AMAÇ: Gastrointestinal sistem cerrahisinden sonra görülen anastomoz kaçaðý ve adezyonlar hala önemli bir morbidite ve mortalite nedenidir. Anastomoz kaçaðý oraný %3–8 iken, kaçaða baðlý mortalite oraný %30’un üzerindedir. Karýniçi sepsis anastomoz kaçaðýnýn iyi bilinen bir nedenidir. Ayrýca, karýniçi adezyon hastane baþvurularýnýn ve morbidite ve mortalite ile iliþkili reoperasyonlarýn önemli bir nedenidir. Bu çalýþmada, bir poliüretan membranýn anastomoz iyileþmesi ve karýniçi yapýþýklýklar üzerine etkileri araþtýrýldý.
GEREÇ VE YÖNTEM: Bu çalýþma için dört gruba ayrýlmýþ 32 Wistar Albino sýçan kullanýldý. Çekal ligasyon ve perforasyon oluþturulduktan sonra peritoneal refleksiyonun 2 cm yukarýsýndan standart sol kolon rezeksiyonu ve anastomozu yapýldý. Kontrol gruplarýna (1, 3) herhangi bir tedavi verilmedi. Deney grubunda (2, 4) ise kolon anastomozunun etrafýna poliüretan membran sarýldý. Patlama basýncý, hidroksiprolin, IL-6 (interlökin 6), NO (nitrik oksit), TPA (doku plazminojen aktivatörü), TNF-α (Tümör nekroz faktörü alfa) seviyeleri ölçüldü ve relaparotomi sonrasý anastomozun histopatolojik özellikleri analiz edildi. Ayrýca adezyon skorlarý ölçüldü.
BULGULAR: Üçüncü ve beþinci günler arasýnda sakrifiye edilen hayvanlar arasýndaki ortalama patlama basýncý deðerlerinde istatistiksel olarak anlamlý bir fark yoktu (p=0.259, p=0.177). Tüm gruplar karþýlaþtýrýldýðýnda, hidroksiprolin, NO, IL-6 seviyeleri arasýnda anlamlý bir fark gözlenmedi (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). Bununla birlikte, grup 2 ve grup 4’te, TPA seviyeleri poliüretan membran tedavisi ile anlamlý olarak yüksekti (p=0.001, p=0.003) ve adezyon skorlarýna göre istatistiksel olarak anlamlý bir fark vardý (p<0.035). Grup 2 ve grup 4, grup 1 ve grup 3’ten daha düþük adezyon skorlarýna sahipti.
TARTIÞMA: Biz deneysel septik kolon anastomoz modelinde poliüretan membranýn histopatolojik ve biyokimyasal iyileþme üzerinde pozitif veya negatif bir etkisi olmadýðýný bulduk. Ancak, poliüretan membranýn anastomoz çevresine uygulanmasý intraabdominal adezyonlarý etkili bir þekilde azaltmaktadýr.

BACKGROUND: Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%–8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions.
METHODS: This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured.
RESULTS: No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3.
CONCLUSION: We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.

AMAÇ: Yanýk yarasýnýn iyileþmesinde, yanýkta oluþan yaralanma zonlarý; hiperemi, staz, koagülasyon zonu büyük önem taþýmaktadýr. Yanýðýn patofizyolojisindeki geliþmeye baðlý olarak yanýk ciltte oluþan yanýk zonlarý bulunmuþ ve tedavi buna göre daha da geliþmiþtir. Bu zonlar; koagülasyon, staz ve hiperemi zonudur. Nekroz zonu tedavisi eksizyon ve kaybolan cildin greft olarak onarýmýdýr. Staz zonu eðer 24–48 saat içinde yanýk tedavisi iyi yönetilirse tam olarak iyileþir. Aksi takdirde koagülasyon zonuna dahil olur. Hiperemi zonu zaten kendiliðinden iyileþebilen bir alandýr. Staz zonunun kurtarýlmasý yanýk tedavisinde oldukça önem taþýmaktadýr. Yanýk alanda oluþan hipermetabolizma sonucu ortaya çýkan aktif oksijen radikalleri staz zonunun koagulasyon zonuna dönüþümünü hýzlandýrdýðý bilinmektedir. Bu deneysel çalýþmanýn amacý, yanýk staz zonu üzerine sildenafil ve N-asetilsisteinin etkilerini incelemek ve yanýkta yara iyileþmesine katkýsý olup olmadýðýný ortaya koymaktýr.
GEREÇ VE YÖNTEM: Çalýþmada 200±20 gr aðýrlýðýnda Wistor Albino cinsi dört aylýk 32 adet diþi sýçan kullanýldý. Sýçanlar dört gruba ayrýldý. Bu 24 sýçana anestezi altýnda Regas ve Ehrlich tarafýndan tanýmlanan deneysel yanýk modeli uygulandý. Grup 1; sham, Grup 2; intraperitoneal kontrol, Grup 3; sildenafil çalýþma (günlük 10 mg/kg dozunda intraperitoneal 10 gün süreyle), Grup 4; N-asetilsistein çalýþma (günlük 100 mg/kg dozunda intraperitoneal 10 gün süreyle) gruplarý olarak belirlendi. Malondialdehit, glutatyon peroksidaz, süperoksit dismutaz, katalaz düzeyleri için serum ve sitopatolojik çalýþma için doku örnekleri alýndý. Tüm sýçanlar deneyin 10. gününde sakrifiye edildi. Ödem, hiperemi, epitel dejenerasyonu, nekroz, iltihabi infiltrasyon ve fibrozis ölçümleri yapýldý.
BULGULAR: Kontrol grubu ile karþýlaþtýrýldýðýnda tedavi edilen iki grupta doku hasar skoru düþük bulundu. MDA düzeyi; Grup 3 ve Grup 4’te, Grup 2’ye göre düþük, Grup 3’te Grup 4’e göre düþük bulundu. SOD, katalaz ve GPH-Px düzeyleri, Grup 3’te ve Grup 4’te Grup 2’ye göre yüksek, Grup 3’te, Grup 4’e göre yüksek bulundu.
TARTIÞMA: Çalýþmamýzýn sonuçlarý, sýçanlarda oluþturulan deneysel yanýk modelinde sildenafil ve N-asetilsisteinin oksidatif stres düzeyini azaltýcý, yara iyileþmesini arttýrýcý olumlu etkileri olduðunu desteklemektedir. Bu konu üzerinde ileri deneysel çalýþmalara ihtiyaç vardýr.

BACKGROUND: In burn wound healing, zones of burn, namely zone of hyperemia, the zone of stasis, and zone of coagulation, have crucial importance. These zones have been identified based on the pathophysiology of the burn, and treatment of burn has been improved. The zone of necrosis is treated by excision and repair through grafting. Zone of stasis fully recovers in 24–48 h if the burn treatment is managed well. Otherwise, it may convert to a zone of coagulation. Hyperemia zone is a zone that recovers itself. Recovery of the zone of stasis is very critical in burn treatment. Active oxygen radicals produced due to the hypermetabolism due to burn wounds are known to speed to the process of the zone of stasis converting into the zone of coagulation. The present experimental study aims to evaluate the effects of sildenafil and N-acetylcysteine on the zone of stasis and to establish whether they had any contribution to wound healing in burns.
METHODS: In the present study, 32 four months old female Wistar Albino rats with 200±20 gr body weights were used. The rats were divided into four groups as the sham group (Group 1), the intraperitoneal group (Group 2), Sildenafil group (Group 3, intraperitoneal 10 mg/kg for 10 days), N-acetylcysteine (Group 4, intraperitoneal 100 mg/kg for 10 days). Tissue samples were collected for serum and cytopathology studies of the Malondialdehyde level, glutathione peroxidase, superoxide dismutase, and catalyze enzyme activity. All the rats were sacrificed on the 10th day of the tests edema, hyperemia, epithelial degeneration, necrosis, inflammatory infiltration and fibrosis measurements were made.
RESULTS: When compared with the controls, both of the treatment groups had lower tissue damage scores. MDA level was lower in Group 3 and 4 compared to Group 2 and lower in Group 3 compared to Group 4. SOD, catalase and GPH-Px levels were higher in Group 3 and Group 4 compared to Group 2 and higher in Group 3 compared to Group 4.
CONCLUSION: The results of our study conducted on an experimental burn model created by rats support that Sildenafil and N-acetylcysteine have positive effects, such as decreasing oxidative stress level and increasing wound healing in burns. Further experimental studies are required on this subject.

AMAÇ: Bu çalýþma 60 yaþ ve üzeri Türk erkekleri arasýnda abdominal aort anevrizmasý (AAA) prevalansýný ve bununla iliþkili faktörleri deðerlendirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Ankara ilinin Keçiören ilçesinde bulunan 62 aile hekimliði aracýlýðýyla 60 yaþ ve üzeri erkek bireyler çalýþmaya davet edildi ve 239 gönüllü çalýþmaya alýndý. Gönüllüler B-mod ultrason ile tarandý. Dýþtan dýþa çapý 3 cm ve üzeri tespit edilen aort anevrizmatik kabul edildi. Ayrýca katýlýmcýlar yaþ, boy, aðýrlýk, bilinen hastalýklar ve risk faktörleri açýsýndan da sorgulandý.
BULGULAR: On bir katýlýmcýda AAA tespit edildi (%4.6). Sigara içme öyküsü olanlarda AAA riskininin arttýðý tespit edildi (Odds ratio: 12.75; CI %95, 1.2–134.3). Daha önce miyokart enfarktüsü geçirmiþ olanlarda anevrizma oranýnýn, geçirmemiþ olanlara göre daha yüksek olduðu tespit edildi (p=0.007). Benzer bir þekilde, koroner anjiyo yapýlma öyküsü olanlarda yapýlmayanlarra göre anevrizma oranýnýn daha fazla olduðu görüldü (sýrasýyla %9.5 ve %1.9). Ayrýca aort çaplarý ile diyabet ve periferik arter hastalýðý arasýnda negatif korelasyon olduðu görüldü.
TARTIÞMA: Abdominal aort anevrizmasý rüptüre olduðu zaman ölüm oraný yüksek fakat önlenebilir bir hastalýktýr. AAA’yý önlemeye hastalýðýn toplumda görülme oranýný araþtýrarak baþlamak gereklidir. Sonuçlarýmýz literatür ile uyumlu bulunmuþtur. Fakat çalýþmamýz bir pilot çalýþma olarak tasarlanmýþtýr ve daha geniþ katýlýmlý çalýþmalara ihtiyaç vardýr.

BACKGROUND: This study aims to evaluate the prevalence of abdominal aortic aneurysm (AAA) in Turkish men aged 60 years and older and the factors associated with AAA.
METHODS: Through sixty-two family health centers located in the Kecioren district of Ankara, 239 male volunteers of the target age were recruited for this pilot study. The volunteers were scanned using B-mode ultrasonography. An aorta of 3 cm or larger in outer to outer diameter was accepted as having AAA. The participants were screened for age, height, weight, known diseases and risk factors.
RESULTS: AAA was detected in 11 volunteers (4.6%). A history of smoking increased the risk of AAA (Odds ratio: 12.75; CI 95%, 1.2–134.3). The presence of an aneurysm with a history of myocardial infarction (MI) was statistically significant when compared to volunteers without a history of MI (p=0.007). Similarly, volunteers with a history of coronary angiography had a greater risk of an aneurysm than volunteers without (9.5% and 1.9%, respectively). Also, there was a negative correlation between diabetes, peripheral arterial disease, and aortic diameters.
CONCLUSION: Although AAA has high mortality rates when ruptured, it is a preventable disease. Therefore, it is necessary to know the prevalence of AAA in Turkey. Our findings were compatible with the literature. However, our study was performed as a pilot study, and there is a need for larger studies in our country.

