AMAÇ: Mikrovasküler anastomozda en sýk kullanýlan teknik basit aralýklý dikiþ tekniðidir. Bu tekniðin en önemli riski, arka duvarýn iðne ucuyla fark edilmeden yakalanmasý ve anastomozun baþarýsýzlýkla tamamlanmasýdýr. Çalýþmamýzda, bu riski ortadan kaldýrmak ve anastomoz süresini kýsaltmak için açýk-ilmek tekniði ile Airborne baðlama tekniðinin kombinasyonu kullanýldý. Bu kombinasyonunun konvansiyonel teknik ile karþýlaþtýrýlmasý için deneysel ve klinik bir çalýþma gerçekleþtirildi.
GEREÇ VE YÖNTEM: Deneysel olarak sýçan femoral arterinde konvansiyonel tekniðin kullanýldýðý (kontrol grubu) ve açýk-ilmek/Airborne baðlama kombinasyonunun kullanýldýðý (deneysel grup) iki deneysel gruptaki anastomozlarda, anastomoz patensi ve anastomoz süresi karþýlaþtýrýldý. Klinik olarak ise açýk-ilmek/Airborne baðlama kombinasyonunun kullanýldýðý acil parmak replantasyonlarý ve serbest flep transferi vakalarýndaki anastomoz patensleri ve anastomoz süreleri retrospektif olarak analiz edildi.
BULGULAR: Deneysel çalýþmada iki grupta toplam 40 mikrovasküler arteriyel anastomoz gerçekleþtirildi. Total anastomoz süresinin kontrol gru-bunda 779,65 saniye, deneysel grupta 527,4 saniye olduðu ve farkýn istatistiksel olarak anlamlý olduðu görüldü (p<0.001). Erken ve geç dönemdeki anastomoz patensileri arasýnda anlamlý fark bulunmadý (p=0.5483). Klinik çalýþma dahilinde 16 hastada 18 acil parmak replantasyonu ve 15 hastada 17 serbest flep transferi gerçekleþtirildi (toplam 104 anastomoz). Anastomoz baþarýsýnýn acil replantasyon vakalarýnda %94.2, serbest flep transfer-lerinde %95.1 olduðu görüldü.
TARTIÞMA: Konvansiyonel teknik ile karþýlaþtýrýldýðýnda açýk-ilmek/Airborne kombinasyonu mikrocerrahýn mikrovasküler anastomozu daha kýsa sürede, güvenle ve asistans gerektirmeksizin tamamlamasýna olanak saðlar.

BACKGROUND: The continuous open-loop technique accelerates anastomosis and eliminates the risk of inadvertently catching the back wall, which is the primary cause of technical failure when using interrupted sutures in microsurgical anastomosis. Combined with airborne suture tying, the total anastomosis time is significantly reduced. We conducted an experimental and clinical study to compare this combination to the conventional technique.
METHODS: Experimentally, anastomoses were performed on the femoral arteries (0.60 mm) of rats in two groups. The control group used simple interrupted suturing with conventional tying, while the experimental group employed open-loop suturing with air-borne tying. We recorded the total time taken for anastomosis completion and patency rates. Clinically, we retrospectively analyzed replantation and free flap transfer cases using the open-loop suture and airborne tying technique for arterial and venous microvascular anastomoses, assessing total anastomosis time and patency rates.
RESULTS: Experimentally, a total of 40 anastomoses were performed in two groups. The control group required 779.65 seconds, and the experimental group needed 527.4 seconds for anastomosis completion; this difference was statistically significant (p<0.001). Immediate and long-term patency rates were similar (p=0.5483). Clinically, 18 replantations were performed on 16 patients, and 17 free flap transfers were performed on 15 patients, totaling 104 anastomoses. The anastomosis success rate was 94.2% (33 of 35) for free flap transfers and 95.1% (39 of 41) for replantation cases.
CONCLUSION: The open-loop suture technique with airborne knot tying allows surgeons to complete microvascular anastomoses safely and in less time with minimal assistance when compared to the simple interrupted suture technique.

