyileþmeye katkýda bulunmaktadýr.

BACKGROUND: The purpose of this study was to investigate the effects of Caffeic Acid Phenethyl Ester (CAPE) on proinflammatory cytokines, IL-1β and TNF-α, and explore its healing effect after acute spinal cord injury.
METHODS: Forty-eight male Wistar-Albino rats were used in this study which was planned as three groups. All groups were divided into two sub-groups. Group 1a was the control group, in which only lower segment thoracic laminectomy was performed. In group 1b,
spinal cord trauma was performed with aneurysm clip. In the second group, serum physiologic was given systemically thirty minutes after trauma, and rats were sacrificed after the first and sixth hour. In the third group, CAPE was given systemically thirty minutes after
trauma, and rats were sacrificed after the first and sixth hour. Serum IL-1β and TNF-α levels were analyzed by ELISA in the serum. Histopathological analysis was performed in damaged cord tissues.
RESULTS: CAPE suppressed TNF-α and IL-1β levels in the serum. In histopathological evaluation, it was detected that CAPE decreased hemorrhage and necrosis.
CONCLUSION: CAPE suppresses the levels of proinflammatory cytokines, TNF-α and IL-1β, after acute spinal cord injury in the early phase and contributes to the healing process.

AMAÇ: Negatif apandektomiler gereksiz hasta kabullerine neden olarak, saðlýk hizmetlerine yük ve mali külfet getirmektedir. Bu çalýþma, negatif apendektomilerin azaltýlmasýnda total lökosit ve nötrofil sayýlarýný deðerlendirmek üzere yürütüldü.
GEREÇ VE YÖNTEM: Hastaneye kabul edilen ve apandektomi geçiren hastalarýn verileri incelendi. Deðiþik kestirim noktalarý için total lökosit ve nötrofil sayýlarýnýn alýcý iþletim karakteristik eðrisi (ROC) analizi hesaplandý. Optimal duyarlýlýk, özgüllük, genel doðruluk derecesi ve eðrisi altýnda kalan alan belirlendi.
BULGULAR: Toplam 408 hastada cerrahi deðerlendirmeye göre gerçek ve negatif apandisit oranlarý %72.1 (n=294) ve %27.9 (n=114) iken histopatolojik olarak bu oranlar sýrasýyla %76.2 (n=311) ve %23.8 (n=97) idi. Total lökosit sayýmýnýn optimal kestirim deðeri olan >11.9x109/L, %87.14 duyarlýlýk ve %91.75 özgüllüðe sahipti. Total nötrofil sayýsýnýn optimal kestirim deðeri olan >7.735x109/L %98.71 duyarlýlýk ve %91.75 özgüllüðe sahipti. Total lökosit ve nötrofil sayýlarý için eðri sýrasýyla 0.9603 ve 0.9872 olup, genel doðruluk oranlarý sýrasýyla %91.2 ve 97.1 idi.
TARTIÞMA: Normal total lökosit ve nötrofil sayýlarý negatif apandektomilerle kuvvetle iliþkilidir. Cerrahi dýþý önlemler, toplam lökosit ve nötrofil sayýlarý dikkatli klinik takip oldukça önemlidir.

Background:
Negative appendectomies result in unnecessary admissions, health care burden and cost. This study was conducted to assess Total leukocyte and Neutrophil counts as preventive tools in reducing negative appendectomies.
Methods:
Data of admitted patients who underwent appendectomies was analyzed. Receiver operator characteristic (ROC) curve analysis of Total Leukocyte and Neutrophil Counts was calculated for various cut-off points. Optimum sensitivity, specificity, over-all accuracy and area under the curve was determined.
Results:
Of the 408 total patients, true and negative appendicitis by operative assessment was 294(72.1%) and 114(27.9%) compared to 311(76.2%) and 97(23.8%) by histopathology, respectively. Optimal cut-off for Total Leukocyte Count was >11.9x109/Liter with 87.14% sensitivity and 91.75% specificity. Optimal cut-off point for Neutrophil Count was >7.735x109/Liter with 98.71% sensitivity and 91.75% specificity. Area under the curve for Total Leukocyte and Neutrophil Counts was 0.9603 and 0.9872, respectively with overall accuracy of 91.2% and 97.1%, respectively.
Conclusion:
Normal Total Leukocyte and Neutrophil counts strongly associate with negative appendectomies. Non-operative measures and careful observation for Total Leukocyte and Neutrophil Counts <11.9x109/Liter and <7.735x109/Liter, respectively can reduce the negative appendectomy rate. In cases with normal values of these, a trial period can be given if the condition allows.

