AMAÇ: Kýsa baðýrsak sendromu (SBS) ince baðýrsaklarýn uzunluðunun azalmasýna baðlý vücut için gerekli olan sývý veya besinlerin emilim eksikliðine yol açan mortalitesi ve morbiditesi yüksek klinik durumdur. Glutamin ise baðýrsak mukoza hücrelerinin beslenmesini ve proliferasyonunu artýran bir proteindir. Bu çalýþmanýn temel amacý SBS geliþen ratlarda Glutaminin intestinal neomucosa oluþumu üzerine olan etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: On altý wistar-Hannover sýçan üzerinde ileumun mukozal yüzeyi ile parietalperiton yüzeyinin (karýn duvarýna yapýþýk) arasýnda enteroperitoneal anastomoz yapýldýktan sonra rastgele iki eþit gruba bölündü. Grup 1 (kontrol grubu), Salin ile tedavi edilirken grup 2 Glutamin ile tedavi edildi. On dört gün sonra tüm sýçanlara ötenazi uygulandý ve kan alýndý. Eþ zamanlý olarak anastomoz parçasýnýn en blok rezeksiyonu yapýlarak neomukoza oluþumu yönü ile histopatolojik inceleme yapýldý. Glutaminin anastomoz üzerine olan etkileri mikroskobik ve biyokimyasal analizler yapýlmak sureti ile belirlendi.
BULGULAR: Biyokimyasal analizler serumda oksidan (MDA ve 8-OHdG), antioksidan (SOD ve GPx) parametrelerin ölçümü ile yapýldý. Kontrol grubu ve Glutamin verilen grubun antioksidan deðerlerinin biyokimyasal deðerlendirme sonuçlarýna göre Glutamin verilen sýçanlarda serum anti-oksidan seviyesi (SOD ve GPx aktivitesi) kontrol grubuna göre anlamlý ölçüde yüksek (p<0.05) iken oksidatif hasarýn (MDA ve 8-OHdG) kontrol grubuna göre düþük olduðu (p<0.05) gözlendi. Neomukoza oluþumu yönü ile yapýlan histolojik deðerlendirme sonucunda ise Glutamin verilen grupta neomukoza oluþumu sayýca fazla olmasýna raðmen kontrol grubuna göre istatistiksel olarak anlamlý çýkmamýþtýr (p=0.315).
TARTIÞMA: Kýsa baðýrsak sendromu geliþen hastalarda Glutamin kullanýmý neomukoza oluþumunu artýrarak yüzey emilimini artýrabilir. Ancak bunun yeterince güçlü klinik deneylerle belirlenmesi gerekiyor.

BACKGROUND: Short bowel syndrome (SBS) is a clinical condition with high mortality and morbidity, which leads to the lack of absorption of fluids or nutrients necessary for the body due to the decrease in the length of the small bowel (SB). Glutamine is an amino acid essential for the nutrition and proliferation of intestinal mucosa cells. The main aim of the present study was to investigate the effect of glutamine on intestinal neomucosa formation in rats which developed SBS.
METHODS: Sixteen Wistar Hannover rats were randomly divided into two groups of eight rats. Saline was applied to the rats in Group 1 (control) following the enteroperitoneal anastomosis between mucosal surface of the ileum and the parietal peritoneum surface (adherent to abdominal wall) while glutamine was applied to the rats in Group 2 following the same anastomosis. Fourteen days later, the rats were euthanatized and blood samples were taken. Simultaneously, en bloc resection of the anastomosis part was performed and histopathological examination was carried out to observe neomucosa formation. The effects of glutamine on anastomosis were determined by microscopic and biochemical evaluations.
RESULTS: Biochemical analyses were performed by measuring serum oxidant (malondialdehyde [MDA] and 8-hydroxy-2’-deoxyguanosine [8-OHdG]) and antioxidant (superoxide dismutase [SOD] and glutathione peroxidase [GPx]) parameters. Based on the biochemical evaluation results of the antioxidant values of the control and glutamine groups, it was found that while the serum antioxidant level (SOD and GPx activity) was significantly higher (p<0.05) in the glutamine-administered rats compared to the control group, the oxidative damage (MDA and 8-OHdG) was lower (p<0.05). In terms of the histological evaluations made for the neomucosa formation, the number of neomucosa formation was higher in the glutamine group, but the difference was not significant (p=0.315).
CONCLUSION: The use of glutamine in patients with SBS may increase surface absorption by increasing neomucosa formation. However, additional studies of large statistical power are needed.

AMAÇ: Hepatopankreatobiliyer cerrahi ile uðraþan cerrahlarýn en korkulan komplikasyonlarýndan biri hepatik arter (HA) yaralanmalarýdýr. Bu çalýþmada, ciddi morbidite ve mortalite riski olan HA yaralanmalarýnýn (laserasyon, transseksiyon, ligasyon ve rezeksiyon) yönetiminde son yýllarda geliþen yaklaþýmlarýn, klinik deneyimlerimiz ýþýðýnda incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Hastanemizde son 10 yýlda, hepatopankreatobiliyer patoloji nedeniyle opere edilen 615 hastanýn dosyalarý geriye dönük olarak incelendi.
BULGULAR: Toplam 13 HA travmasý tespit edildi, bunlardan sekzinde HA yaralanmasý vardý ve beþinde HA rezeksiyonu planlandý. Ameliyat sonrasý takip döneminde karaciðer apsesi, anastomoz kaçaðý ve geç biliyer darlýk tespit edildi.
TARTIÞMA: Hepatik arter yaralanmasý veya ligasyonuna baðlý komplikasyonlar ve ölümler günümüzde daha az yaygýndýr. Hemodinamik olarak stabil olmayan, sarýlýk, kolanjit ve sepsisli hastalarda komplikasyon riski artar. Ameliyat öncesi radyolojik deðerlendirmedeki varyasyonlarýn ortaya çýkarýlmasý ve uygun yaklaþým planýnýn belirlenmesi riskleri azaltacaktýr. HA yaralanmasý saptanan durumlarda primer anastomoz, arter transpozisyonlarý veya greftlerle arteriyel akým devamlýlýðý saðlanmaya çalýþýlmalýdýr.

BACKGROUND: One of the most feared complications of surgeons dealing with hepato-pancreato-biliary (HPB) surgery is hepatic artery (HA) injury. Here, we aimed to evaluate our clinical experience (laceration, transection, ligation, and resection) related to HA traumas, which have serious morbidity and mortality risks, in the light of literature data and the rapidly evolving management methods in recent years.
METHODS: The files of 615 patients who were operated on for HPB pathologies in the last decade, in our hospital, were retrospectively reviewed. Clinical, laboratory, and imaging data obtained from patients’ files were evaluated.
RESULTS: A total of 13 HA traumas were detected, eight of them had HA injury and five had planned HA resection. During the post-operative follow-up period, liver abscess, anastomotic leakage, and late biliary stricture were detected.
CONCLUSION: Complications and deaths due to HA injury or ligation are less common today. The risk of complications increases in patients with hemodynamically unstable, jaundice, cholangitis, and sepsis. Revealing the variations in the pre-operative radiological evaluation and determining the appropriate approach plan will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to be maintained with primary anastomosis, arterial transpositions, or grafts.