Amaç: Bu çalýþma pandeminin ilk yýlýnda Tersiyer Bakým Hastanemizdeki acil sezaryen doðumlarda anestezi yönetiminin deðiþimini araþtýrdý. Öncelikle spinal ve genel anestezi oranlarýný, ikincil olarak yetiþkin ve neonatal yoðun bakým ihtiyaçlarýný pandemik öncesi yýla göre karþýlaþtýrdýk. Ayrýca üçüncül bir sonuç olarak acil sezaryen doðumda postoperatif PCR testlerini sergiledik.
Gereç ve Yöntem: Anestezi tekniði, postoperatif yoðun bakým, hastanede kalýþ süresi, postoperatif PCR sonucu ve yenidoðan statüsü gibi bilgileri retrospektif olarak analiz ettik.
Bulgular: Pandemiden sonra spinal anestezi oraný dikkat çekici þekilde % 44,1 den % 72.1 oranýna deðiþti (p = 0.001). Çalýþma gruplarýnýn ortanca süresi, Kovid- 19 öncesi gruptan belirgin derecede uzun bulundu (p = 0.001). Kovid-19 sonrasý grubundaki hastalarýn postoperatif yoðun bakým ihtiyacý oraný daha yüksekti (p = 0.058). Kovid-19 grubundaki yenidoðanlarýn postoperatif yoðun bakýmýnýn oraný, Kovid-19 öncesi grubundan anlamlý olarak daha yüksekti (p = 0.001).
Sonuç: Kovid-19 pandemisi sýrasýnda üçüncü basamak hastanelerde acil sezaryen doðumlarýnda spinal anestezi oraný önemli ölçüde artmýþtýr. Hastanede kalým sayýlarý, yetiþkin ve yenidoðan yoðun bakým ihtiyaçlarýnýn yükselmesi ile görüldüðü üzere pandemi sonrasý toplam saðlýk bakým hizmetleri çoðalmýþtýr.

Background: This study explored the change of anesthesia management for emergent cesarean sections in our tertiary care hospital in the first year of pandemic. We searched primarily for the changes in spinal to general anesthesia rate and secondarily for presented adult and neonatal intensive care needs in comparison to the year before the pandemic. We also presented the postoperative PCR tests of the emergent cesarean sections as a tertiary outcome.
Methods: We retrospectively analyzed clinical data such as anesthetic technique, need for postoperative intensive care, duration of hospital stays, postoperative PCR result, and newborn status.
Results: The rate of spinal anesthesia changed remarkably from 44.1% to 72.1% after the pandemic (p=0.001). The comparison of the median duration of hospital stays of the pre-pandemic group and post-pandemic group was found significantly longer than that of the before COVID-19 group (p=0.001). The rate of need for postoperative intensive care in the after COVID-19 group was higher (p=0.058). The rate of postoperative intensive care of the newborns in the after COVID-19 group was significantly higher than that of the before COVID-19 group (p=0.001).
Conclusion: The spinal anesthesia rate for emergent cesarean sections increased significantly during the peak of the COVID-19 pandemic in tertiary care hospitals. Total health care services after the pandemic were enhanced as seen with elevated numbers of hospital stays, postoperative need of adult and neonatal intensive care.

