AMAÇ: Acil servislerde sýk olarak karþýlaþýlan beyin travmalý hastalarda, olgularýn taný ve tedavisi sýrasýnda olasý akut böbrek hasarýnýn (ABH) yeni biyokimyasal belirteçler eþliðinde erken tanýsýný koyarak, komplikasyonlarýn önüne geçmeyi, tedavi süresini ve hastanýn hastanede yatýþ süresini kýsaltmayý amaçladýk. Deney hayvaný kullanarak materyal metod açýsýndan bilimsel sonuçlara ulaþabileceðimize karar verdik.
GEREÇ VE YÖNTEM: Çalýþmamýza Wistard albino sýçanlar alýndý. On beþ sýçan rasgele üç gruba ayrýldý. Sham kontrol (n=1, sadece kraniyotomi), kontrol (n=7, saðlam), travma grup (n=7, kraniyotomiyi takiben beyin travmasý).
BULGULAR: Plazma kreatinin seviyelerinde 0. ve 24. saatlerde istatistiksel olarak anlamlý fark bulunamadý (sýrasýyla, 0.35±0.02, 0.33±0.03, p>0.05). Her iki grubun plazma NGAL ve KIM-1 konsantrasyonlarýnda belirgin istatistiksel anlamlýlýk vardý (Friedman p<0.05). NGAL ve KIM-1 konsantrasyonlarýnýn zamana göre karþýlaþtýrýlmasýnda (0 saat [s]-2s, 0s-24s, 2s-24s) belirgin istatistiksel anlamlýlýk vardý (Wilcoxon p<0.001, Bonferroni düzeltmesinden sonra).
TARTIÞMA: Hafif ve orta beyin travmasý olan hastalarda ABH’nýn varlýðý mortaliteyi artýrmaktadýr. ABH’nýn ilk 24 saat içerisinde tanýsýnýn erken biyobelirteçlerle konularak tedaviye baþlanmasý hayati önem taþýmaktadýr.

BACKGROUND: We aimed to diagnose possible acute kidney injury (AKI) with new early biochemical markers in patients who were admitted to the emergency department frequently with mild and moderate brain trauma, and to prevent possible complications, shorten the duration of treatment and hospital stay. With this purpose, we decided to reach our scientific target using the experimental rat model.
METHODS: Wistar albino rats were included our experiment. Fifteen rats were randomly separated into three groups: Sham control (n=1: Underwent craniotomy alone), control (n=7: Without craniotomy), and trauma group (n=7: Underwent craniotomy followed by brain injury).
RESULTS: There were no significant differences groups creatinine levels within 0 and 24 h (0.35±0.02 and 0.33±0.03, respectively, p>0.05). Plasma NGAL and KIM1 concentrations were statistically significant different in both control and trauma groups (Friedman p<0.05) and significant differences at both NGAL and KIM-1 concentrations at dual comparisons by means of all sampling time (0–2 h, 0–24 h, and 2–24 h) (Wilcoxon p<0.001, after Bonferroni correction).
CONCLUSION: The presence of AKI in patients with mild-to-moderate brain trauma increases the risk of mortality. Early diagnosis of AKI reduces the hospitalization period and requiring of dialysis. Diagnosis of AKI within 24 h with early biomarkers and starting therapy is crucial issues.

AMAÇ: Akut solunum sýkýntýsý sendromu (ARDS), sepsisin yýkýcý bir komplikasyonudur. Preklinik modeller, doðrudan akciðer hasarýnýn, akciðer epiteline saldýrý ile baþladýðýný, ancak dolaylý akciðer hasarýnýn, enflamatuvar mediatörlere baðlý sistemik endotel hasarýndan kaynaklandýðýný göstermektedir. Bu çalýþmanýn amacý, farelerde cerrahi olarak indüklenen sepsis modelinde oktreotidin akciðerler üzerindeki etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmada 32 erkek Sprague Dawley sýçan kullanýldý ve 4 gruba ayrýldý. Grup 1: normal (opere olmayan ve oral yoldan kontrol, n=8); Grup 2: sham operasyonlu (n=8); Grup 3: CLP (tedavi edilmemiþ grup, n=8); Grup 4: CLP ve 100 µg/kg oktreotid i.p. (n=8). Sepsis için, sepsis modelini indüklemek için 16 sýçanda çekal ligasyon ve ponksiyon (CLP) prosedürü uygulandý. Tüm gruplar analiz edildi, kanlarý arteriyel kan gazý analizi için alýndý. Histolojik inceleme için akciðer dokularý çýkarýldý ve parçalar hazýrlandý.
BULGULAR: Histololojik incelemede CLP+Octreotid’i sadece CLP grubu ile karþýlaþtýrýrsak, CLP+Octreotid grubunda alveoler ve interstisyel alanda enflamatuvar hücrelerin infiltrasyonu azaldý, CLP grubu oktreotid grubuyla karþýlaþtýrýldýðýnda, ödem, kanama azaldý ve tüm histopatolojik parametreler anlamlý olarak geriledi ve ciddiyet indeksi 3’ten 1’e düþtü. Arteriyel kan gazý için, CLP ve oktreotide grubu CLP grubuyla karþýlaþtýrýldýðýnda, iyileþme lehine anlamlý bir deðiþiklik olduðu ve neredeyse kontrol grubu ve sham grubuna yaklaþtýðý görülmüþtür.
TARTIÞMA: Sonuç olarak, sepsis hastalarýnda akut akciðer hasarý durumu için oktreotid uygulamasýnýn yararlý olacaðý düþünülülebilir.

BACKGROUND: Acute respiratory distress syndrome is a devastating complication of severe sepsis. Preclinical models suggest that direct lung injury begins with attack to the lung epithelium, but indirect lung injury results from systemic endothelial damage due to inflammatory mediators. The aim of the present study was to explore the effect of octreotide on lungs in a surgically induced sepsis model in rats.
METHODS: We used 32 male Sprague Dawley rats and divided into four groups. Group 1: Normal (non-operative and orally fed control, n=8); Group 2: Sham operated (n=8); Group 3: Cecal ligation and puncture (CLP) (untreated group, n=8); and Group 4: CLP and 100 µg/kg octreotide i.p. (n=8). For sepsis, CLP procedure was performed on 16 rats to induce a sepsis model. All groups were analyzed, their blood was taken for arterial blood gas analysis. For histological examination, lung tissues were removed and sections were prepared.
RESULTS: In histological examination, if we compare CLP + Octreotide with only CLP group in CLP + Octreotide group decreased inflammatory cell infiltration in alveolar and interstitial area as well as edema, bleeding, when CLP group was compared with octreotide group, all histopathological parameters improved significantly and the severity index decreased from 3 to 1. For arterial blood gas, when CLP and octreotide groups were compared with CLP group, it was observed that there was a significant change in favor of healing and that they almost came up to controls and sham group.
CONCLUSION: It could be hypothesized that it would be beneficial to administer octreotide for ameliorate lung injury state in sepsis patients.

