AMAÇ: Bu çalýþmada, spinal kord yaralanmasýnda klorojenik asidin antioksidan ve nöroprotektif özellikleri araþtýrýldý.
GEREÇ VE YÖNTEM: Üç gruba ayrýlmýþ 21 sýçan üzerinde yapýlan çalýþmada, L grubuna sadece laminektomi (n=7) yapýldý, T grubunda spinal kord travmasý oluþturuldu. C grubunda spinal kord travmasý oluþturulup klorojenik asit tedavisi baþlandý. Tüm deneklerin serumunda bazal ve 12. saat, birinci gün, üçüncü gün ve beþinci günde oksidatif katalaz, nativ thiol (NT), toplam thiol (TT), disülphide (SS), SS/TT, SS/NT, NT/TT bakýldý. Ayný zaman noktalarýnda BBB skorlarý ile fonksiyonel deðerlendirmeler yapýldý. Yedinci gün sakrifiye edilen deneklerin spinal kordunda TAS (total antioksaidant status), TOS (total oksidaive stres), OSI (oksidative stres indeksi) ve Cox-2 incelendi. Sonuçlar istatistiksel olarak deðerlendirildi.
BULGULAR: Katalaz bazal seviyeleri yedinci günde bazal seviyelerine istatistiksel açýdan anlamlýlýk oluþturacak þekilde C grubunda yüksek, T grubunda düþük, L grubunda ise belirgin deðiþiklik göstermedi (p=0.008). SS deðerleri yedinci günde C grubuna ve L grubuna göre seviyede düþük bulundu. NT/TT düzeyi travma sonrasý en az düþen grup C grubu olmuþtur. SS/TT düzeyi yedinci günde T grubunda yüksek bulunurken, C ve L grubunda ise stabildi (p=0.04). Doku çalýþmasýnda C grubu Cox-2 ve TAS deðerleri anlamlý olarak travma grubundan daha düþük bulundu (sýrasýyla, p=0.003, p=0.017).
TARTIÞMA: Bu çalýþma spinal kord yaralanmasýný öncelikle thiol-disülfid dengesi üzerinden incelemiþ ve klorojenik asidin, spinal kord yaralanmasýnda antioksidan ve nöroprotektif etkileri olduðu deneysel modellemeler üzerinden gösterilmiþtir.

BACKGROUND: We aimed to investigate antioxidant and neuroprotective properties of chlorogenic acid in spinal cord injury (SCI).
METHODS: Twenty-one rats were divided into three groups. Laminectomy was performed in group L (n=7), spinal cord trauma was induced in group T (n=7), and spinal cord trauma was induced and chlorogenic acid treatment was started in group C (n=7). Blood samples were collected to analyze baseline values and the 12th h, 1st day, 3rd day, and 5th day catalase, native thiol (NT), total thiol (TT), disulfide (SS), SS/TT, SS/NT, and NT/TT levels. Functional analysis with Basso-Beattie and Bresnahan scores was performed at the same time points. Total antioxidant status (TAS), total oxidative stress, oxidative stress index, and cyclooxygenase-2 (Cox-2) were examined in the spinal cord of rats euthanized on day 7; results were statistically analyzed.
RESULTS: On day 7, catalase levels in Group C were significantly higher than baseline levels, whereas those in Group T were significantly
lower than baseline levels; Group L showed no significant difference (p=0.008). SS values on day 7 were lower in Group T than in Groups C and L. Group C showed the lowest decrease in NT/TT level after trauma. On day 7, SS/TT level was high in Group T but stable in Groups C and L (p=0.04). Histopathological examination revealed significantly lower Cox-2 and TAS levels in Group C than in Group T (p=0.003, p=0.017, respectively).
CONCLUSION: In this study, SCI was primarily examined through thiol-SS balance, and it was demonstrated by experimental models that chlorogenic acid has antioxidant and neuroprotective effects in SCI.

AMAÇ: Hipotezimiz acil servislerde künt abdominal travmalý hastalarýn deðerlendirilmesinde glukoz potasyum oranýn morbidite ve mortaliteyi
tahmin etmede kullanýlabileceðidir. Çalýþmanýn amacý, serum glukoz/potasyum oranýndaki deðiþikliklerin morbidite ve mortalite üzerindeki etkisinin gösterilerek hasta yönetiminin daha seri ve yeterli yapýlmasýný saðlamaktýr.
GEREÇ VE YÖNTEM: Hastanemize Ocak 2016–Ocak 2020 yýllarý arasýnda baþvuran izole künt karýn travmasý olan 99 hastanýn baþvuru anýndaki hemogram parametreleri ve biyokimsayal parametreleri geriye dönük olarak incelendi. Hastalar mortal seyreden ve sað kalanlar olarak iki gruba ayrýldý, glukoz potasyum oraný hesaplandý ve mortalite ve morbiteyi öngörmedeki yeterliliði istatiksel olarak deðerlendirildi.
BULGULAR: Mortal seyreden grupta, yaþayan gruba göre kan üre azotu, serum kreatinin, serum glukoz ve glukoz potasyum oraný istatistiksel olarak anlamlý olacak þekilde yüksekti (p<0.005). Ayrýca serum glukoz potasyum oranýn mortaliteyi ön görmede %72.7 sensitiviteye, %84.1 spesifiteye sahip olarak bulundu.
TARTIÞMA: Sonuçta, serum glukoz potasyum oranýn künt karýn travmalý hastalarý deðerlendirmede basit, hýzlý ulaþýlabilen kolay bir önbelirteç olarak kullanýlarak hastalarýn takip ve yönetiminde önemli role sahip olabileceðini düþünmekteyiz.

BACKGROUND: Our hypothesis is that glucose-potassium (GLU/K) ratio can be used to predict morbidity and mortality in the evaluation of patients with blunt abdominal trauma in emergency departments. The aim of the study is to demonstrate the effect of changes in serum GLU/K ratio on morbidity and mortality and to ensure that patient management is performed more quickly and effectively.
METHODS: The hemogram and biochemical parameters of 99 patients with isolated blunt abdominal trauma, applied to our hospital between January 2016 and January 2020, have been retrospectively reviewed. Patients were divided into two groups as non-survivors and survivors. The GLU/K ratio was calculated, and their ability to predict mortality and morbidity was statistically evaluated between the groups.
RESULTS: In the non-survivor (mortal) group; blood urea nitrogen, serum creatinine, serum GLU and GLU/K ratio were statistically higher than the living group (p<0.005). Moreover, the sensitivity and specificity of the serum GLU/K ratio were found 72.7% and 84.1% respectively.
CONCLUSION: We think that serum GLU/K ratio can have an important role in the follow-up and management of patients using it as a simple, quickly accessible, and easy predictor in evaluating patients with blunt abdominal trauma.

