AMAÇ: Ýskemi/reperfüzyon hasarý (IRH), hipoksik bir organýn yeniden oksijenlenmesi sonucu ortaya çýkan hücresel bir hasardýr. Bu çalýþmada, inotropik bir ajan olan levosimendan ile antioksidanlarýn ve glutatyonun öncüsü olan N-Asetilsistein (NAS) kombinasyonunun deneysel bir karaciðer IRH modelindeki etkilerini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Otuz sekiz sýçan rastgele beþ gruba ayrýldý. Ýskemiden önce çalýþma gruplarýna önceden belirlenmiþ bir miktarda ve sürede fizyolojik salin çözeltisi, NAS, levosimendan veya NAS+levosimendan kombinasyonu verildi ve infüzyon çalýþmanýn sonuna kadar devam etti. Hepatik pedikül, bir atravmatik ven klempi kullanýlarak baðlandý ve 60 dakikalýk iskemi saðlandý. Daha sonra klemp açýldý ve 60 dakika reperfüzyon saðlandý. Karaciðer dokusu örnekleri sýçanlar sakrifiye edildikten sonra alýndý ​​ve doku malondialdehit (MDA) ve miyeloperoksidaz (MPO) seviyeleri belirlendi. Ayrýca alýnan kan örneklerinden serum tümör nekrozis faktör (TNF)-α, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT) ve MPO düzeylerine de bakýldý.
BULGULAR: IRH sonrasý karaciðer dokusundaki konjesyon, vakuolizasyon ve nekroz düzeylerine dayanarak oluþturulan histopatolojik hasar skorlama sisteminde gruplar arasýnda, histopatolojik deðiþiklikler bakýmýndan, istatistiksel olarak anlamlý farklýlýklar bulundu. Histopatolojik hasar skoru, plazma MPO, AST, ALT, doku MPO ve doku MDA deðerleri, tedavi alan gruplarda kontrol gruplarýna oranla istatistiksel olarak anlamlý derecede düþük bulunurken, levosimendan ve NAS kombinasyon grubunda karaciðer histopatolojik hasar skoru diðerlerine oranla istatistiksel olarak ciddi anlamda düþük bulundu.
TARTIÞMA: Literatürde ilk kez, karaciðer IRH’sýnda levosimendan ve NAS kombinasyonunun kullanýlmasý ile enflamasyon ve oksidatif stresin belirgin þekilde baskýlandýðý ve karaciðer iskemisi reperfüzyon hasarýnýn önemli ölçüde azaldýðý gösterilmiþtir. Bu sonuca göre, IRH durumunda levosimendan veya NAS’nin tek ajan olarak kullanýmý yerine kombinasyon olarak kullanýmý önerilebilir.

BACKGROUND: Ischemia-reperfusion injury (IRI) is cellular damage that emerges from re-oxygenation of a hypoxic organ. In the present study, we aimed to examine the effects of a combination of levosimendan, an inotropic agent, and N-Acetylcysteine, the precursor of antioxidants and glutathione, in an experimental liver IRI model.
METHODS: In this study, 38 rats were randomly divided into five groups. Before the ischemia, study arms were given physiological saline solution, N-Acetylcysteine (NAS), levosimendan or a combination of NAS+levosimendan in a predetermined amount and duration, and the infusion was continued until the end of this study. The hepatic pedicle was occluded using an atraumatic vein clamp, and 60 minutes of ischemia was achieved. The clamp was then opened and 60 minutes of reperfusion was ensured. Liver tissue samples were obtained after sacrifice, and tissue malondialdehyde (MDA) and myeloperoxidase (MPO) levels were determined. Serum Tumor Necrosis Factor (TNF)-α, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and MPO levels of blood samples were also measured.
RESULTS: Among the histopathological changes in the liver tissue after IRI, differences between groups were statistically significant in the injury scoring system based on congestion, vacuolization and necrosis levels. Histopathological injury score, plasma MPO, AST, ALT, tissue MPO and tissue MDA values were statistically significantly lower in the treatment groups, prominently in the levosimendan and NAS combination group concerning liver histopathological damage.
CONCLUSION: The use of a levosimendan plus NAS combination in liver IRI markedly suppressed inflammation and oxidative stress and significantly reduced liver ischemia-reperfusion injury and can be recommended for decreasing IRI instead of single agent use of levosimendan or NAS.

AMAÇ: Ýntestinal iskemi sonrasý reperfüzyon gerçekleþmesi ile oluþan serbest oksijen radikalleri hücre için son derece toksiktir. Glutatyon peroksidaz ise reaktif oksijen türlerinin oluþumunu engelleyen önemli enzimlerdendir ve kofaktör olarak selenyuma ihtiyaç duyar. Çalýþmamýzýn amacý selenyum uygulanmasýnýn iskemi-reperfüzyon hasarýný azaltýcý etkisini göstermektir.
GEREÇ VE YÖNTEM: Çalýþmada 28 adet erkek Wistar sýçan kullanýldý. Denekler dört gruba ayrýldý. Üçüncü ve dördüncü gruba beþ gün süre ile 10 mikrogram/kg/gün sodyum selenat intraperitoneal olarak verildi. Birinci ve üçüncü grup deneklere laparotomi yapýldý, ikinci ve dördüncü gruptaki deneklere ise laparotomi sonrasý superiyor mezenterik arter 45 dakika klempe edilip iskemi oluþturuldu, ardýndan 90 dakika reperfüzyon saðlandý. Deneklerden malondialdehit için kan, karaciðer ve ileum örneði alýndý. Bakteriyel translokasyon için karaciðer, dalak ve mezenterik lenf nodu doku örnekleri alýndý, ayrýca ileumdan alýnan örnek ile histopatolojik inceleme yapýldý.
BULGULAR: Ýskemi-reperfüzyon grubunda mezenterik lenf nodlarýnda bakteriyel translakasyon diðer gruplardan anlamlý derecede fazla idi (p<0.05). Histopatolojik deðerlendirmelere bakýldýðýnda yine iskemi-reperfüzyon grubunda skor diðer gruplardan anlamlý derecede yüksekti (p<0.05). Serum, karaciðer ve ileum malondialdehit düzeyleri de iskemi-reperfüzyon grubundaki yüksekliðe baðlý olarak gruplar arasýnda anlamlý farklýlýk gösterdi (p<0.05).
TARTIÞMA: Çalýþmamýz selenyumun serum ve doku MDA düzeylerini düþürdüðü, baðýrsaklarda iskemi-reperfüzyon hasarý ile geliþen histopatolojik hasarý ve buna baðlý bakteriyel translokasyonu azalttýðý göstermiþtir.

BACKGROUND: The free oxygen radicals formed with reperfusion following intestinal ischaemia are extremely toxic for the cells. Glutathione peroxidase, an important enzyme that prevents the formation of reactive oxygen species, requires selenium as a co-factor. This study aims to demonstrate the effects of selenium administration on reducing ischaemia-reperfusion damage.
METHODS: In this study, 28 male Wistar rats were separated into four groups. To Groups 3 and 4, sodium selenite at the dose of 10 µg/kg/day was administered intraperitoneally for five days. In Groups 1 and 3, laparotomy was applied, and in Groups 2 and 4, following laparotomy, ischaemia was created by clamping the superior mesenteric artery for 45 mins, then reperfusion was provided for 90 mins. Blood, liver and ileum samples were taken from all the animals for examination of malondialdehyde. For examination of bacterial translocation, liver, spleen and mesenteric lymph node tissue samples were taken. A sample taken from the ileum was examined histopathologically.
RESULTS: There was determined to be significantly more bacterial translocation in the mesenteric lymph nodes of the ischaemia-reperfusion group (p<0.05). In the histopathological evaluation, the score in the ischaemia-reperfusion group was significantly higher than the scores in the other groups (p<0.05). Elevated serum, liver and ileum malondialdehyde levels in the ischaemia-reperfusion group were significantly higher than those in the other groups (p<0.05).
CONCLUSION: Selenium was seen to have decreased serum and tissue malondialdehyde levels and increased the histopathological damage developing in the intestines with ischaemia-reperfusion and thereby increased bacterial translocation.

