AMAÇ: Protokateþuik asit (PCA) yeþil çay, fýndýk, badem baþta olmak üzere birçok bitki, sebze ve meyvede yaygýn olarak bulunan anti-oksidan özelliði olan basit bir fenol bileþiðidir. Bu çalýþmada PCA’nýn iskemi/reperfüzyon (IR) hasarý oluþturulan böbrekler üzerine olan etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Sprague-Dawley cinsi sýçanlar rastgele dört gruba ayrýldý: (1) Sham, (2) Renal IR (3) Renal IR + Vehicle (4) Renal IR + PCA. Renal IR hasarý sað nefrektomi yapýldýktan sonra 45 dakika boyunca sol renal pedikül klemplenip sonrasýnda üç saat boyunca reperfüzyon yapýlarak indüklendi. Tedavi edici olarak kullanýlan PCA renal iskemiden hemen önce 80 mg/kg dozunda intraperitoneal olarak uygulandý. Protokateþuik asiti çözmek için araç olarak %33’lük polietilen glikol kullanýldý. Sýçanlar sakrifiye edildikten sonra alýnan kan örmeklerinde ve böbrek dokusunda total antioksidan kapasite (TAS), malondialdehit (MDA), süperoksitdismutaz (SOD), tümör nekroz faktör alfa (TNF-α), interlökin-6 (IL-6) seviyesi ölçüldü. Böbrek doku örneklerinde histopatolojik incelemeler yapýlarak histopatolojik skorlama elde edildi. Apoptotik hücreleri görüntülemek için terminal deoxynucleotidyltransferase-mediated dUTP digoxigenin nick-end-labeling (TUNEL) boyama yapýldý.
BULGULAR: Protokateþuik asitin serum MDA ve TNF-α ile böbrek MDA seviyelerini anlamlý olarak azalttýðý, serum ve böbrek TAS ile SOD seviyelerini ise anlamlý olarak artýrdýðý görüldü. Histopatolojik skorlamanýn PCA verilen grupta anlamlý olarak daha iyi idi.
TARTIÞMA: Oksidatif stresi ve renal iskemi reperfüzyon hasarýný azalttýðýný ortaya koyduðumuz PCA, IR hasarýna karþý etkili bir ajan olarak kullanýlabilir.

BACKGROUND: Protocatechuic acid (PCA), which has antioxidant property, is a simple phenolic compound commonly found in many plants, vegetables, and fruits, notably in green tea and almonds. Present study was an investigation of the effects of PCA on rat kidney with ischemia/reperfusion (IR) injury.
METHODS: Sprague-Dawley rats were randomly divided into 4 groups: (1) Sham, (2) Renal IR, (3) Renal IR+Vehicle, and (4) Renal IR+PCA. Renal reperfusion injury was induced by clamping renal pedicle for 45 minutes after right nephrectomy was performed, followed by reperfusion for 3 hours. Dose of 80 mg/kg PCA was intraperitoneally administered to 1 group immediately before renal ischemia; 33% polyethylene glycol was used as vehicle. Total antioxidant status (TAS), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor alpha (TNF-α), and interleukin-6 levels were measured in blood and kidney tissue samples taken from sacrificed rats. Kidney tissue samples were examined and scored histopathologically. Terminal deoxynucleotidyltransferase-mediated dUTP digoxigenin nick end labeling assay method was used to detect apoptotic cells.
RESULTS: It was found that PCA significantly reduced serum MDA, TNF-α, and kidney MDA levels, while it increased serum and kidney TAS and SOD levels. Histopathological scores were significantly higher for the group given PCA.
CONCLUSION: PCA reduced oxidative stress and can be used as an effective agent in treatment of renal IR injury.

AMAÇ: Periferik sinir defektlerinin onarýmýnda ‘sinir dolmasý’ tekniði araþtýrýldý.
GEREÇ VE YÖNTEM: Çalýþmada 21 adet Wistar Albino cinsi sýçan kullanýldý. Her grupta yedi sýçan olacak þekilde üç grup belirlendi. Tüm sýçanlarýn siyatik sinirinde 10 mm’lik defekt oluþturuldu. Grup 1’de otojen sinir grefti ile, grup 2’de içi boþ ven grefti ile, grup 3’de içi parçalanmýþ sinir ile doldurulmuþ ven grefti ile onarým yapýldý. On ikinci haftanýn sonunda aksonal rejenerasyonu deðerlendirmek için elektrofizyolojik ve histomorfolojik analizler yapýldý.
BULGULAR: Latans süresi ve tepe-tepe potansiyelleri istatistiksel olarak karþýlaþtýrýldýðýnda grup 1 ve grup 3, grup 2 ve grup 3 arasýndaki fark anlamsýzdý. Grup 1’in latans süresi grup 2’den daha kýsa ve tepe-tepe potansiyeli ise daha büyüktü. Aksonal rejenerasyonu deðerlendirmek için; akson sayýsý, akson çapý ve miyelin kýlýf kalýnlýðý gruplar arasýnda karþýlaþtýrýldý. Aksonal rejenerasyonun grup 1 ve grup 3’de benzer olduðu ayrýca grup 2’den daha iyi olduðu görüldü.
TARTIÞMA: Sinir dolmasý tekniðinin otojen sinir grefti ile benzer elektrofizyolojik ve histomorfolojik özellikler göstermesi otojen sinir greftinin bir alternatifi olabileceðini gösterdi.

BACKGROUND: Presently described is research examining the ”stuffed nerve” technique to repair peripheral nerve defects.

METHODS: Twenty-one male Wistar Albino rats were divided into 3 groups of 7, and standard 10-mm defects were created in the sciatic nerve of all subjects. Rats were treated with autogenous nerve graft (Group 1), hollow vein graft (Group 2), or vein graft stuffed with shredded nerves (Group 3). After 12 weeks, electrophysiological and histomorphological analyses were performed to evaluate axonal regeneration.
RESULTS: Rat groups were compared in terms of latency period and peak-to-peak potential. Latency period was significantly shorter and peak-to-peak potential was significantly greater in Group 1 than in Group 2. However, latency period and peak-to-peak potential did not differ significantly between Groups 1 and 3 or between Groups 2 and 3. To evaluate axonal regeneration, number of axons, axon diameter and myelin sheath thickness was compared between groups. Results indicated that axonal regeneration was similar in Groups 1 and 3, and was better than results seen in Group 2.
CONCLUSION: The stuffed nerve technique is an alternative to autogenous nerve grafting and produces similar electrophysiological and histomorphological properties.

