AMAÇ: Fibronektin (FN), hücre dýþý matriksin vazgeçilmez bir parçasýdýr. Rejenerasyon veya yara iyileþmesi sýrasýnda FN’nin plazma formu, geçici bir fibrin-FN matrisi oluþturmak için fibrin pýhtýlarýna dahil olur ve ayrýca lokal olarak sentezlenen hücresel FN, yaralý dokuyu rejenere etmek için pýhtýya göç eder. Bu çalýþmada tavþanlarda deneysel yara iyileþme modelinde yara dokusu EIIIB ve plazma EIIIB ekspresyon düzeylerini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Plazma ve doku EIIIB ekspresyon düzeyleri, tavþanlarýn kutanöz yara modelinde RT-qPCR ile seri olarak ölçüldü.
BULGULAR: Doku FN ekspresyonu 3. günden baþlayarak arttý, 6. ve 9. günlerde artmaya devam etti, azalmaya baþlamadan önce 12. günde maksimum ekspresyona ulaþtý. Doku seviyelerinin aksine, plazma FN seviyeleri ekspresyon baþlangýç deðerlerine döndüðünde 15. güne kadar kademeli olarak azaldý.
TARTIÞMA: Sonuç olarak, mevcut çalýþmanýn bulgularý, yara iyileþmesi sýrasýnda doku EIIIB ekspresyon seviyesinin arttýðýný desteklemektedir; plazma EIIIB ekspresyon seviyesi minimum düzeyde azalýr. Bu, plazma FN’nin geçici olarak ECM oluþumuna yardýmcý olduðu raporlarýn aksine deðerlerdir. Bu nedenle verilerimiz, yara iyileþme sürecini hýzlandýrmada EIIIB’nin doku düzeyinde önemli bir rol oynadýðýný göstermektedir. Ayrýca, deneyde kullandýðýmýz ölçme yöntemimiz olan RT-qPCR yöntemi, antikor bazlý yöntemlere kýyasla daha doðru ve kesin sonuçlar saðlayabilir.

BACKGROUND: Fibronectin (FN) is an indispensable part of the extracellular matrix. During regeneration or wound healing, the plasma form of FN is incorporated into the fibrin clots to form a temporary fibrin-FN matrix, and also locally synthesized cellular FN migrates to the clot to regenerate the injured tissue. We aimed to examine wound tissue FN EIIIB and plasma FN EIIIB expression levels in an experimental wound healing model in rabbits.
METHODS: Plasma and tissue EIIIB splice variant expressions were measured serially with RT-qPCR in a cutaneous wound model of rabbits.
RESULTS: Tissue FN expression increased as beginning on day 3 and continued to increase on days 6 and 9, reaching maximum expression at day 12 before starting to decrease. On the contrary to the tissue levels, plasma FN levels gradually decreased until day 15 when expression returned to the initial values.
CONCLUSION: The findings of the current study support that tissue EIIIB expression level increases during wound healing; and plasma EIIIB expression level decreases minimal changed. This is in contrast to reports where plasma FN provisionally helps ECM formation. Therefore, our data show an essential role of EIIIB at the tissue level in accelerating the wound healing process. The RT-qPCR method in our experimental setup can provide more accurate and precise results compared to the antibody-based methods.

AMAÇ: Enflamatuvar baðýrsak hastalýðý (EBD) önemli bir saðlýk sorunudur. Hastalýðýn patogenezinde ileri sürülen en önemli hipotezler baðýrsak florasýndaki bakterilere karþý tolerans kaybý ve immün yanýtýn bozulmasýdýr. Çok geniþ araþtýrmalara raðmen, EBD’nin tedavisi hala zordur. Bu çalýþmada deneysel kolit modelinde sarýmsak yaðýnýn (GO) etkilerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Yirmi sekiz sýçan rastgele dört eþit gruba ayrýldý; grup 1 (sham), grup 2 (kontrol), grup 3 (topikal tedavi grubu) ve grup 4 (topikal ve sistemik tedavi grubu). Grup 2, 3 ve 4’te asetik asitle indüklenen kolit modeli oluþturuldu. Grup 2’ye salin, grup 3’e topikal GO ve grup 4’e topikal ve sistemik GO verildi.
BULGULAR: Hidroksiprolin seviyeleri tedavi gruplarýnda kontrol grubundan daha düþüktü. Grup 3’teki TNF-α seviyeleri kontrol grubuna göre anlamlý olarak düþüktü. Makroskopik skorlarý grup 4’te kontrol grubundan anlamlý olarak düþüktü. Tedavi gruplarý ve kontrol grubu arasýnda epiteliyal kayba göre anlamlý fark gözlendi.
TARTIÞMA: Sarýmsak yaðý asetik aside baðlý kolit modelinde kolonik hasarý ve enflamasyonu azaltýr. Bu etki, topikal uygulamada daha belirgin olmakla birlikte hem topikal hem de sistemik uygulamada ortaya çýkmaktadýr.

BACKGROUND: Inflammatory bowel disease (IBD) is an important health problem. The most important hypotheses for the pathogenesis of this disease are the deterioration of immune responses and loss of tolerance against bacteria in the enteric flora. Although IBD has been widely investigated, its treatment remains difficult. This study aims to investigate the effects of garlic oil (GO) on an experimental colitis model.
METHODS: Twenty-eight rats were randomly divided into four equal groups as follows: group 1 (sham), group 2 (control), group 3 (topical treatment) and group 4 (topical and systemic treatment). An acetic acid-induced colitis model was produced in groups 2, 3 and 4 and was administered normal saline, topical GO and topical and systemic GO, respectively.
RESULTS: Hydroxyproline levels were lower in the treatment groups than in the control group. TNF-α levels were significantly lower in group 3 than in group 2. Macroscopic scores were significantly lower in group 4 than in group 2. Significant differences were observed between the treatment and control groups according to their epithelial loss.
CONCLUSION: GO can reduce colonic damage and inflammation in the acetic acid-induced colitis model, with effects on both local and systemic treatments, but with a more pronounced effect in local treatment.

AMAÇ: Çalýþmamýzýn hipotezi, sugammadeks’in sýçanlarda iskemi reperfüzyon (Ý/R) hasarýna karþý koruyucu etkinliðe sahip olmasýdýr.
GEREÇ VE YÖNTEM: Çalýþmaya 28 erkek Wistar Albino sýçaný dahil edildi. Sýçanlar dört gruba ayrýldý. Sham grubuna anestezi uygulamasý dýþýnda bir giriþim uygulanmadý. Kontrol grubuna 3 saat iskemi ve 24 saat reperfüzyon uygulandý. Sgdks4 grubu ve Sgdks 16 grubu, intravenöz olarak sýrasýyla 4 mg/kg ve 16 mg/kg sugammadeks aldý ve ardýndan reperfüzyon uygulandý. Histopatolojik inceleme ve serum kreatin kinaz (CK), laktat dehidrojenaz (LDH), serum ve doku malondialdehid (MDA) ve süperoksit dismutaz (SOD) analizleri yapýldý.
BULGULAR: Sham grubu ve kontrol grubu karþýlaþtýrýldýðýnda, histopatolojik olarak istatistiksel olarak anlamlý farklýlýklar vardý (p<0.01). Sgdks4 grubu ile sham ve kontrol gruplarý arasýnda histopatolojik olarak anlamlý fark yoktu (p>0.01). Sgdks16 grubu ile sham grubu arasýnda histopatolojik olarak anlamlý bir fark vardý (p<0.01). Sham ve kontrol gruplarý arasýnda CK ve LDH düzeyleri açýsýndan anlamlý fark vardý (p<0.01). Kontrol grubu ile Sgdks4 grubu arasýnda CK düzeyleri arasýnda ve kontrol grubu ile Sgdks16 grubu arasýnda CK ve LDH düzeylerinde anlamlý bir fark vardý (p<0.01).
TARTIÞMA: Çalýþmamýzda, sýçanlarda tek taraflý alt ekstremite Ý/R yaralanmasý üzerine 4 mg/kg sugammadeks’in histolojik ve biyokimyasal koruyucu etkileri incelendi. 4 mg/kg sugammadeks dozunun 16 mg/kg dozdan daha etkili olduðunu görüldü.

BACKGROUND: The hypothesis of our study is that sugammadex has protective efficacy against ischemia-reperfusion (I/R) injury in rats.
METHODS: Our study included 28 male Wistar Albino rats. The rats were assigned to four groups. The sham group had no procedure other than anesthesia administration. The control group received three hours of ischemia and 24 hours of reperfusion. The Sgdx4 group received 4 mg/kg, and the Sgdx16 group received 16 mg/kg sugammadex intravenously, and then, reperfusion was applied. Histopathological investigation, and serum creatine kinase (CK), lactate dehydrogenase (LDH), and serum and tissue malondialdehyde (MDA) and superoxide dismutase (SOD) analyses were performed.
RESULTS: When the sham group and the control group were compared, there were statistically significant differences histopathologically (p<0.01). There was no significant difference between the Sgdx4 group compared with the sham and control groups histopathologically (p>0.01). There was a significant difference between the Sgdx16 group and the sham group histopathologically (p<0.01). There were significant differences between the sham and control groups concerning CK and LDH levels (p<0.01). There was a significant difference in the levels of CK between the control group and Sgdx4 group and in the levels of CK and LDH between the control group and Sgdx16 group (p<0.01).
CONCLUSION: In our study, we examined the histological and biochemical protective effects of 4 mg/kg sugammadex on unilateral lower extremity I/R injury in rats. The findings suggest that a 4 mg/kg dose of sugammadex was more effective than a 16 mg/kg dose.

AMAÇ: Sepsis enfeksiyona karþý oluþan sistemik bir enflamatuvar yanýttýr ve morbidite ve mortalitenin ana nedenlerinden biridir. Travma sonrasý ikinci darbe artmýþ enflamatuvar yanýta ve çoklu organ yetersizliðine (ÇOY) neden olur. Yanýk hasarý sonrasý geliþen enfeksiyon iki darbe travma çalýþmasý için uygun bir modeldir. Sepsis çoklu organ yetersizliðinde anahtar rol oynayabilecek lipid peroksidasyonuna neden olan serbest oksijen radikalleri (SOR) gibi biyokimyasal mediyatörlerin salýnýmýna neden olur. Biz bu çalýþmada iki darbe modelinde fosfodiesteraz (PDE) inhibitörleri (sildenafil, milrinon, pentoksifilin) ve N-asetilsisteinin (NAS) oksidatif stres ve organ hasarý üzerindeki etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu deneysel çalýþmada 40 sýçanda %30’luk haþlama yanýðý oluþturulduktan 72 saat sonra çekal ligasyon ve ponksiyon (CLP) yöntemi ile peritonit oluþturuldu. Sýçanlar her biri sekiz sýçandan oluþan beþ gruba ayrýldý. Grup I: Tedavi uyulanmadý; Grup II: CLP sonrasýnda 72 saat boyunca 10/mg/kg gün dozunda intraperitoneal (i.p) sildenafil tedavisi uygulandý; Grup III: CLP sonrasýnda 72 saat boyunca 1/mg/kg gün dozunda i.p milrinon tedavisi uygulandý; Grup IV: CLP sonrasýnda 72 saat boyunca 150/mg/kg gün dozunda i.p NAS tedavisi uygulandý; Grup V: CLP sonrasýnda 72 saat boyunca 50/mg/kg gün dozunda i.p pentoksifilin tedavisi uygulandý. Tüm sýçanlar deneyin yedinci gününde sakrifiye edildi. Malondialdehit (MDA), glutatyon peroksidaz (GPx), süperoksit dismutaz (SOD), katalaz, tümör nekröz faktör alfa (TNF-α), düzeyleri ve histopatolojik çalýþma için doku (akciðer, böbrek) ve serum örnekleri alýndý.
BULGULAR: Kontrol grubu ile karþýlaþtýrýldýðýnda tedavi edilen tüm gruplarda doku hasar skoru düþük bulundu. Sildenafil, milrinon ve NAS gruplarýnda böbrek GPx düzeyi kontrol grubuna göre yüksek bulundu. Akciðer dokusunda milrinon ve pentoksifilin gruplarýnda SOD kontrol grubuna göre yüksek bulunurken milrinon ve NAS ile GPx düzeyi yüksek bulundu. Böbrekte pentoksifilin ve milrinon gruplarýnda TNF-α düzeyi kontrol grubuna göre düþük bulundu.
TARTIÞMA: Bu deneysel çalýþma iki darbe modelinde PDE inhibitörleri ve NAS’nin oksidatif stres düzeyini ve uzak organ hasarýný azaltýcý etkileri olduðunu göstermiþtir. Bu konu üzerinde ileri klinik ve deneysel çalýþmalara ihtiyaç vardýr.

