AMAÇ: Translarengeal entübasyon ve trakeostomi uygulandýktan sonra mekanik ventilatörle solunum desteði saðlanan sýçanlarda, oluþan kan gazý deðiþiklikleri, iskemi/reperfüzyon sonucu ortaya çýkan malondialdehit ve endojen antioksidan glutatyonun kan ve akciðer dokusundaki deðerleri ile akciðer dokusunda meydana gelmiþ histopatolojik hasarlanmalarýn karþýlaþtýrýlmasýný amaçladýk.
GEREÇ VE YÖNTEM: Grup1; translarengeal entübasyon, grup 2; trakeostomi uygulandýktan sonra mekanik ventilatör desteði saðlanan, grup 3; ise yalnýzca anestezi uygulanmýþ kontrol grubu sýçanlardan oluþmaktaydý. Meydana gelen kan gazý deðiþiklikleri, MDA ve GSH düzeyleri ile akciðer dokusunda oluþmuþ histopatolojik deðiþikliklerin gruplararasý karþýlaþtýrýlmalarý yapýldý.
BULGULAR: Grup 2’de, pO2 deðerlerindeki artýþ ve pCO2 deðerlerinde ki düþüþün grup 1’e göre daha yüksek olduðu (p<0.05), grup 1’deki serum MDA deðerlerinin grup 2’ye göre daha yüksek olduðu saptandý (p<0.05). Doku GSH deðerleri ise her iki grupta da kontrol grubuna göre sayýsal olarak yüksekti, ancak bu fark istatistiksel olarak anlamlý deðildi (p>0.05). Histopatolojik incelemeler sonucu yapýlan skorlama açýsýndan ise grup 1’deki hasar skorunun grup 2’deki hasar skoruna göre daha fazla olduðu saptandý (p<0.05).
TARTIÞMA: Kan gazý deðiþiklikleri ve ortaya çýkan iskemi/reperfüzyon hasarlanmasýnýn serbest oksijen radikallere olan etkisi ile akciðer dokusunda oluþturduðu yapýsal deðiþiklikler açýsýndan trakeostominin translarengeal entübasyona göre daha avantajlý olduðu ilk kez bu deneysel çalýþmayla ortaya konmuþtur.

BACKGROUND: Our aim in this study was to compare the blood gas changes, the malondialdehyde (MDA) and endogenous antioxidant glutathione (GSH) levels in blood and lung tissues after ischemia/reperfusion, the histopathological damage in lung tissue in rats provided respiratory support with mechanical ventilation after translaryngeal intubation and tracheostomy.
METHODS: Group 1 rats were provided mechanical ventilator support after translaryngeal intubation, Group 2 mechanical ventilator support after tracheostomy, and Group 3 was the control group where rats were only anesthetized. Three groups were compared for blood gas changes, MDA, GSH, and histopathological changes.
RESULTS: Blood gas evaluation showed a more marked increase in pO2 values and decline in pCO2 values in Group 2 than Group 1 (p<0.05), and higher serum MDA levels in Group 1 than Group 2 (p<0.05). Tissue GSH levels in Groups 1 and 2 were higher than the control group, but this difference was not statistically significant (p>0.05). In terms of histopathological scoring, the damage score in Group 1 was higher than in Group 2 (p<0.05).
CONCLUSION: This is the first study to show tracheostomy to be more advantageous than translaryngeal intubation in terms of blood gases, ischemia/reperfusion damage, and structural changes in the lung tissue.

AMAÇ: Hiperoksinin olumsuz etkileri üzerine yapýlan çalýþmalara raðmen, Dünya Saðlýk Örgütü (WHO) hiperoksinin kullanýmýný önermektedir. Bu çalýþmanýn amacý sýçan mekanik ventilasyon modelinde hiperoksinin akciðer, böbrek, kalp ve karaciðer üzerindeki olasý olumsuz etkilerini test etmektedir.
GEREÇ VE YÖNTEM: Erkek Wistar sýçanlar dört saat boyunca normoksik (FiO2: 0.3) veya hiperoksik (FiO2: 1.0) ventile edilerek iki gruba (n=6/grup) ayrýldý. Hasar hücre yüzey bütünlüðü, ekstraselüler matriks (sialik asit, sindekan-1), ozmotik stres (serbest hemoglobin) ve redoks homeostazisi-lipit peroksidasyonu (malondialdehit) açýsýndan bronkoalveolar lavaj, kan, akciðer, böbrek, kalp ve karaciðer örneklerinde deðerlendirildi. Ayrýca bronkoalveolar lavaj ve ýslak/kuru aðýrlýk oraný ile hücre geçirgenliði deðerlendirildi.
BULGULAR: Dört saatlik hiperoksik ventilasyon sialik asit, sindekan-1, malondialdehit düzeylerinde ve organlarýn ýslak kuru aðýrlýklarýnda anlamlý bir deðiþikliðe neden olmadý.
TARTIÞMA: Hiperoksik ventilasyonun normoksik ventilasyona benzer bir etki gösterdiði görülmektedir. Ancak, hiperoksinin uzun vadeli etkileri deðerlendirilmelidir.

BACKGROUND: Despite studies on the adverse effects of hyperoxia, its use is still recommended by the World Health Organization. The aim of this study was to test the possible harmful effects of hyperoxia on the lung, kidney, heart, and liver in a rat mechanical ventilation model.
METHODS: Male Wistar rats were randomly assigned into two groups (n=6/group): Normoxic (FiO2: 0.3) or hyperoxic (FiO2: 1.0) ventilation for 4 h. The injury was evaluated in bronchoalveolar lavage (BAL), blood, lung, liver, kidney, and heart was evaluated in terms of cell surface integrity, extracellular matrix (sialic acid, syndecan-1), osmotic stress (free hemoglobin), and redox homeostasis-lipid peroxidaation (malondialdehyde). BAL and wet/dry weight ratio were also evaluated for cellular permeability.
RESULTS: Four hours of hyperoxic ventilation did not lead to significant changes in (1) sialic acid, syndecan-1, (2) malondialdehyde levels and wet/dry weight ratio in liver, kidney, heart, and lung compared to normoxic ventilation.
CONCLUSION: Mechanical ventilation with hyperoxia seems to have almost similar effects compared to ventilation with normoxia. However, the long term effect of hyperoxia should be evaluated.