AMAÇ: Bu çalýþmanýn amacý, sýçanlarda melatoninin yanýk yara iyileþmesine etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada 40 adet Wistar-albino cinsi deneysel erkek sýçanlar dört gruba ayrýldý: Grup 1; kontrol grubu, Grup 2; eksojen melatonin verilen grup, Grup 3; pinealektomi uygulanan grup ve Grup 4; pinealektomi yapýldýktan sonra eksojen melatonin uygulanan grup idi. Sýçanlarýn sýrtlarýna kaynar suda bekletilmiþ metal plak ile ikinci derece derin yanýk oluþturuldu. Yedi gün boyunca yanýk alanlarýnýn iyileþmesi takip edildi. Yedi gün sonunda eksize edilen yanýk alan dokularýnda hidroksiprolin, Tip 3 kollajen, ödem, iltihabi infiltrasyon, konjesyon, vasküler proliferasyon, fibrozis düzeyleri, staz zonu ve epitel kalýnlýklarý deðerlendirildi.
BULGULAR: Staz zonu kalýnlýðý Grup 2’de diðer gruplara oranla daha azdý (p=0.009). Tip 3 kollajen boyanma (p=0.031), fibrozis (p=0.011) ve ödem (p=0.031) Grup 2’de diðer gruplara oranla daha fazlaydý. Konjesyon kontrol grubunda Grup 4’e göre daha fazlaydý (p=0.031). Deðerlendirilen diðer parametrelerde, gruplar arasýnda anlamlý bir fark görülmedi.
TARTIÞMA: Bu çalýþmada, total melatonin düzeyinin belli eþik düzeyi geçmesi durumunda, staz zonunu azaltarak yanýk yara hasarýnýn ilerlemesinde önleyici etkisi bulundu. Melatoninin, ayrýca hipertrofik skar geliþimini de önleyebildiði görüldü. Melatonin yanýk yaralarýnda geleneksel tedaviyi destekleyebilecek potansiyel bir tedavi seçeneði olabilir. Bunun yanýsýra, bu çalýþmada belirtilen etkileri daha fazla deðerlendirmek için daha uzun sürelerde ve daha yüksek dozlarda eksojen melatoninin uygulandýðý çalýþmalara ihtiyaç vardýr.

BACKGROUND: The present study aims to investigate the favorable effects of melatonin on burn wound healing in rats.
METHODS: In this study, forty Wistar-albino-type male rats were divided into four groups. Group 1 was the control group, Group 2 rats were treated using exogenous melatonin, Group 3 rats were pinealectomized, and Group 4 rats were pinealectomized then treated with exogenous melatonin. In all groups, a deep second-degree burn was created on the backs of the rats with a metal plate heated in boiling water. We monitored the progress of burn healing for seven days. At the end of them, we evaluated hydroxyproline levels, type III collagen, edema, inflammatory infiltration, congestion, vascular proliferation, fibrosis, the thickness of the zone of stasis and the epithelium to assess the progress of healing.
RESULTS: The zone of stasis was less thick in Group 2 than the other groups (p=0.009). Type III collagen dyeing (p=0.031), fibrosis (p=0.011) and edema (p=0.031) were higher in Group 2 than the other groups. Congestion was higher in the control group than Group 4 (p=0.031). Other evaluated parameters showed no significant differences among the groups.
CONCLUSION: In this study, it was noted that once total melatonin levels exceeded a certain threshold, a preventive effect was exerted on burn wound damage progression by reducing the zone of stasis. Melatonin may also prevent the development of hypertrophic scarring. Melatonin may be a potential therapeutic option that can supplement traditional treatment in burn wounds; however, further studies with higher doses of exogenous melatonin administered over longer periods are needed to further evaluate the effects noted in this study.

AMAÇ: Akut mezenterik iskemi neticesinde geliþen iskemi reperfüzyon hasarýndaki histopatolojik bozulmanýn temel sorumlusu serbest oksijen radikalleri ve proenflamatuvar sitokinlerin artýþýdýr. Ficus carica ve çeþitli kýsýmlarýnýn antioksidan ve antienflamatuvar özellikler gösterdiði geçmiþ çalýþmalarda bildirilmiþtir. Bu çalýþmada da Ficus carica çekirdek yaðýnýn, sýçanlarda intestinal iskemi reperfüzyon hasarý üzerine etkilerini incelemek amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Elli adet Wistar albino sýçan beþ eþit gruba bölündü. Negatif kontrol (NC), sham-operated (Sham), iskemi ve reperfüzyon (IR), 3 ml/kg/gün Ficus carica çekirdek yaðý (FC3), 6 ml/kg/gün Ficus carica çekirdek yaðý (FC6). IR, FC3 ve FC6 gruplarýna iskemi ve reperfüzyon prosedürü 45+120 dk boyunca uygulandý. Sham grubu sýçanlar yalnýzca abdominal orta hat laparotominin ardýndan 165 dk boyunca bekletildi.
BULGULAR: Proenflamatuvar sitokinler olan IL-1β ve TNFα doku seviyeleri FC6 grubunda IR grubuna gore anlamlý derecede düþüktü (p<0.05) FC6 ve FC3 gruplarýnýn MDA ve MPO düzeyleri IR grubuna kýyasla düþük olup, FC6 grubundaki düþüþ FC3 grubundaki düþüþten istatistiksel olarak daha fazlaydý (p<0.05). FC6 ve FC3 gruplarýnýn her ikisinde de SOD ve CAT enzimleri ile indirgenmiþ glutatyon seviyeleri IR grubuna kýyasla düþük olsa da FC3 ve FC6 gruplarý arasýnda anlamlý fark yoktu (p<0.05). Histopatolojik olarak FC3 ve FC6 gruplarýnýn her ikisi de IR grubundan düþük, FC6 grubu ise FC3 grubundan daha düþük bir skorla evrelendi (p<0.05).
TARTIÞMA: Ýncir çekirdeði yaðýnýn oral kullanýmý, olasýlýkla antioksidan ve antienflamatuvar özellikleri sebebiyle, sýçanlarda akut mezenterik iskemi modeline baðlý geliþen iskemi reperfüzyon hasarýndaki biyokimyasal ve histopatolojik bulgularý tersine çevirebilmektedir.

BACKGROUND: The increase in free oxygen radicals and proinflammatory cytokines in the ischemia-reperfusion injury caused by acute mesenteric ischemia are the key responsibilities of intestinal histopathological alterations. It has been reported that Ficus carica and its various parts contain antioxidant and anti-inflammatory compounds recently. Thus, in the present study, we aimed to investigate how Ficus carica seed oil affects intestinal ischemia-reperfusion injury in a rat model.
METHODS: In this study, 50 male Wistar albino rats were randomly divided into five equal groups. Negative control (NC), sham-operated (Sham), ischemia and reperfusion (IR), 3 ml/kg/day Ficus carica seed oil (FC3), 6 ml/kg/day Ficus carica seed oil (FC6). IR, FC3 and FC6 groups underwent ischemia and reperfusion procedure for 45+120 min. Only abdominal midline laparotomy was performed in the Sham group for 165 minutes.
RESULTS: Tissue levels of TNFα and IL-1β, which were proinflammatory cytokines, were significantly reduced in the FC6 group than the IR group (p<0.05). In FC3 and FC6 groups, the tissue MPO and MDA enzyme levels were significantly lower than the IR group, but there was a significantly greater decrease in the FC6 group than the FC3 group (p<0.05). SOD and CAT enzymes and reduced glutathione levels of FC3 and FC6 groups were significantly lower than IR group (p<0.05); however, there was no statistically significant difference between the FC3 and FC6 groups. FC3 and FC6 groups were histopathologically graded statistically lower than the IR group, and the FC6 group showed a significant decrease than the FC3 group (p<0.05).
CONCLUSION: Oral administration of fig seed oil may reverse biochemical and histopathological findings resulting from ischemia-reperfusion injury in an experimental model of acute mesenteric ischemia in rats, probably because of its antioxidant and anti-inflammatory compounds.