AMAÇ: Kolorektal kanser (KRK) baþlýca yaþlý kiþilerin hastalýðýdýr. Doksanlý yaþlardaki hastalarda kanser cerrahlar ve onkologlar için etik bir ikilemi temsil eder. Bu hasta grubunda, komplike KRK’nin acil durumda tedavisi tartýþýlmaktadýr. Kolorektal kanser komplikasyonlarý için acilen cerrahiye baþvuran doksanlýk hastalarda altý acil cerrahi bölümünün tedavideki deneyimlerini sunmak amacýyla bu geriye dönük çalýþma yapýldý.
GEREÇ VE YÖNTEM: Ocak 2011 ile Haziran 2015 arasýnda komplike KRK için altý acil cerrahi kliniðinde yatýrýlan 90 yaþ üstü hastalara iliþkin veriler geriye dönük olarak analiz edildi. Veriler bu amaca iliþkin veri tabanýnda toplandý. IBM SPSS 22 yazýlýmý kullanýlarak istatistiksel analiz yapýldý ve istatistiksel anlamlýlýk düzeyi olarak p=0.05 belirlendi.
BULGULAR: Çalýþma döneminde 90 yaþ üstü 15 hasta komplike KRK için acilen cerrahi geçirdi. Olgularýn %52.63’ü kadýn olup kadýn/erkek oraný 1.11: 1 ve yaþ ortalamasý 92.52±1.49 yýl (daðýlým: 90–97) idi. Ameliyat öncesinde ASA skoruyla cerrahi risk deðerlendirildi. ASA skorlarý ≤3 ve >3 olan hastalar arasýnda hastane içi mortalitede istatistiksel açýdan hiçbir farklýlýk yoktu. Hastalarýn %31.57’sinde (6/19) primer anastomoz uygulandý. Bu hastalarýn tümü sað kolon kanserinden etkilenmiþti. Hastalarýn %63.15’ine (12/19) diversiyon stromasý gerçekleþtirildi. Sað veya sol kolon kanser hastalar arasýnda ameliyat sonrasý komplikasyonlarýn insidansý arasýnda istatistiksel açýdan farklýlýk vardý (p=0.0498). Hastanede ortalama kalýþ süresi 12.87±6.31 (daðýlým: 2–31). Hastanede mortalite oraný %21.05 (4/19 hasta) idi. Ýzlem sýrasýnda genel saðkalým oraný %47.36 (9/19 hasta) idi.
TARTIÞMA: Etkilenmiþ hastalarýn tümünde KRK’yi tedavi etmenin en iyi yöntemi elektif cerrahidir. Hastalarýn ameliyat öncesinde dikkatli seçimi ve deðerlendirmesiyle 90 yaþ üstü hastalarda KRK komplikasyonlarý için acil cerrahi mümkündür. Seçilmiþ hastalarda tek evrelik cerrahi en iyi seçimdir. Peritonitli, güçsüz hastalarda, hemodinamik açýdan kararsýz, anastomoz yeri kaçaðý açýsýndan yüksek risk taþýyan hastalarda iki–üç evreli cerrahi endikedir. Elektif cerrahiye geçiþ olarak ve ilerlemiþ neoplastik hastalýkta palyatif iþlem olarak dekompresif stoma gerçekleþtirilir. Acil durumlarda doksanlýk hastalarda cerrahi riski, morbidite ve mortaliteyi azaltma açýsýndan diversiyon stomasý iyi bir cerrahi seçimdir. Bunu doðrulama için klinik randomize kontrollü çalýþmalara gerek vardýr.

BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people.
Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated.
Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications.
METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed. Data were collected in a dedicated database. Statistical analysis was conducted using IBM software SPSS 22 (IBM Corp., Armonk, NY, USA); statistical significance was set at p=0.05.
RESULTS: In the period of study,19 patients aged over 90 underwent surgery in emergency department for complicated CRC. Of the total,
52.63% were female, with sex ratio F: M of 1.11: 1. Mean age was 92.52 years (range: 90-97 years; SD 1.49). Preoperative assessment of surgical risk was made using American Society of Anesthesiologists (ASA) score. There was no statistically significant difference in terms of in-hospital mortality between patients with ASA score ≤ 3 and patients with an ASA score >3. 
Primary anastomosis was performed in 6 of 19 patients (31.57%), all of whom had right-side colon cancer. Diverting stoma was created for 12 of 19 patients (63.15%).
There was a statistically significant difference in incidence of postoperative complications between patients with right-side colon cancer and patients with left-side colon cancer (p=0.0498).
Mean length of hospital stay was 12.78 days (range: 2–31 days; SD 6.31).
In-hospital mortality rate was 21.05% (n=4).
At follow up, overall survival was 47.36% (n=9).
CONCLUSION: Elective surgery is the best way to manage CRC in all patients affected.
Emergency surgery for CRC complications in patients over 90 is feasible with careful preoperative selection and evaluation of the patient.
One-stage surgery is the best choice, in selected patients. Two- and three-stage surgery is indicated in case of peritonitis, for frail patients, for hemodynamically unstable patients. If there is high risk of anastomotic leakage, decompressive stoma is suggested as bridge to elective surgery, and in advanced neoplastic disease, as palliative procedure. In emergency setting, diverting stoma is a good surgical option in nonagenarian patients to decrease surgical risk, morbidity, and mortality; however, clinical randomized controlled trials are necessary to confirm this.