AMAÇ: Bu çalýþmada, tavþan diz eklemi deneysel kýkýrdak defekti modelinde eklem kýkýrdaðýnýn borik asit (BA) enjeksiyonuyla kýkýrdak iyileþmesi üzerine etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Dokuz adet iskelet geliþimi olgun, diþi, Yeni Zelanda beyaz tavþaný kullanýldý. Tavþanlarýn sað dizleri çalýþma grubu olarak atandý ve BA çözeltisi eklem içine enjekte edildi. Tavþanlarýn sol dizleri ise kontrol grubu olarak belirlendi. Tavþanlara anestezi altýnda, medial femur kondilinin eklem yüzeyinin ön tarafýnda matkap ucu kullanýlarak, silindirik tam kalýnlýkta bir osteokondral defekt (4 mm çapýnda ve 3 mm derinliðinde) oluþturuldu. BA çözeltisi tavþanlarýn sað dizlerine altý hafta boyunca, her hafta ayný gün ve saatte eklem içi enjeksiyonu (8 mg/kg) þeklinde uygulandý. Ýkinci ayýn sonunda hayvanlara ötenazi uygulandý.
BULGULAR: Makroskopik ve mikroskobik deðerlendirmede, BA enjeksiyon grubunda kontrol grubuna göre anlamlý farklýlýklar gözlendi (p<0.05). Defekt bölgesinin makroskopik deðerlendirmesinde defekt onarým derecesi, sýnýr bölgesi integrasyonu ve makroskopik görünüm açýsýndan gruplar arasýnda BA grubu lehine anlamlý farklýlýklar tespit edildi (p<0.05). ICRS görsel histolojik deðerlendirme skoruna gore deðerlendirilen tüm parametrelerin ortalama sonuçlarý BA grubu için daha iyi olarak tespit edildi.
TARTIÞMA: Kýkýrdak yaralanmasýnýn iyileþme süreci BA enjeksiyon uygulamasý ile geliþtirilebilir. Gelecekte BA, yaygýn olarak görülen bir sorun olan kýkýrdak yaralanmalarýnýn iyileþme sürecini arttýrmak için klinik uygulamalarda ek bir tedavi yöntemi olarak kullanýlabilir.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee.
METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month.
RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p<0.05). In the macroscopic examination of the defect area, statistically significant differences were observed between the groups in terms of degree of defect repair, integration to border zone, and macroscopic appearance (p<0.05). The averaged results of all evaluated parameters of the International Cartilage Repair Society visual histological assessment score were better for the BA group.
CONCLUSION: The healing process of the cartilage injury could be improved by BA injection administration. In future, BA may safely be used as an additional treatment modality in clinical practice to enhance the healing process of cartilage injuries, which are commonly observed orthopedic problem.

AMAÇ: Periferik sinir yaralanmalarý genellikle öldürücü deðildir, ancak uygun þekilde tedavi edilmezse ciddi nörolojik defisitlere neden olabilir. Bu çalýþmanýn amacý son 10 yýlda periferik sinir travmasý nedeniyle cerrahi tedavi gören hastalarýmýzý sunmak ve sonuçlarýný literatür ýþýðýnda tartýþmaktýr.
GEREÇ VE YÖNTEM: 2010–2019 yýllarý arasýnda kliniðimizde cerrahi tedavi uygulanan 182 hastanýn klinik ve elektrofizyolojik sonuçlarý geriye dönük olarak incelendi. Tüm ameliyatlarda intraoperatif sinir aksiyon potansiyelleri kullanýldý. Demografik özellikler, etiyolojiler, cerrahi zamanlama ve cerrahi tedavi sonuçlarý analiz kaydedildi.
BULGULAR: Periferik sinir travmasý olan 182 hastaya 10 yýllýk bir sürede toplam 199 cerrahi giriþim yapýldý. Yüz altmýþ iki hasta erkek, 20 kadýn ve ortalama yaþ erkeklerde 29.34 yýl, kadýnlarda 30.2 yýl idi. Siyatik sinir travmasý erkeklerde ve peroneal sinir hasarý kadýnlarda en yaygýn olanýdýr. Travmanýn en yaygýn nedeni erkeklerde ateþli silah yaralanmalarý ve kadýnlarda ise künt/kesicitravmalar idi. Eksternal ve internal nöroliz en sýk uygulanan cerrahi teknik olup bunu epinöral anastomoz ve sural sinir grefti izlemiþtir. Yüz seksen iki hastanýn 155’inde ameliyattan sonraki üç ay içinde kýsmi nörolojik düzelme görülürken, 27’sinde nörolojik durumlarýnda deðiþiklik olmadý.
TARTIÞMA: Erkekler periferik sinir travmasýna kadýnlardan daha sýk maruz kalmaktadýr. Þiddetli kýsmi sinir lezyonlarý çoðunlukla cerrahi tedaviden yararlanýr ve nöroliz en çok tercih edilen cerrahi tedavi yöntemi haline gelmiþtir. Ýntraoperatif sinir aksiyon potansiyelleri kaydý daha iyi klinik sonuçlar vermektedir. Nörolojik iyileþme her zaman elektrofizyolojik iyileþme ile iliþkili olmayabilir.

BACKGROUND: Peripheral nerve injuries are usually not lethal but may cause serious neurological deficits if not treated properly. The aim of this study is to present our patients who underwent surgical treatment for peripheral nerve trauma in the past 10 years and to discuss their results in light of the literature.
METHODS: The clinical and electrophysiological results of 182 patients who underwent surgical treatment in our department between 2010 and 2019 were retrospectively analyzed. All surgeries were performed using intraoperative nerve action potentials (NAP) recordings. Demographic characteristics, etiologies, surgical timing, and results of surgical treatment were recorded.
RESULTS: A total of 199 surgical interventions were performed in 182 patients with peripheral nerve trauma within 10 years. 162 patients were male, 20 were female and the mean age was 29.34 years for males and 30.2 years for females. The sciatic nerve trauma was the most common in men and peroneal nerve injury women. The most common cause of trauma was gunshot wounds in menand blunt/sharp traumas in women. External and internal neurolysis was the most common surgical technique, followed by epineural anastomosis and sural nerve grafting. 155 of 182 patients showed partial neurological improvement within 3 months after surgery, while 27 had no change in their neurological condition.
CONCLUSION: Men are more frequently exposed to peripheral nerve trauma than women. Severe partial nerve lesions mostly benefit from surgical treatment, and neurolysis has become the most preferred method of surgical treatment. Intraoperative NAP recordings provide better clinical outcomes. Neurological improvement may not always be in correlation with electrophysiological improvement.

AMAÇ: Travmatik hemorajik þok, hýzlýca tanýnýp müdahale edilmediði takdirde yüksek mortalite ile seyreden bir durumdur. Hemorajik þokun evresi ve þiddeti bu hastalarýn yönetiminde kararlarý belirleyen temel faktördür. Bu çalýþmada, travmatik hemorajik þokta olan hastalarda objektif bir kriter olan tiyol disülfid homeostazisi dengesi ile þokun þiddet ve derecesini daha net ortaya koyarak, hýzlý bir þekilde hastalarýn uygun tedaviyi alabilmesine rehberlik etmek ve böylece morbidite ve mortaliteyi azaltmak amaçlandý.
GEREÇ VE YÖNTEM: Çalýþma, 01.10.2018–30.04.2019 tarihleri arasýnda, Saðlýk Bilimleri Üniversitesi Ankara Numune Saðlýk Uygulama ve Araþtýrma Merkezi Acil Týp Kliniði’nde kontrollü, ileriye yönelik, klinik bir çalýþma olarak yapýldý. Çalýþmada hasta ve saðlýklý gönüllülerden alýnan kanda, tiyol disülfid homeostazisinin deðerlendirilmesi yapýldý. Çalýþmaya acil servise baþvuran travmatik hemorajik kanamasý olan 18 yaþ ve üstü, kadýn-erkek 52 gönüllü hasta ve herhangi bir hastalýðý olmayan saðlýklý gönüllü kiþilerden oluþan 50 kiþilik kontrol grubu olmak üzere toplam 102 kiþi alýndý.
BULGULAR: Hasta ve kontrol grubunda native tiyol, total tiyol, disülfid, disülfid/native tiyol, disülfid/total tiyol düzeyleri arasýnda anlamlý fark bulundu (sýrasýyla, native tiyol, total tiyol, disülfid, disülfid/native tiyol ve disülfid/total tiyol p deðerleri; 0.001>, 0.001>, 0.018, 0.002, 0.002). Ýkili grup karþýlaþtýrmalarýna göre; Evre 3 hemorajik þokta native tiyol ve total tiyol, Evre 1 ve 2 hemorajik þoka göre istatistiksel olarak anlamlý þekilde daha düþüktür. (Evre 1 ve Evre 3 hemorajik þok karþýlaþtýrmasý; native tiyol için p deðeri=0.001, total tiyol için p deðeri=0.002) (Evre 2 ve Evre 3 hemorajik þok karþýlaþtýrmasý; native tiyol için p deðeri=0.009, total tiyol için p deðeri=0.006). Total tiyol düzeyi hayatýný kaybeden hastalarda yaþayanlara göre daha düþük bulundu (p=0.040).
TARTIÞMA: Bu çalýþma ile tiyol disülfid homeostazisi verilerinin þok evresi ve mortalite ile korelasyon gösterdiði bulunmuþtur. Tiyol disülfid homeostazisi deðerlendirmesinin travmatik hemorajik þok hastalarýnda; hastalýðýn þiddeti, evrelemesi, prognozunu deðerlendirmek ve tedavi yönetimi konusunda bize rehberlik edebileceði düþünülmektedir.