AMAÇ: Bu çalýþmada, vücut dokunulmazlýðýna karþý iþlenen suçlar kapsamýnda acil hekimlerince düzenlenen adli raporlar ile ayný adli olgular için Adli Týp Kurumu Ýkinci Adli Týp Ýhtisas Kurulu’nca düzenlenen raporlarý karþýlaþtýrarak, acil hekimlerinin düzenledikleri adli raporlardaki eksiklikleri belirlemeyi ve bu raporlarda sýk yapýlan hatalarýn tespit edilmesini amaçladýk.
GEREÇ VE YÖNTEM: 01.02.2019–01.05.2019 tarihleri arasýnda Adli Týp Kurumu Adli Týp Ýkinci Ýhtisas Kurulu’na çeþitli nedenlerle gönderilen ve acil hekimlerince düzenlenmiþ 241 olguya ait adli raporlardaki standart adli raporda bulunmasý gereken bilgilerinin varlýðý (adý, soyadý, adres, olay tarihi v.b) geriye dönük incelendi. Ayrýca bu raporlarda belirtilen adli olaya neden olan travmanýn yaþamsal tehlike gösterip göstermediði ve basit týbbi müdahale ile giderilebilme durumlarý ayný olaylar için Adli Týp Kurumu Adli Týp Ýkinci Ýhtisas Kurulu’nca düzenlenen raporlarla karþýlaþtýrýlarak yapýlan hatalar tespit edildi.
BULGULAR: Çalýþmamýzda, acil servislerde düzenlenen adli raporlarýn %95.5’inde adres, %63.9’unda muayene saati, %75.9’unda olay tarihi belirtilmemiþti. Elle yazýlan adli raporlarýn %23.2’si okunaklý bulunmadý. Adli Týp Kurumu ve acil hekimlerinin ayný adli olaylar için düzenledikleri raporlarýn yaþamsal tehlike ve basit týbbi müdahale ile giderilebilme durumlarý karþýlaþtýrýldýðýnda, acil hekimlerinin adli olaya neden olan travmanýn yaþamsal tehlike ve basit týbbi müdahale ile giderilebilme durumlarýný tespit etmede yetersiz olduklarý gösterildi. Üçüncü basamak hastanelerde (eðitim ve araþtýrma hastanesi ile üniversite hastaneleri) düzenlenen adli raporlarýn, birinci ve ikinci basamak hastanelerde düzenlenen adli raporlara göre adli olaya neden olan travmanýn yaþamsal tehlike ve basit týbbi müdahale ile giderilebilme durumlarýný daha doðru tespit ettiði görüldü.
TARTIÞMA: Acil servislerde çalýþan hekimlerin pratisyen ya da acil uzmaný olmalarý fark etmeksizin, adli rapor düzenlenmesi ile ilgili hassasiyetlerinin ve bilgi düzeylerinin yetersiz olduðu tespit edilmiþtir. Acil týp ve adli týp uzmanlýk alanlarýnýn içinde yer aldýðý koordineli planlanan multidisipliner eðitimlerin arttýrýlmasýyla hatalý düzenlenen adli raporlarýn azalacaðý ve hekimlerin düzenledikleri adli raporlarýn sonuçlarý hususunda farkýndalýklarýnýn artacaðý düþüncesindeyiz.

BACKGROUND: Identify the deficiencies in the forensic reports prepared by the emergency physicians and to identify the frequent mistakes in these reports by comparing the forensic reports issued by the emergency physicians in the context of offences against physical integrity and the forensic reports issued by the Second Forensic Medicine Specialization Board for the same forensic cases.
METHODS: Existence of the information that should be included in the standard forensic report (name, surname, address, event date, etc.) of 241 cases prepared by emergency physicians who were sent to the Forensic Medicine Second Forensic Medicine Second Specialization Board due to various reasons between February 1, 2019, and May 1, 2019, were reviewed retrospectively. Besides, whether the trauma causing the forensic event stated in these reports is life threatening or not and whether it can be eliminated with simple medical intervention or not were compared with the reports prepared by the Council of Forensic Medicine Forensic Medicine Second Specialization Board for the same events and certain mistakes were determined.
RESULTS: Address, examination time, and incident date were not specified in forensic reports issued by emergency physicians with a ratio of 95.5%, 63.9%, and 75.9%, respectively. About 23.2% of forensic reports written by hand were not legible. When the reports prepared by the Council of Forensic Medicine and the emergency physicians for the same forensic events were compared in terms of the presence of life threat and treatment with simple medical intervention, it was shown that the emergency physicians were insufficient in determining the life hazard and the simple medical intervention to resolve the trauma causing the forensic event. It was found that the forensic reports issued in tertiary hospitals (education and research hospitals and university hospitals) were more accurate in determining the life hazard and treatment with simple medical intervention status of trauma which caused the forensic event when compared with forensic reports which were issued in primary and secondary line hospitals.
CONCLUSION: Regardless of whether the physicians working in the emergency departments are general practitioners or emergency specialists, their sensitivity and knowledge level regarding the preparation of a forensic report was found to be insufficient. We believe that with the increase of coordinated planned multidisciplinary trainings that include emergency medicine and forensic medicine, the forensic reports that are arranged incorrectly will decrease and the awareness of physicians about the results of forensic reports will increase.

AMAÇ: Üst gastrointestinal kanamalarýnda (ÜGÝK) tekrar kanama riski mortal seyredebilen ve önemli bir komplikasyondur. Bu çalýþmada tekrar kanama riskini öngörebilecek faktörlerin saptanmasý amaçlandý.
GEREÇ VE YÖNTEM: ÜGÝK ile eriþkin yoðun bakýma yatan hastalar geriye dönük olarak tarandý. Yaþ ve cinsiyetin yanýnda hastalarýn baþvuru yakýnmasý, vital bulgularý, komorbiditeleri, laboratuvar bulgularý, kullandýðý ilaçlar, endoskopi durumu ve tekrar kanama durumlarý kaydedildi. Bu bulgular ýþýðýnda hastalarýn Glasgow-Blatchford ve AIMS65 skorlarý hesaplandý. Ýstatistiksel inceleme için Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL) paket program kullanýldý.
BULGULAR: Toplam 241 hasta çalýþmaya alýndý. Hastalarýn ortalama yaþý 57.58±19.3 yýldý ve olgularýn 176’sý (%73.0) erkekti. Hastalarýn 77’sinde (%32.0) tekrar kanama olduðu ve 117’sinin (%48.5) H. pylori pozitif olduðu saptandý. Toplam 103 (%42.7) hastaya skleroterapi, beþ (%2.1) hastaya elektrokoagülasyon, dört (%1.7) hastaya hemoklips uygulandýðý ve endoskopi yapýlan ve yapýlmayan hastalar arasýnda tekrar kanama açýsýndan anlamlý fark olduðu saptandý (p<0.001). Hematokrit ve üre deðerleri ile Glasgow-Blatchford ve AIMS65 skorlarýnýn tekrar kanama olan ve olmayan gruplar arasýnda istatistiksel olarak fark olduðu saptandý (sýrasýyla, p=<0.00, <0.001, <0.001, 0.008). Glasgow Blatchford ve AIMS65 skorlama sistemlerinin tekrar kanama riskini öngörmedeki performansýnýn deðerlendirilmesi için yapýlan ROC analizinde AUC deðerleri sýrasýyla 0.700 (p<0.001, %95 Güven Aralýðý-GA: 0.626–0.775) ve 0.557 (p=0.194, %95 GA: 0.469–0.645) olarak hesaplandý. Hastalarýn 5’inde (%2.1) mortalite görüldüðü saptandý.
TARTIÞMA: Üst GÝS kanamasýnda tekrar kanama riski için laboratuvar deðerlerinden hematokrit ve üre deðerleri faydalý olabilirken, skorlama
sistemlerinden Glasgow-Blatchford skorlama sisteminin AIMS65’e göre daha iyi performans gösterdiði saptanmýþtýr. Klinisyenler için daha spesifik öngörücü belirteçlerin faydalý olabileceði deðerlendirilmiþtir.

BACKGROUND: The risk of re-bleeding in upper gastrointestinal bleeding (UGIB) is a major complication that can be mortal. In this study, we aimed to determine the factors that can predict the risk of re-bleeding in UGIB patients.
METHODS: We retrospectively screened UGIB patients admitted in adult intensive care. Along with age and gender, complaints of admission, vital signs, comorbidities, laboratory findings, medications, endoscopy status, and re-bleeding status were recorded. According to these findings, Glasgow-Blatchford and AIMS65 scores of the patients were calculated. All statistical tests were performed with the Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL).
RESULTS: A total of 241 patients were included in the study. Mean age of patients was 57.58±19.31, years and 176 (73.0%) of them were male. A total of 117 (48.5%) patients were Helicobacter pylori positive and re-bleeding occurred in 77 (32.0%) patients. Sclerotherapy was applied in 103 (42.7%) patients, while 5 (2.1%) underwent electrocoagulation, and 4 (1.7%) underwent hemoclips. There was a significant difference between patients with and without endoscopic intervention for re-bleeding (p<0.001). Hematocrit, urea values, Glasgow-Blatchford, and AIMS65 scores were statistically significant different between the groups with and without re-bleeding (p=<0.001, <0.001, <0.001, and 0.008, respectively). In the ROC analysis of Glasgow-Blatchford and AIMS65 scoring systems area, under the curve values were 0.700 (p=<0.001, 95% CI: 0.626–0.775), and 0.557 (p=0.194, CI 95%: 0.469–0.645), respectively. Mortality rate was 2.1% (n=5) among study population.
CONCLUSION: Hematocrit and urea values seem beneficial among studied laboratory values, however, Glasgow-Blatchford scoring system performed better than AIMS65 in the prediction of re-bleeding risk in UGIB. The authors concluded that more specific predictive markers may be useful for clinicians.