BACKGROUND: Sepsis is a systemic inflammatory response to infection and is one of the leading causes of morbidity and mortality. The second hit after trauma causes increased inflammatory response and multiple organ failure (MOF). The infection which develops after burn injury is a suitable model for a two-hit trauma study. Sepsis causes the release of biochemical mediators, such as Free Oxygen Radicals (FORs), which may lead to lipid peroxidation, which may play a key role in multiple organ failure. In this study, we aimed to investigate the effects of phosphodiesterase (PDE) inhibitors (sildenafil, milrinone, pentoxifylline) and N-acetylcysteine (NAS) on oxidative stress and organ damage in two-hit models.
METHODS: In this experimental study, peritonitis was created by cecal ligation and puncture (CLP) method in 40 rats, 72 hours after creating a 30% scalding injury. Rats were divided into five groups of eight rats each as follows: Group I: No treatment; Group II: 10/mg/kg/day dosage of intraperitoneal (i.p) sildenafil treatment was applied for 72 hours after CLP; Group III: 1/mg/kg/day dosage of i.p milrinone treatment was applied for 72 hours after CLP; Group IV: 150/mg/kg/day dosage of i.p NAS treatment was applied for 72 hours after CLP; Group V: 50/mg/kg/day dosage of i.p pentoxifylline treatment was applied for 72 hours after CLP. All rats were sacrificed on the seventh day of this study. Malondialdehyde (MDA), Glutathione Peroxidase (GPx), Superoxide Dismutase (SOD), catalase, Tumor Necrotic Factor-alpha (TNF-α) levels, and tissue (lung, kidney) and serum samples were taken for histopathological study.
RESULTS: When compared to the control group, the tissue damage score was found to be lower in all treatment groups. Sildenafil, milrinone and NAS groups had higher kidney GPx levels compared to the control group. Milrinone and pentoxifylline were higher in the lung tissue compared to the SOD control group. TNFα levels were lower in pentoxifylline and milrinone groups compared to the control group.
CONCLUSION: This experimental study has shown that PDE inhibitors and NAS have a decreasing effect on oxidative stress and distant organ damage in the two-hit model. Further clinical and experimental studies are needed on this subject.

AMAÇ: Künt göðüs travmasýndan sonra, yaralanma sonrasý erken dönemde ve yaralanmadan birkaç gün sonra hayati tehlike oluþturan aritmiler ortaya çýkabilir. Bu çalýþmada, künt göðüs travma hastalarýnda Tp-e aralýðý, Tp-e/QT oraný ve Tp-e/QTc oraný kullanýlarak aritmi riskini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmada künt göðüs travmasý nedeniyle acil servise baþvuran hastalar ileriye yönelik olarak incelendi. Künt göðüs travmasý ve kontrol gruplarýna 12 derivasyonlu EKG uygulandý. Her iki gruptan da QT ve Tp-e aralýklarýnýn EKG ölçümleri yapýldý.
BULGULAR: Kýrk bir künt göðüs travmalý hasta ve 40 saðlýklý gönüllü olmak üzere, toplamda 81 katýlýmcý çalýþmaya dahil edildi. Tpe, Tpe/QT, Tpe/QTc deðerleri travma grubunda kontrol grubuna göre istatistiksel olarak anlamlýydý (p<0.01). Her ne kadar Tpe/QTc, maksimum QT ve min QT, kaburga kýrýðý olan hastalarda istatistiksel olarak anlamlý olsada (p<0.05) kaburga kýrýðý olmayan gruba göre Tpe, Tpe/QT açýsýndan fark bulunmadý (p>0.05).
TARTIÞMA: EKG’de Tpe aralýðý, Tp-e/QT oraný ve Tp-e/QTc oraný, künt kardiyak travmada, özellikle künt göðüs travma hastalarýnda oluþabilecek aritmileri öngörmektedir.

BACKGROUND: After blunt chest trauma, life-threatening arrhythmias may occur in the early post-injury period, as well as a few days after the injury. This study aimed to evaluate the risk of arrhythmias in blunt chest trauma patients using Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio.
METHODS: In this study, patients who applied to the emergency department due to blunt chest trauma were examined prospectively. The 12-lead ECG was performed to both blunt chest trauma and control group. ECG measurements of QT and Tp-e intervals were performed from both groups.
RESULTS: A total of 81 participants; 41 blunt chest trauma patients and 40 healthy volunteers were included in this study. Tpe, Tpe/QT, Tpe/QTc values were statistically significant in the trauma group compared to the control group (p<0.001). Although Tpe/QTc, max QT and min QT were statistically significant (p<0.05) in patients with a rib fracture, no difference was detected concerning Tpe, Tpe/QT compared to no-rib fracture group (p>0.05).
CONCLUSION: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in ECG predict the arrhythmias that may occur in blunt cardiac trauma, especially in blunt chest trauma patients.

AMAÇ: Bu ileriye yönelik çalýþmanýn amacý künt toraks travmalarý nedeniyle izole kot fraktürü geliþen olgularda solunum fizyoterapisi ve aðrý kontrolünün, olasý komplikasyonlardan hemotoraks ve/veya pnömotoraks geliþim riski üzerine etkisinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Bu ileriye yönelik çalýþmaya Çanakkale Onsekiz Mart Üniversitesi Týp Fakültesi Hastanesi Acil Servis ve Göðüs Cerrahisi Polikliniði’ne, künt toraks travmasý sonrasý ilk 24 saat içinde baþvuran ve izole kot fraktürü tespit edilen hastalar alýndý. Kot fraktürü olan hastalardan ilk baþvuru anýnda hemotoraks, pnömotoraks, yelken göðüs, atelektazi, pnömoni, akciðer kontüzyonu gibi ek yaralanmasý olmayan hastalar çalýþmaya dahil edildi. Hastalar, kapalý zarf usulü sadece analjezik tedavi verilecek hastalar (Grup A) ve analjezik tedavi ile birlikte solunum fizyoterapisi verilecek hastalar (Grup B) olarak iki ayrý gruba ayrýldý. Birinci ve ikinci kot fraktürü saptanan olgular ile üç veya daha fazla kot fraktürü saptanan ve ek organ yaralanmasý olmayan hastalar göðüs cerrahisi kliniðine, ek organ yaralanmasý olanlar ise ilgili kliniklere yatýrýlarak takibe alýndý. Bu kriterlerin dýþýnda kalan izole kot fraktürlü hastalar ise gerekli tedavileri düzenlenerek poliklinikten takip edildi. Olgular travmayý takip eden ilk hafta ve birinci ayýn sonunda fizik muayene ve radyolojik incelemeler ile deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen 114 hastanýn yaþlarý ortalama 56.3±16.4 (22–87) olarak bulundu. Hastalarýn 37’si (%32.5) kadýn, 77’si (%67.5) erkekti. A ve B gruplarýna 57’þer hastadan oluþtu. Hastalarýn en sýk geçirdikleri travma %31.6 ile ayný seviyeden düþme idi. Hastalarýn kot fraktürü sayýlarýnýn ortalamasý 2.6±0.7 (1–10), ortanca sayý 1.5 olarak bulundu. Bu 114 hastanýn 52’si (%45.6) hastanede yatarak tedavi edildi. Çalýþmaya alýnan hastalarýn yatýþ süreleri incelendiðinde hastalarýn ortalama yatýþ süresi 4.0±1.1 idi. Tedavi ve takipleri sonucunda çalýþmaya alýnan 114 hastanýn 28’inde (%24.6) kot fraktürü geliþen tarafta plevral efüzyon saptandý. Hastalarda plevral efüzyon geliþme durumunun gruplara göre daðýlýmý incelendiðinde B grubundaki hastalarda (%43.9) A grubundaki hastalardan (%5.3) istatistiksel olarak anlamlý þekilde daha fazla plevral efüzyon geliþimi izlendi (p<0.0001). Çalýþmamýzda takipler sonucunda A grubundaki hiçbir hastaya müdahale gerekmezken, B grubundaki dört hastaya hemotoraks tanýsýyla tüp torakostomi uygulandý (p<0.05).
TARTIÞMA: Çalýþmamýzda künt toraks travmasý sonucu izole üç ve daha fazla kot fraktürü geliþen hastalarda solunum fizyoterapisi uygulamalarýnýn gecikmiþ hemotoraks geliþme riskini önemli derecede artýrdýðý, minimal hemotorakslarýn (<300 ml) uygun takip prosedürlerine uyulduðu takdirde spontan regrese olabileceði ve ek cerrahi müdahaleye gerek olmayabileceði tespit edilmiþtir. Künt toraks travmasý sonucu üç ve daha fazla kot fraktürü olan hastalara eðer solunum fizyoterapisi uygulanmasý planlanýyorsa hastalarýn hastaneye yatýrýlarak takip ve tedavi edilmesi olasý riskleri içeren ek komplikasyonlar geliþebilmesi açýsýndan önerilebilir.

