AMAÇ: Geliþmekte olan ülkelerde daha sýk görülen ve korozif madde yutulmasýna baðlý oluþan özefageal yanýklarý kýsa dönemde özefagus perforasyonuna ve uzun dönemde darlýk oluþmasýna neden olmaktadýr. Korozif özefagus yanýklarýnda tedavinin asýl amacý özefagusta darlýk oluþumunu önlenmektir. Biz, bu çalýþmada korozif özefagus yanýklarýnýn tedavisinde metilen mavisinin (MB) antienflamatuvar ve koruyucu etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmada 28 sýçan kullanýldý ve sýçanlar rastgele dört eþit gruba ayrýldý; 1. grup (Sham), 2. grup (kontrol), 3. grup (topikal tedavi) ve 4. grup (topikal ve sistemik tedavi). Sham grubu hariç diðer gruplara özefageal yanýk oluþturmak için sodyum hidroksit (NaOH) verildi. Ek olarak, ikinci gruba normal salin, 3. gruba topikal metilen mavisi ve 4. gruba topikal ve sistemik metilen mavisi verildi.
BULGULAR: Hidroksiprolin seviyeleri her bir tedavi grubunda kontrol grubuna göre daha düþüktü (p=0.005 grup 3’e göre, p=0.00 grup 4’e göre). Tümör nekrozis faktör-α seviyelerine göre gruplar arasýnda fark yoktu. Tedavi gruplarýna ait stenoz indeksleri kontrol grubuna göre daha düþüktü (p=0.016 grup 3’e göre, p=0.015 grup 4’e göre). Histopatolojik hasar skoru kontrol grubu ile karþýlaþtýrýldýðýnda grup 4’te belirgin olarak daha düþüktü (p=0.05).
TARTIÞMA: Metilen mavisi korozif özefageal yanýklarýn neden olduðu doku hasarýný tedavi etmede ve özefageal stenozu önlemede etkilidir. Korozif özefageal yanýklardaki komplikasyon oranlarý yanýk esnasýnda kullanýlan metilen mavisi ile azaltýlabilir.

BACKGROUND: In developing countries, esophageal burns are quite common. They are caused by the ingestion of corrosive substances that may lead to esophageal perforation in the short-term and stricture formation in the long-term. Prevention of stricture progression in the esophagus is the main aim of the treatment for corrosive esophageal burns. We aimed to investigate the protective and anti-inflammatory effects of methylene blue (MB) treatment on corrosive esophageal burns.
METHODS: Twenty-eight rats were used in the study and randomly divided into four equal groups; group 1 (Sham), group 2 (control), group 3 (topical treatment), and group 4 (topical plus systemic treatment). Except for group 1 (Sham group), all three groups received sodium hydroxide (NaOH) in order to generate esophageal burns. In addition, group 2 was given normal saline, group 3 topical MB, and group 4 topical and systemic MB.
RESULTS: Hydroxyproline levels were found to be lower in each of the treatment groups as compared to the control group (p=0.005 for group 3 and p=0.009 for group 4). There were no differences in the tumor necrosis factor-α (TNF-α) levels between the groups. The stenosis index (SI) in the treatment groups was also lower than the control group (p=0.016 for group 3 and p=0.015 group 4). The histopathologic damage score (HDS) was prominently lower in group 4 as compared to the control group (p=0.05).
CONCLUSION: MB is effective in treating tissue damage caused by corrosive esophageal burns and in preventing esophageal stenosis. Complication rates of corrosive esophageal burns may be decreased by using MB in the initial treatment stage.

AMAÇ: Deniz canlýlarýndan gelen yaðlarýn farklý yað asidi bileþimleri vardýr. Balýk yaðý (FO), triasilgliserollere esterlenmiþ yüksek oranda eikosapentaenoik ve dokosahekssaenoik asit içeriðine sahipken, krill yaðýnda (KO) yað asitleri temel olarak fosfolipidlere esterlenir. Bu çalýþmada, iki farklý, omega-3 yað asidi kaynaðýnýn kolon anastomozu uygulanan sýçan modelinde, anastomoz iyileþmesindeki etkinliðini karþýlaþtýrdýk.
GEREÇ VE YÖNTEM: Çalýþmada 42 erkek Wistar albino sýçan kullanýldý. Yedi sýçandan oluþan altý grup þu þekilde oluþturuldu: CO3: Üçüncü günde sakrifiye edilen sol kolon anastomu yapýlan sýçan (kontrol grubu); KO3: Üçüncü günde sakrifiye edilen sol kolon anastomozu yapýlan sýçan + oral KO; FO3: Üçüncü günde sakrifiye edilen sol kolon anastomozu yapýlan sýçan + oral FO; CO7: Yedinci günde sakrifiye sol kolon anastomozu yapýlan sýçan (kontrol grubu); KO7: Yedinci günde sakrifiye edilen sol kolon anastomozu yapýlan sýçan + oral KO; FO7: Yedinci günde sakrifiye edilen sol kolon anastomozu yapýlan sýçan + oral FO. Peritoneal adezyonlar, anastomoz patlama basýnçlarý, hidroksiprolin düzeyleri ve anastomotik dokunun histolojik özellikleri deðerlendirildi.
BULGULAR: Kril yaðý grubunun patlama basýncý ve hidroksiprolin ölçümleri, yedinci günde FO grubundan anlamlý olarak daha yüksekti (sýrasýyla, p=0.012; p=0.002). Ayrýca, enflamatuvar hücre infiltrasyonuna, fibroblast aktivitesi, neoanjiyogenez ve kollajen birikimine göre gruplar arasýnda, yedinci günde KO grubu lehine istatistiksel olarak anlamlý bir fark gözlendi (sýrasýyla, p=0.023; p=0.028; p=0.016; p=0.012).
TARTIÞMA: Kolorektal cerrahi öncesi hastalara hem KO hem de FO desteði anastomoz kaçaðý riskini azaltabilir ancak KO daha iyi bir omega-3 kaynaðý olarak öne çýkmaktadýr.