AMAÇ: Çalýþmamýzýn amacý, aerosol oluþturma prosedürleri (AGP’ler) için kiþisel koruyucu ekipman (PPE) giyen saðlýk görevlileri tarafýndan simüle edilmiþ COVID-19 hastalarýnýn farklý senaryolarýnda VieScope® ve Macintosh laringoskop ile entübasyonun etkinliðini belirlemekti.
GEREÇ VE YÖNTEM: Çalýþma ileriye yönelik, gözlemsel, randomize ve çapraz tasarlanmýþ simülasyon çalýþmasý olarak tasarlanmýþtýr. Çalýþmaya 37 saðlýk görevlisi katýldý. COVID-19 olduðundan þüphelenilen hastalarýn endotrakeal entübasyonunu (ETI) gerçekleþtirdiler. Entübasyon, iki araþtýrma senaryosunda VieScope® ve Macintosh laringoskoplar kullanýlarak gerçekleþtirildi: Senaryo A - normal hava yolu ve Senaryo B - zor hava yolu olarak tasarlandý. Hem katýlýmcýlarýn sýrasý hem de entübasyon yöntemleri rastgele idi.
BULGULAR: Senaryo A’da VieScope® ve Macintosh laringoskop kullanýlarak entübasyona kadar geçen süre (TTI) sýrasýyla 35.3 (IQR; 32–40) sa-niye ve 35.8 (IQR: 30–40) saniye idi. Neredeyse tüm katýlýmcýlar hem VieScope® hem de Macintosh laringoskop ile ETI’yi baþarýyla gerçekleþtirdi (%100’e vs. %94.6). B senaryosunda, Macintosh laringoskop ile karþýlaþtýrýldýðýnda VieScope® ile entübasyon, daha kýsa entübasyon süresi (p<0.001), ilk entübasyon giriþiminde daha yüksek baþarý oraný (p<0.001), daha iyi görüntü alma (p=0.012) ve entübasyonun daha kolay olduðu saptanmýþtýr (p<0.001).
TARTIÞMA: Analizimiz, PPE-AGP’yi kullanan saðlýk görevlileri tarafýndan gerçekleþtirilen zor hava yolu entübasyonunda Macintosh laringoskopa kýyasla VieScope® kullanýmýnýn daha kýsa entübasyon süreleri, daha yüksek entübasyon verimliliði ve ayrýca glottisin daha iyi görüntülenmesi ile iliþkili olduðunu göstermektedir. Elde edilen sonuçlarý doðrulamak için ek klinik deneyler gereklidir.

BACKGROUND: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs).
METHODS: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random.
RESULTS: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32–40) seconds and 35.8 (IQR: 30–40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001).
CONCLUSION: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

AMAÇ: Sigmoid volvulus yaþlý hastalarda sýk görülmesi nedeniyle mortal seyreden bir patolojidir. Baðýrsak gangreni durumunda mortalite ve morbidite daha da artmaktadýr. Sigmoid volvuluslu hastalarda baðýrsak gangreni olup olmadýðýný sadece kan tahlileri ile tahmin etmeyi ve böylece tedavi yön-temlerine hýzlý bir þekilde rehberlik etmeyi amaçlayan bir model oluþturarak modelin etkinliðinin deðerlendirildiði geriye dönük bir çalýþma planladýk. GEREÇ VE YÖNTEM: Kliniðimizde 1999–2021 tarihleri arasýnda sigmoid volvulus nedeniyle opere edilen hastalarýn yaþ, cinsiyet gibi demografik verilerinin yanýnda white blood cell (WBC), C-reaktif protein (CRP), LDH, potasyum gibi labaratuar deðerleri, kolonoskopik bulgulara ve operas-yonda kolonda gangren olup olmadýðý geriye dönük olarak incelendi. Verilerin analizinde Mann-Whitney U ve ki-kare testlerinin yanýsýra Univariate ve Multivariate Logistic Regresyon analizleri ile baðýmsýz risk faktörü belirlendi. Ýstatistiksel olarak anlamlý olan sürekli sayýsal veriler için ROC analizi yapýlarak cut off deðerleri belirlendi ve Malatya Volvulus Gangren Modeli (MVGM) oluþturuldu. Oluþturulan modelin etkinliði yine ROC analizi ile deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 74 hastanýn 59’u (%79.7) erkekti. Popülasyonun ortanca yaþý 74 (19–88) olmasýnýn yanýsýra ameliyatta 21 (%28.37) hastada gangren tespit edildi. Tek deðiþkenli analizlerde lökositler <4000/mm3 ve >12000/mm3 (OR: 10.737; CI %95: 2.797–41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI %95: 2.520–26.082, p<0.0001), potasyum ≥3.85 mmol/L (OR: 3.889; %95 GA): 1.333–11.345, p=0.013) ve LDH ≥288 U/L (OR: 3.889; CI %95: 1.333–11.345, p=0.013), çok deðiþkenli analizlerde ise sadece CRP ≥0.71 mg/dl (OR: 3.965; CI %95: 1.071–15.462), p=0.047) baðýrsak gangreni için baðýmsýz bir risk faktörü olarak bulundu. MVGM’nin gücü AUC 0.836 (0.737–0.936) idi. Ayrýca MVGM ≥7 ise (OR: 9.846; %95 GA: 3.016–32.145, p<0.0001) baðýrsak kangreni olasýlýðýnýn yaklaþýk 10 kat arttýðý gözlendi.
TARTIÞMA: Kolonoskopik iþleme kýyasla noninvaziv olmasýnýn yanýnda MVGM, baðýrsak gangrenini tespit etmede kullanýþlý bir yöntemdir. Ayrý-ca baðýrsak ansý gangrene giden hastalarýn tedavi basamaklarýnda vakit kaybetmeden acil ameliyata alýnmasýnda klinisyeni yönlendirmekle birlikte kolonoskopi esnasýnda meydana gelebilecek komplikasyonlardan da uzak durulmasýný saðlayacaktýr. Bu sayede morbidite ve mortalite oranlarýnýn azaltýlabileceðini düþünmekteyiz.