BACKGROUND: This prospective study aims to investigate the effect of chest physiotherapy and analgesic therapy on the possible complications of isolated rib fractures attributable to blunt thoracic trauma, such as hemothorax and pneumothorax.
METHODS: Patients who presented to Çanakkale Onsekiz Mart University School of Medicine Hospital’s Emergency Department and Thoracic Surgery outpatient clinics within the first 24 hours of the post-traumatic period and did not have additional intrathoracic complications at presentation with blunt thoracic trauma and who were diagnosed with isolated rib fractures were enrolled in this prospective research study. The groups were designated as the patients who would receive analgesic treatment only (Group A) and the patients who would receive chest physiotherapy and analgesic treatment together (Group B). Patients who had first and second rib fractures or three or more rib fractures and who did not have additional organ injury were hospitalized in the Thoracic Surgery clinics; patients who had other organ trauma were hospitalized in related clinics. Patients were reassessed on their seventh and 30th post-traumatic days with physical examination and radiologic studies.
RESULTS: The mean age of the 114 patients were 56.3±16.4 (22–87). There were 37 (32.5%) women and 77 (67.5%) men. Each group included 57 patients. The most common form of trauma was the same-level falls (31.6%). The mean number of rib fractures of all participants was 2.6±0.7 (1–10); the median number was 1.5. Fifty-two (45.6%) patients were hospitalized. The mean length of stay was 4.0±1.1 days. At the end of their treatment and follow-up periods, pleural effusion was found in 28 patients (24.6%) out of 114 enrolled at the side of trauma. Group B had a higher number of patients with pleural effusion (43.9%) than group A (5.3%). We performed tube thoracostomy in four patients, all of which were in group B (p<0.05).
CONCLUSION: As a result of this study, chest physiotherapy maneuvers have increased the incidence of late hemothorax in patients with three or more isolated rib fractures. Also, minimal hemothoraces (<300 ml) may spontaneously regress, and no additional surgical treatment are required if the proper follow-up procedures are performed. It is advisable to hospitalize the blunt thoracic trauma patients who have three or more rib fractures and who are planned to undergo chest physiotherapy and or are prone to develop additional complications because of possible risks.

AMAÇ: Yüze alýnan travmalarda internal orbital hasar görülebilir. Artan intraorbital basýnç ile yumuþak doku bütünlüðünü bozulmadan orbital rimde ya da orbita tabanýnda kýrýk oluþumuna “blow-out fraktürü” adý verilir. Yalnýzca orbita tabanýnýn etkilendiði kýrýklar “saf blow-out fraktürü” adý verilirken, zigoma, maksilla ve nazoetmoid kemiklerin de etkilendiði kýrýklar “saf olmayan, kompleks blow-out fraktürleri” olarak nitelendirilir. Fizik muayenede periorbital ödem ve ekimiz, subkonjonktival kanama, göz hareketlerinde kýsýtlýlýk, diplopi,enoftalmi, distopi ve infraorbital hipoestezi bulgularý görülebilir. Orbital kemik yapýlarýn rekonstruksiyonu hem standart göz fonksiyonunun saðlanmasý hem de estetik görünüm için elzemdir. Cerrahi yaklaþým ve zamanlamasý açýsýndan birçok görüþ olmasýna raðmen bir konsensus oluþmamýþtýr. Literatürde, orbita kemik defektlerini düzeltilmesi için birçok otojen ve alloplastik biyomateryallerin kullanýmý konusunda çalýþmalar mevcuttur.
GEREÇ VE YÖNTEM: Bu çalýþmada, saf ve kompleks blow-out fraktürü olan, kartilaj ve ya kemik greftleri ile titanyum mesh ya da poroz polietilen implant kullanýlarak orbital rekonstrüksiyonu yapýlan olgularýn postoperatif sonuçlarý karþýlaþtýrýlmýþtýr. 2011–2018 yýllarý arasýnda kliniðimize maksillofasiyal travma ile baþvuran 62 olgunun 64 orbital taban kýrýðý çalýþmaya dahil edildi. Tüm hastalara maksillofasiyal muayene yapýldý, radyolojik olarak Waters radyografi ve ayrýca aksiyal-koronal düzlem maksillofasiyal ve orbital bilgisayarlý tomografi ile deðerlendirildi.
BULGULAR: Ýliyak kemik grefti ile rekonstrüksiyon yapýlan 14 hastanýn 3’ünde aþýrý bakýþta kalýcý, ameliyat sonrasý, dikey diplopi saptandý. Aurikula konkal kartilaj grefti ile rekonstrüksiyon yapýlan 19 olgunun ikisinde operasyondan dört ay sonra aþýrý bakýþlarda dikey diplopi mevcuttu. Ýmplant, gözenekli polietilen implant grubundaki 15 hastanýn 2’sinde ekstrüde oldu ve palpe edilebilir hale geldi. Ýliyak kemik ve konkal karitlaj otogreft gruplarýnda hiçbir hastada greft rezorpsiyonuna göre geç postoperatif enoftalmi izlenmedi. Titanyum mesh grubunda 11 hastadan 1’inde aþýrý bakýþlarda kalýcý, ameliyat sonrasý dikey diplopi mevcuttu. Bu gruptaki hiçbir hastada herhangi bir donör bölgesi komplikasyonu, enfeksiyon veya implant ekstrüzyonu geliþmedi.
TARTIÞMA: 4 cm²’den küçük defektlere yol açan blow-out fraktürlerinde kullanýlabilecek en iyi biyomateryal aurikula konkal kartilaj iken; titanyum mesh 4 cm²’den büyük defektleri onarmak için iyi bir seçenek olmuþtur. Bununla birlikte, orbita blow-out fraktürlerini onarmak için kullanýlacak optimal biyomateryalin seçimi hasta özellikleri ve preoperatif bulgulara, yaralanmanýn ciddiyetine, kullanýlacak biyomateryalin maliyetine ve cerrahýn uzmanlýðýna göre yapýlmalýdýr.

BACKGROUND: Trauma to the face caused by assault or impact may cause internal orbital fracture. Increased intraorbital pressure without disruption of soft tissue integrity or causing a fracture line in orbital rims or orbital floor fractures described as “orbital blow-out fracture”. Such fractures have been categorized as “pure blow-out fractures” in which only the orbital floor is affected, and “impure blow-out fractures” in which other maxillofacial bones such as zygoma, maxilla and nasoethmoid are also affected. Physical examination reveals periorbital edema and ecchymosis, subconjunctival hemorrhage, limitation of eye globe movements, diplopia, enophthalmos, dystopia, and infraorbital hypoesthesia. Reconstruction of the orbital bony structures is the most important issue to preserve the standard orbital functions and providing an aesthetic view. Although many surgical approaches have been defined in the literature regarding the attitude and timing of treatment, no consensus exists. In literature; many autogenous and alloplastic biomaterials have been recommended to correct orbital bone defects.
METHODS: This study aims to compare postoperative outcomes of patients presenting with pure and impure blow-out fractures repaired with cartilage, bone grafts, titanium mesh or porous polyethylene implant. Sixty-four orbital floor fractures of 62 cases were included in this research who admitted to our clinic with maxillofacial trauma between 2011 and 2018. All patients underwent maxillofacial radiological examination; Waters radiography and also axial-coronal plane maxillofacial and orbital computerized tomography.
RESULTS: Permanent, post-operative, vertical diplopia in extreme gazes was detected in 3 of 14 patients in whom the orbital floor was reconstructed with an iliac bone graft. Two of nineteen cases who underwent reconstruction using auricular conchal cartilage graft had vertical diplopia in extreme gazes four months after the operation. The implant extruded and became palpable in 2 of 15 patients in the porous polyethylene implant group. None of the patients in the iliac bone and conchal cartilage autograft groups was presented late postoperative enophthalmos according to the graft resorption. In titanium mesh group, 1 of eleven patients had permanent, post-operative vertical diplopia in extreme gazes. None of the patients in this group developed any donor area complications, infection, or implant extrusion.
CONCLUSION: Results show that the auricular conchal cartilage graft was the best biomaterial used to repair defects smaller than 4 cm², where as titanium mesh was a good option to repair defects larger than 4 cm². However, selection of the optimal biomaterial to be used to repair orbital blow-out fractures should be made according to patient characteristics and preoperative findings, the severity of the injury, the cost of the biomaterial to be used, and surgeon’s expertise.

AMAÇ: Hafif kafa travmasý acil servise (AS) konsültasyon için sýk baþvurulma nedenidir. Bilgisayarlý tomografi (BT) kullanýmý hastalarýn bakýmýný önemli ölçüde iyileþtirmiþtir. Ýyi bir zaman yönetimi ve yorumu gereklidir. Bu yazýda, AS yönetiminde hafif kafa travmasý önerilerine uyum düzeyi ve simülasyon temelli bir eðitimin (SBT) profesyonel uygulama deðiþiklikleri üzerindeki etkisi incelendi.
GEREÇ VE YÖNTEM: Bir AS’de, SBT öncesinde ve sonrasýnda hasta bakýmý için profesyonel uygulamanýn 2012 yýlýnda kurulan Fransýz Acil Týp Derneði’nin (Société Française de Médecine d’Urgence: SFMU) önerilerine göre teorik ve simülasyon kurslarýný içeren deðerlendirmesi yapýldý. BT taramasý yapmak için zaman analizine, ayrýca beyin ve omurga tarama endikasyonlarýna ve hastaneye yatýþ kriterlerine uyum analizine dayanýyordu.
BULGULAR: Mesleki uygulamalarýn deðerlendirilmesinde gerçekleþtirilen SBT, kriterleri karþýladýðýnda bir saat içinde BT taramasý sonucunu alma açýsýndan aciliyet kavramýný edinmeyi mümkün kýlmaktadýr (p=0.007). SBT’den sonra hastaneye yatýþ önerilerine uyumuna iliþkin deðerlendirici güvenilirliði daha iyi idi (p=0.03, Kappa’yý 0.73’den 0.93’e yükseltti). Öte yandan, týbbi dosyada kafa travmasýnýn oluþ zamaný gibi temel bilgilerin eksik olduðu ortaya çýktý.
TARTIÞMA: Bu tip hastanýn yönetimi tatmin edici görünmektedir. SBT tarafýndan SFMU 2012 uzlaþý konferansý temelinde SBT uygulanarak bu durum geliþtirilebilir. Acil servisler tarafýndan kullanýlan ve travma zamanýný ve önerileri içermesi gereken yazýlýmý geliþtirmeye ihtiyaç vardýr. Klinik ve biyobelirteçlerin birlikteliði BT taramasýnýn endikasyonlarýný sýnýrlamaya ve böylece daha hýzlý organize edilmesine yardýmcý olabilir.

BACKGROUND: Minor head injury is a frequent reason for consultation in the emergency department. The use of computed tomography (CT) has increased dramatically in patients’ care. Good time management implementation and interpretation are required. To study the level of agreement with recommendations for a minor head injury in emergency department management and the impacts of simulation-based training (SBT) on professional practice changes.
METHODS: Evaluation of professional practice for patient care in an emergency department according to the recommendations of the French Emergency Medicine Society (SFMU) established in 2012 before and after an SBT, including theoretical and simulation courses. It was based on the analysis of time to carry out a CT scan. It was also based on analysis of adherence to brain and spine scan indications and to hospitalization criteria.
RESULTS: The SBT carried out in the evaluation of the professional practices makes it possible to acquire the notion of urgency to obtain the CT Scan within one hour when the criteria are met (p=0.007). Rater reliability for agreement with the hospitalization recommendations was better after SBT (p=0.03, increased Kappa from 0.73 to 0.93). On the other hand, there appeared to be a lack of essential information in the medical file, such as time of onset of head trauma.
CONCLUSION: Management of this type of patient appeared to be satisfactory. It can be improved by SBT on the basis of the SFMU 2012 consensus conference. There is a need to improve the software used by the emergency departments, which should include the time of trauma and recommendations. The association of the clinic and the biomarkers could help to limit the indications of the CT scan, and thus to have it organized more rapidly.