BACKGROUND: Oils from marine organisms have a different fatty acid composition. Fish oil (FO) has a high content of eicosapentaenoic and docosahexaenoic acids esterified to triacylglycerols; while in krill oil (KO), fatty acids are primarily esterified to phospholipids. This study aimed to compare the efficacy of two different, marine-derived omega-3 fatty acid sources in the wound healing of colon anastomoses rat model.
METHODS: For the study, we used 42 male Wistar albino rats. The rats were divided into six groups with seven rats in each group—CO3: left colonic anastomosis (control group), sacrificed on the third day; KO3: left colonic anastomosis + oral KO, sacrificed on the third day; FO3: left colonic anastomosis + oral FO, sacrificed on the third day; CO7: left colonic anastomosis (control group), sacrificed on the seventh day; KO7: left colonic anastomosis + oral KO, sacrificed on the seventh day; FO7: left colonic anastomosis + oral FO, sacrificed on the seventh day. Peritoneal adhesions, anastomotic bursting pressures, hydroxyproline levels, and histological examination of the anastomotic tissue were evaluated.
RESULTS: On day 7, bursting pressure and hydroxyproline measurements of the KO group was significantly higher than the FO group (p=0.012; p=0.002, respectively). Also, on day 7, a statistically significant difference was observed between the groups according to inflammatory cell infiltration, fibroblast activity, neoangiogenesis, and collagen deposition in favor of the KO group (p=0.023; p=0.028; p=0.016; p=0.012, respectively).
CONCLUSION: Both KO and FO supplementation in patients before colorectal surgery may reduce some risk of anastomotic leakage; and KO might be a better alternative and excellent omega-3 source.

AMAÇ: Hiperoksinin yoðun bakým ünitelerinde mekanik ventilasyon desteði ile takip edilen hastalarda mortalite ve morbiditeyi artýran baðýmsýz bir risk faktörü olduðuna dair farklý çalýþmalar olmasýna raðmen bu konu belirsizliðini korumaktadýr.
GEREÇ VE YÖNTEM: Bu çalýþma, etik komite onayý alýndýktan sonra mekanik ventilatör desteði ile yoðun bakým ünitesine takip edilen 18 yaþ üzerindeki 7689 hastanýn ilk 24 saatteki verileri incelenerek yapýlan geriye dönük, gözlemsel bir çalýþmadýr. Hastalarýn demografik özellikleri, mekanik ventilasyon ve kan gazý parametleri analiz edildi. Hiperoksemiyi PaO2 ≥120 mmHg, normoksemiyi PaO2 60–120 mmHg olarak tanýmlandý. PaCO2 deðeri <30 mmHg olan hastalar hipokapnik, 30–50 mmHg olanlar normokapnik, >50 mmHg olanlar hiperkapnik olarak tanýmlandý.
BULGULAR: Hastalarýn yaþ ortalamasý 59.60±16.96 (daðýlým, 18–93) yýl idi. Ortalama PaO2 deðeri 16.2 kPa (121.50 mmHg) ve FiO2 deðeri %60 idi. Ýki yüz otuz iki hasta normoksi (%51.5) ve 218 hastada (%48.5) hiperoksi gözlendi. Hastalarýn mortalite oran %56 idi. PaO2 düzeyleri ve PCO2 düzeyleri ile mortalite arasýnda istatistiksel olarak anlamlý fark bulunmadý (p>0.05). PaO2 ve FiO2 sýnýflamasýna göre mortalitede istatistiksel olarak anlamlý fark yoktu (p>0.05). PCO2 sýnýflamasýna göre saðkalým oranlarý arasýnda istatistiksel olarak anlamlý fark bulunmadý (p=0.602, p>0.05).
TARTIÞMA: Yoðun bakým ünitesindeki mekanik ventilatör desteði ile takip edilen hastalarda oksijen ve karbondioksit deðerleri ile mortalite arasýnda anlamlý iliþki bulunmadý.

BACKGROUND: Although there are studies demonstrating hyperoxia may be an independent risk factor for increased mortality and morbidity, this issue remains unclear. Our research then aimed to examine the relationship between arterial oxygen tension, arterial carbon dioxide tension, and in-hospital mortality of critically ill patients in intensive care unit (ICU).
METHODS: After obtaining ethics committee approval, we analyzed a retrospective data of patients over the age of 18 who survived at least 24 hours in the ICU on mechanical ventilatory support between year 2008 and 2012. The demographic properties, mechanical ventilation, and blood gas parameters were studied. We defined hyperoxia group as PaO2 value of ≥120 mmHg and normoxemia group as PaO2 of 60–120 mmHg. Patients with PaCO2 value <30 mmHg were determined to have hypocapnia, those with 30–50 mmHg normocapnia, and those with >50 mmHg hypercapnia.
RESULTS: Between 2008 and 2012, a total of 7689 patients were admitted to the ICU. Of 450 patients meeting the inclusion criteria of the study, 263 (58.4%) were male and 187 (41.6%) were female. Normoxia was observed in 232 (51.5%) patients and hyperoxia in 218 (48.5%) patients. The mean PaO2 was 16.2 kPa (121.50 mmHg), and FiO2 was 60%. 254 (56%) of the patients had died during the five-year period. There was no statistically significant difference in mortality between PaO2 levels and PCO2 levels (p>0.05). According to the classification of PaO2 and FiO2, there was no statistically significant difference in mortality (p>0.05) among patients. In addition, no statistically significant difference was found between the survival rates according to PCO2 classification (p=0.602, p>0.05).
CONCLUSION: There was no significant association between mortality and oxygen and carbon dioxide of patients in ICU on mechanical ventilatory support.

AMAÇ: Bu deneysel çalýþma yanýk yaralarýnda Ankaferd Blood Stoper ve gümüþ sülfadiazinin (SSD) etkinliðini karþýlaþtýrmak üzere dizayn edilmiþtir.
GEREÇ VE YÖNTEM: Çalýþma için Wistar albino cinsi 21 sýçan kullanýldý. Yanýk oluþturmak için 3x3 cm çapýnda yuvarlak özel dizayn edilmiþ pirinç prob kullanýldý. Yanýk oluþturulduktan sonra, sýçanlar üç gruba ayrýldý. Ankaferd Blood Stoper (Grup ABS) grup 1’de, Gümüþ sülfadiazin (Grup SSD) grup 2’de, izotonik emdirilmiþ spançlarda (Grup kontrol) grup 3’de kullanýldý. Ýyiliþme dönemi klinik ve histoplatolojik olarak takip edildi. Yara ölçümleri yapýldý, %50 ve %80 re-epitelizasyona ulaþtýðý günler her sýçan için belirlendi.
BULGULAR: Ortalama %50 re-epitelizasyon zamaný sýrasýyla ABS grubu için 10.8 gün, SSD grubu için 13.8 gün ve kontrol grubu için 16.8 gündü (p<0.001). Yine ortalama %80 re-epitelizasyon zamaný sýrasýyla ABS grubu için 16.4 gün, SSD grubu için 19.7 gün ve kontrol grubu için 25.2 gündü (p<0.001). Ortalama enflamatuvar skora göre, ABS grubunda anlamlý bir fark mevcuttu (p<0.05).
TARTIÞMA: Çalýþmamýz ABS’nin yanýk tedavisinde, SSD’ye oranla daha iyi sonuçlarý olduðunu göstermiþtir.