BACKGROUND: Traumatic hemorrhagic shock is a condition associated with a high mortality rate in the absence of timely diagnose and intervention. The class and severity of hemorrhagic shock are the key factors that guide the decisions in the management of these patients. This study aims to provide guidance for the timely administration of an appropriate treatment to patients with traumatic hemorrhagic shock, and thus, decrease morbidity and mortality, by determining shock severity and class more clearly with the use of the thiol disulfide homeostasis balance, which is an objective criterion.
METHODS: This controlled, prospective, and clinical study was conducted in the Emergency Medicine Clinic at the University of Health Sciences, Ankara Numune Training and Research Hospital between October 1, 2018 and April 30, 2019. Thiol disulfide homeostasis was assessed in blood collected from patients and healthy volunteers. A total of one hundred two patients were included; of whom 52 were female and male volunteer patients aged 18 or older who presented to the emergency department with traumatic hemorrhagic bleeding and fifty were control subjects.
RESULTS: Patient and control groups demonstrated significantly different native thiol, total thiol, disulfide, disulfide/native thiol, and disulfide/total thiol levels (P-values for native thiol, total thiol, disulfide, disulfide/native thiol, and disulfide/total thiol: 0.001>, 0.001>, 0.018, 0.002, and 0.002, respectively). According to pairwise comparisons; Class-3 hemorrhagic shock was associated with significantly lower native thiol and total thiol levels compared to Class-1 and Class-2 hemorrhagic shock (Comparison of Class-1 and Class-3 hemorrhagic shock: p-value for native thiol = 0.001, p-value for total thiol = 0.002) (Comparison of Class-2 and Class-3 hemorrhagic shock: p-value for native thiol = 0.009, p-value for total thiol = 0.006). Total thiol levels were found to be lower in patients who died compared to those who survived (p=0.040).
CONCLUSION: Thiol disulfide homeostasis data were found to be correlated with the shock class and mortality. The assessment of thiol disulfide homeostasis can serve as a guide in the determination of the severity and classification of the disease, evaluation of the prognosis, and management of the treatment in traumatic hemorrhagic shock patients.

AMAÇ: Bu çalýþmanýn amacý, apandisitli pediatrik ve yetiþkin hastalar arasýnda bazý farklýlýklar olup olmadýðýný araþtýrmaktýr.
GEREÇ VE YÖNTEM: Ýki yüz yetmiþ dokuz pediatrik ve 275 eriþkin hastanýn kayýtlarý demografik özellikler, geçmiþ týbbi öykü, semptomlarýn süresi, laboratuvar ve radyolojik bulgular, ameliyat notlarý, patolojik raporlar, hastanede kalýþ süresi ve ameliyat sonrasý sonuçlar açýsýndan geriye dönük olarak incelendi.
BULGULAR: Çocuklar ile yetiþkinler arasýnda cinsiyet, perforasyon ve negatif apendektomi oranlarý, laboratuvar bulgularý ve komplikasyonlar açýsýndan anlamlý bir fark bulunmadý. Bununla birlikte, çalýþmamýz çocuklara taný koymanýn daha zor olduðunu, en çok tercih edilen radyolojik yöntemlerin çocuklarda karýn grafisi ve ultrasonografi, eriþkinlerde ise bilgisayarlý tomografi olduðunu, hava-sývý seviyelerinin ve sað taraflý skolyozun çocuklardaki grafilerde daha çok tespit edildiðini, apendiks perforasyonunun her iki uç yaþ grubunda daha sýk görüldüðünü, çocuklarda apendiks perforasyonunun daha erken geliþtiðini ve hastanede kalýþ süresinin daha uzun olduðunu, çocuklarda ilk baþvuru esnasýnda taný konulamamasýnýn ve eriþkinlerde ise ileri yaþýn komplikasyonlarla iliþkili risk faktörleri olduðunu ortaya koydu.
TARTIÞMA: Bu çalýþma eriþkinlerde ve çocukluk çaðýnda görülen apandisitler arasýnda bazý önemli farklýlýklar olduðunu gösterdi. Hastalar deðerlendirilirken bu farklýlýklar göz önüne alýnýrsa hem klinisyenler hem de hastalar için arzu edilen sonuçlar elde edilebilir.

BACKGROUND: This study aimed to investigate whether there are some differences between pediatric and adult patients with appendicitis.
METHODS: We retrospectively reviewed the records of 279 pediatric and 275 adult patients with respect to demographics, past medical history, duration of symptoms, laboratory and radiological findings, operation notes, pathological reports, length of hospital stay and post-operative outcomes.
RESULTS: No significant differences were found with respect to gender, rates of perforation and negative appendectomy, laboratory findings, and overall outcomes between children and adults. However, our study suggests that the diagnosis is more difficult in children, the most preferred radiologic diagnostic methods are abdominal ultrasound and plain X-ray in children vs. computed tomography in adults, air-fluid levels and right-sided scoliosis are more commonly detected on X-ray in children, appendiceal perforation is more common at both extreme of ages, the appendix is perforated earlier and length of hospital stay is longer in children, and misdiagnosis at first admission in children and advanced age in adults were the risk factors associated with the complications.
CONCLUSION: The present study found some important differences between childhood and adulthood appendicitis. If these differences are considered when evaluating the patients, more desired outcomes can be achieved for both clinicians and patients.

AMAÇ: Pelvik apselerin drenajý, organ yakýnlýðý nedeniyle iyi planlanmasý gereken giriþimsel prosedürlerdir. Literatürde pelvik apse drenajýnýn tedavi yöntemlerini deðerlendiren ve baþarý oranlarýný karþýlaþtýran yeterli yayýn bulunmamaktadýr.
GEREÇ VE YÖNTEM: Bu çalýþmaya Haziran 2017 ve Aralýk 2019 tarihleri arasýnda giriþimsel radyoloji birimimizde pelvik apse drenajý yapýlan 15 hasta geriye dönük olarak alýndý. Apse büyüklüðü, apse özellikleri, apse eriþim yöntemi (transrektal, transvajinal, transgluteal) ve drenaj tedavi prosedürü (iðne aspirasyonu, kateter tedavisi) tedavinin baþarýsý üzerindeki etkiler açýsýndan istatistiksel olarak deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 15 hastanýn altýsý (%40) erkek, dokuzu (%60) kadýn olup ortalama yaþlarý 31.6 yýldý. Sadece iðne aspirasyonu ile tedavi edilen hastalarýn ikisinde apse koleksiyonu tekrarladý ve ikinci iþlem yapýldý. Çalýþmamýzda teknik baþarý %100 ve tam klinik baþarý %80 idi. Hiçbir hastaya drenaj tedavisi sonrasý apse nedeniyle açýk cerrahi uygulanmadý.
TARTIÞMA: Sonuç olarak, pelvik apselerin endokaviter ve perkütan drenaj tedavileri güvenli ve etkili tedavi yöntemleridir. Ýðne aspirasyon tedavisinin baþarýsý kateter tedavisinden daha düþüktür ve apse koleksiyonunun tekrarlayabileceði göz önünde bulundurulmalýdýr.