AMAÇ: Peptik ülser perforasyonu (PUP), akut karýn nedenlerinden biridir, bu durumun insidansý tüm abdominal acillerin %5’idir. PUP sonrasý morbidite ve mortalite için çok sayýda prognostik faktör bildirilmiþtir, bu çalýþma PUP’lu hastalarda mortalite ve morbiditeyi etkileyen faktörleri analiz etmeye çalýþmaktadýr.
GEREÇ VE YÖNTEM: Ocak 2008–Ocak 2018 tarihleri arasýnda kliniðimizde PUP nedeniyle opere edilen hastalarýn týbbi kayýtlarý geriye dönük olarak incelendi. Bu çalýþmaya toplam 318 hasta dahil edildi. Hastalar geriye dönük olarak yaþ, cinsiyet, komorbidite, ASA skoru, biyokimyasal, hematolojik parametreler, komplikasyonlar ve mortalite açýsýndan incelendi. Morbidite ve mortaliteyi etkileyen risk faktörleri de deðerlendirildi. BULGULAR: Çalýþma popülasyonu 318 hastadan oluþmaktaydý ve hastalarýn yaþ ortalamasý 41.30±19.37 (min-maks: 16–89) idi. Çalýþmada 271 (%85.22) hasta erkek, 47 (%14.78) kadýn ve erkek/kadýn oraný 5.76 idi. Morbidite belirteçlerinin analizinde, yaþ ≥60, (p<0.001); perforasyon-cerrahi aralýðý >24 saat (p<0.001); pürülan intraperitoneal kontaminasyon (p<0.001); ameliyat öncesi böbrek yetersizliði (p<0.001); duodenal perforasyon (p<0.001); ameliyat öncesi þok (p<0.001) ve ASA skoru >III (p<0.0001) istatistiksel olarak anlamlý bulundu. Cinsiyet istatistiksel olarak anlamlý bulunmadý (p=0.672). Ameliyat sonrasý dönemde 318 hastanýn 15’inde (%4.71) mortalite geliþti. Çok deðiþkenli analizde yaþ ≥60, (p<0.001); perforasyon-cerrahi aralýðý >24 saat (p<0.001); pürülan intraperitoneal kontaminasyon (p<0.001); ameliyat öncesi böbrek yetersizliði (p<0.001); duodenal perforasyon (p<0.001) ve ameliyat öncesi þok (p<0.001) ameliyat sonrasý mortalitenin baðýmsýz öngörücüleri olarak bulundu. TARTIÞMA: Çalýþmamýzda; yaþ ≥60, perforasyon-ameliyat aralýðý >24 saat, pürülan intraperitoneal kontaminasyon, ameliyat öncesi böbrek yetersizliði, duodenal perforasyon, ameliyat sonrasý dönemde ameliyat öncesi þok ve yoðun bakým ünitesi ameliyat sonrasý morbidite ve mortalitenin baðýmsýz öngördürücüleri olarak bulundu. Kapsamlý bir klinik deðerlendirme, yeterli sývý resüsitasyonu, uygun antibiyotik tedavisinin baþlatýlmasý ve cerrahiye erken eriþim, PUP’ta morbidite ve mortalite riskini en aza indirebilir.

BACKGROUND: Peptic ulcer perforation (PUP) is one of the cause of acute abdomen, incidence of this entity is 5% of all abdominal emergencies. Numerous prognostic factors have been reported for morbidity and mortality after PUP, this study attempts to analyze the factors affecting mortality and morbidity in patients with PUP.
METHODS: The medical record of patients who were operated for PUP in our clinic was retrospectively evaluated between January 2008 to January 2018. A total of 318 patients were included in this study. Patients were retrospectively analyzed in terms of age, gender, comorbidity, ASA score, biochemical, hematological parameters, complications, and mortality. The risk factors affected to morbidity and mortality were also evaluated.
RESULTS: The study population consisted of 318 patients and the mean age of the patients was 41.30±19.37 (min-max: 16–89). In the study, 271 (85.22%) patients were male and 47 (14.78%) were female and male to female ratio was 5.76. In the analysis of the predictors of morbidity, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); pre-operative shock (p<0.001); and ASA score > III (p<0.0001) were found statistically significant. Gender was not found statistically significant (p=0.672). Mortality developed in 15 (4.71%) of 318 patients in the post-operative period. In the multivariate analysis, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); and pre-operative shock (p<0.001) were found to be independent predictors of post-operative mortality.
CONCLUSION: In our study, age ≥60 years, perforation-surgery interval >24 h, purulent intraperitoneal contamination, pre-oper-ative renal failure, duodenal perforation, pre-operative shock, and intensive care unit in the post-operative period were found to be independent predictors of post-operative morbidity and mortality. A comprehensive clinical evaluation, adequate fluid resuscitation, initiation of appropriate antibiotic therapy, and early access to surgery can minimize the risk of morbidity and mortality in PUP.

AMAÇ: Feokromasitoma eksizyon cerrahisinin anestezi yönetimi ciddi hemodinamik dalgalanmalarla iliþkilidir. Bu çalýþmanýn amacý, feokromasitomada magnezyum-deksmedetomidin ile tedavi edilen grup ile geleneksel grup arasýnda sodyum nitroprussid uygulamasý gerektiren hipertansif kriz sayýsýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük kohort çalýþmasý, 2011–2020 yýllarý arasýnda feokromasitoma ameliyatý geçiren hastalarý içermektedir. Hastalar iki gruba ayrýldý: 1- Geleneksel grup (GC); 2011–2015 yýllarý arasýnda standart anesteziyoloji hazýrlýðý ile ameliyat edilen ve perioperatif ek ilaç almayan hastalarý içeriyordu. 2-Magnezyum-deksmedetomidin tedavi grubu (GMD); 2015–2020 yýllarý arasýnda ameliyat edilen ameliyattan bir hafta önce günde oral 300 mg Magnezyum ve intraoperatif olarak magnezyum-deksmedetomidin infüzyonu alan hastalardan oluþuyordu. Ameliyat boyunca kan basýncý, kalp atým hýzý ve sodyum nitroprussid gereksinimi, demografik ve operatif veriler kaydedildi. Hipertansif kriz sistolik kan basýncý >180 mmHg, taþikardi ise kalp atým hýzý >110 atým olarak tanýmlandý.
BULGULAR: Toplam 108 hastanýn dökümanlarýndan 78 hastanýn verileri analiz edildi (GC’de 38, GMD’de 40 hasta). Sodyum nitroprussid gereksinimi GC’de (%39.5) GMD’ye (%7.5) göre anlamlý derecede yüksekti (p=0.001). Tümör manipülasyonu dönemindeki sistolik kan basýnçlarý, GC’de 10., 15., 20., 25., 30. ve 35. dakikalarda GMD’ye göre istatistiksel olarak daha yüksekti. Tümör manipülasyon periyodunun 10. ve 15. dakikalarýnda kalp atým hýzý deðerleri GC’de GMD’ye göre anlamlý derecede yüksekti (p<0.05).
TARTIÞMA: Magnezyum-deksmedetomidin kombinasyonu, feokromasitomanýn perioperatif yönetiminde vazodilatatör gereksinimini azaltmak için alternatif bir tedavi gibi görünmektedir.

BACKGROUND: Anesthesia management of pheochromocytoma excision surgery is associated with severe hemodynamic fluctuations. The objective of this study is to compare the number of hypertensive crisis requiring sodium nitroprusside (SNP) administration between the groups treated with magnesium (Mg)-dexmedetomidine (Dex) and conventional group in pheochromocytoma.
METHODS: This retrospective cohort study included patients who underwent pheochromocytoma surgery between 2011 and 2020. Patients were examined into two groups: 1-Conventional group (GC) included patients who were operated between 2011 and 2015 under standard anesthesia care and who did not receive perioperative additional medication. 2- Mg-Dex therapy group (GMD) comprised the patients who were operated between 2015 and 2020 and who had received 300 mg Mg per oral daily 1 week before the surgery and Mg-Dex infusion intraoperatively. Blood pressure, heart rate (HR), and SNP requirement were recorded throughout surgery as well as demographics and operative data. Hypertensive crisis was defined as systolic blood pressure (SBP) >180 mmHg, and tachycardia was defined as HR >110 bpm.
RESULTS: A total of 78 patients’ data were analyzed from 108 patients’ documentary. (38 in GC, 40 in GMD) SNP requirement was significantly higher in GC (39.5%) comparing GMD (7.5%) (p=0.001). SBPs during tumor manipulation period were statistically higher in GC than in GMD at 10th, 15th, 20th, 25th, 30th, and 35th min. HR values were significantly higher in GC compared to GMD at 10th and 15th min of tumor manipulation period (p<0.05).
CONCLUSION: Combination of Mg-Dex seems to be an alternative therapy for reducing vasodilator requirement in perioperative management of pheochromocytoma.

