AMAÇ: Akut pankreatit, pankreas enzim aktivitesinin arttýðý pankreas enflamasyonudur. Pankreasýn parasempatik uyarýmý, pankreasýn çeþitli fonksiyonlarýnda önemli rol oynar. Bu çalýþmanýn amacý, botulinum toksin’in (BTx), akut pankreatit’de pankreas aktivitesinin baskýlayabileceðini göstermektir.
GEREÇ VE YÖNTEM: Sýçanlarda deneysel ön çalýþmada 15 (u/kg) BTx, sýçan pankreasýna direkt veya intraduktal uygulandý. Kan amilaz, lipaz, tripsinojen, insülin ve glukagon seviyeleri 10 gün sonra ölçüldü ve anlamlý fark saptanmadý. Çalýþmaya klinik uygulanabilirlik açýsýndan akut pankreatit modelinde intraduktal BTx uygulama ile devam edildi. Kontrol, akut pankreatit (AP), intraduktal BTx ve akut pankreatit’de BTX (AP+BTx) gruplarý sekizer sýçandan oluþturuldu. Akut pankreatiti intraperitoneal cerulein (20µg/kg) ile saðlandý. Sýçanlar 24 saat sonra serum amilaz, lipaz, IL-6, IL-1β, TNF-α, ve IL-10 ölçümü için sakrifiye edildi. Pankreas dokularý enflamasyon ve nekroz incelemesi için alýndý.
BULGULAR: AP grubunda ortalama serum amilaz, lipaz, IL-6, IL-1β ve TNF-α deðerleri diðer gruplara göre anlamlý yüksek bulundu. Kontrol, BTx, AP+BTx gruplarý arasýnda ortalama serum amilaz ve lipaz deðerleri açýsýndan anlamlý fark saptanmadý. AP grubunda ortalama serum insulin ve gluka-gon deðerleri kontrol ve BTx grubuna göre anlamlý yüksek saptandý. Ortalama serum insülin ve glukagon düzeyleri AP ve AP+BTx gruplarý arasýnda anlamlý deðildi. Patolojik incemelede AP+BTx grubunda AP’ye göre daha az sentrilobüler nekroz, inflamasyon izlendi.
TARTIÞMA: Intraduktal BTx uygulamasý pankreas endojen aktivitesinde belirgin süpresyon yapmadan akut pankreatit’i baskýlamýþtýr.

BACKGROUND: Acute pancreatitis (AP) is inflammation of pancreas in which pancreas enzymatic activity is increased. Parasym-pathetic innervation of pancreas plays an important role in several functions of pancreas. Botulinum toxin (BTx) might be a tool to suppress the pancreas activity in AP.
METHODS: In the preliminary experimental study, BTx (15U/kg) was administered directly and intraductal ways. After 10 days, blood amylase, lipase, trypsinogen, insulin, and glucagon levels were compared and no significant difference was seen between groups. Intraductal BTx administration is preferred for experimental AP model in rats; control, AP, intraductal BTx, and AP with Intraductal BTx (AP+BTx). AP was created by intraperitoneal injection of cerulean 20 µg/kg/injection (5 times). After 24 h, serum amylase, lipase, IL-6, IL-1β, TNF-α, and IL-10 were measured and pancreas tissue was evaluated for inflammation and necrosis.
RESULTS: Mean serum amylase, lipase IL-6, IL-1β, and TNF-α levels of the AP group were significantly higher compared to the other groups (p<0.05). However, there was no significant difference between the amylase and lipase levels of control, BTx, and AP+BTx groups. Serum insulin and glucagon levels in AP group were significantly higher than control and BTx groups (p<0.05). However, there is no significant difference between the insulin and glucagon levels of AP and AP+BTx groups. in pathological evaluation. In AP+ BTx group, there is less amount of centrilobular necrosis and there is mild inflammation and hyperplasia of pancreatic duct epithelium.
CONCLUSION: Administration of intraductal BTx suppressed the AP without making significant suppression in endogenous activity of pancreas.

AMAÇ: Ýskelet kasý iskemi reperfüzyon hasarý (ÝRH) turnike uygulamalarý ve replantasyon sonrasý görülen klinik bir problemdir. Bu çalýþmada, klinik pratikte sýk kullanýlan bir molekül olan feniramin maleatýn (Ph) ÝRH’ný azaltmadaki etkisinin belirlenmesi ve ÝRH’ný azaltmada etkinliði kanýtlanmýþ olan N- asetil sisteinle (NAC) karþýlaþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: 28 adet Sprague-Dawley sýçan rastgele yediþerli dört gruba ayrýldý. Gruplar sham, iskemi-reperfüzyon (ÝR), ÝR + Ph, ÝR + NAC olarak belirlendi. Sýçanlarýn sað alt ekstremitesinde femoral arter klempi ve elastik turnike ile üç saat süreyle iskemi oluþturuldu. Ph ve NAC, iskemi bitiminden 15 dakika önce intraperitoneal uygulandý. Reperfüzyondan 24 saat sonra kas dokusunda, tiobarbiturik asitle reaksiyon veren maddeler (TBARS), katalaz (CAT), süperoksit dismutaz (SOD), miyeloperoksidaz (MPO), poli adenozin di fosfat riboz polimeraz (PARP), nötrofil infiltrasyonu ve bir hafta sonra iNOS monoklonal antikor pozitifliði deðerlendirildi.
BULGULAR: Sham grubunda kas dokusundaki MPO, TBARS, PARP, SOD, CAT düzeyleri diðer gruplara oranla belirgin olarak düþük bulundu (p<.001). MPO, PARP, SOD, CAT düzeyleri ÝR + Ph grubunda ve ÝR + NAC grubunda ÝR grubundan belirgin olarak düþük bulundu (p<.001). Nöt-rofil infiltrasyonu ÝR grubunda ÝR + NAC ve ÝR + Ph grubundan belirgin olarak yüksek bulundu (p<0.005). ÝRH azaltýlmasýnda Ph ve NAC’ýn etklili olduðu, ikisi arasýnda anlamlý fark olmadýðý bulundu.
TARTIÞMA: Feniramin maleat sýçan iskelet kasýnda oluþan ÝRH’nýn azaltýlmasýnda etkin bir moleküldür.