AMAÇ: Fournier gangreni hýzlý ilerleyen bir yumuþak doku nekrozu olup agresif cerrahi tedavi uygulanmadýðýnda yaþamý tehdit edebilir. Fournier gagren ciddiyet skorlamasý ilk olarak Laor ve arkadaþlarý tarafýndan mortalite oranýný tahmin etmek için tanýmlanmýþtýr. Bu skorlamanýn prognostik önemi kanýtlanmýþ olmakla birlikte gangrene neden olan mikrobik ajanlarla baðlantýsý ya da hastalarýn tedavi süreçlerinin uzunluðu ile ilgisini araþtýran çok az çalýþma vardýr. Bu çalýþmada, Fournier gangreni ciddiyet skorlamasý ve yara yerlerinden izole edilen enfektif ajanlarýn hastanede kalýþ, debridman sýklýðý ve mortalite üzerindeki etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Ocak 2013–Ocak 2018 tarihleri arasýnda Fournier gagreni tanýsýyla ameliyat edilen 34 hasta geriye dönük olarak incelendi. Baþvuru sýrasýndaki Fournier gagreni ciddiyet skorlarý hesaplandý ve hastalar eþik deðerine göre iki gruba ayrýldý. Ayrýca, debridman kültürlerinden izole edilen mikrobiyal ajanlara göre kategorize edilerek iki ayrý grup oluþturuldu. Fournier gagreni ciddiyet skorlamasý ve mikrobiyal ajan tipinin hastanede kalýþ, debridman sýklýðý ve mortaliteye etkisi analiz edildi. Hayatta kalan ve hayatta kalmayanlar grubu arasýnda hasta özellikleri karþýlaþtýrýldý.
BULGULAR: Fournier gagreni ciddiyet skoru >9 olan grupta diðer gruba göre mortalite oranýnýn anlamlý olarak yüksek olduðu (%100’e karþý %6.7; p=0.001>) ve bu skorlamanýn mortalite oranýný %100 ve saðkalým oranýný ise %93.3 öngördüðü görüldü. Fournier gagreni ciddiyet skoru ile debridman sýklýðý ve hastanede kalýþ sýklýðý arasýnda anlamlý bir iliþki yoktu. Kolostridiyal ve atipik ajanlarla enfekte hasta alt grubunda mortalite oraný (%50’ye karþý %4.2; p=0.005) ve debridman sýklýðý (3.10±0.73’e karþý 2.00±0.72; p=0.001) anlamlý olarak daha yüksekti.
TARTIÞMA: Fournier gagreni ciddiyet skorunun prognozu baþarýlý bir þekilde öngörebilmesine karþýn debridman sýklýðýný ve hastanede kalýþ süresini belirlemede yetersiz olduðu görüldü. Ayrýca çalýþma kolostridiyal ve atipik ajanlarla enfekte hastalarýn daha fazla sayýda debridman gerektireceðini ve mortalite geliþtirme olasýlýðýnýn daha yüksek olduðu öngörmüþtür. Bu grubun ilk debridmanda daha agresif cerrahiye ihtiyaç duyma eðiliminde olduðu söylenebilir.

BACKGROUND: Fournier gangrene (FG) is a rapidly progressive soft-tissue necrosis that may be life-threating unless aggressive treatment is applied immediately. FG severity index was described first by Laor et al. to predict mortality rate but there are few studies on the prognostic significance of FG severity index and especially the microbial agents isolated from debridement on patient prognosis. Hence, in the present study, it has been aimed to investigate the significance of FG severity index and infective agents on hospital stay, frequency of debridement, and mortality.
METHODS: Thirty-four patients who were operated with the diagnosis of FG between January 2013 and January 2018 were retrospectively analyzed. FG severity index scores in admission were calculated and patient was divided into two groups according to the cutoff value of FG severity index. Patient was categorized according to the microbial agents isolated from debridement cultures. Patient characteristics were compared between the group of survivors and non-survivors. The effect of FG severity index and microbial agent type on hospital stay, frequency of debridement, and mortality was analyzed.
RESULTS: It was found that mortality rate was significantly higher in the group of FG severity index score >9 than the other group (100% vs. 6.7%; p=0.001>) and it was observed that FG severity index had predicted the mortality rate as 100% and survival rate as 93.3% but there were no significant relation between FG severity index with the frequency of debridement and hospital stay. The mortality rate (50% vs. 4.2%; p=0.005) and frequency of debridement (3.10±0.73 vs. 2.00±0.72; p=0.001) were significantly higher in the subgroup of patient infected with clostridial and atypical agents. CONCLUSION: FG severity index was found to be insufficient in determining the frequency of debridement and the hospital stay but it accurately predicts the rates of mortality and survival. The patients who were infected with clostridial and atypical agents are more likely to develop mortality and tend to be need more aggressive surgical interventions than the others.

AMAÇ: Türkiye’nin farklý bölgelerinde yaþlý eriþkinlerdeki yanýk yaralanmalarýnýn epidemiyolojik profilini tanýmlayan sýnýrlý sayýda epidemiyolojik araþtýrma vardýr. Bu çalýþmada, Adana Þehir Eðitim ve Araþtýrma Hastanesine yatarak tedavi için baþvuran yaþlý eriþkinlerde yanýk yaralanmalarýnýn yaygýn epidemiyolojik verilerini gözden geçirerek tedavi sonuçlarýmýz ve mortaliteye en fazla etki eden faktörlerin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Yanýk merkezinde 1 Ocak 2016’dan 31 Aralýk 2019 tarihleri arsýnda yatarak tedavi edilen 60 yaþ ve üstündeki hastalarýn demografik verileri yanýk total vücut alaný yüzdesi (TBSA), kýsaltýlmýþ yanýk þiddeti indeksi (ABSI) ve Revize Baux skorlarý, ko-morbiditeler, tedavi yaklaþýmlarý, hastanede yatýþ süresi ve mortalite geriye dönük olarak incelendi.
BULGULAR: Çalýþmaya 60 yaþ ve üzeri hastanede yatarak 24 saatten fazla tedavi gören toplam 104 (%5.5) eriþkin yanýk hastasý dahil edildi. Hastalarýn 38’i erkek, 66’sý kadýndý. Hayatta kalanlarda erkek/kadýn oraný 1.00: 2.05, hayatta kalmayanlarda ise 1.25: 1.00 olarak saptandý. Hayatta kalanlar için ortalama yaþ 70.9±8.5 (60.0–92.0), hayatta kalmayanlar için 72.7±8.4 (62.0–90.0) olarak saptandý. Ortalama yanýk TBSA yüzdesi hayatta kalanlar için %11.4±9.9 ve hayatta kalmayanlar için %37.8±30.0 idi. Yanýk yaralanmalarýnýn büyük çoðunluðun (%81), özellikle mutfak ve banyoda olmak üzere ev ortamýnda meydana geldiði ve tüm yanýklarýn üçte birinden daha fazlasýnýn etiyolojisin sýcak suya baðlý (%37) haþlanma yanýklarýnýn oluþturduðu gözlendi. Yaþ (p=0.329), etiyoloji (p=0.984) ve yanýk yaralanmasýnýn meydana geldiði yer (p=0.071), yanan anatomik bölgeler (p=0.817), cerrahi iþlem (evet/hayýr) (p=0.798) göz önüne alýndýðýnda istatistiksel olarak hayatta kalanlar ve hayatta kalmayanlar arasýnda anlamlý fark gözlenmedi.
TARTIÞMA: Daha geniþ total vücut yanýk alaný (TBSA) yüzdesinin, inhalasyon hasarý ve derin yanýklarýn mortaliteye en fazla etki eden faktörler olduðu bulundu. Revize edilmiþ Baux (R Baux) ve kýsaltýlmýþ yanýk þiddet indeksi (ABSI) skorlarýnýn mortaliteyi tahmin etmede yüksek bir deðere sahip olduðu saptandý.