AMAÇ: Dalak, künt travma nedeniyle yaygýn olarak yaralanan bir batýn içi organdýr. Künt dalak yaralanmasý vakalarýnda sýklýkla acil tedavi gerekir. Bu çalýþma, künt dalak yaralanmasý olan hastalarýn tedavisinde travma merkezleri kurulmasýnýn prognostik etkisini araþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: 2012–2019 yýllarý arasýnda dalakta künt yaralanma nedeniyle merkezimizi ziyaret eden 235 hastayý geriye dönük olarak inceledik. Çalýþma süresi iki gruba ayrýldý: Ocak 2012–Eylül 2015 arasý travma merkezi öncesi dönem (TÖD) ve Eylül 2015–Aralýk 2019 arasý travma merkezi dönemi (TMD). Her bir dönemde, üç tedavi grubu mevcuttu: Cerrahi grup, embolizasyon grubu ve konservatif tedavi grubu. Birincil sonuç mortalite idi; ikincil sonuçlar ise, yaralanma þiddeti skoru (ISS) ve kýsaltýlmýþ yaralanma ölçeði puaný gibi hasta özellikleri, baþvurudan müdahaleye kadar geçen süre (hem cerrahi hem de anjiyografi embolizasyonu) ve dalak koruyucu cerrahi oraný idi.
BULGULAR: Konservatif tedavi grubunda TMD’de Hb ve Hct deðerleri, TÖD’ye göre nispeten düþüktü (sýrasýyla, p=0.007, p=0.008). TMD’de yoðun bakýma yatýþ oraný nispeten yüksekti (%72.9’a karþý %90.6, p=0.031). TMD’de yaralanma þiddeti skoru (ISS) nispeten düþüktü (18’e karþý 17, p=0.001). Cerrahi grubunda, hasta kabulünden sonra ameliyathaneye transfer için geçen süre TMP’de büyük ölçüde azalmýþtýr (151 dakikaya karþý 107 dakika, p=0.028). Embolizasyon grubunda hastanýn yaþý ve SBP, TÖD’de TMD’ye göre daha düþüktü (sýrasýyla p=0.003, p=0.049); TÖD’de üç hastaya CPR ile embolizasyon uygulanmýþ, TMD’de ise hiçbir hastaya CPR uygulanmamýþtý. TÖD’de üç ölüm mevcuttu; TMD’de hiç ölüm gerçekleþmemiþti (p=0.05).
TARTIÞMA: Bir travma merkezinin kurulmasý, künt dalak yaralanmasý olan ve üç tedaviden birini alan hastalarýn tedavi kalitesinde ve prognozunda iyileþmelere yol açmýþtýr.

BACKGROUND: The spleen is a commonly injured intra-abdominal organ from blunt trauma. In cases of traumatic blunt spleen injury, immediate treatment is often required. This study aimed to investigate the prognostic impact of the establishment of a trauma center on the treatment of patients with blunt trauma injury to the spleen.
METHODS: We retrospectively reviewed 235 patients who visited our center from 2012 to 2019 for blunt trauma injury to the spleen. The study period was divided into two groups: January 2012 to September 2015 was the pre-center period (PCP), and September 2015 to December 2019 was the trauma center period (TCP). In each period, there were three treatment groups: Surgical group, embolization group, and conservative treatment group. The primary outcome was mortality, and the secondary outcomes were patient characteristics, such as injury severity score and abbreviated injury scale score, time from admission to intervention (both surgery and angiography embolization), and rate of spleen-preserving surgery.
RESULTS: In the conservative treatment group, the Hb and hct values were relatively low in the TCP than in the PCP (p=0.007, p=0.008, respectively). The intensive care unit admission rate was relatively high in the TCP (72.9% vs. 90.6%, p=0.031). The ISS was relatively low in the TCP (18 vs. 17, p=0.001). In the surgical group, the time taken to transfer patients to the operating room after admission was greatly reduced in the TCP (151 min vs. 107 min, p=0.028). In the embolization group, the patient’s age and SBP were lower in the PCP than in the TCP (p=0.003, p=0.049, respectively); three patients had undergone embolization with CPR in the PCP, and no patient underwent CPR in the TCP. There were three deaths in PCP and none in the TCP (p=0.05).
CONCLUSION: The establishment of a trauma center has led to improvements in the treatment quality and prognosis of patients with blunt trauma injury to the spleen receiving either of the three treatments.

AMAÇ: Safra kesesi hastalýklarý geliþmiþ ülkelerde nüfusun yaklaþýk %20’sini etkileyen önemli bir saðlýk sorunudur. Akut kolesistit, safra taþý hastalýðýnýn en yaygýn komplikasyonudur ve tipik olarak semptomatik safra taþý öyküsü olan hastalarda geliþir. Çalýþmamýzýn amacý kolay uygulanabilen, hýzlý sonuç veren ve enflamatuvar olaylarla iliþkisi olduðu düþünülen bir belirteç olan nesfatin-1’in; akut kolesistitin tanýsýnda ve evrelendirilmesinde kullanýlabilirliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya Ýstanbul Eðitim ve Araþtýrma Hastanesi’ne 01.07.2020 ile 01.12.2020 tarihleri arasýnda akut kolesistit ile baþvuran ve hastaneye yatýrýlarak tedavi gören hastalar alýndý. Hastalar rutin kan incelemeleri ve görüntüleme yöntemleri baz alýnarak yapýlan Tokyo Guidelines 2018 sýnýflamasýna göre hafif, orta ve aðýr þiddette kolesistit olarak üç ana gruba ayrýldý. Çalýþmaya dahil edilen tüm hastalardan yatýþ sonrasý 24 saat içinde kan alýnarak kanda lökosit, nötrofil, lenfosit, nötrofil/lenfosit ve nesfatin-1 seviyeleri ölçüldü.
BULGULAR: Her grupta en az 15 kiþi olmak üzere saðlýklý gönüllüler, hafif kolesisit, orta kolesistit ve aðýr kolesistit olarak toplam 61 gönüllü çalýþmaya dahil edildi. Çalýþmaya katýlanlarýn ortalama yaþý 58.11±19.76 yýl, kadýn oraný yüzde 47.54 ve erkek oraný 52.46 idi. Çalýþmada hasta gruplarýndaki nesfatin-1 deðerleri kontrol grubuna göre düþük saptanmýþtýr. Alt grup analizlerinde orta hasta grubundaki nesfatin-1 deðerleri kontrol grubuna göre anlamlý olarak daha düþük bulunmuþtur; ancak hastalýðýn þiddeti ile nesfatin-1 arasýnda anlamlý istatistiksel bir iliþki görülmemiþtir.
TARTIÞMA: Sonuç olarak nesfatin-1 hastalýðýn tanýsý için klinisyeni yönlendirebilir; ancak nesfatin-1 ile hastalýðýn þiddeti veya evresi arasýnda anlamlý iliþki bulunmamýþtýr. Bulgularýmýz gelecekteki çalýþmalar için umut vericidir.