AMAÇ: Penetran kalp yaralanmalarý (PKY) yüksek ölümcül sonuçlara sahiptir. Bu nedenle, bu acil durumlarýn yönetimi özellikle önemlidir. Bu çalýþmada, PKY’de ölümü ve sakat kalmayý etkileyebilen ana faktörler araþtýrýldý.
GEREÇ VE YÖNTEM: Geriye dönük olarak son on yýl içerisinde PKY ile acil servise baþvuran 112 hasta deðerlendirildi. Demografik veriler, ilk müdahaleler, transfer süreleri ve durumlarý, hayati durum ve bulgular, yaralanma þekli, bölgesi, karakteristikleri ve uygulanan cerrahinin þekli kayýt edildi.
BULGULAR: Demografik veriler (yaþ, cinsiyet, yaralanma sebebi) ölüm için anlamlý etken olarak bulunmadý. Erken mortalite (1 haftalýk izlem süresi içerisinde) 14 (%12.5) hasta da gözlendi. Ayrýca, hastaneye transfer þekli (saðlýk ekibi gözetiminde ambulansla veya gözetimsiz), transfer süresi, ilk geliþteki hayati bulgular (kan basýncý, ritim, solunum, bilinç), operasyon zamanlamasý (elektif veya acil) ve ek organ yaralanmasý sað kalým için önemli belirleyiciler olarak saptandý.
TARTIÞMA: Kalp yaralanmalarý son derece ölümcül acil durumlardýr. Sað kalým için tecrübeli týbbi yönetim önemlidir. Nitekim, temel ilk yardým yaklaþýmlarý ve acil hastane transferi tecrübeli klinik yaklaþým kadar önemlidir.

BACKGROUND: Penetrating cardiac injury (PCI) has highly mortal outcome. Therefore, management of this emergency situation is extremely important. The present study is an investigation of main factors that can affect mortality and morbidity in PCI.
METHODS: Records of 112 patients who were admitted to emergency department with PCI in the last decade were evaluated retrospectively. Demographic data, initial approach, transfer duration and conditions, vital status and findings, type of injury, localization, characteristics, and type of surgical application were recorded.
RESULTS: Demographic findings (age, sex, cause of injury) were not found to be significant factors affecting mortality. Early mortality (1-week observation period) occurred in 14 (12.5%) patients. Method of transfer to hospital (under medical team supervision by ambulance, or without supervision), transfer duration, initial vital findings upon arrival (blood pressure, rhythm, breathing, consciousness), operation timing (elective or emergency), and injuries to additional organs were determined to be important predictors of survival.
CONCLUSION: Cardiac injury is highly mortal emergency situation. Expert medical management is important for survival. However, basic first aid measures and immediate hospital transfer are as important as expert clinical management.

AMAÇ: Akut apandisit cerrahi kliniklerinde görülen en yaygýn karýn aðrýsý sebeplerinden birisidir. Taný kolay konulabilse de özellikle premenopozal kadýnlar ve yaþlýlarda karýþtýrýlabilmektedir. Bu sebeple mevcut bazý skorlama sistemlerinin hastalýðýn kolay taný konabilmesine ve hastalýðýn enflamasyon þiddetine yol göstermesine katkýsýný araþtýrmak istedik.
GEREÇ VE YÖNTEM: Akut apandisit tanýsý konan toplam 105 hasta çalýþmaya dahil edildi. Alvarado ve Ohmann skorlamalarý yapýlan hastalara ultrasonografi yapýlýp apendektomi uygulandý. Ameliyatta “intraoperatif þiddet skorlamasý” uygulandý ve bu skorlamalarýn birbiriyle korelasyonu, Alvarado ve Ohmann skorlarýnýn akut apandisiti ön görmede önemi araþtýrýldý.
BULGULAR: Alvarado skoru ile, Ohmann skoru arasýnda pozitif yönde orta derecede korelasyon bulundu (r=0.508, p<0.001). Histopatolojik sonuçlara göre Alvarado skorunun akut apandisit tanýsýný ön görme oraný istatistiksel olarak anlamlý iken (p=0.027) Ohmann skorlamasýnýn ön görme oraný istatistiksel olarak anlamlý bulunmadý (p=0.807). Ameliyatta þiddet skoruna bakýldýðýnda ise, her iki skorun da ameliyat sýrasýnda yapýlan skorlama ile baðýntýsý zayýf bulunurken Alvarado skorlamasý ile intraoperatif þiddet skorlamasý arasýnda anlamlýlýk saptandý (r=0.30, p=0.002). Ohmann skorlamasý ile intraoperatif þiddet skorlamasý arasýnda anlamlýlýk saptanmadý (r=0.09, p=0.384).
TARTIÞMA: Alvarado skorlamasý akut apandisiti ön görme ve enflamasyon þiddeti hakkýnda fikir verebilirken, Ohmann skorlamasý daha çok akut apandisiti dýþlama konusunda fikir vermektedir.

BACKGROUND: Acute appendicitis is one of the most common causes of abdominal pain seen in surgical clinics. Although it can be easily diagnosed, the picture may be confusing, particularly in premenopausal women and the elderly. The present study is an evaluation of 2 of the current scoring systems with respect to accurate diagnosis of the disease and indication of inflammation severity.
METHODS: A total of 105 patients diagnosed with acute appendicitis were included in the study. Subsequent to Alvarado and Ohmann scoring, ultrasonography image was obtained and appendectomy was performed. A unique intraoperative severity scoring system was used to measure severity of inflammation and to compare Alvarado and Ohmann scoring system results to assess accuracy of predictive value for acute appendicitis.
RESULTS: Moderate positive correlation was found between Alvarado score and Ohmann score (r=0.508; p<0.001). Rate of Alvarado score successfully predicting diagnosis of acute appendicitis based on histopathological results was statistically significant (p=0.027), while rate of Ohmann score was not statistically significant (p=0.807). Correlation between both scores and grading of inflammation performed during the operation was weak, but statistical significance was observed between Alvarado scoring system and intraoperative severity scoring (r=0.30; p=0.002). No statistical difference was observed between Ohmann scoring and intraoperative severity scoring (r=0.09; p=0.384).
CONCLUSION: Alvarado score is better able to predict acute appendicitis and provide an idea of severity of inflammation. Ohmann score is more useful to provide guidance and eliminate acute appendicitis from consideration when conditions are more uncertain and obscured.

