Amaç
Oda sýcaklýðýndaki serum fizyolojikle yapýlan periton lavajý peritonda hipotermi, vazokonstriksiyon, hipoksi ve asidoza neden olur. Bu etkilerin fibrinolizi azalttýðý bilinmektedir. Fibrinolizin bozulmasý ise kalýcý adezyona neden olmaktadýr. Normotermik lavaj bu zararlý süreci engelleyerek peritoneal adezyonlarý azaltabilir.

Gereç ve Yöntem
Rat çekal abrzyon modeli kullanýldý. Kontrol hayvanlarýna herhangi bir tedavi uygulanmazken, deney gruplarýna (her birinde n=24) hipotermik ve normotermik serum fizyolojik ile lavaj uygulandý. Postoperatif 1, 3 ve 10’uncu günlerde periton dokusunda peritoneal fibrinolizin ana parametreleri olan doku plazminojen aktivatörü (tPA) ve plazminojen aktivatör inhibitor tip-1 (PAI-1) bakýldý.
Adezyonlar ameliyat sonrasý 10. günde deðerlendirildi. Sham grubunda (n=8) laparotomi sonrasý periton örnekleri alýndý ve saðlýklý peritondaki bazal tPA ve PAI-1 deðerleri tespit edildi.

Bulgular
Çekal abrazyon, PAI-1 düzeylerini postoperif 1. günde yaklaþýk 10 kat kadar artýrarak adezyonlara neden oldu. Normotermik serum fizyolojik ile lavaj bu travmatik PAI-1 artýþýný engelleyerek deney boyunca normal seviyeye sabitledi ve adezyon geliþimini azalttý. Hipotermik lavaj da PAI-1 yükseliþini azalttý ancak adezyonlarýn önlenmesi istatistiksel olarak anlamlý deðildi.

Sonuç
Sonuçlarýmýz göstermektedir ki, normotermik serum fizyolojik ile lavaj peritoneal fibrinolizi düzelterek adezyonlarý azaltmaktadýr.

Background
Peritoneal lavage with saline at room temperature causes peritoneal hypothermia, vasoconstriction, hypoxia, and acidosis. These effects are known to reduce fibrinolysis. Decreased fibrinolysis causes permanent adhesions. Normothermic lavage may prevent this deleterious process and reduces peritoneal adhesions.

Methods
A rat model of cecal abrasion was used. Control animals received no medication, while hypothermic or normothermic saline lavage were administered intraperitoneally to the experimental groups (n = 24 for each group). Cardinal parameters of peritoneal fibrinolysis (tissue plasminogen activator [tPA] and plasminogen activator inhibitor type 1 [PAI-1]) were determined in peritoneal tissue samples at the postoperative day 1, 3, and 10. At postoperative day 10 adhesions were graded. In the sham group (n=8), following laparotomy peritoneal samples were taken to determine basal values of tPA and PAI-1 in healthy peritoneum.

Results
Cecal abrasion increased PAI-1 levels about tenfold at postoperative day 1 and caused adhesions. Normothermic saline lavage prevented this traumatic PAI-1 increase and stabilized it to baseline values throughout the experiment and reduced peritoneal adhesion formation. Hypothermic lavage also caused an inhibition of PAI-1 rise but adhesion, prevention was not significant.

Conclusion
Our results suggest that normothermic saline lavage reduces adhesions by improving peritoneal fibrinolysis.

Amaç: Periferik sinir defektlerinin onarýmda ven greftleri ile beraber hücre kültürleri kullanýmý çalýþmalarý literatürde bulunmaktadýr. Yað dokusu kaynaklý kök hücrelerin periferik sinir iyileþmesini arttýrdýðýný gösteren çalýþmalar literatürde bulunmaktadýr. Bu nedenlerle periferik sinir defekti onarýmlarýnda ven grefti ve yað dokusu kaynaklý kök hücre kombine olarak kullanýmý etkilerini deðerlendirmek amacý ile sýçanlarda deneysel çalýþma uyguladýk.
Yöntem ve Gereç: Bunun için yaklaþýk 300gr aðýrlýðýnda 30 adet Wistar albino cinsi sýçan 3 çalýþma grubuna ayrýldý. Birinci cerrahi basamakta tüm hayvanlarýn sað tibial sinirlerinde yaklaþýk 8mm sinir defekti oluþturuldu. Grup 1’de (10 hayvan) otojensinir grefti kullanýldý. Grup 2’de (10 hayvan) içi boþ ven grefti ile, Grup 3’de (10 hayvan) ise ven grefti içine yað dokusu kaynaklý kök hücre doldurularak onarým uygulandý. Bu iþlemden 3 ay sonra çalýþmanýn ikinci cerrahi basamaðýnda hayvanlar sakrifiye edilerek onarým uygulanan sinir bölgesinden biyopsi alýndý. Alýnan örnekler ýþýk mikroskopu ile histopatolojik olarak deðerlendirildi.
Bulgular: Ýstatistiksel olarak gruplar arasýnda myelin ve akson çapý arasýnda anlamlý farklar yokken, akson sayýsý açýsýndan anlamlý farklar mevcuttu.
Sonuç: Sonuçlarýmýza göre periferik sinir kayýplarýnýn onarýmýnda SVF ve ven grefti kombinasyonu uygulanabilir bir seçenektir.

Objectives: There are many studies in the literature combining vein grafts with cell cultures, muscle, tendon, nerve tissues but none of them could replaced isolated nerve grafts for nerve repair in clinical settings. There are studies in the literature indicating that adipose tissue derived stromal vascular fraction(SVF) enhances peripheral nerve healing. Considering these facts we performed an experimental study in rats based on combining SVF with vein grafts for peripheral nerve defect repairs.
Methods: We studied with 30 rats and produced 3 groups. In the first stage 8 mm nerve defect was created in tibial nerve of each rat. In group 1 defect was reconstructed with nerve graft, in group 2 defect was reconstructed with vein graft and in group 3 defect was reconstructed with vein graft filled with SVF solution. After 3 months, second surgical stage was performed and nerve biopsies were take. Tissue samples were observed histopathologically.
Results: Statistically there were no meaningful differance between nerve grafts, vein grafts and adipose tissue derived SVF- vein grafts combination groups considering myelin diameter, axonal diameter. Axon count was superior statisticcly in nerve graft and study group when compared empty vein groups.
Conclusion: Ýn conclusion, our results support usage of stromal vascular fraction-vein graft combination for peripheral nerve defect repairs.