AMAÇ: Yara iyileþmesi üzerine etkili olduðu düþünülen Alpinia officinarum’un (AO) (havlýcan) deneysel temas tipi yanýklarda iyileþtirici olup olmadýðýnýn belirlenmesi ve etkilerinin gümüþ sülfadiazin (GSD) ile karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Otuz beþ sýçan her grupta yedi adet olacak þekilde beþ gruba ayrýldý. Sýrtlarýndaki üç ayrý traþlý alana 100°C sabit sýcaklýkta tutulabilen, 1x1 cm’lik bakýr uç, on saniye süreyle hiç basýnç uygulanmadan temas ettirilerek yüzeyel ikinci derece yanýk oluþturuldu. 100 cc serum fizyolojik ile tüm gruplar iki dakika boyunca yýkandý. Grup I’e (kontrol) bir iþlem veya tedavi uygulanmadý. Grup II’ye (yanýk kontrol) irrigasyon, Grup III’e (GSD) topikal GSD altý saatte bir dört kez (0, 6, 12 ve 18. saatlerde), Grup IV’e (havlýcan) topikal AO dört kez, Grup V’e (jel) topikal AO hazýrlanmasýnda kullanýlan plasebo topikal materyal dört kez uygulandý. Yara iyileþmesi bulgularý histolojik olarak deðerlendirildi.
BULGULAR: Havlýcan grubunda; kolajen diskolorasyonunun diðer gruplara kýyasla derin dermise ilerlemediði, epidermis, kýl folikülleri ve sebase gland yapýlarýnýn yanýk kontrol grubuna kýyasla korunduðu ve daha kalýn bir epidermis tabakasýnýn olduðu görüldü. Havlýcan grubunun yapýsal olarak kontrol grubuna en yakýn grup olduðu histopatolojik olarak saptandý. Havlýcan grubunda diðer üç gruba kýyasla; epidermis kalýnlýðýnýn ve dejenere kýl kökü sayýsýnýn tüm saatlerde anlamlý oranda daha fazla olduðu saptanýrken (p<0.05), damar sayýsýnýn dördüncü, toplam kýl kökü sayýsýnýn ise sekizinci saatte anlamlý oranda daha çok olduðu saptandý (p<0.05). Hem gruplar arasý hem de gruplarýn kendi süreçleri içindeki karþýlaþtýrmalarda havlýcan grubunun; ödem, PMNL infiltrasyonu, kolajen diskolorasyonu, damar, kýl folikülleri ve glandula sebasea hasarý deðerlendirilmesinde en düþük skorlara sahip olduðu saptandý.
TARTIÞMA: Alpinia officinarum içeren jeli ilk 24 saat içinde günde dört kez uygulamak deneysel temas tipi ikinci derece yanýk modelinde etkilidir. GSD tedavisinden, özellikle uygulamanýn ilk sekiz saatinde, önemli ölçüde üstündür.

BACKGROUND: It was aimed to determine whether Alpinia officinarum (AO) (galangal), which has been regarded to be effective on wound healing, is healing on experimental contact type burns and compare its effects with silver sulfadiazine (SSD).
METHODS: Thirty-five rats were divided into five groups of seven rats each group. Superficial second degree burns were formed by contacting a 1×1 cm copper tip which was kept at 100°C constant temperature to the three shaved areas on the back of rats without applying any pressure for 10 s. All groups were irrigated with a 100 cc saline solution for 2 min. Any procedure or treatment was not applied to Group I (Control). Group II (Burn Control) was only irrigated, Group III (SSD) was applied topical SSD 4 times, with 6-h intervals (at h 0, 6, 12 and 18), Group IV (Galangal) was applied topical AO 4 times, and Group V (Gel) was applied placebo topical material, used for the preparation of topical AO, 4 times. Wound healing findings were evaluated histopathologically.
RESULTS: In the galangal group, it was found that collagen discoloration didn’t penetrate into deep dermis compared to other groups; epidermis, hair follicles, and sebaceous glands remained protected compared to the burn control group, and there was a thicker layer of epidermis. It was found that the galangal group was the closest group to the control group histologically. In the galangal group, it was determined that the number of vessels and total hair follicles were significantly higher in the 8th h and 4th h respectively (p<0.05), while epidermal thickness and number of degenerated hair follicles were significantly higher in all hours compared to other three groups (p<0.05). It was determined that galangal group had the lowest scores in the evaluation of edema, polymorphonuclear leukocytes infiltration, collagen discoloration, injury of vessels, hair follicles and sebaceous glands in comparisons between groups and within groups’ own processes.
CONCLUSION: Administrating AO containing gel 4 times a day within the first 24 h is effective in the experimental contact type second degree burn model. It is significantly superior to SSD treatment, especially in the first 8 h of administration.

AMAÇ: Covid-19 pandemisinin tüm týbbi uygulamalarda yarattýðý hýzlý ve etkili deðiþim ile travma cerrahisi pratiði de etkilendi. Pandeminin ilk 100 gününün ortopedi ve travmatoloji alanýnda referans üniversite hastanesinde yapýlan operasyonlara olan etkisini bir önceki yýlýn ayný dönemiyle karþýlaþtýrarak deðerlendirmeyi ve uygulanan kýsýtlamalarýn önemini göstermeyi amaçladýk.
GEREÇ VE YÖNTEM: 18 Mart 2020 (elektif ameliyatlarý durdurduðumuz gün) ile 1 Temmuz 2020 (normalleþme sürecinin baþladýðý gün) arasýnda hastanemiz ortopedi ve travmatoloji kliniðinde gerçekleþtirilen ameliyatlar, 2019 yýlýnýn ayný dönemiyle karþýlaþtýrýlmak üzere elektronik arþivden çýkarýldý.
BULGULAR: 2020 yýlý Covid-19 kýsýtlamalarýnýn uygulandýðý zaman aralýðýnda yapýlan 102 ameliyata karþý, 2019 yýlýnýn ayný döneminde 380 ameliyat yapýldýðý görüldü. Covid-19 döneminde yapýlan ameliyatlarýn büyük bölümünü travma olgularý oluþturmasýna raðmen, bu olgu grubunda %25 oranýnda azalma ile 73’den 58’e düþtüðü deðerlendirildi (p<0.001). Kýsýtlama döneminde ameliyat edilen travma hastalarý arasýnda pediatrik gruptaki azalma (p<0.04) ve 65 yaþ üstü hastalarda artýþ istatistiksel olarak anlamlý görülmüþtür. Geçen yýlýn ayný dönemine göre diyabetik ayaða baðlý amputasyon olgularýnda %50 artýþ olduðu görüldü (p<0.001).
TARTIÞMA: Covid-19 salgýný nedeniyle elektif olgularýn ertelenmesi, kapasite kullanýmýnýn azalmasýna raðmen travma olgularýnýn yeterli yönetimini saðladý. Ayrýca, okullarýn online eðitime geçmesi ve sokaða çýkma kýsýtlamalarý uygulanmasý pediatrik grubun travma sayýlarýnda belirgin azalma saðladýðý görüldü. Ameliyathane ve servislerin ayrýlmasý, Covid-19 dýþý hastalarýn korunmasýnda çok büyük bir etkiye sahip olduðu görüldü. Bu çalýþmanýn ýþýðýnda, saðlýk politikalarýna rehberlik edebileceðimizi ve diðer meslektaþlarýmýzýn pandemi sürecinin olasý yeni dalgalarýný veya gelecekte meydana gelebilecek benzer süreçleri yönetmelerine yardýmcý olabileceðimizi umuyoruz.

BACKGROUND: With the rapid and effective change created by the COVID-19 pandemic in all medical practice, we aimed to evaluate the impact of the first 100 days of the COVID-19 pandemic on the operations performed in a reference university hospital in the field of orthopedics and traumatology. Compare the results with the same period of the previous year and aim to evaluate importance of restrictions.
METHODS: The operations performed in orthopedics and traumatology clinic between March 18, 2020 (the day we stopped the elective surgeries), and July 1, 2020 (when the normalization process began), were collected from the electronic archive to compare with the same period of 2019.
RESULTS: Comparing the same periods of the year, it was seen that 102 surgeries were performed in the 2020 COVID-19 period compared to 380 operations performed in 2019. Although most of the operations performed during the COVID-19 period were traumas, the comparison revealed that trauma cases decreased by 25% from 73 to 58 (p<0.001). Among trauma patients operated in the restraint period, decrease in the pediatric group and the increase in patients over 65 years of age had seen statistically significant. Compared to the same period of the previous year, 50% increase seen in amputation cases related to diabetic foot (p<0.001).
CONCLUSION: The postponement of elective cases due to the COVID-19 pandemic enabled us to manage trauma cases despite decreasing capacity utilization. In addition, it was observed that the transition of schools to online education and the implementation of curfews significantly reduced the number of trauma in the pediatric group. Separation of operating rooms and wards had a huge effect on protection of non-COVID patients. We hope that, in light of this study, we can guide health policies and help other colleagues to manage the possible new waves of the pandemic process or similar processes that may occur in the future.