BACKGROUND: Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods.
METHODS: In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann–Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis.
RESULTS: Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19–88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797–41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI 95%: 2.520–26.082, p<0.0001), potassium ≥3.85 mmoL/L (OR: 3.889; 95% CI): 1.333–11.345, p=0.013), and LDH ≥288 U/L (OR: 3.889; CI 95%: 1.333–11.345, p=0.013), whereas, in multivariate analyzes, only CRP ≥0.71 mg/dL (OR: 3.965; CI 95%: 1.071–15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737–0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was ≥7 (OR: 9.846; 95% CI: 3.016–32.145, p<0.0001).
CONCLUSION: Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.

AMAÇ: Entübasyonu zor olacak hastalarýn belirlenmesi, gerekli önlemlerin alýndýðýndan emin olmak çok önemlidir. Bu çalýþmada, zor endotrakeal entübasyonu (DEI) öngörmede kullanýlan hemen hemen tüm testlerin gücünü göstermeyi ve bu amaçla hangi testlerin daha doðru olduðunu belir-lemeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu gözlemsel çalýþma, Mayýs 2015 ile Ocak 2016 tarihleri arasýnda Türkiye’de üçüncü basamak bir hastanenin anesteziyoloji bölümünde yapýldý (n=501). DEI için kullanýlan toplam 25 parametre ve 22 test Cormack-Lehane sýnýflamasýna (altýn standart) göre oluþturulan gruplara göre karþýlaþtýrýldý.
BULGULAR: Ortalama yaþ 49.83±14.00 yýldý ve 259 (%51.70) hasta erkekti. DEI sýklýðýný %7.58 olarak bulduk. Mallampati sýnýflamasý, atlanto-oksi-pital eklem hareket testi (AOJMT), üst dudak ýsýrma testi, mandibulohyoid mesafe (MHD), maksillofaringeal açý, tiromental mesafe yükseklik oraný testi ve maske ventilasyon testi baðýmsýz olarak zor entübasyon ile iliþkiliydi.
TARTIÞMA: Bu çalýþmada 22 testin karþýlaþtýrýlmasýna raðmen, elde edilen sonuçlar zor entübasyonu öngören tek bir testi kesin olarak tanýmlaya-mamaktadýr. Bununla birlikte, sonuçlarýmýz MHD (yüksek duyarlýlýk ve negatif prediktif deðer) ve AOJMT’nin (yüksek özgüllük ve pozitif prediktif deðer) zor entübasyonu öngörmede en faydalý testler olduðunu göstermektedir.

BACKGROUND: It is critical to identify patients whose intubation will be difficult to ensure that necessary precautions are taken. In this study, we aimed to show the power of almost all tests used to predict difficult endotracheal intubation (DEI), and to determine which test are more accurate for this purpose.
METHODS: This observational study conducted between May 2015 and January 2016 at department of anesthesiology of a tertiary hospital in Turkey (n=501). A total of 25 parameters and 22 tests used for DEI were compared according to groups formed according to the Cormack-Lehane classification (gold standard).
RESULTS: The mean age was 49.83±14.00 years, and 259 (51.70%) patients were males. We found difficult intubation frequency to be 7.58%. Mallampati classification, atlanto-occipital joint movement test (AOJMT), upper lip bite test, mandibulohyoid distance (MHD), maxillopharyngeal angle, height-to-thyromental distance ratio, and mask ventilation test were independently associated with difficult intubation.
CONCLUSION: Despite comparing 22 tests, the results obtained in this study cannot definitively identify any single test that pre-dicts difficult intubation. Nonetheless, our results show that MHD (high sensitivity and negative predictive value) and AOJMT (high specificity and positive predictive value) are the most useful tests to predict difficult intubation.