BACKGROUND: Drainage of pelvic abscesses is interventional procedures that should be well planned due to organ contiguity. There are not enough publications in the literature evaluating the treatment methods of pelvic abscess drainage and comparing success rates.
METHODS: In this study, 15 patients who underwent pelvic abscess drainage in our interventional radiology unit between June 2017 and December 2019 were retrospectively included. Abscess size, abscess characteristics, the method of access to abscess (transrectal, transvaginal, transgluteal), and drainage treatment procedure (needle aspiration, catheter treatment) were evaluated statistically in terms of effects on the success of treatment.
RESULTS: Of the 15 patients included in the study, 6 (40%) were male and 9 (60%) were female, with a mean age of 31.6 years.In 2 of the patients treated with needle aspiration alone, the abscess collection was repeated and the second procedure was performed. In our study, the technical success was 100% and the complete clinical success was 80%. None of the patients underwent open surgery due to abscess after drainage treatment.
CONCLUSION: In conclusion, endocavitary and percutaneous drainage treatments of pelvic abscesses are safe and effective treatment methods. The success of needle aspiration treatment is lower than catheter treatment and it should be considered that the abscess collection may recur.

AMAÇ: Yangýn birçok nedenden dolayý ortaya çýkabilen, canlýlarýn hayatýný tehdit eden ve ekonomik zarara sebep olan önemli bir halk saðlýðý sorunudur. Yangýn ortamýndan çýkarýlan kiþilerde yapýlacak ilk týbbi incelemeler, olay yeri incelemesi ve adli soruþturma önemli deliller ortaya koyabilmektedir.
GEREÇ VE YÖNTEM: Adli Týp Kurumu Trabzon Adli Týp Grup Baþkanlýðý’nda 2007–2016 yýllarý arasýndaki dönemde, yangýn ortamýnda bulunan ölüm olgularýna ait otopsi raporlarý geriye dönük olarak incelendi.
BULGULAR: On yýllýk arþiv taramasý neticesinde yangýn ortamýnda bulunan ve adli otopsileri yapýlan 158 olgunun 100’ünün (%63.3) erkek, 58’inin (%36.7) kadýn olduðu tespit edildi. Orijini tespit edilemeyen grup dýþlanarak; cinayet orijinli ölümlerle ile diðer orjinli ölümler (kaza ve intihar) arasýnda karboksihemoglobin seviyeleri açýsýndan yapýlan deðerlendirmede iki grup arasýnda istatistiksel olarak anlamlý farklýlýk bulundu. Yangýn ortamý açýk ve kapalý alanlar olarak gruplandýrýldýðýnda olgularda tespit edilen karboksihemoglobin düzeylerinin karþýlaþtýrýlmasý Tablo 6’da gösterilmiþtir. Ýki grup arasý fark istatistiki olarak anlamlý bulundu (p<0.05).
TARTIÞMA: Yangýn ortamýndan çýkarýlan kiþilerde olay yeri incelemesinden baþlanarak, iyi bir radyolojik, toksikolojik ve patolojik inceleme yapýlmasý esastýr. Toksikolojik incelme, karboksihemoglobin, siyanür ve irade ve hareketi etkileyecek alkol, uyutucu, uyuþturucu vb gibi birçok maddeyi kapsamalýdýr. Karboksihemoglobin düzeyleri ölümün meydana geldiði mekan, orijin ve kiþideki mevcut ek hastalýklarla ilgili bilgi verebileceðini göstermektedir.

BACKGROUND: The fire is a public health problem that occurs because of various reasons, threatens the lives of organisms, and may cause economic losses. The forensic investigation and the crime (event) scene investigation and first medical examination to be performed for the persons in the fire scene might reveal important evidences.
METHODS: The autopsy reports prepared in Trabzon Branch Office, The Ministry of Justice Council of Forensic Medicine, for the death cases found in fire scene between 2007 and 2016 were retrospectively examined.
RESULTS: As a result of analyzing the 10-year archive data, it was determined that 100 (63.3%) of 158 cases, which have been found in the fire scene and undergone forensic autopsy, were male and 58 (36.7%) were female. By excluding the group of cases with undetected origin, it was determined that there was a statistically significant difference between the homicide-caused deaths and the deaths with other causes (accident and suicide) in terms of the carboxyhemoglobin (HbCO) levels. By grouping the fire scene as outdoor and indoor areas, the comparison made between the HbCO levels of cases is presented in table. The difference between the two groups was found to be statistically significant (p<0.05).
CONCLUSION: Starting from the crime scene investigation, a detailed radiological, toxicological, and pathological investigation must be performed for the persons taken out from the fire scenes. It was observed that the HbCO levels can be used in determining the space in which death occurred, the origin, and the comorbidities of the individual.

AMAÇ: Bu çalýþmanýn amacý, birinci düzey üçüncü basamak travma hastanesinde 20 yaþ altý, 20–65 yaþ ve 65 yaþ üstü hasta gruplarý için kýsýtlamalarýn, COVID-19 pandemisi ve pandemi öncesi dönem arasýndaki kýrýk baþvurusu üzerindeki etkisini deðerlendirmek amacýyla tasarlanmýþtýr.
GEREÇ VE YÖNTEM: Pandemi döneminde 10 Mart–1 Haziran tarihleri arasýnda ortopedik tedavi için hastaneye kaldýrýlan ve tedavi edilen hastalar geriye dönük olarak incelendi. Kontrol grubu, 2019 yýlýnda ayný zaman aralýðýnda hastaneye baþvuran hastalardan oluþturuldu. Hastalar 20 yaþ altý, 20–65 yaþ ve 65 yaþ üstü olmak üzere üç gruba ayrýldý. Hastalarýn verileri yaþ, cinsiyet, travma mekanizmasý, kýrýk tipi, herhangi bir COVID-19 radyolojik veya klinik semptomu içeriyordu.
BULGULAR: Ortopedik travma merkezine baþvuran 65 yaþ üstü hasta sayýsý pandemik aralýkta pre-pandemi zamanýna göre yüksekti. Gruplar 20–65 yaþ grubu hastalarla karþýlaþtýrýldýðýnda; kýrýk tipi açýsýndan anlamlý fark vardý (p<0.05). Pandemi öncesi grupta alt ekstremite kýrýklarý yüksek, pandemik grupta ise çoklu travmalar yüksekti. 20–65 yaþ alt gruplarýnda düþük enerjili travmalar pandemi öncesi grupta daha yüksek, yüksek enerjili travmalar pandemi grubunda daha sýktý.
TARTIÞMA: COVID-19 pandemisi sýrasýnda ortopedik travma merkezlerine kýrýk baþvurusunda 20 yaþ altý ve 20–65 yaþ alt gruplarýnda azalma, 65 yaþ ve üzeri için önemli bir artýþ görülürken, çoðu osteoporotik kalça kýrýklarý ile iliþkilidir. Bu nedenle ileri yaþ grubu, osteoporozdan kaçýnmak için her gün sýnýrlý bir süre için evde harekete geçmeye ve yürüme ve fiziksel aktivite yapma iznine sahip olmaya teþvik edilmelidir.