BACKGROUND: Skeletal muscle ischemia-reperfusion injury (IRI) is a common clinical problem encountered after tourniquet ap-plication or replantation. This study investigated the effect of pheniramine maleate (Ph), which is frequently used in clinical practice to reduce IRI, and compared its efficacy in IRI with N-acetylcysteine (NAC), a molecule that has been shown to be effective in IRI.
METHODS: Twenty-eight male Sprague–Dawley rats were randomly divided into four groups (sham, ischemia-reperfusion [IR], IR+Ph, IR+NAC; n=7 rats per group). Ischemia was induced in the lower right extremities of rats for 3 h using a femoral artery clamp and an elastic tourniquet. Ph and NAC were administered intraperitoneally 15 min before ischemia was terminated. At 24 h after reperfusion, levels of thiobarbituric acid reactive substance (TBARS), catalase (CAT), myeloperoxidase (MPO), superoxide dismutase (SOD), polyadenosine diphosphate ribose polymerase (PARP), and neutrophil infiltration were evaluated. Inducible nitric oxide syn-thase (iNOS) density in muscle tissue was evaluated by immunohistochemical methods after 1 week.
RESULTS: SOD, MPO, PARP, CAT, and TBARS levels in muscle tissue were significantly lower in the sham group compared with the other groups (p<0.001). All parameters except TBARS were lower in the NAC and Ph groups than in the IR group (p<0.001). Neu-trophil infiltration in the muscle tissue samples from the IR group was significantly increased compared with the NAC and Ph groups (p<0.05). iNOS staining was not observed in the sham and NAC groups.
CONCLUSION: Ph is effective at reducing experimental rat skeletal muscle IRI.

AMAÇ: COVID-19 salgýný sýrasýnda akut apandisitin yönetimi ile ilgili çocuk yaþ grubundaki çalýþmalar olgu sunumlarý ve küçük hasta gruplarý ile sýnýrlýdýr. Bu çalýþmanýn amacý, COVID-19 salgýný süresince akut apandisit nedeniyle tedavi ettiðimiz olgularý salgýn öncesi dönemdeki olgularla karþý-laþtýrarak salgýn döneminde akut apandisitin seyrinde ne gibi deðiþiklikler olduðunu araþtýrmaktýr.
GEREÇ VE YÖNTEM: 1 Mayýs 2019–29 Þubat 2020 (Grup I) ve 1 Mart–31 Aralýk 2020 (Grup II) tarihleri arasýnda akut apandisit nedeniyle ameliyat edilen 1–18 yaþ arasýnda toplam 601 çocuk üzerinde gerçekleþtirildi. Grup I ve Grup II’de yer alan hastalarýn demografik ve hastalýk özellikleri ile tedavi sürecine iliþkin özellikleri karþýlaþtýrýldý.
BULGULAR: Çalýþmaya alýnan olgularýn %59.1’i (n=355) Grup I, %40.9’u (n=246) Grup II’de yer almaktadýr. Salgýn döneminde; ailelerin hem kendileri hem de çocuklarý için taþýdýðý bulaþýcý hastalýða yakalanma endiþesi, saðlýk profesyonelleri ve hükümet yetkilileri tarafýndan yapýlan acil bir durum olmadýðý sürece evlerinden çýkmamalarý ve hastaneye gelmemeleri yönündeki uyarýlar nedeniyle hastaneye baþvuru süreleri uzamýþtýr. Salgýn öncesi hastalarýn %20.3’ü þikayetlerinin baþladýðý ilk gün hastaneye baþvururken salgýn sürecinde hastalarýn sadece %2’si ilk gün, %15’i ise dört gün ve daha uzun süre sonra hastaneye baþvurmuþtur. Bu durumun sonucu olarak salgýn öncesi %10.4 olan perfore apandisit oraný salgýn döneminde %24.8’e yükselmiþtir (p<0.01). Salgýn döneminde COVID-19 test sonucu pozitif olan dört hastamýzý ameliyat ettik. Hastalarýmýzda COVID-19 ve ameliyata baðlý komplikasyon geliþmedi.
TARTIÞMA: Mevcut küresel salgýndan duyulan korku çocuklarýn hastaneye baþvurma süresinin uzamasýna, perfore apandisit sayýsýnýn artýþýna ve hastanede kalýþ süresinin uzamasýna neden olmuþtur.

BACKGROUND: The present study aimed to investigate the changes in the course of acute appendicitis during the pandemic period by comparing the cases treated during the coronavirus disease 2019 (COVID-19) pandemic with those in the pre-pandemic period.
METHODS: The study was conducted with 601 children aged 1–18 years who were operated for acute appendicitis between May 1, 2019, and February 29, 2020 (Group I) and between March 1 and December 31, 2020 (Group II). The demographic and disease characteristics as well as the treatment processes were compared between the groups.
RESULTS: It was found that 59.1% (n=355) of the cases included in the study were in Group I and 40.9% (n=246) were in Group II. During the pandemic period; due to the concerns of families about contracting a contagious disease for both themselves and their children, and warnings by health professionals and government officials that they should not leave their homes and not come to the hospital unless there is an emergency, the time to apply to the hospital has been extended. Before the pandemic, 20.3% of the patients presented to the hospital on the 1st day of their complaints, where during the pandemic, only 2% of the patients reported to the hospital on the 1st day, and 15% presented after 4 days or more. As a result, the rate of perforated appendicitis, which was formerly 10.4%, increased to 24.8% during the pandemic period (p<0.01). During the pandemic, we operated on four patients with positive COVID-19 test results. There were no complications related to COVID-19 and surgery in our patients.
CONCLUSION: Concern of the current pandemic resulted in late presentation to the hospital, increase in the number of perforated appendicitis, and prolonged hospital stay.