AMAÇ: Yetiþkinlerde yabancý cisme baðlý gastrointestinal perforasyon hakkýnda çok az bilgi sahibi olunduðu gibi, yalnýzca birkaç olgu çalýþmasýnda gastrointestinal perforasyon belgelenmiþtir. Bu çalýþmanýn amacý bu olgularda karþýlaþtýrmalý yöntemleri sunmaktýr.
GEREÇ VE YÖNTEM: Ocak 2003 ile Ekim 2013 tarihleri arasýnda yabancý cisimle gastrointestinal perforasyon tanýsý konmuþ 20 hastada geriye dönük bir çalýþma yürütüldü. Bu hastalarýn hepsinde perforasyonlar ince baðýrsak yerleþimliydi ve bu hastalar travma dýþý nedenlere baðlý ince baðýrsak perforasyonu olmuþ 87 hasta ile karþýlaþtýrýldý.
BULGULAR: Yabancý cisim grubundaki hastalarýn %35’i, yerel popülasyona göre çok daha yaþlý olup 65 yaþýn üstündeydi (p=0.002). Yabancý cisim grubunda daha fazla sayýda hastada yaygýn abdominal fiziksel bulgu olmadýðý gibi (p=0.008) ve ameliyat öncesi bilgisayarlý tomografi taramalarý daha büyük bir doðruluk derecesine sahipti (p=0.027). Daha büyük bir sýklýkla perforasyon onarýmý yapýlmýþtý (p=0.024). Ortalama MPI 19.9 ve morbidite oraný %35 olup diðer nedenlere baðlý olgulara göre anlamlý derecede daha düþük idi (p=0.001 ve 0.041). Diðer nedenlere baðlý perforasyonlara göre hastanede yatýþ süresi daha kýsaydý (p=0.038).
TARTIÞMA: Yabancý cisme baðlý ince baðýrsak perforasyonun klinik sunumu atipik olup ameliyat öncesi taný bilgisayarlý tomografi taramalara baðlýdýr. Birincil perforasyonun kapanmasý güvenli ve etkili olup göreceli olarak daha iyi sonuçlar elde edilebilir.

BACKGROUND: Little was known about gastrointestinal perforation secondary to foreign body in adults, which was only documented by several case series reports. The aim of this study was to characterize it with comparative methods.
METHODS: A retrospective study was conducted on twenty patients with the diagnosis of gastrointestinal perforation secondary to foreign body between January 2003 and October 2013. The perforations were all located in the small intestine and compared to eighty-seven patients with non-traumatic small intestinal perforation.
RESULTS: 35% of the patients in the foreign body group were over 65 years of age, which is much higher than the local elderly population ratio (p=0.002). In the foreign body group, more patients presented without diffuse abdominal physical signs (p=0.008) and preoperational CT scans had higher accuracy (p=0.027). Perforation repair was performed more often (p=0.024). Mean MPI was 19.9 and the morbidity rate was 35%, significantly lower than in the cases of other causes (p=0.001, 0.041). Mean duration of hospitalization was 11.5 days and was shorter compared to other causes (p=0.038).
CONCLUSION: Clinical performance of small intestinal perforation secondary to foreign body is atypical, and preoperative diagnosis relies on CT scans. Primary perforation closure is safe and effective, and relatively better outcomes can be achieved.