BACKGROUND: This present study was designed to evaluate the effect of restrictions on fracture admission to a Level-1 tertiary trauma hospital between COVID-19 pandemic and pre-pandemic restriction time intervals that included groups of younger than <20-years-old, 20–65-years-old, and older than aged >65-years-old.
METHODS: Patients who were hospitalized and treated for orthopedic treatment between 10 March and 1 June during the pandemic period were retrospectively analyzed. Control group consisted of patients admitted to the hospital in the same time interval in 2019. The patients were divided into three groups, under 20 years of age, between 20 and 65 years of age, and over 65 years of age. The patients’ data included age, gender, trauma mechanism, fracture type, and any COVID-19 radiological or clinical symptoms.
RESULTS: The number of patients >65-years-old admitted to the orthopedic trauma center was high at pandemic intervals compared to pre-pandemic time. When the groups were compared for patients of 20–65-years-old; there was a significant difference for the fracture type (p<0.05). Lower extremity fractures were high at pre-pandemic group, whereas multiple traumas were high at pandemic group. For sub-group 20–65 ages, low-energy traumas were higher at pre-pandemic group, whereas high-energy traumas were more frequent at the pandemic group.
CONCLUSION: We observed a decrease in fracture admission to orthopedic trauma centers during COVID-19 pandemic for subgroups of <20-years-old and 20–65-years-old ages, whereas there was a significant increase for >65-years-old age, most of them related to the osteoporotic hip fractures. So that older age group should be encouraged to mobilize at home and have permission to walk and make physical activity to avoid osteoporosis for a limited time daily.

AMAÇ: Minimal invaziv plak osteosentez (MIPO) cerrahi tekniðini basitleþtirmek üzere distal femur ve proksimal lateral tibia için daha az invaziv stabilizasyon sistemleri geliþtirilmiþtir. Bununla birlikte MIPO, klavikula orta þaft kýrýklarýnda giriþ kýlavuzunun yardýmý olmadan fiksasyonda kullanýma sunulmuþtur ve ciddi komplikasyonlar olmaksýzýn tatmin edici klinik ve radyolojik sonuçlar görülmüþtür. Bu çalýþmanýn amacý, giriþ kýlavuzunu kullanarak klaviküler orta þaft kýrýklarýnda MIPO sonuçlarýný belirlemekti.
GEREÇ VE YÖNTEM: Eylül 2016 ile Eylül 2018 arasýnda MIPO ile giriþ kýlavuzu kullanýlarak tedavi edilen klaviküler orta þaft kýrýðý olan 15 hasta dahil edildi. Ortalama 15.4 aylýk takipte (aralýk: 12–24 ay) kemik kaynamasý, Constant skor ile omuz fonksiyonu ve komplikasyonlarý deðerlendirdik.
BULGULAR: Ortalama cerrahi süre 55.9±9.4 dakika (aralýk: 50–70 dakika) ve floroskopi süresi 146.5±29.0 saniye (aralýk: 110–190 saniye) idi. Tüm hastalarda, gecikmeli kaynama veya kaynamama olmadan 8.8±1.0 haftada (aralýk: 8–10 hafta) kemik kaynamasý saðlandý. Takipte ortalama Constant skoru 99.1±1.2 (aralýk: 96–100) idi. Enfeksiyonlar, vidanýn dýþarý çýkmasý, donaným çýkýntýsý ve nörovasküler yaralanma gibi ameliyat sonrasý komplikasyonlar gözlenmedi, ancak bir hastada hafif plak rahatsýzlýðý þikayeti görüldü.
TARTIÞMA: Giriþ kýlavuzu kullanýlarak uygulanan MIPO’nun klavikula orta þaft kýrýklarýnýn operatif tedavisinde kabul edilebilir ve etkili bir seçenek olduðu düþünülmektedir.

BACKGROUND: The less invasive stabilization systems for the distal femur and proximal lateral tibia have been developed to simplify the surgical technique of minimally invasive plate osteosynthesis (MIPO). MIPO, however, has simply been introduced into clavicular midshaft fixation without the aid of insertion guide though the procedure for midshaft clavicular fractures was found to produce satisfactory clinical and radiologic outcomes without serious complications. The purpose of this study was to determine the outcome of MIPO of clavicular midshaft fractures using an insertion guide.
METHODS: A total of 15 patients with clavicular midshaft fractures treated by MIPO using insertion guide between September 2016 and September 2018 were included. We assessed bony union, shoulder function by the Constant score, and complications at a mean follow-up of 15.4 months (ranged from 12 to 24 months).
RESULTS: The mean surgical time 55.9±9.4 min (ranged from 50 to 70 min) and the fluoroscopic time was 146.5±29.0 s (ranged from 110 to 190 s). In all patients, the bony union was achieved at 8.8±1.0 weeks (ranged from 8 to 10 weeks) with no delayed unions or nonunions. The average Constant score was 99.1±1.2 (ranged from 96 to 100) at follow-up. Postoperative complications including infections, screw pull-out, hardware prominence, and neurovascular injury were not observed, however, one patient complained of mild plate discomfort.
CONCLUSION: MIPO using insertion guide is believed to be an acceptable and effective choice in the operative treatment of clavicular midshaft fractures.

AMAÇ: Minimal invaziv perkütan plak osteosentezi (MIPO) ve kanal içi çivileme (IMN) distal tibia eklem dýþý kýrýklarý için en sýk kullanýlan iki yöntemdir; ancak ideal tedavi halen tartýþmalýdýr. Bu çalýþmanýn amacý, distal tibia eklem dýþý kýrýklarýnýn tedavisinde MIPO ve IMN’yi Türkiye’deki saðlýk sigortasý kayýtlarýna göre maliyet analizi açýsýndan karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmada 2013–2018 yýllarý arasýnda distal tibia eklem dýþý kýrýklarý tedavisi için MIPO veya IMN uygulanan hastalarýn verileri incelendi. Hastalarýn klinik verileri ve ilk yatýþtan iþe dönüþe kadar hastaneye yatýþ dahil toplam masraflar ve tüm ayakta tedavi kontrolleri hastanenin faturalandýrma bölümünde gözden geçirildi. Sosyal Güvenlik Kurumu (SGK) tarafýndan iþe dönene kadar hastaya aylýk ödenen toplam para miktarý da kaydedildi.
BULGULAR: Çalýþmaya yaþ ortalamasý 37.2±13.4 olan 118 ardýþýk hasta (35 kadýn–83 erkek) katýldý. Ýntramedüller çivileme (IMN) grubu yaþ ortalamasý 36.7±12.8 yýl olan 57 hastadan, MIPO grubu ise yaþ ortalamasý 37.8±13.6 yýl olan 61 hastadan oluþmaktaydý. Çalýþma gruplarý arasýnda hastalarýn yaþý, cinsiyeti, kýrýk sýnýflamalarý (AO/OTA sýnýflandýrmasý), yumuþak doku yaralanmasý (Tscherne sýnýflandýrmasý), tip 1 açýk kýrýk varlýðý ve eþlik eden fibula kýrýðý varlýðý açýsýndan anlamlý fark gözlenmemiþtir. Ameliyat öncesi hastanede kalýþ süresi açýsýndan iki grup arasýnda istatistiksel fark yoktu (p=0.713). Ancak ortalama hastanede kalýþ süresi MIPO grubunda anlamlý olarak daha yüksekti (p=<0.001). MIPO grubunda toplam ayaktan tedavi kontrolü sayýsý, kaynama süresi ve iþe dönüþ süresi de anlamlý olarak daha yüksekti (sýrasýyla, p=0.005 p<0.001 ve p<0.001). Taburculuða kadar ortalama hastane maliyeti ve iþe dönüþe kadar ortalama toplam maliyet MIPO grubunda anlamlý olarak daha yüksekti (sýrasýyla, p=0.001 ve 0.001). MIPO grubunda ortalama hastanede yatýþ ve ayaktan tedavi kontrolleri maliyetleri de anlamlý derecede yüksekti (sýrasýyla, p=0.001 ve 0.004). Ortalama implant maliyetleri gruplar arasýnda anlamlý farklýlýk göstermedi (p=0.179).
TARTIÞMA: Mevcut çalýþmadan elde edilen sonuçlara göre IMN, Türkiye’de ulusal saðlýk sigortasý tarafýndan ödenen maliyetler açýsýndan eklem dýþý distal tibia kýrýklarýnýn tedavisinde MIPO ile karþýlaþtýrýldýðýnda daha iyi bir seçenektir.