Introduction: The Chinese people in Fuyang city, a northwest city of Anhui Province, are accustomed to burning incense at home for blessing during the Spring Festival. Their children, especially toddlers like playing around the burning incense and are at risk to burn by hot incense ashes. The purpose of this study is to describe the unique cause and clinical characteristics of pediatric deep burns caused by hot incense ashes during 2014 Spring Festival.
Methods: Twelve consecutive children admitted to our Burn Center and Fuyang People’s Hospital during 2014 Spring Festival, with burn injuries caused by the hot incense ashes were epidemiologically studied retrospectively. Data on age, gender, size, depth and site of burn, incidence by day, number of operation, hospital stay, and causes of burns, were collected.
Results: All patients came from Fuyang city. Of the 12 patients, the average age was 2.17 years with a range of 1-6. The boy-to-girl ratio was 2: 1. The mean total burn surface area (TBSA) was 5.83% and 91.67% of children sustained full-thickness burn. Hands were the most common parts of body to be injured. Dry necrosis developed in 14 fingers of 3 patients. January 31, 2014, the first day of the Chinese New Year, was the time of highest incidence. Six patients (50 percent) required surgical intervention while the number of operations including escharectomy, excision, skin grafting, or amputation of necrotic fingers, per patient was 2. A total of 14 fingers were amputated of the necrotic parts. All children survived and the mean time in hospital of the patients was 20 days.
Conclusion: Hot incense ashes cause serious injuries to children in Fuyang city during the Spring Festival. Preventive programs should be directed towards high risk groups to reduce the incidence of this burn.

Akut apandisitte tek baþýna taný koydurucu bit parametre yoktur. Tanýda anamnez, klinik, laboratuar testleri, radyolojik görüntüleme yöntemleri bir arada kullanýlarak negatif laparatomi oranýný azalmak ve tanýda gecikme nedeniyle morbidite oranýný artýrmamak hedeflenmektedir. Ayýrýcý tanýlarý ekarte etmek bu amaca yardýmcý olmaktadýr. Biz bu çalýþmayla karýn aðrýsýnýn en sýk sebepleri olan apandist ve renal koliðin ayýrýmýnda kullanýlacak inflamatuarmarkýrlarý deðerlendirerek ayýrýcý tanýda bize saðlayabileceði katkýlarý irdelemeyi amaçladýk.
MATERYAL-METOT
Çalýþmamýz da karýn aðrýsý þikayeti ile gelmiþ ve tetkikleri sonucu akut apandisit ön tanýsý konularak ameliyata alýnan ve patolojik tanýsýdaakut apandisit olan 215 hastanýn verileri ile yine ayný þikayetlerle acil servisimize baþvurup yapýlan tetkikleri sonucunda renal kolik tanýsý konan 200 hastanýn verilerinin retrospektif olarak yeniden deðerlendirilmiþtir. Kontrol grubu olarak dâhiliye polikliniðine herhangi bir þikayeti olmayýp, sadece kan sayýmý yaptýrmak için baþvuran 65 hastannýn verileri gene retrospektif olarak deðerlendirmeye alýnmýþtýr. Vakalarýn acil servise geliþ anýnda alýnan WBC, RDW, Hb, MCV, MPV, Nötrofil, Lenfosit, NLR, PLR deðerleri incelenmiþ olup, p≤0,05 istatistiksel olarak anlamlý kabul edilmiþtir.
Her bir grup kontrol grubuyla ve birbiriyle karþýlaþtýrýlmýþtýr. Karþýlaþtýrýlmalar yapýlýrken gruplarýn daðýlýmýna bakýlmýþ, daðýlýmý normal olan gruplara parametrik, daðýlýmý normal olmayan gruplarda nonparametrik testler yapýlmýþtýr.

BULGULAR:
Akut apandisit(n: 215) ve renal kolik(n: 200) grubunda; yaþ, WBC, Hb, MCV, Nötrofil, Lenfosit, NLR ve PLR arasýnda istatistiksel olarak anlamlý deðiþiklik olduðu, Akut Apandisit(n: 215) ve kontrol grubunda; yaþ, WBC, Hb, RDW, MPV, nötrofil, Lenfosit NLR ve PLR arasýnda istatistiksel anlamlý fark olduðu ve yine renal kolik ve kontrol grubunda; yaþ, WBC, RDW, MPV, nötrofil ve NLR arasýnda istatistiksel fark olduðu görülmüþtür
Hastalara ROC Curve analizi yapýldýðýnda WBC,Nötrofil, NLR ve PLR’nin AUC altýnda kalan alanlarý sýrasýyla 0.896, 0.916, 0.888 ve 0.725 olarak tespit edilmiþtir.
SONUÇ
WBC, RDW, MPV, Nötrofil ve NLR’nin renal kolik ile herhangi bir rahatsýzlýðý olmayan hastalarýn ayýrýmýnda ve WBC, Hb, RDW, MPV, Nötrofil, Lenfosit, NLR ve PLR’nin akut apandist hastalarýnýn herhangi bir rahatsýzlýðý olmayan hastalardan ayýrýmýnda, daha da önemlisi WBC,Hb, Nötrofil, Lenfosit, PLR ve NLR’nin acil servislerde karýn aðrýsý ile baþvuran hastalarda akut apandisit ile renal kolik ayýrýmýnda kullanýþlý bir parametre olabileceðini düþünmekteyiz.

Aim: Only one diagnostic parameter is not available for acute appendicitis. For the establishment of diagnosis, combination of medical history, clinical, laboratory tests, radiological imaging modalities are used so as to decrease the rates of negative laparotomy and morbidity secondary to delay in diagnosis. In the present study, we aimed to determine haematological and inflammatory markers which will be used in the discrimination of acute appendicitis (AA) and renal colic which are the most frequent and indistinguishable causes of abdominal pain in patients who applied to the emergency service
Methods: A total of 215 patients who presented with abdominal pain and histopathologically diagnosed as AA, and 200 patients who presented with abdominal pain and diagnosed as renal colic were included. Control group consisted of 65 patients without any complaints who came to the outpatient clinics of internal medicine only for blood counts. Analyzed blood samples were WBC, RDW, Hb, MCV, MPV, neutrophil, lymphocyte, NLR and PLR. All differences associated with a chance probability of.05 or less were considered statistically significant.
Results: Statistically significant intergroup difference was seen between AA and renal colic groups as for age, WBC, Hb, MCV, neutrophil, lymphocyte, NLR and PLR. Statistically significant intergroup difference was seen between AA and control groups regarding age, WBC, Hb, RDW, MPV, neutrophil, lymphocyte, NLR and PLR. Statistically significant intergroup difference was seen between renal colic and control groups as for age, WBC, RDW, MPV, neutrophil and NLR. In ROC curve analysis, the area under AUCs for WBC, neutrophil, NLR and PLR were 0.896, 0.916, 0.888 and 0.725, respectively (p≤0.05).
Conclusion: In the discrimination between patients with renal colic and those without any illness, WBC, RDW, MPV, neutrophil and NLR; in the differentiation between the patients with AA and healthy individuals, WBC, RDW, MPV, neutrophil, lymphocyte, NLR and PLR; and more importantly in the discrimination between patients with AA and those with renal colic who presented to emergency services with abdominal pain WBC, neutrophil, lymphocyte, PLR and NLR can be useful parameters.