AMAÇ: Bu retrospektif çalýþma akut apandisit ön tanýsýyla apendektomi yapýlan gebe ve gebe olmayan hastalarýn demografik ve klinikopatolojik özelliklerini karþýlaþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Haziran 2009 ve Ocak 2019 tarihleri arasýnda üreme çaðýndaki 431 kadýn hastaya akut apandisit ön tanýsýyla apendektomi yapýldý. Hastalar gebelik durumlarý gözönünde bulundurularak iki gruba ayrýldý: Gebe grup (n=48) ve gebe olmayan grup (n=383). Her iki grup demografik, klinik ve histopatolojik özellikler yönünden karþýlaþtýrýldý.
BULGULAR: Gebe ve gebe olmayan gruplar arasýnda total bilirubin (p=0.019) ve ultrasonografik bulgular (p=0.016) dýþýnda istatistiksel olarak anlamlý farklýlýk saptanmadý. Gebe olmayan grupta negatif apendektomi ve perforasyon oranlarý sýrasýyla %26 ve %10.5 olarak hesaplanýrken gebe grupta bu oranlar sýrasýyla %20.8 ve %4.2 olarak hesaplandý. Ultrasonografinin gebe grubundaki sensistivite, spesifisite ve doðruluk oranlarý sýrasýyla %50, %100 ve %58.5 olarak saptanýrken gebe olmayan grupta bu oranlar sýrasýyla %67.3, %57.9 ve %65 olarak bulundu. Gebelerin %52.1’i birinci trimesterda, %29.2’si ikinci trimesterda ve geriye kalan %16.7’si üçüncü trimesterdaydý. Miadýnda gerçekleþen doðumlarýn (%87.5) hiçbirinde fetal veya maternal komplikasyon geliþmedi. Buna karþýn preterm gerçekleþen doðumlarýn (%12.5) ikisi neonatal mortalite ile sonuçlandý.
TARTIÞMA: Ýstatistiksel olarak anlamlýlýk göstermemekle birlikte gebelerde negatif apendektomi ve perfore akut apandisit oranlarý gebe olmayan hastalara göre daha düþük bulundu ki bu durumun en önemli sebebi akut karýn ile baþvuran gebelerin klinik olarak daha hassas bir þekilde deðerlendirilmesidir.

BACKGROUND: This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis.
METHODS: Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features.
RESULTS: No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality.
CONCLUSION: Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.

AMAÇ: Çalýþmamýzda anevrizmal subaraknoid kanama (aSAK) hastalarýnýn yoðun bakým izlemlerinde hemodinamik deðiþiklikleri ve hidrasyon, hipertansiyon tedavisi sýrasýnda PiCCO ile ölçülen hemodinamik parametrelerin klinik seyre etkisini inceledik.
GEREÇ VE YÖNTEM: Çalýþmamýzda 01.03.2015 ve 01.03.2016 tarihleri arasýnda cerrahi klip veya endovasküler koil ile anevrizmasý tedavi edilen, eriþkin, 15 aSAK hastasý vazospazm açýsýndan incelendi. Günde en az iki kez PiCCO ölçümü yapýldý. Sývý tedavisi günlük en az 1000 mL pozitiflik olacak þekilde, Global end-diyastolik Ýndeks (GEDÝ) deðeri 680–800 mL/m2 þeklinde hedeflendi. Hastalarýn geliþ ortalama arter basýncý (OAB), sistolik arter basýncý (SAB), kalp atým hýzý (KAH), santral venöz basýnç (CVP) ve kardiyak indeks (CI), GEDI, sistemik vasküler rezistans indeksi (SVRI), ekstravasküler akciðer volüm indeksi (ELWI) deðerleri kaydedildi. Hastalarýn günlük nörolojik muayeneleri, klinik vazospazm bulgularý, GKS deðerleri kaydedildi.
BULGULAR: Hastalarýn volüm durumlarý ve volüm tedavisi takibinde CVP deðerinin rastgele deðiþtiði fakat termodilüsyon ile saptanan GEDI deðerinin uyumlu olduðu görüldü. Hastaneye geliþ süresi ile ilk ölçülen SVRI deðeri arasýnda ileri düzeyde pozitif korelasyon saptandý. Düþük GEDI deðerinin vazospazm açýsýndan risk faktörü olduðu bulundu.
TARTIÞMA: Volüm tedavisinin takibindeki deðiþikliklerle GEDI deðerindeki deðiþikliklerin uyumlu olduðu görüldü. Düþük GEDI deðerinin vazospazm açýsýndan risk faktörü olduðu bulunmasýna raðmen, önerilecek ideal bir GEDI deðeri saptanamadý.

BACKGROUND: In this study, we investigated the hemodynamic changes in patients with aneurysmal subarachnoid hemorrhage (aSAH) during the intensive care unit and the effects of PiCCO on the hemodynamic clinical course during hydration and hypertension treatment.
METHODS: In our study, 15 adult aSAH patients, whose aneurysm had been treated by surgery or coiling, were examined for the signs of vasospasm in between the dates 03/01/2015 and 01/03/2016. The PICCO measurement was made at least twice in a day. Positive daily fluid balance was attempted to be at least 1000 mL and the value of the Global end-diastolic index (GEDI) was targeted to 680 to 800 mL/m2 for each patient. The values of mean arterial pressure (MAP), systolic arterial pressure (SAP), heart rate (HR), central venous pressure (CVP), and cardiac index (CI), GEDI, systemic vascular resistance index (SVRI), extravascular lung water index (ELWI) measured by PiCCO, and daily neurological outcome of patients and GCS values were recorded.
RESULTS: It had been observed that CVP value was randomly changing during the volume therapy, but the GEDI value determined by thermodilution was consistent. A positive correlation was detected between the period of reaching the hospital and the first measured value of SVRI. Low GEDI value was detected as a risk factor in the perspective of vasospasm, but an ideal GEDI value could not be determined.
CONCLUSION: GEDI values were correlated with daily fluid balance. While low GEDI value was found as a risk factor, we could not determine an ideal GEDI value.

AMAÇ: Metalik yabancý cisim maruziyeti sonrasý oluþan korneal yaralanmalarda lazer fotometri kullanarak ön kamara flare deðiþikliklerini deðerlendirmek.
GEREÇ VE YÖNTEM: Bir gözünde yabancý cisim yaralanmasý olan 54 hastanýn saðlýklý gözü karþýlaþtýrmalý, gözlemsel ve kesitsel bir çalýþmada incelendi. Flaredeki deðiþkenlik demografik özellikler, önceki maruziyetlerin öyküsü, korneal yabancý cismin yaralý korneadaki yeri ve penetrasyonuna göre analiz edildi.
BULGULAR: Korneal yabancý cisim gelen gözlerde ortalama flaremetre deðeri diðer kontrollere göre anlamlý derecede yüksekti (sýrasýyla, 11.35±14.17 ph/ms ve 6.30±3.81 ph/ms) (p=0.014). Daha önce birden fazla korneal yabancý cisim çýkarýlmasý öyküsü olan gözlerde, flaremetrenin ortalama deðeri diðerlerinden anlamlý derecede düþüktü (p=0.029).
TARTIÞMA: Korneanýn yabancý cisme maruz kalmasýyla flare deðeri artar. Bununla birlikte, daha önce birçok korneal yabancý cisme maruz kalma durumunda, flare deðeri muhtemelen korneanýn duyarsýzlaþtýrýlmasýndan dolayý nispeten düþük olabilir.

BACKGROUND: This study aims to use laser flare photometry to evaluate flare changes in patients following corneal damage from a metallic foreign body (FB).
METHODS: Foreign body injured eyes and the healthy fellow eyes of 54 consecutive patients were studied in this comparative, observational, cross-sectional study. Flare levels were analyzed according to demographics, history of previous exposures, foreign body location, and foreign body penetration into the injured cornea.
RESULTS: The mean flare value was significantly higher for the eyes with corneal foreign body injury compared to the fellow-control eyes (11.35±14.17 ph/ms and 6.30±3.81 ph/ms, respectively) (p=0.014). The mean flare values were significantly lower in eyes with a history of more than one previous corneal foreign body removal flare values than in other eyes (p=0.029).
CONCLUSION: Flare is increased by corneal foreign body exposure. However, eyes that experience multiple previous corneal foreign body exposures may show relatively low flare, probably due to corneal desensitization.

AMAÇ: Hafif travmatik beyin hasarý (mTBI), Glascow Koma Skalasý (GCS) 13 ve üzerinde olan, taný alamayan aksonal hasar nedeniyle geç dönemde ‘sessiz epidemik’ olarak adlandýrýlan bir halk saðlýðý sorunudur. Bilgisayarlý tomografi (BT) ve konvansiyonel manyetik rezonans gorüntülemede (MRG) hasara baðlý mikrohemorajiler çoðunlukla görüntülenememektedir. Bu çalýþmada, MRG sekanslarýndan duyarlýlýk aðýrlýklý görüntülemenin (SWI) mTBI olgularýnda uygulanabilir olup olmadýðýnýn araþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Beyin hasarý sonrasý GCS’si 14 ve 15 olan, kýsa süreli bilinç bulanýklýðý, konsantrasyon zorluðu, hafýza kaybý, baþ aðrýsý, baþ dönmesi, dengesizlik gibi semptomlarý bulunan 58 hasta acil serviste deðerlendirildi. Altýncý saatten sonra semptomlarý gerilemeyen hastalara beyin BT ve difüzyon aðýrlýklý ve SWI sekanslarýný içeren MRG çekildi. On üç hasta, ileri yaþ, diyabet, hipertansiyon öyküsü ve kronik sekel deðiþiklikler, akut serebrovasküler hastalýk bulgusu bulunmasý nedeniyle dýþlandý.
BULGULAR: Olgularýn BT bulgularý normaldi, difüzyon aðýrlýklý sekanslarda difüzyon kýsýtlanmasý izlenmedi. Yedi hastada (%15.6) SWI’da mikrohemoraji odaklarý saptandý. Bunlarýn beþinde SWI’daki mikrohemoraji alanlarý konvansiyonel sekanslarda hiperdens odaklar olarak izlendi. Bu olgularýn üçünde ise mikrohemoraji odaklarý sayý ve boyut açýsýndan SWI sekansýnda T2A ve FLAIR’a göre artmýþtý.
TARTIÞMA: Diffüz aksonal hasara baðlý mikrohemoraji varlýðýný ve ciddiyetini deðerlendirebilen SWI, hafif beyin hasarlý (mTBI) hastalarda semptomlarýn nedenini açýklamak, nedene yönelik tedavisini sürdürmek ve geliþebilecek komplikasyonlarý önlemek için tavsiye edilir.