BACKGROUND: The present study was designed to compare the effectiveness of topical silver sulfadiazine (SSD) and Ankaferd Blood Stopper® (ABS) usage in experimental partial-thickness burns in rats.
METHODS: Twenty-one male Wistar albino rats weighing 250–290 (range: 270±19) g were used in the present study. A round brass probe that was specifically designed (3×3 cm diameter) was used to induce the burns in rats. After the presence of partial-thickness burns was confirmed, the rats were divided into three groups: Group 1 (ABS group) Ankaferd Blood Stopper® pad, Group 2 (SSD group) silver sulfadiazine (Silverdin®), and Group 3 (Control group) 1% isotonic saline solution-impregnated pad. The healing period was followed up clinically and histopathologically. The day on which 50% and 80% of re-epithelization at first were detected for each rat was also recorded.
RESULTS: The mean times of 50% and 80% of re-epithelization at first were 10.8 days, 13.8 days, and 16.8 days in Groups 1, 2, and 3, respectively (p<0.001), and 16.4 days, 19.7 days, and 25.2 days, respectively (p<0.001). The mean inflammatory scores were also found to be better in the ABS group than in other groups (p<0.05).
CONCLUSION: Our study showed that ABS has better results for the healing of the burn wound than SSD in experimental partial-thickness burns in rats.

AMAÇ: Bu çalýþma, sýçanlarda künt göðüs travmasýna baðlý geliþen kardiyak hasar üzerine resveratrolün terapötik etkisini ve endokanýn enflamasyon sürecinde bir biyobelirteç olarak kullanýlmasýný araþtýrmýþtýr.
GEREÇ VE YÖNTEM: Sýçanlar randomize olarak aþaðýdaki dört gruba ayrýldý (her grupta, n=7): bir kontrol grubu (tedavi veya travma olmadan); travma uygulanan grup (travma grubu); resveratrol grubu (resveratrol, [0.3 mg/kg] intraperitoneal [i.p.] yol grubu yoluyla uygulandý); ve resveratrol + travma grubu (travmanýn uygulanmasýndan 1 saat önce i.p. yolla resveratrol [0.3 mg/kg] verilen).
BULGULAR: Travma grubundaki tümör nekroz faktörü-α ve indüklenebilir nitrik oksit sentazýn immünreaktivitesi artarken, resveratrol + travma grubundaki reaksiyon þiddeti azaldý. Gruplarýn ortalama endokan deðerleri farklýydý (p<0.001). Resveratrol + travma grubundaki ortalama endokan ortalamasý diðer gruplardan daha yüksekti.
TARTIÞMA: Resveratrol, künt göðüs travmasý sonrasý akciðer hasarýnda anti-enflamatuvar ve antioksidan etkilere sahip olup tedavi sürecine katkýda bulunmuþtur. Künt göðüs travmasý sonrasý oluþan kardiyak hasarda enflamasyonun takibinde endokanýn bir biyobelirteç olarak klinik kullanýmý ile ilgili daha fazla çalýþma yapýlmasý gerektiðine inanýyoruz.

BACKGROUND: The present study investigated the therapeutic effect of resveratrol on cardiac injury resulting from blunt chest trauma and the utility of endocan as a biomarker of the inflammation process using rats.
METHODS: The rats were randomly divided into the following four groups (n=7 in each group): a control group (no treatment or trauma); trauma-induced group (trauma group); resveratrol group (resveratrol 0.3 mg/kg administered via the intraperitoneal [i.p.] route group); and resveratrol + trauma group (resveratrol 0.3 mg/kg administered via the i.p. route 1 hour prior to the induction of trauma).
RESULTS: The immunoreactivity of tumor necrosis factor-α and inducible nitric oxide synthase in the trauma group was increased, whereas the reaction intensity in resveratrol + trauma group was deceased. The mean endocan values of the differed between the groups (p<0.001). The mean endocan value in the resveratrol + trauma group was higher than that of the other groups.
CONCLUSION: Resveratrol exhibited anti-inflammatory and antioxidant effects in lung injury after blunt chest trauma and contributed favorably to the treatment process. We believe that there is a need for further studies on the clinical use of endocan as a biomarker of inflammation in cardiac injury after blunt chest trauma.

BACKGROUND: Chest injuries, accounting for 25% of all trauma-related deaths, are one of the main causes of death in young
adults. Our priority is the early identification of life-threatening injuries both immediate and delayed. The role of various biomarkers,
such as Clara cell protein 16, von Willebrand factor, interleukin-6, tumor necrosis factor, and angiopoietin, has been studied in
trauma-related acute respiratory distress syndrome (ARDS). Serum angiotensin-converting enzyme (ACE) levels have been studied
in non-trauma-related ARDS. The aim of this prospective observational study was to evaluate the role of ACE levels as a prognostic
marker in thoracic trauma.
METHODS: A prospective observational study was conducted to evaluate serum ACE levels in thoracic trauma patients and to
explore its prognostic potential with regard to clinical outcome. A total of 48 thoracic trauma patients were included in the study.
RESULTS: The mean ACE level in the study population was 66.54±11.18. A strong positive correlation was found among serum ACE
levels and Thoracic Trauma Severity Score (TTSS).
CONCLUSION: Our study demonstrates that serum ACE levels are increased in thoracic trauma patients with higher levels, indicating
the severe nature of trauma in concordance with increased TTSS scores.

AMAÇ: Bu çalýþmanýn amacý, ultrason (US) ve elle muayene yöntemlerinin baþarý oranlarýný araþtýrmak ve bilgisayarlý tomografiye (BT) karþý US ile elle muayenenin kýyaslanarak krikotiroid membranýn (KTM) tanýmlamak.
GEREÇ VE YÖNTEM: Çalýþmaya 110 hasta alýndý. Tiroit kartilajýn çýkýntýsýndan sternal çentiðin ortasýna kadar düzlemde orta hat belirlendikten sonra, iki nokta arasýndaki mesafe (milimetre) ölçüldü. A noktasý-KTM’nin orta noktasý ile B noktasý-tiroit kartilajýn inferiyor kýsmý arasýndaki mesafe (milimetre) US ve elle muayene ile tek bir araþtýrmacý tarafýndan iþaretlenerek ölçüldü. Ayrýca A noktasý ile B noktasý arasýndaki mesafe BT kullanýlarak hesaplandý. US ve elle muayene ile KTM’in belirlenmesi için geçen süre ve VAS skoru kullanýlarak her iki yöntemin kolaylýðý kaydedildi. Ek olarak hastalarýn demografik ve morfometrik karakteristikleri not edildi.
BULGULAR: Krikotiroit membran elle muayene ile 50 hastada (%45.5) ve US ile 82 (%74.5) hastada doðru olarak saptandý. Blant-Altman analizine göre US ile elle muayeneye göre daha iyi uyum gözlendi. KTM yerinin belirlenmesi için geçen süre US ile elle muayeneden daha kýsa idi (p<0.001). VAS deðerleri elle muayene ve US ile sýrasýyla 5.13±1.1, 3.32±0.9 bulundu (p<0.001). Artan boyun kalýnlýðý ve tiromental mesafe elle muayene baþarýsýný etkileyen risk faktörü olarak saptanýrken US için risk faktörü olarak vücut kitle indeksi (VKÝ) bulundu.
TARTIÞMA: Krikotiroit membranýn lokalizasyonu US ile elle muayeneden daha doðru ve kolay saptanmýþtýr. Ayrýca US ile bulunan sonuçlar BT’ye daha yakýn bulunmuþtur.

BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method—computed tomography (CT) scan.
METHODS: A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted.
RESULTS: The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland–Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p<0.001. The VAS scores for the palpation and US difficulty were 5.13±1.1 and 3.32±0.9 (p<0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US.
CONCLUSION: Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.

yoðun bakým merkezlerinde on sene boyunca travmaya baðlý yaralanmalardaki mortal seyreden hastalardaki organ tedariði sürecini deðerlendirerek travma sonrasý mortal sonuçlanan hastalardaki organ baðýþýndaki týbbi belirteçleri ortaya koymaktýr.
GEREÇ VE YÖNTEM: Geriye dönük olarak planlanan bu çalýþmada etik kurul onayýný takiben, acil cerrahi ünitesinde, ameliyathanede ve cerrahi yoðun bakýmda organ baðýþçýsý olan hastalarýn 2000–2011 yýllarý arasýndaki kayýtlarý incelendi. Hasta demografileri, baðýþlanan organlarýn daðýlýmlarý, entübasyon sahasý, hastaneye nakil þekli ile hasta yakýnlarýnýn organ baðýþýný kabulleri esnasýnda hastanýn bulunduðu servis, travma türü, yaralanma mekanizmasýyla þiddetleri incelendi. Sürekli deðiþkenler baðýmsýz gruplarda student t-test veya Mann-Whitney U-testiyle, ikili deðiþkenler Pearson ki-kare testiyle deðerlendirildi. Acil serviste (AS) hayatýný kaybeden ve kaybetmeyen olgular yaþ bakýmýndan 1: 3 eþleþtirmeyle kýyaslandý. Sonuçlar çoklu lojistik regresyonla deðerlendirildi.
BULGULAR: Sistolik kan basýncý (SKB) 90 mmHg’nin altýndaki hastalarla, penetran travma olgularý AS’ye organ baðýþý adayý olma olasýlýklarý çok daha yüksektir. Sýrasýyla (%68.2 ve %15.2, AOR: 4.59 [1.14, 18.40] [p<0.031]) ve %63.6 ve %37.9 (AOR: 6.25 [1.27–30.49] [p<0.024]). Beyin travmasý açýsýndan AIS ≥3 olmasýnýn ve 1500 cc veya daha fazla hastane kan ürünleri replasmaný yapýlan olgularda AS sonrasý organ baðýþçýsý olma olasýlýklarý daha yüksektir (%54.5 ve %97, AOR: 0.074 [0.014–0.548] [p<0.01]) ve (%10 ve %58.1, AOR: 0.098 [0.016-0.591], [p<0.01]).
TARTIÞMA: Travma sonrasý potansiyel organ vericileri belirlemede acil servise kabulde SKB’nin 90 mmHg altýnda olmasý ve ciddi penetran hasarlanmalar, beyin travmasý hasar skoru (AIS ≥3) ve 1500 cc üzeri kan ve kan ürünü replasmanlarýna göre potansiyel donörlerin belirlenmesinde daha öngördürücüdür.

BACKGROUND: The prediction of posttraumatic potential organ donors is a complex process. The aim of this study is to evaluate the organ procurement process in trauma-related injuries and determine the medical markers in organ donors and posttraumatic mortal patients at the first level emergency, in emergency surgical service, and surgical intensive care departments.
METHODS: In this retrospective study, after the approval of the ethics committee, the records of the patients in the emergency surgery unit, the operating room, and the organ donors in surgical intensive care unit between the years 2000 January–2011 December were examined. Patient demographics, distribution of donated organs, intubation area, transfer to the hospital, patient’s service, trauma type, injury mechanism, and severity of the injury were examined. Continuous variables were evaluated with independent samples by the Student’s t-test or Mann-Whitney U test and binary variables with the Pearson Chi-Square test. The patients who lost their lives and survived in the emergency department (ED) were compared with an age ratio of 1: 3. Final results were evaluated by multiple logistic regression.
RESULTS: The patients with ≤90 mmHg systolic blood pressure (SBP) or penetrant serious injuries were more likely to be candidates for organ donation in ED, respectively; 68.2% vs. 15.2% [AOR: 4.59 (1.14, 18.40), p<0.031] and 63.6% vs. 37.9% (AOR: 6.25 [1.27–30.49] [p<0.024]). Patients with AIS head ≥3 and in-hospital blood replacement of 1500 cc or more, were more likely to be organ donors after ED: 54.5% vs. 97% (AOR: 0.074 [0.014 kan0.548], [p<0.01]) and 10% vs. 58.1% (AOR: 0.098 [0.016–0.591], p<0.01]).
CONCLUSION: In terms of predictive traits for organ procurement, a SBP of ≤90 mmHg and presence of serious penetrant injuries were found to be more predictive for organ transplantation than other factors such as AIS Head ≥3 or 1500 cc or more replacement of blood and blood products.

