AMAÇ: Akut pankreatit, asiner hücre hasarý ve lökosit infiltrasyonu ile karakterize pankreas enflamasyonun eþlik ettiði enflamatuvar hastalýktýr. Günümüzde pankreatitin mevcut tedavisine raðmen mortalite ve morbidite yüksektir; bu nedenle yeni çalýþmalara ve tedavi araþtýrmalarýna ihtiyaç vardýr. Bu çalýþma, sýçanlarda L-arginin ile indüklenen deneysel akut pankreatit modelinde alfa-tokoferol’ün farklý dozlarda etkileri araþtýrýldý.
GEREÇ VE YÖNTEM: Otuz adet yetiþkin erkek Sprague Dawley albino sýçan, rastgele dört gruba ayrýldý; kontrol (sham) grubu (n=6), akut pankreatit grubu (n=8), düþük doz alfa-tokoferol (200 mg/kg bir kez i.p.) grubu (n=8) ve yüksek doz alfa-tokoferol (400 mg/kg bir kez i.p.) grubu (n=8). Deneysel akut pankreatit modeli, tek doz i.p. 5 g/kg L-arginin verilmesiyle oluþturuldu. Alfa-tokoferol, Grup 3 ve 4’te L-arginin indüksiyonu ile oluþturulan deneysel akut pankreatit modelinden otuz dakika önce intraperitoneal olarak tek dozda uygulandý. L-arginin enjeksiyonundan 72 saat sonra anestezi altýnda doku ve kan örnekleri alýndý; sonrasýnda sýçanlar dekapitasyon ile sakrifiye edildi. Serum amilaz, lipaz, IL-1b, IL-6, TNF-alfa, C-reaktif protein (CRP) düzeyleri incelendi. Pankreas doku örnekleri histopatolojik inceleme için ýþýk mikroskop altýnda incelendi.
BULGULAR: Akut pankreatit grubu (grup 2) ile kontrol grubu (grup 1) karþýlaþtýrýldýðýnda; serum amilaz, lipaz, IL-1β, IL-6, TNF-alfa, CRP düzeylerinin anlamlý derecede arttýðý gözlendi (hepsi için p<0.05). Histopatolojik incelemede ödem (p<0,001) ve enflamasyon (p=0,007) skorlarýnda anlamlý farklýlýk saptandý. Düþük (grup 3) ve yüksek (grup 4) doz alfa-tokoferol gruplarý ile grup 2 karþýlaþtýrýldýðýnda; amilaz, lipaz, IL-1β, IL-6, TNF-alfa ve CRP parametreleri istatistiksel olarak anlamlý derecede düþük bulundu (hepsi için p<0.05). Grup 2, 3 ve 4’ün histopatolojik karþýlaþtýrýlmasýnda; grup 3 ve 4’te grup 2’ye göre ödem ve enflamasyon skorlarýnda azalma saptandý. Grup 4 ile grup 3 karþýlaþtýrýldýðýnda lipaz (p<0.01), IL-6 (p=0.038) ve TNF-alfa (p=0.002) deðerlerinin anlamlý düzeyde düþtüðü gözlendi; histopatolojik deðerlendirmede ise anlamlý fark gözlenmedi.
TARTIÞMA: Alfa-tokoferol’ün, akut pankreatitte oluþan enflamasyonu ve pankreas hasarýný azalttýðý ve yüksek dozlarda daha etkili olduðu saptandý.

BACKGROUND: Acute pancreatitis is an inflammatory disease accompanied by pancreatic inflammation characterized by acinar cell damage and leukocyte infiltration in the tissue. At present, mortality and morbidity rates are high despite the current treatment of pancreatitis; therefore, new studies and treatment studies are needed. In this study, the effects of alpha-tocopherol on different doses of L-arginine-induced experimental acute pancreatitis model were investigated.
METHODS: Thirty adult male Sprague–Dawley albino rats were randomly divided into four groups; control (sham) group (n=6), acute pancreatitis group (n=8), low-dose alpha-tocopherol (200 mg/kg once intraperitoneal [IP]) group (n=8), and high dose alpha-tocopherol (400 mg/kg once ip) group (n=8). Experimental acute pancreatitis model was created by a single IP dose of 5 g/kg of L-arginine. Alpha-tocopherol was administered in a single dose intraperitoneally, 30 min before the creation of the experimental model of acute pancreatitis induced by L-arginine induction in Groups 3 and 4. Tissue and blood samples were taken under anesthesia 72 h after L-arginine injection; then the rats were sacrificed by decapitation. Serum amylase, lipase, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP) levels were examined. Pancreatic tissue samples were examined under a light microscope for histopathological examination.
RESULTS: When the acute pancreatitis group (Group 2) was compared to the control group (Group 1), serum amylase, lipase, IL-1β, IL-6, TNF-alpha, and CRP levels were all significantly increased (p<0.05 for all). Histopathological examination showed significant difference in edema (p<0.001) and inflammation (p=0.007) scores. When the low (Group 3) and high (Group 4) dose alpha-tocopherol groups were compared to Group 2, amylase, lipase, IL-1β, IL-6, TNF-alpha, and CRP parameters were statistically significantly lower (p<0.05 for all). In the histopathological comparison of Groups 2, 3, and 4, edema and inflammation scores were decreased in Groups 3 and 4 compared to Group 2. Comparing Group 4 to Group 3, lipase (p<0.01), IL-6 (p=0.038), and TNF-alpha (p=0.002) levels were significantly decreased; no significant difference was observed in the histopathological evaluation.
CONCLUSION: Alpha-tocopherol was found to reduce inflammation and pancreatic damage in acute pancreatitis and was more effective in high doses.

AMAÇ: Hemorajik þok sonucu geliþen yetersiz intestinal perfüzyon yara iyileþmesini olumsuz etkilemektedir. Bu deneysel çalýþmada kontrollü hemorajik þok oluþturulan sýçanlarda hipertonik salin ile resüsitasyon yapýlmasýnýn kolon anastomozu üzerine etkilerini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmada, aðýrlýklarý 200–250 gr arasýnda olan toplam 24 erkek Wistar albino sýçan kullanýldý. Sýçanlar kontrol, hipotonik, izotonik ve hipertonik olmak üzere dört gruba ayrýldý. Kontrol grubundaki sýçanlara median laparotomi, kolon rezeksiyonu ve kolokolonik anastomoz uygulandý. Diðer üç gruptaki sýçanlara kontrollü hemorajik þok oluþturulduktan sonra hipotonik, izotonik ve hipertonik salin ile resüsitasyon saðlandý. Resüsitasyon sonrasý bu üç gruptaki sýçanlara da median laparotomi, kolon rezeksiyonu ve kolokolonik anastomoz yapýldý. Ameliyat sonrasý beþinci gün tüm gruplara median laparotomi yapýldý ve anastomoz hatlarý deðerlendirildi. Gruplar arasýnda anastomotik patlama basýncý, doku hidroksiprolin seviyesi ve doku fibrozis derecesi karþýlaþtýrýldý.
BULGULAR: Anastomoz patlama basýncý, doku hidroksiprolin seviyesi ve doku fibrozis derecesi açýsýndan gruplar arasýnda istatistiksel anlamlý fark saptanmadý (sýrasýyla; p=0.320, p=0.537, p>0.05).
TARTIÞMA: Kontrollü hemorajik þok oluþturulan sýçanlarda, resüsitasyonun hipertonik salin ile yapýlmasýnýn kolon anastomozu iyileþmesi açýsýndan izotonik veya hipotonik salinden anlamlý bir farký yoktur.