BACKGROUND: Mild traumatic brain injury (mTBI) is a public health problem that is recognized as a “silent epidemic” in its late stages due to undiagnosed axonal damage rated 13 and above on the Glasgow Coma Scale (GCS). Injury-related microhemorrhages often cannot be detected on computed tomography (CT) scans and conventional magnetic resonance imaging (MRI). This study aims to investigate whether susceptibility-weighted imaging is feasible in mTBI patients.
METHODS: Fifty-eight patients with GCS scores of 14 and 15 and with symptoms of brief mental fogs, impairment of concentration, memory loss, headache, dizziness, or imbalance after brain injury were examined at the emergency service. A brain CT scan and MRI containing diffusion-weighted and susceptibility-weighted imaging (SWI) sequences were performed on the patients whose symptoms did not seem to alleviate after the sixth hour. Thirteen patients were excluded from this study because of advanced age, diabetes, a history of hypertension or its chronic sequelae, or acute cerebrovascular disease; 45 patients were included in this study.
RESULTS: The patients’ CT results were normal, and no diffusion restrictions were observed. The SWI revealed microhemorrhages in seven patients (15.6%). Five of these patients had hyperintense areas in conventional sequences corresponding to the hemorrhages spotted in the SWI. In three of the five patients, these pockets of hemorrhages were higher in number and size in comparison with conventional in the SWI sequence.
CONCLUSION: Susceptibility-weighted imaging, which can be used to assess the presence and severity of microhemorrhages due to diffuse axonal injury, is recommended for determining the cause of symptoms in patients with mTBI, to continue targeted treatment and prevent complications that may develop.

AMAÇ: Bu çalýþmada, kolorektal kanser nedeniyle ameliyat edilen ve yoðun bakýmda takip edilen hastalarda, C-reaktif proteinin plazma albüminine oranýnýn (CRP/ALB), güncel skorlama sistemleri ile karþýlaþtýrýlarak, morbidite ve mortaliteyi ön görmedeki sensitivite ve spesifitesini ortaya koymak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Kliniðimizde 2015–2018 yýllarý arasýnda verilerine ulaþýlabilen kolorektal kanser nedeniyle ameliyat olan ve yoðun bakýmda yatan hastalarýn verileri geriye dönük incelendi. CRP/ALB, hem gastrointestinal hemde kolorektal cerrahi için hazýrlanan, physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) ve kolorektal hastalar için hazýrlanan “Association of Coloproctology of Great Britain and Ireland” (ACPGBI-CRC) skorlama sistemlerinin mortalite ve morbidite ön görmedeki baþarýlarý karþýlaþtýrýldý.
BULGULAR: Toplam 119 hasta çalýþmada deðerlendirilmeye alýndý. Hastalarýn dokuzunda mortalite, 38’inde morbidite olduðu görüldü. Morbiditeyi gösteren tek skorlama sistemi olan P-POSSUM ile kýyaslandýðýnda CRP/ALB oranýnýn daha yüksek bir doðrulukla ön görüsü olduðu bulundu. Mortaliteyi göstermede, CRP/ALB deðerinin P-POSSUM, CR-POSSUM ve ACPGBI-CRC’ye oranla daha zayýf olduðu tespit edildi.
TARTIÞMA: Skorlama sistemleri kolorektal hastalarda morbidite ve mortaliteyi tahmin etmede kullanýþlý olsa dahi pratikte çok fazla parametre içerdikleri için kullanýmlarý zordur. Bu çalýþmanýn sonuçlarýna göre, ek maliyet getirmeden hesaplanabilecek CRP/ALB oranýnýn mortalite ve özellikle morbiditeyi tahmin etmede klinisyene yardýmcý olabileceðini düþünüyoruz.

BACKGROUND: This study aims to demonstrate the sensitivity and specificity of C-reactive protein to plasma albumin (CRP/ALB) ratio in predicting morbidity and mortality in patients operated for colorectal cancer followed up in the intensive care unit by comparing it with current scoring systems.
METHODS: The data of patients who underwent surgery for colorectal cancer and hospitalized in the intensive care unit between 2015–2018 with available data were retrospectively analyzed in this study. The CRP/ALB ratio, the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) prepared for both gastrointestinal and colorectal surgery, and the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CRC) scoring system prepared for colorectal patients, were compared to determine their success in predicting mortality and morbidity.
RESULTS: A total of 119 patients were included in this study. Mortality was observed in nine patients and morbidity was observed in 38 patients. When compared with P-POSSUM, which is the only scoring system showing morbidity, the CRP/ALB ratio was found to have a high prediction accuracy. The C reactive protein to plasma albumin ratio values was found to have lower power than P-POSSUM, CR-POSSUM and ACPGBI-CRC.
CONCLUSION: Although scoring systems are useful in predicting morbidity and mortality in colorectal patients, they are difficult to use in practice since they include many parameters. that the findings obtained in this study suggest that the CRP/ALB ratio, which can be calculated without any additional cost, may help the clinician predict mortality and especially morbidity.

AMAÇ: Araþtýrma, kombine mediolateral yaklaþýmla tedavi edilen intraartiküler distal humerus kýrýklarýnýn fonksiyonel sonuçlarýný deðerlendirmeyi ve eþ zamanlý olarak olekranon osteotomisi ile karþýlaþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Altmýþ iki distal humerus kýrýðý geriye dönük olarak incelendi. Otuz olguda (14 erkek, 16 kadýn) olekranon osteotomisi ve 32 olguda kombine mediolateral (15 erkek, 17 kadýn) yaklaþým kullanýldý. Fonksiyonel sonuçlar Mayo Dirsek Performans Skoru (Mayo Elbow Performance Score: MEPS) ve Kol, Omuz ve El Sakatlýklarý (Disabilities of Arm, Shoulder and Hand: DASH) anket skoru ile deðerlendirildi. Takip süreleri kombine mediolateral yaklaþým grubu için 15.4±3.5 ay (10–24 ay) ve olekranon osteotomisi için ise 14.6±2.6 ay (10–20 ay) idi.
BULGULAR: Dirseklerin fleksiyon-ekstansiyonu kombine mediolateral grupta 115.3°±16.1° ve olekranon osteotomisi grubunda 110.1°±15.2° idi. Dirseklerin fleksiyon-ekstansiyonu açýsýndan iki grup arasýnda anlamlý bir fark gözlendi (p=0.041). Önkollarýn pronasyon-supinasyonu açýsýndan kombine mediolateral grup (160.6°±7.2°) ile olekranon osteotomisi grubu (154.1°±9.3°) arasýnda anlamlý bir fark gözlenmedi (p=0.025). Kombine mediolateral yaklaþýmlar için ortalama MEPS, DASH skorlarýna göre mükemmel -iyi sonuç puanlarý ve komplikasyon oranlarý sýrasýyla 88.6±6.9 puana karþýn 9.8±6.6 puan ve %90.6’ya karþýn %9.4 idi. Ýki grup arasýnda komplikasyon oraný (p=0.005) dýþýnda ortalama MEPS, DASH skorlarý ve mükemmel ve iyi oranlar (sýrasýyla p=0.594, p=0.505, p=0.934) arasýnda önemli farklýlýklar görülmemiþtir.
TARTIÞMA: Kombine mediolateral yaklaþým, intraartiküler distal humerus kýrýklarýnýn (özellikle tip C1 ve C2) tedavisinde dirsek hareketi, ameliyattaki kanama hacmi ve komplikasyonlar açýsýndan olekranon osteotomisine göre daha iyi sonuçlar veren baþarýlý bir yaklaþýmdýr.

BACKGROUND: This research aimed to evaluate the functional outcomes of intra-articular distal humeral fractures treated through a combined medial-lateral approach and comparing with olecranon osteotomy simultaneously.
METHODS: In this study, 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10–24 months) for a combined medial-lateral group and 14.6±2.6 months (range 10–20 months) for olecranon osteotomy. Level of Evidence: Level, retrospective study.
RESULTS: The flexion–extension of elbows was 115.3°±16.1° in the combined medial-lateral group, and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion–extension of the elbows (p=0.041). Pronation–supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences were not noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005).
CONCLUSION: The combined medial-lateral approach is successful approach in the treatment of intra-articular distal humeral fractures (especially type C1 and C2) that provides better outcomes for the motion of the elbow, bleeding volume in surgery and complications than olecranon osteotomy.

AMAÇ: Ýnkarsere fýtýk, baðýrsaklarýn veya baþka bir abdominal dokunun fýtýk kesesi içerisinde sýkýþmasý ile oluþur. Boðulmuþ fýtýklardan gelen baðýrsak rezeksiyonlarýndan sonra morbidite ve mortalitede bir artýþ meydana gelir. Bu çalýþmanýn amacý, inkarsere fýtýklardan dolayý ince baðýrsak rezeksiyonu riskini belirlemede etkili olabilecek belirteçleri incelemektir. Bu riski belirlemede, özellikle kan laktat düzeylerinin etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Kesitsel, geriye dönük bir çalýþma tasarlandý. Ameliyat öncesi tanýsý hapsedilmiþ fýtýk olarak bildirilen ve gerekli bilgileri olan hastalar çalýþmaya dahil edildi. Rezeksiyona sahip olup olmadýklarýna göre iki gruba ayrýldý. Yaþ, cinsiyet, fýtýk tipi, fýtýk tarafý, rezeksiyon materyali, kan laktat seviyesi (BLL), beyaz kan hücresi (WBC), nötrofil sayýsý (NE), lenfosit sayýsý (LY), nötrofil/lenfosit oraný (NLR), trombosit sayýsý (PLT), laktat dehidrojenaz (LDH), radyolojik baðýrsak týkanýklýðý iþareti ve komorbiditeler deðerlendirildi.
BULGULAR: Ýlgili verileri elde edilebilen 67 hasta çalýþmaya dahil edildi. Bu hastalarýn 16’sýnda (%23.9) ince baðýrsak rezeksiyonu, 16’sýnda (%23.9) omentum rezeksiyonu, 35’inde (%52.2) rezeksiyon yapýlmadýðý görüldü. Radyolojik olarak baðýrsak týkanýklýðý (p=0.001), fýtýk tipi (p=0.005), BLL (p<0.001), WBC, NLR ve LDH deðerleri (p<0.05) arasýnda istatistiksel olarak anlamlý fark vardý. Laktat deðeri ≥1.46 mg/dL olan hapsedilmiþ fýtýk hastalarýnda duyarlýlýk %84.0 ve özgüllük %86.0 olarak gözlendi (p<0.001).
TARTIÞMA: Ýnkarsere fýtýk ön tanýsý olan hastalarda, olasý ince baðýrsak rezeksiyonu riski, bir operasyona karar vermede en önemli noktadýr. Radyolojik incelemelerde baðýrsak týkanýklýðýnýn varlýðý ve özellikle yüksek WBC, NLR, LDH ve BLL seviyeleri, olasý ince baðýrsak rezeksiyonu için bir gerekliliði gösterebilir. Ýnce baðýrsak rezeksiyonu ile iliþkili risk açýsýndan, ≥1.46 mg/dL kan laktat seviyeleri uyarýcý olabilir.