AMAÇ: Geriatrik hastalarda abdominal acillerinin tanýnmasý ve tedavisi, genç popülasyona göre daha karmaþýktýr. Biz bu çalýþmada, akut apandisit tanýsý alan geriatrik hastalarýn demografik özellikleri ve erken dönemde perforasyonla iliþkili faktörleri araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Lokal etik kurul onayý alýndýktan sonra, Ocak 2015–Aralýk 2019 tarihleri arasýnda apendektomi yapýlan 65 yaþ ve üzeri hastalar çalýþmaya alýndý. Hastalarýn demografik verileri, fizik muayene bulgularý, laboratuvar sonuçlarý incelendi. Hastalar, cerrahi raporlarýna göre perfore ve basit apandisit olarak iki gruba ayrýldý.
BULGULAR: Çalýþma süresince 72 hasta deðerlendirildi. Çalýþmamýzda hastalarýn %48.6’sý erkek, ortanca yaþ 71.5 idi (IQR 25–75, 68–80). Hastalarýn %28’inde perfore apandisit saptandý. Perfore apandisitli hastalarýn büyük çoðunluðunun erkek olduðu; kronik böbrek hastalýðý ve ameliyat sonrasý lokal komplikasyonlarýn daha sýk olduðu; lökosit, nötrofil, kan üre azotu, kreatinin ve toplam bilirubin deðerlerinin yüksek; albümin deðerlerinin daha düþük olduðunu tespit ettik ve bu farklýlýklar istatistiksel olarak anlamlýydý (tüm deðerler, p<0.05). Çok deðiþkenli analiz ise artmýþ nötrofil sayýsýnýn ve erkek cinsiyetin perfore apandisit ile anlamlý olarak iliþkili olduðunu gösterdi (sýrasýyla, p=0.035, p=0.01).
TARTIÞMA: Kronik böbrek hastalýðý olan geriatrik hastalarda yetersiz karýn fizik muayene sonuçlarý nedeniyle perforasyon apandisit riski daha fazladýr. Ek olarak, erkek cinsiyet ve artmýþ nötrofil sayýsý perforasyonun baðýmsýz belirleyicileridir.

BACKGROUND: Recognition and management of abdominal emergencies in geriatric patients are more complicated compared to the younger population. We aimed to investigate the demographic characteristics of geriatric patients diagnosed with acute appendicitis and to investigate the factors associated with perforation in the early stages in this study.
METHODS: After obtaining local ethical committee approval, patients 65 years and older who had appendectomy between January 2015 and December 2019 were included the study. Demographic data of the patients, physical examination findings, and laboratory results were analyzed. Patients were divided into two groups based on surgical reports: Perforated and simple appendicitis.
RESULTS: During the study period, 72 patients were evaluated. In our study, 48.6% of the patients were male, and the median age was 71.5 years (IQR 25–75, 68–80). Perforated appendicitis was detected in 28% of the patients. We were determined that the vast majority of patients with perforated appendicitis were male; had more frequent chronic kidney disease and post-operative local complications; had increased leukocytes, neutrophils, blood urea nitrogen, creatinine, and total bilirubin; and had reduced albumin; and these differences were statistically significant (all values p<0.05). Multivariate analysis shows increased neutrophil count and male sex was significantly associated with perforated appendicitis (p=0.035 and p=0.01, respectively).
CONCLUSION: Geriatric patients with chronic kidney disease can be at higher risk of perforated appendicitis due to inadequate abdominal physical examination results. In addition, male gender and an elevated neutrophil count are independent predictors of perforation.

AMAÇ: Varis dýþý üst gastrointestinal (GÝS) kanamasý olan yaþlý hastalar için acil servis baþvurularý artmaktadýr. AIMS65 ve Glasgow-Blatchford skoru (GBS), bu hastalarda hastane içi ve taburculuk sonrasý mortaliteyi, kalýþ süresini ve saðlýkla ilgili maliyetleri tahmin etmek için önerilen iki ayrý skorlama sistemidir. Bu çalýþmanýn amacý, 80 yaþýnda veya daha büyük olan UGIB hastalarýnda 30 günlük mortalite ve kalýþ süresini tahmin etmek için, Charlson komorbidite indeksi (CCI) ile birlikte bu skorlama sistemlerinin etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çanakkale Onsekiz Mart Üniversitesi Hastanesi Acil Servisi’ne baþvuran varis dýþý üst GÝS kanamalý 182 hasta geriye dönük olarak incelendi. AIMS65, GBS ve CCI skorlarý hesaplandý ve olumsuz hasta sonuçlarý deðerlendirildi.
BULGULAR: Hastalarýn ortalama yaþý 85.59±4.33 yýl idi ve hastalarýn 90’ý (%49.5) erkekti. AIMS65, 30 günlük mortaliteyi tahmin etmede GBS’den (sýrasýyla, AUROC 0.695 vs 0.877) ve CCI’dan (sýrasýyla, AUROC 0.526 vs 0.877) üstündür. Her üç skor da hastanede kalýþ süresini tahmin etmede yetersiz performans gösterdi. AIMS65 skoru için mortalite tahmininde, duyarlýlýk ve özgüllük en üst düzeye çýkaran kesme deðeri 3 (duyarlýlýk, 0.87; özgüllük, 0.80; NPD, 0.977; PPD, 0.392), GBS için 14 (duyarlýlýk, 0.83; özgüllük, 0.51; NPD, CC23 için 0.923; PPD, 0.367) ve CCI için 5 (duyarlýlýk, 0.91; özgüllük, 0.22; NPD, 0.946; PPD, 0.145) olarak tespit edilmiþtir.
TARTIÞMA: AIMS65, acil servis ayarlarýnda kolayca yapýlabilen basit, doðru ve endoskopik olmayan bir skorlama sistemidir. UGIB’li yaþlý hastalarda 30 günlük mortaliteyi tahmin etmede GBS ve CCI’den daha üstündür.

BACKGROUND: The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older
METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed.
RESULTS: The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145).
CONCLUSION: The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.

AMAÇ: Mevcut çalýþmada özellikli bir hastalýk grubu olan Fournier’s gangrenli hastalarda kullanýlacak anestezik yöntem seçiminde etki eden faktörlerin incelenmesi ve literatür eþliðinde tartýþýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Ocak 2014–Mayýs 2019 yýllarý arasýnda Fournier’s gangreni nedeniyle ameliyat edilen 113 hasta geriye dönük olarak deðerlendirildi. Yetmiþ sekiz hastanýn spinal anestezi (Grup S), 35 hastanýn ise genel anestezi (Grup G) ile ameliyat edildiði görüldü. Hastalar yaþ, cinsiyet, kullanýlan anestezi yöntemi (spinal, genel), uygulanan anestezik ajan sepsis varlýðý, biyokimyasal, hematolojik ve enflamatuvar parametreler gibi bilgiler açýsýndan deðerlendirildi.
BULGULAR: Çalýþmaya alýnan hastalarýn FGSI skorlarý açýsýndan deðerlendirildiðinde de grup 1’deki hastalarýn daha düþük deðerlere sahip olduklarý görüldü (p=0.001). Ameliyat öncesi dönemde hastalarýn 87’sine (%77) tomografik inceleme yapýldýðý görüldü. Hastalarýn tomografik görüntüleri incelendiðinde genel anestezi uygulanan hastalardan 13’ünde (%37.1) sað/sol gluteal alandan birisi ya da her ikisinde de bulunan ve cilt altý dokuya dek uzanan içerisinde hava deðerleri izlendiði görüldü. Genel anestezi seçimine etki eden faktörler incelendiðinde FGSI deðerindeki artýþýn (r=0.482, p=0.001), sepsis varlýðý ile (r=0.485, p=0.001) ve gluteal bölge tutulumu ile (r=0.628, p<0.001) pozitif yönde korelasyon izlenirken platelet deðerlerindeki düþüþle de spinal anestezi uygulamasý arasýnda iliþki olduðu görüldü (r=0.238, p=0.011).
TARTIÞMA: Fournier’s gangrenli hastalarda anestezi yöntem seçimi hastanýn genel durumu, sepsis varlýðý, kanama dizatezi bulunup bulunmamasý, gibi faktörlerin yaný sýra FGSI indeksi ve tomografik olarak gluteal bölge tutulumu gibi pek çok faktörün etkilediði kompleks bir durum olup anestezi yöntem tercihinde hastalarýn risk-fayda dengesinin bireysel olarak deðerlendirilmesi gerekmektedir.