AMAÇ: COVID-19 pandemisi, saðlýk sistemlerinde ve acil cerrahi müdahalelerde önemli deðiþikliklere neden olmuþtur. Bu çalýþmada, acil servislere baþvuran akut apandisitli hastalarý inceleyerek pandemi öncesi ve pandemi döneminde taný, tedavi ve tedavi sonrasý süreçleri karþýlaþtýrýlmýþ ve pandeminin akut apandisit tedavisini nasýl etkilediðini araþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: Klinik ve/veya radyolojik olarak akut apandisit tanýsý almýþ 18 yaþýndan büyük hastalar, pandemi öncesi dönem (1 Ocak–30 Nisan 2019) ve pandemi dönemi (1 Ocak–30 Nisan 2020) olarak iki gruba ayrýlmýþtýr. Çalýþmada ameliyat öncesi görüntüleme yöntemleri, plastron apandisit/apse varlýðý, konservatif/cerrahi yaklaþým, verilen anestezi türü, laparoskopik/açýk cerrahi yaklaþým, baðýrsak rezeksiyonu oranlarý, dren yerleþtirme oranlarý ve ameliyat sonrasý komplikasyon varlýðý karþýlaþtýrýlmýþtýr.
BULGULAR: Ýki çalýþma grubu için 69 merkezden 8972 hasta incelenmiþtir, 4582 hasta pandemi öncesi dönemde ve 4234 hasta pandemi döne-minde ameliyat edilmiþtir. Pandemi döneminde hastalarýn %63.6’sýna açýk cerrahi, %34.4’üne ise laparoskopik cerrahi uygulanmýþtýr. Pandemi öncesi dönemde 60 hasta (%1.3) ameliyatsýz takip talebinde bulunurken, pandemi döneminde 94 hasta (%2.2) bunu talep etmiþtir. Hastalarýn durumlarý kendi istekleri dýþýnda deðerlendirildiðinde, pandemi öncesinde 114 hasta (%2.4) ve pandemi sýrasýnda 163 hasta (%3.8) ameliyatsýz takip almýþtýr. TARTIÞMA: Çalýþmamýz, COVID-19 ile ilgili kýsýtlamalarýn uygulanmasý ile akut apandisit þiddeti arasýnda doðrudan bir iliþki göstermemiþtir. CO-VID-19 döneminde ameliyatsýz tedavi oranlarý artmýþ olsa da, COVID-19 kriz döneminde hem komplike hem de komplike olmayan apandisit insi-danslarý benzerdir. Bu bilgiler göz önüne alýndýðýnda, apandisit teþhisi konan hastalarda ameliyatsýz yönetim uygulanabilir.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emer-gency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and com-pared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis.
METHODS: A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diag-nosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1–April 30, 2019) and after (pandemic period: January 1–April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications
RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pan-demic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up.
CONCLUSION: Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this infor-mation non-operative management can be employed for patients diagnosed with appendicitis.

AMAÇ: Þiddet tüm dünyada kesin olgu sayýsý bilinmeyen yaygýn bir sorundur. Kiþilerarasý, eþ veya aile içi þiddet þeklinde tipleri vardýr. Çalýþmamýzda þiddet içeren olgularýn demografik özelliklerini, yaralanma mekanizmalarýný ve kafa ve yüz travmasý ile iliþkisini ortaya koymayý amaçlýyoruz.
GEREÇ VE YÖNTEM: Ocak 2018–Aralýk 2020 tarihleri arasýnda üniversite hastanemiz eriþkin acil servisine (AS) darp edilerek baþvuran hastalarýn dosyalarý geriye dönük olarak incelendi. Veriler SPSS 20.0 ile analiz edildi. Demografik bulgular, yaralanma mekanizmalarý ve etkilenen alanlar kaydedildi. Ki-kare testi gruplar arasýndaki farklýlýklarý test etti ve p<0.05 anlamlý kabul edildi.
BULGULAR: Darp edilerek baþvuran 1280 hastanýn %71’i erkekti ve medyan yaþý 32 (IQR 25–43) idi. Olgularýn %84’ünde darp eden bilinmeyen kiþiler, %9’unda darp eden eþleri olmuþtur. En çok darp edilen alan ev olarak belirtildi (%11). Kullanýlan yöntemler, boðuþma (%43) ve yumruk atma (%42) idi. En sýk etkilenen bölge baþ (%70) ve en sýk taný burun kýrýðý (%4) idi; iki hastada epidural kanama, bir hastada pnömotoraks saptandý. Erkekler en sýk 20–40 yaþ grubundaydý (χ2, p=0,003). Kadýn maðdurlarýn çoðu eþleri tarafýndan dövülmüþtü (χ2, p<0,001). Kan alkol düzeyi yüksek olan hastalarýn %83’ünde kafa travmasý (χ2, p<0.001) ve erkek hastalarýn %75’inde kafa travmasý (χ2, p<0.001) bulundu.
TARTIÞMA: Saldýrý, aðýrlýklý olarak genç erkekler arasýnda yaygýn bir sorundur. En sýk etkilenen vücut kýsmý baþ ve en sýk taný burun kýrýklarýydý. Kan alkol seviyeleri yüksek olan hastalarýn çoðu erkek kurbanlar arasýndaydý. Kadýn kurbanlarý darp edenler eþleriydi. Acil servise kafa travmasý ile baþvuran erkek hastalar saldýrý maðduru olarak deðerlendirildi.

BACKGROUND: Violence is a common issue without an exact number worldwide. The types are interpersonal, spousal, or domestic violence. We aim to reveal the demographic characteristics of cases involving violence, mechanisms of injury, and their relationship with head and face trauma.
METHODS: The files of patients presented to our University Hospital Adult Emergency Department (ED) between January 2018 and December 2020 after an assault were reviewed retrospectively. The data were analyzed with SPSS 20.0. The demographic findings, injury mechanisms, and affected areas were reported. The Chi-square test tested the differences between the groups, and p<0.05 was considered significant.
RESULTS: Among the 1280 patients presented after an assault, 71% were male with a median age of 32 (IQR 25–43). In 84% of the cases, the perpetrators were unknown, while their spouses were the perpetrators in 9% of the cases. The place was most noted as home (11%). The methods used were struggling (43%) and punching (42%). The most common affected area was the head (70%) and diagnosis for nasal fracture (4%); two patients had epidural bleeding, and one had a pneumothorax. Males were more common in the 20–40 age groups (χ2, p=0.003). Most of the female victims were battered by their spouses (χ2, p<0.001). Head injury was found in 83% of patients with high blood alcohol levels (χ2, p<0.001) and 75% of male patients had head injuries (χ2, p<0.001).
CONCLUSION: Assault is a common problem predominantly among young males. The most commonly affected body part was the head, and nasal fractures were the diagnosis. Most of the patients with high blood levels were among the male victims. The perpetrator of the female victims was their spouses. In the ED, male patients who presented with head trauma were considered as assault victims.