BACKGROUND: Gallbladder diseases are an important health concern affecting approximately 20% of the population in developed countries. Acute cholecystitis is the most common complication of gallstones. The aim of our study is to determine the use of Nesfatin-1, which is an easily applicable and fast resulting and is thought to have an association with inflammatory events, in the diagnosis and grading of acute cholecystitis.
METHODS: Patients who admitted and were hospitalized and treated with the acute cholecystitis diagnosis in Ýstanbul Training and Research Hospital between July 1, 2020, and December 1, 2020, were included in the study. The patients were divided in threemain groups as mild, moderate, and severe according to Tokyo Guidelines 2018 based on their routine blood tests and imaging results. All patients who are included in the study were tested for their blood leukocyte, neutrophil, lymphocyte, Nesfatin-1 levels, and neutrophil/lymphocyte ratios within the first 24 h of their hospitalization.
RESULTS: With at least 15 patients in each group, 61 volunteers in total were included in the study as healthy volunteers, mild, moderate, and severe cholecystitis. The average age of the participants were 58.11±19.76 years. About 47.54% of the participants were female and 52.46% weremale. In the study, Nesfatin-1 levels in the patient groups were found to be lower than the control group. In the subgroup analyzes, Nesfatin-1 values in the middle patient group were found to be significantly lower than the control group; however, there was no statistically significant relationship between the severity of the disease and Nesfatin-1.
CONCLUSION: Nesfatin-1 may guide the clinician for the diagnosis of the disease; however, no significant relationship was found between Nesfatin-1 and the severity or stage of the disease.

AMAÇ: Akut apandisitte perforasyonun erken tahmini ve teþhisi cerrahlarýn en uygun tedaviyi seçmesine olanak tanýr. Bu çalýþmanýn amacý, ameliyat öncesi rutin laboratuvar incelemelerinin komplike akut apandisiti öngörmede rolü olup olmadýðýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmada 2014–2019 yýllarý arasýnda akut apandisit tanýsý ile ameliyat edilen 783 hasta geriye dönük olarak incelendi. Perfore olmayan ve perfore akut apandisiti olan hastalar arasýnda ameliyat öncesi laboratuvar testleri arasýnda lökosit (WBC), nötrofil, lenfosit, trombosit (PLT), ortalama trombosit hacmi (MPV), trombosit daðýlým geniþliði (PDW), C-reaktif protein bulunur. Çalýþmada CRP ve nötrofil-lenfosit oraný (NLR) parametreleri karþýlaþtýrýlmýþtýr.
BULGULAR: Toplam 81 olguda histopatolojik olarak apandisit saptanmamýþtýr. Çalýþmada 702 hastanýn %89.9’u (n=631) perfore bulunmamýþtýr, %10.1’i (n=71) perfore akut apandisit tanýsý almýþtýr. Yaþlý hastalarda perforasyon oraný daha yüksek bulunmuþtur (p<0.01). Lenfosit sayýsýnýn perfore grupta anlamlý olarak daha düþük olduðu, CRP ve NLR’nin anlamlý olarak yüksek olduðu görüldü (sýrasýyla p=0.048, p=0.001, p=0028). Perfore akut apandisit tanýsýnda eþik deðerleri CRP için 44.0 mg/dL, NLR için 7.65 ve lenfositler için 1.7/mm3 idi. Gruplar arasýnda WBC, nötrofil, PLT, MPV ve PDW deðerleri açýsýndan istatistiksel olarak fark yoktu.
TARTIÞMA: Düþük lenfosit sayýsý, yüksek CRP ve yüksek NLR, komplike akut apandisit tanýsýnda güvenilir ve güçlü prediktif parametreler olarak bulunmuþtur.

BACKGROUND: Early prediction and diagnosis of perforation in acute appendicitis allow surgeons to choose the most appropriate treatment. The purpose of this study is to evaluate whether pre-operative routine laboratory examinations have a role in predicting complicated acute appendicitis.
METHODS: In the study, 783 patients operated with the diagnosis of acute appendicitis between the years 2014 and 2019 were analyzed retrospectively. Among the patients with non-perforated and perforated acute appendicitis, pre-operative laboratory tests include leukocyte (WBC), neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte rate (NLR) parameters were compared.
RESULTS: Appendicitis was not detected histopathologically in 81 cases. In the study, 89.9% (n=631) of the 702 patients were non-perforated and 10.1% (n=71) were perforated acute appendicitis cases. Perforation rate was higher in elderly patients (p<0.01). It was seen that lymphocyte count was significantly lower in the perforated group, and CRP and NLR were significantly higher (p=0.048, p=0.001, p=0.028, respectively). In the diagnosis of perforated acute appendicitis, cutoff values were 44.0 mg/dL for CRP, 7.65 for NLR and 1.7/mm3 for lymphocytes. There was no statistical difference between the groups in terms of WBC, neutrophil, PLT, MPV, and PDW values.
CONCLUSION: Low lymphocyte count, high CRP, and high NLR were found to be reliable and strong predictive parameters in the diagnosis of complicated acute appendicitis.

AMAÇ: Yanýk hasarý ve erektil disfonksiyon (ED) arasýndaki iliþkiyi araþtýran ileriye yönelik çalýþma sayýsý azdýr. Bu çalýþmanýn amacý, majör yanýk ile ilgili olarak erektil fonksiyonlardaki deðiþikliði ileriye yönelik olarak araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma, majör yanýk hasarý olan hastalarda ileriye yönelik bir araþtýrma olarak yürütüldü. Çalýþma grubu, Wallace Dokuz Kuralý’na göre vücut yüzey alanýnýn en az %20’sinin etkilendiði yanýk olgularýndan oluþuyordu. Yanýk ünitesindeki hastalara baþlangýçta Uluslararasý Erektil Disfonksiyon-5 Ýndeksi (IIEF-5) uygulandý ve üçüncü ve altýncý aylarda tekrarlandý. Yanýk tipleri, yanýklarýn þiddeti, hastalarýn yaþý ve IIEF-5 skorlarýndaki deðiþiklikler karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 63 erkek hasta alýndý. Hastalarýn ortanca yaþý 35 (20–73), ortanca yanma yüzdesi 22 (20–60) idi. ED oraný, baþlangýçta 3. ve 6. ay deðerlendirmelerinde sýrasýyla %8, %39.7 ve %25.4 olarak belirgin þekilde arttý. Hastalarýn ortanca baþlangýç IIEF-5 skoru 23 (5–25) idi. Alt grup analizi, elektrik ve alev yanýðý olan hastalarýn IIEF-5 skorunun, baþlangýç deðerlerine kýyasla üçüncü ve altýncý aylarda anlamlý derecede azaldýðýný ortaya koymuþtur.
TARTIÞMA: Mevcut çalýþma, majör yanýk hastalarýnýn IIEF-5 skorlarýnýn uzun vadede önemli bir bozulma gösterebileceðini göstermiþtir. Bu, daha uzun bir takip programýnda yanýk hastalarýnýn erektil fonksiyonunu izlemek için IIEF’in kullanýlabileceðini gösteren ilk ileriye yönelik çalýþmadýr.

BACKGROUND: There were few prospective studies investigating the relationship between the burn injury and erectile dysfunction (ED). The aim of this study was to prospectively explore the alteration in erectile functions regarding major burn.
METHODS: This study was conducted as a prospective survey in patients with major burn injury. The study group consisted of burn cases with at least 20% of body surface area affected according to the Wallace Rule of Nines. Initially International Index of ED-5 (IIEF-5) was administered to the patients in the burn unit, and it was repeated in the 2rd and 6th months. Burn types, the severity of burns, age of patients, and alteration in IIEF-5 scores were compared.
RESULTS: The study included 63 male patients. The median age of the patients was 35 (20–73) years, and the median burn percent-age was 22 (20–60). The rate of ED was markedly increased during follow-up as 8%, 39.7%, and 25.4% at baseline, 3rd, and 6th month evaluation, respectively. The median initial IIEF-5 score of the patients was 23 (5–25). Subgroup analysis revealed that IIEF-5 score of patients with electrical and flame burn significantly decreased at 3rd month compared with the baseline values. The median IIEF-5 score of patients with electrical burn increased at 6th month compared with 3rd month (p=0.042). Binary logistic regression analysis showed that age and service period, and IIEF-5 Score at 3rd month and burn grade were all statistically significantly associated with the normal erectile function (IIEF-5>=18), at 3rd month and 6th month, respectively.
CONCLUSION: The current trial demonstrated that IIEF-5 scores of patients with major burn can show significant impairment in long term, and it seems a time-dependent process. This is the first prospective trial showing that IIEF can be utilized to monitor erectile function of burn patients in a longer follow-up program.