AMAÇ: Çalýþmamýzda 65 yaþ ve üzeri geriatrik travma hastalarýn Travma Spesifik Kýrýlganlýk Ýndeksi ve Geriatrik Travma Sonlaným skorunun hasta-larýn 30 günlük mortaliteleriyle iliþkisini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Ýleriye yönelik gözlemsel çalýþmamýza bir eðitim araþtýrma hastanesine künt travma sebebiyle baþvuran 65 yaþ ve üzeri 382 hasta dahil edildi. Hastalarýn kendilerinden ve/veya yakýnlarýndan onam alýndý. Hastalarýn acil servise baþvurularýnda tespit edilen vital bulgularý, kro-nik hastalýk ve ilaç kullaným bilgilerinin yanýsýra laboratuvar sonuçlarý, radyolojik görüntülemeleri, kan replasmaný ihtiyaçlarý, acil servis ve hastanede kalýþ süreleri ve mortaliteleri vaka formuna kaydedildi. Glasgow Koma Skalasý, Yaralanma Þiddeti Ölçeði, Geriatrik Travma Sonlaným Skoru, Travma Spesifik Kýrýlganlýk Ýndeksi ve Beden Kitle Ýndeksi araþtýrmacýlar tarafýndan hesaplandý. Hastalarýn 30 günlük sonlanýmlarýyla ilgili hasta ve/veya hasta yakýnlarýndan 30 gün sonra telefonla bilgi alýndý.
BULGULAR: Travma sonrasý 30. günde ölen ve yaþayan hastalar karþýlaþtýrýldýðýnda Beden Kitle Ýndeksi ve Travma Spesifik kýrýlganlýk indeksi açýsýndan anlamlý fark saptanmadý (p>0.05). Baþvurusu sýrasýnda Geriatrik Travma sonlaným skoru ≥95 olan hastalarýn 30 günlük mortalitelerinin yüksek oldu-ðu saptandý (sensivitesi %76, spesifitesi %72.27 (p<0.001). Ýki grup arasýnda iki veya daha fazla komorbid hastalýða sahip olmakla mortalite arasýnda korelasyon saptandý (p=0.001).
TARTIÞMA: Çalýþmamýzýn sonucunda acil servise baþvuruda hesaplanan Travma Spesifik Kýrýlganlýk Ýndeksi’nin tek baþýna mortaliteyi belirlemede yeterli olmadýðý, hastanýn laktat deðerinin, Geriatrik Travma Sonlaným Skoru (GTOS)’un ve hastanede kalýþ süresinin de mortalitede etkili olduðu ve bu parametrelerin kullanýlmasýyla daha güvenilir bir kýrýlganlýk puaný elde edilebileceðini düþünmekteyiz. GTOS 24 saatlik mortaliteyi belirlemede kullanýlmaktadýr, buna ek olarak uzun dönem mortalite öngörme skorlarýna dahil edilmelidir.

BACKGROUND: We aimed to determine the relationships of the trauma-specific frailty index (TSFI) and the geriatric trauma out-come score (GTOS) with 30-day mortality among geriatric trauma patients aged 65 and older.
METHODS: This prospective observational study included 382 patients aged 65 years and older who were admitted to a training and research hospital due to blunt trauma. Informed consent was obtained from them and/or their relatives. In addition to patients’ vital signs, information about chronic diseases and drug use was obtained on admission to the emergency service and the results of labo-ratory examinations, radiological imaging, blood replacements, length of stay in the emergency room and hospital, and mortality were recorded in case forms. Glasgow coma scale, ýnjury severity score, GTOS, TSFI, and body mass index (BMI) values were calculated by the researchers. Outcome information was obtained from the patient and/or relatives by phone 30 days later.
RESULTS: When the patients who died and those who survived were compared at the 30th day after trauma, no significant difference was found in terms of BMI or TSFI (p>0.05). It was determined that patients with a GTOS of ≥95 at admission would have higher 30-day mortality (the sensitivity was 76%, and the specificity was 72.27% (p<0.001)). When correlations were evaluated according to mortality, a correlation was found between the presence of two or more comorbid diseases and mortality (p=0.001).
CONCLUSION: We think that a more reliable frailty score can be obtained using these parameters as we have determined that the TSFI as calculated at admission to the emergency department is not sufficient on its own, while the lactate, GTOS, and the length of hospital stay are also effective in mortality. We suggest that it would be appropriate to use the GTOS in long-term follow-up as well as for predictive power for mortality within 24 h.