AMAÇ: Proksimal humerus kýrýklarý sýk görülen ve fonksiyonel kýsýtlanmaya neden olan kýrýklardandýr. Bu geriye dönük çalýþmanýn amacý ayný fiksasyon metodu kullanýlarak deltopektoral ile deltoid split giriþimin karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Eylül 2005 ile Temmuz 2011 arasýnda bu iki giriþim kullanýlarak cerrahi tedavi edilen 86 hasta çalýþmaya alýndý. Grup A deltoid split giriþim, Grup B deltopektoral giriþim kullanýlan hastalardan oluþturuldu. Grup A 22 erkek, 34 kadýn toplam 56 hastanýn yaþ ortalamasý 62.5 yýl (26-90 yýl), Grup B 14 erkek, 16 kadýn, toplam 30 hastanýn yaþ ortalamasý 54.8 yýl (24-84 yýl) idi. Tüm hastalarda internal fiksasyon aracý olarak PHÝLOS plak vida sistemi kullanýldý. Her iki grubun fonksiyonel sonuçlarý ve komplikasyonlarý karþýlaþtýrýldý.
BULGULAR: Lateral deltoid split giriþim kullanýlan olgularda baþ ve tüberküler fragman redüksiyonunun daha iyi olduðu ve Constant omuz skorunun erken dönemde daha yüksek olduðu saptandý (sýrasýyla, 66.8-57.4; p<0.01). Aksiller sinir gözlenip askýya alýndýðý için bu sinire ait komplikasyon saptanmadý. Altýncý aydaki Constant skorlarý arasýnda anlamlý farklýlýk saptanmadý (sýrasýyla, 92.2-91.3; p>0.05).
SONUÇ: Deltoid split giriþim, özellikle AO/ASÝF B ve C tipi kýrýklarda proksimal humerusun 270 derece kontrolüne, tüberküler parçalardan ve döndürücü manþet tendonlarýndan geçirilen dikiþlerle redüksiyon ve plaða tespitine olanak saðlamaktadýr. Deltopektoral giriþime göre hastanýn iyileþme sürecinde Constant skorlarý anlamlý olarak farklýdýr. Aksiller siniri eksplore ederek yapýlan lateral deltoid split giriþim, deltoid kas fonksiyonlarýný ve aksiller siniri tehlikeye atmadan geniþ ve çok yönlü kýrýk kontrolü saðlayan faydalý bir cerrahi giriþim tekniðidir.

BACKGROUND: Fractures of the proximal humerus that limit function are quite common. The objective of this retrospective study was to compare deltoid splitting and deltopectoral approaches by using the same fixation method.
METHODS: Eighty-six patients who underwent surgical treatment between September 2005 and July 2011 were included into the study group. Deltoid splitting approach was used by exploring the axillary nerve on Group A patients as described by Codman, and deltopectoral approach was used on Group B patients. Group A consisted of a total of fifty-six patients of whom twenty-two were male and thirty-four were female patients, with a mean age of 62.5 years (range, 26 to 90 years). Group B consisted of a total of thirty patients of whom fourteen were male and sixteen were female patients, with a mean age of 54.8 years (range, 24 to 84 years). PHILOS plate system was utilized as an internal fixation tool in all patients. Functional results and complications of the two groups were compared using Constant scores.
RESULTS: It was observed that humeral head and tubercular fragment reduction were better with lateral deltoid splitting approach, and Constant shoulder scores were higher in the early stages (66.8-57.4 consecutively; p0.05).
DISCUSSION: Deltoid splitting approach, especially with AO/ASIF B and C type fractures, enables reduction and plate fixing under 270 degree control of the proximal humerus without forceful retraction and soft tissue damage, providing easy access to posterior tubercular fragment. Compared to deltopectoral approach, patients treated with deltoid splitting approach achieved higher Constant scores at an earlier stage. Lateral deltoid
splitting approach, by exploring the axillary nerve, is a useful surgical technique which provides an expansive and multi-dimensional control without risking the deltoid muscle function and the axillary nerve.