AMAÇ: Perkütan kolesistostomi akut kolesisti olan yüksek riskli hastalar için bir alternatif veya köprü tedavisi görevi görmektedir. Amacýmýz per-kütan kolesistostomili yüksek riskli hastalarda mortaliteyi tahmin etmek ve elektif kolesistektomi kararýný belirleten parametreleri tespit etmektir. GEREÇ VE YÖNTEM: Akut kolesistit nedeniyle, 2010–2018 yýllarý arasýnda perkutan kolesistostomi iþlemi yapýlmýþ olan 127 hastanýn medical bilgileri geriye dönük olarak toplandý. Kolesistektomi oranlarý ve yüksek riskli hastalarda mortaliteyi belirleyen faktörler analiz edildi. Tanýmlayýcý istatistikler yapýldý. Ayrýca mortalite, elektif kolesistektomi ve albumin için ROC analizi kullanýldý.
BULGULAR: Perkütan kolesistostomi yapýlan 127 hastadan yüksek riskli olanlarýnýn sadece %43.1’ine elektif kolesistektomi yapýldý. Otuz günlük mortalite %11 ve bir yýllýk mortalite %17.3 idi. The American Society of Anesthesiologists (ASA) skoru, Charlson comorbidity index (CCI) skoru, 2018 Tokyo Klavuzu’nda belirlenmiþ olan negatif prediktif faktörlerin varlýðý, American College of Surgeons (ACS) beklenen mortalite yüzdesi ve albümin deðeri; mortaliteyi ve elektif kolesistektomiyi belirlyen anlamlý faktörler olarak bulundu. Albümin deðeri 3.16 mg/dL’den büyük olan hiçbir hastada mortalite izlenmedi ve %82 elektif kolesistektomi oraný elde edildi.
TARTIÞMA: Plazma albümin deðeri, ASA skoru, CCI ve ACS beklenen mortalite yüzdesi mortaliteyi ve elektif kolesistektomiyi kararýný belirlemek için kullanýlabilir. Perkütan kolesistostomi enflamasyonu azaltmak için faydalýdýr ancak hastalarýn medikal komorbiditeleri, nihai durumlarýný belirlemektedir.

BACKGROUND: Percutaneous cholecystostomy is an alternative or bridge to cholecystectomy (CCY) in high-risk patients with acute calculous cholecystitis. Our primary aim was to determine the parameters that could be used in interval CCY decision-making and to predict mortality in high-risk patients.
METHODS: The medical records of 127 patients who underwent percutaneous cholecystostomy for acute calculous cholecystitis between 2010 and 2018 were retrospectively analyzed. The primary outcomes were the CCY rate and the factors affecting mortality in high-risk patients. Descriptive statistics and receiver operating characteristic analysis were performed using albumin and elective surgery.
RESULTS: Of the 127 patients undergoing percutaneous cholecystostomy, elective CCY was performed only in 43.1% of the high-risk patients. The 30-day and 1 year mortality rates were 11% and 17.3%, respectively. The American Society of Anesthesiologists’ (ASA) score, Charlson comorbidity index (CCI), the negative predictive factors described in the Tokyo Guidelines 2018, the American College of Surgeons’ (ACS) expected mortality rate, and albumin level were found to be significant factors affecting mortality and elective CCY probability. No mortality was observed, and an 82% elective CCY rate was achieved in patients whose albumin levels were higher than 3.16 mg/dL at initial presentation.
CONCLUSION: The plasma albumin level, ASA score, CCI, and ACS expected mortality rate can be used to predict mortality and decide on elective CCY. Percutaneous cholecystostomy is sufficient for resolving inflammation, but medical comorbidities determine the final condition of patients.

AMAÇ: Çapraz bacak serbest flepleri, büyük doku defektlerinde alýcý damar yokluðunda, serbest doku transferi için kullanýlan ekstremite kurtarma yöntemlerinden birisidir. Posterior tibial arterin üzerindeki fasyokütan flep, pedikülü korumak ve fasiyokütan flep uzunluðuna eþit bir mesafede yaraya yaklaþabilmek için kullanýlabilir.
GEREÇ VE YÖNTEM: Çalýþmaya 2010–2020 yýllarý arasýnda çapraz bacak serbest flebi ile yaralanmamýþ taraftan fasiyokütan flep kullanýlarak ameliyat edilen hastalar alýndý. Yaþ, cinsiyet, defektlerin yeri ve boyutu, arteriyel açýklýklar, flep seçenekleri, fasyokütan flep boyutu, ameliyat süresi, flep ayýrma zamanlamasý, komplikasyonlar ve iþe dönüþ süresi deðerlendirildi.
BULGULAR: Yüksek enerjili elektrik yanýðý ve travma etiyolojisi olan altý hasta vardý. Üç hastada sadece bir arterde dolum varken, diðerlerine hiç dolum yoktu. Latissimus dorsi cilt kas flebi, bir hasta dýþýnda tüm hastalarda kullanýldý. Ortalama defekt boyutu 6.6x14.8 cm idi. Fasiyokütan fleplerin ortalama boyutu 4.08x5 cm idi. Ortalama operasyon süresi 360 dakikaydý. Yara bakýmý ile iyileþen bir açýlma ve bir marjinal nekroz ve enfeksiyon dýþýnda komplikasyon görülmedi. Ortalama iþe dönüþ süresi dokuz aydý.
TARTIÞMA: Bir arter dolumu olan veya dolumu hiç olmayan alt ekstremiteli benzer olgularda orta büyüklükteki defektler varsa, köprü flep seçeneði adýmýndan hemen öncesinde, alýcý damarlar üzerindeki fasyokütan flebin kullanýlmasý iyi bir seçenektir.

BACKGROUND: Cross leg free flaps are one of the salvage methods used for free tissue transfer in large tissue defects in the absence of recipient vessels. The fasciocutaneous flap above the posterior tibial artery can be harvested to protect the pedicle and to advance a distance to wound, which is equal to the length of fasciocutaneous flap.
METHODS: Patients who were operated with cross leg free flap with the supporting fasciocutaneous flap on unwounded side were included in the study between years 2010 and 2020. Age, sex, location and size of the defects, arterial patencies, flap choices, fascio-cutaneous flap size, duration of operation, cross flap separation timing, complications, and time to return to work were evaluated.
RESULTS: There were six patients with the etiology of high-energy electrical burns and trauma. There was only one arterial refilling for three patients and no refilling for others. Latissimus dorsi skin muscle flap was used in all but one patient. The mean defect size was 6.6×14.8 cm. The mean size of fasciocutaneous flaps was 4.08×5 cm. The mean operation time was 360 min. There was no complication except one dehiscence and one marginal necrosis and infection which were healed with wound care. Average time to return to work was 9 months.
CONCLUSION: In similar cases, as wounded lower extremities with one or no artery refill, harvesting a fasciocutaneous flap with recipient vessels will be useful before considering the option of using a bridge free flap in medium to moderate sized defects.