BACKGROUND: Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey.
METHODS: The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients’ clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital’s billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient’s returns to work were also recorded.
RESULTS: 118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients’ age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p=<0.001). The means of number of total outpatient controls, time to union, and return to work were also significantly higher in the MIPO group (p=0.005, p<0.001 and p<0.001, respectively). The mean hospital cost until discharge and the mean total cost until return to work were significantly higher in the MIPO group (p=0.001 and 0.001, respectively). The mean total costs of hospital stay and outpatient controls were also significantly higher in the MIPO group (p=0.001 and 0.004, respectively). The mean implant costs did not significantly differ between groups (p=0.179).
CONCLUSION: According to the results acquired from the present study, IMN is a better option compared to MIPO for the treatment of extra-articular distal tibial fractures in terms of costs paid by the national health insurance in Turkey.

AMAÇ: Manyetik rezonans görüntüleme kullanarak tel demet ve çift demet ön çapraz bað tamir yöntemlerinin klinik sonuçlarýný deðerlendirmek ve karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Ýki farklý ön çapraz bað (ÖÇB) rekonstrüksiyon grubuna 38 hasta blok randomizasyon ile randomize edildi: çift demet tekniði (n=19) ve tek demet tekniði (n=19). Ameliyat öncesi ve takip süresinin sonunda onikinci haftada hastalarýn deðerlendirilmesi klinik muayenesi, manyetik rezonans görüntüleme deðerlendirmesi, Modifiye Cincinnati Diz Deðerlendirme skoru ve Lysholm diz skorlarý ile yapýldý.
BULGULAR: Ön çapraz bað açýsý, posterior çapraz bað (PÇB) açýsý ve tibial translasyonda çift demet grubu ile tek demet grubu arasýnda anlamlý bir fark bulunmadý. Klinik skorlar ile ilgili olarak teknikler arasýnda anlamlý bir fark yoktu. Tek demetli grupta radyolojik sonuçlarýn klinik skorlarla korelasyonuna göre, ameliyat sonrasý ÖÇB açýsý deðerleri ile Lysholm klinik skoru arasýnda negatif, güçlü ve anlamlý bir korelasyon vardý (r=-0.66, p=0.002).
TARTIÞMA: Ameliyat sonrasý ÖÇB açýsý, tek demetli ÖÇB rekonstrüksiyonu yapýlan hastalarda klinik iyileþme derecesini öngörebilir.

BACKGROUND: The objective of the study is to compare the clinical results of the single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) repairing techniques using magnetic resonance imaging (MRI).
METHODS: Thirty-eight patients were randomized by block randomization into two different groups of ACL reconstruction: DB (n=19) and SB techniques (n=19). MRI evaluation and clinical examination with modified Cincinnati Knee Rating Score and Lysholm knee scores were performed pre-operatively and at the end of a follow-up period of 36 months.
RESULTS: No significant differences were found in the ACL angle, posterior cruciate ligament angle, and tibial translation between the DB and the SB groups. Regarding the clinical scores, there were no significant differences between the techniques. As for the correlation of radiologic results with clinical scores in the SB group, there was a strong and significant correlation between the post-operative ACL angle values and the Lysholm clinical score (r=–0.66; p=0.002).
CONCLUSION: The post-operative ACL angle can predict the degree of clinical recovery in patients undergoing SB ACL reconstruction.

AMAÇ: Tibial eminensia kýrýklarý, oluþum mekanizmasý açýsýndan ACL rüptürüne benzeyen avülsiyon yaralanmalarýdýr. Ýnsidansý çok fazla olmasa da, doðru tedavi edilmediði takdirde bazý komplikasyonlara ve diz ekleminde kalýcý hasarlara neden olabilmektedir. Bu çalýþmadaki amacýmýz kliniðimizde pediatrik popülasyondaki tibial eminensia kýrýklarýnýn tedavisinde uyguladýðýmýz artroskopik dikiþ tekniðinin orta dönem sonuçlarýnýn deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Ocak 2013–Aralýk 2017 tarihleri arasýnda bulunan tip 2 (>5 mm deplasman), 3 ve 4 tibial eminensia kýrýðý nedeniyle kliniðimizde artroskopik dikiþ fiksasyon cerrahisi uygulanmýþ 28 hasta geriye dönük olarak incelendi. Hastalar; demografik özellikleri, yaralanma mekanizmasý, kýrýk sýnýflamasý, ortalama takip süresi, radyografik iyileþme süresi, aktiviteye dönüþ süresi, instabilite muayenesi, eklem hareket açýklýðý (EHA) ve KOOS parametreleri ile klinik ve fonksiyonel olarak deðerlendirildi.
BULGULAR: Takip edilen hasta grubunun yaþ ortalamasý 14.2 olup, bu hastalarýn 17’si (%61) erkek cinsiyette ve 20’si (%71) vücut kitle indeksine göre saðlýklý popülasyondaydý. Modifiye Meyer and McKeever sýnýflamasýna göre en sýk tip 2 tibial eminensia kýrýðý görüldü. Ortalama takip süresi 4.64 yýl olup, ortalama radyolojik iyileþme süresi 2.17 ay olarak hesaplandý. Yirmi yedi (%96) hasta EHA yönünden tamamen fonksiyoneldi. Bir hastaya artrofibrozis ve kýsýtlý EHA nedeniyle ikincil cerrahi uygulandý. Ortalama altýncý ay KOOS 82.3, 12. ay KOOS 91.4 ve 24. ay KOOS 95.7 olarak ölçülmüþ olup bu skorlar arasýnda anlamlý fark saptandý (p=0.024).
TARTIÞMA: Pediatrik popülasyondaki tibial eminensia kýrýklarýnýn tedavisinde artroskopik dikiþ tekniðinin sonuçlarý klinik ve fonksiyonel açýdan tatmin edicidir. Anatomik fiksasyon ve erken rehabilitasyon bu kýrýklarýn tedavisindeki baþarý oranýný arttýrmaktadýr. Daha uzun süreli takipler bizlere daha fazla bilgi verecektir.