BACKGROUND: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier’s gangrene.
METHODS: A retrospective evaluation was made of 113 patients operated on because of Fournier’s gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters.
RESULTS: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001).
CONCLUSION: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients’ general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

AMAÇ: Yanýklar özellikle geliþmekte olan ülkelerde çocuklarda sýk görülen önemli bir mortalite ve morbidite sebebidir. Epidemiyolojik veriler, önleyici tedbirler için yol gösterebilir ve çocuklarda yanýk olgularýnýn azaltýlmasýna katkýda bulunabilir. Bu çalýþmanýn amacý yanýk merkezinde yatarak tedavi edilen çocuk hastalarda yanýklarýn epidemiyolojik özelliklerini incelemek ve önleyici tedbirler önermektir.
GEREÇ VE YÖNTEM: Çalýþmamýzda 1 Ocak 2015–30 Haziran 2019 tarihleri arasýnda 3. basamak yanýk merkezine yatýrýlarak tedavi edilen 1442 çocuk hastanýn demografik ve epidemiyolojik verileri, yanýk mekanizmasý, yanýk etiyolojisi, yanýk total vücut alaný yüzdesi (TBSA), tedavi sonuçlarý geriye dönük olarak deðerlendirildi.
BULGULAR: Yanýk total vücut alaný (TBSA) yüzdesi 1442 hasta için 11.23±10.70 olurken hastanede yatýþ süresi 14.38±18.1 gün olarak bulundu. Hastalarýn %89.18’inde (n=1286) yanma olayý ev içerisinde gerçekleþmiþti. Yanýk etiyolojisinde tüm yaþ gruplarýnda sýcak su ve çay ile yanma en sýk görülürken, süt çocuðu döneminden sonra alev yanýklarý artmakta, okul çaðýnda elektrik yanýklarý daha fazla görülmektedir. Toplam 10 hasta (%0.69) hayatýný kaybetti. Bunlardan yedisi baþka hastanelerden gelen gecikmiþ hastalardý.
TARTIÞMA: Yanýk merkezimizdeki çocuk hastalarýn çoðunluðu süt çocuðu ve erkek hastalar idi. Yaþ arttýkça TBSA oranlarý ve hastanede yatýþ süresi de artmakta idi. Çocuk yanýklarý genellikle okul öncesi çocuklarda ev içerisinde ve yanlarýnda bir ebeveyn varken olmaktadýr. Bu nedenle bu çocuklarýn gözetimini yapan aile bireylerine yönelik eðitim programý ve farkýndalýk yaratacak çalýþmalara ihtiyaç vardýr.

BACKGROUND: Burns are common injuries among children resulting with significant mortality and morbidity, especially in developing countries. Epidemiological data may guide for the preventive measures and contribute reducing the incidence of burns in children. The aim of this study is to report the epidemiological features of pediatric burn patients treated in a tertiary burn center and to suggest preventive measures.
METHODS: Between January 1, 2015, and June 30, 2019, a total of 1442 children hospitalized in our burn center were evaluated retrospectively. Demographic, epidemiological, and clinical data including burn etiology, percentage of burned total body surface area (TBSA), hospital stay, infection, and mortality rate were reported.
RESULTS: The percentage of burned TBSA was 11.23±10.70 and the length of hospital stay was 14.38±18.1 days. In total, 89.18% of the patients (n=1286) experienced burn injury indoors. With regard to the etiology, scalding with hot water and tea was the most common in all age groups. Flame burn incidence increases after infancy, and electrical burns occur more in school age. A total of 10 patients (0.69%) were died and seven of them were delayed referrals from other hospitals.
CONCLUSION: Infants and males consist of the majority of our pediatric burn patients. The percentage of burned TBSA and length of hospital stay increased as the patient age increased. Childhood burn injuries are mainly scald burns that occur indoors, while their parents were nearby. Therefore, education programs focusing on primary prevention addressing family members are required to avoid pediatric burns.

AMAÇ: Bu çalýþmanýn amacý, mülteci hastalarýn komplike apandisit ile baþvurma olasýlýðýnýn daha yüksek olup olmadýðýný belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Çalýþma kapsamýnda 2018–2020 yýllarý arasýnda akut apandisit tanýsý ile yatýrýlarak, tedavi edilen hastalar deðerlendirilmeye alýndý, çalýþma popülasyonu mülteci hastalar (n=140) ve yerel hastalar (n=386) olarak iki gruba ayrýldý. Çalýþmanýn birincil sonucu komplike apandisit oranlarýydý, semptomlarýn süresi, apendektomiye kadar geçen süre, tanýsal yöntemler ve hastanede kalýþ süresi ayrýca deðerlendirildi. Ameliyat sýrasýndaki bulgular ve patoloji raporlarýna göre olgular komplike ve non-komplike apandisit olarak sýnýflandýrýldý.
BULGULAR: Komplike apandisit oranlarý ve semptom süresi 72 saatten daha uzun olan hasta sayýsý mülteci hasta grubunda istatistiksel olarak daha anlamlý idi (sýrasýyla, p=0.009 ve n=186, p=0.000). Mülteci hastalarýn yaþ ortalamasý daha gençti ve erkek hasta oraný istatistiksel olarak anlamlý þekilde daha yüksekti (her ikisi için p=0.000). Gruplar arasýnda apendektomi zamaný, ameliyat süresi, cerrahi yöntem, hastanede yatýþ süresi ve tanýsal yöntemler açýsýndan anlamlý fark yoktu (p>0.05).
TARTIÞMA: Ülkemizde mülteci hastalar saðlýk hizmetlerine eþit eriþim imkanýna sahip olmalarýna raðmen, bu çalýþmanýn sonuçlarý mülteci hastalarýn daha yüksek komplike apandisit ve geç baþvuru oranlarýna sahip olduklarýný göstermiþtir. Mülteci hastalarýn sonuçlarýný etkileyen faktörleri belirlemek için gelecekte yapýlacak araþtýrmalara ihtiyaç vardýr.

BACKGROUND: This study aims to determine whether refugee patients are more likely to present with complicated appendicitis.
METHODS: Patients who were hospitalized and treated with the diagnosis of acute appendicitis in a single center between 2018 and 2020 were evaluated within the scope of this study, and the included patients were divided into two groups as refugees (n=140) and local patients (n=386). The primary outcome was complicated appendicitis rate, and the duration of symptoms, time to appendectomy, operation time, diagnostic modality, and length of hospital stay were also analyzed. According to operational diagnosis and pathology reports, cases were categorized as either non-complicated or complicated.
RESULTS: The complicated appendicitis rate, and the number of patients with symptoms lasting longer than 72 h were statistically more significant in refugee patients (p=0.009 and n: 186, p=0.000, respectively). The refugee patients had a younger mean age and a higher male patient rate which was statistically significant (p=0.000 for both). There was no significant difference between the groups concerning time to appendectomy, operation time, type of surgery, hospital length of stay, and diagnostic modality (p>0.05).
CONCLUSION: The findings of this study demonstrated that refugee patients have a higher complicated appendicitis rate and late admission rate, even though refugee patients have equal access to healthcare in our country. Future research is needed to identify factors affecting outcomes of refugee patients.