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk.
METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated.
RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001).
CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

AMAÇ: Korunmuþ ejeksiyon fraksiyonu (KEF-KY) ile kalp yetersizliðinin (KY) ve sýnýrda ejeksiyon fraksiyonu (SEF-KY) ile KY’nin kalça kýrýðý cerrahisini takiben perioperatif kardiyak ve kardiyak olmayan sonuçlar üzerindeki etkisini incelemek.
GEREÇ VE YÖNTEM: Kalça kýrýðý ameliyatý geçiren yaþlý hastalarýn (≥65 yaþ) verileri geriye dönük olarak incelendi. Sol ventrikül ejeksiyon fraksiyonu (SVEF) <%40 olan hastalar çalýþmaya dahil edilmedi. Ameliyat öncesi KEF-KY (SVEF ≥%50) ve SEF-KY (SVEF %40–49) tanýmý, hastalarýn ameliyat öncesi týbbi kayýtlarýnda KY’nin klinik dokümantasyonuna dayanmaktadýr. Çalýþmanýn birincil sonuçlarý perioperatif olumsuz olaylar ve mortaliteydi. Ýlgilenilen ikincil sonuç hastanede kalýþ süresiydi.
BULGULAR: Toplam 328 hasta (ort. yaþ 79.2±8.7 yýl ve %57.3 kadýn) çalýþmaya dahil edildi. Çalýþma popülasyonunun 250’sinde (%76.2) KY yoktu, 50’sinde (%15.2) KEF-KY ve 28’inde (% 8.6) SEF-KY vardý. Perioperatif kardiyovasküler ve kardiyovasküler olmayan komplikasyonlarýn sýklýðý %7.0 ile benzerdi. Ortalama hastanede kalýþ süresi 8.1±5.8 gündü ve hastane içi mortalite oraný %4.6 idi. KEF-KY ve SEF-KY hastalarýnýn kalýþ süresi daha uzundu ve KY olmayan hastalara göre perioperatif komplikasyon ve ölüm yaþama olasýlýðý daha yüksekti. Çok deðiþkenli analizler, KEF-KY ve SEF-KY varlýðýnýn her ikisinin de artmýþ perioperatif komplikasyonlar ve mortalite ile iliþkili olduðunu göstermiþtir.
TARTIÞMA: Çalýþmamýz, KEF-KY ve SEF-KY varlýðýnýn kalça kýrýðý ameliyatý geçiren yaþlý hastalarda perioperatif olumsuz olaylarý ve mortaliteyi tahmin edebileceðini göstermiþtir.

BACKGROUND: To examine the influence of heart failure (HF) with preserved ejection fraction (HFPEF) and HF with mid-range ejection fraction (HFmrEF) on perioperative cardiac and noncardiac outcomes following hip fracture surgery.
METHODS: Data of elderly patients (≥ 65 years) who underwent hip fracture surgery were retrospectively analyzed in this study. Patients with a left ventricular ejection fraction (LVEF) <40% were not included in this study. The definition of preoperative HFPEF (LVEF ≥50%) and HFmrEF (LVEF 40%–49%) was based on clinical documentation of HF in patients’ medical records before surgery. The primary outcomes of this study were perioperative adverse events and mortality. The secondary outcome of interest was the length of stay in the hospital.
RESULTS: A total of 328 patients (mean age 79.2±8.7 years, and 57.3% female) were enrolled. Of the study population, 250 (76.2%) patients had no HF, 50 (15.2%) patients had HFPEF, and 28 (8.6%) patients had HFmrEF before surgery. The frequency of perioperative cardiovascular and non-cardiovascular complications was similar to a rate of 7.0%. The mean length of hospital stay was 8.1±5.8 days, and the in-hospital mortality rate was 4.6%. Patients with HFPEF and HFmrEF had a longer length of stay and were more likely to experience perioperative complications and death than the patients without HF. Multivariate analyses showed that the presence of HFPEF and HFmrEF were both associated with increased rates of perioperative complications and mortality.
CONCLUSION: Our findings suggest that the presence of HFPEF and HFmrEF may predict perioperative adverse events and mortality in elderly patients undergoing hip fracture surgery.

AMAÇ: Ortogeriatrik popülasyonda kalça kýrýðý mortalite ve morbiditeye neden olan ve giderek sýklýðý artan bir saðlýk problemidir. Çalýþmamýzýn amacý pertrokanterik kýrýk nedeniyle sadece proksimal femur çivi (PFÇ) cerrahi yöntemi ile tedavi edilmiþ hastalarda; ameliyat öncesi nötrofil-lenfosit oranýnýn (NLO) ameliyat sonrasý mortalite riski için preditif bir deðer olup olmadýðýný irdelemektir. Literatürde benzer popülasyonda planmýþ baþka bir çalýþma tespit edilememiþtir.
GEREÇ VE YÖNTEM: Geriye dönük olarak planlanan çalýþmamýza ulusal ortopedi kurul sertifikalý iki cerrah tarafýndan PFÇ yöntemi ile ameliyatý gerçekleþtirmiþ 55 hasta alýndý. Hastalar ameliyat sonrasý ilk bir yýl hayatýný kaybedenler (Grup A [n=13]) ve hayatta kalanlar (Grup B [n=42]) olarak iki gruba ayrýldý. Tüm hastalarýn ameliyat öncesi NLO deðerleri, demografik bilgileri, hastanede kalýþ süreleri, ameliyat sonrasý yoðun bakým (POYB) ihtiyaçlarý ve komorbid hastalýklarý kayýt altýna alýndý.
BULGULAR: En uzun hasta takip süresi 27 ay olan çalýþmamýz sonucunda her iki grup arasýnda; yaþ, cinsiyet, vücut kitle indeksi, ameliyat öncesi American Society of Anesthesiologist (ASA) skorlarý, kýrýk tipleri, POYB ihtiyaçlarý, hastanede kalýþ süreleri ve hastalarýn acil servis baþvurusundan ameliyathaneye alýnmasýna kadar geçen süre açýsýndan anlamlý fark saptanmadý (p>0.05). Bununla birlikte anlamlý þekilde grup A hastalarýnda NLO deðeri daha yüksek gözlenmiþ (p<0.01), kestirim deðer 5.25, sensitivitesi %84.6, spesifitesi %78.6 idi.
TARTIÞMA: Ameliyat öncesi NLO deðerinin ortopedik cerrahlar açýsýndan; pertrokanterik kýrýk nedeniyle acil servise baþvuran ve PFÇ cerrahisi planlanan ortogeriatrik hastalarýn ameliyat sonrasý mortalite riski için prediktif deðiþkenlerden olacaðýný düþünmekteyiz.

BACKGROUND: Hip fractures in the orthogeriatric population are a health problem that causes mortality and morbidity, with an increasing frequency. The present study aims to investigate whether the preoperative neutrophil-to-lymphocyte ratio (NLR) is a predictive value for the postoperative mortality risk in patients who underwent only proximal femoral nail (PFN) surgery due to pertrochanteric fractures (PTF). To our knowledge, there is not any study conducted with a similar population in the litertaure.
METHODS: Fifty-five patients who were operated on by two National Board-certified surgeons with the PFN method were included in our retrospective study. The patients were divided into two groups. Group A included the patients who lost their lives within the postoperative first year (n=13), while Group B included the survivors (n=42). Preoperative NLR data, demographic information, duration of hospitalization, postoperative intensive care requirements (ICU) and comorbid diseases of all patients were recorded.
RESULTS: In our study with a maximum follow-up period of 27 months, no statistically significant difference was found between the groups concerning age, gender, body mass index, preoperative American Society of Anesthesiologists scores (ASA), types of fractures, ICU requirements, duration of hospitalization (p>0.05). However, the NLR was significantly higher in Group A (p<0.01), with a cut-off value of 5.25, sensitivity of 84.6% and specificity of 78.6%.
CONCLUSION: We believe that the preoperative NLR is a predictive variable for orthopedic surgeons in assessing the postoperative mortality risk in orthogeriatric patients who presented to the emergency room due to PTF and were planned to undergo PFN surgery.

AMAÇ: Çalýþmamýzda ateþli silah yaralanmalarý (ASY) nedeniyle tersiyer merkezimizde takip ve tedavisi yapýlan hastalarýn alt toraks tomografisi (ATT) ve üst batýn tomografi (ÜBT) sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmamýz geriye dönük tanýmlayýcý bir çalýþma olarak planlandý. Ocak 2016–Nisan 2020 tarihleri arasýnda ASY nedeniyle kliniðimizde yatýþý yapýlan hastalar geriye dönük olarak analiz edildi. Ameliyat sonrasý alt toraks ve üst batýn tomografileri çekilen 44 hasta deðerlendirmeye alýndý.
BULGULAR: Hastalarýn 43’ü (%97.72) erkek 1’i (%2.27) kadýn, yaþ ortalamasý 27.45 (daðýlým, 20–53) idi. Hastanede kalýþ süreleri ortalama 14.93 (daðýlým, 5–38) gündü. Çekilen tomografi sayýsý ortalama 1.65 (daðýlým, 1–4) olup Injuriy Severity Score (ISS) ortalama 24.38 (daðýlým, 12–43) idi. Hastalarýn 31’i (%70.45) tabanca ya da tüfek gibi doðrudan ASY’ye maruz kalýrken, 13’ü (%29.5) bomba patlamasý sonucu ortama daðýlan þarapnel parçalarý ile sekonder olarak yaralandý. Ýlk operasyonlarý dýþ merkezde yapýlan 23 (%52.27) hastaya klinik izlem yapýldý, 15 (%34.09) hasta ilk kez ameliyat edildi, 6 (%13.63) hasta ise 2. kez ameliyat edildi. ATT; 25 (%56.81) hastada solunum sýkýntýsý nedeniyle,13 (%29.54) hastada dogrudan toraks travmasý nedeniyle, 6 (%13.63) hastada ise batýn tomografisine ek olarak kontrol amaçlý çekildi. ÜBT ise 29( %65.90) hastada ameliyat sonrasý kontrol amaçlý, 12 (%27.27) hastada ameliyat öncesi deðerlendirme amaçlý, 3 (%6.81) hastada ise doðrudan batýn travmasý olmadan, blastik travmanýn etkilerini deðerlendirmek için çekildi. ATT’de en sýk gözlenen bulgu efüzyon (%47.7) idi. ÜBT’nin %61.36’sýnda patoloji gözlenmezken, %20.45’inde karaciðer lasersayonu gözlendi. ATT ve ÜBT’nin toplam maliyeti tüm toraks ve batýn tomografisinin toplam maliyetinin yaklaþýk yarýsý kadardý.
TARTIÞMA: Ateþli silah yaralanmasý sonrasýnda çekilen selektif alt toraks ve üst batýn tomografileri sadece patolojiyi saptamada deðil ameliyat sonrasý takipte de etkili, hýzlý, güvenilir, kost efektif bir görüntüleme yöntemi olarak kullanýlabilir.

BACKGROUND: The present study aimed to evaluate the results of lower thoracic tomography (LTT) and upper abdominal tomography (UAT) of the patients who were treated and followed at our tertiary center due to gunshot wounds (GSWs).
METHODS: The present research was designed as a retrospective descriptive study. All patients, who were admitted to our clinic due to GSW between January 2016 and April 2020, were retrospectively analyzed. This study included 44 patients who had postoperative lower thoracic and upper abdominal tomography scans.
RESULTS: Among the patients, 43 (97.72%) were male, and one (2.27%) patient was female, with a mean age of 27.45 (range: 20–53) years. The mean length of hospital stay was 14.93 (range: 5–38) days. The mean number of tomography scans per patient was 1.65 (1–4), and the mean Injury Severity Score (ISS) was 24.38 (12–43). Among the patients, 31 (70.45%) had a direct GSW from a pistol or a rifle, while 13 (29.5%) sustained secondary injuries from shrapnel emanating from a bomb explosion. Furthermore, 23 (52.27%) patients who were initially operated at another center were clinically observed, while 15 (34.09%) patients were operated for the first time, and six (13.63%) patients had their second operation. LTT scans were obtained due to dyspnea, direct thoracic trauma and in addition to abdominal tomography for follow-up in 25 (56.81%), 13 (29.54%) and six (13.63%) patients, respectively. UAT scans were obtained for postoperative follow-up in 29 (65.90%), preoperative assessment in 12 (27.27%) and assessment of blast trauma in the absence of,direct abdominal trauma in three (6.81%) patients. The most common finding on LTT was effusion (47.7%). No pathology was observed in 61.36% of the UAT scans, while liver laceration was noted in 20.45%. The total cost of LTT and UAT was almost half that of a total thoracic tomography and a whole abdominal tomography.
CONCLUSION: Selective lower thoracic and upper abdominal tomography obtained following a gunshot injury may be used not only to detect pathology but also as an efficacious, fast, reliable and cost-effective imaging method.