BACKGROUND: There is a lack of epidemiological research on defining the epidemiological profile of burn injuries in older adults in different regions of Turkey. This study was designed to document the prevalent epidemiological pattern of burn injuries and factors that affect mortality in older adults admitted for treatment to the inpatient unit of Adana City Training and Research Hospital (ACTRH).
METHODS: Demographic data, burn mechanism, presentation, percentage of total body surface area (TBSA) burn, abbreviated burn severity index (ABSI) and revised Baux scores, comorbidities, and treatment modalities burn patients aged 60 years and over admitted to our burn center January 1, 2016, and December 31, 2019, were evaluated retrospectively in this study.
RESULTS: The medical records of 1754 inpatient burns over 4 years were retrospectively reviewed. A total of 104 (5.5%) hospitalized adult burn patients aged 60 years old or over and treated more than 24 h were included in the study. There were 38 males and 66 females with a male-to-female ratio of 1.00: 2.05 in survivors and 1.25: 1.00 in non-survivors. The mean age was 70.5±8.5 (60.0–92.0) for survivors and 72.7±8.4 (62.0–90.0) years for non-survivors. The mean (%) TBSA burned was 11.4±9.9% for survivors and 37.8±30.0% for non-survivors. Most of the burn injuries occurred at indoor locations (81%), caused by hot water scalds, representing more than one-third of all burns, especially in the kitchen and bathroom. Considering the age (p=0.329), the etiology (p=0.984) and place of burns (p=0.071), burned anatomical regions (p=0.817), and the surgical procedure (yes/no) (p=0.798), no statistical difference was observed between survivors and non-survivors.
CONCLUSION: The more extended %TBSA burn, the inhalation injury, and deep burns were found to be significantly the most effective factors in mortality. Revised Baux (R Baux) and ABSI scores had a high value of predicting mortality.

AMAÇ: Pandemi sýrasýnda akut apandisit (AA) tanýsýyla hastanemize baþvuran hastalarýn pandemi öncesi döneme göre bekleme ve ameliyat olma sürelerini, AA özelinde sürecin nasýl yönetildiðini ve hastaya ait diðer verileri karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’ne AA ön tanýsýyla yatýþý yapýlan hastalar arasýnda geriye dönük kohort analizi yapýldý. Bu amaçla iki grup oluþturuldu. 1. grup: 11 Mart ve 1 Haziran 2020; 2. grup: 11 Mart ve 1 Haziran 2019 tarihleri arasý akut apandisit ön tanýsýyla ameliyat edilen hastalarýn oluþturduðu grup.
BULGULAR: Grup 1’de 46 hasta, grup 2’de 79 hasta akut apandisit ön tanýsýyla ameliyat edildi. Gruplar arasýnda ameliyat öncesi semptom süreleri veya cerrahi bekleme süreleri açýsýndan bir fark bulunamadý.
TARTIÞMA: COVID-19 pandemisi sürecinde AA nedeniyle ameliyat edilen hasta sayýlarýndaki belirgin azalma, hastalarýn enfeksiyon kapma endiþesiyle hastaneye baþvurmaktan duyduklarý sakýnma olarak yorumlanabilir. Komplike olmayan olgularýn spontan rezolüsyona uðradýklarýný da düþündürebilir ancak bu varsayýmý desteklemek ve bu durumun kriterlerini bilimsel kanýt düzeyi içerecek þekilde tanýmlamak için daha fazla araþtýrmaya ihtiyaç vardýr.

BACKGROUND: This study aims to compare the waiting and operating times of the patients who applied to our hospital with the diagnosis of acute appendicitis (AA) during the pandemic, how the process was managed in terms of AA and other data of the patient compared to the pre-pandemic period.
METHODS: A retrospective cohort analysis was performed among patients who were hospitalized in the Fatih Sultan Mehmet Training and Research Hospital General Surgery Clinic with a pre-diagnosis of AA. For this purpose, two groups were formed. Group 1: It comprised patients who were operated between March 11 and June 1, 2020; Group 2: It comprised patients who were operated between March 11 and June 1, 2019, with a pre-diagnosis of AA.
RESULTS: Forty-six patients in Group 1 and 79 patients in Group 2 were operated with the pre-diagnosis of AA. There was no difference between groups in terms of pre-operative symptom durations or surgery waiting times.
CONCLUSION: During the COVID-19 pandemic, significant decrease observed in the number of patients operated because of AA can be interpreted as the avoidance of patients from applying to the hospital with the concern of infection. Moreover, it may suggest that uncomplicated cases undergo spontaneous resolution; however, there is a requirement for further research to support this assumption and define the criteria for this condition by including a level of scientific evidence.

AMAÇ: Pandemi sürecinde genel cerrahi kliniklerinde elektif operasyonlar ertelense de acil travma, akut karýn ve kanser ameliyatlarý gibi ertelenemeyen operasyonlara devam edildi. Çalýþmamýzda salgýn süresince hastanemiz genel cerrahi kliniðinde ameliyat edilen acil ve ertelenemeyen elektif olgularý sunmayý, pandemi sýrasýnda bu hastalara müdahale eden saðlýk çalýþanlarý için asýl risk oluþturan genel cerrahi hasta grubunu belirlemeyi ve benzer bir durum yaþanma olasýlýðý için tecrübemizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþma geriye dönük bir kohort çalýþmasý olarak tasarlanmýþtýr. 10 Mart–23 Mayýs 2020 tarihleri arasýnda Ýstanbul Kartal Dr. Lütfi Kýrdar Þehir Hastanesi’ne baþvuran acil ve ertelenemeyen elektif ameliyata alýnan hastalar çalýþmaya dahil edildi. Hastalar ameliyat öncesi SARS-CoV-2 enfeksiyonu açýsýndan test edildi. Taburculuk sonrasý da pansuman ve poliklinik takiplerinde rutin olarak ateþ ve COVID-19 semptomlarý açýsýndan kontrollerine devam edildi. Ayrýca ulusal saðlýk takip sisteminden (e-nabýz) taburculuk sonrasý ilk 15 günde COVID-19 tanýsý alýp almadýðý kontrol edildi. Taburculuk sonrasý ilk on beþ günde COVID-19 sürüntüsü (RT-PCR) pozitif olan ya da çekilen toraks tomografisinde infiltrasyonu olan hastalar hastane bulaþý açýsýndan þüpheli kabul edildi.
BULGULAR: 10 Mart–23 Mayýs 2020 tarihleri arasýnda COVID-19 salgýný süresince çalýþmamýzda toplam 195 hasta ameliyat edildi. Bunlarýn 96’sý (%49.2) acil, 99’u (%50.8) ertelenemez elektif ameliyatlardý. Baþvuru esnasýnda hastalarýn 13’üne COVID-19 sürüntü (RT-PCR) ve toraks tomografi bulgularý ile COVID-19 tanýsý konuldu. Covid(+) ameliyat olan hasta grubunun büyük bir kýsmýnýn (n=12, %92.3) acil nedenlerden ameliyat olduðu görüldü. Covid(+) grupta ameliyat sonrasý birinci gün üç hastada mortalite saptandý. Mortalite oranlarý Covid(+) hastalarda istatistiksel olarak daha yüksekti (n=3, 23.1% ve n=8, 4.4%). Çalýþma süresince kliniðimizdeki hiçbir saðlýk çalýþanýnda COVID-19 semptomu saptanmadý. Elektif ameliyat olan 3 hastada ise hastane yatýþ ve taburculuk sonrasý takiplerinde COVID-19 pozitifliði saptandý.
TARTIÞMA: Bu zor zamanlarda ameliyatlarýn sürmesi saðlýk sistemimizin önemli bir yönü olmaya devam edecektir. Sonuçlarýmýzýn hastane içi hastalýk yayýlýmýnýn azalmasýnda, saðlýk personeline bulaþýn engellenmesinde ve cerrahi ekibin hangi hasta grubunda yüksek risk altýnda olacaklarýný bilmelerinde faydalý olacaðýna inanýyoruz.