AMAÇ: Bu çalýþmanýn amacý apendektomi sonrasý patolojik incelemesi yapýlan spesmenlerde akut apendisitin nadir görülen nedenlerini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Nadir görülen apendisit sebeplerini belirlemek için üçüncü basamak tek merkezde opere edilmiþ 6785 olgunun histopatoloji raporlarý geriye dönük olarak analiz edilmiþtir.
BULGULAR: Doksan sekiz (40 kadýn, 58 erkek) olguda (%1.44) sýra dýþý akut apendisit nedeni bulunmuþtur. Apendiksin nöroendokrin tümörleri en sýk izlenen patolojidir. Bunu sýrasýyla serrated adenom, low grade apendiküler müsinöz neoplasm, hiperplastik polip ve intestinal parazitler izlemiþtir. Dört (%0.05) hastada apendiks adenokarsinomu saptanmýþ olup mortalitesi %75’tir. Nadir görülen apendektomi sebeplerinde yaþ, normal apendektomilere göre anlamlý olarak daha yüksektir. Sýra dýþý apendektomilerin sað kalým analizi, ileri yaþýn prognostik öneme sahip olduðunu göstermiþtir (Kaplan Meier p<0.0001). Sýra dýþý apendisitlerde farklý hastalýk gruplarý arasýnda sað kalým farký saptanmýþtýr. Ancak Cox multifaktöriyel analizi bu iki faktörün istatistiksel olarak anlamlý olmadýðýný göstermiþtir.
TARTIÞMA: Sýra dýþý apendisit nedenleri oldukça nadirdir. Ýleri yaþ grubunda bu tanýlar akýlda tutulmalý ve apendisit tanýsý dikkatle verilmelidir.

BACKGROUND: This study aims to determine the uncommon causes of acute appendicitis in analyzed post appendectomy specimens.
METHODS: Histopathology reports of 6785 removed appendices were analyzed retrospectively in order to confirm the uncommon cause of acute appendicitis in single tertiary institution.
RESULTS: Unusual cause of acute appendicitis was found in 98 (1.44%) samples (40 female and rest 58 male patients). Neuroen-docrine tumor of the appendix was the most common pathology, followed by serrated adenoma, low-grade appendicular mucinous neoplasm, hyperplastic polyp and intestinal parasite. In four patients (0.05%), appendicular adenocarcinoma was confirmed with an overall mortality of 75%. Age was significantly higher in uncommon acute appendectomies than in ordinary appendectomies. Survival analysis of unusual appendectomies showed that advanced age is of prognostic importance (Kaplan Meier p<0.0001). There was also a difference in survival between different disease groups in unusual appendectomies, but Cox multifactorial analysis showed that these two factors were not statistically significant.
CONCLUSION: Although rare, unusual causes are the etiological factor responsible for acute appendicitis. These reasons should be kept in mind in the older age group and the diagnosis of appendicitis should be made carefully.

AMAÇ: Akut kolesistit (AK) safra kesesinin akut enflamatuvar hastalýðýdýr ve akut karýn aðrýsýnýn en yaygýn sebeplerinden biridir. Hastaneye kabulde AK þiddetini belirlemek en etkili tedavi yöntemini seçmek ve hayati prognozu tahmin etmek için son derece önemlidir. Bu çalýþmanýn amacý, immatür granülosit yüzdesinin (IG%) AK þiddetini derecelendirmedeki etkinliðini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma AK tanýsýyla hastaneye yatýrýlan 528 hasta üzerinde yapýldý. Hastalarýn demografik verileri, beyaz küre sayýsý (WBC), nötrofil lenfosit oraný (NLR), IG% ve C-reaktif protein (CRP) düzeyleri ve görüntüleme bulgularý kaydedildi. Ayrýca hastalarýn hastanede kalma süreleri tespit edildi. AK þiddetini derecelendirmek için Tokyo Kýlavuzlarý kullanýldý. Bu derecelendirmeye göre hastalar grade 1 (hafif), grade 2 (orta) ve grade 3 (þiddetli) AK olarak üç gruba ayrýldý. Gruplar arasýndaki farklar istatistiksel olarak analiz edildi.
BULGULAR: Hafif AK grubunda 386 (%73.1), orta AK grubunda 102 (%19.3) ve þiddetli AK grubunda 40 (%7.6) hasta mevcuttu. Hafif AK’yý orta ve þiddetli AK’dan ayýrmada WBC, NLR, CRP ve IG% anlamlý parametreler idi. Ancak orta AK’yý þiddetli AK’dan ayýrmada sadece IG% anlamlý parametre idi. Ayrýca IG%’sinin hafif ve orta AK’lý hastalarý þiddetli hastalardan ayýrma gücü diðer parametrelerden önemli ölçüde daha yüksek idi.
TARTIÞMA: Artmýþ IG% AK þiddetinin erken tespitinde etkili ve güvenilir bir tahmin edici olarak görülmektedir.

BACKGROUND: Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC at hospital admission is extremely important to choose the most effective treatment method and predict vital prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in grading AC severity.
METHODS: This retrospective study was carried out on 528 patients hospitalized due to AC diagnosis. Demographic data, white blood cell (WBC) count, neutrophil lymphocyte ratio (NLR), IG%, C-reactive protein (CRP) levels, and imaging results of patients were recorded. Furthermore, patients’ length of hospital stay was determined. Tokyo Guidelines were used to grade AC severity. According to this grading, patients were classified into three groups as grade 1 (mild), grade 2 (moderate), and grade 3 (severe) AC. Differences among groups were analyzed statistically.
RESULTS: There were 386 patients (73.1%) in the mild AC group, 102 patients (19.3%) in the moderate AC group, and 40 patients (7.6%) in the severe AC group. WBC, NLR, CRP and IG% were significant parameters in discriminating mild AC from moderate and severe AC. However, only IG% was a significant parameter in discriminating moderate AC from severe AC. Moreover, the power of IG% to discriminate between patients with mild and moderate AC and those with severe AC was dramatically higher than the other parameters.
CONCLUSION: Increased IG% is seen as an effective and reliable predictor in the early determination of AC severity.