AMAÇ: Bilindiði üzere akut apandisit, en sýk acil abdominal cerrahi nedenidir. COVID-19 pandemisinin akut apandisit ve cerrahi tedavisi üzerindeki etkilerini deðerlendirmek amacýyla yapýlan çalýþmalar kýsýtlýdýr ve yeterli bilgi mevcut deðildir. Mevcut karþýlaþtýrmalý çalýþma, COVID-19 pandemisi sýrasýnda ve geçen yýl ayný periyodu kapsayan dönemde apendektomi ameliyatý geçiren hastalarýn apendektomi sonuçlarýný ve enfeksiyon kontrolünü bildirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Gerçekleþtirilen geriye dönük gözlemsel çalýþma, karþýlaþtýrmalý olarak 13.03.19–13.05.19 ve 13.03.20–13.05.20 tarihleri arasýnda akut apandisit nedeniyle ameliyat edilen hastalar üzerinde gerçekleþtirildi.
BULGULAR: Çalýþmaya 150 hasta (2019’da 110 hasta; 2020’de 40 hasta [COVID-19 pandemi sýrasýnda]) dahil edildi ve hastalar sýrasýyla Grup A (Normal dönem) ve Grup B (Pandemi dönemi) olarak isimlendirildi. Ortalama yaþ, ortalama VKÝ ve ortalama kalýþ süresi arasýnda anlamlý bir fark olmadýðý için istatistiksel olarak kýyaslanabilir gruplar olarak deðerlendirildi. Grup A ve Grup B komorbiditeleri arasýnda anlamlý fark gözlendi (p=0.033). Grup A ve Grup B’nin laboratuvar deðerleri ve radyolojik bulgularý arasýnda anlamlý bir fark yoktu. Grup A ile Grup B’nin perforasyon sayýsý arasýnda anlamlý fark tespit edildi (p=0.029). Grup A ve Grup B’nin yoðun bakým ihtiyacý ile laparoskopiden konvansiyonel apendektomiye geçiþ sayýlarý arasýnda anlamlý bir fark yoktu.
TARTIÞMA: Çalýþmamýzda da görüldüðü üzere, hastaneye geç baþvuru, komplike olgulara neden olmuþ ve zaten sýkýntýlý bir dönem olan pandemi sürecinde, akut apandisit yönetimini daha da zorlaþtýrmýþtýr. COVID-19 salgýný sýrasýnda, acil cerrahide uygulanan ilkeler hem þüpheli hem de doðrulanmýþ COVID-19 olgularýna uygulanmalýdýr.

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period.
METHODS: This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively.
RESULTS: This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B.
CONCLUSION: The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.

AMAÇ: Acil serviste akut apandisit ile renal kolik’in ayýrýcý tanýsýnda WBC, PLR ve NLR deðerlerinin etkinliðini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmaya Çukurova Üniversitesi Týp Fakültesi Giriþimsel Olmayan Klinik Araþtýrmalar Etik Kurulu’nun onayý alýndýktan sonra baþlandý. Hastane otomasyon ve arþiv sisteminde dosya verilerine tam olarak ulaþýlan toplam 440 hasta çalýþmaya dahil edildi.
BULGULAR: Çalýþmaya alýnan 440 hastanýn %59.5’i erkek (n=262), %40.5’i (n=202) ise kadýndý. Hastalarýn yaþ ortalamasý 37.74±13.39/yýl idi. Hastalarýn patolojik tanýsýna göre, 207 hastanýn akut apandisitle uyumlu olduðu tespit edildi. Hematolojik parametrelerin ayýrýcý tanýda kullaným etkinliði ROC analizi ile incelendiðinde en güçlü tahmin etme özelliðine nötrofil/lenfosit oranýnýn (NLR) sahip olduðu saptandý (AUC, 0.716, SS=0.024, %95 GA 0.668–0.764). NLR’den sonra ikinci sýrada platelet/lenfosit oranýnýn (PLR) ayýrýcý tanýda güçlü tahmin edici olduðu saptandý (AUC, 0.608, SS=0.027, %95 GA 0.555–0.661).
TARTIÞMA: Akut apandisit ve renal kolik akut abdominal aðrý ile acil servise sýklýkla baþvurmaktadýr. Akut apandisitli hastalar cerrahi yöntemler ile tedavi edilirken, renal kolikli hastalarda akut dönemde týbbi tedavi uygulanmaktadýr. Bu iki hasta grubunun ayýrýcý tanýsýnýn net olarak yapýlmasý önem arz etmektedir. PLR ve NLR deðerlerinin ayýrýcý tanýnýn net olarak yapýlamadýðý durumlarda kullanýlabileceðini düþünmekteyiz.

BACKGROUND: To investigate the efficacy of WBC, PLR and NLR for use in the differential diagnosis of acute appendicitis and renal colic in the emergency department.
METHODS: This study was conducted after consent was received from the Cukurova University Medicine Faculty Noninvasive Clinical Research Ethics Committee. In this study, 440 patients for whom file data could be accessed in the hospital automation and archive system who were admitted to the hospital with abdominal pain were included.
RESULTS: Of the 440 patients included in this study, 59.5% were male and 40.5% were female. The average age of the patients was 37.74±13.39 years. According to the pathological diagnosis, 207 patients were diagnosed with acute appendicitis. When the efficacy of differential diagnosis using hematological parameters was examined with ROC analysis, the neutrophil/lymphocyte ratio (NLR) value had the strongest predictive ability (AUC, 0.716, SS=0.024, 95% GA 0.668–0.764). After NLR, the platelet/lymphocyte ratio (PLR) value was the second-best concerning predictive ability for differential diagnosis (AUC, 0.608 SS=0.027, 95%, GA 0.555–0.661).
CONCLUSION: Patients with acute appendicitis and renal colic often present to the emergency department with abdominal pain. While patients with acute appendicitis are usually treated with surgical methods, medical treatment is used for renal colic in the acute period. The differential diagnosis of these two patient groups is important. We believe that the PLR and NLR values can be used when an exact differential diagnosis cannot be made.

AMAÇ: Akut kolesistit (AC), safra kesesi taþlarýnýn yaygýn bir komplikasyonu olup acil servis baþvurularýnýn önemli bir bölümünü oluþturur ve kolesistektomi tek kesin tedavi yöntemidir. Erken dönem kolesistektominin bildirilmiþ birçok avantajý mevcuttur. COVID-19 pandemi sürecinde yapýlan operasyonlar ile iliþki morbidite ve mortalite artmýþtýr. Biz bu çalýþmada pandemi sürecinde acil serviste AC tanýsý konulan hastalara genel klinik yaklaþýmýmýzý ve perkütan kolesistostomi deneyimini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 11 Mart 2020 ile 31 Mayýs 2020 tarihleri arasýnda hastanemiz acil servisine AC nedeniyle baþvuran 72 hasta çalýþmaya dahil edildi. Hastalar ayaktan tedavi edilen (Grup 1), yatýrýlarak tedavi edilen (Grup 2) ve perkütan kolesistostomi ile tedavi edilen (Grup 3) olmak üzere üç gruba ayrýldý. Bu üç grubun demografik ve klinik özellikleri karþýlaþtýrýldý.
BULGULAR: Grup 1’de 36 (%50), Grup 2’de 25 (%34,7) ve Grup 3’te 11 hasta (%15.3) vardý. Hastalarýn demografik özellikleri birbirine benzerdi. Grup 3’teki hastalarýn acil servise baþvuru anýndaki CRP ve WBC deðerleri diðer iki gruba göre belirgin yüksekti. Ayrýca Grup 3’teki hastalarda safra kesesi duvarý daha kalýn, kese boyutu daha büyük saptandý. Hastalara ortanca 3.5 günde perkütan kolesistostomi takýldýðýný ve yatýþ gününün Grup 2’deki hastalara kýyasla daha uzun olduðunu saptadýk (sýrasýyla, 3.9 gün ve 9.2 gün, p=0.00). Taburculuk sonrasý yeniden yatýþ oranlarý birbirine benzerdi. Ayaktan takip yapýlan Grup 1’deki hastalarýn hiçbirinde yatýþ gerekmedi. Yetmiþ iki hastanýn tamamýnda cerrahi gerektiren acil bir durum ortaya çýkmadý ve mortalite izlenmedi.
TARTIÞMA: Birçok yayýn ilk yatýþ anýnda düþük morbidite ile laparoskopik kolesistektomi yapýlabileceðini vurgulasa da, AC COVID-19 pandemisi ve buna benzer acil durumlarda elektif cerrahiye ertelenebilecek bir klinik durumdur. Bu amaçla perkütan kolesistostomi efektif kullanýlmalý ve gerekirse endikasyonlar geniþletilmelidir (Daha genç hastalar, CCI veya ASA daha düþük hastalar gibi). Bu yaklaþým ile hem hastayý hem de operasyonu gerçekleþtirecek saðlýk ekibini COVID-19 riskinden koruyabiliriz.

BACKGROUND: Acute cholecystitis (AC), a common complication of gallstones, is responsible for a significant part of emergency applications, and cholecystectomy is the only definitive treatment method for AC. Early cholecystectomy has many reported advantages. Operation-related morbidity and mortality have increased during the COVID-19 pandemic. In this study, our aim is to present our general clinical approach to patients who were diagnosed with AC during the pandemic and our percutaneous cholecystostomy experience during this period.
METHODS: This study included 72 patients who were presented to our hospital’s emergency room between March 11 and May 31, 2020, with AC. Patients were divided into three groups based on their treatment: outpatients (Group 1), inpatients (Group 2) and patients undergoing percutaneous cholecystostomy (Group 3). These three groups were compared by their demographic and clinical characteristics.
RESULTS: There were 36 (50%) patients in Group 1, 25 (34.7%) patients in Group 2, and 11 (15.3%) patients in Group 3. The demographic characteristics of the patients were similar. The CRP and WBC levels of the patients in Group 3 were significantly higher compared to the other groups. Moreover, the wall of the gallbladder was thicker and the size of the gallbladder was larger in Group 3. Patients had percutaneous cholecystostomy at the median of 3.5 days and the length of hospital stay was longer compared to Group 2 (3.9 days versus 9.2 days, p=0.00). The rate of re-hospitalization after discharge was similar in Group 2 and Group 3, but none of the patients in Group 1 required hospitalization. None of 72 patients developed an emergency condition requiring surgery, and there was no death.
CONCLUSION: Although many publications emphasize that laparoscopic cholecystectomy (LC) can be performed with low morbidity at the first admission in acute cholecystitis, it is a clinical condition that can be delayed in the COVID-19 pandemic and other similar emergencies. Thus, percutaneous cholecystostomy should be effectively employed, and its indications should be extended if necessary (e.g., younger patients, patients with lower CCI or ASA). This approach may enable us to protect both patients and healthcare professionals that perform the operation from the risk of COVID-19.