AMAÇ: Akut kolesistit (AC) genel cerrahlarýn sýk karþýlaþtýðý acillerdendir. En uygun tedavi laparoskopik kolesistektomidir (LK); ancak yüksek morbidite ve mortalite riski nedeniyle cerrahi uygulanamayan hastalarda diðer tedavi yöntemleri uygulanabilir. Perkütan kolesistostomi (PK) bu alternatif yöntemlerden biridir. Yaþlý ve komorbid hastalýklarý olan hastalarda acil cerrahi yapýlamadýðý durumlarda bu yöntem kullanýlabilinir. Safra kesesinin drenajý ile enfeksiyon kontrol altýna alýnmaktadýr. Perkütan kolesistostomi sonrasýnda, kolesistektomi daha uygun ve elektif koþullarda yapýlabilir. Bu çalýþmada yüksek riskli, yaþlý akut kolesistiti olan hastalardaki perkütan kolesistostomi deneyimlerimiz sunuldu.
GEREÇ VE YÖNTEM: Ocak 2011 ve ocak 2014 arasýnda hastanemizde PK uygulanmýþ tüm hastalarýn týbbi kayýtlarý incelendi. Çalýþmamýza hastanemiz kurulu tarafýndan onay verildi. Akut kolesistit tanýsý ve derecelendirmesi için Tokyo ölçütleri kullanýldý. Perkütan kolesistostomi uygulama nedenleri; komorbiditeler, yaþ veya semptomlarýn süresi idi. Hastalara PK uygulama kararý kýdemli cerrah tarafýndan kar-zarar oranýna bakýlarak verildi. Tüm PK uygulamalarý ayný giriþimsel radyolog tarafýndan lokal anestezi ile ultrasonografi eþliðinde yapýldý.
BULGULAR: Toplam 40 PK iþlemi belirtilen çalýþma süresinde hastanemizde yapýldý. Hastalarýn 22’si (55%) erkek ve 18’i (45%) kadýn; ortalama yaþ 70.5 (daðýlým, 52–87 yýl) idi. Perkütan kolesistostomi uygulanan hastalarýn tümünün ASA deðeri 3 veya 4 olarak deðerlendirildi. Perkütan kolesistostomi uygulamasýnýn baþarý oraný %100 ve komplikasyon oraný da 2.5% (n=1) idi. Drenler altý hafta yerinde tutuldu. Toplam 40 hastanýn 16’sý (40%) takiplerinde dren çekildikten sonra ameliyat edildi. Ameliyatlardan sadece üçünde (18.8%) laparoskopiden açýða dönüldü. Kalan 23 (%57.5) hasta ise drenlerin çekilmesinden sonara ameliyat edilmeden takip edildi ve takiplerinde herhangi bir hastalýk nüksü olmadý.
TARTIÞMA: Acil koþullarda AC ile gelen yaþlý, eþlik eden hastalýklarý olan ve kötü genel durumu olan hastalarda LK yapýlamadýðýnda PK güvenli bir þekilde uygulanabilir. Drenin çekilmesi sonrasýnda uygun olan hastalarda LK kabul edilebilir %18.8 açýða dönme oranlarý ile elektif koþullarda yapýlabilir.

BACKGROUND: Acute cholecystitis (AC) is a common emergency seen by general surgeons. Optimal treatment is laparoscopic cholecystectomy (LC); however, in cases where surgery cannot be performed due to high risk of morbidity and mortality, such as in elderly patients with comorbid diseases, other treatment modalities may be used. Percutaneous cholecystostomy (PC) is one alternative method to treat AC. PC can be used to provide drainage of the gall bladder and control infection. Subsequently, interval cholecystectomy can be performed when there are better conditions. Presently described is experience and results with PC in high risk, elderly patients with AC.
METHODS: Medical records of all consecutive patients who underwent PC between January 2011 and January 2014 were identified. Tokyo Guidelines were used for definitive diagnosis and severity assessment of AC. Senior surgeon elected to perform PC based on higher risk-benefit ratio due to comorbidity, age, or duration of symptoms. All PC procedures were performed by the same interventional radiologist under local anesthesia with ultrasonographic guidance.
RESULTS: Total of 40 PC procedures were performed during the study period. Of those, 22 (55%) were male and 18 were (45%) were female, with median age of 70.5 years (range: 52–87 years). All of the patients had American Society of Anesthesiologists classification of either 3 or 4. Success rate of PC was 100% with complication rate of 2.5% (n=1). One patient was operated on shortly after PC procedure due to bile peritonitis complication. PC drains were kept in place for 6 weeks. Total of 16 patients (40%) had surgery following removal of PC drain. In 3 (18.8%) cases, conversion from LC was required. Remaining 23 (57.5%) patients did not have subsequent operation after drain removal. No disease recurrence was observed in follow-up.
CONCLUSION: When elderly patients present in emergency setting with AC and LC cannot be performed due to comorbid disease or poor general condition, PC can be performed safely. After removal of PC drain, LC may be performed with acceptable conversion rate of 18.8%.

AMAÇ: Yoðun bakým ünitelerinde (YBÜ) takip edilen farklý hasta gruplarýnda akut böbrek hasarý (ABH) geliþimini inceleyen az çalýþma bulunmaktadýr. Çalýþmamýzda farklý yoðun bakým hasta gruplarýnda ABH geliþmesini ve bunda etkili risk faktörlerini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma üç farklý YBÜ’de gerçekleþtirildi ve AKI network (AKIN) sýnýflandýrmasýna göre ABH oluþumu karþýlaþtýrýldý. Travma, beyin cerrahi ve genel YBÜ’lerde yatan sýrasý ile kafa travmasý, anevrizmal subaraknoid kanama (aSAK) ve septik þok nedeniyle takip edilen 300 hasta ABH insidansý ve risk faktörleri açýsýndan incelendi.
BULGULAR: Anevrizmal subaraknoid kanama grubunda serum kreatin deðerine göre ABH geliþen hasta saptanmadý fakat volüm düzeltilmiþ kreatinin deðerine göre (VACr) hastalarýn %5’inde ABH geliþtiði görüldü. AKI network sýnýflandýrmasý baz alýndýðýnda sepsis grubunda %76, kafa travmasý grubunda hastalarýn %20’sinde hem serum kreatin hemde VACr deðerine göre ABH geliþtiði görüldü ve sepsis grubunda ABH insidansý anlamlý oranda yüksek bulundu (p<0.001). Sadece vazopresör kullanýmý sepsis ve kafa travmasý grubunda ABH geliþimi için risk faktörü olarak saptandý. Hastalarýn mortalite oranlarý aSAK, kafa travmasý ve sepsis grubu için sýrasý ile %8, %22 ve %42 saptandý. Vazopressör kullanýmý ve ABH geliþmesi sepsis grubunda mortalite için risk faktörü olarak saptandý.
TARTIÞMA: Benzer özellikler ve risk faktörlerine raðmen aSAK hastalarýnda ABH daha nadir görülmektedir. Vazospazm tedavisi için uygulanan hipertansiyon, hipervolemi ve tuz kaybettirici sendrom sonucu oluþan poliüri aSAK hastalarýnda ABH geliþimden koruyan faktörler olabilir.