AMAÇ: Doðumsal brakiyal pleksus felci’nde (DBPF) glenohumeral displaziyi engellemek içn botulinum toksini uygulanabilir ve bu sayede eklemin doðal büyümesi saðlanabilir. Tekrarlayýcý uygulamalar kasta atrofi yapabilir ve bunun iþlevsel etkileri belirsizdir. Bu çalýþmanýn amacý, tendon transferi öncesi iki kez botulinum toksini enjeksiyonu yapýlan kaslar ile enjeksiyon yapýlmayan kaslarý mikroyapý ve iþlev açýsýndan karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak 2013 ile Aralýk 2015 arasýnda DBPF’ye yönelik omuza tendon transferi yapýlan hastalar çalýþmaya dahil edilmiþtir. Latis-simus dorsi ve teres majör kaslarý humerusa standart yöntem ile transfer edilmiþtir. Hastalar ameliyat öncesinde uygulanmýþ olan botulinum toksini durumuna göre ikiye ayrýlmýþtýr. Grup 1’e toksin uygulanmamýþken Grup 2’ye toksin uygulanmýþtýr. Her hasta için ortalama latissimus dorsi miyosit kalýnlýðý (LDMK) elektron mikroskopi için ölçülmüþtür. Ameliyat öncesi ve sonrasýndaki etkin omuz abdüksiyonu, fleksiyonu, dýþ ve iç rotasyonu ve Mallet skorlarý goniometre ile ölçülmüþtür.
BULGULAR: On dört hasta (grup baþý yedi hasta) deðerlendirilmiþtir. Beþ hasta kýzdýr ve dokuz hasta erkektir. Ortalama LDMK gruplar arasý anlamlý farklýlýk göstermemiþtir (p>0.05). Transfer sonrasý her iki grupta da, toksin uygulamasýndan baðýmsýz olarak, omuz abdüksiyonu, fleksiyonu ve dýþ rotasyonu anlamlý olarak iyileþmiþtir (p<0.05). Grup 2’de iç rotasyon anlamlý olarak azalmýþtýr (p<0.05). Mallet skoru her iki grupta da, toksin uygu-lamasýndan baðýmsýz olarak artmýþtýr ancak anlamlý artýþ saptanmamýþtýr (p>0.05).
TARTIÞMA: Latissimus dorsi ve teres majör kaslarýna iki kez uygulanan botulinum toksin enjeksiyonu glenohumeral displaziyi engellemiþtir ve geç dönemde, kasta kalýcý atrofiye ve iþlev kaybýna yol açmamýþtýr. Bu uygulama ile iç rotasyon kontraktürü ortadan kaldýrýlarak üst ekstremite iþlevleri iyileþtirilmiþtir.

BACKGROUND: In brachial plexus birth palsy (BPBP), botulinum toxin may be utilized to prevent glenohumeral dysplasia and to maintain the stable growth of the glenohumeral joint. Repeated injections may cause muscular atrophy and their functional effects are uncertain. The aim of this study was to compare the microstructure and the function of the muscles that received two injections before transfer with the muscles that were not injected.
METHODS: BPBP patients that were operated between January 2013 and December 2015 were included in the study. Latissimus dorsi and teres major muscles were transferred to humerus in standard fashion. Patients were divided in two groups according to bo-tulinum toxin status. Group 1 was toxin negative whereas Group 2 was toxin positive. For each patient, mean latissimus dorsi myocyte thickness (LDMT) was measured with electron microscopy and pre-operative and post-operative active shoulder abduction, flexion, external and internal rotation, and Mallet scores were evaluated with goniometry.
RESULTS: Fourteen patients (seven patients per group) were evaluated. Five patients were female whereas nine were male. Mean LDMT was not affected significantly (p>0.05). The operation improved shoulder abduction, flexion, and external rotation significantly (p<0.05), independent of the toxin status. The internal rotation decreased significantly only in Group 2 (p<0.05). The Mallet score increased in both groups, but it was not significant (p>0.05), independent of the toxin status.
CONCLUSION: Botulinum toxin that was applied twice prevented glenohumeral dysplasia and it did not cause permanent latissimus dorsi muscle atropy and function loss in late period. It augmented upper extremity functions by alleviating internal rotation contracture.