BACKGROUND: Inadequate intestinal perfusion resulting from hemorrhagic shock negatively affects wound healing. In this experimental study, we aimed to evaluate the effects of resuscitation with hypertonic saline on colonic anastomosis in rats with controlled hemorrhagic shock.
METHODS: A total of 24 male Wistar albino rats weighing between 200 and 250 g were used in this study. The rats were divided into four groups as: Control, hypotonic, isotonic, and hypertonic. Median laparotomy, colon resection, and colocolonic anastomosis were performed to the rats in the control group. After creating controlled hemorrhagic shock to rats in other three groups, resuscitation was achieved with hypotonic, isotonic, and hypertonic saline. After resuscitation, median laparotomy, colon resection, and colocolonic anastomosis were performed on rats in these three groups. On the 5th post-operative day, a median laparotomy was applied to the rats in all groups and anastomosis lines were evaluated. Anastomotic bursting pressure, tissue hydroxyproline level, and tissue fibrosis degree were compared between the groups.
RESULTS: There was no statistically significant difference between the groups in terms of anastomotic bursting pressure, tissue hydroxyproline level, and tissue fibrosis degree (respectively; p=0.320, p=0.537, p>0.05).
CONCLUSION: In rats with controlled hemorrhagic shock, resuscitation with hypertonic saline does not differ significantly from isotonic or hypotonic saline in terms of healing of colonic anastomosis.

AMAÇ: Toraks travmalarý, travmaya baðlý baþvurularýn %10’unu oluþturmakta ve travmaya baðlý ölümlerin %25–%50’sine neden olmaktadýr. Hastalarda göðüs travmasýnýn düzeyini doðru ve erken deðerlendirmek, doðru tedaviye baþlamak, yoðun bakým ihtiyacýný ve mortaliteyi tahmin etmek ve geliþebilecek komplikasyonlarý önlemek önemlidir. Bu çalýþmada majör torasik travmalý hastalarda serum laktat düzeyi, þok indeksi ve skorlama sistemlerinin prognozla ilgili prediktif etkinliði karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: 2014–2020 yýllarý arasýnda hastanemiz acil servisine travma nedeniyle baþvuran 683 hastanýn dosyalarý geriye dönük olarak incelendi. Ýzole göðüs travmasý olan hastalar çalýþmaya dahil edildi.
BULGULAR: Çalýþmaya toplam 683 hasta dahil edildi. Hastalarýn 34’ü (%5) sað kalmayan grupta, 649’u (%95) sað kalan gruptaydý. Her iki grupta da sistolik kan basýncý, diyastolik kan basýncý, nabýz hýzý, solunum hýzý veya þok indeksi arasýnda istatistiksel olarak anlamlý bir fark yoktu (p>0.05). Hayatta kalmayan gruptaki GCS skoru, hayatta kalan grubunkinden anlamlý derecede düþüktü (p=0.000). Hayatta kalmayan gruptaki laktat seviyesi ve RTS, ISS ve NISS, hayatta kalanlar grubundakilerden önemli ölçüde daha yüksekti. Yaþ, laktat seviyesi ve GCS, RTS, ISS ve NISS açýsýndan anlamlý bir fark bulundu (p<0.05). Lojistik regresyon analizinde, laktat deðerindeki 1 birimlik artýþýn, travma skorlarýnýn ve laktat düzeyindeki sayýsal deðiþikliðin mortaliteye etkisi açýsýndan ölüm oranýný 1.19 kat artýrdýðý bulunmuþtur.
TARTIÞMA: Torasik travmalý hastalarda, NISS hýzlý bir karar alýnmasý gerektiðinde acil servislerde kullanýlabilecek yararlý bir faktör olabilir. Ancak hasta takibi sýrasýnda kan laktat düzeylerindeki artýþlar da klinisyenin dikkat etmesi gereken bir kan parametresi olabilir. Ek olarak, torasik travmalý hastalarda skorlama konusunda ileri çalýþmalar yapýlmalýdýr.

BACKGROUND: Chest trauma constitutes 10% of admissions due to trauma and causes 25–50% of trauma-related deaths. It is important to evaluate the level of thoracic trauma in patients accurately and early, start the correct treatment, predict the need for intensive care and mortality, and prevent complications that may develop. In this study, the predictive efficiency of the serum lactate level, shock index, and scoring systems regarding the prognosis in patients with major thoracic trauma were compared.
METHODS: The files of the 683 patients who applied to the emergency department of our hospital due to trauma, between 2014 and 2020, were analyzed retrospectively. Patients with isolated thoracic trauma were included in the study.
RESULTS: A total of 683 patients were included in the study. Of the patients, 34 (5%) were in the non-survivor group and 649 (95%) were in the survivor group. There was no statistically significant difference between the systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, or shock index in either group (p>0.05). The Glasgow Come Scale (GCS) score in the non-survivor group was significantly lower than that in the survivor group (p=0.000). The lactate level, revised trauma score (RTS), injury severity score (ISS), and New ISS (NISS) in the non-survivor group were significantly higher than those in the survivor group. A significant difference was found in terms of age, lactate level, and the GCS, RTS, ISS, and NISS (p<0.05). In logistic regression analysis, it was found that a 1 unit increase in the lactate value increased the mortality rate by 1.19 times in terms of the effect of the trauma scores and numerical change in the lactate level on mortality.
CONCLUSION: In patients with thoracic trauma, the NISS may be a useful factor that can be used in emergency rooms when a quick decision is required. However, increases in blood lactate levels during patient follow-up may also be a blood parameter that the clinician should pay attention to. In addition, further studies should be conducted on scoring in patients with thoracic trauma.

AMAÇ: Travmaya sekonder doku defekti mevcut acýk kýrklarda, Negatif Basýnçlý Yara Tedavi (NPWT) sistemi ile kombine borik asit parçacýklý süngerin etkinliði araþtýrýlmak istendi.
GEREÇ VE YÖNTEM: 2016–2018 yýllarý arasý travmaya sekonder açýk kýrýðý mevcut, yumuþak doku defektide olan 49 hasta çalýþmaya dahil edildi. Hastalar iki grupta incelendi. Birinci gruptaki 27 hastaya NPWT sistemi ile kombine, yeni bir yöntem olan borik asit emdirilmiþ sünger, ikinci gruptaki 22 hastaya NPWT sistemi ile kombine gümüþ nitratlý sünger kullanýldý. Gümüþ nitratýn geniþ spektrumlu antibakteriyel özelliðinin deðelendirilmesinin yanýnda, borik asitin antimikrobiyal, angiogenetik ve epitelizan etkileri, makroskopik ve histopatolojik olarak araþtýrýldý.
BULGULAR: Her iki grupta yara boyutunda küçülme ve granülasyon izlendi. Makroskopik olarak yara boyutunda küçülme, epitelizasyon ve granülasyon birinci grupta ve ikinci grupta belirgindi. Mikroskopik olarak fibroblast sayýsý, kollojen sentezi ve angiogenezisin, grup1’de grup 2 ile karþýlaþtýrýldýðýnda anlamlý olarak arttýðý görüldü.
TARTIÞMA: Bu klinik çalýþmada asit boriðin hem geniþ spektrumlu antimikrobik özelliði, hem de yara iyileþmesinden sorumlu olan hücrelere pozitif etkisi gümüþ nitratlý süngerlere kýyaslandýðýnda alternatif olabileceði görüldü. Asit borikli süngerlerin NPWT sistemi ile kombine edilerek kullanýlmasý travmaya baðlý açýk yara iyileþmesinde iyi bir alternatif bir yöntem olabilir.