AMAÇ: Bu çalýþmanýn amacý, Kirschner (K) tellerinin sayýsý ve pozisyonunun ve immobilizasyon þekli ve süresinin, kapalý olarak K-teli fiksasyonu ile tedavi edilen distal radius kýrýklarýnýn radyolojik ve fonksiyonel sonuçlarý üzerine etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Doksan iki hasta ortalama 19.84±5.22 ay (aralýk: 13-34 ay) takip ile çalýþmaya alýndý. Grup I’deki 45 hastaya üç adet K-teli ile tespit saðlandý ve ilk üç hafta volar yarým alçý ile, sonraki üç hafta da ise çýkarýlabilir splintle desteklendi. Grup II’deki, 47 hasta ise iki adet K-teli ile tespit edildi ve ameliyat sonrasý altý hafta dirsek altý sirküler alçýyla desteklendi.
BULGULAR: Her iki grup arasýnda kavrama gücü ve DASH skorlarý arasýnda önemli bir deðiþiklik yoktu. Klinik muayenede, daha iyi fonksiyonel sonuçlar, çýkarýlabilir volar splint ile desteklenen hastalarda saptandý. Ameliyat sonrasý altýncý haftada, volar tilt, radial inklinasyon ve radial yükseklik Grup I’deki hastalarda Grup II’dekilerden daha iyi idi (tüm p deðerleri <0.05).
TARTIÞMA: Tripod tekniðiyle üç K-teli uygulamasý stabilite ve iyi radyolojik sonuçlar elde etmek için güvenli ve geçerli bir yöntemdir. Çýkarýlabilir splint kullanýmý, eklem içi ve eklem dýþý distal radius kýrýklarýnýn tedavisinde fonksiyonel sonuçlarý geliþtirmektedir.

BACKGROUND: The aim of the study was to investigate whether the number and position of Kirschner (K)-wires, and the manner and duration of immobilization influence radiologic and functional outcomes of distal radius fractures treated with percutaneous K-wire fixation.
METHODS: Ninety-two patients were included into the study with a mean follow-up period of 19.84±5.22 months (range, 13-34 months). In Group I, forty-five patients were treated with 3 K-wires and supported with a volar semi-circular cast for the first 3 weeks followed by a removable splint for a further 3 weeks. In Group II, forty-seven patients were treated with 2 K-wires and supported with a below-elbow circular cast for 6 weeks postoperatively.
RESULTS: No significant difference in grip strength and DASH scores was found between the two groups. In clinical examination, significantly better functional results were determined in patients supported with a removable volar splint. At 6 weeks postoperatively, volar tilt, radial inclination, and radial length were significantly better in Group I compared to Group II (all p values).
CONCLUSION: Tripod technique with 3 K-wires is a safe and reliable procedure to achieve stability and good radiological results. The use of a removable splint also improves the functional outcomes in the treatment of both intra- and extra-articular distal radius fractures.

AMAÇ: Bu çalýþmada travmatik ölümlerde, travma bakým kalitesinin bir göstergesi olarak önlenebilir ölüm oranlarýnýn ve medikal hatalarýn otopsi raporlarýna göre araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Eskiþehir/Türkiye’de 2011 ve 2012 yýllarýna ait travmatik otopsi raporlarý geriye dönük olarak incelendi. Olgularýn demografik verileri, yaralanma tipi, yaralanma nedeni, yaralanma bölgesi, ISS deðerleri, ölüm nedeni ve ölüm yeri kaydedildi. Bütün ölümler önlenebilir, potansiyel önlenebilir ve önlenemez ölümler olmak üzere üç gruba ayrýldý.
BULGULAR: Çalýþma döneminde 386 travmatik otopsi raporu incelendi. Olgularýn %81.9’unun (n=316) künt, %18.1’inin (n=70) ise penetran yaralanmaya maruz kaldýðý gözlendi. Yine olgularýn %56.7’sinin (n=219) olay yerinde, %11.7’sinin hastane öncesinde (n=45), %31.6’sýnýn (n=122) hastanede öldüðü belirlenmiþtir. Önlenebilirlik analizinde olgularýn %4.1’inin önlenebilir (n=16), %14.5’inin (n=56) potansiyel önlenebilir ve %81.3’ünün (n=314) önlenemez nitelikte olduðuna karar verildi. Toplamda olgularýn %65.3’ünde (n=47) suboptimal bakým, %58.3’ünde (n=42) müdahalenin gecikmesi hatalarý gözlendi.
TARTIÞMA: Önlenebilir ölüm oranlarýnýn hastane öncesi periyotta, penetran yaralanmalarda ve özellikle göðüs travmalarýnda yüksek bulunmasýnýn dikkat çekici bulgular olduðu deðerlendirilmektedir.