AMAÇ: Akut pankreatit (AP) pankreas bezinde inaktif halde bulunan sindirim enzimlerinin çeþitli nedenlerle aktif hale geçmesi sonucunda, pankreas bezinde, çevre dokularda ve enflamasyonun yayýlmasýyla sistemik bir etki gösterebilen klinik durumdur. Hastalýðýn prognozunda en sýk Ranson ve Atlanta gibi sýnýflama sistemleri kullanýlmaktadýr. Ancak akut pankreatite baðlý geliþen organ yetersizlikleri, laboratuvar verileri ve hastalarýn antropometrik özelliklerinin de hastalýðýn þiddeti ve prognozuyla iliþkili olduðu ortaya konmuþtur. Çalýþmamýzda AP seyrinde ortaya çýkan organ yetersizlikleri, biyokimyasal parametreler ve hastalara ait antropometrik verilerin, Ranson ve Atlanta sýnýflama (AS) sistemleri ile arasýndaki iliþkiyi ortaya koymayý amaçladýk.
GEREÇ VE YÖNTEM: AP’li 19 ile 89 yaþlarý arasýnda 153 hastanýn Ranson ve Modifiye Atlanta Sýnýflamasý (MAS) skoru hesaplanarak laboratuvar verileri, bel çevresi, vücut kitle indeksi (VKÝ) gibi antropometrik verileri, organ yetersizliði tablosu araþtýrýldý. Geliþen organ yetersizlikleri (akciðer, karaciðer, böbrek, kalp ve multiorgan yetersizliði) Ranson deðeri ve MAS skoru yüksekliðiyle iliþkili (p<0.05) olarak bulundu. Çalýþmaya alýnan hastalardan 13’ünde (%8.4) multiorgan yetersizliði, 17’sinde (%11.1) Sistemik enflamatuvar response sendromu (SIRS) geliþmiþtir. On hasta (%6.5) hayatýný kaybetti. Organ yetersizlikleri, multiorgan yetersizliði (MOY) ve SIRS geliþen hastalarla hayatýný kaybeden hastalar arasýnda yapýlan istatistiksel analizde p deðeri (p<0.05) olarak anlamlý iliþki saptandý. Bel çevresi ve vücut kitle indeksi Ranson deðeriyle iliþkili saptanmazken, Modifiye Atlanta Sýnýflamasýyla bel çevresi arasýnda anlamlý iliþki saptandý (p<0.01). Laboratuvar verilerinden üre ve ALT yüksekliði, Ranson ve Modifiye Atlanta Sýnýflamasýyla iliþkili saptanýrken (p<0.001), 0 ve 48. saatte bakýlan C-reaktif protein (CRP) deðerindeki yüksekliklerden sadece 48. saatteki CRP deðeri Ranson deðeriyle iliþkili olarak bulundu (p<0.05).
BULGULAR: Organ yetersizliði, MOY, SIRS, her iki þiddet skoruyla korele olmasýnýn yanýnda mortalite ile de anlamlý olarak koreleydi. Ek olarak kolesterol, trigliserit ve yatýþ anýndaki CRP düzeyiyle mortalite arasýnda anlamlý korelasyon elde edilirken; kalsiyum, lipaz ve hematokrit gibi laboratuvar verileriyle anlamlý iliþki saptanmadý.
TARTIÞMA: Sonuç olarak, akut pankreatitin þiddet ve prognozunu belirlemede ve þiddetli seyreden pankreatitlerde ortaya çýkabilecek olan organ yetersizlikleri açýsýndan dikkatli olunmasýnda; klasik þiddet skorlama sistemlerinin yanýnda hastalara ait vücut kitle indeksi, bel çevresi ve kolesterol, trigliserit, ALT, CRP gibi laboratuvar verileri önemli prognostik bilgiler vermektedir.

BACKGROUND: Organ failures that develop due to acute pancreatitis (AP), some laboratory values and the anthropometric characteristics of the patients have been shown to play a role in the prognosis AP and have been increasingly used to investigate the prognosis of the disease although classification systems, such as Ranson’s criteria, are still used habitually. In this stud, we aimed to investigate the relationship of the organ failures observed during the course of AP, the biochemical parameters and the anthropometric characteristics of the patients and compare using Ranson’s and Atlanta Classifica-tion (AC) systems.
METHODS: Laboratory values, anthropometric data, including the waist circumference and body mass index, Systemic inflammatory response syndrome (SIRS) and organ failures developed during the course of the disease, were investigated prospectively in 153 AP patients and the Ranson and Modified Atlanta Classifications (MAC) were made.
RESULTS: A relationship was observed between the organ failures that were established in the course of the disease (lung, liver, kidney, heart and MOF (multiple organ failure)) and higher Ranson’s and MAC scores (p<0.05). Among the patients included in this study, 13 (8.4%) had multiple organ failure and 17 (11.1%) had SIRS. Exitus occurred in 10 patients (6.5%). A statistically significant relationship was found with organ failure, multiple organ failure and SIRS; and ensuing exitus (p<0.05). While no relationship was observed between the waist circumference, body mass index, Ranson’s score, there was a significant relationship between the MAC and the waist circumference (p<0.01). Among the laboratory values, high urea and ALT values showed a relationship with the Ranson and MAC (p<0.001), while between the CRP values tested at the 0 time point and the 48th hour, only the CRP value at the 48th hour had a relationship with Ranson’s score (p<0.05). Organ failure, MOF, and SIRS showed a correlation with both the severity scores and the mortality rate. In addition, a significant corre-lation was observed between the cholesterol, triglycerides and the CRP level at the time of hospitalisa-tion and mortality. On the contrary, no significant relationship was observed with the other laboratory results, including calcium, lipase and hematocrit.
CONCLUSION: In conclusion, to determine the severity and prognosis of acute pancreatitis, and ex-pect the organ failures that may occur in severe pancreatitis, the body mass index, waist circumference and laboratory values, including cholesterol, triglycerides, ALT, and CRP may supply important prog-nostic data besides the conventional disease severity scoring methods.

AMAÇ: Endotrakeal entübasyon klinisyenler için önemli bir beceridir ve bazý hastalarda çeþitli nedenlerden dolayý zor olabilir. Günümüzde çeþitli tiplerde videolaringoskoplar mevcuttur ve genellikle direkt laringoskopi baþarýsýz olduðunda kurtarma cihazý olarak kullanýlmaktadýr. Pediatrik hava yolunun; yetiþkinlerle karþýlaþtýrýldýðýnda bazý farklýlýklarý vardýr ve bunlar zorlayýcý olabilir. Bu çalýþmanýn amacý pediyatrik hastalarda C-Mac D-Blade ve yaygýn olarak kullanýlan Macintosh laringoskopu karþýlaþtýrmak ve deðerlendirmektir.
GEREÇ VE YÖNTEM: Etik kurul onayý ve ebeveynlerden bilgilendirilmiþ onam sonrasý, elektif cerrahi geçirecek ve endotrakeal entübasyon gereksinimi olan 5–10 yaþ arasý (10–40 kg) toplam 56 pediatrik hasta çalýþmaya dahil edildi. Hastalar Macintosh laringoskop veya C-Mac D-Blade videolaringoskop ile laringoskopi ve entübasyon için eþit iki gruba randomize edildi. Glottik görünüm, giriþim sayýsý, entübasyon süresi, herhangi bir komplikasyon ve hemodinamik veriler kaydedildi. Ýstatistiksel anlamlýlýk düzeyi p<0.05 olarak kabul edildi.
BULGULAR: Zor hava yolu beklenmeyen pediyatrik hastalarda; ortalama entübasyon süresi C-Mac D-Blade ile anlamlý olarak daha kýsaydý (21±9 ve 41±7 saniye, sýrasýyla) (p<0.001). Ýki grubun sonuçlarý geri kalan parametreler açýsýndan benzerdi.
TARTIÞMA: Mac D-Blade videolaringoskop, güvenli bir þekilde ve benzer bir baþarý oraný ile Macintosh Blade’e kýyasla entübasyon süresini yaklaþýk iki kat kýsalttý. Videolaringoskoplar rutin entübasyon, eðitim ve zor entübasyon için bir kurtarma cihazý için iyi bir alternatif olabilir.