AMAÇ: Künt travmalarda karýn bölgesi üçüncü en sýk etkilenen yerdir. Bu hastalarýn deðerlendirilmesinde bilgisayarlý tomografi (BT) altýn standarttýr. BT’nin hastaya olan zararlý etkileri ve maliyet yönünden düþünüldüðü zaman her acil servise gelen hastaya çekilmesi uygun bir yaklaþým olmayabilir. Çalýþmamýzda künt batýn travmasý ile acil servise gelen hastalarýn ultrasonografi (US) ve fizik muayene bulgularýnýn altýn standart olan BT ile karþýlaþtýrýlmasý yapýlarak gereksiz BT çekimlerinin önüne geçilmesi amaçlandý.
GEREÇ VE YÖNTEM: Hastanemiz acil servisine batýn travmasý ile gelen 2248 hastanýn dosya ve görüntüleri geriye dönük olarak tarandý ve çalýþmaya uygun olan ve acil servisteki fizik muayenesinin ardýndan US ve sonrasýnda BT çekilen 535 yetiþkin hasta çalýþmaya alýndý. Karýn içi serbest sývý ve organ laserasyonlarýnýn US ve fizik muayene bulgularý BT sonuçlarý ile ayrý ayrý karþýlaþýrýldý. Elde edilen deðerlerin uyumluluk, duyarlýlýk, özgüllük, pozitif ve negatif tahmini deðerleri istatistiksel olarak hesaplandý.
BULGULAR: Künt batýn travmalý hastalarda US’nin karýn içi serbest sývýyý gösterme duyarlýlýðý BT ile istatistiksel olarak benzerdi (p=0.302). Karýn içi organ yaralanmalarýnýn saptanmasýnda ise US’nin duyarlýlýðý %49.6, özgüllüðü %99.3 olarak bulundu. Fizik muayenenin ise BT’ye göre serbest sývý ve organ yaralanmasýnýn saptanmasýnda genel duyarlýlýðý %59, özgüllüðü %87 olarak hesaplandý. Organ yaralanmalarý için ayrý ayrý istatistiksel olarak hesaplandýðý zaman fizik muayenenin duyarlýlýk ve özgüllüðünün yüksek olmasýna raðmen istatistiksel olarak anlamlý bir belirleyiciliðinin olmadýðý görüldü (p<0.001).
TARTIÞMA: Ultrasonografinin karýn içi sývý saptanmasýnda gerçekten güvenilir bir yöntem olduðu anlaþýlmakla birlikte organ yaralanmalarýnýn saptanmasýnda US ve fizik muayenenin güvenilir olmadýðý görülmektedir.

BACKGROUND: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations.
METHODS: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods.
RESULTS: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001).
CONCLUSION: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

AMAÇ: Kafa travmalarý tüm yaþ gruplarýnda görülebilen, saðlýk ve ekonomi açýsýndan önemli kayýplara neden olabilen bir saðlýk sorunudur. Çalýþmamýzýn amacý, acil servise minör kafa travmasý nedeniyle baþvuran ve bilgisayarlý beyin tomografisi (BBT) çekilen hastalarda, anormal BBT prevalansýný ve beyin cerrahi kliniðine yatýþ oranlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmada Afyonkarahisar Saðlýk Bilimleri Üniversitesi Týp Fakültesi Hastanesi Acil Servisi’ne 01.01.2017–31.12.2017 tarihleri arasýnda kafa travmasý nedeniyle gelen ve BBT çekilen hastalar geriye dönük olarak incelendi. Hastane bilgi sisteminden bu hastalarýn elektronik dosyalarýna, BBT’lerine ve konsültasyon notlarýna ulaþýldý.
BULGULAR: Bir yýllýk (2017) süre içerisinde acil servise baþvuru yapan 43.389 hastaya ulaþýldý. Ýnceleme sonucunda 2515 (%5.7) hastaya BBT çekildiði saptandý. Bu hastalarýn 1152’sinin (%45) baþvuru nedeni travma idi. Travmaya baðlý olarak BBT çekilen 618 (%53.6) hastanýn 18 yaþ altý olduðu, 280 (%24.3) hastanýn iki yaþ altý olduðu, 179 (%15.5) hastanýn beyin cerrahisi kliniði ile konsülte edildiði ve 94 (%8.1) hastaya yatýþ verildiði saptandý. BBT çekilen sadece 68 (%5.9) hastada anormal BT bulgularý saptandý.
TARTIÞMA: Acil servise minör kafa travmasý ile gelenlerde, daha önce tespit edilen ve güvenilirliði kanýtlanan BBT çekim endikasyon kriterlerinin kullanýlmasý, düþük riskli hastalarýn takip edilmesi, gereksiz BBT çekimlerini ve çekime baðlý uzun dönemde geliþebilecek komplikasyonlarý azaltabilir.

BACKGROUND: Head trauma is a health problem that may be observed in all age groups, and it may cause significant losses in terms of health and economy. The purpose of our study is to evaluate the abnormal computerized brain tomography (CBT) prevalence and the rate of admission to brain surgery clinics in patients who applied to the Emergency Service Department for CBT due to minor head trauma.
METHODS: In the present study, the patients who were admitted to Afyonkarahisar Health Sciences University, Faculty of Medicine Hospital, Emergency Service Department between January 1st, 2017, and December 31st, 2017, due to head trauma and in who CBT was performed were examined retrospectively. The electronic files, CBTs, and consultation notes of these patients were accessed in the information system of the hospital.
RESULTS: A total of 43,389 patients who applied to the Emergency Service Department in 1 years’ time (2017) were examined retrospectively. As a result of the examination, it was determined that a total of 2,515 (5.7%) patients received CBT. The reason for a total of 1,152 (45%) of these patients was traumatic injury. It was determined that 618 (53.6%) of the patients in who CBT was performed due to trauma were aged <18 years; 280 (24.3%) patients were aged <2 years; 179 (15.5%) patients had to consult with the Brain Surgery Clinic; and 94 (8.1%) were hospitalized. It was also determined that there were abnormal computed tomography (CT) findings in only 68 (5.9%) of the patients in who CBT was performed.
CONCLUSION: The use of CBT indication criteria, which have been previously established and which reliability has been proven, in emergency trauma cases applying to the Emergency Service Department with minor head traumas may reduce the complication risk that may appear as a result of an unnecessary CBT and avoid complications that may occur in the long run due to CBT.

AMAÇ: Dekompresif kraniyektominin (DK) pediyatrik subdural hematom hastalarýndaki sonuca etkisi tam olarak belirlenmemiþtir. Bu çalýþmada pediyatrik yaþ grubunda travmatik subdural hematom hastalarýnda DK rolünü araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Pediyatrik akut subdural hematom hastalarýnda DK deneyimimiz sonuç analizleri ile açýklandý.
BULGULAR: On bir (7 tek taraflý ve 4 iki taraflý) DK uygulandý. Hastalarýn yaþlarý 8 ay ile 15 yaþ arasýnda idi. Ortalama Glasgow koma skoru (GKS) baþvuru anýnda 7.8 idi ve hastalarýn tümü ilk iki saat içinde duraplasti ile birlikte DK ameliyatýna alýndý. Tüm hastalar ameliyat sonrasý dönemde 10 gün yoðun bakým ünitesinde izlendi. Hastalarýn ortalama hastanede kalýþ süreleri 22 gün ve ortalama takip süreleri 3.7 yýl idi.
TARTIÞMA: Pediyatrik subdural hematom hastalarýnda erken DK hastaneye baþvuru anýndaki GKS’den baðýmsýz olarak yararlýdýr. Pediyatrik yaþ grubunda endikasyonlar, cerrahi teknik ve DK’nýn zamanlamasý için daha geniþ hasta sayýlý çalýþmalara ihtiyaç vardýr.