AMAÇ: Kadýna yönelik þiddet, kadýnlarý eþitlik, güvenlik, haysiyet, öz deðer ve temel özgürlüklerden yararlanma haklarýndan yoksun býrakan, kadýnlarý deðersizleþtiren; kadýnlarý erkeklere göre daha aþaðý toplumsal bir durumda var olmaya zorlayan en önemli sosyal oluþlardandýr ve saðlýklý toplumlarýn oluþmasýnda önemli bir engel oluþturmaktadýr. Bu araþtýrma, Türkiye’nin Doðusunda yer alan Elazýð il merkezinde yaþayan 15 yaþ ve üzeri evli kadýnlarýn eþ þiddetine maruz kalma durumlarýný belirlemek amacýyla yapýldý.
GEREÇ VE YÖNTEM: Elazýð il merkezinde bulunan tüm aile saðlýk merkezlerine gidilerek ilgili kayýtlardan sistematik örnekleme yapýlarak 792 evli kadýn seçildi. Veri toplama aracý olarak anket formu kullanýldý. Anket formu iki bölümden oluþmaktaydý. Ýlk bölümde katýlýmcýlarýn yaþý, cinsiyeti, eðitim düzeyi, mesleði gibi demografik özelliklere iliþkin sorulara yer verilirken, ikinci bölümde þiddete maruz kalma durumlarýný belirlemeye yönelik sorular soruldu. Anketler ev ziyaretleri yapýlarak yüz yüze görüþme tekniði kullanýlarak dolduruldu.
BULGULAR: Araþtýrmaya katýlan kadýnlarýn %51.5’i fiziksel þiddete, %82.9’u sözel/duygusal þiddete, %39.7’si cinsel þiddete, %47.6’sý ekonomik þiddete maruz kalmýþtý. Kadýnýn ve eþinin eðitim düzeyinin düþüklüðü, ailenin ekonomik durumunun kötü olarak algýlanmasý, kadýnýn gelir getiren bir iþte çalýþmýyor olmasý eþi tarafýndan hem fiziksel þiddet hem de ekonomik þiddet görmesinin önemli bir faktör olabileceði bulundu.
TARTIÞMA: Elazýð il merkezinde yaþayan evli kadýnlarda eþ þiddeti maruziyeti yüksektir. Sorunun bireysel, ailesel toplumsal düzeylerde çözümüne yönelik eðitim ve hizmet sunulmalýdýr.

BACKGROUND: Violence against women deprives women of their rights to enjoy equality, security, dignity, self-worth and fundamental freedoms and devalues them; is one of the most significant social facts that force women to exist at a lower social level than men and constitute a significant obstacle to the formation of healthy societies. This study was conducted to determine the status of exposure to spousal violence of 15 years and older married women living in the city center.
METHODS: Family health centers in Elazig Province were visited and 792 married women were selected from the related records by systematic sampling. As a data collection tool, a questionnaire form was used. The questionnaire consists of two parts. In the first part, participants were asked about demographic characteristics such as age, gender, education level, and profession, while in the second part, questions were asked to determine the extent of exposure to violence. Questionnaires were filled out using interview technique by making home visits.
RESULTS: It has been found that the low level of education of the wife and her spouse, perception of the economic situation of the family as being bad, and the fact that the woman does not work in an income-generating business can be an important factor in exposing to both physical violence and economic violence by her husband.
CONCLUSION: Conclusion: Rate of exposure to spousal violence is high in married women living in the city center of Elazig Province. Education and services should be provided for solving the problem at individual, familial, and social levels.

AMAÇ: Günümüzde tarýmsal üretim yapan birçok yerde traktör tarla sürme yük taþýma gibi birçok amaçla kullanýlmaktadýr. Yaygýn kullaným alanýna sahip olan traktörlerin yerine zamanla daha basit ihtiyaçlara uygun tarým araçlarý imal edilmiþtir. Çalýþmasý esnasýnda çýkardýðý yüksek motor sesinden ötürü “patpat” olarak adlandýrýlan ve asýl amacý tarla sürmek olan araç bunlara örnektir. Patpatlar römork eklenmiþ iki tekerlekli tek akslý traktörlerdir.
GEREÇ VE YÖNTEM: Bu tanýmlayýcý çalýþmada; Adli Týp Kurumu Trabzon Grup Baþkanlýðý’nda 2006–2017 tarihleri arasýnda otopsileri yapýlan “patpat” kazasý ile iliþkili ölümlerde olay yeri inceleme belgelerindeki bilgiler, otopsi ve laboratuvar bulgularý ýþýðýnda, olgulara ait tanýmlayýcý bilgiler ve olgularýn ölüm nedenleri analiz edildi.
BULGULAR: Olgular ortalama 47.6±20.3 yýl (medyan: 57, daðýlým: 10–75 yýl) olan 17 (%81) erkek ve dört (%19) kadýndan oluþmuþtur. Kazalarýn %85.7’si (n=18) tek taraflý patpat kazasý idi. Kaza sonrasýnda patpatlarýn %52.4’ü (n=11) karayolununu kenarýnda, %33.3’ü (n=7) bir derenin kenarýnda veya dik bir vadinin altýnda bulundu. Kaza sebeplerinin %33.3 (n=7) olguda patpatýn virajda devrilmesi ve %85.7’sinde (n=18) patpatýn devrilmesi veya yan dönmesi olduðu tespit edildi. En sýk yaralanma þekli kaza esnasýnda araçtan (%38.1, n=8) fýrlamaydý. Olgularýn %66.7’sinde (n=14) ölen kiþi patpat sürücüsü idi.
TARTIÞMA: Patpat kazalarý; kullaným sýkýlýðý, denetime elveriþli olmamasý ve özellikle kullanýldýðý coðrafyanýn zorlu þartlarý nedeniyle ciddi bir sorun olarak karþýmýza çýkmaktadýr.

BACKGROUND: Overtime, agricultural machines have been designed appropriate to more simple needs, instead of tractors which have a wide area of use. An example of these is the “patpat,” so named because of the sound of the motor, and for which the main purpose is ploughing.
METHODS: A patpat is a single-axle, two-wheeled tractor with a trailer attached. In this descriptive study, the descriptive characteristics and causes of death were analyzed of case related to patpat accidents for which autopsies were performed by the Forensic Medicine Institution Trabzon Group Directorate between 2006 and 2017.
RESULTS: Information was retrieved from the scene of accident examination documents, and the autopsy and laboratory records. The 21 cases comprised 17 (81%) males and 4 (19%) females, with a mean age of 47.6±20.3 years (median: 57, range: 10–75 years). Of the total accidents, in 85.7% (n=18), no other vehicle was involved. Following the accident, 52.4% (n=11) of the patpats were found at the side of the road, and 33.3% (n=7) at the edge of a stream or at the bottom of a steep valley. The cause of the accident was determined to be that the patpat had overturned on a bend in 33.3% (n=7) cases and in 85.7% (n=18) of cases, the patpat was found overturned or on its side. The most common injury was being thrown from the vehicle (38.1%, n=8), and in 66.7% (n=14) of cases, the deceased was the patpat driver.
CONCLUSION: Patpat accidents are a serious problem because of the frequency of use of these vehicles without proper supervision and especially because of the hazardous topographical conditions where they are used.