BACKGROUND: The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths.
METHODS: A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskiþehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors.
RESULTS: A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1).
CONCLUSION: High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma
centres would enable the development of trauma care and reduce the rates of preventable deaths.

AMAÇ: Koruyucu önlemleri iyileþtirme amacýyla Birleþik Arap Emirliklerinde Al-Ain ilinde hayvanlarýn neden olduðu yaralanmalarýn insidansý, mekanizmalarý, tipleri, anatomik daðýlýmý ve sonucunu incelendi.
GEREÇ VE YÖNTEM: Mart 2003 ile Mart 2007 yýllarý arasýnda hayvanlar tarafýndan yaralandýktan 24 saatten uzun bir süre sonra Al-Ain Hastanesine getirilen ve acil serviste ölen hastalarýn hepsi incelendi.
BULGULAR: Seksen dokuz (%2.3) hastanýn %99’u erkek hastalardan ibaretti. Hastalarýn ortanca (aralýðý) yaþý 30 (5-89 yaþ) yaþýndaydý. En sýk develerin (%84.3), daha sonra ineklerin (%6.7) neden olduðu yaralanmalar görülmekteydi. Yaralanmalarýn %88.7’si iþteyken oluþmuþtu. En sýk görülen yaralanma hayvan çiftesi (%32.6) ve düþmeler (%30.3) sonucu oluþmuþtu. En sýk üst ekstremite yaralanmýþtý. Ortanca (aralýk) ISS, 4 (1-13) ve hastanede yatýþ süresi 6 (1-53 gün) idi.
TARTIÞMA: En çok develerin neden olduðu yaralanmalar görülmüþtür. Hayvanlarla uðraþýda deneyim, hayvan davranýþlarýný iyi bilme, güvenli cihazlarýn kullanýlmasý ve yaralanmalardan koruyucu eðitim hayvanlarýn neden olduðu yaralanmalarýn oranýný azaltabilmektedir.

BACKGROUND: The objective of this study was to investigate the incidence, mechanisms, types, anatomical distribution, and outcome of animal related-injuries in Al-Ain, the United Arab Emirates in order to improve preventive measures.
METHODS: The study included all patients admitted to Al-Ain Hospital with animal-related injuries for more than 24 hours or the patients who died in the Emergency Department between March 2003 and March 2007.
RESULTS: There were eighty-nine (2.3%) patients, of whom 99% were males. The median age of the patients was 30 (range, 5-89) years. Camel-related injuries were the most common (84.3%) injuries followed by cow-related injuries (6.7%). 88.7% of the injuries
occurred at work. Animal kick was the most common mechanism of injury (32.6%) followed by falls (30.3%). Upper extremity was the most commonly injured region. The median Injury Severity Score (ISS) was 4 (range, 1-13) and the median hospital stay was 6
(range, 1-53) days.
CONCLUSION: The majority of animal-related injuries were caused by camels. Experience in handling the animals, a good knowledge of animal behavior along with using safety devices and prevention education can reduce the toll of animal-related injuries.

AMAÇ: Bu çalýþmanýn amacý, akut apandisit tanýsý alan hastalarda toplam okstadif durum, toplam antioksidan durum deðerleri ile paraoksonaz enzim aktivitesinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Ameliyat öncesi akut apandisit tanýsýyla ameliyata alýnan 73 hasta (Grup I) ile kontrol grubu olarak (Grup II) saðlýklý 30 kiþi çalýþmaya alýndý. Patolojik inceleme sonucunda hastalar: 1) Akut fokal apandisit, 2) Akut ilerlemiþ apandisit (süpüratif, flegmenöz ve gangrenöz apandisit), 3) Akut perfore apandisit, 4) Subakut apandisit ve 5) Negatif eksplorasyon olarak sýnýflandýrýldý. Paraoksonaz enzim aktivitesi, toplam okstadif durum, toplam antioksidan durum deðerleri için kan örnekleri ameliyat öncesinde alýndý.
BULGULAR: Hastalarýn toplam oksidatif ve antioksidatif durum düzeyleri kontrol grubuna göre yüksekti. Paraoksonaz enzim aktivitesi karþýlaþtýrýldýðýnda grup I ile II arasýnda herhangi bir anlamlý fark saptanmadý. Akut perfore apandisitli hastalarýn toplam oksidatif ve antioksidatif durum düzeyleri hem akut fokal apandisitli hem de akut ilerlemiþ apandisitli hastalardan daha yüksek bulundu.
TARTIÞMA: Toplam oksidatif ve antioksidatif durum düzeylerinin akut apandisitli hastalarda enflamasyonun ilerlemesi ile artmaktadýr