AMAÇ: Klinik prezentasyonu akut batýnla veya akut batýn olmadan gerçekleþen tubal gebeliklerin (TG) demografik verileri, klinik bulgularý, ektopik gebelik (EG) lokalizasyonunu (sol veya sað taraflý) ve tedavilerini deðerlendirmek.
GEREÇ VE YÖNTEM: Tubal gebelik tanýlý gebeler akut batýn olsun veya olmasýn, EG lokalizasyonu (sað/sol), yaþ, parite, semptomlar (adet gecikmesi, vajinal kanama, kasýk aðrýsý), baþlangýç β-hCG deðeri, endometriyal kalýnlýk, rüptür varlýðý ve tedavi tipi (metotreksat, cerrahi) açýsýndan deðerlendirilmiþ ve karþýlaþtýrýlmýþtýr.
BULGULAR: Toplam 122 TG’li gebenin 32’si akut batýn göstermekteydi, 45’inin sað tüpünde ve 32’sinin sol tüpünde TG mevcuttu. Akut batýn grubunda parite, baþlangýç β-hCG düzeyi ve endometrial kalýnlýk akut batýn olmayan gruba göre daha fazlaydý. Buna ek olarak, akut batýn olmayan gruba göre kanama þikayetlerinin sýklýðý, sað taraflý TG olma, rüptür durumu ve ameliyat gerekliliði daha yüksekti. Sol taraflý TG olanlarda geçirilmiþ EG ve metotreksat tedavi sýklýðý, sað taraflý TG olanlara göre daha yüksekti.
TARTIÞMA: Acil servise akut batýn semptomlarý ile baþvuran TG’li hastalardaki EG, çoðunlukla sað tüpte yerleþmiþ olup daha fazla sýklýkta açýk cerrahi yoluyla salpenjektomiyi gerektirir.

BACKGROUND: The aim of the study was to evaluate the demographic data, clinical findings, ectopic pregnancy (EP) localization (left or right-sided), and treatments versus clinical presentation of tubal pregnancies (TP) with or without acute abdomen.
METHODS: Pregnants with a diagnosis of TP, selected for acute abdomen or not, were evaluated and compared, concerning EP local-ization (right/left), age, parity, symptoms (menstrual delay, vaginal bleeding, and groin pain), initial β-hCG value, endometrial thickness, presence of rupture, and treatment type (methotrexate and surgery).
RESULTS: On a total of 122 pregnants with TP, 32 showed acute abdomen, 45 had a TP located in the right tube and 32 in the left tube. In the acute abdomen group, parity, initial β-hCG level, and endometrial thickness were greater than non-acute abdomen group. In addition to this, the frequency of bleeding complaints, right-sided TP, rupture, and need for surgery were higher, than to the non-acute abdomen group. The frequency of the previous EP and methotrexate treatment was higher in those with the left-sided TP compared to those with the right-sided TP.
CONCLUSION: EP rate, in patients with TP who applied to the emergency department with acute abdominal symptoms, was mostly located in the right tube with greater frequency of salpingectomy in open surgery.

AMAÇ: Akut pankreatit (AP), önemli morbidite ve hatta mortalite ile iliþkili bir hastalýktýr. Etiyolojide özellikle safra taþlarý ve aþýrý alkol tüketimi olmak üzere çeþitli faktörler rol oynamaktadýr. Çoðu olguda hastalýðýn seyri genellikle hafif olmakla birlikte, bazý durumlarda hastalýk þiddetli olabilir ve pankreas veya peripankreatik nekroza yol açabilir. Radyolojik olarak “Balthazar CT þiddet indeksi” (CTSI), pankreatitte nekrozun þiddetini ve varlýðýný deðerlendirmek için kullanýlýr. Bu çalýþmada, Balthazar CTSI ile AP’nin þiddetini sýnýflandýrarak bazý serum parametreleri ile AP þiddeti arasýnda korelasyon olup olmadýðýný, hangi serum parametrelerinin AP þiddetini ve pankreas nekrozunun (PN) geliþimini tahmin etmek için güvenli bir belirteç olarak kullanýlabileceði araþtýrdýk.
GEREÇ VE YÖNTEM: 2012–2018 yýllarý arasýnda genel cerrahi kliniðimizde yatan ve AP tanýsý alan 341 hasta çalýþmaya dahil edildi. Hastalarýn hematolojik ve biyokimyasal parametreleri kaydedildi. Hastalarýn abdominal BT’leri Balthazar CTSI’ye göre deðerlendirildi. Bu parametreler ile Balthazar CTSI tarafýndan deðerlendirilen AP þiddeti arasýndaki iliþki araþtýrýldý.
BULGULAR: Çalýþmaya katýlan 341 hastanýn %19.4’ünde pankreas nekrozu saptandý. Balthazar CTSI tarafýndan abdominal BT’lerinde pankreas nekrozu saptanan hastalar; nötrofil sayýlarý, nötrofil/lenfosit oraný (NLR), trombosit/lenfosit oraný (PLR), nötrofil/monosit oraný (NMR) önemli ölçüde daha yüksekti ve serum albümini, pankreas nekrozu olan hastalara göre önemli ölçüde daha düþüktü.
TARTIÞMA: Nötrofil sayýsý, serum albümin seviyeleri, NLR, LR ve NMR, AP þiddetini belirlemek için prediktif belirteçler olarak kullanýlabilir.

BACKGROUND: Acute pancreatitis (AP) is a disease related to significant morbidity and even mortality. Various factors are involved in the etiology, especially gallstones and excessive alcohol consumption. Although, the course of the disease in most of the cases is generally mild, in some cases, the disease can be severe and lead to pancreatic or peripancreatic necrosis. Radiologically, “Balthazar computed tomography severity index” (CTSI) is used to assess the severity and presence of necrosis in pancreatitis. In this study, we classified the severity of AP in patients with Balthazar CTSI and investigated whether there is a correlation between some serum parameters and AP severity and which serum parameters can be used as a safe marker to predict the AP severity and the development of pancreatic necrosis (PN).
METHODS: A total of 341 patients diagnosed with AP and hospitalized in our general surgery clinic between the years 2012 and 2018 were included in this study. Hematological and biochemical parameters of the patients were recorded. Abdominal CT’s of the patients were evaluated according to the Balthazar CTSI. The correlation between these parameters and AP severity evaluated by Balthazar CTSI was investigated.
RESULTS: PN was detected in 19.4% of 341 patients who participated in the study. Patients whose PN detected in their abdominal CT’s by Balthazar CTSI; neutrophil counts, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio, plateletlymphocyte ratio, and neutrophil/monocyte ratio (NMR) were significantly higher and the serum albumin was significantly lower than patients with PN.
CONCLUSION: Neutrophil count, serum albumin levels, NLR, LR, and NMR can be used as predictive markers to determine AP severity.