AMAÇ: Akut apandisit (AA), halen genel cerrahi acilleri arasýndaki önemini korumaktadýr ve bir insanýn hayatýnda AA geliþme riski, erkeklerde %8.6 ve kadýnlarda %6.7’dir. AA’nýn klinik tanýsý yaklaþýk %20 yanlýþ pozitif ve yanlýþ negatiflik oranýna sahiptir. Görüntüleme yöntemlerinden de bu alanda en çok ultrason (US) ve bilgisayarlý tomografiden (BT) faydalanýlmýþtýr. Bu çalýþmanýn amacý AA tanýsý amacýyla çekilen kesitsel görüntüleme incelemelerinin deðerlendirmesinde hastayý muayene eden klinisyenin deðerlendirme sonuçlarý ile radyoloji uzman deðerlendirmesi arasýndaki iliþkiyi saptamaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada Ocak 2010 ile 2017 tarihleri arasýnda, Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde apendektomi yapýlan 1891 hastanýn dosyasý geriye dönük olarak incelendi. AA kliniði ile apendektomi yapýlan ve BT sonuçlarýnda apendiks normal olarak rapor edilen hastalarýn dosyasýndan, hastanýn acil servise baþvurusundaki klinik muayene bulgularý ile birlikte ilgili cerrahýn BT deðerlendirme sonuçlarý (AA ile uyumlu, normal apendiks veya apendiks görüntülenmedi) kayýt edildi.
BULGULAR: Akut apandisit þüphesiyle apendektomi yapýlan 1891 hastanýn 1478’ine taný amacýyla BT çekildi ve 145’i radyoloji uzmanlarý tarafýndan normal olarak rapor edildi. Radyoloji uzmanlarý tarafýndan tamamý normal olarak rapor edilen bu BT sonuçlarýnýn cerrahlar tarafýndan yapýlan deðerlendirmesinde 105’i (%72.4) AA ile uyumlu bulunurken, 18’i (%12.4) normal olarak deðerlendirildi. Yirmi iki (%15.2) hastada cerrahlar tarafýndan apendiks vizüalize edilemedi. Patoloji sonucu lenfoid hiperplazi - fibröz obliterasyon gelen olgularýn %70.0’i; AA sonucu gelenlerin %73.8’i; Flegmenöz apandisit sonucu gelenlerin %75.6’sý ve gangranöz/perfore apandisit sonucu gelenlerin ise %64.0’ü genel cerrah tarafýndan yapýlan BT deðerlendirmesinde apandisit tanýsý almýþtýr.
TARTIÞMA: Hastanýn klinik deðerlendirmesini yapan cerrah tarafýndan yorumlanan BT sonucunda tanýsal doðruluk oranlarý belirgin bir þekilde artmaktadýr. Genel cerrahi uzmanlýk eðitimi sýrasýnda abdominal kesitsel görüntüleme tekniklerini yorumlayabilme yetisi kazanýlmasýyla birlikte doðru tanýya ulaþma þansý artacaktýr.

BACKGROUND: Acute appendicitis (AA) still maintains its prominence among general surgical emergencies, and the risk of developing AA is 8.6% for men and 6.7% for women. The clinical diagnosis of acute appendicitis has a rate of approximately 20% false positive and false-negative. Ultrasound (US) and Computed Tomography (CT) are the imaging methods most utilized in this field. The present study aims to determine the relationship between the evaluation results of the clinician who examined the patient and the radiologist’s evaluation in the evaluation of cross-sectional imaging tests for the diagnosis of acute appendicitis.
METHODS: In this study, the records of 1891 patients who underwent an appendectomy in the General Surgery Clinic of Fatih Sultan Mehmet Training and Research Hospital between January 2010 and 2017 were reviewed retrospectively. From the file of the patients who underwent appendectomy with acute appendicitis and whose appendix was reported as normal in CT results, clinical examination findings of the patient in the emergency department and CT evaluation results of the relevant surgeon (Compatible with acute appendicitis, normal appendix or appendix could not be visualised) were recorded.
RESULTS: Of the 1891 patients, who underwent appendectomy on suspicion of acute appendicitis, 1478 had CT scans for diagnosis and 145 were reported as normal by radiologists. In the evaluations by surgeons of these CT results all reported as normal by radiologists, 105 (%) 72,4) were compatible with acute appendicitis, while 18 (12.4%) were considered normal. In 22 (15.2%) patients, appendix could not be the visualized by surgeons. 70.0% of the cases with Lymphoid hyperplasia - fibrous obliteration pathology result; 73.8% of the cases with acute appendicitis; 75.6% of those with phlegmonousappendicitis and 64.0% of those with gangrenous/perforated appendicitis were diagnosed as appendicitis by CT evaluation performed by a general surgeon.
CONCLUSION: Diagnostic accuracy rates increase significantly when the CT results are interpreted by the physician performing the clinical evaluation of the patient. The chance of reaching the correct diagnosis will increase with gaining the ability to interpret abdominal cross-sectional imaging techniques during general surgery specialty training.

AMAÇ: Akut apandisitin deðerlendirilmesinde laboratuvar parametreleri önemli tanýsal deðere sahiptir. Bu çalýþmanýn amacý, lökosit deðerleri normal referans aralýðýnda olan hastalarda bilirubin deðerlerinin akut ve komplike apandisiti ön görmedeki etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Lökosit deðeri normal referans aralýðýnda olan ve apendektomi yapýlan 18 yaþ ve üzeri 200 hasta çalýþmaya dahil edildi. Hastalarýn demografik özellikleri total ve direkt bilirubin ve C-reaktif protein deðerleri incelendi. Hastalar patoloji sonucuna göre normal apendiks ve akut apandisit olarak ikiye ayrýldý. Akut apandisitlerde, basit apandisit ve komplike apandisit olarak sýnýflandýrýldý.
BULGULAR: Çalýþmaya dahil edilen 200 hastanýn 110’u (%55) kadýn, 90’ý (%45) erkekti ve yaþ ortanca deðeri 37±16 yýl idi. Patoloji sonuçlarý 45’inde (%22.5) normal apendiks, geri kalanýnda ise akut apandisit olarak raporlandý. Akut apandisit tanýsý alanlarýn 141’inde (%91) basit apandisit ve 14’ünde (%9) komplike apandisit saptandý. Normal apendiks ve akut apandisit karþýlaþtýrýldýðýnda total ve direkt bilirubin seviyeleri akut apandisit tanýsý alanlarda daha yüksek bulundu. Akut apandisiti ön görmede iþlem karakteristik eðrisi analizinde total bilirubin ve direkt bilirubin’in eðri altýnda kalan alaný sýrasýyla 0.597 ve 0.625 idi.
TARTIÞMA: Lökosit deðerinin normal olduðu hastalarda yüksek bilirubin deðerleri akut apandisit tanýsýný ön görmede faydalý olabileceði sonucuna varýldý.

BACKGROUND: Laboratory parameters have important diagnostic value in the evaluation of acute appendicitis. This study aimed to evaluate the efficacy of bilirubin values in predicting acute and complicated appendicitis in patients with leukocyte values in the normal reference range.
METHODS: This study included 200 patients aged 18 and over who underwent appendectomy with leukocyte values within the normal reference range. The demographic characteristics, total and direct bilirubin and C-reactive protein values of the patients were examined. According to the pathology results, the patients were divided into two groups as a normal appendix and acute appendicitis. Acute appendicitis was further classified as simple and complicated.
RESULTS: Of the 200 patients included in this study, 110 (55%) were female and 90 (45%) were male, and the mean age was 37±16 years. The pathology results were reported as normal in 45 (22.5%) and acute appendicitis in the remainder of the sample. Of those diagnosed with acute appendicitis, 141 (91%) had simple appendicitis and 14 (9%) had complicated appendicitis. When the normal appendix and acute appendicitis groups were compared, the total and direct bilirubin levels were higher in the patients diagnosed with acute appendicitis. According to the receiver operator characteristic curve analysis, the area under the curve values of total bilirubin and direct bilirubin for the prediction of acute appendicitis were 0.597 and 0.625, respectively.
CONCLUSION: In patients with normal leukocyte values, high bilirubin levels may be useful in predicting the diagnosis of acute appendicitis.

AMAÇ: Çalýþmanýn amacý; biri Suriye sýnýrýna yakýn olan, ülkemizdeki iki farklý hastanenin travma birimlerinde, toraks travmalý politravma hastalarýnýn yönetiminde ve sonuçlarýnda farklýlýk olup olmadýðýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2012–Ocak 2014 arasýnda, toraks travmalý politravma geçiren, Manisa Celal Bayar Üniversitesi Hastanesi’ndeki (MH) 348 olgu, Suriye sýnýrýna yakýn Þanlýurfa Eðitim ve Araþtýrma Hastanesi’ndeki (ÞH) 917 olgu ile yaþ, cinsiyet, yaralanma mekanizmasý, eþlik eden yaralanmalar, kýsaltýlmýþ yaralanma ölçeði (AIS), yaralanma ciddiyeti skoru (ISS), tedavi yöntemleri ve mortalite açýsýndan geriye dönük olarak analiz edildi.
BULGULAR: ÞH olgularýnda; kesici delici alet yaralanmalarý (MH; %9’a karþý ÞH; %17, p<0.05), ateþli silah yaralanmalarý (MH; %5’e karþý ÞH; %18, p<0.05), ortalama ISS (MH; 30.2±8.4’e karþýlýk ÞH; 42.8±10.2, p<0.001) ve mortalite (MH; %2.6’ya karþý ÞH; %11.1, p<0.001) oranlarý daha yüksekti. ÞH olgularýnda en yüksek bileþen AIS karýn (AIS karýn= 4.8±0.7) olmakla birlikte, MH olgularýnda en yüksek bileþen AIS ekstremiteydi. (AIS ekstremite= 3.6±0.2).
TARTIÞMA: ÞH olgularýndaki demografik özellikler, yaralanma mekanizmalarýndaki farklýlýklar ve yüksek mortalite, sýnýrlarýmýzdaki ihtilaf bölgesine yakýn olmanýn getirdiði cerrahi zorluklarý göstermekte ve yansýtmaktadýr. Ülkemizde biri Suriye sýnýrýna yakýn diðeri ise sýnýra uzak iki hastanenin verileri, Suriye ihtilafýnýn Türk saðlýk sistemi üzerindeki etkisini vurgulamýþtýr.

BACKGROUND: The present study aims to assess whether there are any differences in the management and outcome of polytrauma patients with thoracic trauma in trauma units of two different hospitals in the same country; one hospital is near the Syrian border.
METHODS: A retrospective analysis (January 2012 to January 2014) of 348 polytrauma casualties with thoracic trauma from Manisa Celal Bayar University Hospital (MH) were compared according to age, gender, mechanism of injury, associated injuries, abbreviated injury scale (AIS), injury severity score (ISS), treatment modalities, and mortality with 917 patients of Þanlýurfa Training and Research Hospital (SH) registry (near the Syrian border).
RESULTS: Of the 348 patients in the MH, 230 (66%) and of the 917 patients in the SH, 697 (76%) were males (p<0.001). Mean age was 45.6±18.3 yrs in the MH group and 26.4±22.4 yrs in the SH group (p<0.001). The SH patients had a larger proportion of stab wounds (MH; 9% vs. SH; 17%, p<0.05), gunshot injuries (MH; 5% vs. SH; 18%, p<0.05), higher mean ISS (MH; 30.2±8.4 vs. SH; 42.8±10.2, p<0.001), and increased mortality (MH; 2.6% vs. SH; 11.1%, p<0.001). AISabdomen was the highest component in the SH registry (AISabdomen = 4.8±0.7), whereas AIS extremities were the highest component in the MH registry (AISextremities = 3.6±0.2).
CONCLUSION: Significantly different demographic features, mechanisms of injury, worse outcomes and higher mortality rates in SH demonstrate and reflect the surgical challenges depending on the combat environment. Two hospitals in Turkey, one seemingly adjacent to a war zone and another with the more standard civilian experience highlight the impact of the Syrian conflict on the Turkish healthcare system.