BACKGROUND: The aim of this study was to investigate the levels of oxidative stress including total oxidant status, total antioxidant status, and paraoxonase activity in patients with a diagnosis of acute appendicitis.
METHODS: Seventy-three patients who underwent surgery with a preoperative diagnosis of acute appendicitis (Group I) were included into the study. The control group (Group II) consisted of thirty otherwise healthy subjects. After histopathologic examination, the patients were categorized as follows: 1) Acute focal appendicitis, 2) Acute advanced appendicitis including acute suppurative, phlegmonous and gangrenous appendicitis, 3) Acute perforated appendicitis, 4) Sub-acute appendicitis, and 5) Negative exploration.
Blood samples for paraoxonase activities, and total oxidant and antioxidant status levels were obtained preoperatively.
RESULTS: Total oxidant and antioxidant status of the patients in the acute appendicitis group were higher than those of the control group. When paraoxonase activities of Group I was compared with Group II, no significant difference was determined. Both total oxidant and antioxidant status levels of acute perforated appendicitis were higher than those of both acute focal appendicitis and acute advanced appendicitis.
CONCLUSION: The increase in the oxidative status (total oxidant and antioxidant status) was related with the progression of inflammation to the perforation in acute appendicitis.

AMAÇ: Sekiz Kasým 2013 tarihinde Haiyan tayfunu Filipinler’in merkezinde toprak kaymalarýna neden olmuþ ve bölgeyi yerle bir etmiþtir. Bu felaketten hemen sonra birçok yabancý saðlýk ekibi bölgeye hareket etmiþtir. Kore ekibi de onlardan biriydi.
GEREÇ VE YÖNTEM: Bu çalýþma ilk yardým döneminde yerel saðlýk ekibiyle iþbirliði çabalarýna odaklanarak ilk etapta ekibin deneyimlerini anlatmaktadýr.
BULGULAR: Kore ekibi birincil bakýmý saðlayabilmiþ, Filipin ekibi hasta yükünü kapsamak için yetersiz ikincil bakým hizmeti saðlamýþtýr. Kore ekibi hastanenin çalýþmasý için elektrik ve deðiþik malzemeler saðlamakla kalmamýþ, acil ve poliklinikler için týbbi personel katkýsýnda bulunmuþtur. Ortak iþbirlikçi çabalarla birbirlerinin açýðýný doldurmuþ, sonuçta büyük bir sinerji oluþmuþtur.
TARTIÞMA: Yabancý saðlýk ekibinin afetlerde týbbi yardým misyonu bir koordinasyon mekanizmasý içinde iþbirliði için çalýþmalýdýr. Yerel kaynaklarla iþbirliði her iki taraf için büyük bir fýrsat olabilir ve herhangi bir afet durumunda gözden kaçýrýlmamalýdýr.

BACKGROUND: On 8 November 2013, Typhoon Haiyan made landfalls over the center of the Philippines and devastated the region. Soon aftermath of the disaster, many foreign medical teams (FMTs) headed toward the site, and the Korean team was one of them.
METHODS: This study described the experiences of the team during the initial phase of response, focusing on collaborative efforts with the local medical team.
RESULTS: The Korean team was capable of providing primary care, and the Filipino team provided incomplete secondary care which was insufficient for covering the patient load. Not only did the Korean team provide electricity for hospital operation and various materials, but also supplemented medical personnel, who covered the emergency and outpatient departments. Collaborative efforts filled in each other’s gap, and resulted in great synergy.
CONCLUSION: Disaster medical relief mission of FMTs should be cooperated with a coordination mechanism. Collaboration with the local resources can be a great opportunity for both parties, and should not be overlooked in any disaster situations.