BACKGROUND: To investigate the efficacy of new foams with boric acid particles combined with a negative pressure wound treatment (NPWT) system in open fractures with tissue defects secondary to trauma.
METHODS: Forty-nine patients with open fractures secondary to trauma with soft tissue defects who were admitted between 2016 and 2018 were included in the study. Patients were examined in two groups. In Group 1, boric acid-impregnated foams combined with the NPWT system were used in 27 patients, and in Group 2, silver nitrate-impregnated foams combined with NPWT systems were used in 22 patients. In addition to evaluating the broad-spectrum antibacterial feature of silver nitrate, the antimicrobial, angiogenetic, and epithelializing effects of boric acid were investigated macroscopically and histopathologically.
RESULTS: A reduction in wound size and granulation was observed in each group. Macroscopically, the reduction in wound size, epithelialization and granulation were pronounced in Group 1 and in Group 2. Microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1 compared with Group 2.
CONCLUSION: In this clinical trial, both the broad spectrum antimicrobial feature of boric acid and its positive effect on the cells responsible for wound healing were found to be an alternative compared with silver nitrate. The use of new foams with boric acid particles combined with the NPWT system may be a good alternative method in the treatment of open wounds due to trauma.

AMAÇ: Çoklu künt travma (ÇKT) sonrasý hastalarýn travma þiddetini ve prognozunu belirlemek için çeþitli skorlama sistemleri geliþtirilmiþtir. Bununla birlikte, bu skorlama sistemleri tam olarak istenen þiddet deðerlendirmesini saðlamaz. Son yýllarda, birçok spesifik miRNA’larýn serum konsantrasyonunun, özellikle kafa travmasý için taný, þiddet ve prognozun belirlenmesinde önemli bir rol oynadýðý gösterilmiþtir. Bununla birlikte, bugüne kadar, hiçbir çalýþma ÇKT’li hastalarda serum mikroRNA’larýný araþtýrmamýþtýr. Bu çalýþmada, ÇKT’si olan yetiþkinlerin serumunda miRNA-93 ve -191 ekspresyonu ölçülerek Yaralanma Þiddet Skoru (ISS) ve Revize Travma Skoru (RTS) ile korelasyonlarý incelendi. MiRNA düzeylerinenin bu hastalarda travma þiddetini tahmin etmesi amaçlandý.
GEREÇ VE YÖNTEM: Ýleriye yönelik, olgu-kontrollü olarak yapýlan bu çalýþmaya çoklu travma tanýsý alan 50 eriþkin hasta ile benzer yaþ ve cinsiyette 60 saðlýklý kontrol grubu alýndý. Hastalarýn önce ISS ve RTS’leri hesaplanýp ISS >16 (grup 1, majör ya da aðýr travma) ve ISS ≤16 (grup 2, minör ya da hafif-orta travma) olmak üzere iki ayrý gruba ayrýlarak deðerlendirildi. ÇKT geçiren hastalar ile saðlýklý kontrol grubunun serum miRNA-93 ve mikroRNA-191 düzeyleri kantitativ real-time reverse transcription-PCR kullanýlarak ölçüldü. MiRNA’larýn majör ve minör ÇKT hastalarýnda farklý þekilde eksprese edilip edilmediði deðerlendirildi ve yaralanma þiddetinin deðerlendirilmesinde faydalarý belirlendi.
BULGULAR: Kontrol grubu ile karþýlaþtýrýldýðýnda multitravmalý hastalarýn ortalama serum miRNA-93 ve miRNA-191 düzeylerinde anlamlý yükseklik tespit edildi (p<0.001). Ek olarak, ISS >16 olan hastalarýn ortalama serum miRNA-93 ve miRNA-191 düzeyleri, ISS ≤16 olan hastalarla karþýlaþtýrýldýðýnda, istatistiksel olarak anlamlý olmamasýna raðmen, upregüle olarak saptandý. Hastalarýn ISS skorlarý ve serum miRNA-93 düzeyleri arasýnda anlamlý korelasyon bulunmazken, serum miRNA-191 düzeyleri arasýnda negatif yönde, anlamlý ve zayýf bir korelasyon saptandý (Rho=-0.320, p=0.023). ÇKT hastalarýnda ISS skoruna göre serum miRNA-93 düzeyinde anlamlý bir cut-off deðeri saptanmadý (AUC 0.617, [0.455–0.779]). Bununla birlikte, þiddetli travmayý göstermede serum miRNA-191 <1.94 optimal bir kesim deðeri olarak tanýmlandý (AUC 0.668 [0.511–0.826]; %65.6 duyarlýlýk, %77.8 özgüllük).
TARTIÞMA: Kontrol grubu ile karþýlaþtýrýldýðýnda, ÇKT geçiren hastalarda miRNA-191 ve -93 düzeyleri önemli ölçüde yükselmiþtir. ISS ile birlikte MiRNA-191 seviyesi, ancak miRNA-93’ün seviyesi deðil, çoklu travmalý hastalarda travma þiddetini belirlemek için yararlý bir biyobelirteç olabilir.

BACKGROUND: Various scoring systems have been developed to determine the trauma severity and prognosis of patients following multiple blunt trauma (MBT). However, these scoring systems do not provide exactly the desired severity assessment. In recent years, serum concentration of many specific microRNAs (miRNAs), especially for head trauma, has been shown to play an important role in determining the diagnosis, severity, and prognosis of injury. To date, however, no studies have investigated serum miRNAs in patients with MBT. Thus, this study measured the expression of miRNA-93 and -191 in the serum of adults with MBT and examined the correlations of Injury Severity Score (ISS) and Revised Trauma Score values with serum miRNA-93 and -191 levels in these patients with the aim of predicting trauma severity based on the miRNA levels.
METHODS: This prospective case–control study enrolled 50 consecutive adults with MBT and age- and sex-matched 60 healthy controls. The patients were divided into ISS >16 (Group 1, major or severe trauma) and ISS ≤16 (Group 2, minor or mild-moderate trauma) groups. Serum miRNA-93 and -191 levels were assessed using quantitative real-time reverse transcription-PCR. We evaluated whether the miRNAs were differentially expressed in major and minor MBT patients and determined their utility for assessing the severity of injury.
RESULTS: The mean serum miRNA-93 and -191 levels were significantly elevated in the patients compared to the controls and were higher in patients with ISS >16 compared to those with ISS ≤16, although the difference was not significant. In the patients with multitrauma, ISS was significantly, negative and weak correlated with serum miRNA-191 level (rho=−0.320, p=0.023) but not with the serum miRNA-93 level. No optimal cutoff for the serum miRNA-93 level was found with respect to trauma severity (AUC 0.617, [0.455–0.779]). However, an optimal cutoff value for serum miRNA-191 was identified, with values <1.94 indicating severe trauma (AUC 0.668 [0.511–0.826]; 65.6% sensitivity, 77.8% specificity).
CONCLUSION: miRNA-191 and -93 levels were significantly upregulated in multitrauma patients compared to controls. The level of miRNA-191 in conjunction with ISS, but not that of miRNA-93, may be a useful biomarker for determining injury severity in patients with multitrauma.