BACKGROUND: Self-immolation is one of the most violent methods of suicide in the developing countries. present study is to investigate survival rate and factors affecting survival of self-immolation patients.
METHODS: All people either died or hospitalized of Intentional burns were assessed in Kermanshah province during 2010 to 2013. Required information gathered from two sources of Kermanshah province legal medicine and burning center of Imam Khomeini hospital. we estimate the survival function through Cox regression. The data analyzed with Stata 12 software.
RESULTS: During 2010 to 2013 (three years), 446 person attempted self-immolation of which 370 were female (83%). In general, 276 people (61.8%) died due to severity of burns. The median of survival time was 47±5 day. The survival rate after one day, one week, and 21 day after accident was 86%, 52%, and 38%, respectively. Multivariate analysis demonstrates that burns is the most powerful risk factor, so that the risk in those with over 70% burns is 17 times more than those with burns less than 30%.
CONCLUSION: Burns percentage is the strongest risk factor, those with high burns percentage should be hospitalized quickly and without waste of time.

Introduction: The trauma and injury severity score (TRISS) and Acute Physiology And Chronic Health Evaluation IV (APACHE IV) are accurate but complex.
Aim of the work: To compare venous glucose, levels of serum lactate and base deficit in polytraumatized patients as simple parameters to predict the mortality in these patients versus (TRISS) and (APACHE IV).
Patient and Method: a comparative cross-sectional study of 282 patients with polytrauma attended to the Emergency Department (ED).

Results: The best cut off value of TRISS probability of survival score for prediction of mortality among poly-traumatized patients is ≤ 90. APACHE IV demonstrated 67% sensitivity and 95% specificity at 95% CI at cut off point 99. The best cutoff value of Random Blood Sugar was>140 mg/dl, with 89%, sensitivity, 49% specificity; base deficit was less than -5.6 with 64% sensitivity, 93% specificity; lactate for was > 2.6 mmol/L with 92%, sensitivity, 42% specificity.

Conclusion: Venous glucose, serum lactate and base deficit are easy and rapid biochemical predictors of mortality in patients with polytrauma. These predictors could be used as TRISS and APACHE IV in predicting the mortality.

Giriþ: Yanýk tüm dünyada çocuklarda travmaya baðlý ölümlerin en önemli nedenlerinden biridir.

Amaç: Hastanemizde çocuk yanýk merkezi Aðustos 2009’da kuruldu. Bu çalýþmanýn amacý; yanýk tedavi merkezi kurulmadan önceki ve kurulduktan sonraki hasta profillerini ve verileri karþýlaþtýrmaktýr.
Gereç ve Yöntem: Ocak 2005 ile Aðustos 2009 tarihleri arasýnda yanýk hastalarý Çocuk cerrahisi servisine kabul edilmekteydi ve bu serviste yoðun bakým hizmeti verilmiyordu. Aðustos 2009 tarihinden itibaren hastanemizde kurulan yanýk merkezinde ise yoðun bakým hizmeti de verilmeye baþlandý. Ýlk dönemde serviste takip edilen toplam 316 olgu Grup I, ikinci dönemde yanýk merkezine kabul edilen toplam 442 olgu ise Grup II olarak tanýmlandý ve bu iki grup arasýndaki veriler karþýlaþtýrýldý.
Bulgular: Grup I de olgularýn yaþ ortalamasý 5.1 yýl; Grup II’ de 7.7 yýldýr. Toplam vücut yanýk yüzdesi ortalamasý Grup I de %16.12, Grup II de %17.54 tür. Her iki grupta da en sýk haþlanma yanýklarý görülmekle birlikte Grup I ile karþýlaþtýrýldýðýnda Grup II’de alev yanýklarýnýn 2.13 kat elektrik yanýklarýnýn 3.44 kat ve alev + inhalasyon yanýklarýnýn 8.33 kat ve toplam yanýk yüzey alanýnýn % 40’ýn üzerinde olduðu olgularýn 2.41 kat daha fazla oranda görüldüðü tesbit edildi. Mortalite oranlarý Grup I de % 0, Grup II de ise %2.26 bulundu.
Sonuç: Yanýk ünitesi formatýnda hasta kabul edilen bir servisten yanýk merkezine dönüþ; çok daha aðýr olgularýn kabul edilmesini getirmektedir. Bu ise yanýk ekibinin bir yandan bu yeni hasta profili ile mücadele ettiði diðer yandan daha önce hiç karþýlaþmadýðý hasta kayýplarýný daha az travma ile atlatmayý öðrendiði yeni, sabýr ve dikkat gerektiren bir süreci getirmektedir. Bu ayný zamanda tüm yanýk ekibi için gerçek bir eðitim sürecidir.

Introduction: Burns are one of the most important causes of traumatic death in children worldwide.

Aim: A pediatric burn center was established in our hospital in August 2009. The aim of this study was to compare the patient profiles and data before and after the burn treatment center was established.
Material and Method: Burn patients were admitted to the pediatric surgery department between January 2005 and August 2009 and there was no intensive care service in this department. Intensive care service has been provided since August 2009 with the burn center established at our hospital. The 316 cases that were followed-up at the pediatric surgery department in the first period were identified as Group I and the 442 cases that were admitted to the burn center in the second period were identified as Group II. The data of the groups were then compared.
Results: The mean age of the cases was 5.1 years in Group I and 7.7 years in Group II. The total mean body burn percentage was 16.12% in Group I and 17.54% in Group II. Although scalding burns were the most subtype in both groups, flame burns were 2.13 times, electrical burns 3.44 times, flame+inhalation burns 8.33 times, and burns with an over 40% total burn surface area 2.41 times more common in Group II than in Group I. The mortality rates were 0% in Group I and 2.26% in Group II.
Conclusion: Converting a normal department admitting burn patients in a burn unit format to an actual burn center means more severe cases will be admitted. This requires a patient and attentive process while the burn team struggles with the new patient profile on one hand and has to learn how to overcome with less personal trauma the loss of patients, a feeling it is unfamiliar with, on the other hand. This is also an actual training process for the entire burn team.