BACKGROUND: Although elective operations in general surgery clinics were postponed during the pandemic, non-deferrable operations such as emergency trauma, acute abdominal, and cancer surgeries continued. We aimed to present emergency and non-deferrable elective surgery cases in our hospital’s general surgery clinic during the pandemic, to identify the general surgery patients that pose the greatest risk for healthcare workers who served these patients, and to share our experience in these situations.
METHODS: The study was designed as a retrospective cohort study. The study included patients admitted for emergency and non-deferrable elective surgeries in Kartal Dr. Lutfi Kirdar City Hospital in Istanbul between March 10, 2020, and May 23, 2020. The patients were tested before the operation for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection. They were also routinely checked for fever and coronavirus disease 2019 (COVID-19) symptoms during dressing changes and outpatient follow-up visits after discharge as well as through the national health monitoring system (e-nabýz) whether the patients were diagnosed with COVID-19 within the 15 days of discharge. Patients who tested positive in the reverse transcription-polymerase chain reaction (RT-PCR) tests in the first 15 days after discharge or had infiltration in thorax tomography were considered suspicious in terms of hospital transmission.
RESULTS: During the COVID-19 pandemic period between March 10, 2020, and May 23, 2020, a total of 195 patients were operated on. Of these, 96 (49.2%) were operated due to emergencies, and 99 (50.8%) were non-deferrable elective surgeries. At the time of admission, 13 patients were diagnosed with COVID-19 through RT-PCR and thorax tomography findings. A higher proportion of the patients with COVID-19 (n=12, 92.3%) were found to be operated for emergencies. Three patients with COVID-19 died on the 1st postoperative day. Mortality was significantly higher in this group than in those who tested negative (n=3, 23.1% vs. n=8, 4.4%). During the study, none of the healthcare workers in our clinic developed COVID-19 symptoms. Three patients who had elective surgery were found to be SARS-CoV-2 (+) in the follow-up period after discharge.
CONCLUSION: Maintaining functional surgery departments under challenging times, such as a pandemic, will continue to be an important aspect of health systems. We believe that the results of this study will help reduce in-hospital transmission, help prevent disease transmission to healthcare personnel, and allow the members of the surgical teams to know in which patient group they will be at higher risk of infection during the operation.

AMAÇ: Bu çalýþmada median sternotomi ile yapýlan izole koroner arter baypas greft cerrahisinden sonra geliþen mediastinit olgularýnýn, etken olan mikroorganizmalarýný, risk faktörlerini ve klinik özelliklerini ortaya koymak amacýyla deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Mart 2009–Aralýk 2018 tarihleri arasýnda kalp ve damar cerrahisi kliniðinde median sternotomi ile izole koroner arter baypas greft cerrahisi yapýlan ve ameliyat sonrasý dönemde mediastinit geliþen toplam 44 hasta (32 erkek, 12 kadýn; ort. yaþ 62.84±6.951 yýl; daðýlým 46–78 yýl) çalýþmaya alýndý. Hastalarýn demografik özellikleri, eþlik eden hastalýklarý, alýþkanlýklarý, operasyon öncesi yatýþ süreleri, elektif veya acil cerrahi durumlarý, perioperatif internal mammarian arter kullanýmlarý, perioperatif kan ve kan ürünü transfüzyonu, operasyon ve kardiyopulmoner baypas süreleri, antibiyotik profilaksilerinin uygunluðu, týbbi ve cerrahi tedavileri, klinik bulgular ve laboratuvar sonuçlarý dahil olmak üzere veriler geriye dönük olarak incelendi. Pürülan akýntý kültürü cerrahi alandan veya cerrahi onarým yapýldýðý zaman doðrudan mediastinal boþluktan alýndý, elde edilen materyalden yapýlmýþ olan mikrobiyolojik inceleme kaydedildi.
BULGULAR: Yaklaþýk 10 yýllýk bir periyotta yapýlan izole koroner arter baypas greft cerrahisinden sonra geliþen mediastinit oraný %1 olarak belirlendi. Mediastinit geliþen hastalarda geliþmeyenlere göre yaþ, cinsiyet, sigara kullanýmý, operasyon ve kardiyopulmoner baypas süresi ve perioperatif kan transfüzyonu açýsýndan istatistiksel olarak anlamlý fark saptanmadý. Diabetes mellitus varlýðý ve ortalama vücut kitle indeks’inin yüksekliði mediastinit geliþen hastalarda geliþmeyenlere göre anlamlý bulundu. Mediastinit tanýsý hastalarýn 38’ine (%86.3) ilk bir ayda, beþine (%11.3) ilk üç ayda, birine (%2.2) ise ilk bir yýlda konulmuþtur. Pürülan akýntý kültürlerinde üreyen mikroorganizmalarýn 25’ini (%56.9) Gram pozitif bakteriler, on üçünü (%29.6) Gram negatif bakteriler ve birini (%2.3) mantarlar oluþturmuþtur. Beþ (%11.4) olguda ise patojen mikroorganizma üretilemedi. En sýk izole edilen üç etken metisiline rezistan koagülaz negatif stafilokoklar (MRKNS) (%50), Escherichia coli (%9.1) ve Klebsiella pneumoniae (%6.8) idi.
TARTIÞMA: Kardiyovasküler cerrahi giriþim geçiren hastalarda özellikle cerrahi alan enfeksiyonuna dikkat edilmelidir. Taburcu olduktan sonraki takip önemlidir ve enfeksiyon ortaya çýktýðýnda ampirik tedavi yaklaþýmý hastanemizde önde gelen enfeksiyöz ajanýn MRKNS olduðu dikkate alýnarak belirlenmelidir.

BACKGROUND: In this study, we aimed to evaluate mediastinitis cases developed after isolated coronary artery bypass graft surgery performed by median sternotomy to determine the causative microorganisms, risk factors, and clinical features.
METHODS: Between March 2009 and December 2018, a total of 44 patients (32 males and 12 females; mean age 62.84±6.951 years; range, 46–78 years) who underwent isolated coronary artery bypass grafting surgery with median sternotomy and developed mediastinitis postoperatively were included in the studying our cardiovascular surgery (CVS) department. Patients demographic information, comorbidities, habits, pre-operative hospital stay, elective or emergency surgery, perioperative internal mammary artery use, perioperative blood or blood product, operation and cardiopulmonary bypass times, suitability of antibiotic prophylaxis, medical and surgical treatment, clinical data, and laboratory results were retrospectively analyzed. Purulent discharge cultures obtained directly from the mediastinal space and microbiological examination notes made from the material obtained from the surgical site or surgical repair were recorded.
RESULTS: In isolated coronary artery bypass grafting surgery performed over a period of approximately 10 years, the rate of mediastinitis was 1%. There was no statistically significant difference between patients with and without mediastinitis in terms of age, sex, smoking habits, duration of operation and cardiopulmonary bypass, and intraoperative blood transfusion. The presence of diabetes mellitus and high mean body mass index was significantly higher in patients with mediastinitis compared to those without. Mediastinitis was diagnosed in 38 (86.3%) patients in the 1st month, 5 (11.3%) in the first 3 months, and 1 (2.2%) in the 1st year. Twenty-five (56.9%) Gram-positive bacteria, 13 (29.6%) Gram-negative bacteria, and 1 (2.3%) fungi were the microorganisms grown in purulent discharge cultures. Pathogen microorganisms could not be produced in 5 (11.4%) cases. The three most commonly isolated agents were methicillin-resistant coagulase-negative staphylococci (MRCNS) (50%), Escherichia coli (9.1%), and Klebsiella pneumoniae (6.8%).
CONCLUSION: Attention should be paid to surgical site infection in patients undergoing CVS. Following discharge, follow-up is important and empirical treatment should be determined by considering the presence of MRCNS as the leading infectious agent in our hospital when infection occurs.

AMAÇ: Dudak damak yarýðý (DDY), deformitesi en sýk görülen konjenital yüz anomalisidir. Bu çalýþmada yarýk dudak/damak onarým cerrahisi sonrasý vomer kemiði deðiþikliklerinin hacmi ve þekli deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Yaþlarý, 9–12 arasýnda olan toplam 30 hastanýn bilgisayarlý tomografi (BT) görüntüleri geriye dönük olarak incelendi. Bireyler, üç gruba ayrýldý 1) herhangi bir sendromu olmayýp tek taraflý CLP (n=10) için ameliyat edilen grup, herhangi bir sendromu olmayan opere edilmiþ çift taraflý CLP grubu (n=10) ve herhangi bir sendromu ve dudak damak yarýðý deformitesi olmayan kontrol grubu (n=10). Hastalarýn verileri, üç boyutlu bir yazýlým programýna aktarýlarak, Vomer kemiðinin üç boyutlu görüntüsü üzerinde metrik ve hacimsel ölçüm yapýldý.
BULGULAR: Üç grup arasýnda Sella-Nasion uzunluðu, Vomer taban uzunluðu ve Vomer dikey uzunluðu arasýnda istatistiksel olarak anlamlý bir fark yoktu. Ancak çift taraflý CLP’li hastalarýn Vomer kemik hacimi, kontrol grubundan istatistiksel olarak önemli derecede yüksek bulundu.
TARTIÞMA: Çift taraflý Vomer flebinin elevasyonunu takiben periost reaksiyonu oluþurken, erken dönemde damak mukoperiosteal flebe dikilince maksilla büyürken vomeri de sürükleyerek daha fazla kemik oluþumuna neden olabilir. Bulgularýmýz, Vomer kemiðinin boyutunun ve hacminin çevresel faktörlerden önemli ölçüde etkilenebileceði sonucuna varmamýzý saðladý. Fonksiyonel matriks teorisine göre skar dokusu oluþumu ve Vomer-maksilla füzyonunun yetersizliði, ön kraniyal kemiklerin geliþiminin yetersiz olmasý, ön kafa kaidesinin daha kýsa kalmasýna neden olabilmektedir.