BACKGROUND: The impact of decompressive craniectomy (DC) on the overall outcome of pediatric acute subdural hematoma patients has not been fully determined to date. In this paper, we aimed to investigate the role of decompressive craniectomy performed to treat traumatic subdural hematoma in patients from the pediatric age group.
METHODS: We described our experience with DC in pediatric acute subdural hematoma patients and analyzed the outcomes.
RESULTS: Eleven (7 unilateral and 4 bilateral) DCs were performed. The patients’ ages ranged from 8 months to 15 years. The mean GCS score at admission was 7.8. All patients underwent DC with duraplasty within 2 hours of injury. All the patients were admitted to the intensive care unit for 10 days postoperatively. The mean hospital stay was 22 days and the mean follow-up period was 3.7 years.
CONCLUSION: Early DC for pediatric subdural hematoma patients, independent of their initial GCS, was recommended. Larger studies are needed to define the indications, surgical techniques, and timing of DC in the pediatric population.

AMAÇ: Bu geriye dönük çalýþmanýn amacý, ateþli silah yaralanmalarýnda ilk müdahelede geçici vasküler þant (GVÞ) uygulamasýnýn etkilerini irdelemektir.
GEREÇ VE YÖNTEM: Ekim 2013 ve Mart 2016 tarihleri arasýnda ateþli silah yaralanmasý nedeniyle ameliyat edilen 96 hasta çalýþmaya alýndý. Hastalar; ilk giriþim olarak GVÞ uygulanan hastalar (GVÞ grubu, n=24) ve ilk giriþim olarak kompresyon, turnike ve ligasyon/klempaj uygulanan hastalar (GVÞ yapýlmayan grup, n=72) olmak üzere iki gruba ayrýldý.
BULGULAR: Yaralanma mekanizmasý karþýlaþtýrýldýðýnda, her iki grup arasýnda fark yoktu. Ayný þekilde ortalama hematokrit seviyesi, ortalama sistolik kan basýncý, eþlik eden ven ile sinir ve yumuþak doku ve kemik yaralanmalarý her iki grupta benzerdi. Tüm ampütasyon oraný %19 idi. Biri GVÞ grubunda, 17’si diðer GVÞ yapýlmayan hasta grubunda olmak üzere toplam ampütasyon sayýsý 18 idi. Ortalama travmaya uðramýþ ekstremite skoru (MESS) GVÞ grubunda 6.45 iken GVÞ yapýlmayan grupta 7.44 idi. Ýskemi süresi GVÞ grupta 4.84±1.84 saat iken GVÞ yapýlmayan grupta 5.95±1.92 saat idi. MESS ve iskemi süresindeki farklýlýk istatistiksel olarak anlamlý deðerlendirildi.
TARTIÞMA: Geçici vasküler þant kullanýmýnýn iskemi süresini kýsaltmak ve cerrahi revaskülarizayon için zaman kazandýrmasý bakýmýndan hastalar için faydalý olabileceðini düþünmekteyiz. Sonuç olarak, bu çalýþma GVÞ kullanýmýnýn yaralanma baþlangýcýndan nihai cerrahi onarýmýna kadar baþarýlý bir köprü görevi gördüðünü ve ampütasyon oranýný azalttýðýný göstermektedir.

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention.
METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72).
RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84±1.84 h in the TVS group and 5.95±1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant.
CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.

AMAÇ: Kolon divertikül hastalarýnýn yaklaþýk %10–25’i hayatlarý boyunca kolon divertiküliti ile karþýlaþmaktadýrlar. Batý ülkelerinde sað taraflý divertiküler hastalýk nadir görülen bir durum iken, Asya ülkeleri arasýnda yaygýndýr. Bu çalýþmanýn amacý, sað kolon divertiküliti saptanýlan hastalarýmýzýn klinik ve tedavi sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: 2011 ve 2015 yýllarý arasýnda çekum ve sað kolon divertiküliti tanýsýyla tedavi edilen 22 hastanýn demografik ve klinik verileri analiz edildi. Radyolojik inceleme ve klinik bulgulara göre hastalara Hinchey Evrelemesi yapýldý. Daha sonra Hinchey Evrelemesine göre hastalarýn demografik ve klinik özelliklerinin oransal olarak deðerlerine ve istatistiksel olarak olarak anlamlýlýðýna bakýldý.
BULGULAR: Araþtýrmamýza sað kolon divertiküliti tanýsý konulan 22 hasta alýndý. Kadýn/erkek oraný 0.69 idi. Karýn tomografisi ile yapýlan deðerlendirme sonrasýnda hastalarýn %68.1’i Hinckey evre I, %31.8’i Hinckey evre II divertikülit saptandý. Çoðunlukla Hinchey Evre I divertikülit sað kolonda (%66.7) ve Hinchey Evre II divertikülit çekumda (%57.1) bulundu. Hinchey Evre II hastalarýnýn ortalama yaþý daha yüksekti (ortalama, 63.6 yýl) ve istatistiksel olarak anlamlýydý (p<0.05). Ýki hastada apendektomi ve bir hastada sað hemikolektomi yapýlmýþtý. Diðer 19 hastaya konservatif tedavi uygulandý. Ortalama hastanede yatýþ süresi 3.4 gündü. Ýki yýllýk takipte konservatif tedavi alan dört hastada nüks görüldü; cerrahi tedavi alan hastalarda nüks görülmedi.
TARTIÞMA: Sað kolon divertiküliti genellikle doðu toplumlarýnda 50 yaþ altý erkeklerde ve soliter olarak görülmektedir. Tedavi seçeneði olarak özellikle komplike olmayan olgularda konservatif yöntemler tercih edilmelidir. Cerrahi tedavi ise genellikle nüks ve komplike olgularýn tedavisinde kullanýlmalýdýr.