Amaç: Mandibula kondil bölgesinin kýrýklarý çok yaygýn görülmesine raðmen bu bölgenin tedavisi üzerinde tartýþmalar devam etmektedir. Son yýllarda ekstrakapsüler kondil kýrýklarýnýn tedavisinde açýk cerrahi yöntemlerin kapalý tedavilere göre daha etkili olduðu yönünde genel bir görüþ birliði mevcuttur. Ancak, bu sefer de cerrahi yaklaþým tartýþmalý hale gelmiþtir. Bu çalýþmanýn amacý, retromandibular transparotid yaklaþýmýn subkondil/yüksek ramus mandibula kýrýklarýnýn onarýmýndaki etkinliðini test etmektir.
Gereç ve Yöntem: Subkondil/yüksek ramus mandibula kýrýðý olan 24 hasta retromandibular transparotid yaklaþýmla iki nokta fiksasyonu ile opere edilmiþtir. Hastalar operasyon sýrasýnda kanama ve operasyon sonrasýndaki dönemde ise hematom, infeksiyon, frey sendromu, tükrük fistülü, fasyal sinir hasarý, oklüzyon, kýrýk stabilitesi, kýrýk bölgesinde kronik aðrý, kulakta hissizlik ve temporomandibular eklem hareketleri açýsýndan deðerlendirilmiþtir.
Bulgular: Sadece bir hastada major bir komplikasyon olarak, fasyal sinirin temporal dal hasarýyla karþýlaþýlmýþtýr.
Sonuç: Retromandibular transparotid yaklaþým extrakapsüler kondil kýrýklarýnýn internal fksasyonunda güvenli ve etkili bir yöntem olarak gözükmektedir.

BACKGROUND: Although the fractures of the mandibular condylar region are very common, the controversies about the treatment of this area is still ongoing. In recent years, general agreement has emerged that open treatment is more effective than closed approaches for extracapsular condylar fractures. However, the method of surgical approach has become controversial at this time. The aim of this study was to evaluate the effectiveness of the retromandibular transparotid approach for fixation of subcondylar/high ramus mandible fractures.
METHODS: Subcondylar/high ramus mandible fractures were operated via the retromandibular transparotid approach with a two-point fixation in 24 patients. The patients were evaluated for bleeding during the operation and for hematoma, infection, Frey's syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site, hypoesthesia of the ear, and temporomandibular (TME) joint movements in the postoperative period.
RESULTS: Only one major complication was encountered in one (4.1%) patient, which was damage to the temporal branch of the facial nerve.
CONCLUSION: The retromandibular transparotid approach appears to be a safe and effective method for the internal fixation of extracapsular condylar fractures.

High voltage electrical injuries can cause devastating results especially in distal extremities. Althought the free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF). This flap can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury.
In this study, we evaluate long term results of 11 patients who had reconstruction to the lower extremity due to a high voltage electrical burn injury between the years of 2003-2013.
The cross-leg DBSF has good tissue compliance, provides tissue of adequate quantity and quality for leg and foot defects, and has low complication rates in the long term.

Distal tibia kýrýklarýnýn cerrahi tedavisi: Acik veya MIPO?

GÝRÝÞ
Yetersiz cilt örtusu, hemen cilt altinda olmasý ve zayýf kan dolaþýmý nedeniyle distal tibia kýrýklarýn cerrahi tedavisi tartýþmalýdýr. Bu vaka-kontrol çalýþmasinda geleneksel yerine oturtma, içerden tespit ile minimal invazif(MIPO) plaklama yöntemini karþýlaþtýrmayý amaçladýk.Hipotezimiz ise MIPO yöntemiyle daha iyi sonuçlarýn elde edilebileceðiydi.
MATERYAL VE METOD,
Yaþ(+3), cinsiyet ve kýrýk paterni(AO sýnýflamas) esas alýnarak; geleneksel yerine oturtma ve içerden tespit uygulanan 22 hasta, MIPO kullanýlarak tedavi edilen 22 hasta ile kýyaslanmýþtýr. Yara sorunlarý, Amerkan ayak ve ayak bileði cerrahi skorlamasý(AOFAS), radyolojik kaynama, kötü kaynama, gecikmiþ kaynama, hastanedeyatissuresi, travmadanameliyatakadarbeklemesuresi ve operasyon süresi deðerlendirme kriterleri olarak kullanilmistir.
SONUCLAR
Gruplar arasýnda AO/OTA kýrýk tipi, yaþ, cinsiyet, AOFAS skoru, travmadan ameliyata kadar geçen süre,takip süresi, kaynama süresi, gecikmiþ kaynama, kötö kaynama ve enfeksiyon açýsýndan istatiksel olarak anlamlý fark saptanmamýþtýr. Operasyon süresi açýk grupta MIPO grubuna kýyasla anlamlý þekilde uzun olduðu gözlendi.Hastanede yatýþ süresi açýk cerrahi grubunda MIPO grubuna göre anlamlý þekilde uzun olduðu gözlendi.
ÇIKARIMLAR
Sonuç olarak, MIPO;kýsalmýþ hastane kalýþ süresi, azalmýþ enfeksiyon oraný ve düþük maliyet nedeniyle distal tibia AO/OTA A ve B tip kýrýklarda; daha baþarýlý olduðunu söyleyebiliriz.

Introduction
Treatment of the distal tibial fractures are challenging due to the limited soft tissue, the

subcutaneous location and poor vascularity. In this control-matched study, we aim to compare

the traditional open reduction and internal fixation with minimal invasive plating(MIPO). We

hypothesized that superior results may be achieved with MIPO technique.

Materials and Methods
22 patients treated with traditional open reduction and internal fixation were matched

with 22 patients treated with closed reduction and MIPO on the basis of age (±3), gender, and

fracture pattern (AO classification). Evaluation was assed according to the wound problems,

the American Orthopaedic Foot and Ankle surgery (AOFAS) scoring [14], radiological

union, malunion, delayed union, hospitalisation time, time from injury to surgery, and

operation time.

Results

There was no significant difference in the distribution of AO/OTA classification, age,

gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed

union, malunion and infection (p>0.05). The operation time was significantly longer in the

open group than in the MIPO group. 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the

MIPO group (p< 0.01).The hospitalisation time was significantly longer in the open group

than in the MIPO group. 7.64±4.71 days for the MIPO, and 10.18±4.32 days for the ORIF

group (p< 0.05).