AMAÇ: Bu çalýþmada amacýmýz 60 yaþ üstü hastalarda femur intertrokanterik kýrýk cerrahisi sonrasý yaþanan komplikasyonlar ve klinik sonuçlar ile literatürde femur proksimal morfolojisini tanýmlayan radyolojik indeksler olan Singh Index (SI), Canal Calcar Ratio (CCR), Cortical Thickness Ýndex (CTI), Canal Flare Ýndex (CFI) arasýndaki iliþkiyi incelemektir.
GEREÇ VE YÖNTEM: 2015–2019 yýllarý arasýnda ameliyat edilen 350 hastanýn çalýþma verileri geriye dönük olarak deðerlendirildi. Çiftlag vidalý proksimal femoral çivileme yapýlan ve intraop redüksiyon kalitesi fogagnolo kriterlerine göre iyi olan hastalar çalýþma kapsamýna alýndý. Travma sonrasý çekilen xrayler üzerinden ölçümleri yapýlan radyolojik indeksler ile ameliyat sonrasý komplikasyonlar, Barthel Aktivite Ýndeksi ve Harris Kalça Skorlamasý arasýndaki iliþki istatistiksel olarak deðerlendirildi.
BULGULAR: Çalýþma kriterlerine uyan 121 hastanýn 63’ü kadýn (%52.07) ve 58’i (%47.93) erkekti. Ortalama takip süresi 37.09 ay (36–60) olarak deðerlendirildi. Hastalarýn yaþlarýna baktýðýmýzda ise; ortalama yaþ 79.78 (60–97) idi. Çalýþma grubundan 32 hastada (%26.4) en az bir mekanik komplikasyon geliþti. Radyolojik indeksler ve ameliyat sonrasý komplikasyonlar arasýnda anlamlý iliþki kurulamadý (p>0.05). SI ile Harris kalça skorlamasý arasýndaki iliþki istatistiksel olarak anlamlýydý (p<0.05). CCR, CTI VE CFI ile Barthel Aktivite Ýndeksi ve Harris Kalça Skorlamasý arasýndaki iliþki istatistiksel olarak anlamlý deðildi (p>0.05).
TARTIÞMA: Radyolojik indeksler ile ameliyat sonrasý komplikasyonlar arasýnda istatistiksel olarak anlamlý iliþki kurulamamýþtýr. SI’nin klinik sonuçlarý etkileyen bir parametre olabileceði göz önünde bulundurulmalýdýr.

BACKGROUND: This study aimed to explore the relationship between the complications and clinical outcomes after intertrochanteric femoral fracture surgery, and the Singh index (SI), canal-calcar ratio (CCR), cortical thickness index (CTI), and canal flare index (CFI) – the radiological indices defining proximal femoral morphology in the literature – among patients over 60 years of age.
METHODS: The data of 350 patients who were operated between 2015 and 2019 were evaluated retrospectively. The study included patients who underwent dual lag screw proximal femoral nailing and had good intraoperative reduction quality according to Fogagnolo’s criteria. The relationships among radiological indices measured on radiographs acquired after trauma, and post-operative complications, Barthel activity index, and Harris hip score (HHS) were assessed statistically.
RESULTS: Among 121 patients who met the study criteria, there were 63 (52.07%) female and 58 (47.93%) male patients. The mean length of follow-up was 37.09 (36–60) months. The patients had a mean age of 79.78 (60–97) years. At least one mechanical complication developed in 32 (26.4%) patients in the study group. No significant relationship could be established between radiological indices and post-operative complications (p>0.05). The relationship between SI and HHS was statistically significant (p<0.05). CCR, CTI, and CFI did not have a statistically significant relationship with and HHS (p>0.05).
CONCLUSION: No statistically significant relationship could be established between radiological indices and post-operative complications. It should be considered that SI may be a parameter that affects clinical outcomes.

AMAÇ: Ýntramedüller çivileme (IMÇ) ile tedavi edilen 65 yaþ üstü intertrokanterik kýrýklý hastada kemik morfolojisinin kýrýk tipine ve tedavi sonucuna etkisini araþtýrmayý amaçladýk. Çalýþmanýn birincil sonucu, kýrýk tipi (stabil veya stabil olmayan) ile kemik yoðunluðu arasýndaki iliþkiyi araþtýrmaktýr. GEREÇ VE YÖNTEM: Bu, tek travma merkezinde yürütülen, 2010–2021 yýllarý arasýnda hasta verilerinin deðerlendirildiði, ameliyat sonrasý en az üç aylýk kontrol, ameliyat sonrasý en az üç ay kontrolü olan hastalarý içeren, tek bir travma merkezinde yürütülen geriye dönük bir kohort çalýþmasýdýr. Tüm kýrýklar AO sýnýflandýrma sistemine göre sýnýflandýrýldý. Kliniðimizde 2010–2016 yýllarý arasýnda PFNA, 2016 yýlýndan sonra ise intertan kullanýlmýþtýr. Kemik morfolojisinin deðerlendirilmesi için hem kýrýk tarafýnýn hem de karþý tarafýn ön-arka kalça radyografisinde kanal-kalkar oranýný (KKO), kortikal kalýnlýk indeksi (KKÝ) ölçüldü ve Dorr morfolojisine göre sýnýflandýrýldý. Komplikasyonlar da radyolojik olarak deðerlendirildi. Baþarýsýzlýklar kaynamama veya fiksasyon yetersizliði olarak tanýmlandý. Üçüncü ay kontrol vizitinde kalça grafisi ile aþýrý kollaps ve vida belirginliði de deðerlendirildi. BULGULAR: Bu çalýþmaya 150 kadýn ve 59 erkek dahil edildi. Ortalama yaþ 81.6±8.8 yýldý. Yüz kýrk dört hasta Intertan ile ve 65 hasta býçak tipi IMÇ (PFNA) ile tedavi edildi. Stabil intertrokanterik (A1 tipi) kýrýðý olan 78 hasta, stabil olmayan olan 131 hasta (A2 tipi 109 hasta ve A3 AO tipi kýrýðý olan 22 hasta) vardý. Ortalama KKÝ kýrýk ve etkilenmemiþ femurlarda sýrasýyla 0.469±0.09 ve 0.510±0.09 (p<0.001), KKO kýrýk ve etkilenmemiþ femurlarda sýrasýyla 0.636±0.15 ve 0.568±12 idi (p<0.001) olarak saptandý. Kýrýk tarafýnda 36 hasta Dorr tip A, 115 hasta Dorr tip B ve 48 hasta Dorr tip C ve kýrýk olmayan tarafta is 65 hasta Dorr tip A, 123 hasta Dorr tip B ve 21 hasta Dorr tip C olarak saptandý (p<0.001). Vida (n=14) ve býçak (n=15) belirginliði olan 29 (%13.9) hasta vardý. Otuz hastada (%14.4) aþýrý kollaps görüldü ve 16 hastada (7.7) yetersizlik saptandý. TARTIÞMA: AO sýnýflamasýna göre stabil olmayan kýrýk grubunda stabil gruba göre istatistiksel olarak anlamlý olarak daha fazla yetersizlik saptadýk. Ortalama KTÝ, KKO ve Dorr indeksinin etkilenmeyen tarafa göre kýrýk tarafta anlamlý olarak düþük saptandý ki bu durum kýrýk tarafta daha düþük kemik kalitesi olduðunu gösterir.