BACKGROUND: Cleft lip/palate (CLP) deformity is the most common congenital facial anomaly. In this study, it was aimed to evaluate the changes in volume and shape of Vomer bone after CLP repair surgery.
METHODS: The images of a total of 30 patients aged between 9 and 12 years which were recorded with computed tomography were retrospectively analyzed. The patients were divided into three groups: No syndrome, operated for unilateral CLP group (n=10), no syndrome, operated for bilateral CLP group (n=10), and control group (n=10) with no syndrome, no operation history, or no lip/palate deformities. Data of the patients were transferred to a software program and a new three-dimensional image was created for the Vomer.
RESULTS: There was no statistically significant difference in the Sella-Nasion lengths, Vomer base lengths, and Vomer vertical lengths among the three groups. However, the Vomer bone volume of the patients with bilateral CLP was found to be statistically significantly higher than the control group.
CONCLUSION: We can conclude that more bone formation may be observed due to the periosteal reaction following bilateral Vomer flap elevation or during maxillary growth, tension on the palatal flap may be increased new bone formation by pulling the bilateral Vomer flap if it is elevated and sutured palatal mucoperiosteal flap in the early period. Our findings have led us to the conclusion that size and volume of the Vomer bone can be significantly affected by environmental factors. According to the functional matrix theory, scar tissue formation and lack of Vomer-maxilla fusion cannot stimulate the further development of the anterior cranial bones, leading to shorter anterior cranial base.

AMAÇ: El travmasý olan hastalar genellikle hastanelerin acil servislerinde muayene edilir. El travmalarýnda el kemik kýrýklarý sýklýkla görülür. Bu çalýþmada, derin öðrenme yöntemlerini kullanarak el kýrýklarýnýn tanýsýnda hekimlere yardýmcý olmak için bilgisayar destekli bir yöntem geliþtirmeyi hedefledik.
GEREÇ VE YÖNTEM: Bu çalýþmada, konvolüsyonel sinir aðlarý kullanýlmýþ ve öðrenme transferi yöntemi uygulanmýþtýr. Veri kümesinde 275 el bilek kýrýðý, 257 falanks kýrýðý ve 270 normal el radyografisi vardý. Bu çalýþmada derin öðrenme yöntemi olan konvolüsyonel sinir aðlarý kullanýlmýþtýr. Modelin performansýný artýrmak için önceden eðitilmiþ VGG-16, GoogLeNet ve ResNet-50 aðlarý ile öðrenme transferi uygulanmýþtýr.
BULGULAR: Grup 1 (el bilek kýrýðý ve normal el) veri setindeki doðruluk, duyarlýlýk, özgüllük ve kesinlik sonuçlarý VGG-16 ile sýrasýyla %93.3, %96.8, %90.3 ve %89.7, ResNet-50 ile sýrasýyla %88.9, %94.9, %84.2 ve %82.4 ve GoogLeNet ile sýrasýyla %88.1, %90.6, %85.9 ve %85.3 idi. Grup 2 (falanks kýrýðý & normal el) veri setindeki doðruluk, duyarlýlýk, özgüllük ve kesinlik sonuçlarý, VGG-16 ile sýrasýyla %84.0, %84.1, %83.8 ve %82.8, Resnet-50 ile sýrasýyla %79.4, %78.5, %80.3 ve %79.7 ve GoogLeNet ile sýrasýyla %81.7, %81.3, %82.1 ve %81.3 idi.
TARTIÞMA: Derin öðrenme uygulamalarýnda son teknoloji uygulamalar olan transfer öðrenme, veri artýrma gibi yöntemler uygulayarak geliþtirdiðimiz bu bilgisayar destekli taný yönteminde umut verici sonuçlar elde ettik. Bu bilgisayar destekli taný yöntemi, el radyografilerini yorumlarken, özellikle gece vardiyalarý ve hafta sonlarý gibi uzman meslektaþlara ulaþmak zor olduðunda, küçük hastanelerin acil servislerinde çalýþan hekimlere yardýmcý olabilir.

BACKGROUND: Patients with hand trauma are usually examined in emergency departments of hospitals. Hand fractures are frequently observed in patients with hand trauma. Here, we aim to develop a computer-aided diagnosis (CAD) method to assist physicians in the diagnosis of hand fractures using deep learning methods.
METHODS: In this study, Convolutional Neural Networks (CNN) were used and the transfer learning method was applied. There were 275 fractured wrists, 257 fractured phalanx, and 270 normal hand radiographs in the raw dataset. CNN, a deep learning method, were used in this study. In order to increase the performance of the model, transfer learning was applied with the pre-trained VGG-16, GoogLeNet, and ResNet-50 networks.
RESULTS: The accuracy, sensitivity, specificity, and precision results in Group 1 (wrist fracture and normal hand) dataset were 93.3%, 96.8%, 90.3%, and 89.7%, respectively, with VGG-16, were 88.9%, 94.9%, 84.2%, and 82.4%, respectively, with Resnet-50, and were 88.1%, 90.6%, 85.9%, and 85.3%, respectively, with GoogLeNet. The accuracy, sensitivity, specificity, and precision results in Group 2 (phalanx fracture and normal hand) dataset were 84.0%, 84.1%, 83.8%, and 82.8%, respectively, with VGG-16, were 79.4%, 78.5%, 80.3%, and 79.7%, respectively, with Resnet-50, and were 81.7%, 81.3%, 82.1%, and 81.3%, respectively, with GoogLeNet.
CONCLUSION: We achieved promising results in this CAD method, which we developed by applying methods such as transfer learning, data augmentation, which are state-of-the-art practices in deep learning applications. This CAD method can assist physicians working in the emergency departments of small hospitals when interpreting hand radiographs, especially when it is difficult to reach qualified colleagues, such as night shifts and weekends.