Conclusions

In conclusion, MIPO technique can be beneficial for the treatment of distal tibia AO/OTA

A and B type fractures with reduced hospital stay, cost-effectiveness, infection rate.

Key words: MIPO, Distal tibia, malunion, fracture.

AMAÇ: Eklem içi humerus alt uç kýrýklarýnýn tedavisinde triseps-reflekting ankoneus pedikül (TRAP) ve olekranon osteotomisi yöntemlerinin fonksiyonel sonuçlarý karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: Eklemi içi humerus kýrýðý olan 40 hasta geriye dönük olarak incelendi. Bunlardan 22 hastaya (12 erkek, 10 kadýn; ortalama yaþ 37.8 yýl daðýlým 17–70) TRAP, 18 hastaya (11 erkek, 7 kadýn; ortalama yaþ 35.4 yýl daðýlým 18–62) olekranon osteotomisi uygulandý. Kýrýk sýnýflamasý AO/ASIF sýnýflamasýna göre yapýldý. Fonksiyonel sonuçlar Mayo dirsek performans skoru ve Kol, Omuz ve El Engellilik (DASH) skoru ile deðerlendirildi.
BULGULAR: Triseps-reflekting ankoneus pedikül grubunda dirsek eklem hareket açýklýðý ortalama 108° (daðýlým 40°–140°) iken olekranon osteotomisi grubunda ortalama 98° (daðýlým 70°–115°) bulundu. Eklem hareket açýklýðý bakýmýndan iki grup arasýnda istatiksel olarak anlamlý fark bulundu (p=0.038). Her iki grup arasýnda DASH ve MEPS puaný bakýndan istatiksel olarak anlamlý fark saptanmadý (p=0.412, p=201, sýrasýyla). Komplikasyon oranlarý TRAP grubunda %27.2 iken olekranon osteotomisi grubunda %55 bulundu.
TARTIÞMA: Triseps-reflekting ankoneus pedikül yöntemi, olekranon osteotomisine göre dirsek eklem hareket açýklýðýný saðlamada daha baþarýlýdýr. Ayrýca TRAP yöntemi komplikasyon oranlarýný ve yeniden ameliyat gereksinimini azaltmaktadýr.

BACKGROUND: This study aimed to evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy.
METHODS: Forty patients with intra-articular distal humerus fractures were retrospectively analyzed. TRAP approach was used in 22 patients (12 males, 10 females; mean age 37.8 years, range 17-70), and olecranon osteotomy in 18 patients (11 males, 7 females; mean age 35.4 years, range 18–62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score.
RESULTS: The overall mean arc of elbow motion was 108° (range 70°–140°) in the TRAP group, whereas that of the olecranon osteotomy group was 98° (range 70°–115°). A significant difference was observed between the two groups in terms of overall mean arc of elbow motion (p=0.038). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.412, p=201, respectively). The overall complication rate was 27.2% in the TRAP group and 55% in the olecranon osteotomy group.
CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates.

Amaç: Çalýþmada; trafik kazasýna maruz kalan ve otopsi yapýlmadan defnedilen olgularýn analizi ile adli olgu bildirimi ve otopsinin öneminin vurgulanmasý amaçlanmaktadýr.
Gereç ve Yöntem: Adli Týp Kurumu Birinci Ýhtisas Kurulu’nda 2004-2008 yýllarý arasýnda düzenlenen raporlar içerisinde trafik kazasýna maruz kalmýþ ve otopsi yapýlmadan defnedilmiþ bulunan toplam 542 ölüm olgusu retrospektif olarak deðerlendirildi.
Bulgular: Olgularýn 376’sý (%69,37) erkek, 166’sý (%30,63) kadýn; ortalama yaþ 58.50±20,91 (3-98 yaþ arasýnda) idi. En fazla olgu 61-üstü yaþ grubunda (301 olgu-%55,53) bulunuyordu. Olgularýn 336’sý (%61,99) hastanede, 241’i (%44,47) kaza sonrasý 1-12 ay içerisinde ölmüþ olup ölü muayenesi sadece 124 (%22,88) olguda yapýlmýþtý. Olgularýn 344’ünde (%63,5) adli olgu bildirimi yapýlmadan Mernis ölüm tutanaðý düzenlendiði belirlendi. Kurul kararýnda; 95 olguda (%17,53) otopsi yapýlmadýðýndan ölüm nedeninin belirlenemediði, 57 (%10,52) olguda ise otopsi yapýlmadýðýndan kaza ile ölüm arasýnda illiyet baðý olup olmadýðýnýn bilinemeyeceði yönünde görüþ belirtilmiþti.
Sonuç: Bulgularýmýz, trafik kazasýna maruz kalan olgularda adli olgu bildiriminin gerçekleþtirilmesinin ve zamanýnda otopsi yapýlmasýnýn önemini vurgulamaktadýr.

Introduction and Aim: In this study, it is aimed to analyze the cases of traffic accident related deaths, that were buried without performing autopsy, in order to increase awareness of the physicians about declaration liability of forensic cases and also emphasize the decleration of the forensic case and autopsy importance.
Material and Method: In the First Specialization Board of Council of Forensic Medicine, 542 death cases that was reported between the years 2004-2008, who were exposed to traffic accidents, and buried without an autopsy being performed, were evaluated retrospectively.
Results: It was found that 69.37% of the cases (n: 376) were male, whereas %30.63 (n: 166) were female; the average age was 58.50±20.91 (between 3-98 years). The age 61 and above was the most frequent age group with 301 cases (55.5%). Of the cases, 336 (61.99%) had died in hospital, 241 (44.46%) had died in 1-12 months following the accident and medico-legal corpse examination was performed only in 123 (22.88%) cases. Three hundred fourty four (63.5%) of the cases were not reported as forensic cases and death certificate was signed by any physician other than medical examiner without declerated as a legal case. According to the decisions of Board; since an autopsy was not duly performed, the cause of death could not be determined for 95 cases (17.5%) and for 57 cases (10.5%) it was not possible to determine whether there was a causality between the accident and death.
Conclusion: Our findingsemphasizes the importance of decleration of the forensic cases and performing autopsy in time in traffic accident victims.