AMAÇ: Yüz travmasý pediatrik çaðýnda son derece yaygýndýr. Pediatrik acile sevk ve baþvurularýn önde gelen sebeplerin arasýnda düþünülmektedir. Bu çalýþmanýn amacý yüz kesileri ile pediatrik acile baþvuran hastalarýn demografik özelliklerinin incelenmesidir.
GEREÇ VE YÖNTEM: 2012 ile 2017 yýllarý arasýnda basit yüz laserasyonu ile Baþkent Üniversitesi Hastanesi pediatrik acil servisine baþvuran toplam 1160 hasta geriye dönük olarak incelendi. On sekiz yaþýna kadar olan hastalar çalýþmaya dahil edildi. Tüm hastalara plastik ve rekonstrüktif cerrahi doktorlarý tarafýndan müdahele edildi. Aðýz içi ve maksillofasiyal kýrýkla iliþkili yüz kesileri olan hastalar çalýþmaya alýnmadý. Hastalarýn yaþý, cinsi, travmanýn sebebi, laserasyonun konumu, travmanýn zamanlamasý ile ilgili bilgiler toplandý. Yaþ Ulusal Çocuk Saðlýðý ve Ýnsan Geliþimi Enistitüsü (NICHD) pediatrik terminolojisine göre beþ gruba sýnýflandýrýldý: 0–12 ay (süt çocukluðu dönemi), 12 ay–2 yýl (oyun çocukluðu dönemi veya Toddler yaþ grubu), 2–5 yýl (erken çocukluk), 6–11 yýl (orta çocukluk) ve 12–17 yýl (püberte). Her yaþ grubuna þu analizler yapýldý: Olgu sayýsý, erkek-kadýn oraný, travmanýn ve hastaneye baþvurunun zamanlamasý (örn. sabah, öðleden sonra, akþam, geç akþam ve gece), travmanýn gerçekleþtiði alan (örn. evde, okulda, spora salonunda... vs), mevsime göre insidans, travmanýn türü (örn. düþme, kafayý sert bir objeye vurmak... vs) ve laserasyonun lokalizasyonu (alýn, periorbital, yanak... vs).
BULGULAR: Bu çalýþmaya toplam 1160 hasta alýndý. Olgularýn sayýsý ve oranlarý þöyledir: 0–12 ay (n=127, %10.9), 12–24 ay (n=113, %9.7), 3–5 yýl (n=385, %33.1), 6–11 yýl (n=403, %34.7) ve 12–17 yýl (n=132, %11.3). Çocuklarýn ortalama yaþý 6.5 yýl (ortalýk, 5 ay–17.9 yýl). Popülasyonun %35’i altý yaþýndan küçüktü. En yüksek insidans 6–11 yaþ grubunda görüldü. Genel olarak erkek hastalar olgularýn çoðunluðunu oluþturmaktaydý (%59.31).
TARTIÞMA: Bu veriler yüz kesisi ile acil servisine baþvuran hastalarla ilgili detaylý bir yorum ve gözlem sunmuþtur. Bu çalýþmalar Türkiye’deki yüz travmasý geçiren çocuklarýn yüz kesilerinin tabiatý, oraný ve þiddetini azaltacak yaralanma önleme programlarýnda faydalýdýr. Bu tür yaralanmalar ile ilgilenen plastik cerrah ve diðer saðlýk personellerinin yaralanma önleme tavsiyelerinde bulunmalarý çocukluk çaðý yaralanma oranlarýnýn azaltmasýnda yararlýdýr.

BACKGROUND: Soft tissue trauma of the face is considered a leading cause of presentation and referral to the pediatric emergency department. The present study aims to evaluate the demographics properties of facial injuries presenting to the pediatric emergency.
METHODS: In this study, 1160 patients presented with a simple facial laceration to the pediatric emergency department of Baþkent University were reviewed from 2011 to 2017. Patients up to 18 years of age were included. We evaluated demographics about patients’ age, sex, the cause of injury, the location of laceration and timing of the injury. Age was categorized according to the National Institute of Child Health and Human Development (NICHD) pediatric terminology into five groups as follows: 0–12 months, 12 months-2 years, 2–5 year, 6–11 year, and 12–18 years. The following analyses were performed to each age group: a number of cases, male to female predominance, timing of injury (e.g., early morning, afternoon, evening, late evening and at night), the place that the injury has occurred (e.g., at home, at school, in sport hall), the cause of injury (fall, hitting a hard subject, sports-related), the location of laceration (forehead, periorbital area, cheek, perioral area, nose, submental area) and the incidence according to the season.
RESULTS: Number and relative percentages of cases were as follows: 0–12 months (n=127, 10.9%), 12–24 months (n=113, 9.7%), 3–5 years (n=385, 33.1%), 6–11 years (n=403, 34.7%) and 12–17 years (n=132, 11.3%). The average age of children was 6.5 year (range, 5 month - 17.9 year). The age group 6–11 showed a higher incidence compared to other age groups (n=403, 34.7%). Fifty-three percent of the population was younger than six years and there was a male predominance in all age groups.
CONCLUSION: The demographic data provided in this study can be useful in trauma prevention programs which are effective in reducing the incidence, nature and severity of facial lacerations. Parents should be reminded of age-specific preventive measures in injury avoidance.

AMAÇ: Acil cerrahi patolojilerin taný ve tedavisinin saatler içinde yapýlmasý gerekmekte olup, geç kalýnan durumlarda hastanýn prognozu daha da kötüye gidebilmektedir. Bu konuda kolay ve etkili belirteçlere ihtiyaç duyulmaktadýr. Bu çalýþmadaki amacýmýz, yoðun bakýma yatan acil cerrahi hastalarýnda C-reaktif protein (CRP)/albümin oraný ve hematolojik parametrelerin prognozu ön görmede kullanýlabilirliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþma yoðun bakýmýnda takip edilen hastalarýn dosyalarýnýn geriye dönük olarak taranmasý ile yapýldý. Acil cerrahi sonrasý yatan hastalar ‘acil grubu’ olarak, elektif majör cerrahi sonrasý yatan hastalar ‘kontrol grubu’ olarak alýndý. Hastalarýn demografik özelliklerinin yaný sýra, yoðun bakýmda yatýþ süreleri, mekanik ventilatör ihtiyacýnýn olup olmadýðý, yoðun bakýma yatýþtan önce, ameliyat öncesi kan deðerlerinden platelet/lenfosit (P/L), nötrofil/lenfosit (N/L), CRP/albümin deðerleri kaydedilip her iki grubun deðerleri istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Çalýþmaya toplam 341 hasta alýndý, bunlarýn 111’i acil (%32.6) (Grup 1), 230’u elektif (%67.4) (Grup 2) olgu idi. Acil ve elektif olgular karþýlaþtýrýldýðýnda, Grup 1’de ortalama CRP/albümin deðeri 49.05 saptanýrken, Grup 2’de 32.8 olarak saptanmýþtýr (p=0.001). N/L deðerleri ise Grup 1’de 11.9, Grup 2’de 9.87 bulunmuþtur (p=0.04). Diðer bir hematolojik parametre olan P/L deðerlerine bakýldýðýnda ise Grup 1’de 272.62 bulunurken, Grup 2’de 229.17 olarak saptanmýþtýr (p=0.03). Hastanede yatýþ günleri Grup 1’de ortalama 13.61 gün iken, Grup 2’de 12.43 gündür. CRP/albümin >40 olduðunda duyarlýlýðý %80.49, seçiciliði ise %67.22 olarak belirlenmiþtir (p<0.001).
TARTIÞMA: CRP/albümin oraný cerrahi olgularýn aciliyetini belirlemede ve mortalitesi hakkýnda öngörüde bulunmada etkili bir belirteç olarak kullanýlabilir.

BACKGROUND: Diagnosis and treatment of emergency surgical pathologies should be addressed within hours, and the prognosis of the patient may deteriorate further in cases of delay. Easy and effective markers are needed in this regard. Our aim in this study is to evaluate the CRP/albumin ratio and the usability of hematological parameters in predicting prognosis in emergency surgical patients in intensive care.
METHODS: This study was performed by retrospectively scanning the files of the patients who were followed up in the intensive care unit. Patients hospitalized after emergency surgery were taken as ‘emergency group’ and patients hospitalized after elective major surgery were taken as ‘control group’. In addition to the demographic characteristics of the patients, the length of hospitalization in the intensive care unit, whether there was a need for mechanical ventilation, platelet/lymphocyte (P/L), neutrophil/lymphocyte (N/L), C-reactive protein (CRP)/albumin values were recorded and the values of both groups were compared statistically.
RESULTS: In this study, 341 patients were included, of which 111 were emergency (32.6%) (Group 1), 230 were elective (67.4%) (Group 2) cases. When the emergency and elective cases were compared, the average CRP/albumin value was 49.05 in Group 1 and 32.8 in Group 2 (p=0.001). N/L values were 11.9 in Group 1 and 9.87 in Group 2 (p=0.04). When looking at another hematological parameter, P/L, it was found 272.62 in Group 1 and 229.17 in Group 2 (p=0.03). Hospitalization days were 13.61 days in Group 1, while 12.43 days in Group 2. When CRP/albumin >40, its sensitivity was determined as 80.49% and its selectivity as 67.22% (p<0.001).
CONCLUSION: The CRP/albumin ratio can be used as an effective marker in determining the urgency of surgical cases and predicting mortality.

AMAÇ: Bu çalýþmada trafik kazasý geçirmiþ gebelerde hastaneye yatýþýn gerekli olup olmadýðýný göstermek amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Ýstanbul Türkiye’deki bir hastanede 2012 ve 2018 yýllarý arasýnda trafik kazasý geçirmiþ hastalar çalýþýlarak, gebe hastalarýn kayýtlarý incelendi. Hastalarýn demografik ve obstetrik özellikleri, kaza türü, travma çeþidi, Glasgow koma skoru, hastaneye yatýþ endikasyonu, hastanýn hastaneye yatýþ önerisine yanýtý ve kazanýn obstetrik ve maternal sonuçlarý deðerlendirildi.
BULGULAR: Toplamda çalýþmaya 95 hasta dahil oldu. Elli hastaya hastaneye yatýþ önerildi, bu hastalarýn %58’i yatýþý kabul etmedi. Yatýþý kabul etmeyen hastalarýn hiçbirisinde komplikasyon geliþmedi. Hastalarýn yüzde 3.2’sinde preterm doðum, %3.2 fetal kayýp ve %5.3 plasenta dekolmaný görüldü. Bir anne (%1.1) trafik kazasý sonucu oluþan çoklu travma nedeniyle kaybedildi. Gebelik haftasýnýn artýþýyla hastaneye yatýþ gerekliliði artarken, diðer parametrelerin hastaneye yatýþ üzerinde herhangi bir etkisi bulunmadý.
TARTIÞMA: Gebelik haftasýnýn artmasýyla, trafik kazasý geçirmiþ gebelerin hastaneye yatýþ gereksinimleri artar. Hastaneyi yatýþý kabul etmeyen minör travmalý gebelerde herhangi bir komplikasyon geliþmedi.