AMAÇ: Koronavirüs hastalýðý 2019 (COVID-19) pandemisini takiben eðitime ara verilmesi, sosyal izolasyon ve sokaða çýkma kýsýtlamalarý gibi bulaþ riskini azaltmaya yönelik alýnan önlemler sonucunda toplumda aktif rol alan insan sayýsýnda azalma olmuþtur. Bunun sonucu olarak acil cerrahi etiyolojisinde bir deðiþiklik olacaðý düþünülebilir. Bu çalýþmada, COVID-19 pandemi öncesi ve pandemi dönemlerinde hastanemizde yapýlan acil ameliyatlarý ve acil cerrahi anestezi yöntemlerini deðerlendirmeyi ve þüpheli COVID-19 enfeksiyonu olan hastalarýn acil anestezi yönetimini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 22 Ocak–29 Nisan 2020 tarihleri arasýnda hastanemizde acil ameliyat olan hastalar geriye dönük olarak incelendi. Hastalar, 11 Mart 2020 tarihi öncesinde ameliyat olanlar (Grup 1) ve sonrasýnda ameliyat olanlar (Grup 2) olarak iki gruba ayrýldý. Ýki grup verileri karþýlaþtýrýldý. Grup 1’deki tüm hastalara ve Grup 2’de COVID-19 þüphesi olmayanlara rutin acil anestezi ve cerrahi yaklaþým uygulandý. Grup 2’de COVID-19 þüphesi olan hastalar, resmî kurumlarýn ve bilimsel derneklerin kýlavuzlarýna uygun olarak oluþturulan algoritma ile tedavi edildi.
BULGULAR: Yaþ, cinsiyet, kronik hastalýklar, ASA sýnýflamasý, Mallampati skoru, cerrahi branþ, cerrahi prosedürler, cerrahi etiyolojisi, ameliyat süresi ve hastanede yatýþ süresi her iki grupta benzerdi. Genel anestezi ve spinal anestezi uygulanan hasta sayýsý Grup 1 için sýrasýyla 198 (%82.5) ve 42 (%17.5), Grup 2 için sýrasýyla 161 (%73.9) ve 57 (%26.1) idi (p=0.025).
TARTIÞMA: Pandemi döneminde ki acil hastalarýn klinik verileri ve cerrahi iliþkili özellikleri pandemi öncesi acil hastalar ile benzerdir ancak pandemi döneminde daha fazla spinal anestezi uygulanmýþtýr. Acil anestezi uygulamalarý sonucu anestezi ekibinde çapraz enfeksiyon gözlenmemesi için kiþisel koruyucu ekipman kurallarýna uyulmalýdýr. T.C. Saðlýk Bakanlýðý’nýn düzenli olarak güncellenen tavsiyelerine ve kýlavuz önerilerine uyularak ameliyathanede gerekli acil müdahalelerin güvenli bir þekilde yapýlabileceðini ve COVID-19 nozokomiyal enfeksiyonunun önlenebileceðini düþünüyoruz.

BACKGROUND: The number of people actively participating in society has decreased following the coronavirus disease 2019 (COVID-19) pandemic as a result of the measures taken to reduce the risk of transmission, such as interruption to education, social isolation, and curfews. Accordingly, change in the etiology of emergency surgery and characteristics of patients may be expected. The current study aimed to compare emergency surgery between the COVID-19 pre-pandemic and pandemic periods and to present the data and emergency anesthesia management of patients with suspected COVID-19.
METHODS: Patients who underwent emergency surgery in our hospital between January 22 and April 29, 2020, were examined retrospectively. The patients were divided into two groups: Those operated before March 11, 2020 (Group 1) and those operated from this date April 29, 2020 (Group 2). The data of the two groups were compared. Routine emergency anesthesia and surgical approach were applied to all patients in Group 1 and those without suspected COVID-19 in Group 2. Patients with suspected COVID-19 in Group 2 were treated with an algorithm created in accordance with the guidelines of official institutions and scientific associations.
RESULTS: Age, gender, chronic medical diseases, ASA classification, Mallampati score, surgical department, surgical procedures, surgical etiology, duration of surgery, and length of hospital stay were similar in both groups. The number of patients undergoing general anesthesia and spinal anesthesia was 198 (82.5%) and 42 (17.5%) for Group 1 while it was 161 (73.9%) and 57 (26.1%), respectively, for Group 2 (p=0.025).
CONCLUSION: The clinical data and surgical features of emergency patients during the pandemic were similar to those before the pandemic; however, the rate of spinal anesthesia was higher in the former. Personal protective equipment standards should be followed to prevent cross-infection among the anesthesiology team during anesthesia procedures for emergency operations. We consider that necessary emergency interventions can be safely performed and COVID-19 nosocomial infection can be prevented in the operating room by following the Ministry of Health recommendations and guidelines that are updated regularly.

AMAÇ: Akut apandisit, acil cerrahi gerektiren en yaygýn hastalýklardan biridir. Günümüzde akut apandisit tanýsý öykü, fizik muayene ve ileri görüntüleme yöntemleri ile konmaktadýr. Termal görüntüleme geleneksel tekniklerine göre, taþýnabilir olmasý, invaziv olmamasý, kolayca yapýlabilir olmasý, iyonizasyon radyasyon içermemesi ve ucuz olmasý gibi avantajlar saðlar. Dijital kýzýlötesi termal görüntüleme çeþitli klinik çalýþmalara araþtýrma konusu olmuþtur. Bu ileriye yönelik randomize kontrollü çalýþmada, akut apandisitte dijital kýzýlötesi termal görüntülemenin tanýsal potansiyeli araþtýrýldý.
GEREÇ VE YÖNTEM: Toplam 224 gönüllü (112 saðlýklý gönüllü, 112 hasta gönüllü) kontrol grubu ve hasta grubu olmak üzere iki gruba ayrýldý. Tüm olgular dijital kýzýlötesi termal görüntüleme ile deðerlendirildi. Hem alt kadranlarýn hem de sternumun görüntüleri alýndý. Termal görüntüler bilgisayar yazýlýmýna aktarýldý ve analiz edildi. Tanýsal yöntem olarak termal görüntülemenin potansiyeli deðerlendirildi.
BULGULAR: Kadranlar arasýndaki sýcaklýk farklarýna iliþkin olarak, istatistiksel analiz, her iki grup arasýnda anlamlý farklýlýk göstermiþtir (p<0.001). Analiz sonucunda, akut apandisit tanýsý için kesim deðerinin, ortalama alt kadran sýcaklýklarý arasýnda 0.4 °C fark olduðu bulunmuþtur.
TARTIÞMA: Bu çalýþma, özellikle akut apandisit baðlamýnda, karýn aðrýsýnda dijital kýzýlötesi termal görüntülemenin uygulanmasýný geniþletmiþtir.

BACKGROUND: Acute appendicitis (AA) is one of the most common diseases requiring emergency surgery. Today, diagnosis of AA is made through anamnesis, physical examination along with advanced imaging methods. Thermal imaging confers advantages over conventional techniques for being portable, non-invasive, easily conducted, ionization radiation-free, and inexpensive. Digital infrared thermal imaging (DITI) has been the subject of research in various clinical scenarios. In this prospective randomized controlled study, diagnostic potential of DITI in AA was investigated.
METHODS: Totally, 224 volunteers (112 healthy volunteers and 112 patient volunteers) were enrolled and divided into two groups; control group and patient group. All subjects were assessed by DITI. Steady-state images of both lower quadrants and sternum were taken. Thermal images were transferred to computer software and analyzed. Potential of thermal imaging as a diagnostic method was evaluated.
RESULTS: Regarding temperature differences between the quadrants, statistical analysis delivered significant difference between the both groups (p<0.001). As a result of the analysis, the cutoff value for the diagnosis of AA was found to be 0.4°C difference between the average lower quadrant temperatures.
CONCLUSION: This study has enlarged the application of DITI to abdominal pain, especially within context of AA. Thermal evaluation of patients with abdominal pain seems promising.