Amaç: Bu çalýþmada akut apandisit þüphesiyle ameliyat edilenlerde preoperatif lökosit sayýmý, nötrofil yüzdesi ve CRP’nin kesim deðeri düzeylerinde apandisit tanýsý koymada prediktif deðerlerinin araþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Ocak 2008 - Kasým 2010 tarihleri arasýnda acil servise karýn aðrýsý ile baþvuran ve akut apandisit ön tanýsý ile ameliyata alýnan hastalar retrospektif tarandý. Hastalar histopatalojik bulgulara göre üç gruba ayrýldý. Grup I: normal apendiks, grup II: komplike olmayan apandisit, grup III: komplike apandisit. Laboratuar ölçümlerinin ayýrt ediciliðine yönelik ROC eðrileri oluþturularak, her bir ölçüme ait kesim deðerleri belirlendi ve pozitif patolojiyi ayýrt edicilik performanslarý deðerlendirildi
Bulgular: Çalýþmaya alýnan 320 hastanýn 175’i erkek (%54,7) ve 145’i kadýn (%45,3) olup, yaþ ortalamasý 35,95±14,75’idi. WBC kesim deðeri 12,080 olup toplam apandisitlileri (grup II+III) normal apendikslilerden ve grup II’yi grup I’den ayýrmada anlamlý bulunurken (p<0,001,) grup II’yi, grup III’ten ayýrt etmede anlamlý bulunmadý (p=0,768). Yüzde nötrofil oraný kesim deðeri %73 olup, grup II+ grup III’ü, grup I’den ve grup II’yi, grup I’den anlamlý olarak ayýrt ettiði (p<0,001) ancak grup II’yi, grup III’ten ayýrt edemediði tespit edildi (p=0,681). CRP kesim deðeri 45,98 olup grup II+grup III’ü grup I’den ve grup II’yi grup I’den ayýrmada anlamlý bulunmadýðý, grup II’yi, grup III’ten ayýrt etmede anlamlý olduðu( p<0,001) saptandý. Tüm ölçümler birlikte deðerlendirildiðinde sadece yüzde nötrofil artýþý komplike olmayan apandisit riskini artýrýrken (OR: 1,082; p < 0,001), hem nötrofil hem de CRP’deki artýþ komplike olma riskini arttýrdýðý tespit edildi (OR: nötrofil =1,066; p=0,009- CRP= 1,005; p=0,013).
Sonuç: Laboratuar testlerinin kesim deðerleri tanýya ve tedavini þeklinin belirlenmesine yardýmcý olabilir. Özellikle CRP düzeylerinde belirlenen kesim deðerleri, konvansiyonel appendektomi veya laparoskopik appendektomi þeklinde seçilecek cerrahi yöntemin belirlenmesinde ve ameliyat sýrasýnda kullanýlacak insizyonun tercihi açýsýndan yol gösterici olabilir

Background: Present study aimed to investigate predictive importance of cut-off levels of preoperative WBC, neutrophil and CRP concentrations in operated appendicitis patients.
Methods: Patients operated for acute appendicitis between January 2008-November 2010. retrospectively screened.Patients were divided three groups accordingly postoperative histopathology. Group I: normal appendix, Group II: Uncomplicated appendicitis, Group III: complicated appendicitis. ROC curves are intended for positive distinguishing pathological laboratory measurements. Cut-off values determinated and distinguishing performances are assessed.
Results: 175 of 320 patients were male (%54.7), 145 were female (%45.3). Average age was 35.95±14.75. Cutoff values for WBC=12,080 and significant distinguishing total appandisitis (group II+ group III) from normal appendixes and distinguishing group II from group I (p<0,001), however was'nt significant distinguishing group II from group III (p=0,768). Cut-off values for neutrophil=73% significant distinguishing group II+group III from group I and distinguishing group II from group I (p<0,001), however was'nt significant distinguishing group II from group III (p=0,681). Cut-off values for CRP=45.98 and was'nt significant distinguishing group II+group III from group I and distinguishing group II from group I, however was significant distinguishing group II from group III (p<0,001). When all measurements are evaluated together it is detected that the increase of only neutrophil percentage increases the non complicated acute appendisitis (OR: 1,082; p < 0,001) and increase of both neutrophiles and CRP increase the risk of complication (OR: nötrofil =1,066; p=0,009- CRP= 1,005; p=0,013).
Conclusion: The cut-off value of labaratuary tests may help the determination of diagnosis and treatment. Especially cut-off value of CRP may be helpful to determine the method of incision during the operation as conventional appendectomy or laparoscopic appendectomy.

AMAÇ: Çocuk suprakondiller humerus kýrýðý sonrasý ekstremite distalinde nabýz alýnamayan hastalarýn sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Suprakondiler humerus kýrýðý sonrasý ekstremite distalinde nabýz alýnamayan 42 hasta retrospektif olarak deðerlendirildi. Preoperatif ve post operatif nörolojik muayene bulgularý, yaralanma þekli, yaralanma ile hastaneye baþvuru arasýnda geçen süre ve ameliyata alýnma zamaný, hastanede kalma süresi ve ameliyat sonrasý görülen komplikasyonlar açýsýndan hastalar deðerlendirildi.
BULGULAR: Tüm hastalarda Gartland tip 3 kýrýk mevcuttu. Yirmi yedi hastada redüksiyon sonrasý radial nabýz palpe edilmeye baþlandý. On hastada sadece doppler ile belirlenen akým mevcut iken, iki hastada akým alýnamadý. Dolaþým bozukluðu olmayan bu iki hastada da ameliyattan bir gün sonra doppler ile akým alýnmaya baþlandý. Redüksiyon sonrasý dolaþým bozukluðu devam eden ve doppler USG ile akým alýnamayan diðer 3 (%7) hastaya acil vasküler eksplorasyon uygulandý. Bir hastaya primer sütürasyon, diðer 2 hastaya ise saphenous greft ile tamir uygulandý.
SONUÇ: Suprakondiller humerus kýrýðýna baðlý nabýzsýz el geliþen hastalar, redüksiyon sonrasý yeniden deðerlendirilmeli; ekstremite dolaþýmý düzelenler ve dolaþým bozuluðu bulgularý olmayanlar için sadece yakýn takip, dolaþým bozukluðu devam edenlere ise damar tamiri yapýlmalýdýr.

BACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures.
MATERIAL AND METHOD: 42 pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluations included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications.
RESULTS: In 27 patients radial pulse was palpated following the reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture and the other two were managed with saphenous vein graft and primary repair.
CONCLUSION: It is vital to re-evaluate the patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

Amaç: Bu çalýþmada AO 42A ve 42B tipi tibia kýrýklarýnda uygulanan perkütan kilitli plak(PKP) ve intramedüller çivi(ÝMÇ) tespit sonuçlarýnýn retrospektif analizi yapýldý. Tespit tipinin kaynama zamaný ve fonksiyonel sonuçlar üzerinde etkisinin olup olmadýðý ve komplikasyonlarý sorgulandý.
Gereç ve yöntem: Bu retrospektif çalýþmaya 2006-2010 yýllarý arasýnda eklem dýþý tibia distal uç kýrýðý tanýsýyla cerrahi tedavi edilen 42 hasta dahil edildi. Hastalarýn 18’i kapalý ÝMÇ ile(grup 1), 24’ü ise PKP(grup 2) ile tedavi edildi. Ortalama yaþ 41 (daðýlým: 16-70) yýl olan hastalarýn 32’si erkek, 10’u kadýndý. Kýrýklar AO sýnýflamasýna göre sýnýflandýrýldý. Hastalarýn kaynama zamanlarý, fonksiyonel sonuçlarý ve komplikasyonlarý ( kaynamama, kötü kaynama, enfeksiyon, implant çýkarma) karþýlaþtýrýldý. Fonksiyonel sonuçlarý karþýlaþtýrmada The American Orthopaedic Foot and Ankle surgery(AOFAS) skorlamasý kullanýldý.
Bulgular:
Ortalama takip süresi Grup I için 20 (12-32) ay, Grup II için 22 (13-34) aydý. Kýrýk kaynama zamaný grup 1’de 16 (12-24) hafta, grup 2’de 19 (16-24) haftaydý. Kýrýk kaynama zamaný ÝMÇ ile tespit edilen hastalarda anlamlý derecede daha kýsaydý ( p=0.002 ). Son kontroldeki AOFAS skoru Grup I için 85 ( daðýlým: 69-100 puan ), Grup II için 81 puan ( daðýlým: 60-95 puan ) bulundu, aralarýndaki fark istatistiksel açýdan anlamlý deðildi ( p=0.06 ). Grup II’deki 2 hastada kaynamama görüldü. Grup 1'de 2 hastada, grup 2'de 1 hastada dizilim kusuru görüldü. Grup 1’de 2 hastada, grup 2’de ise 3 hastada yüzeyel enfeksiyon oluþtu.
Sonuç: ÝMÇ ile tespit edilen kýrýklarda kaynama daha erken oluþtu. Ýstatistiksel olarak anlamlý olmasada ÝMÇ yapýlanlarda komplikasyonlar daha az, fonksiyonel sonuçlar daha iyiydi.
Anahtar Kelimeler: intramedüller çivi, perkütan kilitli plak, distal tibia, kýrýklar

Introduction: In this study, the results of AO 42A and 42B type tibia fractures treated with intramedullary nail(IMN) and percutaneus locking plate(PLP) were evaluated. It was questioned whether the type of fixation affect union time, functional results, complications or not.
Material-methods: Forty-two patients with extraarticular distal tibial fractures were enrolled in this retrospective study. Eighteen patients were treated with closed IMN (Group I) and 24 patients were treated with PLP fixation (Group II). The mean age was 41 (range: 16-70) years; thirty-two of the patients were men. Fractures were classified according to the AO classification system. The union time, functional results and complications(malunion, malalignment, infection) were compared. The American Orthopaedic Foot and Ankle surgery(AOFAS) scoring was used to compare the functional results.
Results: The average follow-up period was 20(12-32) months for group I, 23(13-36) months for group II. The average union time was 16(12-24) weeks in Group I and 19(range: 16-24) weeks in Group II ( p=0.002 ). The AOFAS scoring was 85 (range: 69-100) point in group I, 81 (range: 60-95) point in group II. The difference in AOFAS scoring was not significant (p=0.06). Two patients had nonunion in Group II. Two patients in group I and three patients in group II had a malalignment.
Conclusion: We suggest that IMN can provide early healing time. Although it is not statistically significant, complication rate was lower and functional results was better in patients treated with ÝMÇ.
Key words: intramedullary nail, percutaneus locking plate, distal tibia, fractures

Yirmi yaþýnda, erkek hasta her iki gözünde nesnelerin yarýsýný görememe ve okurken bulanýk görme yakýnmalarýyla baþvurdu. Hastanýn yakýnmalarý bir yýl önce kranyo-orbital kýrýklara yolaçan bir trafik kazasýndan sonra baþlamýþtý. Göz muayenesinde total bitemporal hemianopsi ve hafif ekzotropya saptandý. Görme keskinlikleri her iki gözde 1.0’dý. Radyolojik incelemede fronto-etmoid ve sfenoid kemiklerde kýrýklar ve optik kiyazmada incelme saptandý. Hipotalamo-hipozifer bir bozukluk saptanmadý. Ýzlem sýrasýnda görsel bulgularda deðiþiklik olmadý. Nadir olmakla birlikte, künt kafa travmasý kiyazmal çaprazlaþan sinir demetlerinde izole bir hasara ve buna baðlý olarak normal görme keskinliðinin eþlik ettiði bir bir bitemporal hemianopsiye yol açabilir. Travmatik kiyazmal sendrom bitemporal hemianopsinin ayýrýcý tanýsýnda göz önünde tutulmalýdýr.

A 20-year old man presented with complaints of inability to see the outer half of objects and blurred near vision when reading. His complaints began one year ago after a motor vehicle accident that caused cranio-orbital fractures. Ocular examination revealed complete bitemporal hemianopsia and slight exotropia. Central visual acuity was 20/20 in both eyes. Radiologic studies demonstrated fractures in the fronto-ethmoid and sphenoid bones and thinning of the optic chiasm. No hypothalamic-pituitary abnormality was detected. Clinical findings remained unchanged during follow-up. Although rare, blunt head trauma may cause an isolated damage to the chiasmal crossing nerve fibers, resulting in a complete, bitemporal hemianopsia associated with normal visual acuity. Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.

Acil servise düþme veya motorlu taþýt kazasý sonrasý bilinç kaybýyla gelen olgularýn yaklaþýk %5-10’unda servikal vertebra fraktürü ve kord hasarlanmasý vardýr. Tanýda görüntüleme yöntemleri özellikle bilgisayarlý tomografi(BT) ve direk grafi önemli role sahiptir. Amacýmýz C3-4 dislokasyonu ve distraksiyonu olan ve shearing hasarlanma olarak adlandýrýlan servikal travma olgusunda ilginç BT ve direk grafi bulgularýný tanýmlamaktýr. C3-4 vertebra korpuslarý arasýnda hematom nedeniyle belirgin geniþleme görülmüþtür fakat fraktür hattý ve major vasküler yaralanma saptanmamýþtýr. Görüntüler oldukça ilginçti. Ayrýca klinik deðerlendirmede NEXUS ve Kanada kurallarý dikkate alýnmýþtýr. Görüntüleme yöntemleri özellikle de reformat BT görüntüleri hasarýn ne olduðu ve nerede olduðunu bulmada kolaylýk saðlar.