BACKGROUND: Approximately 10%–25% of patients with colon diverticular disease experience colonic diverticulitis during their lives. Right-sided diverticulosis is a rare condition in Western countries, but it is common among Asian countries. The aim of this study was to evaluate the clinical and treatment outcomes in our patients with right colon diverticulitis.
METHODS: Demographic and clinical data of 22 patients with a diagnosis of cecum and right-sided colon diverticulitis between 2014 and 2017 were analyzed. The Hinchey staging was applied according to the radiological evaluation and clinical findings. Then, the proportions of demographic and clinical features of the patients according to the Hinchey staging and its statistical significance were evaluated.
RESULTS: Our study included 22 patients who suffered from right colon diverticulitis. The female-to-male ratio was 0.69. A total of 68.1% of the patients were the Hinchey Stage I, and 31.8% were the Hinchey Stage II, all of which were evaluated by tomography. The Hinchey Stage I diverticulitis was mostly found in the right colon (66.7%) and the Hinchey Stage II diverticulitis in the cecum (57.1%). The mean age of the Hinchey Stage II patients was higher (63.6 years) and statistically significant (p<0.05). Two patients had appendectomy, and one had right hemicolectomy. Conservative treatment was applied to other 19 patients. The mean hospitalization time was 3.4 days. Four patients who received conservative treatment at the 2-year follow-up had recurrence. No recurrence was observed in patients receiving surgical treatment.
CONCLUSION: Right colon diverticulitis is usually seen in solitary men aged <50 years from Eastern societies. As a treatment option, conservative methods should be preferred, especially in uncomplicated cases. Surgical treatment is usually used in the treatment of recurrent and complicated cases.

AMAÇ: Acil kliniðe baþvuran hastalar arasýnda 5. metakarp boyun kýrýðýna baðlý yaralanmalar yaygýndýr. Travma mekanizmasý çeþitli tiplerde olabildiði gibi bazý durumlarda istemli yaralanamalar görülebilmektedir. Beþinci metakarpal boyun kýrýk yaralanmalarý etiyolojiye baðlý olarak tedavi ve rehabilitasyon aþamalarýnda psikolojik faktörlerin önemli rolü olabilmektedir. Bu aþamada istemli veya istemsiz olarak meydana gelen yaralanmalarýnýn sonuçlarýnýn karþýlaþtýrýldýðý bir araþtýrma yapýlmamýþtýr. Bu çalýþmada, yaralanma mekanizmalarý arasýndaki sosyoekonomik düzey, eðitim seviyesi ve klinik sonuçlar arasýndaki iliþkiyi incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma metakarp boyun kýrýklý 59 hastayý kapsamaktadýr. Hastalar iki ayrý grup olarak deðerlendirildi. Grup 1 istemli yaralanmalý hastalar ve Grup 2 istemsiz yaralanmalý hastalar ile oluþturuldu. Her iki grup öfke analizi, dürtüsel düzey ve anksiyete düzeylerinin somatik bulgular VAS ve Q-DASH skorlarý ile olan iliþkisi açýsýndan deðerlendirildi. Ayrýca öfke, dürtüsellik ve anksiyete düzeylerinin sosyoekonomik ve eðitim seviyesi ile olan iliþkisi deðerlendirildi.
BULGULAR: Grup 2 hastalarda öfke ve dürtüsellik deðerleri Grup 1’e göre daha düþük olduðu ve Grup 2’deki bu düþük deðerlerin VAS ve Q-DASH skorýndaki düþüþle parelel olduðu görüldü. Grup 1 hastalarda Barrat dürtüsellik skor 61.5 (42–78), anksiyete skor 64 (55–77), öfke skoru 20 (16–30) ve Grup 2’de barrat dürtüsellik skor 61 (55–69), anksiyete skor 66 (58–72), öfke skoru 19 (14–26) ortalama deðer olarak bulundu. Eðitim düzeyi düþük olan hastalarda dürtüsellik skor deðerleri ve öfke skor deðerleri Grup 2’de düþük bulunmuþtur. Düþük gelire sahip hasta sayýsý her iki grupta yüksek olarak bulunmuþ ve bu hastalarda dürtüsellik skor deðeri, öfke skor deðeri Grup 1’de yüksek, anksiyete skor deðeri Grup 2’de yüksek olarak bulunmuþtur.
TARTIÞMA: Sosyodemografik faktörlerin ve etiyolojinin istemli yaralanma oluþmasýnda psikolojik faktörler açýsýndan etkinliði saptanamamýþ, ancak istemli beþinci metakarp boyun kýrýklarýn klinik olarak el fonksiyonlarý üzerindeki etkileri ve tedavi sonrasý aðrý seviyesinde etkili rol oynadýðý görülmüþtür.

BACKGROUND: The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures.
METHODS: The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed.
RESULTS: It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42–78), anxiety score 64 (55–77), state anger score 20 (16–30), and Group 2 barrat impulsivity score 61 (55–69), anxiety score 66 (58–72), and anger score 19 (14–26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2.
CONCLUSION: Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

AMAÇ: Bu çalýþmanýn amacý, basit pertrokanterik kýrýklar için proksimal femur antirotasyon çivisinin (PFNA) klinik ve radyolojik sonuçlarýný dinamik kalça çivisi (DHS) ve perkütan kompresyon plaðý (PCCP) ile karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmaya 203 hasta alýndý. Hastalarýn 73’ünde PFNA (PFNA grubu), 68’inde DHS (DHS grubu) ve 62’sinde PCCP (PCCP grubu) ile fiksasyon yapýldý. Ana sonuç ölçümleri perioperatif özellikler, Harris kalça skoru, boyun-þaft açýsýnýn deðiþimi ve abdüktör kas kuvveti kaybý idi. Veriler gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Ortalama tahmini toplam kan kaybý ve kan transfüzyonu alan hasta oraný PFNA grubunda istatistiksel anlamlý olarak düþüktü. Ortalama operasyon ve floroskopi süreleri PCCP grubunda istatistiksel anlamlý olarak yüksekti. Ortalama boyun þaft açýsýndaki deðiþim ve abdüktör kas gücü kaybý PFNA grubunda istatistiksel anlamlý olarak yüksekti. Ortalama Harris kalça skorlarý benzerdi.
TARTIÞMA: Bulgularýmýz, PFNA’nýn perioperatif verilerde üstün olmasýna raðmen DHS ve PCCP’nin redüksiyonun ve abdüktör kas gücünün sürdürülmesinde üstün olduðunu göstermiþtir. Her üç implant da fonksiyonel sonuçlar açýsýndan benzer ve tatmin edici idi.

BACKGROUND: The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures.
METHODS: A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck–shaft angle, and loss of the abductor muscle strength. Data were compared between the groups.
RESULTS: The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck–shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar.
CONCLUSION: Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.