Omuzun yüksek enerjili travmalarý çoklu yaralanmalarla iliþkili olduðundan deðerlendirmesi sýklýkla zordur. Bu kompleks travmalardan biri de humerus baþýnýn toraks boþluðu içine deplasmanýdýr. Üçüncü kattan düþtükten sonra baþvuran bir hastayý tanýmlamaktayýz. Ýlk önce deplase olmuþ humerus baþýný çýkartmak için kadýn hastaya toraks drenajý ve torakoskopi yapýlmýþ, daha sonra hastaya geç dönemde yapay humerus baþý replasmaný uygulanmýþtýr. Bu hastalar için hemodinamik stabilite, sistematik deðerlendirme, humerus baþýnýn çýkartýlmasý ve bireye uygun omuz rekonstrüksiyonu önerilmektedir.

High-energy trauma to the shoulder is associated with multiple injuries and is often difficult to evaluate. One of these complex traumas is the displacement of the humeral head into the thoracic cavity. This study aimed to report a patient who presented after falling three floors. Initially, the patient underwent chest drainage and thoracoscopy to remove the displaced humeral head and, subsequently, underwent delayed artificial humeral head replacement. Hemodynamic stability, systematic evaluation, removal of the humeral head, and individual shoulder reconstruction are recommended for these patients.

Kazýk þeklindeki cisimlerin batmalarýna baðlý penetran yaralanmalar seyrek görülen, en dikkat çekici ve dramatik travmatik lezyonlardan biridir. Toraksýn penetran yaralanmasý sonucu hastanýn saðkalmasý son derece nadir görülen bir olaydýr. Yirmi dört yaþýnda, göðüs kafesine kazýk batmasý sonucu aðýr derecede yaralanmýþ, hastanemize geç dönemde baþvurmasýna raðmen baþarýyla tedavi edilmiþ bir olguyu sunmaktayýz. On iki santimetre çapýnda bir kütük göðüs kafesinin sað tarafýna saplanmýþ, sað ana bronþ, sað akciðer lobu, sað subklavyen arteri yaralamýþ, yaygýn pariyetal lezyonlara neden olmuþtu. Bu lezyonlarýn kesin cerrahi onarýmý travmadan yedi saat sonra yapýlmýþtý. Vurgulamak isteyeceðimiz, baþarýlý sonuçlara katkýda bulunan tedavi ilkeleri: travma ekibinin hýzla olay yerine ulaþýmý ve olaya müdahalesi, batan cismin minimal manipülasyonu, ameliyathanede doðrudan görüþ altýnda batan cismin tek parça halinde çýkartýlmasý, solunum desteði, yaygýn debridman ve lavajla birlikte uygun antibiyoterapi.

Impalement injuries are rare and among the most spectacular and dramatic traumatic lesions. The survival of a patient with a thoracic
impalement injury is an extremely rare event. The objective of this study was to present the case of a 24-year-old male patient with a
severe thoracic impalement injury successfully treated despite his late arrival in our hospital. A log in 12 cm diameter penetrated his right thorax producing injuries of the right main bronchus, right pulmonary lobe, right subclavian artery as well as extensive parietal lesions. Definitive surgical repair of these lesions was performed more than seven hours after trauma. The management principles contributing to the successful outcome that we would like to emphasize are: rapid transportation and reaction of the trauma team, minimal manipulation of the impaling object, removal of the log as one piece under direct vision in the operating room, ventilatory support, extensive debridement, and lavage associated with appropriate antibiotherapy.