AMAÇ: Çocuk yanýklarýnýn çoðu yakýnýnda bir yetiþkin varken meydana gelmektedir. Bu durum yanýk nedeni olarak yetiþkin dikkatsizliði veya ihmalinin rolünü düþündürmektedir. Bu çalýþmanýn amacý pediatrik el yanýklarý hakkýnda klinik veriler saðlamak ve çocuklarda yanýk yaralanmalarýnda ihmalin rolüne dikkat çekmektir.
GEREÇ VE YÖNTEM: Çalýþmaya Eylül 2017–Ekim 2018 tarihleri arasýnda üçüncü basamak yanýk merkezinde yatarak tedavi edilen çocuklar dahil edildi. Yaþ, cinsiyet, yanýk etiyolojisi, olay yeri, yakýnlardaki eriþkin varlýðý, fiziksel istismar veya ihmal varlýðý, yanýk toplam vücut yüzey alaný, yatýþ süresi ve komplikasyonlar kaydedildi.
BULGULAR: Yanýk merkezinde yatarak tedavi edilen 335 pediatrik yanýk hastasý arasýndan el yanýðý olan 89 hasta çalýþmaya alýndý. Hastalarýn %79.8’i 6 yaþ altýndaydý. Yanýk kazalarýnýn %88.8’i iç mekanlarda meydana gelmiþti. El yanýklarýnýn çoðu haþlanma yanýðý idi. Hastalarýn %71.9’unda yanýk yaralanmasý esnasýnda yakýnlarda bir yetiþkin vardý. El yanýðý olan hastalarýn 19’u (%21.35) ihmal olarak deðerlendirildi. Tüm ihmal olgularý altý yaþýn altýndaydý.
TARTIÞMA: Pediatrik yanýklar çoðunlukla ev içerisinde ve yakýnlarda bir yetiþkin varken meydana gelmiþtir. Sýcak içecek tüketme alýþkanlýklarý, mutfakta tehlikeli piþirme uygulamalarý ve farkýndalýk eksikliði yanýk kazasýna yol açan bazý önemli konulardýr. Etiyolojik bir neden olarak ihmal el yanýklarýnýn %21.35’inde tespit edilmiþtir. Tekrarlanan yanýk yaralanmalarýnýn önlenmesi için genel önlemlerin yaný sýra hastalarýn deðerlendirilmesinde ihmal bulgularýna özellikle dikkat edilmesi gerekmektedir. Ebeveynin yetersiz denetim veya ihmali düþünüldüðünde resmi makamlara bildirimde bulunulmalýdýr.

BACKGROUND: Majority of the pediatric burns happen when an adult is nearby the child. This suggests the role of adult carelessness or neglect as a cause of burns. The aim of this study is to provide clinical data on pediatric hand burns and to draw attention to the role of neglect in pediatric burn injuries.
METHODS: Children admitted to a tertiary burn center between September 2017 and October 2018 were included in the study. Epidemiological data including age, sex, etiology and place of injury, presence of caregiver nearby, physical signs of neglect or abuse, clinical outcomes including burned total body surface area, length of admittance, and complications were recorded.
RESULTS: A total of 335 pediatric burns were admitted to the burn center. Among them 89 patients with hand involvement were included in the study. Most of the patients were under the age of 6 (79.8%) and 88.8% of the burn accidents occurred indoors. Scalding was the main mechanism for hand burns. There was an adult nearby in 71.9% of the patients. Among patients with hand involvement, 19 (21.35%) were considered as neglect. All the neglect cases were under the age of 6.
CONCLUSION: Pediatric burn accidents occurred mainly at home, mostly with an adult around. Habits of drinking hot beverages, dangerous cooking practices and lack of awareness are some important issues leading to burn accident. Neglect is found in 21.35% of hand burns as the etiology. In addition to general preventive measures special attention should be paid to the signs of neglect in the evaluation of patients. These burns should also be reported to official services, as they may reflect inadequate supervision or neglect by the caregiver.

AMAÇ: Bu makalede Libya sivil savaþýnda genitoüriner yaralanma sonrasý ileri inceleme ve tedavi amacýyla tarafýmýza transfer edilen hastalarýn tedavi sonuçlarýný deðerlendirmeyi ve sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Bir ya da daha fazla kombine 21 (%17.3) ürogenital yaralanmasý olan hasta olmak üzere toplam 121 yaralý hasta, Ekim 2014–Eylül 2016 arasýnda Yeni Yüzyýl Üniversitesi Özel Gaziosmanpaþa Hastanesi’nde tedavi edildi.
BULGULAR: Yirmi bir hastanýn 13’ünde (%61.9) patlayýcý silahlar, %8’inde (%38.1) mermi yaralarý vardý. Yirmi bir hastanýn yedisinde böbrek yaralanmasý (%33.4), beþinde (%23.8) üreteral yaralanma, beþinde (%23.8) mesane yaralanmasý, ikisinde (%9.5) skrotum, ikisinde (%9.5) penis yaralanmasý saptandý. Ürogenital sistem dýþýndaki organ yaralanmalarý 21 hastanýn tamamýnda eþlik etmekteydi. Böbrek yaralanmasý olan iki hastada nefrektomi yapýldý. Geri kalan hastalarda ürogenital organ rezeksiyonu yapýlmadý. Ürogenital travma oranýnýn karaciðer hasarý, genel enfeksiyon, kan transfüzyonu ve uzamýþ hastane yatýþýndan daha fazla olduðu saptandý.
TARTIÞMA: Savaþla iliþkili cerrahi hastalarýnýn ayrý ve standart olmayan bir kategori olarak ele alýnmasý gerektiðini bilerek, her olgu ayrý ayrý deðerlendirilmelidir. Hastalar multidisipliner bir yaklaþýmla deðerlendirilmeli ve doktorlar morbidite ve mortaliteyi etkileyen enfeksiyonlarýn farkýnda olmalýdýr.

BACKGROUND: In this article, we aimed to evaluate results of patients who acquired various injuries during Libya civil war who then were transferred to our facility with genitourinary trauma for further assessment and treatment.
METHODS: A total of 121 wounded patients, including 21 (17.3%) with 1 or more combined urogenital injuries, were treated at Yeni Yüzyýl University Private Gaziosmanpaþa Hospital from October 2014 to September 2016.
RESULTS: Of the 21 patients, 13 (61.9%) were injured by explosive weapons, while the rest 8 (38.1%) had bullet wounds. The 21 urogenital injuries were to the kidney in 7 cases (33.4%), ureter in 5 (23.8%), bladder in 5 (23.8%), scrotum in 2 (9.5%), and penis in 2 (9.5%). There was associated damage to organs other than the urogenital system in 21 patients (100%). Two patients had nephrectomies performed on-site medical facility. The rest of patients had no urogenital organ resections. Urogenital trauma had higher rates of liver damage, generalized infection, blood transfusions, and longer hospital stay.
CONCLUSION: Knowing that war related surgery patients should be approached as a distinct and non-standard category, every case must be evaluated individually. Patients should be evaluated in a multidisciplinary approach and physicians should be aware of infections affecting morbidity and mortality.

AMAÇ: Bu çalýþmanýn amacý, uygulanan sosyal izolasyon önlemlerinin COVID-19 pandemisine baðlý karantina döneminde pediatrik kýrýklarýn özellikleri üzerindeki etkilerini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Merkezimize 3 Nisan 2019–31 Mayýs 2019 (karantina olmayan dönem) ve 3 Nisan 2020–31 Mayýs 2020 (karantina dönemi) olmak üzere iki dönem arasýnda baþvuran hastalar çalýþmaya dahil edildi. Grup 1, karantina olmayan dönemde tedavi edilen 743 hastadan oluþurken, Grup 2, karantina döneminde tedavi edilen 615 hastadan oluþuyordu. Hastalarýn týbbi kayýtlarý ve radyografileri hastanemizin bilgisayar veri tabaný üzerinden gözden geçirildi. Ek olarak, hastalarýn yaþý, cinsiyeti, kesin taný, travmanýn anatomik yeri, travma tipi (kýrýk, çýkýk, tendon yaralanmasý, bað yaralanmasý, kýrýklý çýkýk, açýk kýrýk vb.), pediatrik kýrýk tipi (deplase kýrýk, torus kýrýðý, epifiz kýrýðý, patolojik kýrýk, vb.) ve tedavi yöntemi (konservatif/cerrahi) kaydedildi.
BULGULAR: Hastalarýn ortalama yaþý Grup 2’de anlamlý olarak daha düþüktü (p<0.001). Gruplar arasýnda travmalarýn anatomik lokalizasyonu açýsýndan anlamlý farklýlýklar vardý (p<0.001). Travma tipleri, pediatrik travma ve tedavi gruplar arasýnda anlamlý olarak farklýydý (sýrasýyla, p<0.001, p<0.001 ve p<0.001). Cerrahi tedavi sýklýðý Grup 2’de anlamlý olarak daha yüksekti (p<0.001).
TARTIÞMA: Sonuçlarýmýz, COVID-19 pandemisi sýrasýnda hasta demografisinde ve kýrýk özelliklerinde önemli farklýlýklar göstermiþtir.