AMAÇ: Taný ve tedavideki tüm geliþmelere raðmen akut apandisitin tanýsýnýn ve ciddiyetinin deðerlendirilmesi halen zor olabilmektedir. Bu çalýþmada, birinci basamak saðlýk kuruluþlarýnda dahil rahatça ulaþýlabilen ve hýzlýca sonuçlanan hemogram parametrelerinin akut apandisitin tanýsý ve hastalýðýn ciddiyetini ortaya koymadaki etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Beþ yüz yirmi bir hasta geriye dönük incelendi. Çeþitli sebeplerle hemogram sonucunu etkileyen 53 hasta çalýþma dýþý býrakýldý. Hastalarýn yaþ, cinsiyet, hastanede yatýþ süresi, hemogram alt parametreleri ve histopatolojik sonuçlarý incelendi.
BULGULAR: Çalýþmada 468 hasta incelendi. Hastalarýn 279’u erkek %59.6, 189’u kadýn %40.4 olup tüm hastalarýn yaþ ortalamasý 33.37±13.05 yýl idi. Akut apandisit ön tanýsýyla ameliyat yapýlmayýp týbbi tedavi uygulanan 90 hasta (grup I), akut apandisit tanýsý alan nonkomplike 227 apandisit (grup II), komplike apandisit 151 (grup III) olarak üç grup halinde incelendi. beyaz kan hücresi (WBC), nötrofil, nötrofil-lenfosit oraný (NLR) deðerleri en az grup I’de, en fazla grup III’te görüldü. Gruplar arasýnda istatiksel olarak anlamlý fark saptandý (p<0.05). ortalama trombosit hacmi (MPV) deðerleri en fazla grup II’de en az grup III’de görüldü. Gruplar arasýnda istatiksel anlamlý fark saptanmadý (p>0.05).
TARTIÞMA: Akut apandisit karnýn en sýk görülen cerrahi hastalýðýdýr. Hemogram hemen tüm saðlýk kuruluþlarýnda kolay ulaþabilen, hýzlý sonuçlanan, maliyet etkin ve kabul edilebilir düzeylerde tanýsal etkinliði olan hastalýðýn tanýsýnda kullanýlabilen bir testtir. Hemogram parametrelerinden WBC, nötrofil, NLR akut apandisit tanýsý koymada ve þiddetini belirlemede fiziki muayene ve diðer taný yöntemlerine yardýmcý ve kullanýþlý deðiþkenlerdir. Ancak MPV deðerinin düþük tanýsal oranlarý ve çeliþkili sonuçlarý nedeniyle kullanýmýný önermiyoruz.

BACKGROUND: The diagnosis and severity of acute appendicitis (AA) are still challenging despite all the improvements in diagnosis and treatment. This study aimed to evaluate the efficacy of complete blood count (CBC) parameters in diagnosing AA and measuring severity.
METHODS: Data of 521 patients were reviewed retrospectively. Fifty-three patients with CBC results influenced by various reasons were excluded from the study. Age, gender, length of stay, CBC parameters, and histopathological results were examined.
RESULTS: The study included 468 patients: 90 patients with a preliminary diagnosis of AA, not undergoing surgery but receiving medical treatment (Group I), 227 patients with uncomplicated appendicitis (Group II), and 151 patients with complicated appendicitis (Group III). Of the patients, 279 were male (59.6%) and 189 were female (40.4%). The mean age was 33.37±13.05 years. Groups I and III had the lowest and highest white blood cell (WBC), neutrophil, and neutrophil-to-lymphocyte ratio (NLR), respectively. There was a statistically significant difference between the groups (p<0.05). The highest and lowest mean platelet volume (MPV) values were in Groups II and III, respectively. There was no statistically significant difference between the groups (p>0.05).
CONCLUSION: AA is the most common cause of abdominal surgery. The CBC is a cost-effective and easily-accessible test with acceptable diagnostic accuracy. It provides fast results and can be used in the diagnosis of appendicitis. Neutrophil, WBC, and NLR are helpful and useful parameters for physical examination and other diagnostic methods in diagnosing AA and measuring severity. However, the use of MPV is not recommended as it has a low diagnostic rate and contradictory results.

AMAÇ: Bu çalýþmanýn amacý kardiyak cerrahi geçiren hastalarda görülen nekrotizan enterokolite (NEC) ikincil sindirim kanalý perforasyonun etiyolojik farklýlýklar, risk faktörleri, tedavi ve izleme ait özellikler açýsýndan deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Nekrotizan enterokolite ikincil sindirim kanalý perforasyonu nedeni ile ameliyat edilen hastalarýn dosya bilgileri geriye dönük olarak deðerlendirildi. Hastalar doðuþtan kalp hastalýðý nedeni ile kardiyak cerrahi uygulanmasý öyküsü temel alýnarak iki gruba ayýrýldý. NEC’ye ikincil sindirim kanalý perforasyonu kardiyak cerrahi sonrasý izlemde geliþen hastalar Grup 1’de kardiyak cerrahi giriþim olmaksýzýn NEC’ye ikincil geliþen sindirim kanalý perforasyonlarý Grup 2’de toplandý. Gruplara ait demografik özellikler, pre ve postnatal takip özellikleri, uygulanan cerrahi giriþimler, ameliyat öncesi ve sonrasý izlem farklýlýklar açýsýndan istatistiksel olarak deðerlendirildi.
BULGULAR: Belirtilen süre içerisinde 30 hastanýn NEC’ye ikincil sindirim kanalý perforasyonu nedeni ile ameliyat edildiði tespit edildi. Prematürite, düþük doðum aðýrlýðý ve intrauterin geliþme geriliði öyküsü Grup 2’de yer alan hastalarda daha sýktýr (p=0.001, p=0.001, p=0.05). NEC tanýsý öncesi hipotansif atak geçirme öyküsü Grup 1’de yer alan hastalarda daha sýktýr (p=0.018). Prostaglandin kullanýmý ve renal replasman tedavisi gereksinimi oraný Grup 1’de yer alan hastalarda daha yüksek orandadýr (p=0.022, p=0.03). Grup 1’de yer alan hastalarýn tamamýnda taný anýnda NEC ileri evredir. Mortalite Grup 1’de yer alan hastalarda daha yüksektir (p=0.018).
TARTIÞMA: Kardiyak cerrahi sonrasý geliþen NEC tablosu etiyoloji, kolaylaþtýrýcý faktörler ve klinik seyir açýsýndan yenidoðan döneminde görülen NEC’den farklýdýr. Kardiyak cerrahi sonrasý ortaya çýkan NEC’ye ikincil sindirim kanalý perforasyonunda mortalite oraný daha yüksektir. Bu grupta ayrýca NEC tanýsýnýn ve sindirim kanalý perforasyonun klinik olarak tespit edilmesi klasik NEC bulgularýnýn baskýlanmasý ve fizik inceleme bulgularýnýn belirsizliði nedeni ile zordur. Kardiyak saðaltým esnasýnda prostaglandin kullanýmý ve takipte renal replasman tedavisi gereksinimi olasý sindirim sistemi preforasyonu geliþimi açýsýndan uyarýcý bulgulardýr.

BACKGROUND: The aim of this study is to evaluate the patients with intestinal perforation secondary to necrotizing enterocolitis (NEC) following cardiac surgery in the terms of risk factors and diagnosis/treatment process.
METHODS: A series of cases operated for intestinal perforation secondary to NEC were retrospectively reviewed in two groups. Group I involved patients who had cardiac surgery for congenital heart disease previous to intestinal perforation secondary to NEC. Group II consisted patients who had intestinal perforation secondary to NEC without any previous cardiac surgery. Demographic characteristics, prenatal and postnatal features, and pre- and post-operative course of groups were statistically compared to define differences.
RESULTS: Thirty-two patients underwent laparotomy secondary to intestinal perforation in this period. The gestational age and birth weight were smaller in Group II (p=0.001, p=0.001). Intrauterine growth retardation was more frequent in Group II (p=0.05). More Group I patients had hypotensive periods (p=0.018) before the diagnosis of NEC. Prostaglandin treatment and requirement of renal replacement therapy were more frequent in Group I (p=0.022, p=0.03). The mortality rate was higher in Group I (p=0.018). All patients in Group I were late stage NEC at the time of diagnosis.
CONCLUSION: NEC developing after cardiac surgery is different from NEC seen in the neonatal period in the terms of etiology, facilitating factors, and clinical course. Mortality rate is higher in NEC after cardiac surgery. The diagnosis of intestinal perforation might be difficult in NEC after cardiac surgery due to insignificant physical examination findings and characteristic radiological signs of NEC. The history of prostaglandin usage and requirement of renal replacement were thought as alarming signs in terms of possible intestinal complications after cardiac surgery.