BACKGROUND: This study aimed to show whether it is necessary to hospitalize pregnant women who have been involved in traffic accidents.
METHODS: Patients at a hospital in Istanbul, Turkey, who underwent traffic accidents between 2012 and 2018 were studied, and pregnant patients’ files were evaluated. Demographic and obstetric features of patients, type of accident, type of trauma, Glasgow Coma Score, whether or not hospitalization were examined, the response of patients to hospitalization, and the obstetric and maternal results of accidents were assessed.
RESULTS: In the present study, 95 patients were included. Overall, hospitalization was recommended for 50 patients, but of these, 58% refused to be admitted. No patients who refused hospitalization had complications. Preterm labor was seen in 3.2% of patients, while 3.2% had a fetal loss and 5.3% had a placental abruption. Only one mother was lost (1.1%) due to sustaining multiple traumas in a traffic accident. Hospitalization was increasingly indicated with increasing gestational age, but other parameters had no effect on hospitalization.
CONCLUSION: The likelihood that hospitalization was recommended for pregnant women involved in traffic accidents increased with gestational age. Patients with minor trauma who refused hospitalization had no complications.

AMAÇ: Blast etki ile gerçekleþen iþitme kaybý, yaygýn olarak el yapýmý patlayýcý cihazlarýn yüksek enerji patlamalarýndan kaynaklanan akustik travmadýr ve iþitme sistemi patlama hasarýndan etkilenebilir. Bu çalýþmanýn amacý, kulak zarý perforasyonunun (KZP) iç kulak üzerindeki blast yaralanmasýna karþý koruyucu etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Blast yaralanmasý olan toplam 43 yetiþkin hasta, her iki kulaðýndaki saðlam kulak zarý, tek taraflý KZP ve iki taraflý KZP olarak üç alt gruba ayrýldý. Her hastaya odyoloji bölümünde kemik iletimi dahil olmak üzere kapsamlý bir odyogram uygulandý.
BULGULAR: Toplam 43 (%100) erkekten oluþan hastalarýn yaþ ortalamasý 31.44±8.01 yaþ (18–52 yýl) idi. Ýþitme kaybý tipi her kulak için ayrý ayrý deðerlendirildiðinde, 31 (%36) sensörinöral, 26 (%30.2) yüksek frekanslý sensörinöral, 8 (%9.3) iletim tipi ve 21 (%24.4) mikst tip iþitme kaybý gözlendi. Kýrk üç hastanýn 21’inde (%48.8) KZP izlendi. Bu hastalarda KZP dördünde (%9.3) sað tarafta, yedisinde (%16.3) sol tarafta ve 10’unda (%23.3) iki taraflý idi. Akustik travma türü deðerlendirildiðinde, el yapýmý patlayýcý patlamasýndan 15 (%34.9), silah patlamasýndan 12 (%30.2), bomba yüklü araç patlamasýndan altý (%14), roket atýþýndan üç (%7), havan patlamasýndan üç (%7), mayýn patlamasýndan iki (%4.7) ve zýrhlý araçta patlamaya maruz kalma travmasýndan iki (%4.7) hasta etkilenmiþti.
TARTIÞMA: Blast yaralanmalý hastalarýn neredeyse tamamýnda, kulak zarý perfore olsun veya olmasýn, iþitme eþiklerinde anlamlý fark izlenmedi ve blast yaralanmasýndan kaynaklanan kulak zarý perforasyonunun iç kulak üzerinde koruyucu bir etkiye sahip olmadýðý sonucuna varýldý.

BACKGROUND: Blast-induced hearing loss is an acoustic trauma commonly caused by high-energy explosions of improvised explosive devices, and the auditory system may be affected by blast damage. This study aims to evaluate the protective effect of tympanic membrane perforation (TMP) on the inner ear against blast injury.
METHODS: In this study, 43 adult patients who had suffered blast injury were divided into three subgroups: intact tympanic membranes in both ears, unilateral TMP, and bilateral TMP. Each patient underwent a comprehensive audiogram, including bone conduction, in the audiology department.
RESULTS: Evaluation was performed on 43 (100%) males with a mean age of 31.44±8.01 years (range, 18–52 years). When the type of hearing loss was evaluated separately for each ear, sensorineural hearing loss (SNHL) was observed in 31 (36%), high-frequency SNHL in 26 (30.2%), conductive hearing loss in eight (9.3%), and mixed type hearing loss in 21 (24.4%) ears. TMP was detected in 21 (48.8%) of 43 blast-injured patients, on the right side in four (9.3%) patients, on the left side in seven (16.3%), and bilateral in 10 (23.3%). When the type of acoustic trauma was evaluated, 15 (34.9%) patients were observed to have suffered from the explosion of an IED, 12 (30.2%) from weapon explosion, six (14%) were a vehicle bomb explosion, three (7%) were projectile missile explosion, three (7%) were mortar explosion, two (4.7%) were mine explosion, and two (4.7%) were exposed to the explosion in an armored vehicle (Table 1).
CONCLUSION: No significant difference was observed in the majority of the frequencies whether the tympanic membrane was perforated or not in the blast-injured patients and it was concluded that tympanic membrane perforation caused by blast injury had no protective effect on the inner ear.

AMAÇ: Akut apandisit gebelerde non-obstetrik akut karýnýn en sýk nedenidir. Bu çalýþmada, acil servisimize karýn aðrýsý nedeniyle baþvuran ve akut apandisit tanýsý konulan hastalarýmýzý literatür eþliðinde inceledik.
GEREÇ VE YÖNTEM: 2016–2019 yýllarý arasýnda Þanlýurfa Eðitim ve Araþtýrma Hastanesi Acil Servisine baþvuran 17 adet gebe akut apandisit hastasý elektronik kayýt ortamýnda geriye dönük olarak incelendi. Hastalarýmýz yaþ, gebelik haftasý, klinik durumlarý, yapýlan operasyon, ultrasonografi sonuçlarý, patoloji sonuçlarý, ek hastalýk durumlarý, laboratuvar sonuçlarý ve yatýþ süreleri yönünden deðerlendirildi.
BULGULAR: Hastalarýmýzýn yaþ ortalamasý 25.5 (18–41) idi. Baþvuru anýnda 3 hasta birinci trimester (%17.6), 11 hasta ikinci trimester (%64.8), üç hasta da üçüncü trimesterde (%17.6) idi. Hastalarýmýzýn hepsinde karýn aðrýsý þikayeti mevcuttu. Yapýlan ultrasonografi incelemede 11 hastada akut apandisit saptanýrken altý hastada apandisit izlenemedi. Miadý gelen Ýki tanesine apendektomi operasyonuyla eþ olarak sezeryan iþlemi de uygulandý. Hastalarýmýzýn hastanede yatýþ süresi ortalama 2.9 (2–5) idi. Histopatolojik olarak opere olan hastalarýmýzýn 13’ü (%86.7) akut apandisit tanýsý almýþ idi. Ameliyat sonrasý dönemde anne ve bebeklerde ek problem izlenmedi.
TARTIÞMA: Karýn aðrýsý ile acil servise baþvuran gebe hastalarda akut apandisit non-obstetrik bir patoloji olarak göz önünde tutulmalýdýr. Klinik seyir ve fizik muayene bakýmýndan farklýlýklar gösteren bu durum titiz ve multidisipliner bir yaklaþýmla irdelenmesi anne ve bebek saðlýðý açýsýndan önem arz ettiði kanýsýndayýz.

BACKGROUND: Acute appendicitis is the most common cause of non-obstetric acute abdomen in pregnant women. We examined the patients who were admitted to our emergency department with abdominal pain and diagnosed with acute appendicitis in the light of the literature.
METHODS: Seventeen pregnant patients with acute appendicitis who were admitted to the emergency department of Sanliurfa Training and Research Hospital between the years of 2016–2019 were retrospectively analyzed using an electronic recording system. Our patients were evaluated concerning age, gestational week, clinical status, the operation performed, ultrasonography results, pathology results, presence of additional diseases, laboratory results and hospital stay length.
RESULTS: The mean age of our patients was 25.5 (18–41) years. Three patients were in the first trimester (17.6%), 11 patients were in the second trimester (64.8%), and three patients were in the third trimester (17.6%) at the time of admission. All of our patients had abdominal pain. Acute appendicitis was detected in 11 patients, while it was not detected in six patients on the USG examination. Two patients having term delivery underwent caesarean section with concurrent appendectomy. The mean hospital stay length was 2.9 (2–5) days. Histopathologically, 13 (86.7%) of our operated patients were diagnosed with appendicitis. No additional problems were observed in the mothers and infants in the postoperative period.
CONCLUSION: Acute appendicitis should be considered as a non-obstetric pathology in pregnant patients admitted to the emergency department with abdominal pain. We think that it is important for both maternal and infant health to examine this condition, which shows differences concerning clinical course and physical examination, with a meticulous and multidisciplinary approach.

AMAÇ: Laparoskopik kolesistektomi (LC), cerrahi için uygun hastalarda akut kolesistit (AC) için kabul edilen standart tedavidir. Perkütan kolesistostomi (PC), yüksek riskli hastalar için cerrahi için kalýcý bir tedavi saðlayabilir veya cerrahi tedavi için bir köprü görevi görebilir. PC’yi COVID-19 pandemisinde deðerlendirdik.
GEREÇ VE YÖNTEM: AC’li 50 hasta COVID-19 salgýnýnýn baþlangýcýndan Haziran 2020’ye kadar kabul edildi. Pankreatit, kolanjit ve/veya eksik veriler çalýþmadan çýkarýldý. Kalan 36 hastanýn tümü kaydedildi ve tanýmlayýcý istatistiksel analiz elde edildi. Hastalar üç gruba ayrýldý: PC (n=14); Sadece antibiyoterapi (OC) (n=14) ve LC (n=8) ile konservatif tedavi.
BULGULAR: Ortalama yaþ 53 (daðýlým: 26–78 yýl) idi. Kadýn/erkek oraný 1.11’dir. PC geçen yýl ayný dönemde sekiz (%11) hastada, pandemik dönemde 14 (%39) hastada tercih edildi. Otuz altý hastanýn dördü COVID-19 için pozitifti ve bunlardan biri PC grubunda idi. PC grubunda kardiyak arrest nedeniyle bir (% 7.1) mortalite vardý. Gruplar arasýnda hastanede kalýþ süresi istatistiksel olarak anlamlý deðildi.
TARTIÞMA: Pandemi döneminde LC önerilmemektedir, bu nedenle PC AC tedavisinde etkili ve güvenli bir alternatif olabilir.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital.
METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period.
RESULTS: The mean age of the pandemic period patients was 53 years (range: 26–78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant.
CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.