Patients admitted to emergency departments with a loss of consciousness following trauma often have cervical vertebrae fractures and spinal cord injuries with a ratio of 5–10%. Computed tomography (CT) and radiography have important role for diagnosis. We aimed to describe the interesting CT and radiography findings of a patient who had C3-4 dislocation, distraction that was called shearing injury. C3 and C4 seperated but there was no fracture and major vascular injury. Images were interesting. We also mentioned NEXUS and Canadian Rules for clinical evolution. Imaging modalities espacially reformatted CT images make easier to diagnose where and what the problem is.

Spontan ekstrahepatik safra yollarýnýn perforasyonu, genellikle bebeklerde görülür. Eriþkinlerde nadir görülmesine raðmen ölümcül safra peritonitiyle seyredebilir. Bundan dolayý akut karýn tablosu ile baþvuran bir hastaya zaman kaybetmeden karýn ultrasonografisi ve bilgisayarlý tomografi gibi radyolojik görüntüleme yöntemleri ile ayýrýcý taný yapýlmalýdýr. Bu görüntüleme tetkiklerinde safra taþý hastalýðý ile birlikte perihepatik serbest sývý veya koledoðun takip edilememesi durumunda ayýrýcý tanýda düþünülmelidir. Ciddi komplikasyonlarýndan korunmak için acil cerrahi giriþim planlanmalýdýr. Bu yazýda eriþkin bir hastada spontan ortak hepatik kanal perforasyonuna baðlý geliþen nadir bir akut karýn sebebini sunmayý amaçladýk.

Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gall stone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.

Acil serviste nadir olarak görülen spontan splenik arter rüptürü ani baþlayan akut karýn aðrýsýný olarak ortya çýkabilir ve taný zamanlý olarak konulamazsa yüksek mortalite ile seyreder. Karýn aðrýsý yakýnmasý ile baþvuran 33 yaþýnda erkek hastada akut batýn bulgularý ile taný çalýþmasýnda sýrasýnda hipovolemik þoka girdi ve acil aparatomide rüptüre splenik arter anevrizmasý splenektomi ile kontrol altýna alýndý.

Background: Splenic artery aneurysms are very rare causes of acute abdomen but are important to recognize since they carry high rate of mortality when rupture.
Case report: We present a middle aged man with sudden onset of abdominal pain. Previously on steroid treatment due to sarcoidosis the gentleman developed hypovolemic shock during work-up in diagnostic imaging and went on emergency laparatomy. The source was identified as a ruptured splenic artery aneurysm. Splenectomy en bloc with the aneurysmatic distal splenic artery was performed and he was discharged uneventfully.
Conclusion: Although rare it is important to recognize splenic artery aneurysm in the emergency department and immediate intervention is required to save the patient.

Amaç: Kliniðimizde duodenal perforasyon nedeniyle takip ve tedavisi yapýlan olgularýn incelenmesidir.
Olgular ve Yöntem: Duodenal perforasyon tanýsý ile 1990 – 2014 yýllarý arasýnda tedavi edilen 14 olgunun kayýtlarý geriye dönük olarak incelendi.
Bulgular: 1990 – 2014 yýllarý arasýnda kliniðimize baþvuran 14 olgunun (8E, 6K) ort. baþvuru yaþý 6,2 yýl (25 gün - 16 yýl)dý. Ýki olgu primer olarak baþvuruda bulunurken, 12 olgu dýþ merkezlerden yönlendirilmiþti. Ortalama baþvuru süresi 3,2 (1 gün – 1 hafta) gündü. Perforasyon nedeni 10 olguda duodenal ülser, 3 olguda travmatik perforasyon, ichtiosisli 2 aylýk bir olguda ise idiopatik idi. Bir olguda nesidioblastozis nedeniyle totale yakýn pankreatektomi sonrasýnda hiperbilüribineminin devam etmesi üzerine yapýlan laparotomide duodenal perforasyon saptanarak hastaya duodenum 1. ve 2. kýtalara rezeksiyon, pilor rezeksiyonu, koledekojejunostomi, gastrojejunostomi ve jejunojejunostomi uygulandý. Kalan 13 hastada primer tamir yapýldý. Primer tamir yapýlan hastalarýn birinde ek olarak gastrostomi açýlýrken 9 olguya omentoplasti yapýldý. Takipte 12 olgunun herhangi bir klinik yakýnmasý yokken, iki olgu kaybedilmiþtir.
Sonuç: Duodenal perforasyonlar çocuk cerrahlarýnýn nadir karþýlaþtýklarý cerrahi problemlerden biridir. Bu nedenle karýn aðrýsýnýn ayýrýcý tanýsýnda akýlda tutulmalýdýr. Cerrahi saðaltýmda primer onarým (duodenorafi ± omentoplasti), etkin ve güvenli bir cerrahi yöntemdir.

Aim: To analyse patients those admitted to our clinic due to perforation in duodenum. Patients and Method: Fourteen patients those have been admitted to our center with perforation in duodenum between 1990 – 2014 analysed retrospectively. Results: Ten patients (8M, 6F) those have been admitted to our clinic between 1990 – 2014 have a mean age of 6.2 years (25 days – 16 years). Two of cases admitted directly to our clinic and the rest refered from another hospitals. Mean time for appliance to our clinic was 3.2 days ( 1day – 1 week). Ulcer in duodenum was the cause of perforation in 10 cases while in 3 the cause was trauma and in 1 case was surgical complication of infantyl persistant hyperinsulinism (IPHH). The case with hyperbilluribinemia after near total pancreatectomy due to IPHH had been explored and perforation in deuedenum diagnosed. Resection in first two parts of duodenum and pylor, choledochojejunostomy, gastrojejunostomy and jejunojejunostomy was performed. Primary repair was performed in the remaining patients. In one case with primary repair gastrostomy was performed, while in 9 cases omentoplasty were performed. In the follow-up 12 cases has no problems and doing well. Two patients died.
Conclusion: Perforation in duedenum is a rare entity that pediatric surgeons should encounter and keep in mind. Primary repair(duodenoraphy ± omentoplasty) is safe and reliable surgical treatment modality.