AMAÇ: Suprakondiler humerus kýrýklarý, çocuk ve adölesan yaþ grubunda en sýk görülen dirsek kýrýðýdýr. Tedavi planlamasý, güncel olarak Gartland sýnýflamasý ile yapýlmaktadýr. Gartland tip 3 kýrýklarda redüksiyon ve perkütan pinleme uygulanmaktadýr. Kapalý redüksiyonun baþarýsýz olduðu durumlarda, açýk redüksiyon uygulanmaktadýr. Ancak, hangi hastalarda açýk redüksiyona ihtiyaç duyulacaðý konusunda görüþ birliði bulunmamaktadýr. Çalýþmanýn amacý, kýrýk yerleþiminin açýk redüksiyon oraný ve klinik sonuçlara olan etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Aðustos 2011 ile Aðustos 2017 arasýnda Gartland tip 3 suprakondiler humerus kýrýðý nedeniyle baþvuran 112 hasta geriye dönük deðerlendirildi. Yaþ, kýrýk yerleþimi, ameliyat sonrasý redüksiyon kaybý ve komplikasyonlara ait veriler elde edildi. Hastalar, kýrýðýn yerleþimine göre isthmus seviyesi üzeri (yüksek seviye) ve isthmus seviyesi/isthmus altý (düþük seviye) olmak üzere iki gruba ayrýldý. Ýlk olarak kapalý redüksiyon uygulandý. Kapalý redüksiyon ile redüksiyon saðlanamayan hastalarda açýk redüksiyon ve perkütan pinleme uygulandý. Tedavi sonrasý dirsek hareketlerinin deðerlendirilmesinde Flynn’s kriterleri kullanýldý.
BULGULAR: Ortalama takip süresi 39 aydý (16–62 ay). Ortalama yaþ 6.4±2 (1.4–12 years) yýldý. 39 hasta kýz, 73 hasta erkek cinsiyetti. Otuz iki kýrýk dominant kolda, 80 kýrýk non-dominant kolda meydana geldi. 90 kýrýk yüksek seviye (isthmus üzeri), 22 kýrýk düþük seviye (isthmus seviyesi ve altý) olarak deðerlendirildi. Düþük seviye kýrýklý hasta grubunda ortalama yaþ istatiksel olarak daha azdý (p<0.01). Düþük seviye kýrýklý hasta grubunda açýk redüksiyon oraný, yüksek seviye kýrýklý hasta grubuna göre anlamlý olarak daha yüksekti (p<0.01). Klinik sonuçlar Flynn’s kriterleri ile deðerlendirildiðinde her iki grup arasýnda anlamlý fark bulunmamaktaydý (p>0.05).
TARTIÞMA: Suprakondiler humerus kýrýklarýnýn tedavi planlamasýnda Gartland sýnýflamasý önemli rehber olmaktadýr, ancak kýsýtlýlýklar mevcuttur. Çalýþmanýn sonuçlarý, bu sýnýflandýrmaya kýrýk yerleþiminin dahil edilmesinin ameliyat öncesi planlamada faydalý olabileceðini göstermektedir.

BACKGROUND: Supracondylar humerus fractures are the most common form of elbow fracture in children and adolescents. At present, treatment planning is based on the Gartland classification. Reduction and percutaneous pinning are done for Gartland type III fractures. In cases where closed reduction is unsuccessful, the procedure is converted to open reduction. However, there is no consensus on which patients are more likely to require conversion to open reduction. The aim of this study was to investigate the effect of fracture location on the rate of conversion to open reduction and clinical outcomes.
METHODS: A total of 112 patients who underwent early surgery for Gartland type III supracondylar humerus fracture between August 2011 and August 2017 were evaluated. The patients’ age, sex, facture location, post-operative loss of reduction, and complications were noted. The fractures were classified according to fracture level relative to isthmus (high level) or at/below the isthmus (low level). Closed reduction was initially preferred. Open reduction with percutaneous pinning was performed, when necessary. Flynn’s criteria were used to evaluate elbow motion after treatment.
RESULTS: Mean follow-up time was 39 months (16–62 months). The mean age of the patients was 6.4±2 years (1.4–12 years). Thirty-nine of the patients were female, 73 were male; 32 fractures were in the dominant arm, 80 were in the non-dominant arm. Ninety of the fractures were classified as high level (proximal) and 22 as low level (distal). Patients with low-level fractures were significantly younger (p<0.01). Patients with low-level fractures also showed a significantly higher rate of conversion to open reduction compared to those with high-level fractures (p<0.01). Clinical outcomes evaluated with Flynn’s criteria were statistically equivalent between the high and low fracture groups (p>0.05).
CONCLUSION: The Gartland classification provides important guidance for the treatment of supracondylar humerus fractures, but may have limitations. Our results suggest that revising the classification by incorporating fracture location may be more beneficial for pre-operative planning.

AMAÇ: Yetiþkin kýrýklarýnýn epidemiyolojisi, çok faktörlü bir þekilde, zamanla deðiþmektedir. Bu çalýþmanýn amacý, mevcut AO/OTA kýrýk sýnýflamasýna göre, yol güvenliði için mevcut on yýllýk eylem planý kapsamýnda yetiþkin kýrýklarýnýn son beþ yýllýk epidemiyolojik analizini ortaya koymaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük, epidemiyolojik tanýmlayýcý çalýþmaya birinci düzey bir travma merkezinde ortopedi ve travmatoloji ile iliþkili en az bir kýrýk tanýsý almýþ 5324 eriþkin hasta dahil edildi. Hastalar yaþlarýna göre; 18–35, 36–55, 56–69 ve ≥70 olmak üzere gruplandýrýldý. Kýrýklar AO/OTA kýrýk sýnýflamasýna göre incelendi.
BULGULAR: 5324 hastada 5865 kýrýk vardý. Hastalarýn ortalama yaþý 48.6±21.5 idi. Yaþ gruplarýna göre hasta sayýlarý sýrasýyla 1947 (%36.6), 1636 (%30.7), 881 (%16.5) ve 860 (%16.2) idi. AO/OTA kýrýk sýnýflamasýna göre en sýk görülen üç kýrýk; 7 (el, %19.6), 23 (distal önkol, %12.1) ve 8 (ayak, %11.8) idi. Hastalarýn %54.4’ü ameliyatsýz ve %45.4’ü ameliyatla tedavi edildi. Hastalarýn %0.2’si alternatif bir tedaviyi tercih etti. Toplam ölüm oraný %0.4 idi.
TARTIÞMA: Bildiðimiz kadarýyla bu çalýþma, beþ yýllýk bir dönem boyunca AO/OTA sýnýflandýrmasýna göre yetiþkin kýrýklarýnýn analiz eden ilk çalýþmadýr. Geleceðe yönelik olarak, major travmalarýn önlenmesi için sürdürülebilir bir eylem planý oluþturmak amacýyla daha fazla çok merkezli epidemiyolojik çalýþma yapýlmasý gerekmektedir.

BACKGROUND: The epidemiology of adult fractures has been changing timely, in a multifactorial fashion. The aim of this study was to put forward a recent 5-year epidemiological analysis of adult fractures, according to the current AO/OTA fracture classification, in the current decade of action for road safety.
METHODS: 5324 adult patients who were diagnosed with at least one fracture related with orthopedics and traumatology in a level-one trauma center were included in this retrospective, epidemiological descriptive study. The patients were grouped according to their ages as; 18–35, 36–55, 56–69, and ≥70. The fractures were examined according to the AO/OTA classification.
RESULTS: 5865 fractures were present in 5324 patients. The mean age of the patients was 48.6±21.5. The number of patients according to the age groups was as follows; 1947 (36.6%), 1636 (30.7%), 881 (16.5%), and 860 (16.2%), respectively. The most frequent three fractures according to the AO/OTA fracture classification were; 7 (hand 19.6%), 23 (distal forearm, 12.1%), and 8 (foot, 11.8%). About 54.4% and 45.4% of the patients were treated non-surgically and surgically, respectively. About 0.2% of the patients preferred an alternative treatment. Overall mortality rate was 0.4%.
CONCLUSION: To the best of our knowledge, this study represents the first analysis of adult fractures according to the AO/OTA classification, over a 5-year period. As a future prospect, further multi-centric epidemiological studies are warranted to constitute a sustainable action plan for the prevention of major traumas.