BACKGROUND: There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients.
METHODS: Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI.
RESULTS: AKI did not develop in aSAH patients when evaluated based on serum creatinine level; however, it was observed in 5% of aSAH patients according to volume adjusted creatinine (VACr) level. AKI developed in 76% of sepsis group, and in 20% of head injury group, based on AKIN classification, according to both serum and VACr levels. Incidence of AKI was significantly higher in sepsis group (p<0.001). Only use of vasopressor was significantly related to AKI development in sepsis and head injury groups. Mortality rate was 8%, 22%, and 42% in aSAH, head injury, and sepsis groups, respectively. AKI development and vasopressor use were significantly related to mortality in sepsis group.
CONCLUSION: Despite similar characteristics and risk factors, there were fewer instances of AKI in aSAH group. Hypertension or hydration therapy used to treat vasospasm and polyuria due to cerebral salt-wasting syndrome may prevent aSAH patients from developing AKI.

AMAÇ: Bu çalýþmanýn amacý acilde nedeni bilinmeyen gastrointestinal (GÝS) kanama tanýsý ile yatýrýlarak takip edilen hastalarda kapsül endoskopisinin yerini irdelemek.
GEREÇ VE YÖNTEM: Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Acil Cerrahi biriminde 1 Ocak 2007 ile 1 Haziran 2015 tarihleri arasýnda nedeni bilinmeyen aþikar GÝS kanama tanýsý ile takip edilen ve kapsül endoskopisi yaptýðýmýz 38 hastanýn verileri geriye dönük olarak incelendi.
BULGULAR: Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Acil Cerrahi’de nedeni bilinmeyen GÝS kanama tanýsýyla takip edilen ve kapsül endoskopisi yapýlabilen 38 hasta çalýþmaya dahil edildi. On iki hasta kadýn (%32) 26 hasta erkekti (%68). Ortalama yaþ: 55.57 (20–88) idi. Dokuz hasta kan sulandýrýcý ilaç kullanýyordu. 10 hasta yoðun bakýmda takip edildi. Yedi hastaya anjiyo yapýldý aktif kanama saptanmadý. Kapsül endoskopisinde aktif kanama saptanan bir hastaya anjiyoembolizasyon yapýldý. Ortalama eritrosit süspansiyon replasmaný 20.7 ünite idi. On üç hasta kapsül endoskopisinde bulunan kanama odaklarý nedeniyle ameliyat edildi (%34). On bir hastaya çift balon endoskopisi yapýldý. Bunlardan beþine koterizasyon ikisine skleroterapi yapýlarak müdahale edildi (%18). Dört hasta hayatýný kaybetti. Ýki olgu kanama odaðý saptanamadýðý için bir olgu kolanjiyokarsinom nüksü nedeniyle bir olguda anastomoz kaçaðý nedeniyle hayatýný kaybetti. Bir olgu tekrar kanama nedeniyle hastaneye baþvurdu. On dokuz hastaya kapsül endoskopisi bulgularýna dayanýlarak baþarýlý þekilde müdahale edildi (%50). Tanýsal deðer %78.9 olarak saptandý. Hastanede ortalama kalýþ süresi 32.68 (daðýlým, 3–153 gün) idi.
TARTIÞMA: Kapsül endoskopisi kanama etiyolojisini saptamada etkindir. Acile baþvuran hastalarda nedeni bilinmeyen kanamalarda radyolojik olarak obstrüksiyon bulunmayan olgularda ilk tercih edilecek yöntem kapsül endoskopi olmalýdýr.

BACKGROUND: The aim of this study was to investigate the efficacy of capsule endoscopy (CE) performed on patients who presented to emergency room with clinically evident gastrointestinal (GI) bleeding from unknown source and were hospitalized for follow-up.
METHODS: Total of 38 patients who underwent CE and were followed-up for evaluation of clinically perceptible GI bleeding with no obvious etiology in Istanbul Medical Faculty emergency surgery department were included in the study. Patient data, which were collected between January 1, 2007 and June 1, 2015, were reviewed retrospectively.
RESULTS: Of the 38 patients included in this study, 12 (32%) patients were women and 26 (68%) were men. Average age was 55.57 years (range: 20–88 years). Nine patients were using anticoagulants. Ten patients were followed-up in intensive care, and 7 patients underwent angiography. Angioembolization was performed for 1 patient who was diagnosed as having active bleed with CE. Average erythrocyte suspension replacement was 20.7 units. Total of 13 patients underwent surgery for bleeding found with CE. Eleven (34%) patients underwent double-balloon endoscopy, during which 5 patients were treated with cauterization and sclerotherapy was performed on 2. Four (18%) patients died during the study period: 2 died as result of bleeding from unknown source, 1 died of cholangiocarcinoma recurrence, and 1 died of anastomotic leakage. One patient was readmitted to hospital due to recurrence of bleeding. Nineteen (50%) patients were treated successfully based on CE findings. Diagnostic yield of CE was determined to be 78.9%. Average length of hospital stay was 32.68 days (range: 3–153 days).
CONCLUSION: CE is an effective tool to detect source of GI bleeding. CE should be first choice of evaluation method for patients admitted to emergency room with obscure overt GI bleeding once radiological imaging determines absence of obstruction.