BACKGROUND: We aimed to investigate the effect of bone morphology on fracture type and treatment result in patient with inter-trochanteric fracture (IFF) treated with intramedullary nailing (IMN) aged over 65 years. Primary outcome of study was to investigate the relationship between fracture type (stable or unstable) and bone density.
METHODS: This was a retrospective cohort study conducted at single trauma center which included patients aged >65 years, minimum 3 months’ control postoperatively, patients with simple fall by evaluating the patient data from 2010 to 2021. All fractures were classified based on the AO classification system. Proximal femoral nail anti-rotation was used between 2010 and 2016, while InterTAN was used after 2016 in our clinic practice. For the evaluation of the bone morphology, we measured the canal-to-calcar ratio (CCR) and cortical thickness index (CTI) and classified with Dorr morphology on anteroposterior (AP) hip radiograph of both the fracture side and contralateral sides. Complications were also evaluated on radiological view. Failures were defined as non-union or failure of fixation. Excessive collapse and screw/blade prominence also evaluated by hip radiograph on the 3rd month control visit.
RESULTS: One hundred and fifty females and 59 males were included in this study. The average age was 81.6±8.8 years. One hundred and forty-four patients were treated with InterTAN and 65 patients with helical blade type IMN (PFN-A®). There were 78 patients with stable IFF type A1 fracture and 131 patients with unstable IFF (109 patients with A2 and 22 patients with A3 AO type fracture). The mean CTI was 0.469±0.09 and 0.510±0.09 in the fracture and unaffected side femurs, respectively (p<0.001), the CCR was 0.636±0.15 and 0.568±12 in the fracture and unaffected side femurs, respectively (p<0.001). There were 36 patients with Dorr type A, 115 patients with Dorr type B, and 48 patients with Dorr type C in fracture side and 65 patients with Dorr type A, 123 patients with Dorr type B, and 21 patients with Dorr type C in non-affected side (p<0.001). There were 29 (13.9%) patients with screw (n=14) and blade (n=15) prominence. Excessive collapse was seen 30 patients (14.4%) and 16 patients (7.7) evaluated as a failure.
CONCLUSION: We found a significant difference in the failure rate between unstable group than stable group which higher in unstable group according to the AO classification. In addition, the mean CTI, CCR, and Dorr index were significant difference in fractured side than unaffected side which indicated lower bone quality at fracture side.

Ýnternal supravezikal herni, genel insidansý tüm internal abdominal hernilerin %4’ünden az olan, nadir görülen bir internal abdominal herni türüdür. Klinik tanýsý, hem cerrah hem de radyolog için ameliyat öncesi önemli bir zorluktur. Nadir görülen bir intestinal obstrüksiyon nedenidir, ancak strangülasyon durumunda ölümcül olabilir ve acil cerrahi müdahale gerektirir. Bu olgu çalýþmasýnda, akut intestinal obstrüksiyonu olan 63 yaþýndaki erkek hastada internal supravezikal herni olgusu ve insidental renal tümör bulgusu sunulmuþtur. Makalede, bu nadir antitenin klinik tablosu, tanýsý, risk faktörleri, tedavi stratejisi ve komplikasyonlarý tartýþýlmaktadýr.

Internal supravesical hernia is a rare type of internal abdominal hernia with overall incidence <4% of all internal abdominal hernias. The clinical diagnosis is a major preoperative diagnostic challenge for both the surgeon and the radiologist. It is a rare cause of small bowel obstruction, but in case of strangulation it can be fatal and it necessitates urgent surgical intervention. In this case study, we report a case of intravesical type of supravesical hernia in a 63-year-old man with acute intestinal obstruction and an accidental finding of a kid-ney tumor. In the article, we discuss the clinical picture, diagnosis, risk factors, treatment strategy and complications of this rare entity.

Fýtýk kesesinde tek baþýna apendiks epiploika nadirendir, bununla birlikte hipertrofisi varsa ve boðulmuþ bir fýtýk olarak ortaya çýkarsa daha da nadir görülen bir durumdur. Otuz yedi yaþýnda erkek hastada sað kasýk kanalýna herniye olmuþ apendiks epiploika olgusunu sunuyoruz. Laparoskopinin fýtýk içeriðini görüntülemek için açýk tekniðine üstünlüðünü göz önünde bulundurarak laparoskopik Trans-Abdominal Pre-Peritoneal cerrahi planladýk. Yapýlan incelemede sað kasýkta indirekt herni görüldü. Ýçeride boðulmuþ apendiks epiploika vardý ve sigmoid kolon duvarýndan uzanýyordu. Ön duvar inguinal hernioplasti yapýldý. Sonuç olarak kasýk fýtýklarýnda fýtýk kesesi içinde apendiks epiploika olabileceði göz ardý edilmemeli ve laparoskopik yaklaþýmlar tercih edilecek tedavi yöntemi olmalýdýr.

Appendix epiploica without a colon in the hernia sac is a rare condition, which is even rarer if it has hypertrophy and presents as an irreducible hernia. We describe a case of appendix epiploica in a 37-year-old male patient with a strangulated right inguinal hernia that was herniated to the right inguinal canal. Considering the superiority of laparoscopy to open technique for viewing the hernia contents, we planned laparoscopic transabdominal preperitoneal surgery. In the exploration, an indirect hernia was observed in the right groin. Inside was the strangulated appendages epiploica, which extended from the sigmoid colon wall. Anterior wall inguinal hernioplasty was performed. In conclusion, it should not be ignored that there may be appendix epiploica within the hernia sac in inguinal hernias and laparoscopic approaches should be the treatment method of choice.