BACKGROUND: Endotracheal intubation is a key skill for clinicians and may be challenging in some patients due to various reasons. Nowadays, various kinds of videolaryngoscopes are available and usually used as a rescue device when direct laryngoscopy failed. Pediatric airway has some differences when compared with adults and may be challenging. This study aims to compare and evaluate C Mac D-Blade and commonly used Macintosh laryngoscope in pediatric patients.
METHODS: In this study, 56 pediatric patients, 5–10 years old (10–40 kgs) who had undergone elective surgery and need endotracheal intubation were included after obtaining ethical board approval and informed consent from parents. The patients were randomized into two equal groups for laryngoscopy and intubation by either with Macintosh laryngoscope or C Mac D-Blade videolaryngoscope. Glottic view, number of attempts, intubation time, any complications and hemodynamic variables were recorded. A value of p<0.05 was considered significant.
RESULTS: In pediatric patients with unanticipated difficult airway, the mean intubation time was significantly shorter with C Mac D-Blade (21±9 and 41±7 seconds, respectively (p<0.001). The results of the two groups were similar concerning the remaining parameters.
CONCLUSION: C Mac D-Blade videolaryngoscope shortened intubation time about twice when compared to Macintosh blade C Mac D-Blade videolaryngoscope, Videolaryngoscopes may be a good alternative for routine intubation, education and a rescue device for difficult intubation.

AMAÇ: Doðu Azerbaycan bölgesinde helikopter ile acil saðlýk hizmetleri yoluyla taþýnan hastalarýn sonuçlarýný deðerlendirmeyi hedefledik.
GEREÇ VE YÖNTEM: Bu retrospektif kesitsel çalýþma, Aðustos 2014–Mart 2017 arasý Tebriz Helikopter ile Acil Saðlýk Hizmetleri merkezi tarafýndan taþýnan hastalar üzerinde gerçekleþtirildi. Veri toplamak için merkezin kayýtlarý kullanýldý. Ýstatistiksel analiz SPSS v.20 yazýlýmý ile yapýldý; istatistiksel anlamlýlýk düzeyi 0.05’in altýnda kabul edildi.
BULGULAR: Tebriz hastanelerine 167 görevle toplam 268 hasta sevk edildi. Hastalarýn ortalama yaþý 34.26±19.43 idi ve 173 (%65) hasta erkekti. Çaðrýlarýn en yaygýn nedeni profesyonel bakým ihtiyacý idi (%91.4). Görevlerin çoðu kýrsal yollar üzerindeydi. Hedeflerin ortalama mesafesi yaklaþýk 99.13±35.9 km, ortalama transfer süresi 54.68±14.17 dakika iken, ortalama tahmini kara rota süresi 86.38±26.26 dakikaydý. En yaygýn taný travmaydý; Glasgow Koma Skalasý (GCS) 13’ün üzerinde ve hastalarýn çoðunun yaþamsal bulgularý stabildi. Hastalarýn yaklaþýk yüzde 98’i sývý tedavisi almýþ ve yüzde 71’i immobil idi ve sadece yüzde 6’sýnýn entübasyona ihtiyacý vardý. Ayrýca, hastalarýn yüzde 28’inin Yoðun Bakým Ünitesine (YBÜ) ihtiyacý vardý ve bunlarýn yüzde 56’sý daha sonra vefat etti. Ayrýca, hastalarýn yüzde 28’inin Yoðun Bakým Ünitesine (YBÜ) ihtiyacý vardý ve bunlarýn yüzde 56’sý daha sonra hayatýný kaybetti.
TARTIÞMA: Sonuçlarýmýz, Tebriz helikopter acil saðlýk hizmetlerinin hasta nakil süresini kýsalttýðýný ve ölüm oranýný uluslararasý standartlara yaklaþtýrdýðýný göstermektedir.

BACKGROUND: In this study, we aimed to evaluate the outcomes of patients transported by Helicopter Emergency Medical Services in East Azerbaijan Province.
METHODS: This retrospective cross-sectional study was conducted on patients transported by the HEMS centre of Tabriz from August 2014 to March 2017. Records of the centre were used to collect data. Statistical analysis was performed by SPSS software version 20; the statistical significance level was considered below 0.05.
RESULTS: In this study, 268 patients were transferred to Tabriz hospitals by 167 missions performed. The mean age of patients was 34.26±19.43, and 173 (65%) patients were male. The most common reason for call-out was the need for professional care (91.4%). The target of the majority of missions was on countryside routes. The mean distance of destinations was about 99.13±35.9 Kms, with a mean transference time of 54.68±14.17 minutes, while the mean estimated ground route time was 86.38±26.26 minutes. The most prevalent diagnosis was trauma; The Glasgow Coma Scale (GCS) and vital signs of the majority of patients were above 13 and stable, respectively. About 98 percent of patients received fluid therapy, and 71 percent were immobilized, and only 6 percent needed intubation. Also, 28 percent of patients needed Intensive Care Unit (ICU), 56 percent of whom passed away later.
CONCLUSION: Our results suggest that Tabriz HEMS missions have reduced the patient transport time and also made the mortality rate closer to international standards.

AMAÇ: Akut apandisit (AAp) ön tanýsýyla ameliyata alýnan hastalarda AAp ve perfore AAp’yi öngören faktörlerin belirlenmesidir.
GEREÇ VE YÖNTEM: Mayýs 2009 ile Aralýk 2018 arasýnda 1316 hastaya AAp ön tanýsýyla apandektomi yapýldý. AAp’yi öngören faktörlerin belirlenmesi için apendiks’teki enflamatuvar deðiþikliklerin varlýðý gözönünde bulundurularak hastalar iki gruba ayrýldý: AAp (AAp grubu; n=1043) ve normal appendiks (Non-AAp; n=273). Ayrýca apendiks perforasyonunu öngören faktörlerin belirlenmesi için AAp tespit edilen hastalar perforasyon varlýðý gözönünde bulundurularak iki gruba ayrýldý: AAp (AAp grubu; n=850) ve perfore AAp grubu (perfore AAp grubu; n=193). Kantitatif deðiþkenler için optimal kesim noktalarýnýn belirlenmesi için ROC eðri analizi kullanýldý. Gruplar univariate analiz yöntemelri ile karþýlaþtýrýldý ve p≤0.20 deðeri alan deðiþkenler multivariate alojistik regresyon modeline (backward stepwise) alýndý.
BULGULAR: AAp’yi öngören faktörlerin belirlenmesi için yapýlan multivariate analiz cinsiyet (erkek; p=0.034; OR: 1.42), WBC (≥10.900; p=0.022; OR: 1.52), MPV (≥29.1; p=0.006; OR: 1.57), TBil (≥0.61; p=0.034; OR: 1.42), CRP (≥0.725; p=0.002; OR: 1.71), NLR (≥5.13; p=0.034; OR: 1.50), PNR (≥24.04; p=0.001; OR: 0.53) ve US bulgularýnýn (AAp+; p<0.001; OR: 2.88) AAp’yi öngörmede baðýmsýz birer faktör olduðunu göstermiþtir. Apendiks perforasyonunu öngören faktörlerin belirlenmesi için yapýlan multivariate analiz yaþ (≥32 yýl; p<0.001; OR: 2.54), TBil (≥0.67; p=0.046; OR: 1.46), CRP (≥3.75; p<0.001; OR: 2.99) ve NLR (≥5.69; p=0.006; OR: 1.84) perforasyonu öngörmede baðýmsýz birer faktör olduðunu göstermiþtir.
TARTIÞMA: Hem AAp hem de perforasyonun öngörülmesinin, acil servise AAp ön tanýsýyla baþvuran hastalarýn deðerlendirmesinde klinisyene yardýmcý olacaðýna inanýyoruz. Bu yaklaþým ayný zamanda negatif apendektomi ve perforasyon oranlarýnýn azaltýlmasýna katkýda bulunacaktýr.