AMAÇ: Hemofili, faktör VIII ya da IX eksikliði sonucu geliþen, nadir, herediter bir kanama bozukluðudur. Artropati, sinovit ve artrit gibi hemofilinin uzun dönem komplikasyonlarý tekrarlayýcý kronik aðrý geliþimine yol açabilir. Bu nedenle aðrý, hemofilinin kritik bir yönüdür. Son dönem hemofilik diz artropatisi için altýn standart tedavi total diz artroplastisidir. Bu çalýþmanýn hipotezi; diz replasman cerrahisi sonrasý, kronik analjezik tüketimi olan hemofilik hastalarýn hemofilik olmayan hastalara göre daha yüksek aðrý düzeyleri deneyimleyeceðidir.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya, genel anestezi altýnda ameliyat edilmiþ hemofilik ve hemofilik olmayan total diz artroplastisi hastasý 82 hasta alýndý. Yetmiþ üç hasta deðerlendirmeye alýndý ve hastalar hemofili tanýsý olup olmamasýna göre 2 gruba ayrýldý: 36 hasta hemofili grubunda ve 37 hasta hemofilik olmayan grupta incelendi.
BULGULAR: Ameliyat sonrasý tramadol (p=0.002) ve petidin tüketimi (p=0.003) de hemofilik grupta anlamlý olarak daha yüksekti. Hastane yatýþ süresi hemofilik grupta anlamlý olarak daha uzundu (p=0.0001).
TARTIÞMA: Bu bilgiler ýþýðýnda, hemofili hastalarýnýn akut ameliyat sonrasý aðrý yönetiminin, kiþiye özel, multimodal ve önleyici bir analjezi olarak planlanmasý gerektiðini düþünmekteyiz.

BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs.
METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group.
RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001).
CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

AMAÇ: Bu çalýþmanýn amacý, 2009–2020 yýllarý arasýnda hastanemize baþvuran ev tipi kýyma makinesine baðlý el yaralanmasý bulunan hastalarý deðerlendirmek, nedenlerini araþtýrmak ve korunma yollarýný tartýþmaktýr.
GEREÇ VE YÖNTEM: Kýyma makinesi sebebiyle yaralanan 64 hasta geçmiþe yönelik olarak tarandý. Hastalardan 1–18 yaþ aralýðýnda olanlar çocuk grubuna alýnýrken, 18 yaþ üstü hastalar eriþkin grupta deðerlendirildi. Hastalarýn yaþlarý, cinsiyetleri, sað el, sol el, el bileði, hangi parmak, parmaklarýn yaralanma seviyeleri arasýndaki iliþkiler analiz edildi.
BULGULAR: Hastalarýn 22’si çocuk, bunlarýn da 13’ü erkek 9’u kadýn ve yaþ ortalamalarý 11 (daðýlým 1–18 yaþ) idi. Hastalarýn 42’si eriþkin, bunlarýn da 15’i erkek 27’si kadýn ve yaþ ortalamalarý 42 (daðýlým19–74 yaþ) idi. Çocuk grupta 2. parmak metakarpofalangeal (MP) eklemde anlamlý fark bulundu (p=0.016). Çocuk grupta 3. parmak MP eklemde ileri derecede anlamlý fark bulundu (p=0.005). Çocuk grupta 4. parmak MP eklemde anlamlý fark bulundu (p=0.042). Çocuk grupta el bilek seviyesinde anlamlý fark bulundu (p=0.012). Eriþkin grupta sadece 3. parmak distal interfalangeal (DIP) eklemde ileri derecede anlamlý fark bulundu (p=0.007). Birinci ve 5. parmaklarda çocuk ve eriþkin yaþ gruplarý arasýnda anlamlý fark saptanmadý. TARTIÞMA: Bu tip yaralanmalarý önlemek için gerekli çalýþmalarýn yapýlmadýðý ve ulusal bir sorun olduðu görülmüþtür. Ayrýca bu tip yaralanmalarý önlemek için iþ güvenliði sadece iþ yerlerinde deðil evler içinde düþünülmeli ve ayný zamanda toplumu bilinçlendirme amacýyla eðitim çalýþmalarý yapýlmalýdýr.

BACKGROUND: The aim of the study was to evaluate patients with household meat grinder-related hand injuries who presented to our hospital between 2009 and 2020, investigate the causes of these injuries, and discuss prevention methods.
METHODS: Sixty-four patients injured by a meat grinder were retrospectively screened. The patients aged one to 18 years were evaluated in the pediatric group and those over 18 years were evaluated in the adult group. The relationships between age, gender, location of injury (right hand, left hand, wrist, and fingers), and amputation level were analyzed.
RESULTS: Twenty-two of the patients were children, of whom 13 were boys and nine were girls, with a mean age of 11 (range 1–18) years. There were 42 adult patients comprising 15 males and 27 females, and their mean age was 42 (range 19–74) years. In the pediatric group, the rate of amputations at the metacarpophalangeal (MP) and wrist joint levels were significantly higher compared to the adults (p<0.005). In the adult group, the rate of amputations at the third finger distal interphalangeal (DIP) joint was significantly higher compared to the pediatric group (p=0.007). There was no statistically significant difference between the pediatric and adult groups regarding the rate of amputations at the thumb and little finger levels.
CONCLUSION: There seems to be a lack of research to guide the development of strategies to prevent household meat grinder-related injuries, and this type of injury remains a national health problem. To prevent such injuries, occupational safety should be considered not only in workplaces but also at home, and information should be provided to raise the awareness of the society.

AMAÇ: Traneksamik asidin (TXA) ameliyat esnasýndaki kanamayý ve ameliyat sonrasý dönemde allojenik kan transfüzyonu ihtiyacýný azalttýðý gösterilmiþtir. Randomize kontrollü çalýþmamýzda intertrokanterik femur kýrýðý (ITFF) olan ve proksimal femoral çivileme (PFN) ile tedavi edilen ileri yaþ hasta grubunda ameliyat öncesi 15 mg/kg intravenöz TXA’nýn total kan kaybý (TBL), gizli kan kaybý (HBL) ve transfüzyon gereksinimi üzerine etkisini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýzda intertrokanterik femur kýrýðý tanýsýyla (AO tip 31-A1 ve 31-A2) kapalý redüksiyon ve PFN ile tedavi edilen hastalar iki gruba ayrýldý. Grup 1 (TXA grubu) kesi yapýlmadan 15 dakika önce, anestezi verildikten sonra, 100 cc salin içinde IV infüzyon þeklinde 15 mg/kg TXA uygulandý. Grup 2’ye (kontrol grubu) sadece 100 cc izotonik salin verildi. Çalýþmada öncelikli deðerlendirilen sonuç parametresi TBL idi. Ýkincil olarak deðerlendirilen sonuç parametreleri ise, transfüzyon sayýsý, cerrahi (intraoperatif) sýrasýndaki kan kaybý, HBL ve ameliyat sonrasý komplikasyonlar idi. Sonuç parametreleri iki grup arasýnda karþýlaþtýrýldý.
BULGULAR: Çalýþmamýza 102 hasta (her grupta 51 hasta) alýndý. Demografik özellikler ve ameliyat öncesi hemoglobin ve hematokrit deðerleri açýsýndan iki grup arasýnda istatistiksel olarak anlamlý fark bulunmamaktaydý. Ameliyat sýrasýnda ortalama toplam kan kaybý, TXA grubunda kontrol grubuna göre istatistiksel olarak daha düþüktü (sýrasýyla 684.6±370.1 ml ve 971.2±505.3 ml; p=0.002). Her iki grubun da ameliyat sýrasýndaki kan kaybý miktarý istatistiksel olarak farklý deðildi (TXA grubunda 102.4±59.3 ml ve kontrol grubunda 112.7±90.1 ml, p=0.67). Bununla birlikte, ortalama tahmini HBL, TXA grubunda kontrol grubuna göre önemli ölçüde daha düþüktü (sýrasýyla 582.3±341.2 ml vs. 857.8±493.1 ml; p=0.002). Ameliyat sonrasý kan transfüzyon oraný ve kan transfüzyon miktarý, TXA grubunda kontrol grubuna göre anlamlý olarak daha düþük bulundu (sýrasýyla, %8 ve %23.5 [p=0.033], 6 ünite ve 15 ünite [p=0.04] ]). Týbbi ve cerrahi komplikasyonlar açýsýndan her iki grup arasýnda anlamlý fark bulunamadý. TARTIÞMA: Ameliyat öncesi uygulanan tek doz TXA in, ITFF tanýsýyla PFN ile tedavi edilen hastalarda TBL, HBL ve kan transfüzyonu ihtiyacýný önemli ölçüde azaltýrken, derin ven trombozu veya tromboembolik olay riskini artýrmaz.