BACKGROUND: The purpose of this study is to investigate the effects of implemented social isolation measures on the characteristics of orthopedic pediatric traumas during this COVID-19 pandemic lockdown period.
METHODS: Patients who were admitted at our center between two time periods: April 3, 2019–May 31, 2019 (no lockdown period) and April 3, 2020–May 31, 2020 (lockdown period) were included to the study. Group 1 comprised 743 patients who were treated during no lockdown period, whereas Group 2 comprised 615 patients who were treated during lockdown period. Patients’ medical records and radiographs were reviewed through our hospital’s computer database. In addition, we recorded each patients’ age and gender, their definite diagnosis, the anatomic location of the trauma, the type of trauma (fracture, dislocation, tendon injury, ligament injury, fracture dislocation, open fracture, etc.), the type of pediatric fracture (displaced fracture, torus fracture, epiphyseal fracture, pathological fracture, etc.), and the treatment method (non-operative/operative).
RESULTS: The mean age of the patients was significantly lower in Group 2 (p<0.001). There were significant differences between the groups in terms of anatomic locations of the traumas (p<0.001). The types of the traumas, pediatric traumas, and treatment were significantly different between the groups (p<0.001, p<0.001, and p<0.001, respectively). The frequency of operative treatment was significantly higher in Group 2 (p<0.001).
CONCLUSION: Our results demonstrated significant differences in patients’ demographics as well as trauma characteristics during COVID-19 pandemic.

AMAÇ: Mandibula kondil kýrýklarý, intermaksiller fiksasyon (IMF) ile konservatif olarak veya açýk redüksiyon ile tedavi edilmektedir. Birçok çalýþmada bu tip kýrýklar için optimal tedavi yöntemi tartýþýlmýþtýr. Bu çalýþmada, mandibuladaki kondil kýrýklarýnda uygulanabilecek konservatif teknikler ile cerrahi tekniðin karþýlaþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþmamýzda 18–24 yaþ arasý kondil boynu kýrýðý tanýsý konualarak üç farklý tedavi yöntemi ile tedavi edilmiþ toplam 24 hastanýn ameliyat öncesi ve sonrasý arþiv bilgisayarlý tomografi kayýtlarý kullanýlmýþtýr. Cerrahi müdahale uygulanmayan hastalarýn yaþýna ve diþsel durumuna baðlý olarak intermaksiller fiksasyon (IMF) yapýlabilmesi için toplamda 19 hastaya braketleme, ark bar ya da mini vida uygulanmýþ; sekiz adet hastaya sadece ortodontik IMF, 11 hastaya ise tek veya çift taraflý yükselticili okluzal splint IMF ile birlikte uygulanmýþtýr. Ayrýca beþ hastaya da mini plak ile açýk redüksiyon uygulanmýþtýr. Ortodontistler ve cerrahlar tarafýndan, klinik ve radyolojik olarak hastalarýn ameliyat öncesi ve altý aylýk ameliyat sonrasý deðerlendirmeleri yapýlmýþtýr.
BULGULAR: Tek taraflý kondil boynu kýrýðý olan hastalarda, iyileþme sonrasýnda, kondil ve mandibula’nýn en çýkýntýlý noktalarý arasýndaki uzaklýk, etkilenmeyen taraf ile karþýlaþtýrýlarak IMF ile tedavi edilen hastalarda uzunluk farký sadece 5.94 mm; braket ve splint uygulanan hastalardaki uzunluk farký 3.36 mm (p<0.05); vidalý plaklar ile tedavi edilen hastalardaki uzunluk farký 1.80 mm (p>0.05) olarak tespit edilmiþtir. Lakin IMF, Oclusal Splint & IMF ve Mini Plak gruplarýnýn, travma tarafý ve karþý taraf arasýndaki karþýlaþtýrmalarda gruplar arasýnda istatistiksel olarak anlamlý bir fark (p>0.05) bulunmamýþtýr. Travma öncesi oklüzyonlarý bilinmeyen hastalarýn oklüzyonlar ortodontist tarafýndan yeniden konumlandýrýldý ve hiçbir hastada ankiloz, açýk kapanýþ, aðýz açmada kýsýtlýlýk, fasiyal asimetri, laterognati veya retrognati görülmemiþtir.
TARTIÞMA: Uygun olgularda IMF’nin oklüzal splint ile uygulanmasý, açýk redüksiyondan daha konservatif ve kabul edilebilir bir tedavi yöntemidir.

BACKGROUND: Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures.
METHODS: Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment.
RESULTS: The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion.
CONCLUSION: The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.

AMAÇ: Çocuklarda proksimal femur kýrýklarý oldukça nadir görülmektedir. Bu kýrýklar avasküler nekroz, koksa vara, femurbaþý epifizinin erken kapanmasý gibi ciddi komplikasyonlarla sonuçlanabilmektedir. Bu çalýþmanýn amacý en çok görülen ve avasküler nekrozun yoðun olarak saptandýðý delbet tip 2 kýrýklarýn geriye dönük incelenmesini içermektedir.
GEREÇ VE YÖNTEM: Hastanemizde Ocak 2009 - Haziran 2018 yýllarý arasýnda tedavi edilen Delbet tip 2 kýrýklarý olan 42 hasta tarandý. Hastalarýn, kýrýklarýn oluþum mekanizmasý, kýrýðýn deplase olup olmamasý, eþlik eden yaralanmalarýn varlýðý, cerrahi zamanlamasý, açýk ya da kapalý redüksiyon yapýlmasý ve vidalarýn epifiz hattýný geçip geçmemesi, AVN verileri geriye dönük olarak incelendi.
BULGULAR: Taranan 42 hastadan takip grafileri ve dosyalarý tam olan 34 hasta çalýþmaya dahil edildi. Hastalarýn yaþ ortalamasý 11.02 yýl (1–17 yaþ arasý), ortalama takip süresi 40.82 ay (24–98 ay) idi. Hastalarýn takip grafileri incelendiðinde dokuz hastada (%26.5) avasküler nekroz, iki hastada (%5.9) koksa vara, bir hastada (%2.9) kaynamama geliþtiði saptandý. Yüksek enerjili yaralanmasý olan ve baþlangýçta kýrýk deplasmaný fazla olan hastalarda AVN oraný anlamlý olarak daha yüksek saptandý (sýrasýyla, p=0.034, p=0.047).
TARTIÞMA: Delbet tip 2 kýrýklarda bulgularýmýza göre, travmanýn þiddeti ve kýrýðýn ilk yer deðiþtirmesi dýþýnda tedavi süreciyle ilgili faktörlerin avasküler nekroz (AVN) geliþimi üzerinde önemli bir etkisi yoktur. Bu hastalarda yaþ AVN geliþimi için risk faktörü olarak belirlenmemiþtir.