BACKGROUND: To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp.
METHODS: Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p≤ 0.20 were taken into a multivariate logistic regression model.
RESULTS: Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (≥10.900; p=0.022; OR=1.5), MPV (≥29.1; p=0.006; OR=1.6), TBil (≥0.61; p=0.034; OR=1.4), CRP (≥0.725; p=0.002; OR=1.7), NLR (≥5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (≥32 years; p<0.001; OR=2.5), TBil (≥0.67; p=0.046; OR=1.5), CRP (≥3.75; p<0.001; OR=3.0) and NLR (≥5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp.
CONCLUSION: We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.

AMAÇ: Pilonidal sinüs (PS) tedavisinde endoskopik pilonidal sinüs tedavisi (EPSiT) yönteminin erken dönem sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Haziran 2018–Temmuz 2019’da EPSiT yöntemiyle tedavi edilen olgular geriye dönük olarak incelendi. Olgularýn demografik verileri, cerrahi iþlem süresi, ameliyat sonrasý aðrý, hastanede kalýþ süresi, normal aktiviteye geçiþ ve yara iyileþme süresi ve EPSiT iþleminin sonuçlarý deðerlendirildi.
BULGULAR: Yirmi dokuz olgunun (20 erkek, 9 kýz) yaþ ortalamasý 15.5±2.8 yaþ idi. Vücut kitle indeksi (VKÝ) ortalamasý 25.8±4.2 idi. Sekiz olgu (%28) dýþ merkezde giriþim sonrasý nüksle baþvurmuþtu. Fistül sayýsý ortalama 1.17 (1–2) idi. Fistül lokalizasyonu olgularýn 24’ünde orta hat, beþinde lateral yerleþimliydi. EPSiT iþleminin süresi ortalama 57±13.9 dakika, hastanede kalýþ süresi ortalama 11.4±7.2 saat idi. Aðrý skoru ortalama 0.86 (0–3 arasýnda) ve analjezik kullanýmý ortalama 37 saat (12–72 saat) olarak bulundu. Tam yara iyileþmesi primer baþvuran hastalar için 19 gün (7–60 gün) idi. Olgularýn 25’inde erken yara iyileþmesi (ortalama 14 gün) ve dördünde geç yara iyileþmesi (ortalama 60 gün) görüldü. Ýzlem süresi 8.3±3.34 ay idi. Tam günlük aktiviteye geçiþ 2.1 gün (0–30 gün) iken 16 olguda (%53) ayný gün idi. Ameliyat sonrasý izlemde dokuz olguda erken (kanama: 1) ve geç (granülasyon dokusu: 1, nüks: 7) komplikasyonlar görüldü. Nüks saptanan sekiz olgunun (%27.5) yedisi primer, biri nüks sonrasý baþvurmuþtu. Nüks görülme süresi ortalama 5.8±2.8 ay idi. Bu sekiz olgunun ikisine re-EPSiT yapýldý, biri takipten çýktý, beþine tekrar EPSiT planlanmaktadýr.
TARTIÞMA: Endoskopik pilonidal sinüs tedavisi yöntemi kolay uygulanabilir, aðrýsýz, kýsa hastanede kalýþ süresi olan ve normal günlük aktiviteye hýzlý dönüþü saðlayan minimal invaziv bir yöntemdir. EPSiT ve diðer tedavi yöntemleri sonrasý görülen nükslerde rahatlýkla ve tekrarlayan uygulamalar yapma olanaðý saðlamaktadýr.

BACKGROUND: This study aims to evaluate the short term outcomes of the Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group.
METHODS: In this study, between June 2018 and July 2019, pediatric patients with pilonidal sinus (PS) who were treated with the EPSiT method were reviewed retrospectively.
RESULTS: Of the twenty-nine patients (20 males, nine females), the average age was 15.5±2.8 years, and the average body mass index (BMI) was 25.8±4.2. Eight patients (28%) presented with a history of recurrence following the previous surgery. The average number of fistulas present in cases was 1.17 (1–2). The localization of the fistula was midline in twenty-four and lateral in five of the patients. The average time of the EPSiT procedure was 57±13.9 minutes, and the average time of hospital stay was 11.4±7.2 hours. The pain score average was 0.86 (range of 0–3) and the duration of analgesic use was 37 hr (12–72 hr). The mean post-operative time of total wound healing was 18.71 days (7–60 days) for primary presenting cases. Early wound healing was seen in twenty-five patients (average of 14 days), while late wound healing was observed in four patients (average of 60 days). The mean time of follow-up was 8.3±3.34 months. The average time of return to full daily activity was 2.1 days (0–30 days), while it was the same day for sixteen (53%) patients. In post-operative follow-up, early (bleeding: 1) and late (formation of granulation tissue: 1, recurrence: 8) complications were seen in nine patients. Of the eight patients (27.5%) whose recurrence was detected, seven were primary and one was secondary presenting patients. The average time of presentation for recurrence was 5.8 mo (1–10 mo). Re-EPSiT was applied in two of the eight patients with recurrence and is planned for five, while one of the patients lost to follow-up.
CONCLUSION: EPSiT is an easily applicable, pain-free minimal invasive procedure with a short period of hospital stay and a fast return to routine daily activity. It provides comfortable and repeatable intervention in cases with recurrences after the EPSiT procedure and other methods for PS treatment.

AMAÇ: Anevrizmatik subaraknoid kanama için optimal müdahale zamanlamasý nöroþirürjide tarihsel olarak tartýþmalý konulardan biridir. Çok sayýda çalýþma konuya deðinmesine raðmen, hastalýðýn doðasý nedeniyle bu çalýþmalarýn birçok sýnýrlamalarý vardýr. Erken ve ultra-erken müdahaleler son yýllarda giderek daha fazla destekçiye ulaþmýþtýr. Bununla birlikte, erken ve ultra-erken müdahalenin hastalýðýn sondurumu üzerindeki etkileri netlik kazanmamýþtýr.
GEREÇ VE YÖNTEM: Trakya Üniversitesi Týp Fakültesi Eðitim ve Uygulama Hastanesi’nde tek merkezli geriye dönük bir kohort çalýþmasý yapýldý. Çalýþma, 1 Ocak 2001 ve 31 Aralýk 2015 tarihleri arasýnda anevrizmal subaraknoid kanama ile baþvuran tüm hastalara ait verileri içerdi. Hastalar WFNS Derecelerine göre “Ýyi Derece (I-III)” veya “Kötü Derece (IV-V)” olmak üzere iki gruba ayrýldý. Hastalar ayrýca Glasgow Sondurum Skalasý puanlarýna göre “Olumsuz (1–2)” veya “Olumlu (3–5)” sondurum olarak sýnýflandýrýldý. Veriler istatistiksel olarak analiz edilerek, erken ve ultra-erken müdahalenin sondurum üzerindeki etkileri deðerlendirildi.
BULGULAR: Çalýþma döneminde toplam 580 hasta kabul edildi. Bunlar arasýndan 494 hasta çalýþma için uygun bulundu. Ortanca yaþ (çeyrekler arasý aralýk) 55 (18) yýl idi. Ýki yüz kýrk dört hasta (%49.4) kadýn iken 250 hasta (%50.6) erkekti. Üç yüz on dört hasta (%63.6) ameliyat edildi ve 25 hastaya (%5.1) endovasküler tedavi uygulandý. Ultra-erken müdahale 60 hastada (%12.1), erken müdahale 142 hastada (%28.7) (bu grup ultra-erken müdahale grubunu da kapsamaktadýr) saðlandý. Düþük dereceli ultra erken tedavi grubu ile diðerleri arasýnda anlamlý bir sondurum farký mevcuttu (p=0.007). Benzer þekilde, düþük dereceli erken tedavi grubu ile diðerleri arasýnda anlamlý bir sondurum farký vardý (p<0.001).
TARTIÞMA: Bu çalýþma, anevrizmatik subaraknoid kanamada erken veya ultra-erken müdahaleye yönelik artan eðilimi desteklemektedir. Bulgularýmýz, hem erken hem de ultra-erken müdahalenin düþük dereceli anevrizmatik subaraknoid kanama hastalarýnda sondurum üzerinde olumlu etkileri olduðunu göstermiþtir. Anevrizmatik subaraknoid kanama için en uygun müdahale zamanýný açýklýða kavuþturmak için daha homojen ve büyük örneklerle yeni çalýþmalar gerçekleþtirilmelidir.