Bilinen ek hastalýðý ve geçirilmiþ ameliyat öyküsü olmayan 54 yaþýnda kadýn hasta dört gündür devam eden bulantý ve kusma yakýnmasýyla acil servise baþvurdu. Fizik muayenede karýnda hassasiyet saptanmadý. Baþvurusunda yapýlan laboratuvar incelemelerinde yüksek kan þekeri, ketonüri, lökositoz, yüksek C-reaktif protein, gama-glutamil-transferaz, laktat dehidrogenaz ve total bilirubin saptandý. Hasta yeni baþlangýç diabetes mellitus tanýsýyla dahiliye servisine yatýrýldý ve rutin incelemelerine baþlandý. Devam eden bulantý ve kusma nedeniyle yapýlan gastroskopide iyileþmiþ duodenal ülser saptandý. Karýn ultrasonografisinde kolelityazis saptandý. Dahiliye servisinde incelemeleri devam etmekteyken hastanýn týbbi durumu giderek kötüleþti. Hipotansiyon, taþikardi, lökositoz ve akut böbrek yetersizliði geliþen hasta septik þok tanýsýyla yoðun bakým ünitesine alýnarak intravenöz dopamin infüzyonu baþlandý. Çekilen bilgisayarlý tomografide distal duodenumda sýkýþmýþ görünümde bir safra taþý saptandý. YBU’da vital bulgularý stabilize edilen hasta ameliyata alýndý. Laparotomiyi takiben Treitz ligamaný distalinde proksimal jejunumda safra taþý görüldü. Longitudinal enterotomi ile taþ çýkarýldý. Hasta tekrar YBU’ya alýndý. Ameliyat sonrasý beþinci günde drenleri alýnan hastanýn gastrointestinal fonksiyonlarý normale döndü. Takiplerinde bakteriyemi ve fungemiye sekonder sepsis geliþen hasta ameliyat sonrasý 19. günde kaybedildi.

The patient presented in this study was a 54-year-old woman complaining of nausea and vomiting, onset preceding four days, with no significant past medical history and an unremarkable surgical history. The patient was afebrile and hypertensive. Physical examination revealed a non-tender abdomen, and initial laboratory evaluation revealed elevated blood glucose level, ketonuria, leukocytosis, elevated C-reactive protein, gamma glutamyl transferase, lactate dehydrogenase, and total bilirubin. The patient was admitted to the internal medicine ward due to new onset of diabetes mellitus. Due to persistent nausea and vomiting, gastroscopy revealed a healed duodenal ulcer, and abdominal ultrasonography revealed cholelithiasis. The medical condition of the patient deteriorated further in the internal medicine ward, with impending hypotension, tachycardia, leukocytosis, and acute renal failure, and she was admitted to the intensive care unit due to septic shock. A computerized tomography was obtained, which revealed an impacted gallstone in the distal duodenum. The patient was taken to the operating room. The gallstone was encountered in proximal jejunum immediately distal to the ligament of Treitz. A longitudinal enterotomy was made, and the stone was extracted. Her drains were cleared on postoperative day 5, and gastrointestinal function returned to normal. Unfortunately, the patient developed an overwhelming sepsis due to bacteremia and fungemia, and died on post-operative day 19.

Ýnce baðýrsak týkanýklýðýna neden olabilen internal fýtýklar nadir görülür. Öyküsünde travma ya da cerrahi bir operasyon olmadan da görülebilen transomental fýtýklar daha da nadirdir. Seksen beþ yaþýnda ameliyat ya da travma öyküsü bulunmayan erkek hasta þiddetli karýn aðrýsý ve kusma nedeniyle acil polikliniðimize baþvurdu. Yapýlan fiziksel incelemelerde ileus tanýsý konularak ameliyata alýnan olguda transomental fýtýða baðlý strangülasyona uðramýþ ileum anslarý tespit edildi. Rezeksiyon-anastomoz uygulandý ve omental defekt parsiyel omentektomi ile bozuldu. Transomental fýtýklar çok nadir görülseler de hikayesinde ameliyat ve travma saptanmayan olgularda mekanik baðýrsak týkanýklýðý ayýrýcý tanýsýnda düþünülmelidir.

Internal herniation is a very rare condition which can cause small bowel obstruction. Trans-omental hernias are an infrequent form of internal herniation and can be seen without a history of trauma and previous abdominal surgery. An 85-year-old male patient without a history of abdominal surgery or trauma was admitted to the emergency service with severe abdominal pain and vomiting. Physical examination and laboratory tests revealed a diagnosis of ileus. During laparotomy, a trans-omental hernia causing strangulation of the ileum was detected. Resection-anastomosis was performed and the omental defect was disrupted by partial omentectomy. Although trans-omental hernia is a very rare condition, it should be considered in the differential diagnosis of patients without mechanic intestinal obstruction.