BACKGROUND: Fractures of proximal femur are rarely seen in childhood. These fractures can result in serious complications such as avascular necrosis (AVN), coxa vara, and early closure of the femoral epiphysis. The aim of this study is to investigate retrospectively the Delbet type 2 fractures that are commonly seen and has high rates of AVN.
METHODS: Forty-two patients whose Delbet type 2 fractures were treated in our hospital between January 2009 and June 2018 were analyzed. The patients’ mechanism of fracture formation, displacement of the fracture, presence of accompanying injuries, timing of surgery, open or closed reduction, whether the screws cross the epiphyseal growth plate epiphyseal line, and AVN data were analyzed retrospectively.
RESULTS: Of the 42 screened patients, 34 patients with complete follow-up graphs and files were included in the study. The mean age of the patients was 11.02 years (1–17 years old), and the mean follow-up time was 40.82 months (range 24 to 98 months). When the follow-up radiographs of the patients were examined, it was found that AVN in 9 patients (26.5%), coxa vara in 2 patients (5.9%), and non-union in 1 patient (2.9%). The AVN rate was significantly higher in patients with high-energy injuries and high fracture displacement at baseline (p=0.034 and p=0.047, respectively).
CONCLUSION: According to our findings in Delbet type 2 fractures, other than the severity of the trauma and the initial displacement of the fracture, factors related to the treatment process do not have a significant effect on the development of AVN. Age was not determined as a risk factor for the development of AVN in these patients.

Bu çalýþmada, kliniðimize baþvuran 49 yaþýnda bir kadýn hastanýn kanama yerinin lokalize edilmesi amacýyla 99mTc iþaretli RBC gastrointestinal kanama sintigrafisindeki rastlantýsal bir bulgu sunuldu. Hastanýn ayrýca kronik böbrek yetersizliði olup ve femoral kateterizasyon için çeþitli müdahaleler yapýlmýþtý. Takip sýrasýnda sað inguinofemoral bölgede büyük bir yumuþak doku hematomu olarak deðerlendirilen ve daha sonra SPECT/CT ile doðrulanan artmýþ aktivite tutulumu gözlendi. Yirmi dördüncü saatte alýnan geç görüntüde, karýn sað tarafýndaki baðýrsak hattý boyunca bir aktivite birikimi, alt gastrointestinal kanamanýn kanýtý olarak görüldü.

We report an incidental finding on 99mTc-labelled RBC gastrointestinal bleeding scintigraphy of a 49-year-old female patient referred to our clinic in order to localize the bleeding site. The patient has also been suffering from chronic renal insufficiency and received several interventions of femoral catheterization. During the follow-up, an intense uptake was observed at the right inguinofemoral area which is evaluated as a large soft tissue hematoma and confirmed by SPECT/CT subsequently. On the 24th h delayed image an activity accumulation along the bowel trace on the right side of the abdomen was seen as evidence of lower gastrointestinal bleeding.

Ekstrahepatik safra yolu yaralanmalarý nadirdir ve çoklu travma hastalarýnda kolayca gözden kaçabilmektedir. Safra yolu yaralanmasý olan hastalar bu konuda özel bir yaklaþým ile tedavi edilmelidirler. Bu yazýda, ana hepatik kanalýn tamamen ayrýþtýðý bir olgu ve tedavi yaklaþýmý tartýþýldý. Stabil olmayan hastalarda hasar kontrol cerrahisi de kullanýlabilmektedir. Otuz iki yaþýnda erkek hasta, acil servise darp nedeniyle oluþan çoklu travma sonucu getirildi. Radyolojik görüntülemede kranyal, nazal, lumbar vertebral ve kostal kýrýklar, sað böbreðe azalmýþ kan akýmý ve perihepatik, perisplenik sývý mevcuttu. Bu safhada acil cerrahi düþünülmeyen hasta nöroþirürji doktorlarý tarafýndan ameliyat edildi. Takiplerinde, ameliyat sonrasý ikinci günde hasta genel cerrahi kliniðine devredildi ve tanýsal laparotomi uygulandý. Ana hepatik kanal tamamen ayrýþmýþtý ve hastanýn hemodinamik olarak stabil olmamasý nedeniyle hastanýn safra yolunun eksternal fistül þeklinde býrakýlmasýna karar verildi. Hasta ameliyat sonrasý 10. gününde taburcu edildi. Hastanýn klinik takiplerine devam edildi ve elektif þekilde roux-n-y hepatikojejunostomi uygulandý. Ekstrahepatik safra yollarý klinik olarak nadir görülmekle birlikte kompleks multitravma hastalarýnda bu konuda þüphelenmek gereklidir. Hasarýn boyutu her hasta için özeldir ve tamir için kullanýlan cerrahi teknik zorlayýcý olabilmektedir

Extrahepatic bile duct injuries are very uncommon and easily be missed in multitrauma patients. Patients suffer from bile duct injuries need special approach to this situation. In this report, a case with total transection of common hepatic duct and treatment approach was presented. In unstable patients, damage control surgery can be applied. A 32-year-old male patient was brought to the emergency department after a beating that includes multiple blunt trauma. Radiological screening showed cranial, nasal, lumbar vertebral, and costal bone fractures, decreased blood flow to the right kidney and free perihepatic and perisplenic fluid. Neurosurgeons operated this patient at the day of admission and no plan for laparotomy was made for this patient at that time. Second day postoperatively patient was transferred to the department of surgery and exploratory laparotomy has been made. Common hepatic duct was fully transected and because of the patient’s hemodynamic instability, an external fistula has been made. The patient discharged 10th day postoperatively. The patient was operated after follow-up and a Roux-en-y hepaticojejunostomy has been made. Extrahepatic bile duct injuries are rare and high suspicion is important in complex multitrauma patients. Extent of the injury is unique for every patient and technical aspect of repair can be challenging.

Trakeanýn transeksiyonel yaralanmalarý oldukça nadirdir ve bu durumla anestezistlerin baþa çýkmasý zor olabilir. Künt travmalarýn içinde oldukça küçük bir yer kaplayan toraks yaralanmalarý, travma sonrasý ölümlerin %25’ini oluþturmaktadýr. Bunun sonucunda ortaya çýkan solunum yolu hasarý %0.5–2 oranýnda görülür. Tek bir travma merkezinden yakýn zamanda yapýlan bir çalýþmada, künt toraks yaralanmalarý nedeniyle trakeobronþiyal hasar insidansý %0.4 olarak saptanmýþ. Trakeal transeksiyonu olan hastalarýn çoðu, hava yolu kaybý nedeniyle olay yerinde hayatýný kaybeder. Hastalar çoðunlukla, ses kýsýklýðýndan solunum kollapsýna kadar deðiþen klinik özellik yelpazesine sahiptir. Derialtý amfizem olasý trakeobronþiyal hasarý (TBH) düþündürmesi gereken en yaygýn bulgudur. Konservatif yaklaþýmýn olumlu sonuclarý nedeniyle acil cerrahi giriþim nadiren tercih edilir. Künt toraks travmasýna baðlý trakeobronþiyal yaralanma sonrasý trakeal entübasyona raðmen zor ventilasyon kliniðine sahip bir vakanýn yönetimini sunuyoruz. Bu hastalarda fiberoptik bronkoskop (FOB), bölgeyi ve yaralanmanýn ciddiyetini göstermek ve boyun eksplorasyonu, trakeanýn primer end-to-end anastomozu, trakeostomi, faringostomi ve beslenme jejunostomisini sýrasýnda güvenli hava yolunu saðlamak için zorunlu görünmektedir.

Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesiologists to deal with. About 25% of post-traumatic deaths are due to thoracic traumas in which blunt injuries take a rather small place within and the resultant damage of respiratory tract is quite rare with an incidence of 0.5–2%. A recent review from a single trauma center revealed an incidence of 0.4% for tracheobronchial injury (TBI) due to blunt thoracic injuries. Most of the patients having tracheal transection lose their lives on the field due to loss of airway. Patients mostly present with a large spectrum of clinical features varying from hoarseness to respiratory collapse; though subcutaneous emphysema is the most common presenting sign which should remind possible TBI. Emergent surgery is preferred seldomly; such in cases of partial damage or because of late diagnosis, due to favorable outcome of conservative approach. Herein, we report the management of a case on TBI due to blunt thoracic trauma, experiencing difficult ventilation despite tracheal intubation. Fiber-optic bronchoscope (FOB) seems obligatory to visualize site and severity of injury and to ensure safe airway during procedures such as the neck exploration, primary end-to-end anastomosis of the trachea, tracheostomy, diversion pharyngostomy, and feeding jejunostomy.