AMAÇ: Bu çalýþmada, koronavirüs hastalýðý-2019 nedeniyle hastanede takip edilen hastalarda klinik sürece etkili olan faktörler saptanmaya çalýþýldý.
GEREÇ VE YÖNTEM: Tek merkezli ve geriye dönük kohort olarak dizayn edilen çalýþmaya koronavirüs hastalýðý-2019 hastalýðý nedeniyle servise yatan 658 hasta dahil edildi. Çalýþmaya alýnan hastalar öncelikle serviste takip edilenler (Grup 1) ve yoðun bakým ünitesine alýnanlar (Grup 2) þeklinde; sonrasýnda yoðun bakým ünitesine alýnan hastalar, entübe edilenler (Grup I) ve edilmeyenler (Grup NI) olarak ve son olarak entübe edilen hastalar, mortal olanlar (M) ve olmayanlar (NM) olarak gruplandýrýldý ve karþýlaþtýrýldý.
BULGULAR: Çalýþmaya alýnan 658 hastanýn 566’sý (%86) serviste takip edilip taburcu edilirken 99’u (%14) yoðun bakým ünitesine alýnmýþtý. Takip edilen 658 hastanýn ölüm oraný %7.75 olarak bulundu. Grup 1 ve 2 karþýlaþtýrýldýðýnda Grup 2’deki hastalarýn daha fazla komorbiditeye ve daha yüksek KDIGO skorlarýna sahip olduðu gözlendi (p<0.001). Ayrýca Grup 2’deki hastalarýn daha ileri yaþ, daha yüksek APACHE II ve SOFA skorlarý, WBC, nötrofil, lenfosit, N/L oraný, CRP, LDH, CK, PTZ, D-dimer, prokalsitonin and ferritin deðerlerine sahip olduðu gözlendi (bütün özellikler için p<0.001, CK için p=0.034). Grup I ve NI karþýlaþtýrýldýðýnda Grup I’daki hastalarýn daha fazla komorbiditeye sahip olduðu ve yüksek mortalite oranlarýna sahip olduðu gözlendi (p<0.001). Ayrýca Grup I’daki hastalar daha ileri yaþ, yüksek D-dimer ve ferritin düzeylerine sahipti (sýrasýyla, p=0.008; 0.011 ve 0.043). Son olarak Grup M ve NM karþýlaþtýrýldýðýnda Grup M’deki hastalarýn çoðunlukla erkek (p=0.017) ve KDIGO evre 1 ve 2’deki hastalardan oluþtuðu (p=0.005) gözlendi. Ayrýca Grup M’deki hastalarýn daha yüksek CRP ve LDH deðerlerine sahip olduðu saptandý (sýrasýyla, p=0.018 ve 0.023).
TARTIÞMA: Komorbidite, klinik özellikler ve laboratuvar bulgularý koronavirüs hastalýðý-2019 nedeniyle hastaneye yatýrýlan hastalarýn klinik seyrini tahmin etmede yardýmcý olabilecek parametrelerdir.

BACKGROUND: In this study, it was tried to determine the factors affecting the clinical process in patients who were followed up in hospital for coronavirus disease-2019 (COVID-19).
METHODS: The study, which was designed as a single-center and retrospective cohort, included 658 patients admitted to the service due to COVID-19. The patients were grouped and compared as the patients followed up in the wards (Group 1) and those admitted to ICU (Group 2), between those who were intubated (Group I) in the ICU and those who were not (Group NI), and between patient groups who died (Group M) and survived (Group NM) among those who were intubated.
RESULTS: Of the 658 patients hospitalized in the wards, 566 (86%) were discharged and 99 (14%) were later admitted to the ICU. The mortality rate for the 658 patients that were followed up was found to be 7.75%. When Groups 1 and 2 were compared, it was observed that the patients in Group 2 had more comorbidity and higher KDIGO stages (p<0.001). In addition, patients in Group 2 had older age, higher APACHE II and SOFA scores, high WBC counts, neutrophil counts, lymphocyte counts, N/L ratio, CRP, LDH, CK, PTZ, D-dimer, procalcitonin, and ferritin values (all values p<0.001, for CK p=0.034). When the patients in Group I and Group NI were compared, it was observed that the patients in Group I had more comorbidities and higher mortality rate (p<0.001). In addition, patients in Group I had older age, high D-dimer, and ferritin levels (p=0.008; 0.011, and 0.043, respectively). When the patients in Group M and Group NM were compared, it was observed that the patients in Group M were mostly males (p=0.017) and were mostly in KDIGO Stages 1 and 2 (p=0.005). In addition, it was found that the CRP and LDH levels of patients in Group M were significantly higher than those in Group NM (p=0.018 and 0.023, respectively).
CONCLUSION: Comorbidity, clinical features, and laboratory findings are parameters that can help in predicting the clinical course of hospitalized patients due to COVID-19.

AMAÇ: Yanýk hastalarýnda uzun süreli hastanede yatýþ ve tekrarlayan ameliyatlar bulaþ riskini artýrmaktadýr. Covid-19 enfeksiyonu olan yatarak tedavi olan yanýk hastalarý hakkýndaki deneyimimizi tartýþýp paylaþmak istedik.
GEREÇ VE YÖNTEM: Covid-19 enfeksiyonu teyit edilmiþ, hastanede yatan yanýk hastalarý çalýþmaya alýndý. Yaþ, cinsiyet, toplam vücut yanýk yüzey alaný (TVYA), ameliyat sayýsý, yapýlan ameliyat, pansuman sayýsý, yoðun bakým ve klinikte kalýþ süresi, mortalite ve morbidite analiz edildi. Pandemi süresince saðlýk personeli olasý covid enfeksiyonu açýsýndan takip edildi.
BULGULAR: Covid-19 enfeksiyonu olan 11 hastanýn yaþ ortalamasý 51 (±19.37), yanýk TVYA ise %34.36 (±21.97%) idi. Altý hastada (%54.5) Covid-19 PCR testi negatif olmasýna raðmen semptom ve bulgular Covid-19 enfeksiyonu ile uyumluydu. Hastalara hidrocerrahi de dahil olmak üzere toplam 85 ameliyat yapýldý. Toplam 475 pansuman yapýldý. Üç hasta sepsise baðlý olmayan respiratuvar yetersizlik nedeni ile hayatýný kaybetti. Yaþ, TVYA ve yanýk derinlikleri arasýnda bir fark tespit edilmedi. Yanýk tedavi merkezinde yatan diðer hastalarda ve saðlýk personelinde bu süreçte hastane kaynaklý Covid-19 enfeksiyonu tespit edilmedi.
TARTIÞMA: Pandemiler sýrasýnda saðlýk hizmeti devam etmek zorundadýr. Farkýndalýk, kiþisel koruyucu ekipmanlarýn uygun kullanýmý, sosyal mesafe, kliniðe kontrollü eriþimin saðlanmasý viral bulaþý engellemede önde gelen yöntemlerdir. Covid-19 PCR negatif olan hastalarda Covid-19 enfeksiyon tanýsý koymak zordur. Majör yanýklý hastalarda ise her iki durumun bulgularýnýn benzer olmasý tanýyý koymayý daha da zorlaþtýrýr. Hastanýn kliniði yanýk kliniði ile açýklanamýyorsa Covid-19 akýlda bulundurulmalýdýr. Sonuçlarýmýz dikkate alýndýðýnda ve kliniðimizde hastane kaynaklý viral bulaþ olmadýðý da göz önüne alýndýðýnda yanýk hastalarýnýn rutin tedavi þemalarýnýn revize edilen önlemler eþliðinde güvenle yapýlabileceði aþikardýr. Klinikte yatan hasta ve yakýnlarýnýn da viral bulaþ açýsýndan bilgilendirilmeleri önemlidir. Saðlýk çalýþanlarý pandemiler de dahil olmak üzere her durumda kendi saðlýklarýný en önde tutmalýdýrlar. Alýnmasý gereken tedbir ve önlemleri sürekli güncel tutmak ve mutlak uyum þarttýr.