AMAÇ: Bu çalýþmanýn amacý tinere baðlý yanýklarý önlemek için bu yanýklarýn karakteristik özelliklerini incelemek ve risk faktörlerine olan farkýndalýðý artýrmaktýr.
GEREÇ VE YÖNTEM: Tiner yanýðý nedeniyle yanýk ünitesine kabul edilen hastalar geriye dönük olarak tarandý, hastalarýn klinik kayýtlarý kapsamlý bir þekilde incelendi. Ortalama yaþlarý 27.79±11.49 (daðýlým, 16–58 yaþ) olan toplam 48 hasta (3 kadýn, 45 erkek) çalýþmaya alýndý.
BULGULAR: Ortalama hastanede kalýþ süresi 30.25±27.11 (daðýlým, 3–110) gündü, ortalama toplam yanýk yüzey alaný %32.53±24.06 (daðýlým, %3.0–90.0). Toplam 31 hastada yoðun bakým ünitesi ihtiyacý oldu. Tiner yanýðý olan hastalarýn dokuzu kaybedildi (%18.8), geriye kalan 38 hasta tedavileri sonrasýnda taburcu edildi. Ana ölüm nedeni septisemi (n=7) ve respiratuvar yetersizlikti (n=6). Hastalarýn 12’sinde inhalasyon yanýðý eþlik ediyordu, bunlardan altýsý kaybedilmiþti (%50). Septisemi (p=0.031) ve inhalasyon hasarý (p=0.01) varlýðý açýsýndan karþýlaþtýrýldýðýnda, kaybedilen veya taburcu edilen hastalar arasýndaki farklar anlamlý idi.
TARTIÞMA: Tinerle temas, hýzlý ve dikkatli tedaviler gerektiren çok ciddi klinik tablolara neden olabilen önemli bir yanýk nedenidir. Klinisyenlerin bunun bilincinde olmalý, bu hasta grubunda inhalasyon yanýðý ve sepsisin mortalitenin iki önemli nedeni olduðunu bilmelidir. Artan bilinçle önleyici tedbirler tanýmlanabilir. Bu hasta grubunda mortalitenin azaltýlmasý için daha fazla çalýþma yapýlmasýna ihtiyaç vardýr.

BACKGROUND: The aim of the present study was to present characteristic features and risk factors of paint thinner burns in order to raise awareness and help prevent these injuries.
METHODS: Records of patients admitted to the burn unit due to paint thinner burns were retrospectively reviewed, and patients with comprehensive data available were included in the study. Total of 48 patients (3 female and 45 male) with mean age of 27.79±11.49 years (range: 4–58 years) were included in the study.
RESULTS: Mean total hospitalization period was 30.25±27.11 days (range: 3–110 days), and mean total burn surface area was 32.53±24.06% (range: 3.0–90.0%). In 31 cases (64.6%), intensive care unit admission was required. Among all 48 patients, 9 (18.8%) died in hospital and remaining 38 were discharged after treatment. Primary cause of death was septicemia (n=7) or respiratory failure (n=6). Inhalation injury was present in 12 of the patients, 6 of whom died (50%). Statistically significant differences were found between expired and discharged patients when compared for presence of inhalation injury (p=0.01) and septicemia (p=0.031).
CONCLUSION: Ignition of paint thinner is an important cause of burn injuries that may result in very severe clinical picture. Patients require prompt and careful treatment. Clinicians should be aware that inhalation injury and sepsis are the 2 main factors affecting mortality rate in this group of patients. With increased awareness, preventive measures may be defined. Further studies are warranted to decrease mortality rate in this subgroup of burn patients.

AMAÇ: Fiziksel þiddet kurbanda travma, yaralanma, aðrý ve iþlev kaybýna yol açmaya yönelik güç uygulama sonucu oluþan ve en sýk görülen þiddet türüdür. Türkiye için bu alanda öncü nitelikteki çalýþmada fiziksel þiddete uðrayan yaþlýlarýn sosyodemografik özelliklerin ve þiddet mekanizmasýnýn incelenerek Türk toplumunda yaþlýya yönelik þiddetle savaþ için alýnabilecek önlemler araþtýrýldý.
GEREÇ VE YÖNTEM: Geriye dönük çalýþmada Ocak 2012 ve Temmuz 2013 tarihleri arasýnda Þanlýurfa Eðitim ve Araþtýrma Hastanesi Acil Servisi’ne darp nedeniyle baþvuran 54 hastanýn veri tabaný ve adli rapor kayýtlarý deðerlendirildi.
BULGULAR: Darp tanýlý 54 yaþlý hastanýn 50’si (%92.4) erkekti. Olgularýn %55.6’sýnda (n=30) mükerrer darp tanýmlandý. Mükerrer darp ve ateþli silah yaralanma sýklýðý evde gerçekleþtiði belirtilen olgularda anlamlý yüksek bulundu (p=0.006, p=0.007). Cerrahi gerektiren yaralanma sýklýðý evde gerçekleþen darp olgularýnda daha sýk görüldü (p=0.016).
TARTIÞMA: Ateþli silah yaralanmasý gibi ciddi yaralanmalar ve mükerrer darp olgularýnýn hane içinde gerçekleþmesi darp nedeniyle baþvuran yaþlýlarýn koruma altýna alýnmasý gerektiðini göstermektedir.

BACKGROUND: Physical violence is defined as deliberate use of physical force likely to result in trauma, bodily injury, pain, or impairment. Present study is pioneering effort to evaluate mechanisms and sociodemographic features of physical violence targeting the elderly in Turkey and to investigate preventive measures.
METHODS: Database records and forensic reports were analyzed in this retrospective study of 54 elderly patients with trauma as result of physical violence who were admitted to emergency department of Þanlýurfa Training and Research Hospital between January 2012 and July 2013.
RESULTS: Of the 54 patients evaluated, 50 (92.4%) were male. History of experiencing previous violence was described by 55.6% (n=30) of the patients. Instances of repeat violence and firearm injuries most often occurred in the home (p=0.006, p=0.007). Need for surgical treatment was also greater among cases that occurred in the home (p=0.016).
CONCLUSION: Firearm injury, recurrent violence, and surgical treatment rates were higher among cases that occurred in the home. Urgent preventive measures are especially needed for the elderly who have already been victims of physical violence.