BACKGROUND: The optimal timing of intervention for aneurysmatic subarachnoid hemorrhage is one of the historically controversial issues in neurosurgery. Although numerous studies investigated the subject, they had many limitations due to the nature of the disease. Early and ultra-early interventions have gained more and more supporters in recent decades. Nevertheless, the effects of the early and ultra-early intervention on the outcome of the disease are far from clarity.
METHODS: A single-center retrospective cohort study was carried out at Trakya University Medical Faculty Training and Practice Hospital. The study includes data on all patients admitted with an aneurysmal subarachnoid hemorrhage between January 1, 2001, and December 31, 2005. Patients were divided into two groups according to their WFNS grade status: Good (I–III) or poor (IV–V) grades. Patients are also classified according to their Glasgow Outcome Scale score: Unfavorable (1–2) or favorable (3–5) outcomes. Data were analyzed statistically, and the effects of the early and ultra-early intervention on the outcome were assessed.
RESULTS: A total of 580 patients were admitted in the study period. Among them, 494 were eligible for the study. The median age (interquartile range) was 55 (18) years. While 244 (49.4%) patients were women, 250 (50.6%) patients were men. Three hundred and fourteen (63.6%) patients were operated, and 25 patients (5.1%) were undergone endovascular treatment. The ultra-early intervention was achieved in 60 (12.1%) patients and 142 patients (28.7%, including the previous ultra-early intervention group) early intervention was achieved. A meaningful outcome difference was present between the poor-grade ultra-early treatment group and the rest (p=0.007). Analogously, a meaningful outcome difference was present between the poor-grade early treatment group and the rest (p<0.001).
CONCLUSION: This study supports the growing trend toward early or ultra-early intervention in aneurysmatic subarachnoid hemorrhage. Our findings showed that both early and ultra-early interventions have positive effects on the outcome in poor-grade aneurysmatic subarachnoid hemorrhage patients. Future studies with more homogenized and larger samples should be realized to clarify the optimal timing of intervention for aneurysmatic subarachnoid hemorrhage.

AMAÇ: Proksimal humerus kýrýklarý tüm kýrýklarýn %5’ini oluþturur. Yaþlýlarda en sýk görülen üst ekstremite kýrýklarýdýr. Bu geriye dönük çalýþmada proksimal humerus kýrýðý sebebi ile Humelock II Reversible ters omuz protezi kullanarak tedavi ettiðimiz 65 yaþ üstü hastalarýn klinik sonuçlarýný incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Neer 3–4 parça ya da parçalý baþ kýrýðý sebebi ile 2014–2019 yýllarý arasýnda ters omuz protezi kullanarak tedavi ettiðimiz 65 yaþ üstü 31 hasta (25 kadýn, 6 erkek) geriye dönük olarak incelendi. Öncesinde cerrahi tespit denenenler, nörolojik arazý ya da geçirilmiþ üst ekstremite kýrýðý olanlar, travma sonrasý üç haftadan fazla zaman geçenler, altý aydan kýsa takibi olanlar ve eþlik eden kýrýðý olanlar çalýþma dýþý tutuldu. Yirmi sekiz hasta son deðerlendirmeye alýndý. Kýrýk mekanizmasý, travmadan ameliyata kadar geçen süre, hastanede kalýþ süresi ve ASA skorlarý not edildi. Bütün olgularda Humelock II Reversible protez kullanýldý. Hastalarýn son kontrollerindeki eklem hareket açýklýklarý (EHA), UCLA, DASH ve Constant skorlarý incelendi.
BULGULAR: Ortalama yaþ 72.2 (65–95) ve ortalama takip süresi 15.5 (6–48) aydý. Ortalama UCLA, Constant ve DASH skorlarý sýrasýyla 27.6 (14–35), 67.9 (38–80) ve 30.8 (9.9–79.2) bulundu. Ortalama fleksiyon, abdüksiyon, iç ve dýþ rotasyon sýrasýyla 130 (110–160), 100 (70–140), 40 (15–60) ve 39 (15–75) dereceydi.
TARTIÞMA: Ters omuz protezi 65 yaþ üstü hastalarda proksimal humerus kýrýklarýnýn tedavisi için oldukça güvenilir bir yöntemdir. Bu yaþ grubunda bile iyi fonksiyonel sonuçlar ve geniþ EHA elde edilebilir. Omuz abdüksiyonu için tüberkulumlarýn tespiti þart olmasa da, eksternal rotasyonu iyileþtirir ve tüm olgularda denenmelidir. Proksimal humerus kýrýðý nedeniyle ters omuz protezi yapýlmýþ hastalarýn sonuçlarý baþka etiyolojilerle opere edilmiþ hastalarýnki kadar iyidir.

BACKGROUND: Proximal humerus fractures are quite common, constituting 5% of all fractures. Plate osteosynthesis of comminuted fractures in the elderly with osteoporotic bones is prone to complications, including loss of reduction, intraarticular protrusion of screws, avascular necrosis and non-union. Hemiarthroplasty may be preferred to achieve a stable fixation, which permits early shoulder motion. Prerequisites for the successful functional outcome of this surgical technique are to have an intact rotator cuff, which is often torn, and achieve proper soft tissue balance, which is technically demanding. In RSA design, deltoid muscle replaces the function of the supraspinatus, compensating for a dysfunctional rotator cuff or a displaced tuberculum. We designed a retrospective study to evaluate the results of proximal humerus fractures treated with reverse shoulder arthroplasty using Humelock II reversible prosthesis in elderly patients.
METHODS: Thirty-one patients (25 females, six males) above 65 years old who underwent reverse shoulder arthroplasty between 2014 and 2019 for Neer 3-4 part fractures or head split injuries were included in this study. Patients with a previous internal fixation attempt, cases with neurological deficit or previous upper extremity fractures, patients who presented later than three weeks after the trauma, cases with less than six months follow-up and patients with additional fractures were excluded. Twenty-eight patients were available for final analysis. Fracture mechanism, time from trauma till surgery, hospital stay and preoperative ASA scores were noted. Humelock II Reversible (FX Solutions) implants were used in all cases. Patients’ shoulder range of motion and functional outcome using UCLA, DASH and Constant scores at minimum six months follow-up were evaluated.
RESULTS: The mean age was 72.2 (65–95) years, and mean follow-up time was 15.5 (6–48) months. The mean UCLA, Constant and Dash scores at the last follow-up were 27.6 (14–35), 67.9 (38–80) and 30.8 (9.9–79.2), respectively. Mean shoulder flexion, abduction, internal and external rotation were 130 (110–160), 100 (70–140), 40 (15–60) and 39 (15–75) degrees, respectively.
CONCLUSION: RSA is a very reliable treatment for proximal humerus fractures in patients over 65 years old. Early active and passive shoulder exercises can be started postoperatively, and good functional outcome and wide ROM can be achieved with this age group. Although stable fixation of the tuberculum is not required for shoulder abduction, it facilitates external rotation and should be attempted in all cases. Clinical outcomes of patients who underwent RSA due to proximal humerus fracture are as good as the outcomes of patients with different etiologies.