Özellikle anterior yerleþimli olan mediastinal kitleler solunum ya da kardiyovasküler sisteme basý yapabilir. Anestezi prosedürünü takiben kardi-yo-respiratuvar kollaps riski nedeni ile teþhis amaçlý histolojik materyal elde etmek tanýsal bir zorluk teþkil etmektedir. Olgumuz, bu tarz bir olay sonrasýnda venövenöz ektrakorporeyal membran oksijenizasyonu (VV-ECMO) tedavisinin kurtarýcý bir tedavi olarak, kemoterapi süresince uygulanabilirliðini göstermektedir. Dört yaþýnda erkek çocuk, geçmeyen öksürük nedeni ile çekilen göðüs grafisinde büyük mediastinal kitle saptanmasý nedeni ile çocuk onkoloji kliniðine sevk edildi. Göðüs bilgisayarlý tomografisinde anterior mediastende 100x85 mm boyutlarýnda, kalbi saran, trakea, bronþ ve damarsal yapýlara basý yapan kitle saptandý. Tanýsal amaçlý olarak ultrasonografi eþliðinde perkütan iðne biyopsi yapýlmasý planlandý. Operasyon odasýnda prosedürel sedasyon amacýyla düþük doz ketamin ve midazolam uygulandý. Biyopsi iþlemi sonrasý, entübasyon gerektiren ani havayolu obstrüksiyonu geliþti. Mekanik ventilatörde %100 oksijen desteðine raðmen, pulse oksimetre satürasyonlarý %80 altýnda seyretti. Göðüs grafisinde sol akciðerde total kollaps gözlendi. Selektif bronþiyal entübasyona raðmen hastanýn oksijen satürasyonlarý yükselmedi. Bi-kaval dual lümenli ECMO kanülü internal juguler vene yerleþtirildi ve VV-ECMO baþlandý. ECMO sonrasý hipoksemide belirgin düzelme gözlendi. Kemoterapi ile hastanýn ön mediastinal kitlesi hýzla küçüldü ve sol akciðer düzeldi. Hasta ECMO desteðinde dokuz gün kaldý ve ECMO sonlandýrýldýktan iki gün sonra ekstübe edildi. Çocuk yoðun bakým yatýþýnýn 20. gününde çocuk onkoloji kliniðine taburcu edildi. Geniþ ön mediastinal kitleli hastalarýn anestezi prosedüleri sýrasýnda kardiyo-pulmoner kollaps geliþimi için ciddi risk teþkil ettiði iyi bilenmektedir. ECMO dahil tüm hayat kurtarýcý seçenekler, planlanan invaziv prosedürlerden önce hazýr olmalýdýr.

Mediastinal masses can compress the respiratory or cardiovascular system, especially when anteriorly located. Obtaining histological material for diagnosis poses a challenge due to the major risk of cardiorespiratory collapse following anesthetic procedure. Our case shows the utility of rescue with venovenous extracorporeal membrane oxygenation (VV-ECMO) after occurrence of such an event and demonstrates the feasibility of administering chemotherapy during VV-ECMO. A 4-year-old boy was referred to the pediatric oncology clinic of our hospital after a large mediastinal mass was observed on chest radiography ordered due to persistent cough. Computed tomography of the thorax revealed a 100×85 mm mass in the anterior mediastinum, surrounding the heart, and showed that there was compression to the trachea, bronchiole, and vascular structures. Percutaneous needle biopsy accompanied by ultrasonography was planned for diagnostic purposes. Low-dose ketamine and midazolam were administered for procedural sedation in the operating room. After the biopsy procedure, the patient developed sudden airway obstruction requiring intubation. Despite 100% oxygen support with a mechanical ventilator, pulse oximeter saturation remained below 80%. Chest X-ray revealed total collapse of the left lung, and the patient’s oxygen saturation did not increase with selective left bronchial intubation. Bi-caval dual-lumen ECMO cannula was placed in the internal jugular vein and VV-ECMO was initiated, resulting in swift improvement in hypoxemia. The patients’s anterior mediastinal mass shrank rapidly and left lung improved with chemotherapy. The patient remained on ECMO for a total of 9 days and was extubated 2 days after ECMO termination, followed by discharge to the pediatric oncology ward on the 20th day of pediatric intensive care unit stay. It is well known that large, anteriorly-located mediastinal masses carry a considerable risk of causing cardio-pulmonary collapse during procedures involving anesthesia. All life-saving options, including emergency ECMO, should be available before any planned invasive procedures in these patients.

Bu olgu sunumunda unikondiler diz protezinin seyrek görülen bir komplikasyonu tanýmlanmaktadýr. Total diz protezi cerrahisi sonrasý oluþabilen periprostetik suprakondiler femur kýrýklarý, ortopedi cerrahlarý için baþedilmesi zor bir komplikasyondur. Bildiðimiz kadarýyla bu olgu sunumu, unikondiler diz protezi sonrasý gerçekleþen tek periprostetik suprakondiler femur kýrýðýdýr.

This case report defines an infrequent complication of unicompartmental knee replacement. Periprosthetic supracondylar femoral fracture after total knee replacement is a challenging problem for orthopedic surgeon. To the best of our knowledge, this is the only case describing periprosthetic supracondylar femoral fracture after unicondylar knee replacement.

Mesanenin inguinal kanal içine herniasyonu nadir görülen bir klinik antitedir ve tüm inguinal hernilerin yaklaþýk %1-4‘ünü oluþturmaktadýr. Genellikle yaþlý erkek hastalarda ve sað tarafta sýk görülmektedir. Hastalar çoðunlukla asemptomatik olduðundan, intraoperatif olarak taný almaktadýr. Preoperatif süreçte tanýnýn doðrulanmasý, olasý mesane yaralanmalarýnýn önüne geçebilmek adýna önem teþkil etmektedir. Biz de bu çalýþmamýzda; akut mekanik intestinal obstrüksiyon ve strangülasyon semptomlarýyla acil servise baþvuran hastada, mesane herniasyonunun eþlik ettiði nadir bir pantolon herni olgusunu literatür eþliðinde sunmayý amaçladýk.

Mesanenin inguinal kanal içine herniasyonu nadir görülen bir klinik antitedir ve tüm inguinal hernilerin yaklaþýk %1–4’ünü oluþturmaktadýr. Genellikle yaþlý erkek hastalarda ve sað tarafta sýk görülmektedir. Hastalar çoðunlukla asemptomatik olduðundan, intraoperatif olarak taný almaktadýr. Preoperatif süreçte tanýnýn doðrulanmasý, olasý mesane yaralanmalarýnýn önüne geçebilmek adýna önem teþkil etmektedir. Biz de bu çalýþmamýzda; akut mekanik intestinal obstrüksiyon ve strangülasyon semptomlarýyla acil servise baþvuran hastada, mesane herniasyonunun eþlik ettiði nadir bir pantolon herni olgusunu literatür eþliðinde sunmayý amaçladýk.