Yüksekten düþme sonrasýnda özellikle inþaat iþçilerinin etkilendikleri çelik çubuk saplanmasý bilinen bir travma türüdür, fakat sadece çok az sayýda þanssýz kiþi bu tarz bir travma sonrasýnda spinal kord hasarý ile karþýmýza gelmektedir. Yüksek enfeksiyon riski, farklý güzergahlara baðlý çok fazla varyasyon gösteren klinik tablolar ve ilgili herhangi bir mevcut kýlavuzun bulunmamasý bu tarz travmalarýnýn baþarýlý yönetimini zorlaþtýrmaktadýr. Bu yazýdaki amacýmýz, nadir görülen spinal kord hasarýna neden olan çelik çubuk saplanmasý olan bir hasta sunmak, ilgili literatürleri tarayarak bu travmanýn yönetimini geliþtirmek ve enfeksiyon baþta olmak üzere komplikasyonlara neden olan risk faktörlerini belirlemektir. Otuz yedi yaþýnda erkek inþaat iþçisi çalýþýrken yüksekten düþme sonrasý perinesinden girip L4 omurga gövdesine saplanan çelik çubuk nedeniyle baþvurdu. Muayenesinde sol ayakta motor ve duyu kaybý mevcuttu. Çelik çubuk genel anestezi altýnda operasyon odasýnda çekildi ve sonrasýnda laparotomi ile rektal laserasyon primer onarýlýp kolostomi açýldý. Farklý bir oturumda laminektomi yapýldý. Hastanýn taburcu olduktan üç ay sonraki muayenesi geliþi ile aynýydý ve hasta koltuk deðnekleri ile yürüyebiliyordu. Bu olgu, dikkatli bir ameliyat öncesi planlama, multidisipliner yaklaþým ve farklý sekanslý planlanan giriþimler ile kabul edilebilir bir klinik sonuç elde edilmesi açýsýndan örnek teþkil etmektedir. Laparatomi öncesi kapalý olarak çubuðun çýkartýlabileceðinin uygunluðunu ve olasý yararlarýný ortaya koymaktadýr. Baðýrsak perforasyonu enfeksiyon riskini artýrmaktadýr fakat bu durumda bile enfeksiyon önlenebilir. Olay ve cerrahi arasýndaki sürenin kýsa olmasý enfeksiyon ihtimalini azaltabilir.

Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old male construction worker presented to our emergency department due to falling onto a concrete reinforcing steel rod that penetrated through his perineum to the L4 vertebra. Examination revealed paralysis and sensory loss of the left foot. The rod was removed in the operating room (closed removal) under general anesthesia, followed by laparotomy. Rectal laceration was primarily repaired, and colostomy was performed. In a separate session, laminectomy was performed. At 3 months post-discharge, the patient was ambulatory with armrest based on the same motor examination performed on presentation This case is a good example of careful preoperative planning, multidisciplinary involvement, and appropriately sequenced interventions resulting in an acceptable outcome for an injury with high morbidity and mortality and demonstrates the feasibility and potential benefits of closed removal of the rod in an operating room just before laparotomy. The presence of an intestinal perforation increases the infection risk, but infections can still be prevented in this setting. Shorter time intervals between the incidence and surgery may reduce the infection rate.

Transvajinal ince baðýrsak evisserasyonu nadir görülmekle birlikte, taný konulduðu anda acil cerrahi giriþim gerektiren bir klinik tablodur. Olgumuzda da evissere olan baðýrsak segmentinde iskemi bulgularý geliþmiþ, ince baðýrsak mezosunda yýrtýk oluþmuþ ve ince baðýrsak rezeksiyonu yapýlmasý gerekmiþtir. Seksen dokuz yaþýnda kadýn hasta dört saattir olan ani baþlayan karýn aðrýsý, baðýrsaklarýn vajinadan çýkma þikayeti ile getirildi. Hastanýn yapýlan muayenesinde yaklaþýk 50 cm’lik ince baðýrsak ansýnýn mezosu ile birlikte vajenden evissere olduðu görüldü. Baðýrsak anslarý ödemli olup, yer yer iskemi bulgularý ve mezoda yýrtýlma mevcuttu. Hasta acil olarak ameliyata alýndý. Yetmiþ cm’lik ince baðýrsak rezeksiyonunu takiben fonksiyonel uc-uca anastomoz yapýldý. Vajen defekti transvajinal olarak çift kat üzerinden tamir edildi. Transvajinal ince baðýrsak evisserasyonu literatürde az rastlanan bir durumdur. En sýk postmenapozal, yaþlý, daha önceden geçirilmiþ vajinal ameliyatý olan, enteroseli olan kadýnlarda görülmektedir. Tedavisi acil cerrahi giriþimdir. Yapýlacak cerrahi hastanýn bulgularýna göre transvajinal olarak vajen güdüðünün tamir edilmesinden, laparotomi yapýlmasýna hatta baðýrsak rezeksiyonu yapýlmasýna kadar deðiþiklik gösterebilir. Postmenapozal, daha önceden geçirilmiþ vajinal ameliyatý olan hastalar gibi risk taþýyan hastalar ani baþlayan karýn aðrýsý ile baþvurduklarýnda transvajinal ince baðýrsak evisserasyonu da ayýrýcý tanýda düþünülmelidir. Tanýsý konulduktan sonra da hastalar en kýsa sürede ameliyata alýnýp gerekli cerrahi giriþim yapýlmalýdýr.

Transvaginal small bowel evisceration is a rare, life-threatening condition, requiring urgent surgical intervention. In our case, ischemia developed in the intestinal segment with evisceration, with a laceration in the small intestine of the mesentery, and finally, a small bowel resection was required. An 89-year-old woman was brought to the hospital with a sudden onset of abdominal pain, which lasted for 4 hours. Upon the examination, it was found that approximately 50 cm of the small intestine was eviscerated from the vagina, with its mesentery. The intestines were edematous, and also there were signs of ischemia on the mesentery. The patient was urgently transferred to surgery. Functional end-to-end anastomosis was performed, following a 70 cm small bowel resection. The vaginal defect was repaired transvaginally. Transvaginal small bowel evisceration is rarely described in the literature. It is most commonly seen in postmenopausal, elderly women who underwent vaginal surgery before and who have enterocele. The treatment is an emergent surgical approach. Surgical treatment should be based on individual patient. Various surgical techniques have been described for the repair of transvaginal small bowel evisceration, such as vaginal, abdominal, laparoscopic, and combined approaches. Transvaginal small bowel evisceration should be considered in the differential diagnosis of patients with a sudden onset abdominal pain. Patients with an increased risk for transvaginal small bowel evisceration are postmenopausal women and patients who underwent vaginal surgery before. After the accurate diagnosis, patients should be operated as soon as possible, and necessary surgery should be done.