AMAÇ: Kalan safra taþlarýndan kaynaklanan torasik komplikasyonlar oldukça nadirdir; insidanslarý %0.08 ile %0.3 arasýnda deðiþmektedir. Bu komplikasyonlarýn taný ve tedavisi, nadir görülen prezentasyonlarý ve torasik yaklaþýmýn tartýþmalý rolü nedeniyle zordur. Literatürde bildirilen tüm olgularý içeren bu yazý, bu nadir duruma dair en iyi uygulamayý tartýþmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: PubMed, Medline, Embase, ScienceDirect kullanýlarak, Ocak 1993’ten Mayýs 2019’a kadar makaleler için kapsamlý bir literatür taramasý yapýldý. Taramada þu týbbi konu baþlýklarý (MeSH (Medical Subject Headings)) kullanýldý: “kolelitoptizi”, “torasik”, “safra taþlarý” “kalmýþ”, “dökülmüþ”. Laparoskopik kolesistektomi sonrasý kalan safra taþlarýndan kaynaklanan torasik komplikasyonlarý olan tüm vakalar ekstrapole edilmiþtir.
BULGULAR: Çalýþmaya 24 hasta dahil edildi. En yaygýn semptomlar ateþ, hemoptizi ve litoptiziydi. Semptomlar laparoskopik kolesistektomi sonrasý ortalama 9.8±14.2 ay (1 hafta ile 60 ay arasý) sonra ortaya çýktý. On dört hastada (%58.4) gecikmiþ taný saptandý. Sadece dört hasta tek baþýna antibiyotik tedavisi ile baþarýlý bir þekilde tedavi edildi (%16.7); 20 hasta ise cerrahi veya giriþimsel radyolojiye ihtiyaç duydu (%83.3). Yedi hasta (%29.2) abdominal yaklaþýmla baþarýyla tedavi edildi. On hastada (%41.6) sað akciðer dekortikasyonu ve pulmoner kama rezeksiyonu gerekti.
TARTIÞMA: Klinisyenler, tanýsal gecikmeyi önlemek için, tekrarlayan sað taraflý plevral/akciðer rahatsýzlýklarý olan tüm hastalarda, kolelitiyazis ile iliþkili hastalýklar için önceki kolesistektomi hakkýnda her zaman bilgi almak zorundadýr. Arttýrýlmýþ yaklaþým uygulanmalýdýr: ampirik antimikrobiyal tedavi ve ardýndan mikrobiyolojik veriler elde edilir edilmez hedefe yönelik tedavi; daha sonrasýnda yapýlan abdominal cerrahi hastalarýn yaklaþýk %30’unda etkiliyken, geri kalan hastalarda torasik bir yaklaþým gerekir.

BACKGROUND: Thoracic complications from retained abdominal gallstones are quite rare and the incidence rate ranges between 0.08% and 0.3%. Diagnosis and treatment of these complications are challenging due to the uncommon presentations and the debated role of the thoracic approach. This review of all cases reported in literature aims to discuss the best practice of this rare condition.
METHODS: A comprehensive literature search was performed for articles from January 1993 to May 2019 using PubMed, MEDLINE, Embase, ScienceDirect. The following mesh-words were used: “cholelithopthysis”, “thoracic”, “gallstones” “retained”, and “spilled”. All cases of thoracic complications from retained gallstones after laparoscopic cholecystectomy were extrapolated.
RESULTS: Twenty-four patients were included in this study. The most common symptoms were fever, hemoptysis and lithoptysis. Symptoms after laparoscopic cholecystectomy were presented after a mean time of 9.8±14.2 months (range from one week to 60 months). Delayed diagnosis was found in fourteen patients (58.4.%). Only four subjects were treated successfully with antibiotic therapy alone (16.7%), whereas 20 patients needed surgery or interventional radiology (83.3%). Seven patients (29.2%) were successfully managed with an abdominal approach. Three patients were managed using thoracentesis, thoracoscopic-thoracotomic drainage (12.5%). Right lung decortication and pulmonary wedge resections were necessary for ten patients (41.6%).
CONCLUSION: Clinicians always must inquire about the previous cholecystectomy for cholelithiasis related diseases in all patients suffering from recurrent right-sided pleural/lung affections, to improve diagnostic delay. The escalated approach must be performed: empirical antimicrobial therapy followed by targeted therapy as soon as microbiological data are available; afterwards, abdominal surgery is effective in approximately 30% of patients while the remaining patients have to be submitted to a thoracic approach.

AMAÇ: Kalça hemiartroplastisi (HA) için metafizyel ile diyafizyel ve kýsa sap ile uzun sap gibi çeþitli cerrahi teknikler tanýmlanmýþtýr. Bu çalýþmanýn amacý, yaþlý hastalarda stabil olmayan intertrokanterik kýrýklarýn tedavisinde metafizyel sabit kýsa saplý ile diyafizyel sabit uzun saplý HA sonuçlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma geriye dönük olarak yapýldý ve instabil intertrokanterik kýrýðý olan ve HA ameliyatý geçiren 65 yaþ üzerinde olan 129 hastayý içeriyordu. Sonuçlarýn ölçümü iki yýllýk Harris kalça skoru ve Parker ve Palmer’ýn hareketlilik skoru idi; komorbiditeler ve mortalite oranlarý karþýlaþtýrýldý.
BULGULAR: Ortalama operasyon süresi ve tam aðýrlýk taþýma süresi grup B’de anlamlý olarak daha kýsaydý (her ikisi için p<0.05). Harris kalça skorlarýna gelince, B grubu üçüncü ay deðerlendirmesi için daha iyi sonuçlar gösterdi (p=0.006). Ancak iki yýllýk deðerlendirmeler benzerdi (p=0.067). Ayrýca, B grubunda iki yýllýk deðerlendirmede daha yüksek Parker ve Palmer hareketlilik skorlarý elde edildi (p<0.001). Protez dislokasyonu, kortikal porozis ve çökme sýklýðý grup A’da daha yüksekti (herkes için p<0.05).
TARTIÞMA: Diyafiz sabit uzun saplý HA, metafiz sabit kýsa saplý HA’dan daha üstün görünmektedir, çünkü birincisi daha iyi fonksiyonel skorlar, erken mobilizasyon ve düþük komplikasyon oranlarý ile iliþkilidir.

BACKGROUND: Various surgical techniques have been defined for hip hemiarthroplasty (HA), including metaphyseal vs. diaphyseal and short stem vs. long stem. The present study aims to compare outcomes of metaphyseal fixed short-stem vs. diaphyseal fixed long-stem HA in treating unstable intertrochanteric fractures in elderly patients.
METHODS: This study was conducted retrospectively and included 129 patients ≥65 years of age, having unstable intertrochanteric fractures and undergoing HA. Outcome measures were the 2-year Harris hip score and the mobility score of Parker and Palmer; comorbidities as well as mortality rates of the groups were compared.
RESULTS: Mean operation time and median full weight-bearing time were significantly shorter in group B (p<0.05 for both). As for the Harris hip scores, group B showed better outcomes for the third-month evaluation (p=0.006). However, 2-year assessments were similar (p=0.067). In addition, higher Parker and Palmer mobility scores were obtained in group B at the 2-year assessment (p<0.001). The frequencies of prosthetic dislocation, cortical porosis and subsidence were higher in group A (p<0.05 for all).
CONCLUSION: The findings obtained in this study suggest that diaphyseal fixed long-stem HA seems to be superior to the metaphyseal fixed short-stem HA because the former is related to better functional scores, earlier mobilization, and lower complication rates.

AMAÇ: Tillaux-Chaput kýrýklarýn optimal tedavisi tartýþmalýdýr. Bu çalýþma ile, mini-açýk cerrahi ile tedavi edilen olgularýmýzýn sonuçlarý (açýk redüksiyon ve internal fiksasyon); etkililik ve komplikasyonlar açýsýndan, diðer prosedürleri (açýk, perkütan ve artroskopi destekli) literatür verileri ile karþýlaþtýrmak ve de birincil tedavinin mini açýk cerrahi olup olmadýðý sorusuna bir cevap aramaktýr.
GEREÇ VE YÖNTEM: 2014–2017 yýllarý arasýnda tedavi edilen 30 Tillaux-Chaput kýrýðý olgusunun 22’sine mini açýk cerrahi prosedür ile açýk redüksiyon ve internal fiksasyon uygulandý. Kýrýklarýn hepsi bir adet kanüllü vida ile tespit edildi. Hastalar geriye dönük olarak yaþ, cinsiyet, yön, operasyon süresi, komplikasyonlar ve AOFAS skoru incelendi. Fonksiyonel sonuçlarý yaralanma zamanýndan 12 ay sonra istatistiksel olarak deðerlendirildi. Takipler; klinik muayene, elde edilen görüntüleme sonuçlarý ve AOFAS skoru ile yapýldý.
BULGULAR: Hastalarýn, 14’ü (%63.6) erkek ve sekizi (%36.4) kadýndý. Hastalarýn yaþ ortalamasý 13.8 idi. Ortalama ameliyat süresi 21 dakika idi. Tüm kýrýklarda ortalama 14 haftada kaynama elde edildi. Olgularýn hiçbirinde komplikasyon görülmedi. Ortalama takip süresi 24.7 aydý. Ameliyat öncesi ortalama AOFAS skoru 53.3 puandý, ameliyat sonrasý AOFAS skoru 93.6 puandý. Bu veriler arasýndaki fark istatistiksel olarak anlamlýydý. Son takipte AOFAS skoru tüm olgular için mükemmeldi.
TARTIÞMA: Literatürde belirtilenin aksine mini açýk cerrahi prosedürün birçok avantajý mevcuttur. Cerrahi süre kýsadýr. Sinir yaralanma riski çok düþüktür. Bu çalýþma Tillaux-Chaput kýrýklarýnýn tedavisinin mini açýk cerrahi prosedür ile güvenilir ve etkili bir þekilde yapýlabileceðini göstermektedir. Baþarýlý sonuçlar için mini-açýk cerrahi, tam anatomik redüksiyon ve internal fiksasyon öneriyoruz.

BACKGROUND: There is no consensus on the optimal treatment of Tillaux-Chaput fractures. The results of our cases treated with mini-open surgery (open reduction and internal fixation) concerning efficacy and complications, we aim to compare other procedures (open, percutaneous, and arthroscopy-assisted) with the literature data and to look for an answer to the question of whether the primary treatment can be mini-open surgery.
METHODS: Between the years 2014 and 2017, 22 of 30 patients with Tillaux-Chaput fractures were treated using mini-open surgery, open reduction and internal fixation with one cannulated screw. These cases were retrospectively examined concerning age, sex, side, surgery duration, complications, and American Orthopedic Foot and Ankle Score (AOFAS). Functional results were statistically evaluated 12 months after the injury. Follow-up included a clinical examination, imaging and AOFAS.
RESULTS: Of the patients, 14 were male (63.6%) and eight were female (36.4%). The mean age of the patients was 13.8 years. The mean surgery duration was 21 minutes. All fractures healed after an average of 14 weeks. No complications were observed in any of the cases. The mean follow-up time was 24.7 months. The mean preoperative AOFAS score was 53.3 and the mean postoperative AOFAS score was 93.6, which was a statistically significant difference. At the last follow-up, the AOFAS score was perfect for all cases.
CONCLUSION: Contrary to what is stated in the literature, the mini-open surgical procedure has many advantages. The operation is very short and the risk of nerve injury is very low. This study showed that Tillaux-Chaput fractures could be safely and efficiently treated with mini-open surgery. We recommend mini-open surgery, complete anatomical reduction, and internal fixation for successful results.