AMAÇ: Batý toplumlarýnda sað kolon divertikülleri nadir görülmektedir. Bu çalýþmanýn amacý bilgisayarlý tomografi ile tanýsý konan sað kolon divertiküllerinin konservatif tedavi ile sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Þubat 2013 ile Aralýk 2013 tarihleri arasýnda klinik ve radyolojik olarak sað kolon ve çekal divertikülleri olan ve konservatif olarak tedavi edilen 12 hasta çalýþmaya alýndý. Demografik ve klinik veriler geriye dönük olarak deðerlendirildi.
BULGULAR: Çalýþmaya katýlan kadýn ve erkeklerin sayýsý birbirine eþitti. Ortalama yaþ 45.08±14.4 yýl idi. Hastalarýn hastaneye baþvurmadan önce geçen süre 2.08±1.3 gün olup, en sýk görülen semptom sað alt kadran aðrýsýydý (%72.7). On hastaya sadece abdominal tomografi çekilirken, iki hastaya hem abdominal tomografi hem de abdominal ultrasonografi çekilmiþti. Ortalama hastanede yatýþ süresi 2.8±1.5 gün olup hastalarýn hepsi konservatif olarak tedavi edildi. Ortalama 8.2±5.6 aylýk takipte hiçbir hastada nüks gözlenmedi.
TARTIÞMA: Komplike olmayan sað kolon divertikülleri radyolojik olarak tanýmlanabilir, baðýrsaklarýn istirahati ile birlikte antibiyotik tedavisi düþük nüks olanlarý ile tedavi seçeneði olarak kullanýlabileceði gibi sonraki dönemlerde cerrahi gerekebileceði akýlda tutulmalýdýr.

BACKGROUND: Diverticulosis of the right colon is an uncommon entity. Aim of the present study was to report outcome in patients with right-sided diverticulitis diagnosed using computed tomography (CT) and treated conservatively.
METHODS: Twelve patients with clinical and radiological diagnosis of cecal or right-sided diverticulitis who were treated conservatively between February 2013 and December 2014 were included. Demographic and clinical data were retrospectively analyzed.
RESULTS: Female to male ratio was 1: 1 with mean age of 45.08±14.4 years. Mean length of symptom history before admission was 2.08±1.3 days. Most common presenting symptom was right lower abdominal pain, seen in 72.7% of the patients. Abdominal ultrasound alone was performed for 10 patients, and 2 also had abdominal CT. Mean duration of hospitalization was 2.8±1.5 days. All patients were successfully treated with medical therapy. There was no recurrence during mean follow-up period of 8.2±5.6 months.
CONCLUSION: If uncomplicated diverticulitis of the right colon is correctly diagnosed with radiological evaluation, antibiotic therapy and bowel rest should be considered as treatment modality, as there was no recurrence observed in short-term follow-up period and this option presents advantage of avoiding surgical intervention.

AMAÇ: Tek taraflý kanaliküler kesi tamiri uygulanan hastalarda anatomik ve fonksiyonel baþarýyý deðerlendirmek.
GEREÇ VE YÖNTEM: 1 Ocak 2009 ile 31 Aralýk 2014 tarihleri arasýnda tek cerrah tarafýndan kanalikül kesi tamiri yapýlan hastalar çalýþmaya dahil edildi. Hastalarýn demografik verileri, travmanýn zamaný ve etkeni, uygulanan cerrahi yöntem ve izlem süreleri kaydedildi. Hastalarýn sulanma yakýnmalarý cerrahi sonrasý entübasyon tüpünün çýkarýlmasýný takiben en son kontrol muayenede Munk skorlamasýna göre deðerlendirildi. Gözyaþý yolunun açýklýðý kanaliküler irigasyon ile incelendi.
BULGULAR: Tek taraflý kanaliküler kesi tamiri yapýlan 41 hastanýn (35 erkek, 6 kadýn) ortalama yaþý 31.85±18.9 (sýnýrlar, 1–79) idi. Travma daðýlýmý indirekt-avülsif yaralanma %66 (n=27), direkt-penetran yaralanma %34 (n=14) þeklindeydi. Kesi yeri sol alt kanalikül %63.4 (n=26), sað alt kanalikül %19.5 (n=8) sað üst kanalikül %9.8 (n=4) ve sol üst kanalikül %7.3 (n=3)olarak saptandý. Kýrk bir hastadan 10’una pigtai lprob ile bikanaliküler anüler entübasyon uygulanýrken, 31 hastaya monokanaliküler entübasyon uygulandý. Ýzlem süresi ortalama 6±5.7 ay idi. Hastalarýn tümünde lavaj açýk bulundu. Munk skoru hastalarýn tamamýnda grade 0 olarak belirlendi.
TARTIÞMA: Günümüzde mikrocerrahi yöntemlerle yapýlan kanalikül kesi tamiri ile çok baþarýlý sonuçlar elde edilmektedir.

BACKGROUND: The present study was designed to evaluate functional and anatomical success of traumatic canalicular laceration repair.
METHODS: Consecutive patients who presented at Atatürk Training and Research Hospital Eye Clinic, Ýzmir Katip Çelebi University Faculty of Medicine and had canalicular laceration repair performed by the same surgeon between January 2009 and December 2014 were included in the study. Demographic data, length of time between injury and surgery, and cause of the trauma, surgical method employed, and duration of follow-up were recorded. Postoperative epiphora was evaluated using Munk score. Patency of lacrimal system was assessed with canalicular irrigation.
RESULTS: Thirty-five male and 6 female patients were included in the study. Mean age of 41 participants was 31.85±18.9 years (range: 1–79 years). Avulsive injury was observed in 66% (n=27), and direct (penetrating) injury in 34% (n=14). Distribution of injured canaliculi was as follows: left inferior canaliculus 63.4% (n=26), right inferior canaliculus 19.5% (n=8), right superior canaliculus 9.8% (n=4), and left superior canaliculus 7.3% (n=3). Thirty-four patients had monocanalicular tube implantation (mini-Monoka) and 10 patients had bicanalicular annular intubation using pigtail probe. Average follow-up time was 6±5.7 months. Munk score was Grade 0 in all patients. Canalicular irrigation indicated all canaliculi were patent.
CONCLUSION: Recent microsurgical techniques result in successful repair of canalicular laceration.