AMAÇ: Ayak bileði kýrýðý nedeniyle ameliyat edilen hastalarda distal tibiofibular eklem (DTFE) uyumundaki deðiþikliklerin klinik ve fonksiyonel sonuçlar üzerindeki etkisi belirsizdir. Çalýþmamýzýn amacý, ayak bileði kýrýklarý nedeniyle ameliyat edilen hastalarýn kýsa dönem takiplerinde DTFE uyumunda meydana gelen deðiþiklikler ile klinik ve fonksiyonel sonuçlar arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Ayak bileði kýrýðý nedeniyle ameliyat edilen hastalarýn hastane kayýtlarý retrospektif olarak incelendi. Ameliyattan en az 18 ay sonra bilateral ayak bileði bilgisayarlý tomografi taramasý yapýlan hastalarýn verileri kullanýldý. DTFE uyumu dört yöntem kullanýlarak deðerlendirildi. Metot 1’de tibia ve fibulanýn en belirgin anterior noktalarý arasýndaki mesafe (Anterior insisura [AÝ]) ve tibia ve fibulanýn en belirgin posterior noktalarý arasýndaki mesafe (Posterior insisura [PÝ]) ölçüldü. Metot 2’de fibulanýn longitudinal aksýnýn en belirgin anterior ve posterior noktasýndan tibiaya çizilen dik çizgi temel alýnarak sýrasýyla, direkt anterior (DA) ve direkt posterior (DP) mesafeleri ve tibianýn en belirgin anterior noktasýndan DA’ya çizilen dik çizgi temel alýnarak direkt translasyon (DT) mesafesi ölçüldü. Metot 3’de tibianýn en belirgin anterior ve posterior noktasýný birleþtiren çizgi ile fibulanýn en belirgin anterior ve posterior noktasýný birleþtiren çizgi arasýndaki açý (Rotasyon açýsý [RA]) ölçüldü. Ýlk üç metotda, yaralý ve yaralý olmayan taraf arasýndaki mesafe ve açý farklarý (dAI, dPI, dDA, dDP, dDT, dRA) hesaplandý. Metot 4’de yaralý tarafta herhangi bir rotasyonel/translasyonel uyumsuzluk subjektif olarak rapor edildi. Klinik ve fonksiyonel deðerlendirme için Amerikan Ortopedik Ayak ve Ayak Bileði Derneði (AOFAS) ayak bileði-ayak arkasý skalasý, Olerud-Molander Ayak Bileði Skoru (OMAS) ve Visual Analog Skala (VAS) kullanýldý.
BULGULAR: Otuz hasta (18 erkek, 12 kadýn; ortalama yaþ, 43.3 [daðýlým, 20-78 yýl] yýl) çalýþmaya dahil edildi. Ortalama takip süresi 37.6 (daðýlým, 18-54 ay) aydý. dDA ve AOFAS-aðrý alt skalasý arasýnda (r=-0,37; p=0,04), dDP ve OMAS arasýnda (r=-0.57; p=0.01) ve dDT ve AOFAS-aðrý, AOFAS-fonksiyon ve OMAS arasýnda (r=-0.55 p=0.01; r=-0.40; p=0.03; r=-0.39; sýrasýyla p=0.04) negatif korelasyon belirlendi.
TARTIÞMA: dDA, dDP ve dDT deðerlerindeki deðiþiklikler klinik ve fonksiyonel sonuçlarý etkilemektedir. Daha iyi sonuçlar elde etmek için bu parametreler DTFE'nin redüksiyonu sýrasýnda hastanýn anatomisine uygun olarak saðlanmalýdýr.

BACKGROUND: The effects of changes in distal tibiofibular joint (DTFJ) congruence on clinical and functional outcomes are unclear in patients operated on for ankle fractures. The present study aims to evaluate the relationship between changes in DTFJ congruence and clinical and functional outcomes in the short-term follow-up of the patients operated on for ankle fractures.
METHODS: In this study, hospital records of patients who were operated on for ankle fractures were retrospectively analyzed. The data of patients who underwent bilateral ankle computed tomography scans at least 18 months after surgery were used. DTFJ congruence was evaluated using four methods. Method 1: the distance between the most prominent anterior points of the tibia and fibula (anterior incisura [AI]) and that between the most prominent posterior points of the tibia and fibula (posterior incisura [PI]) were measured. Method 2: the direct anterior (DA) and direct posterior (DP) distances were measured based on perpendicular lines drawn from the most prominent anterior and posterior points of the longitudinal axis of the fibula to the tibia, respectively, and a direct translation (DT) distance was measured based on a perpendicular line drawn to the DA from the most prominent anterior point of the tibia. Method 3: the angle between a line connecting the most anterior and posterior points of the tibia and a line connecting the most anterior and posterior points of the fibula (rotational angle [RA]) was measured. The differences in distances and angles (dAI, dPI, dDA, dDP, dDT, and dRA) between the injured and non-injured sides were calculated in the first three methods. Method 4: any rotational/translational incongruency on the injured side was subjectively reported. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Olerud–Molander Ankle Score (OMAS), and Visual Analog Scale (VAS) were used for clinical and functional evaluations.
RESULTS: Thirty patients (18 males and 12 females; mean age, 43.3 [range, 20–78 years] years) were included in this study. The average follow-up was 37.6 (range, 18–54 months) months. Negative correlations were detected between dDA and the AOFAS-pain subscale (r=−0.37; p=0.04), between dDP and the OMAS (r=−0.57; p=0.01), and between dDT and the AOFAS-pain, AOFAS-function, and OMAS (r=−0.55 p=0.01; r=−0.40; p=0.03; r=−0.39; p=0.04, respectively).
CONCLUSION: Changes in dDA, dDP, and dDT values affect the clinical and functional outcomes. These parameters should be provided in accordance with the anatomy of the patient during the reduction of the DTFJ to achieve better outcomes.

AMAÇ: Bu makale, anterior odontoid vida fiksasyonu (AOF) uygulanan hastalarýn klinik ve radyolojik sonuçlarýný sunmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Unstabil odontoid kýrýðý olan toplam 19 hasta Acutrak vidasý ile ameliyat edildi.
BULGULAR: Hastalar ortalama 12.5 ay takip edildi. Hastalarýn bilgisayarlý tomografi incelemelerinde %87.5 oranýnda radyolojik füzyon saptandý.
TARTIÞMA: Acutrak vidalarý AOF için kullanýlabilir. Bu çalýþma, Acutrak vidasý kullanýlarak yapýlan literatürdeki en geniþ klinik çalýþma olup, Acutrak vidalarýnýn odontoid kýrýklarýn tedavisindeki etkinliðini deðerlendirebilmek için daha büyük ileriye yönelik klinik çalýþmalara ihtiyaç vardýr.

BACKGROUND: This paper aims to present clinical and radiological results of patients who underwent anterior odontoid screw fixation (AOSF).
METHODS: In this study, 19 consecutive patients with an unstable odontoid fracture were operated on using an Acutrak screw.
RESULTS: The patients were followed for a mean duration of 12.5 months. Radiological fusion on CT scans was detected in 87.5% of the patients.
CONCLUSION: Acutrak screws can be used for AOSF. This study contains the maximum number of patients using the Acutrak screw in the literature. However, larger prospective clinical studies can provide more accurate information about the effectiveness of the Acutrak screws for odontoid fractures.