AMAÇ: Acil servise baþvuran hastalarda en sýk görülen omuz yaralanmasý anterior omuz çýkýðýdýr. Bu yaralanmalarýn %25’e kadarýnda eþlik eden kýrýk görülebilmektedir. Genel yaklaþým, redüksiyon öncesi ve sonrasýnda röntgen çekilmesidir. Radyasyon maruziyetini ve tedavide gecikmeleri en aza indirmek için, hangi hastalarýn redüksiyon öncesi radyografiye ihtiyaç duyacaðýný belirlemek üzere Fresno-Quebec Kurallarý (FQK) tanýmlanmýþtýr. Bu çalýþmada, Fresno-Quebec algoritmasýnda kullanýlan klinik belirteçlerin eþlik eden kýrýðý ortaya koymadaki etkinliðini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Omuz çýkýðý þüphesi ile acil serviste deðerlendirilmiþ hastalarýn dosyalarý FQK’na göre geriye dönük olarak gözden geçirildi. FQK’nýn eþlik eden kýrýðý belirlemedeki duyarlýlýk, özgüllük, pozitif ve negatif öngörü deðerleri incelendi.
BULGULAR: Seksen dokuz (%65.9) erkek ve 46 (%34.1) kadýn hasta çalýþmaya alýndý. Hastalarýn ortalama yaþý 46 (16–89) idi. Doksan dokuz (%73.3) hasta ilk kez omuz çýkýðý geçirirken, 36 (%26.7) hastada tekrarlayan çýkýk mevcuttu. Tekrarlayan çýkýðý olan hastalarýn yarýsý (18 olgu) atravmatik çýkýktý. Kalan 18 hastada da tekrarlayan çýkýk öyküsü olmakla beraber son baþvurularýnda travmatik neden ve dört tanesinde de kýrýklý-çýkýk mevcuttu. FQK’nýn kýrýklý-çýkýklarý belirlemede %1000 duyarlýlýðý olduðu bulundu. Tekrarlayan fakat travma sonrasý geliþmiþ çýkýklarda yaralanma mekanizmasýnýn þiddetinin belirleyici olmadýðý görüldü. Tekrarlayan fakat travmaya baðlý çýkýðý olan hastalarýn dört tanesinde eþlik eden kýrýk mevcutken, bu dört olgunun sadece bir tanesi yüksek enerjili yaralanma sonucu meydana gelmiþti.
TARTIÞMA: FQK anterior omuz çýkýðý sebebi ile acil servise baþvuran hastalarda eþlik eden kýrýðý belirlemede %100 duyarlýlýða sahiptir. Kullanmasý ve hatýrlamasý kolay parametrelere dayanmaktadýr. Bu kurallarý kullanarak, gereksiz radyografileri %30 oranýnda azaltmak, maliyeti ve radyasyon maruziyetini düþürmek mümkündür.

BACKGROUND: Anterior shoulder dislocation is the most common shoulder injury in patients presenting to the emergency department (ED). Up to 25% of these injuries are fracture-dislocations. In general, the standard approach is to obtain plain radiographs before and after reduction. Fresno-Quebec Rules (FQR) are described to identify the patients who require an x-ray before reduction to reduce radiation exposure and delays in treatment. We aimed to evaluate the efficacy of clinical predictors used in the Fresno-Quebec algorithm for detecting a shoulder fracture-dislocation.
METHODS: Records of patients who presented to the Emergency Department with presumed shoulder dislocation were retrieved and retrospectively analyzed according to “Fresno-Quebec Rule (FQR)”. Sensitivity, specificity, and predictive values of FQR for detecting associated injuries were calculated.
RESULTS: Eighty-nine (65.9%) men and 46 (34.1%) women were included. The mean age of patients was 46 years (16–89). Ninety-nine (73.3%) of the cases had their shoulder dislocated for the first time, whereas 36 (26.7%) patients had a recurrent dislocation. Fifty percent of the patients (18 cases) with recurrent dislocation presented with an atraumatic episode. The remaining 18 patients with a history of recurrent dislocations had their shoulder dislocated as a result of trauma, and four (22%) of them had fracture-dislocation. Using the Fresno-Quebec rules yielded 100% specificity for the diagnosis of fracture-dislocation. The severity of the injury mechanism was not predictive in traumatic but recurrent dislocations. Only one of four patients with a fracture-dislocation in the traumatic recurrent dislocation group had high energy trauma.
CONCLUSION: FQR has 100% sensitivity in detecting fracture-dislocations in patients admitted to ED with anterior shoulder dislocation. It utilizes simple parameters that are easy to use and recall. Using these rules, 30% of unnecessary radiographs can be avoided, saving time and money and reducing radiation exposure in anterior dislocations.

AMAÇ: Bu çalýþmanýn amacý, yanmýþ çocuklarda iki farklý yanýk sargýsýnýn (gümüþlü hidrofiber [HFAg] ve polilaktik membran [PLM]), yanýk sonrasý geliþen enflamasyonun þiddetini gösteren önemli biyo belirteçler olan interlökin-6 (IL-6), tümör nekroz faktörü-alfa (TNF-α) ile yanýk yara iyileþmesinde önemli rol oynayan dönüþtürücü büyüme faktörü-b3’nýn (TGF-b3) kanda ve dokuda tedavi sürecindeki deðiþim açýsýndan incelenmesidir.
GEREÇ VE YÖNTEM: Toplam vücut yüzey alanýnýn %25–50'si ikinci derece kýsmi kalýnlýkta haþlanma yanýklarý olan 1–16 yaþ arasý çocuklar, iki tedavi grubu çalýþmaya dahil edildi. Gruplardan belirli aralýklarla PLM ile ve HFAg ile pansuman yapýlan hastalardan 21 günlük tedavi döneminde 3–7–14–21. günlerde kan ve doku örnekleri alýndý. Saðlýklý çocuklardan bir defa kan ve deri doku örneði alýnarak kontrol grubu oluþturuldu. Gruplardan alýnan kan ve doku örneklerinde IL-6, TNF-α, TGF-b3 düzeylerine bakýldý. Sonuçlar ististiksel olarak analiz edidi.
BULGULAR: PLM grubunda IL-6 ve TNF-α seviyeleri, HFAg grubundan daha erken normal düzeye ulaþtý. PLM grubunda, TGF-b3 seviyeleri diðer gruplara göre daha uzun süre yüksek kaldý.
TARTIÞMA: Bu çalýþmada, PLM'nin hem sistemik hem de yanýk dokusunda enflamasyonu daha erken kontrol ettiðini bulduk. Ayrýca, PLM'nin, kanda ve yanýk dokusunda hipertrofik skar geliþimini engelleyen TGF-b3 seviyesini artýrdýðýný da bulduk.

BACKGROUND: We aimed to evaluate the effects of two different burn dressings, hydrofiber with a silver (HFAg) and polylactic membrane (PLM), on altering the levels of important biomarkers Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Transforming growth factor-β3 (TGF-β3) in blood and burnt tissue in children with second-degree burns.
METHODS: Children between the ages of one to 16 years, with 25–50% second-degree partial-thickness burns of the total body surface area were included in this study. Patients in the PLM group were dressed with PLM in a typical way according to the manual. The HFAg group was dressed with HFAg and a sterile cover. During and at the end of the 21-day treatment, blood and skin tissue samples were taken from the two burn and control groups. IL-6, TNF-α, and TGF-β β3 levels were evaluated in blood and tissue samples from all groups, and the results were analyzed statistically.
RESULTS: In the PLM group, IL-6 and TNF-α levels decreased early days in both serum and tissue samples to reach normal ranges compared with the HFAg group. In the PLM group, TGF-β3 levels were elevated than in other groups for two weeks.
CONCLUSION: In this study, we found that PLM controls inflammation earlier in both systemic and burn tissue. We also found that PLM increased the level of TGF-β3, which may be associated with the prevention of the development of hypertrophic scar in the burn wound, in the blood and burn tissue during this study.

MAÇ: Akut sol kolon divertiküliti (ASKD) klinikte lokalize divertikülitten perforasyon ve fekal divertikülite varan geniþ bir yelpazede görülebilir; tedavi hastalýðýn þiddetine göre konservatif yöntemlerden acil cerrahiye kadar deðiþkenlik gösterebilir. Akut sol kolon divertikülitinin ameliyatsýz tedavisini takiben görülebilen nüksüne neden olan risk faktörleri hala tartýþmalýdýr. Bu çalýþmada, cerrahi tedavi gerektiren hastalarýn uygun zamanda belirlenmesine yönelik olarak ASKD þiddet, progresyon ve nüksünü belirleyici faktörlerin tanýmlanmasýný amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýz çok merkezli ve ileriye yönelik olarak gerçekleþtirildi. Kiliniðimizde aralýk 2017–Haziran 2019 tarihleri arasýnda klinik, laboratuvar ve görüntüleme yöntemleriyle ASKD tanýsý konularak yatýþlý tedavisi yapýlan (n=144) 18 yaþ üzeri hastalar çalýþmaya dahil edildi, 18 yaþ ve daha genç, gebe veya emziren, önceden tanýsý konulmuþ Crohn, ülseratif kolon hastalýðý, kolo-rektal ve/veya anal kanalda malign tümörü mevcut fakat ameliyat edilmemiþ hastalar çalýþmadan dýþlandý. Hastalarýn yatýþ esnasýndaki laboratuvar parametreleri, Modifiye Hinchey Skoru (MHS), klinik özellikleri, demografi, beslenme, sigara ve alkol alýþkanlýklarý, vücut kütle indeksleri (VKÝ), önceki divertikülit ataklarý, mevcut kronik hastalýklarýnýn yanýsýra taburculuktan itibaren 18 ay içindeki divertikülit nüksleri kaydedildi.
BULGULAR: Sigara içme alýþkanlýðý önceden divertikülit ataðý geçirmiþ (p=0.04) veya acil cerrahiye alýnmýþ (p=0.04) hastalarda anlamlý olarak daha fazla görüldü. Nüksetme, MHS 1b ve 2 de, 0 ve 1a’dan anlamlý olarak yüksekti (p=0.03). Acil cerrahi giriþim yapýlan hastalar incelendiðinde 50 yaþ üzeri hastalarýn, daha genç hastalardan anlamlý olarak fazla olduðu görüldü (p=0.049). Yatýþ esnasýnda bulantý, ateþ, solunum sayýsý, prokalsitonin, total bilirubin ve direkt bilirubin seviyeleri MHS 4 olan hastalarda, diðer hastalara göre anlamlý olarak daha yüksek bulundu (sýrasýyla, p=0.03, 0.049, 0.02, 0.001, 0.002, 0.001). Nüksetme, sigara içme alýþkanlýðý, önceden ASKD öyküsü, düþük VKÝ ve pandivertikülit mevcudiyeti olan hastalarda diðer hastalara göre yüksekti.
TARTIÞMA: Laboratuvar parametreleri, VKÝ, yaþ, klinik özellikler, önceden geçirilen divertikülit öyküsü ve sigara kullanýmý, ASKD’nin þiddet ve seyri hakkýnda belirleyicidir. Önceden en az bir ASKD ataðý geçirmiþ olan MHS 1b-2 hastalarda sigara alýþkanlýðý ve düþük VKÝ mevcudiyeti ASKD nüksüne yatkýnlýk oluþturmaktadýr. Kontrol kolonoskopi sonuçlarý nüksetme olasýlýðý hakkýnda yönlendiricidir.

BACKGROUND: Acute left colonic diverticulitis (ALCD) ranges from localized diverticulitis to perforation and fecal peritonitis, and treatment varies from conservative management to emergency surgery. The risk factors for recurrence following nonoperative management of ALCD is still controversial. We aimed to define the factors predicting severity level, progression and recurrence risk of ALCD to timely select patients requiring surgery.
METHODS: This is a multicenter study where patients were included on accrual. Patients in our clinic between December 2017 and June 2019 with ALCD above 18 years of age were included (n=144) in this study, while 18 years and younger, pregnant or nursing mothers, those with Crohn’s disease, ulcerative colitis, colorectal and/or anal cancer were excluded from this study. Laboratory parameters, Modified Hinchey Scores, clinical features, demographics, diet, smoking, alcohol consumption, body mass index, previous diverticulitis episodes, chronic diseases of patients with ALCD, as well as recurrences within 18 months after discharge were evaluated.
RESULTS: The findings showed that smoking was more common in patients with previous episodes (p=0.04) and patients who underwent emergency surgery (p=0.04). Recurrence was higher in Modified Hinchey 1b and 2 (p=0.03) than 0 and 1a. Patients who were older than 50y had a higher propensity to undergo emergency surgery than the patients younger than 50y (p=0.049). Nausea, fever, respiratory rate, procalcitonin, total bilirubin and direct bilirubin levels were higher in patients with Modified Hinchey 4 (p=0.03, 0.049, 0.02, 0.001, 0.002, 0.001, respectively). Recurrence was higher in patients with a smoking history, previous ALCD episodes, lower body mass index and pandiverticulitis.
CONCLUSION: Laboratory parameters, body mass index, age, clinical features, previous episodes of diverticulitis and smoking may predict the severity and progression of ALCD. Smoking and having low BMI seem to be precursors of ALCD recurrence, especially when the patient with MHS 1b or 2 had at least one previous episode of ALCD. Control colonoscopy results are predictive of recurrence.