BACKGROUND: Prolonged stays and multiple operations in burn management increase the risk of transmission. We would like to discuss our experience in hospitalized burn patients with Coronavirus disease (covid-19) infection.
METHODS: In-patient burns with confirmed COVID-19 infection were studied. Age, gender, burned total body surface area (TBSA), number and sort of operations and dressing changes, intensive care unit stay, ward stay, total length of stay, and morbidity and mortality were analyzed. Medical staff observed for infection.
RESULTS: The mean age of the 11 positive patients was 51 (±19.37) years and burned TBSA was 34.36% (±21.97%). Six (54.5%) patients presented with negative polymerase chain reaction (PCR) tests; however, symptoms and findings revealed the illness. Patients underwent 85 operations including hydrosurgery. Totally, 475 dressing changes were done. Respiratory failure caused three mortalities without sepsis. Age, TBSA, and deep dermal burn percent of the mortalities showed no difference. None of the staff and hospitalized other patients had hospital acquired COVID-19 infection.
CONCLUSION: Healthcare must continue during pandemics. Awareness, proper usage of personal protective equipment, keeping social distance, and strengthened access control to the clinic are important priorities to avoid viral transmission. The difficulty in PCR negative patients was the confusing effect of burns as most of the laboratory and radiologic findings overlaps with the major burns’ consequences. Findings, cannot be explained by the clinical course of burn, should indicate COVID infection. Regarding our results, burn patient treatment routines can be applied safely by competence to focused and re-adopted precautions as there were no hospital acquired COVID-19. Patients must trained for cross-contamination. Healthcare’s must prioritize their own health under all situations including pandemics. Updating, the preventive cautions and rigid compliance are a must.

AMAÇ: Biz bu çalýþmamýzda eklem içi distal radius kýrýklarýnda uygulanan volar radius kilitli plak ve K-teli ile güçlendirilmiþ köprü eksternal fiksatör (BEF) tedavilerinin radyolojik, klinik ve fonksiyonel sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Mayýs 2016 ve Ocak 2019 tarihleri arasýnda kliniðimizde ameliyat edilen AO/OTA sýnýflamasýna göre 23-C2 ve 23-C3 tipi kýrýðý olup dahil edilme kriterlerini saðlayan 162 hasta geriye dönük olarak deðerlendirildi. Hastalarýn 78’ine (37 erkek, 41 kadýn, ortalama yaþ 49.92) K-teli ile güçlendirilmiþ köprü eksternal fiksatör (BEF), 84’üne (41 erkek, 43 kadýn, ortalama yaþ 46.81) ise volar kilitli plak (VLP) ile tespit uygulanmýþtýr. Hasta gruplarýnýn demografik (yaþ, cinsiyet, travma þekli, takip süresi) radyolojik (radial inklinasyon, radial yükseklik, volar tilt, kaynama zamaný) klinik ve fonksiyonel (eklem hareket açýklýklarý, kavrama kuvveti, QuickDash, GreenO’Brien ve Mayo skorlamalarý) verileri kaydedilerek istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Hasta gruplarý arasýnda fonksiyonel skorlama sistemleri açýsýndan anlamlý farklýlýk bulunamadý. Radyolojik olarak radial inklinasyon ve radial uzunluk volar plak grubunda anlamlý olarak daha iyiydi. Eklem hareket açýklýklarý açýsýndan fleksiyon, ekstansiyon, pronasyon, supinasyon hareketleri VLP grubunda anlamlý olarak daha iyiydi. BEF grubunda Sudek atrofisi görülme oraný ve sýkma kuvveti kaybý daha fazlaydý. Ortalama kaynama süresi ise BEF grubunda anlamlý olarak daha kýsaydý.
TARTIÞMA: Her iki tedavi yönteminde de baþarýlý sonuçlar alýnabilir. Ancak VLP tedavisi BEF tedavisine göre daha iyi eklem hareket açýklýðý saðlamaktadýr ve komplikasyon oranlarý daha azdýr.

BACKGROUND: In this study, we aimed to compare the radiological, clinical and functional results of volar radius locking plate, and K-wire augmented bridging external fixator (BEF) treatments that applied in intra-articular distal radius fractures.
METHODS: Between May 2016 and January 2019, 162 patients who met the inclusion criteria of 23–C2 and 23–C3 according to the AO/OTA classification who operated in our clinic were evaluated retrospectively. 78 patients (37 males, 41 females, mean age 49.92) were fixated with K wire augmented BEF and 84 patients (41 males, 43 females, mean age 46.81) were fixated with volar locking plate (VLP). Demographic (age, gender, type of trauma, and follow-up time), radiological (radial inclination, radial height, volar tilt, and fracture healing time), and clinical and functional (range of motion [ROM], grip strength, Quick Dash, Green O’Brien and Mayo scores) data of the patient groups were recorded and compared statistically.
RESULTS: There was no significant difference between the patient groups in terms of functional scoring systems. Radiologically, radial inclination, and radial length were significantly better in the volar plate group. In terms of joint ROM, flexion, extension, pronation, and supination movements were significantly better in the VLP group. Sudek atrophy incidence and loss of grip strength were higher in BEF group. Mean time of union was significantly shorter in the BEF group.
CONCLUSION: Successful results can be obtained in both treatment methods. However, VLP treatment provides better joint ROM and lower complication rates compared to BEF treatment.

AMAÇ: Bu çalýþmanýn amacý, merkezimizde radial sinir lezyonu nedeniyle cerrahi müdahale yapýlan hastalarý cerrahi sonuçlarý açýsýndan geriye dönük olarak deðerlendirmektir.
GEREÇ VE YÖNTEM: Merkezimize radial sinire ait disfonksiyon bulgularý ile 38 hasta baþvurmuþtu. Hastalarýn 27’sinde radial sinirin tuzak nöropatisi, 11’inde ise farklý nedenlere baðlý radial sinir yaralanmasý mevcuttu. Cerrahi sonuçlar, cerrahi müdahaleye kadar geçen süre, yaralanma mekanizmasý, rekonstrüksiyon þekli gibi çeþitli faktörler çalýþmamýzda analiz edildi.
BULGULAR: Radial sinir tuzak nöropatisi nedeniyle ameliyat edilen 27 hastanýn tamamýnda ameliyat sonrasý üçüncü ayda el bileði dorsal fleksionda tamamen düzelme saptandý. Radial sinir hasarý nedeniyle ameliyat edilen 11 hastanýn yedisinde ameliyat sonrasý üçüncü ayda el bileði dorsal fleksionda deðiþik derecelerde düzelme saptandý. Yedi hastanýn ikisinde sural sinir grefti kullanýlarak anastomoz yapýlmýþtýr. Tüm olgularýmýzda iyileþme oraný %89 olarak deðerlendirildi (34 hasta). Radial sinir yaralanmasý sonrasý ameliyat edilen hastalardan iyileþmeyen dört hastanýn üçü yaralanma sonrasý ilk bir ay içerisinde ameliyat edilen hastalardý.
TARTIÞMA: Radial sinir lezyonlarýnda ilk bir ay sonrasýnda ameliyat edilen, internal nörolizis yapýlan ve anastomoz için kýsa sinir grefti kullanýlan hastalarda ameliyat sonrasý dönemde daha iyi fonksiyonel sonuçlar elde edildi. Tuzak nöropati ile baþvuran hastalarda ise en erken zamanda yapýlan cerrahi ameliyat sonrasý dönemde yüz güldürücü sonuçlar ortaya çýkarmýþtýr.