Travmatik þilotoraks, künt travmayý takiben nadir görülen bir durumdur. Anatomik bir varyasyon nedeniyle herhangi bir seviyede kanala doðrudan hasar sonucu lenfatik sývý sýzýntýsý meydana gelebilse de, künt travma sonrasý torasik kanal yaralanmasýna baðlý bir solunum yolu týkanýklýðý hiç tanýmlanmamýþtýr. Bu yazýda, whiplash yaralanmasý sonrasý torasik kanal yaralanmasýna baðlý solunum yolu týkanýklýðý geliþen olaðan dýþý bir olguyu sunuyoruz. Altmýþ yaþýnda erkek hasta künt travma sonrasý allodini ile acil servise baþvurdu. Baþlangýç toraks bilgisayarlý tomografisinde (BT) vertebral kýrýk eþlik etmeyen, C2’den T3 spinal seviyesine kadar bir prevertebral hematom ve pnömomediastinum görüldü. Yedi gün sonra çekilen BT’de, solunum yolunun kompresyonuyla beraber üst boyun seviyesine uzanan artmýþ miktarda mediastinal ve prevertebral sývý birikimi gösterdi. Hasta, sað torakotomi yoluyla torasik kanal ligasyonu ve boyun insizyonu yoluyla sývýnýn boþaltýlmasý için ameliyat edildi ve þikayeti olmadan taburcu edildi. Prevertebral boþlukta servikal ve üst torasik omurga seviyesinde hematom ve pnömomediastinum bulunduðunda, torasik kanal yaralanmasýnýn neden olduðu solunum yolu týkanýklýðý komplikasyonunu dýþlamak için hasta yakýndan izlenmelidir.

Traumatic chylothorax is a rare condition following blunt trauma. Although a chyle leak resulting from direct damage to the duct may occur at any level because of an anatomical variation, an airway obstruction due to thoracic duct injury after blunt trauma has never been described. Here, we report a very unusual case with airway obstruction due to thoracic duct injury after whiplash injury. A 60-year-old man presented to the emergency department with allodynia after blunt trauma. Initial chest computed tomography (CT) showed a prevertebral hematoma and pneumomediastinum from C2 to T3 spinal level without vertebral fracture. Seven days later, repeat CT showed an increased amount of mediastinal and prevertebral fluid collection extending to the upper neck level with airway compression. He underwent an operation to drain the fluid via a neck incision and a thoracic duct ligation via right thoracotomy and was discharged without complaint. The findings suggest that if hematoma and pneumomediastinum are found in the prevertebral space at the level of the cervical and upper thoracic spine, the patient should be closely observed to exclude the complication of airway obstruction caused by thoracic duct injury.

Bu yazýda, karýn aðrýsý þikayeti ile acil servise baþvuran 75 yaþýnda bir erkek olgu sunuldu. Bilgisayarlý tomografide (BT), mezenter kökü torsiyonu ile bu bölgeyi çevreleyen sývý ortaya kondu. Genel anestezi altýnda yapýlan acil laparotomide, intestinal malrotasyonlu apendiks apsesi görüldü. Torsiyone mezenter restorasyonundan sonra apandisektomi yapýldý. Ameliyat sonrasý antibiyotikler ve diðer semptomatik tedaviler uygulandý. Bu nedenle, preoperatif abdominal BT’nin mezenterik volvulus, çevre baðýrsak duvarýnýn kalýnlaþtýðý ve eksüdasyon gösterdiði, sað alt karýn aðrýsýnýn olmadýðý durumlarda, nadir görülen intestinal malrotasyon ve batýnda ektopik apandisit durumu göz önünde bulundurulmalýdýr.

Here, we report the case of a 75-year-old male with abdominal pain who was admitted to our Emergency Department. Computed tomography (CT) scan revealed torsion of the mesenteric root with fluid surrounding the area. Emergency laparotomy, performed under general anesthesia, revealed appendiceal abscess with intestinal malrotation. Appendicectomy was performed after the torsional mesentery restoration. Antibiotics and other symptomatic treatments were administered postoperatively. The patient recovered well and was discharged one week after surgery. Intestinal malrotation is more common in neonates than in adults. The diagnosis of appendicitis could be further obscured by intestinal malrotation. Therefore, the rare situation of intestinal malrotation and ectopic appendicitis in the abdomen should be considered in cases with an absence of right lower abdominal pain, where preoperative abdominal CT shows mesenteric volvulus and the surrounding intestinal wall is thickened and demonstrating exudation.

Travmaya baðlý jinekolojik tümör rüptürleri oldukça nadir görülür. Rüptür, tümör çapýna ve kanamaya baðlý olarak rüptüre olduðu alan ya da organda akut abdominal aðrýya yol açabildiði gibi, peritonite de sebep olabilmektedir. Bu çalýþmamýzda, minör travma sonrasý geliþen rüptüre baðlý hipovolemik þok tablosuna neden olan dev epitelyal tip over tümör rüptürü olgusunu sunacaðýz. Altmýþ dokuz yaþýnda kadýn hasta yürürken yere düþme sonrasý geliþen karýn aðrýsý ve bilinç bulanýklýðý þikayetleriyle hastanemiz acil servisine baþvurdu. Abdominal tomografide karýn içi yaygýn hemorajik sývý ve 27.5x21x15 cm çapýnda karýn sað alt kadrandan sol kadrana doðru uzanan kitle lezyonu tespit edildi. Hasta hipovolemik þok tablosunda acil ameliyat edildi. Ameliyatta sað over kaynaklý, ortasýndan tamamen rüptüre olmuþ, kistik komonentler içeren ve yaklaþýk 30x20x15 cm çapýnda kitle lezyonu saptandý. Kanama alanlarýnda hemostaz saðlanarak kitle total olarak çýkarýldý. Hasta ameliyat sonrasý altýncý gün þifa ile taburcu edildi. Travmaya baðlý jinekolojik tümör rüptürleri nadir görülür. Ancak travmanýn tipine baðlý olmaksýzýn mutlaka akýlda tutulmasý gereken bir durumdur. Bu durum özellikle travma sonrasý radyolojik olarak karýniçi kanamanýn saptandýðý ancak sýklýkla yaralanan karaciðer ve dalak gibi organlarýn radyolojik olarak normal olduðu durumlarda önemlidir.

Rupture of gynecologic tumors secondary to trauma rarely occurs. Rupture can lead to acute abdominal pain due to hemorrhage from the ruptured area and organs; rupture can also lead to peritonitis, depending on the size of the tumor. We describe the case of giant epithelial ovarian tumor rupture exhibiting due to minor trauma and the development of hypovolemic shock. A 69-year-old female patient was admitted to the emergency room with complaints of acute abdominal pain and subsequent clouding of consciousness after falling down while walking. Emergency abdominal computed tomography scan revealed widespread hemorrhagic free fluid in the abdominal cavity and a mass measuring 27.5 cm × 21 cm × 15 cm, extending from the right quadrant of the abdomen to the left. The patient underwent an emergency operation due to hypovolemic shock. During surgery, a totally ruptured mass lesion arising from the right ovary was seen; the mass contained cystic components and measured approximately 30 cm × 20 cm × 15 cm. Hemostasis was achieved in the bleeding areas, and the right ovarian mass was totally resected. The patient was discharged as cured on the 6th post-operative day. Gynecologic tumor rupture due to trauma is a rare event. However, it is a clinical condition that should be kept in mind regardless of the type of trauma. This is especially true in patients who experienced trauma and were radiologically found to have intra-abdominal hemorrhage with normal-appearing solid organs, such as liver and spleen, that frequently cause bleeding.