BACKGROUND: Tibial spine fractures are avulsion injuries that are a similar mechanism to anterior cruciate ligament rupture. Although its incidence is not very common, it can cause possible complications and permanent sequelae in the knee joint if not treated correctly. The aim of this study was to evaluate the mid-term results of the arthroscopic suture technique for tibial spine fractures in a pediatric population.
METHODS: Analyzed retrospectively were 28 patients who underwent the arthroscopic suture fixation technique at our clinic, due to type 2 (with >5 mm displacement), 3 and 4 tibial spine fractures, between January 2013 and December 2017. The demographic features, injury mechanism, fracture classification, mean follow-up time, radiographic healing time, return to activity time, instability examination, joint range of motion (ROM), and knee injury and Osteoarthritis Outcome Score (KOOS) parameters of the patients were evaluated both clinically and functionally.
RESULTS: The mean age of the patients was 14.2. In addition, 17 patients were male (61%) and 20 had a healthy body mass index (71%). According to the modified Meyer and McKeever classification, type 2 tibial spine fracture was most common. The mean follow-up period was 4.64 years and the mean radiological healing time was calculated as 2.17 months. Of these patients, 27 were fully functional in terms of ROM (96%). Secondary surgery was performed on 1 patient due to arthrofibrosis and severely limited ROM. The mean 6-month KOOS was 82.3, while the 12-month KOOS was 91.4 and the 24-month KOOS was 95.7. A significant difference was observed between these scores (p=0.024).
CONCLUSION: The outcomes of the arthroscopic suture technique for the treatment of tibial spine fractures in a pediatric population were both clinically and functionally satisfactory. Anatomic reduction and early rehabilitation increased the success rate in the treatment of these fractures. Longer follow-up will provide more information.

AMAÇ: 2020 yýlý Covid-19 pandemisi ile baþladý. Türkiye’de pandemi sýrasýnda devlet tarafýndan alýnan önlemler ve kýsýtlamalar uygulamaya koyuldu. Saðlýk hizmetlerine eriþim konusunda herhangi bir kýsýtlama olmasa da halk coronovirüs bulaþýndan korktuðu için hastaneye gitmekte çekingen kaldý ve buna baðlý olarak tüm hastane baþvurularýnda azalma yaþandý.
GEREÇ VE YÖNTEM: Hastanemiz yanýk merkezi polikliniðine pandeminin ilk dönemi olan 16 Mart 2020 ile 1 Haziran 2020 tarihleri arasýnda baþvuran hastalarýn bir önceki yýlýn ayný tarihlerinde polikliniðe baþvuran hastalarýn demografik ve yanýk spesifik deðiþkenleri karþýlaþtýrýldý ve analiz edildi.
BULGULAR: Covid döneminde otuz dokuz hasta polikliniðe baþvururken 2019 yýlýnda 130 hasta baþvurusu mevcuttu. Hasta baþvurularýnda %70 azalma yaþandý. Bu çalýþmada pandemi döneminde hastalarýn baþvuru sürelerinin, pansuman sayýsýnýn ve toplam iyileþme sürelerinin anlamlý olarak arttýðý görülmüþtür. Cerrahi ihtiyacý olan hasta sayýsý, hastaneye yatýþ endikasyou ve greft ihtiyacý da pandemi döneminde anlamlý olarak artmýþtýr. Ayný zamanda pandemi döneminde hastaneye yatýþ sýrasýnda enfeksiyon varlýðýna daha fazla rastlanmýþtýr.
TARTIÞMA: Covid 19- pandemisi hastalarýn acil durumlarda dahi hastaneye gitmekte çekingen kalmasýna neden olmuþtur. Ancak bu durum istenmeyen sonuçlara neden olabilir. Spesifik saðlýk problemi olan hastalarýn özellikli saðlýk hizmeti veren merkezlere geç baþvurusu komplikasyon geliþmesine neden olur. Sonuç olarak özellikli tedavi gereksinimi olan gerçek acil durumlarda, pandemi sýrasýnda dahi týbbi hizmetin alýnmasýnýn gerekliði ve önemli olduðu konusunda toplum bilgilendirilmeli ve saðlýk hizmetine eriþim teþvik edilmelidir.

BACKGROUND: 2020 has started with Covid-19 pandemic. During the pandemic, govermental stringent precautions and lockdown measures have applied in Turkey. Although there was no limition for health care, people hesitate to go hospitals with the fear of Coronovirus transmission and all addmisions to hospitals decreased.
METHODS: Data of all patients admitted to our burn outpatient clinic during the pandemic period between March16, 2020 and June 1, 2020 compered with the same period in 2019. Demographic information and burn-specific variables of each patient were analysed.
RESULTS: Thirty nine patient admited to our clinic at covid period and 130 patient at 2019. There was a 70% reduction of admissions. In this stduy during pandemic period patients delayed days for admission, number of dressing change and total healing times were significantly longer, higher and longer (p<0.001, p<0.001, p<0.001, respectively). The number of surgery-required patients, hospitalization rates and the number of grafting were significantly high at the pandemic time (p=0.003, p=0.007 and p=0.036, respectively). Burn wound infection at admission has also found more frequent at covid-period (p<0.001).
CONCLUSION: Covid-19 pandemic made people hesitate to go to hospital even for emergencies. Unfortunately this fear caused unexpected consequences. Patients have developed complications due to delayed addmisions to specified medical centers for specific health problems. As a result, patients requiring special treatment, should be encouraged to immediatly seek professional medical advice especially for reel emergencies even during pandemic.

AMAÇ: Ayak anterolateralindeki araba tekeri yaralanmasýna baðlý defektlerin örtümü; hem bölgenin özellikleri hemde travma karakteri nedeniyle güçlükler içermektedir. Amacýmýz lastik yaralanmasý sonrasý ayak dorsolateralindeki cilt defekti geliþen olgularýn reverse sural arter fasyokütanoz flep ile örtüm sonuçlarýný sunmaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada, 2000–2014 yýllarý arasýnda, ortalama yaþý 26.9 yýl (daðýlým, 5–46 yýl) ve ayaðýn dorsolateralinde araba tekerine baðlý doku kaybý bulunan 14 hasta geriye dönük olarak deðerlendirildi. Ortalama defekt büyüklüðü 27.1 cm2 bulundu. Olgular doku örtümü ve komplikasyonlar açýsýndan ortalama 32.4 ay takip edildi.
BULGULAR: Erken donemde fleplerin ikisinde marjinal nekroz geliþmesine raðmen tüm olgularda ek rekonstrüksiyon gerektirmeden baþarýyla doku örtümü saðlandý. Donör saha sorunlarýyla karþýlaþýlmadan tüm hastalarda donör bölgeler primer olarak örtüldü.
TARTIÞMA: Ayak anterolateral araba tekeri yaralanmalarýnda, olgu temelli yaklaþýmla reverse sural arter fasyokütanoz flepler ile düþük komplikasyon ve yüksek baþarý elde edilebilir.

BACKGROUND: Defects due to car wheel injury at the anterolateral aspect of the foot are challenging due to the characteristics of the region and the trauma. The aim of this study was to present the results of the patients whose skin defects on the dorsolateral aspect of the foot due to tire injuries were treated with reverse sural artery fasciocutaneous flaps.
METHODS: Fourteen patients with a mean age of 26.9 years (range: 5–46 years) who experienced loss of tissue at the dorsolateral aspect of the foot due to tire injury between the years 2000 and 2014 were evaluated retrospectively. The mean defect size was 27.1 cm2. The patients were followed up for observing the tissue coverage and complications throughout a mean period of 32.4 months.
RESULTS: Despite the development of marginal necrosis in two flaps in the early period, tissues in all cases were successfully covered without requiring additional reconstruction. Primary donor site coverage was achieved in all patients without any donor site problems.
CONCLUSION: In case of tire injuries at the anterolateral aspect of the foot, low complication and high success rates can be achieved with a case-based approach with reverse sural artery fasciocutaneous flap coverage.