BACKGROUND: The aim of this study was to retrospectively evaluate patients who underwent surgery in our department for radial nerve lesions in terms of surgical outcomes.
METHODS: Thirty-eight patients were admitted to our department with radial nerve lesion. Twenty-seven of the patients had entrapment neuropathy and 11 had radial nerve injury secondary to other traumas. Various factors such as surgical results, time to surgical intervention, injury mechanism, and reconstruction technique were analyzed.
RESULTS: In all of 27 patients who were operated for radial nerve entrapment neuropathy, a complete improvement in wrist dorsal flexion was detected at postoperative 3rd month. Seven of the 11 patients who were operated for radial nerve lesion had different degrees of improvement in wrist dorsal flexion at the postoperative 3rd month. Two of the seven patients underwent anastomosis using a sural nerve graft. The recovery rate in our series was 89%. Three of the 4 patients who did not recover after the radial nerve injury were the patients who were operated within the 1st month after the trauma.
CONCLUSION: Better functional results were obtained in the postoperative period in patients who were operated after the 1st month, underwent internal neurolysis and used a short nerve graft for anastomosis in the radial nerve lesions. In patients with entrapment neuropathy, the earliest surgery revealed satisfactory results in the postoperative period.

Ýki taraflý vertebral arter oklüzyonu yüksek enerjili travmalar sonrasý görülebilen nadir ve ölümcül bir yaralanmadýr. Ankilozan spondilit hastasýnda, travma sonrasý komplet spinal kord hasarý ile birlikte servikal ayrýþma kýrýðýný takiben iki taraflý vertebral arter oklüzyonu geliþen ilginç bir olgu sunuldu. Kýrk dokuz yaþýnda erkek hasta trafik kazasý sonrasý acil servise getirildi. ASIA Skalasý Komplet A olarak deðerlendirildi. Servikal bilgisayarlý tomografide (BT) C2 ve C3 seviyesinde komplet ayrýþma kýrýðý saptandý. Manyetik rezonans görüntülemede spinal kordda belirgin basý ve incelme görüldü. BT anjiyografi sonrasý iki taraflý vertebral arter oklüzyonu tespit edildi. Hastanýn nörolojik durumu, bölgede aþýrý kanama ve ödem nedeniyle cerrahi giriþim planlanamadý. Hasta iki gün sonra kaybedildi. Literatürde günümüze kadar bildirilen sadece 13 servikal spinal travma sonrasý iki taraflý vertebral arter oklüzyonu olgusu mevcuttur. Morbidite ve mortalite ile birlikte kötü prognoza neden olabilecek vertebrobaziler iskemi görülebilir. Tanýda altýn standart katater anjiyografi olsa da BT anjiyografinin de yakýn duyarlýlýk ve özgüllüðü vardýr. Vertebral arter oklüzyonu tedavi stratejileri hala netlik kazanmamýþtýr.

Background: Bilateral vertebral artery occlusion is an uncommon and mortal injury that could be seen after high-energy traumas. We illustrate an extreme case of bilateral vertebral artery occlusion following traumatic cervical disruption with complete spinal cord injury in a patient with ankylosing spondylitis. A 49-year-old male was admitted to our emergency department after a motor vehicle accident. The American Spinal Injury Association Impairment Scale was a complete A grade. Computed tomography (CT) scan of the cervical region revealed complete disruption between C2 and C3 levels. Magnetic resonance imaging showed apparent compression and narrow calibration of the spinal cord. CT angiography demonstrated occlusion of the bilateral vertebral arteries. Because of the neurological status of the patient, extensive hematoma, and edema at the region, no surgical intervention could be planned. The patient died on the second day of his hospitalization. Only fourteen cases of bilateral vertebral artery occlusion following blunt cervical spine traumas have been reported to date. They have a possibility to cause vertebrobasilar ischemic events with a poor prognosis of morbidity and mortality. The gold standard of diagnosis is the catheter angiography, but also CT angiography has close sensitivity and specificity. The treatment strategies of vertebral artery occlusion are still unclear.

Acil hekimleri, ateþli silahýn omurgaya doðrudan etkisi olmadýðý durumlarda hastalarda omurilik yaralanmasýný gözden kaçýrabilirler. Sað göðüs duvarýndan vurulmuþ 30 yaþýndaki erkek hasta acil servise getirildi. Þok durumunda gelen hastaya masif hemotoraks nedeniyle acil torakotomi yapýldý. Ameliyattan sonra hastanýn paraplejik olduðu tespit edildi. Spinal manyetik rezonans görüntülemede T4 seviyesinde kontüzyon görüldü. Delici merminin enerjisi çevre dokulara yayýlýr ve omurilikte kontüzyona neden olur. Omurilik yaralanmasýna dair bir baþka varsayým, spinal korda olan kan akýþýnýn bozulmasýdýr. Ateþli silahla iliþkili dolaylý omurilik yaralanmasý için etkili bir tedavi mevcut deðildir. Bildirilen bu olgular, acil hekimlerine ateþli silah yarasý olan hastanýn stabilizasyonundan sonra, gizli omurilik yaralanmasýný saptamak için tam bir nörolojik muayene yapýlmasý gerektiðini hatýrlatmaktadýr.

Emergency physicians may overlook spinal cord injury in patients when the direct impact of a gunshot on the spine is lacking. A 30-year-old man who was shot on his right chest wall was brought to the emergency department. He arrived in a state of shock and underwent emergent thoracotomy for massive hemothorax. After surgery, he was found to be paraplegic. Magnetic resonance imaging of the spine showed T4 spinal cord contusion. The penetrating bullet dissipates energy to the surrounding tissue and contuses the spinal cord. Another assumption of the spinal cord injury is the impairment of blood supply to the cord. No effective treatment exists for gunshot-related indirect injury to the spinal cord. These reported cases reminded emergency physicians that after stabilization of the patient with a gunshot wound, a complete neurologic examination should be performed to discover occult spinal cord injury.

Primer omental torsiyon akut karýn patolojisi olarak nadir karþýlaþýlan klinik bir durumdur. Primer omental torsiyon erkeklerde kadýnlardan daha sýk görülür. Primer omental torsiyonun tanýsýnýn zor olmasýnýn yanýnda, hamilelik tanýyý çok daha zor ve önemli hale getirir. Gebelikte bilgisayarlý tomografi gibi radyolojik yöntemlerin kullanýlamayacak olmasý taný koymadaki en büyük problemi oluþturmaktadýr. Bu noktada tanýsal laparaskopi gebe hastalarda akut karýn patolojilerinin taný ve tedavisinde önemli bir yer tutmaktadýr. Acil servisimize ani baþlayan karýn aðrýsýnýn þiddetlenmesi üzere acil servisimize baþvuran 28 haftalýk gebe hastanýn tanýsý batýn ultrasonu ile netleþtirilemeyince tanýsal laparoskopi ile primer omental torsiyon tanýsý alan hastanýn ayný zamanda laparaskopik olarak torsiyone olan omentumunun alýnmasý ile saðlýðýna kavuþtu. Gebe hastalarda konservatif takip önemli bir yer tutarken hastanýn gerek laboratuvar, gerekse fizik muayenedeki kötü yönde ilerlemesi görüntüleme yöntemlerinin sýnýrlýlýðý da eklendiðinde tanýsal laparoskopiyi önemli bir noktaya taþýmaktadýr.

Primary omental torsion (POT) is a rarely encountered clinical condition as an acute abdominal pathology. POT is more prevalent in males than females. The diagnosis of POT is challenging, and pregnancy initiates the diagnosis more difficult and essential. The fact that radiological methods such as computed tomography cannot be used during pregnancy constitutes the biggest problem in diagnosis. At this point, diagnostic laparoscopy plays a significant role in the diagnosis and treatment of acute abdominal pathologies in pregnant patients. The diagnosis of a 28-week pregnant woman who was admitted to our emergency department with the aggravation of abdominal pain was not clarified by abdominal ultrasound so the patient was diagnosed with POT by diagnostic laparoscopy. Conservative follow-up plays an important role in pregnant patients, and the poor progress of the patient in both laboratory and physical examination leads diagnostic laparoscopy to an important point when the limitation of imaging methods is added.