BACKGROUND: Tranexamic acid (TXA) has been shown to reduce intraoperative bleeding and the need for post-operative allogenic blood transfusion requirement in surgery. In our randomized controlled study, we aimed to evaluate the effect of pre-operative 15 mg/kg intravenous TXA on total blood loss (TBL), hidden blood loss (HBL), and transfusion requirement in elderly patient group with intertrochanteric femoral fracture (ITFF) and treated with proximal femoral nailing (PFN).
METHODS: Patients diagnosed with ITFFs (AO types 31-A1 and 31-A2) and treated using closed reduction and PFN was divided into two groups in our prospective randomized study. Group 1 (TXA group) was administered 15 mg/kg of TXA 15 min before the incision was made, after anesthesia was given, in the form of an IV infusion in 100 cc of saline. Group 2 (control group) was given only 100 cc of isotonic saline. The primary outcome of the study was TBL. The secondary outcomes were the number of transfusions, HBL, and the surgical (intraoperative) blood loss during the operative procedure and post-operative complications. The outcome values were compared between two groups.
RESULTS: One hundred and two patients (51 patients in each group) were included in our study. There were no statistically significant differences between the two groups in terms of their demographic characteristics and their pre-operative hemoglobin and hematocrit values. The mean TBL was statistically lower in the TXA group than in the control group (684.6±370.1 ml vs. 971.2±505.3 ml, respectively; p=0.002). The amount of intraoperative blood loss was not significantly different between two groups (102.4±59.3 ml in the TXA group vs. 112.7±90.1 ml in the control group, p=0.67). However, the mean estimated HBL was significantly lower in the TXA group than in the control group (582.3±341.2 ml vs. 857.8±493.1 ml, respectively; p=0.002). The post-operative blood transfusion rate and transfusion unit were found to be significantly lower in the TXA group than in the control group (8% vs. 23.5%, respectively [p=0.033], and 6 U vs. 15 U, respectively [p=0.04]). Both medical and surgical post-operative complications were found to be similar for two groups.
CONCLUSION: Single dose of TXA significantly reduces TBL, HBL, and the need for blood transfusions following PFN in elderly patients with ITFFs, while it does not increase the risk of DVT or thromboembolic events.

AMAÇ: Kalça kýrýðý olan yaþlý hastalarda ameliyat sonrasý bir yýllýk mortalite oraný yüksektir. Bu çalýþmanýn amacý nötrofil lenfosit oraný (NLR), trombosit lenfosit oraný (TLR) ve monosit lenfosit oraný (MLR) ile mortalite arasýndaki iliþkiyi araþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak 2015–Ocak 2020 tarihleri arasýnda femoral intertrokanterik kýrýk nedeniyle baþvuran 350 hastanýn verileri incelendi ve çalýþma kriterlerini karþýlayan 124 hastanýn demografik verileri deðerlendirildi. Bir yýllýk takipte hayatýna devam eden 92 hasta (%74) ile ölen 32 (%26) hasta, grup 1 ve grup 2 (%25) olarak ayrýldý. NLR, TLR, MLR ve yandaþ hastalýklar, yaþ, cinsiyet, ASA, hastanede kalýþ süresi, kýrýk tipi ve kýrýk paterni deðerleri bu iki grup arasýnda istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Çalýþma kapsamýnda deðerlendirilen laboratuvar parametreleri olan biyokimyasal parametrelerin ortalamasý þöyle idi: NLR 6.59 (1.61–26.29), TLR 197.94 (86–516) ve MLR 0.73 (0.19–15.68). Bu çalýþmada NLR, TLR, MLR deðerleri ile ameliyat sonrasý bir yýllýk mortalite oluþumu arasýnda istatistiksel olarak anlamlý bir iliþki bulundu (p=0.01) Ayrýca bu parametreler arasýndaki korelasyon iliþkisinde sonuç anlamlýydý. ROC (Alýcý operatör karakteristik eðrisi) analizinde kestirim deðerleri NLR için 7.53, TLR için 192 ve MLR için 0.54 olarak bulundu (p<0.01).
TARTIÞMA: NLR, TLR, PLR deðerleri 60 yaþ üstü kalça kýrýðý olan hastalarda bir yýllýk mortalite göstermede anlamlýdýr.

BACKGROUND: Elderly patients with hip fractures have a high post-operative 1-year mortality rate. The aim of this study was to investigate the relationship of the neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), and monocyte/lymphocyte ratio (MLR) with mortality.
METHODS: The data of 350 patients who suffered femoral intertrochanteric fractures between January 2015 and January 2020 were examined, and the demographic data of 124 patients who met the study criteria were evaluated. During the 1-year follow-up, 92 patients (74%) who continued their lives and 32 patients (25%) who died were divided into two groups: Group 1 (survivors) and Group 2 (non-survivors). NLR, TLO, MLO, presence of comorbidities, age, sex, American Society of Anesthesiologists Physical Status Classification, length of hospital stay, fracture type, and fracture pattern values were statistically compared between the two groups.
RESULTS: NLR, TLR, and MLR are the laboratory parameters assessed within the scope of the study. Preoperatively, the mean NLR was 6.59 (1.61–26.29), mean TLR was 197.94 (86–516), and mean MLR was 0.73 (0.19–15.68). In this study, a significant relationship was found between NLR, TLR, and MLR values and the occurrence of post-operative 1-year mortality (p=0.01). In addition, the result was significant in the correlation between these parameters. Cutoff values were found to be 7.53 for NLR, 192 for TLR, and 0.54 for MLR in receiver operator characteristic curve analysis (p<0.01).
CONCLUSION: NLR, TLR, and PLR are significant predictors of 1-year mortality in patients aged over 60 years with hip fractures.

Bu yazýda, hava tabancasý ile perikarda kurþun isabet eden dokuz yaþýndaki bir erkek çocuðu olgusu sunuldu. Perikarddaki penetran yaralanmanýn, ameliyat öncesi uygulanan taný yöntemlerine göre, baþlangýçta sol plevral boþluðun kardiyofrenik açýsýna nüfuz eden bir yaralanma olduðuna inanýlýyordu. Stabilize edilen hastada, sol anterior minitorakotomi yoluyla mermi bulunarak perikarddan baþarýyla çýkarýlmýþtýr. Burada, göðüs ve kalpte ateþli silah yaralanmasý olan pediatrik hastalarda ameliyat öncesi deðerlendirmenin sýnýrlarý, optimal tedavi prosedürleri ve cerrahi yaklaþýmlar tartýþýlmýþtýr.

The authors present the case of a 9-year-old boy who sustained a gunshot injury to the pericardium by an air gun. The penetrative wound to the pericardium was, according to the performed pre-operative diagnostic methods, initially believed to be a penetrative wound into the cardiophrenic angle of the left pleural cavity. The stabilized patient was indicated for an extraction of the projectile through a left anterior minithoracotomy, during which the projectile was found and successfully removed from the pericardium. The limits of pre-operative assessment, optimal treatment procedures, and surgical approaches in pediatric patients with gunshot injuries to the chest and heart are discussed.