Tromboembolik olaylarýn önlenmesinde yaygýn olarak kullanýlan varfarin en sýk kullanýlan oral antikoagülandýr. Varfarine baðlý spontan meme hematomu oldukça nadiren görülen bir komplikasyondur. Varfarine baðlý memede hematom geliþmesi nadir bir durumdur.

Warfarin is the most commonly used oral anticoagulant and is widely prescribed to prevent thromboembolic events. Warfarin-dependent spontaneous breast hematoma is a very rare complication. Presently described is rare case of warfarin-induced breast hematoma.

Penetran olmayan karýn travmalarýna baðlý geç dönemde oluþan ince baðýrsak striktürü nadir ileus nedenidir. Sýklýkla mezenterde oluþan minör travmaya baðlý baðýrsak duvarýndaki lokalize beslenme bozukluðunun sonucu olduðu düþünülmektedir. Laparoskopi taný ve tedavi uygulamalarýnda artan oranlarda uygulanmaktadýr. Künt karýn travmasýna baðlý intestinal stenozlarda tanýnýn patolojik deðerlendirme ile desteklenmesi gerekir.

Small intestinal stricture forming in the late phase following nonpenetrating abdominal trauma is rare cause of ileus. It has often been suggested that it is result of localized feeding deficiency on the intestinal wall related to minor trauma in the mesentery. Laparoscopy has been increasingly used for diagnosis and treatment. Diagnosis should be supported by pathological analyses in case of intestinal stenosis related to blunt abdominal traumas.

Ýntrahepatik yabanci cisimler nadir olarak gözlenir. Birçok olguda gastrointestinal kanaldan migrasyon ile karaciðere geçiþ olmaktadýr. Komplike olmayan intrahepatik yabanci cisimler cerrahi müdahaleye ihtiyaç duyulmadan takip edilebilirler. Komplike olmuþ intrahepatik yabanci cisimlerde ise laparotomi veya laparoskopi ile cerrahi müdahaleye gerek duyulabilmektedir. Bu olgu sunumunda karaciðerde insidental olarak dikiþ iðnesi saptanmýþ 22 yaþýndaki kadýn olgu komplikasyonu olmadýðý için takibe alýndý. Takipleri sýrasýnda karýn aðrýsý ve aralýklý ateþ þikayetleri geliþti. Laparoskopik olarak eksplore edilen hastada karaciðer sað lob lateralinde hemen safra kesesi komþuluðunda bir ucu karaciðerden dýþarýda olduðu gözlenen dikiþ iðnesi laparoskopik grasper ile çýkarýldý. Bu olgu sunumu ile birlikte literatürde bulunan 23 benzer olgu da irdelendi.

An intrahepatic foreign body (FB) is rarely observed. In most cases, object passes from the gastrointestinal tract to the liver via migration. Uncomplicated intrahepatic FB can be followed without surgical intervention; however, complicated intrahepatic FB requires laparoscopy or laparotomy. Presently described is laparoscopic operation on 22-year-old female patient who had incidental sewing needle in the right liver lobe. As there were initially no complications, follow-up monitoring was recommended. However, the patient subsequently complained of stomach pain and developed fever. Laparoscopic exploration located sewing needle in the right liver lobe lateral to the gall bladder with end of needle protruding from the liver. Needle was removed with laparoscopic grasper. Review of the literature regarding 23 other intrahepatic sewing needle cases is also presented.

Hidatik akut pankreatit nadir görülen ve her zaman akut ödematöz pankreatit olarak seyreden bir tablodur. Karaciðer kist hidatiðinin safra yollarýna açýlmasý ve papiller açýklýðýn hidatik membranlarla týkanmasý olasý mekanizmalardan biridir. Epigastrik ve sað üst kadran aðrýsý, bulantý, kusma þikayetiyle baþvuran 49 yaþýnda erkek hastanýn bilgisayarlý tomografi incelemesinde karaciðer sol lobunda 5x5 cm ebatlarýnda kistin safra yollarýna açýlarak nekrotizan pankreatite yol açtýðý görüldü. Endoskopik retrograd kolanjiyopankreatikografi denemesinin baþarýsýz olmasý nedeniyle hastada kistotomi, koledok eksplorasyonu, T-Tüp drenaj ve omentoplasti operasyonu tercih edildi. Nekrotizan pankreatit için ilave giriþim yapýlmadý. Klinik ve laboratuvar bulgularý hýzla düzelen hastada bir yýllýk takip süresinde tekrar pankreatit geliþimi saptanmadý. Hidatik ödematöz ve nekrotizan pankreatit benzer kliniðe sahiptir, papillada bulunan týkanýklýðýn ortadan kaldýrýlmasýyla iyileþme süreci hýzlý ve sorunsuz olmaktadýr.

Hydatid acute pancreatitis is a rare condition and always presents as consequence of acute edematous pancreatitis. Intrabiliary rupture of hepatic hydatid cysts and obstruction of papillary orifice with hydatid membrane is possible mechanism. A 49-year-old man was admitted with epigastric and right upper quadrant pain, nausea, and vomiting. Computed tomography scan showed 5 x 5 cm cyst in left hepatic lobe, which had ruptured into the biliary tract and caused necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography trial failed. Surgical choice was drainage of cyst, insertion of T-Tube, exploration of common bile duct and omentoplasty. No additional necessary surgical intervention was necessary for necrotizing pancreatitis. Clinical and laboratory findings resolved rapidly and there was no recurrent pancreatitis episode during 1 year of follow-up. Hydatid edematous and necrotizing pancreatitis have similar progress. Recovery is quick and uneventful after elimination of mechanical obstruction of papillary orifice.