Gastrointestinal kanama, pankreatitin nadir fakat potansiyel olarak ölümcül bir komplikasyonudur. Erken taný ve zamanýnda radyolojik müdahale, tedavi edilmediðinde bu hastalarýn mortalitesi yüksek olduðundan saðkalým için çok önemlidir. Her ikisi de þiddetli üst gastrointestinal sistem kanamasý ile komplike olan biri kronik pankreatitli, diðeri akut pankreatitli iki hastayý sunuyoruz. Ýlk endoskopik hemostaz baþarýsýz olduktan sonra hastalar transkateter embolizasyon ile baþarýlý bir þekilde tedavi edildi. Endovasküler cihazlardaki ve embolizasyon malzemelerindeki geliþmeler ve deneyimli giriþimsel radyologlarýn sayýsýndaki artýþ, düþük komplikasyon insidansý ile iliþkili baþarýlý hemostaz elde etmek için güvenli bir minimal invaziv terapötik yöntem olarak anjiyografik embolizasyon prosedürlerinin önemini artýrmýþtýr. Cerrahiye göre avantajlarý nedeniyle endoskopiye dirençli üst gastrointestinal kanamasý olan hastalarda tedavi seçeneði olarak düþünülmelidir.

Gastrointestinal (GI) bleeding is rare but potentially fatal complication of pancreatitis. Early diagnosis and timely radiologic intervention are crucial for survival as when untreated the mortality of these patients is high. We present two patients, one with chronic pancreatitis and one with acute pancreatitis, both complicated with severe upper GI tract bleeding. Patients were successfully treated with transcatheter embolization after initial endoscopic hemostasis failed. The advances in endovascular devices and embolization materials and increased number of experienced interventional radiologists have increased the importance of angiographic embolization procedures as a safe minimally invasive therapeutic method of achieving successful hemostasis associated with the low incidence of complications. Due to its advantages over surgery, it should be considered treatment of choice in patients with upper GI bleeding refractory to endoscopy.

Tip 2 diyabetes mellitus tedavisinde yaygýn þekilde kullanýlan metforminin en önemli ve hayatý tehdit eden yan etkisi laktik asidozdur. Bu olgu sunumu ile intihar amaçlý yüksek doz metformin alýmýna baðlý laktik asidoz nedeniyle yoðun bakýmýmýzda tedavi edilen iki olgu sunulmuþtur. Olgulardan biri sürekli venö-venöz hemodiyafiltrasyon (CVVHDF) ve destek tedavisi ile baþarýlý bir þekilde tedavi edilebilmiþtir. Diðer olguda gecikmiþ tedavi nedeniyle CVVHDF ve destek tedavi yanýnda endotrakeal entübasyon ve mekanik ventilasyon gereksinimi olmuþtur.

Lactic acidosis is the most important and life-threatening side effect of metformin that is widely used in the treatment of type 2 diabetes mellitus. In this case report, two cases who were treated in our intensive care unit for lactic acidosis due to high-dose metformin intake for suicidal purposes are presented. The first patient could be successfully treated with continuous venous-venous hemodiafiltration (CVVHDF) and supportive therapy. The second case required endotracheal intubation and mechanical ventilation in addition to CVVHDF and supportive therapy due to delay in treatment.

Yaþlý hastalarda femur boyun kýrýðýnýn tedavisi çoðunlukla bipolar kalça hemiartroplastidir. Bipolar kalça hemiartroplastinin sýk görülen komplikasyonlarý arasýnda kalça dislokasyonu gelmektedir. Birçok yayýnda hemiartroplasti dislokasyon sýklýklarý %1.2 ile %8.4 arasýnda deðiþmektedir. Ancak bipolar hemiartroplastide femur baþý ile femur komponentleri arasýnda disosiyasyon oldukça nadir görülen bir komplikasyondur. 1985 yýlýndan itibaren kullanýlan Bateman bipolar hemiartroplasti sonrasý polietilen kýrýlmasý sonrasý komponent ayrýþmalarý bildirildi. Femur baþýnýn bipolar kap içerisinde varus pozisyonu önlemek için self-centering sistemler geliþtirilmiþtir. Self-centering bir sistemde, asetabulum ile femoral baþ arasýndaki eklem yüzeyindeki normal kuvvet, femoral baþý valgus pozisyonuna döndürmelidir. Bununla birlikte, asetabuler bileþenlerin disosiyasyonu self-centering sistemiyle de bildirilmiþtir. Literatürde bipolar hemiartroplasti sonrasý komponentler arasýnda disosiyasyonu bildiren olgu raporlarý içinde en fazla hasta sayýsý içeren 2004 yýlýnda yayýnlanan Hasegawa ve ark. bildirdiði yedi hasta içeren çalýþmadýr. Diðer hasta sayýsý fazla olan yayýnlar 2017 yýlýnda Uruç ve ark. bildirdiði beþ hasta içeren çalýþma ve 2006 yýlýnda yayýnlanan Georgiou ve ark. bildirdiði beþ hasta içeren çalýþmadýr. Bu çalýþmada bipolar hemiartroplasti sonrasý komponentler arasý disosiyasyon olan iki farklý olgu raporlanmýþtýr. Sonuç olarak, bipolar hemiartroplasti sonrasý komponentler arasý disosiyasyon nadir görülen bir komplikasyondur, ancak hemen her zaman revizyon cerrahisi ile sonuçlanmaktadýr. Spontan veya travma sonrasý oluþabilen disosiyasyon kalça çýkýðý sonrasý kapalý redüksiyon manevralarýn ardýndan da oluþabileceði için kapalý redüksiyon sýrasýnda oldukça dikkatli olunmalýdýr.

In elder patients, the treatment for femoral neck fracture generally involves bipolar hip hemiarthroplasty. Hip dislocation is one of the most common complications of bipolar hip hemiarthroplasty. In many studies, hemiarthroplasty dislocation frequency ranged from 1.2% to 8.4%. However, dissociation between femoral head and femoral components is an extremely rare complication in bipolar hemiarthroplasty. Component dissociation was reported following polyethylene break after Bateman bipolar hemiarthroplasty which has been used since 1985. Self-centering systems have been developed to varus positioning of femoral head within in bipolar plate. In a self-centering system, normal forces on articular surface between acetabulum and femoral head should rotate femoral head into valgus position. However, dissociation of acetabular components was also reported with self-centering systems. In the literature, the largest case series reporting dissociation between components after bipolar hemiarthroplasty was reported in 2014 by Hasegawa et al., which included seven cases. Other larger studies were reported by Uruç et al. in 2017 (5 cases) and by Georgiou et al. in 2016 (5 cases). In this study, two different cases are reported dissociation between components after bipolar hemiarthroplasty. In conclusion, dissociation between components is a rare complication following bipolar hemiarthroplasty; however, it results in revision surgery in almost all cases. As spontaneous or traumatic dissociation can occur during maneuvers of closed reduction after hip dislocation, one should be careful during closed reduction of hip dislocation.