AMAÇ: Sinir bloðu kateterinin konfigürasyonu epidural analjezi ve sürekli periferik sinir bloklarýnda lokal anestezik yayýlýmýný etkileyebilmektedir. Bu ileriye yönelik ve randomize çalýþmanýn amacý, omuz seviyesinin altýnda gerçekleþtirilen üst ekstremite cerrahilerinde, ultrason rehberliðinde yapýlan sürekli infraklaviküler brakiyal pleksus bloðunda (BPB) üç delikli sinir bloðu kateteri ile tek delikli kateterin ameliyat sonrasý analjezik etkinliklerini karþýlaþtýrmaktýr. Primer sonuç ölçümleri ortalama aðrý skorlarýydý. Sekonder sonuç ölçümleri, kurtarýcý analjezik tüketimi ve hasta kontrollü analjezi (PCA) cihazý tarafýndan gönderilen lokal anestezik miktarlarýydý.
GEREÇ VE YÖNTEM: Omuz seviyesinin altýnda üst ekstremite cerrahisi uygulanan toplam 58 eriþkin hasta rastgele iki gruba ayrýldý: Tek delikli kateter (EHC) grubu (n=31) ve çok delikli kateter (MOC) grubu (n=27). Tüm hastalara, Tuohy iðnesi ile 100 mg %2 lidokain and 75 mg %0.5 bupivakain ile tek doz infraklaviküler BPB uygulandý. Daha sonra MOC grubuna çok delikli (üç delikli) bir sinir kateteri ve EHC grubuna ayný seviyeden uçtan delikli (tek delikli) kateter yerleþtirildi. PCA yoluyla %0.125 bupivakain, kateterlerden infüzyon edildi (infüzyon hýzý: 2 ml/sa, otomatik düzenli bolus: 5 ml/sa, hasta kontrollü bolus: 3 ml, kilitleme süresi: 1 saat, 4 saatlik limit: 40 ml). Aðrý þiddeti görsel analog skala (VAS) kullanýlarak deðerlendirildi.
BULGULAR: VAS skorlarý ameliyat sonrasý ilk gün grup EHC’de, grup MOC’den daha yüksekti (p=0.001). Ortalama kurtarma analjezik tüketimi, PCA üzerindeki bolus sayýsý, PCA bolus dozu ve toplam PCA dozu, grup EHC’de ameliyat sonrasý ilk gün grup MOC’dan daha yüksekti (p<0.05).
TARTIÞMA: Infraklavikular sürekli sinir bloðunda MHC kullanýmýnýn, ilk 24 saat ameliyat sonrasý aðrýyý azaltmada EHC’den daha etkili olduðu sonucuna vardýk.

BACKGROUND: The configuration of a nerve block catheter may affect the local anesthetic spread in epidural analgesia and continuous peripheral nerve blocks. This prospective and randomized study aims to compare the multi-orifice nerve block catheter with an end-hole catheter in ultrasound-guided continuous infraclavicular brachial plexus block (BPB) in terms of providing postoperative analgesia for the orthopedic upper limb surgery below the shoulder. The primary outcome measure was mean pain scores. Secondary outcome measures were the consumption of rescue analgesic and the amount of local anesthetics delivered by a Patient-Controlled Analgesia (PCA) device.
METHODS: A total of 58 adult patients who underwent orthopedic upper limb surgery below the shoulder were randomly assigned into two groups: group end-hole catheter (EHC) (n=31) and group multi-orifice catheter (MOC) (n=27). All patients received a single-shot infraclavicular BPB using 100 mg lidocaine 2% and 75 mg bupivacaine 0.5% administrated through a Tuohy needle. Then, a multi–orifice (triple-hole) nerve catheter was placed in the group MOC and an end-hole (one-hole) catheter in the group EHC at the same location. Bupivacaine 0.125% was infused through the catheters via PCA (infusion rate: 2 mlh-1, automated regular bolus: 5 mlh-1, patient-controlled bolus: 3 ml, lock-out time: 1 hour, 4 hours limit: 40 ml). Pain intensity was evaluated using a visual analogue scale (VAS).
RESULTS: Mean VAS scores were higher in group EHC than group MOC in the first postoperative day (p=0.001). Mean rescue analgesic consumption, the number of bolus demand on PCA, PCA bolus demand dose, and total PCA dose were higher in group EHC than group MOC during the first postoperative day (p<0.05).
CONCLUSION: It is concluded that the use of MHC is more effective than EHC for continuous infraclavicular brachial plexus blocks in providing postoperative pain relief during the first 24 hours.

Spinal epidural hematom (SEH) omurilik basýsý ve nörolojik defisit geliþiminin nadir fakat önemli bir sebebidir. Etyoloji genellikle bilinmez ve acil cerrahi müdahele gerektirir. Bu çalýþmada amacýmýz, nadir bir olgu sunumu ile travmatik SEH’nin klinik önemi, tedavi stratejileri ve tedavi sonrasý son durumlarýný gözden geçirmektir. Olgumuz 42 yaþýnda kadýn hasta olup, sýrt aðrýsý, bacaklarda his ve kuvvet kaybý ile baþvurdu. Hastanýn herhangi bir hastalýðý yoktu ve antikoagülan ilaç kullanýmýyordu. Hasta, ara sýra olan sýrt aðrýsýndan dolayý geleneksel sýrt masajý yaptýrdýktan yarým saat sonra bacaklarýnda uyuþma ve kuvvet kaybý ile baþvurdu. Hasta kliniðimizde görüldüðünde paraplejik ve T4 altýnda anestezik idi. Torakal bilgisayarlý tomografi (BT) ve manyetik rezonans görüntülerde (MRG) T3-T4 seviyelerinde posteriyor epidural akut hemoraji izlendi. On ikinci saatte, acil dekompresif hemilaminektomi iþlemi yapýlarak hematom boþaltýldý. Ameliyat sonrasý 24. saatte hastada semptomatik iyileþme görüldü ve altýncý ayda hasta destekle mobilize oluyordu. SEH, ani baþlayan sýrt aðrýsý ve ekstremite güçsüzlüðü olan olgularda akla gelmesi gereken nadir bir durumdur. Tanýda altýn standart inceleme MRG olmakla beraber, cerrahi müdahaleyi geciktirmemek için BT çoðu zaman yeterli olabilmektedir. Tanýsý koyulan ve nörolojik defisiti olan olgularda acil cerrahi dekompresyon (laminektomi/hemilaminektomi) yapýlmalýdýr.

Spinal epidural hematoma (SEH) is a rare but a significant cause of spinal cord compression and neurologic deficits. Its etiology is usually unknown and requires emergency intervention. The present study aims to review the clinical significance, treatment strategies and clinical outcomes of traumatic SEH with a rare case presentation. Our patient was a 42-year-old female who presented with back pain and loss of sensation and strength in the legs. The patient did not have any disease and did not use anticoagulant drugs. The patient developed numbness in her legs half an hour after having a traditional back walking massage due to occasional back pain. She was paraplegic and anesthetic when seen in our clinic. Thoracic computed tomography (CT) and magnetic resonance imaging (MRI) revealed posterior epidural hemorrhage at Th3-Th4 levels. In the 12th hour, the hematoma was evacuated by an emergency decompressive hemilaminectomy. At the postoperative 24th hour, the patient had symptomatic improvement, and in the sixth month, the patient was mobilized with support. SEH is a rare condition that should be considered in patients with sudden onset of back pain and extremity weakness. Although the gold standard diagnostic tool is MRI, CT is often sufficient to avoid delayed surgery. Immediate surgical decompression (laminectomy/hemilaminectomy) should be performed in cases diagnosed with SEH with neurological deficits.

Littre hernisi, fýtýk kesesi içerisinde, Meckel divertikülünün olduðu nadir bir durumdur. Meckel divertikülü ise ince baðýrsaðýn gerçek divertikülüdür. Ýçerisinde nöronendokrin tümör geliþebilir, ancak bildirilen olgu sayýsý azdýr. Bu yazýda, literatür taramasýnda hiç rastlamadýðýmýz, strangüle Littre hernisi içerisinde nöroendokrin tümörün olduðu bir olgu sunduk. 71 yaþýnda erkek hasta, sol kasýk aðrýsý ve kasýkta þiþlik þikayeti ile polikliniðimize baþvurdu. Ayný zamanda hastanýn karýn muyanesinde akut karýn bulgularý mevcuttu. Hasta acil ameliyat edildi, operasyonda herniye olmuþ Meckel divertikülünün perfore olduðu izlendi. Segmenter ince baðýrsak rezeksiyonu yapýldý. Hastanýn patoloji sonucunda; ince baðýrsaktaki Meckel divertikülü içerisinde mukoza ve submukoza yerleþimli iyi diferansiye nöroendokrin tümör izlendi. Ýnkarsere hernilerde, herni kesesi içerisinde Meckel düvertikülü saptanýrsa, çok nadir de olsa nöroendokrin tümör görülebileceðinden tamamen rezeke edilmesi gerektiðini düþünmekteyiz.

Littre’s hernia is a rare condition that involves Meckel’s diverticulum in the hernia sac. Meckel’s diverticulum is the true diverticulum of the small intestine. Neuroendocrine tumors may develop in it; however, there are very few reported cases. In this study, we present a case of neuroendocrine tumor in strangulated Littre’s hernia, on which we did not find a study when we reviewed the relevant literature. A 71-year-old male patient presented to our outpatient clinic with complaints of left groin pain and swelling in the groin. Acute abdomen findings were also present in the abdominal examination of the patient. The patient was operated on immediately and it was observed during the operation that the herniated Meckel’s diverticulum was perforated. Segmental small intestine resection was performed. The pathology results of the patient revealed a well-differentiated neuroendocrine tumor with mucosal and submucosal localization in Meckel’s diverticulum. We believe that if Meckel’s diverticulum is found in the hernia sac in incarcerated hernias, it must be completely resected as a neuroendocrine tumor may develop, even if only rarely.