AMAÇ: Bu çalýþmada travmatik timpanik membran perforasyonunda (TTMP) sigara kaðýdý yamasý (SPP) ile onarýmýn; perforasyonun kapanmasý ve iþitme fonksiyonlarý üzerindeki etkilerini deðerlendirmek amaçlandý.
GEREÇ VE YÖNTEM: Kliniðimize Ocak 2015–2019 tarihleri arasýnda TTMP nedeni ile baþvurmuþ olan ve tedavide sigara kaðýdý yamasý (SPP) uygulanmýþ olan 61 olgu (67 kulak) geriye dönük olarak deðerlendirildi. TTMP’nin boyutu; timpanik membranýn (TM) tamamý %100 kabul edilerek sýnýflandýrýldý. %25’in altýnda olan perforasyonlar küçük, %25–%50 arasýnda olanlar orta %50 ve üzeri olan perforasyonlar ise büyük olarak deðerlendirildi. Hastalara; SPP prosedüründen önce ve üç ay sonra odyolojik tetkik yapýldý. 0.5, 1, 2 ve 4 khz’de hava ve kemik yolu saf ses ortalamalarý (SSO) ve hava kemik gap (ABG) ortalamalarý karþýlaþtýrýldý.
BULGULAR: Altmýþ yedi kulaðýn 20’sinde (%29.9) perforasyon küçük, 27’sinde (%40.2) orta, 20’sinde (%29.9) ise büyük idi. SPP öncesi hava yolu saf ses ortalamasý (AC SSO) 28.26±5.63, kemik yolu saf ses ortalamasý (BC SSO) 8.80±4.35, ABG 19.26±5.80 olarak bulundu. SPP sonrasý AC SSO 11.90±6.59, BC SSO 8.29±4.05, ABG 14.10±4.66 olarak saptandý. SPP sonrasý birinci ayda 61 kulakda (%91) TM’de iyileþme gerçekleþtiði görüldü. Perforasyon boyutu ve kapanma oranlarý arasýnda istatistiksel olarak anlamlý fark bulunamadý (p>0.05). 0.5, 1, 2 ve 4 khz’de SPP sonrasý AC SSO deðerleri SPP öncesi AC SSO deðerlerinden anlamlý düzeyde düþük bulundu (p<0.001). SPP sonrasý 0.5 khz’de ölçülen ABG deðerlerinin, hem 2 khz, hem de 4 khz deðerlerine göre anlamlý düzeyde yüksek olduðu görüldü (sýrasýyla p<0.001, p<0.001). Sigara kaðýdý uygulamasý sonrasý SS0 deðerlerindeki azalma miktarýna bakýldýðýnda, 0.5 khz’deki deðerler hem 2 khz, hem de 4 khz’dekilere göre anlamlý düzeyde yüksek olarak saptandý (sýrasýyla, p<0.001, p<0.001).
TARTIÞMA: TTMP’nin tedavisinde erken dönemde SPP uygulamasý hem perforasyon kapanmasý hem de iþitme kazancý bakýmýndan etkili bir tedavi yöntemidir.

BACKGROUND: The aim of this study was to evaluate the effects of repairment of traumatic tympanic membrane perforation (TTMP) with cigarette paper patch (CPP) on perforation closure and hearing functions.
METHODS: A retrospective evaluation was made of 67 ears of 61 patients diagnosed with TTMP and treated with CPP in our clinic between January 2015 and 2019. In the classification of TTMP size, the entire tympanic membrane was evaluated as 100%, perforation of <25% was considered small, perforation of between 25% and 50% was considered medium and perforation of ≥50% was considered large. Audiological examination was performed before and at 3 months after the CPP procedure. Air conduction (AC) and bone conduction (BC) pure tone averages (PTAs) and air-bone gap (ABG) at 0.5, 1, 2, and 4 khz frequencies were compared.
RESULTS: Perforations were small in 20 (29.9%) of 67 ears, medium in 27 (40.2%), and large in 20 ears (29.9%). AC PTA before CPP was found to be 28.26±5.63 dB hearing level (HL), BC PTA was 8.80±4.35 dB HL and ABG was 19.26±5.80 dB HL. After CPP, the AC PTA was found to be 11.90±6.59 dB HL, BC PTA was 8.29±4.05 dB HL, and ABG was 14.10±4.66 dB HL. TTMP was determined to have improved in 61 ears (91%) in the 1st month after CPP application. There was no statistically significant difference between perforation size and improvement rates (p>0.05). AC PTA values after CPP application were determined to be significantly lower than AC PTA values before CPP application at 0.5, 1, 2, and 4 khz (p<0.001). The ABG values measured at 0.5 khz after CPP were significantly higher than the values measured at 2 khz. and 4 khz. (p<0.001, p<0.001, respectively). The amount of decrease in PTA value after CPP was found to be significantly greater at 0.5 khz than at 2 khz and 4 khz (p<0.001, p<0.001, respectively).
CONCLUSION: In the treatment of TTMP, early application of CPP is an effective treatment method in terms of both perforation closure and hearing gain.

Splenosis, bir travma ya da rüptür sonrasýnda dalaðýn ototransplantasyonuna verilen isimdir. Otuz dokuz yaþýndaki kadýn hasta, kliniðimize göðüs aðrýsý þikayeti ile baþvurdu. Hasta, 19 yýl önce karnýndan ve sol hemitorakstan ateþli silah ile yaralandýðýný belirtti. Çekilen toraks bilgisayarlý tomografi (BT) ve toraks manyetik rezonansýnda (MR) sol hemitoraksta plevrada birden fazla lezyon görüldü. Bu lezyonlara taný amacý ile yapýlan videotorakoskopik biyopsi sonucu toraksta splenosis tanýsý koyuldu. Olguya herhangi bir tedavi önerilmedi. Hastanýn altý yýllýk takibinde lezyonlarda herhangi bir deðiþim izlenmedi. Toraksta splenosis karýna yönelik ateþli silah ile yaralanmalarda görülebilir ve plevrada tümörü gibi düþünülebilir. Bu antite diyafragma tamiri de dahil olmak üzere hiçbir tedavi gerektirmez ve yýllarca ayný þekilde sebat edebilir.

Splenosis describe a clinical entity of autotransplantation after removal of the spleen secon-dary to a traumatic rupture or surgery. A 39-year-old female was referred to thoracic surgery department with complaints of severe chest pain. She had left thoracic and abdominal gun-shot injury that occurred 19 years earlier. Thorax computed tomograhy and thorax magnetic resonance imaging revealed pleural lesions. A video thoracoscopic biopsy disclosed splenosis in the patient. Splenic implants did not change in 6 years. The patient has mild thoracic pain. Thoracic splenosis can occur in patients who underwent abdominothoracic gunshot injury. The implants did not seem to change in long-term follow-up. Thoracic splenosis may occur, persist for years and it mimics pleural tumor after abdominal gun-shot injury and does not seem to necessitate any surgical intervention including diaphragmatic repair.

Kanama riskleri ve maligniteye dönüþüm potansiyellerinden dolayý Hepatik adenomlarýn önceden tespit etmek önemlidir. Tümör boyutlarý 1 ile 15 cm arasýnda deðiþmekte olup multipl sayýda olanlar ile özellikle büyük boyutlardaki hepatik adenomlarda kanama riski belirgin artmaktadýr. Sunduðumuz bu olguda büyük boyutlarda hepatik adenomlu hastada selektif transarteriyel kemoembolizasyon ile tümör boyutunda azalma ile cerrahi rezeksiyon planlanmýþ ve geliþen nontravmatik spontan tümör rüptür sonrasýnda klinik, bilgisayarlý tomografi, anjiyografi bulgularý yanýsýra tedavi stratejileri tartýþýlmýþtýr.

It is important to detect hepatic adenomas, which are generally well-confined lesions, as urgent treatment is required due to the risk of bleeding and conversion to malignancy. Dimensions can vary between 1 and 15 cm, and the risk of hemorrhage is higher in large and multiple-focus adenomas. The case is here presented of a patient with spontaneous ruptured liver adenoma after selective transcatheter arterial chemo-embolization for reduction of tumor mass, with discussion of the clinical, computed tomography, angiographic findings, and treatment strategies.

Paraduodenal fýtýk, iç fýtýðýn en yaygýn nedeni olan nadir bir doðuþtan anomalidir. Sol taraflý paraduodenal herniler (LPDH) sað taraflýdan daha yaygýndýr ve yaþamýn dördüncü ve altýncý yýllarýndaki erkek hastalarda yaygýndýr. LPDH sýklýkla klinik olarak semptomsuzdur ve sýklýkla cerrahi hastalarda tesadüfen saptanýr. Abdominal bilgisayarlý tomografi (BT) tanýda altýn standarttýr. Paraduodenal herni, baðýrsak týkanýklýðýna baðlý olarak yüksek mortalite oranlarýna sahip iskemiye neden olabilir. Bu nedenle, tanýdan sonra mümkün olan en kýsa sürede cerrahi onarým yapýlmalýdýr. Burada laparoskopik taný ve erken tamir edilen bir LPDH olgusunu sunuyoruz.

Paraduodenal hernia (PDH) is a rare congenital anomaly, the most common cause of internal hernia. The left-sided PDHs (LPDHs) are more common than the right-sided and are common in male patients at the 4th and 6th years of life. LPDH is been often clinically asymptomatic and often detected by chance in surgical patients. Abdominal computed tomography is the gold standard in diagnosis. PDH can cause ischemia with the high mortality rates due to intestinal obstruction. Therefore, surgical repair should be done as soon as possible after diagnosis. Here, we present a case of LPDH that was laparoscopically diagnosed and repaired early.