Osteoseptokutanöz fibula flebi, kemik rekonstrüksiyonu için en deðerli ve en yaygýn kullanýlan fleptir. Ancak daha önce kýrýlmýþ fibulanýn kemik rekonstrüksiyonu için serbest veya pediküllü flep olarak kullanýmý literatürde sýnýrlý bilgiye sahiptir. Literatürde, yüksek enerjili yaralanma sonrasý kompozit tibial rekonstrüksiyon için anterograd pediküllü osteokutanöz fibula flebi olarak kullanýlan proksimal düzeyli kýrýklý fibula kemiði olan bir olgu hakkýnda veri bulunmamaktadýr. Ateþli silah yaralanmasý sonrasý proksimal tibial bölgenin kompozit defektinin osteokutanöz fibula flebi ile rekonstrükte edildiði bir hastada, proksimal seviyede kýrýðý olan fibulanýn subakut dönemde anterograd akým ile pediküllü bir þekilde kullanýlabileceði gösterilmiþtir ve bu flebin kullanýmýnýn akýlda tutulmasý gerektiði düþünülmektedir. Travma geçirmiþ fibula kemiði içerikli fibula flebi için, ameliyat öncesi BT anjiyografinin deðerlendirilmesi ve perioperatif peroneal arterin açýklýðýnýn ve akým yönünün teyit edilmesi sayesinde, bu flep subakut dönemde dahi kullanýlabilir. Subakut dönemde yaralanma bölgesine giren peroneal pedikül etrafýnda mevcut olabilecek enflamatuar alanlarýnýn total diseksiyonu ile iþlemin baþarýsý artýrýlabilir.

Osteoseptocutaneous fibula flap is commonly used as the workhorse flap for bone reconstruction. However, the use of previously fractured fibula as a free or pedicled flap for bone reconstruction has a limited knowledge in the literature. There is not any data in the literature about a case with proximal level of fibula fracture which was used as an anterograde pedicled osteocutaneous fibula flap for composite tibial reconstruction after high-energy injury. Based on a patient in whom the composite defect of the proximal tibial region was reconstructed with osteocutaneous fibula flap after a gunshot injury, it was tried to show that the fibula with a proximal level fracture could be used with anterograde flow in the subacute period and it is thought that the usability of this flap should be kept in mind. It is possible to harvest the pedicled fibula flap even in the subacute period with the evaluation of CT angiography preoperatively and with the checking the patency and flow direction of peroneal artery perioperatively. The success of the procedure may be increased through total dissection of inflammatory areas of pedicle which would extend into the injury zone during the subacute period.

Akut karýn, acil serviste sýklýkla karþýlaþýlan ciddi bir durumdur. Akut karýna neden olan çeþitli etiyolojiler vardýr, en sýk görülen akut apandisittir, ancak nadir akut karýn nedenleri de vardýr ve olaðandýþý klinik özelliklere sahip bir hastayla ilgilenirken bunlarý akýlda tutmak gerekir. Bu yazýda, akut karýn aðrýsý ve distansiyon ile acil servise baþvuran, 26 yaþýnda bir erkek hastayý sunuyoruz. Bilgisayarlý tomografide duodenumu invaze ederek perfore etmis ve akut karina neden olan büyük bir vasküler retroperitoneal kitlesi olduðu bulundu. Cerrahi tedavi olarak, duodenal perforasyon onarýmý ve kitle örneklenmesi uygulandý. Patoloji sonucu testis kaynaklý embriyonal karsinom bileþenli yolk sac tümörü olarak raporlandý. Orijinal tümör testiste tamamen gerilemiþ olmasýna raðmen, retroperitoneal bölgedeki metastazý klinik duruma neden olmuþtu. Bu antite, regrese olmuþ bir testis tümörünün retrope-ritoneal metastazý olarak tanýmlanýr. Retroperitoneal metastaz invazyonuna sekonder gastrointestinal kanama ile baþvuran az sayýda olgu bildirilmiþtir. Bildirdigimiz olgu literatürde duodenal perforasyon ve akut karýn ile prezente olan ilk olgudur. Acil cerrahi müdahale sýrasýnda histopatolojik taný için retroperitoneal tümörün örneklenmesi, bu olgularda tanýyý kolaylaþtýrýr. Testis tümörü belirteçleri ile kombine skrotal muayene hasta yönetimi için gerekli olmasýna raðmen, normal skrotal muayene mevcudiyetinde testis tümörünun tam regrese olma olasýlýðý akýlda tutulmalýdýr.

Acute abdomen is a serious condition frequently encountered in the emergency departments (ED). There are various etiologies causing acute abdomen, most common being acute appendicitis; however, there are rare causes of acute abdomen as well and one should keep them in mind while handling a patient with unusual clinical features. We herein present a 26-year-old male, with no past medical or surgical history, presenting with acute abdominal pain and distension to the ED. He was found to have a large vascular retroperitoneal mass on computed tomography which had invaded and perforated the duodenum thus causing the acute presentation. Repair of the duodenal perforation and sampling of the mass were performed in terms of surgical management. Pathology results revealed the mass originating from a burned out testis yolk sac tumor with embryonal carcinoma component. Although the original tumor had regressed at the testis, its metastasis at the retroperitoneal area had caused the clinical condition. This entity is described as the retroperitoneal metastasis of a burned-out testicular tumor. Few cases presenting with gastrointestinal bleeding secondary to invasion of the retroperitoneal metastasis have been reported. However, this is the first case in the literature presenting with duodenal perforation and acute abdomen. Sampling of the retroperitoneal tumor for histopathological diagnosis during the immediate surgical intervention facilitates the diagnostic management in these cases. Although scrotal examination combined with testis tumor marker assessments is essential for optimal patient management, the possibility of a burned-out testicular tumor with normal scrotal examination should always be kept in mind.

Koronavirüs (Covid-19) enfeksiyonlarýnda þiddetli akut solunum sendromuna sekonder pulmoner semptomlar, hastalýðýn en sýk görülen prezentasyonu olmakla birlikte, hastalarýn küçük bir kýsmýnda ciddi hemorajik komplikasyonlarýn da görülebildiði artýk bilinmektedir. Bu yazýda, antikoagülan tedavi sýrasýnda spontan rektus kýlýf hematomu (RSH) geliþen, Covid-19 enfeksiyonu olduðu bilinen üç yaþlý kadýn olgusu sunuldu. Bu olgular, yoðun bakým ünitelerinde Covid-19 hastalarýnda ani hemodinamik bozulma ve hemoglobin sayýsýnda azalma sonrasýnda bilgisayarlý tomografi (BT) incelemesi yapýlmasý gerektiðini vurgulamaktadýr. Bu klinik bozulma ve hemoglobin düþüþü spontan RSH’den kaynaklanabileceðinden muayene sýrasýnda dikkate alýnmalýdýr. Bu RSH’ler karýn boþluðuna açýlýrsa, iki olgumuzda gösterildiði gibi sonuç birkaç saat içinde ölümcül olabilir. Covid-19 hastalarýnda majör spontan kanama oldukça nadirdir, bu nedenle nadiren dikkate alýndýðý için ciddi komplikasyonlara neden olabilir. Böyle bir riskin gözardý edilmesi, özellikle acil servislerde ve yoðun bakým ünitelerinde hastalarýn prognozunu önemli ölçüde kötüleþtirebilir.

The pulmonary symptoms secondary to severe acute respiratory syndrome in coronavirus (COVID-19) infections are the most common presentation for the disease; however, it is now known that in a small portion of patients, severe hemorrhagic complications can also be seen. In this report, three cases of elderly women with known COVID-19 infection, developing spontaneous rectus sheath hematoma on anticoagulation therapy, are presented. Three cases presented above emphasize the need to perform a computed tomography examination after a sudden hemodynamic deterioration and a decrease in hemoglobin count in COVID-19 patients in intensive care units (ICUs). Since this clinical deterioration can be caused by spontaneous rectus sheath hematomas (RSH), it must be taken into consideration while examination. If these RSHs rupture into the abdominal cavity, the outcome may be fatal in few hours as represented in two of our cases. Major spontaneous hemorrhage in COVID-19 patients is quite uncommon; therefore, it may cause serious complications as it is rarely taken into consideration. Failure to acknowledge such a risk could significantly worsen the prognosis of the patients especially in ERs and ICUs.