AMAÇ: Travmatik posterior segment üretral darlýklarýn ve prostatik üretral stenozlarýn tedavisinde visual internal üretrotomi (VIU) için spinal anestezi (SA) ile %2 lidokainli intraüretral topikal instilasyon+vizüel intraüretral lokal anestezi (T+LIA) kombinasyonunun etkinliðini karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Kliniðimizde Ekim 2018 ve Ocak 2020 tarihleri arasýnda travmaya ikincil geliþen posterior segment üretral darlýk ve prostatik üretral stenoz nedeniyle VIU operasyonu yaptýðýmýz toplam 178 hastanýn sonuçlarý geriye dönük olarak incelendi. Hastalar uygulanan anestezi tipine göre kombine T+LIA (n=146, %82.08) grubu ve SA (n= 32, %17.97) grubu olarak iki gruba ayrýldý. Hastalarýn ameliyat öncesi klinik verileri ve ameliyat sonrasý sonuçlarý incelenerek gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý 67.99±10.87 yýl ve ortalama takip süreleri 5.32±3.27 aydý. T+LIA grubundaki hastalarýn median yaþýnýn SA grubuna göre anlamlý olarak yüksek olduðu görüldü (p=0.033). Gruplar arasýnda ameliyat öncesi Q-max deðeri açýsýndan istatistiksel olarak anlamlý fark saptanmadý (p=0.931). Benzer þekilde, ameliyat sonrasý dönemde hastalarýn Q-max deðerlerinde düzelme oranýnýn gruplar arasýnda benzer düzeyde olduðu görüldü (p=0.572). Ameliyat öncesi komplikasyon varlýðý ve nüks oranlarý da gruplar arasýnda benzer bulundu (sýrasýyla, p=0.879, p=0.904).
TARTIÞMA: Travmatik posterior segment üretral darlýklarýn ve prostatik üretral stenozlarýn tedavisinde VIU için T+LIA anestezisi spinal anestezi ile kýyaslandýðýnda yüksek baþarý oraný ve kabul edilebilir komplikasyon oraný ile güvenle uygulanabilir ve etkin bir yöntemdir.

BACKGROUND: To compare the effectiveness of spinal anesthesia (SA) and the combination of intraurethral topical instillation of 2% lidocaine + intraurethral local visual injection anesthesia (T + LIA) for visual internal urethrotomy (VIU) in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses.
METHODS: In this study, the results of 178 patients who underwent visual internal urethrotomy for posterior urethral strictures and prostatic urethral stenoses secondary to trauma in our clinic between October 2018 and January 2020 were analyzed retrospectively. Patients were divided into two groups as combined T + LIA (n=146, 82.08%) group and SA (n=32, 17.97%) group according to the type of anesthesia used. The preoperative clinical data and postoperative results of the patients were analyzed and compared between the groups.
RESULTS: The mean age of the patients was 67.99±10.87 years and the mean follow-up was 5.32±3.27 months. The median age of the patients in the T + LIA group was significantly higher than that of the patients in the SA group (p=0.033). There was no statistically significant difference between the groups regarding preoperative Q-max value (p=0.931). Similarly, the rate of postoperative improvement in the Q-max values of the patients was similar between the groups (p=0.572). The presence of postoperative complications and recurrence rates were similar between the groups (p=0.879 and p=0.904, respectively).
CONCLUSION: Compared to spinal anesthesia, T + LIA anesthesia is a safe and effective technique for visual internal urethrotomy in treating traumatic posterior urethral strictures and prostatic urethral stenoses, with a high rate of success and acceptable rate of complications.

AMAÇ: Kapsam dýþý klips (OTSC) cihazlarý artýk endoskopistler tarafýndan gastrointestinal kanama, perforasyon veya sýzýntý için yaygýn olarak kullanýlmaktadýr. Bu çalýþmanýn amacý, bu tekniðin terapötik baþarý oranýný incelemekti.
GEREÇ VE YÖNTEM: Bu çalýþma tek merkezli ve geriye dönük olarak yapýldý. Çalýþmaya gastrointestinal kanamasý, sýzýntýsý veya perforasyonu olan toplam 23 hasta alýndý. Prosedür deneyimli endoskopist tarafýndan gerçekleþtirildi.
BULGULAR: Üst gastrointestinal sistem defekti olan hastalarýn altýsýnda perforasyon, bir olguda anastomoz kaçaðý vardý. Sekiz hastada alt gastrointestinal kanalda perforasyon vardý ve iki olgu anastomoz kaçaðý vardý. Sadece altý hastada kanama tespit edildi ve tümü üst gastrointestinal kanama idi. Anastomoz sýzýntýlarý, perforasyonlar ve kanama OTSC ve ek prosedürlerle tedavi edildi. Tek baþýna OTSC kýrpmanýn baþarý oraný %56.5 iken, ek terapötik prosedürlerle (klemp, stent, skleroterapi) baþarý oraný %86.9’du. Kanama, perforasyon ve anastomoz kaçaðý kategorilerine göre yapýlan analizler, klip uygulamasýnýn kanamadaki baþarý oranýnýn perforasyon veya anastomoz kaçaðýna göre anlamlý derecede yüksek olduðunu ortaya koydu (p=0.002). Hastanede ortalama kalýþ süresi beþ gündü (min-maks: 2–30 gün). OTSC prosedürü ile iliþkili herhangi bir komplikasyon yoktu.
TARTIÞMA: OTSC, gastrointestinal kanama, perforasyon veya anastomoz sýzýntýsýnýn yönetimi için güvenli ve etkili bir yöntemdir.

BACKGROUND: Over-the-scope clip (OTSC) devices are now widely used by endoscopists for gastrointestinal bleeding, perforation, or leakage. The present study aims to examine the therapeutic success rate of this technique.
METHODS: This was a single-center, retrospective study. In this study, 23 patients with gastrointestinal bleeding, leakage, or perforation were included. The procedure was performed by an experienced endoscopist.
RESULTS: Of the patients with an upper gastrointestinal tract defect, six had a perforation and there was one case of anastomosis leakage. Eight patients had a perforation in the lower gastrointestinal tract, and there were two cases of anastomosis leakage. Bleeding was detected in only six patients and all of them were upper gastrointestinal bleeding. Anastomosis leaks, perforations, and bleeding were treated with OTSC and additional procedures. The success rate of OTSC clipping alone was 56.5%. However, the success rate was 86.9% with additional therapeutic procedures (clamp, stent, sclerotherapy). Analysis according to categories of bleeding, perforation, and anastomosis leak revealed that the success rate of the clip application in bleeding was significantly higher than that of perforation or anastomosis leak (p=0.002). The median length of stay in the hospital was five days (min-max: 2–30 days). There were no complications associated with the OTSC procedure.
CONCLUSION: OTSC is a safe and effective method for the management of gastrointestinal bleeding, perforation, or anastomosis leak.

Dekompresyon hastalýðý (DKH), ortama basýncýndaki hýzlý düþüþe baðlý ortaya çýkan hava kabarcýklarýnýn neden olduðu nadir bir durumdur. Bu hava kabarcýklarý hem fiziksel hem de kimyasal etkiler göstererek, semptomsuz klinik prezentasyondan ölüme dek geniþ bir spektrumda bulgulara neden olabilir. Literatürde DKH ile iliþkili olarak; bilinç deðiþiklikleri, kas-iskelet sisteminde ve karýnda þiddetli aðrý, solunum sýkýntýsý ve cilt deðiþiklikleri tariflenmiþtir. DKH tanýsýný koymak zordur ancak tanýda öykü ve fizik muayene yol göstericidir. Radyolojik deðerlendirme, DKH tanýlý hastalarda olasý komplikasyonlarý belirlemek ve karýn içi serbest hava kabarcýklarýna yol açan diðer akut patolojileri dýþlamak için yararlýdýr. DKH tanýsý konan hastalarýn bilgisayarlý tomografi (BT) görüntülerinde, portal venöz sistem, iliak ve mezenterik venler, vena kava inferior (VCI) ve serebral ve spinal arterlerde hava kabarcýklarý daha önce tariflenmiþtir. Bu yazýda, abdominal BT’de belirgin olan karýn içi serbest hava kabarcýklarý görülen iki DKH olgusunun klinik ve BT bulgularý sunuldu.

Decompression illness (DCI) is a rare condition caused by air bubbles that arise because of a rapid decrease in ambient pressure. These air bubbles exert both physical and chemical effects associated with a range of findings from asymptomatic clinical presentation to death. In the literature, changes in consciousness, severe musculoskeletal and abdominal pain, respiratory distress, and skin changes have been described. The diagnosis of DCI is difficult, but anamnesis and physical examination are helpful. Radiologic evaluation is useful for determining possible complications in patients with severe disease and excluding other acute pathologies. In computed tomography (CT) images of patients diagnosed with DCI, air bubbles in the portal venous system, iliac and mesenteric veins, the vena cava inferior (VCI), and the cerebral and spinal arteries have been described before. Herein, we present the clinical and CT findings of two cases of DCI with extensive intra-abdominal free bubbles evident on abdominal CT.

Gezici dalak, asýcý baðlarýnýn yokluðu veya gevþekliði nedeniyle dalaðýn normal anatomik lokalizasyonunda olmamasý þeklinde tanýmlanmýþtýr. Doðuþtan ve edinsel faktörler etiyolojide rol oynamaktadýr. Nadir görülen bir durumdur ve torsiyon veya enfarktüs gibi hayatý tehdit eden komplikasyonlara yol açabilir. Nadiren hastalar akut karýn tablosu ile de acile baþvurabilirler. Kronik karýn aðrýsý veya karýniçi kitle ile prezente olabilir. Klinik tanýsý genellikle zor olduðu için, radyolojik incelemeler tanýda oldukça önemli yer tutar. Bu yazýda, akut karýn tablosu ile baþvuran ve acil þartlarda laparoskopik splenektomi uyguladýðýmýz, 24 yaþýnda gezici dalak torsiyonu olgusu sunuldu.

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.

Yirmi yaþýnda bir erkek, sað temporal bölgede aðrýsýz ancak kozmetik bir problem oluþtuðu için þiþlikten yakýndý. Yüzeyel temporal arterin psödoanevrizmasý çok nadirdir. Genellikle temporal bölgeye künt travma sonrasý ortaya çýkar ve izleyen 2–6 hafta boyunca aðrýsýz, preauriküler, pulsatil bir kitle þeklinde ortaya çýkar. Teþhis sadece fizik muayene ve ultrason ile konur. Lokal anestezi altýnda yapýlan ameliyat çok etkili bir tedavi yöntemidir.

A 20-year-old man suffered from a swelling with a painless but cosmetic problem in the right temporal region. Pseudoaneurysm of the superficial temporal artery is rare. It typically occurs after blunt trauma to the temporal region and presents as a painless, preauricular and pulsatile mass during the following 2–6 weeks. The diagnosis is made simply by physical examination and ultrasound. Surgery under local anesthesia is a very effective treatment.