Biz kateter takýlmasý sýrasýnda subklavyen venin iyatrojenik yaralanmasý ile komplike rüptüre bir karaciðer hemanjiyomunun baþarýsýz anjiyoembolizasyonu olgusunu sunuyoruz. Otuz yaþýnda bir kadýn yataðýndan düþtüðünde künt travmaya maruz kalmýþ. Önceden var olduðu görünen hepatik bir hemanjiyomun laserasyonu teþhis edildi. Ameliyat öncesi tanýsal incelemeleri sýrasýnda baþka bir yaralanma tespit edilmedi. Subklavyen ven kateterizasyonu ve ardýndan rüptüre hemanjiyom nedeniyle oluþan kanamayý kontrol etmek için anjiyoembolizasyon yapýldý. Anjiyoembolizasyondan sonra hastanýn sistolik kan basýncý ve hemoglobin düzeyi sýrasýyla 70 mmHg ve 5.3 g/dL idi. Acil laparotomi yapýldý. Ameliyat sýrasýnda, rüptüre hemanjiyomdan abondan kanama nedeniyle karýn boþluðunda büyük miktarda kan gözlendi. Göðüs radyografisinde hemotoraks bulgusu nedeniyle uygulanan torakoskopi sað toraks boþluðunda büyük miktarda kan olduðunu ve subklavyen venin kateter tarafýndan delinmiþ olduðunu gösterdi. Hasar kontrol cerrahisinden sonra hasta güvenli bir þekilde iyileþti. Bu olguda, subklavyen ven kateteri ile iliþkili yaralanma ile komplike olan rüptüre karaciðer hemanjiyomu hasar kontrol cerrahisi ile güvenli bir þekilde tedavi edildi. Kateterle iliþkili yaralanma torakoskopi kullanýlarak tanýmlanabilir ve tedavi edilebilir.

In this study, we report a case of failed angioembolization of a ruptured liver hemangioma complicated by iatrogenic injury of the subclavian vein during catheter insertion. A 30-year-old woman experienced blunt trauma upon falling from her bed. Laceration of a seemingly preexisting hepatic hemangioma was diagnosed. No other injury was detected during a preoperative diagnostic workup. Subclavian vein catheterization was performed, followed by angioembolization to control bleeding due to the ruptured hemangioma. After angioembolization, the patient’s systolic blood pressure and hemoglobin levels were 70 mmHg and 5.3 g/dL, respectively. She underwent emergency laparotomy. During the surgery, a large volume of blood in the abdominal cavity due to profuse bleeding from the ruptured hemangioma was observed. Because of a hemothorax found on chest radiography, we performed thoracoscopy, which revealed a large volume of blood in the right thoracic cavity and perforation of the subclavian vein by the catheter. After the damage-control surgery, the patient recovered safely. In this case, ruptured liver hemangioma complicated by subclavian vein catheter-related injury was treated safely using damage-control surgery. The catheter-related injury could be identified and treated using thoracoscopy.

Trokar yeri hernisi bir insizyonel herni tipi olup ameliyattan sonra farklý zaman dilimlerinde karþýmýza çýkabilmektedir. Ortalama insidansý %1.85 olup ilk kez Maio ve ark. tarafýndan1991 yýlýnda laparoskopik kolesistektomi sonrasý ince baðýrsak obstrüksiyonu ile birlikte trokar yeri herniasyonu geliþimini bildirilmiþtir. Genellikle 10 mm’lik trokar giriþlerinde görülebilen bu durum 5 mm’lik trokar giriþlerinde ise nadiren görülmektedir. Bu yazýda, laparoskopik apendektomi sonrasýnda 5 mm’lik trokar yerinde geliþen, sað fallop tüpü herniasyonu olgusu sunuldu. On dokuz yaþýnda kadýn hasta, acil polikliniðimize sað alt kadrandaki insizyon yerinde akýntý ve sað alt kadran aðrýsý þikayetiyle baþvurdu. Öyküsünde iki gün önce kliniðimizde akut apandisit tanýsý ile laparoskopik apendektomi uygulanmýþtý. Ameliyat lojuna bir adet aspiratif dren konarak ameliyat sonlandýrýldý. Ameliyat sonrasý birinci gün dreni alýnýp þifa ile taburcu edildi. Acil poliklinik muayenesinde sað alt kadrandaki insizyonundan serozal akýntý ve milimetrik yaðlý doku evantrasyonu izlenildi. Olguda akut karýn bulgularý saptanmadý. Akut faz reaktanlarý normal, yapýlan bilgisayarlý tomografide plevik bölgeden sað alt kadran kesi bölgesine uzanan hidropik tubuler bir yapý izlendi. Bunun üzerine erken dönem geliþen trokar herni ön tanýsý ile ameliyata alýndý. Laparoskopik eksplorasyonda sað fallop tüpünün hidropik ve ödemli olduðu ve 5 mm’lik trokar yerine herniye olduðu görüldü. Fallop tüpü laparoskopik olarak redükte edilip batýn içerisine alýndý. Trokar yerindeki açýklýk ise 2/0 prolen ile dikildi. Olgumuz ameliyat sonrasý birinci gün þifa ile taburcu edildi. Trokar yeri hernileri laparoskopik cerrahi sonrasýnda nadir görülmekle birlikte ciddi komplikasyonlardan biridir. Laparoskopik ameliyatlardan sonra erken veya geç dönemlerde geliþebilecek olan bu durumda daha çok mekanik baðýrsak týkanmalarý gözüksede diðer intraperitoneal organlarýnda herniye olabileceði akýlda tutulmalýdýr.

Trocar site hernias are a type of incisional hernias and may occur within a variable time shift after surgery. A mean incidence of 1.85% was reported, and the first trocar site hernia was narrated by Maio et al. in 1991 describing small bowel obstruction due to trocar site herniation after laparoscopic cholecystectomy. The 10-mm-trocar port is more frequently problematic, and a trocar site hernia in 5 mm port is very rare. This report unveils a 5mm trocar site herniation of right fallopian tube following laparoscopic appendectomy. In this case study, a 19-year-old female patient applied to the emergency department because of a discharge in the right lower quadrant was reported. She explained that she had undergone laparoscopic appendectomy two days before and discharged the next day uneventfully. The surgical report described a suction drain in the right lower quadrant where the patient was suffering from the discharge. The physical examination revealed no tenderness, but an abdominal CT disclosed an edematous tubular structure herniating from the 5 mm trocar site where the drain was put. She was re-operated laparoscopically due to early trocar site hernia, and the right fallopian tube was observed herniating through the defect. After the reduction into the abdomen, the fallopian tube was observed fine, and the defect was closed using 2/0 polypropylene suture. Trocar site hernias are rare but may cause serious complications after laparoscopic surgery. They may occur early after the surgery, but the time shift is variable. Although mechanical bowel obstructions are more frequent endpoint, it should be remembered that any organ within the abdominal cavity may herniate.

Median arkuat ligament sendromu (MALS), yemek yeme sonrasý görülen aðrýnýn ve kilo kaybýnýn nadir bir nedenidir. Median arkuat ligament (MAL), diyafragmatik kruslarýn orta kýsmýndaki fibröz bir banttýr. Anormal olarak aþaðý doðru yerleþmiþ MAL veya çölyak arterin daha kraniyalden çýkmasý, çölyak gövdenin dýþtan basýsý ile sonuçlanýr. MAL, trunkus çölyakusu özellikle ekspirium sýrasýnda daha da daraltýr. Çölyak arterin kronik olarak sýkýþmasý damar içinden geçen kan akýþýný azaltýr ve semptomlara neden olur. Semptomatik hastalar son yýllarda artan oranda daha çok laparoskopik olarak tedavi edilmektedirler. Laparoskopiden açýk cerrahiye dönüþüm oraný az olmayýp %10.3’tür, bu da genellikle diseksiyon esnasýnda ortaya çýkan vasküler yaralanmanýn bir sonucu olan kanama nedeniyledir. Aort, trunkus çölyakus ve dallarýnýn birbirleriyle olan yakýn komþuluðu nedeniyle mevcut cerrahi prosedürün güvenli bir þekilde devam ettirilmesi için bir manevra gereklidir. Bu manevra ile cerrahi tekniðin standardize edilmesi komplikasyon oranlarýný azaltabilir. Bu konuda hala dünyada standartlaþmýþ ve yerleþik herhangi bir laparoskopik yöntem yoktur. Literatürde var olan tekniklerin birbirlerine üstünlüðünü gösteren herhangi bir randomize kontrollü çalýþma yoktur. Bu olgu sunumunda, teknik detaylarý verilen manevra ile ameliyatýn süresi kýsalmakta, ayrýca çölyak gövdede mükemmel bir görüntü saðlanmaktadýr. Yanýsýra, çölyak arter üzerindeki hakimiyeti de kolaylaþtýrtýðýndan ameliyatý daha da güvenli kýlar.

The median arcuate ligament syndrome (MALS) is a rare cause of postprandial pain and weight loss. The median arcuate ligament (MAL) is a fibrous band of the diaphragmatic crura. Abnormally downward located MAL or high take off of the celiac artery result in external compression the celiac trunk. MAL narrows the truncus coeliacus even more clearly during the expiration. The chronic compression of the celiac artery reduces blood flow and causes symptoms. Symptomatic patients receive surgical treatment, in recent years, an increasing rate, especially laparoscopic. The rate of conversion to open surgery is 10.3% due to vascular injury in hemorrhage, which generally occurs during dissection. A maneuver is needed to continue with the surgical procedure safely here because of the close neighboring of the aorta, truncus coeliacus, and one of its branches. Technical standardization can reduce the complication rate. There is still no standardized and established laparoscopic method in the world. There are no randomized controlled studies in the literature, which show the superiority of these techniques over one another. The maneuver in this case report, through traction with a tape towards caudal, allows a brilliant view on the celiac axis with shortened operation time. It also makes the operation even safer because of its enabling mastery over the celiac artery and easy dissection.

Son birkaç yýldýr sol kasýk bölgesinde þiþlik olduðunu bildiren 44 yaþýnda 50 kg aðýrlýðýnda kaþektik görünümlü kadýn hasta ayný gün arka arkaya þiddetli öksürük sonrasý sol kasýðýndaki direkt inguinal herni alanýnda eviserasyon ve mezenter ayrýþmasý olan ince baðýrsak evisserasyonu ile acil servise baþvurdu. Hastaya evissere olan cilt insizyonundan segmenter ince baðýrsak rezeksiyonu ve anastomoz yapýldý. Üç ay sonra fýtýk alaný mesh takviye ile onarýldý. Ýnguinal hernilerde sadece inkarserasyon ve strangülasyon nedeni ile deðil kaþeksi ve malnütrisyon durumlarýnda ani karýn içi basýnç artýþlarýnda spontan rüptür ve evisserasyon olabileceði akýlda tutulmalýdýr. Her tür fýtýk türünde elektif cerrahi ile tedavi saðlanmalýdýr. Aksi halde geciktirilen herni hastalarýnda geliþebilecek olan komplikasyonlarýn hayatý tehdit edebileceði unutulmamalýdýr.

Spontaneous evisceration is a rare complication that becomes life-threatening in direct inguinal hernia. A female at the age of 44, weighing 50 kg looked cachectic and was suffering from swelling on the left groin for the last several years. The evisceration of the small intestine as separated from the mesenterium transpired in the subsequent stage of a spontaneous rupture in the left inguinal region after severe coughing. The region ruptured was sealed after small intestine resection carried out through the incision perforated; mesh herniorrhaphy was implemented at the end of the 3rd month. The spontaneous rupture may transpire depending on malnutrition and cachexia not only after the complications by hernia, such as incarceration, strangulation but also after factors increasing intra-abdominal pressure. Elective surgical treatment must be implemented in hernia regardless of its kind. Complications likely to transpire in cases where intervention is conducted too late may threaten the patient’s life.