AMAÇ: Çocuklarda akut karýn ile baþvuran intraabdominal lenfanjiomlarýn (IAL) acil intralezyonel bleomisin enjeksiyonu (ÝBÝ) tedavisinin sonuçlarýný deðerlendirdik.
GEREÇ VE YÖNTEM: Ocak 2013 ile Ocak 2020 arasýnda akut ÝAL nedeniyle acil ÝBÝ yapýlan hastalarýn kayýtlarý geriye dönük olarak yaþ, baþvuru semptomlarý, kist tipi, enjeksiyon sayýsý, tedavi öncesi ve sonrasý kist hacmi, klinik yanýt, komplikasyonlar ve takip açýsýndan deðerlendirildi. BULGULAR: Ortalama yaþý 4.3 (2–13 yýl) olan altý hasta tedavi edildi. Baþvuru semptomlarý akut karýn aðrýsý (n=4), karýn þiþliði (n=1), hipoprotei-nemi ve þilöz asit (n=1) idi. Lezyonlar dört hastada makrokistik, iki hastada makro ve mikro kistik tipteydi. Enjeksiyon sayýsý ortalama 2 (1–11) idi. Ortalama kist hacmi tedaviden sonra 567 cm3’ten (117–1656 aralýðý) 3.4 cm3’e (0–13.8 aralýðý) dramatik bir þekilde azaldý (p=0.028). Tedavi yanýtý, kistlerin tamamen kaybolduðu dört hastada mükemmelken, geri kalan iki hastada iyiydi. Ortalama 40 aylýk (16–56 ay) takip döneminde erken veya geç komplikasyon veya nüks gözlenmedi.
TARTIÞMA: ÝBÝ, akut baþvuran IAL tedavisinde tatmin edici sonuçlar veren güvenli, hýzlý ve kolay uygulanabilir bir yöntemdir. Primer ve tekrarlayan lezyonlarda önerilebilir.

BACKGROUND: We evaluated the results of urgent intralesional bleomycin injection (IBI) treatment of intra-abdominal lymphan-giomas (IAL) presenting with acute abdomen in children.
METHODS: The records of patients who underwent urgent IBI due to acutely presenting IAL between January 2013 and January 2020 were reviewed retrospectively in terms of age, presenting symptoms, cyst type, number of injections, pre- and post-treatment cyst volume, clinical response, complications, and follow-up.
RESULTS: Six patients with a mean age of 4.3 years (2–13 years) were treated. Presenting symptoms were acute abdominal pain (n=4), abdominal distention (n=1), hypoproteinemia and chylous ascites (n=1). Lesions were of macrocystic type in four and macro and micro cystic in two patients. The median number of injections performed was 2 (1–11). Mean cyst volume reduced dramatically from 567 cm3 (range 117–1656) to 3.4 cm3 (range 0–13.8) after treatment (p=0.028). Treatment response was excellent in four patients with complete resolution of the cysts, while good in the remaining two. No early or late complications or recurrence was observed in a mean follow-up period of 40 months (16–56 months).
CONCLUSION: IBI is a safe, fast, and easily applicable method with satisfactory results in the treatment of acutely presenting IAL. It may be recommended in primary as well as recurrent lesions.

AMAÇ: Acil þartlarda opere edilen hastalarýn ölüm ve komplikasyon riski elektif þartlarda yapýlan operasyonlara göre daha fazladýr. Özellikle ko-morbitesi fazla olan hasta grubunun özel olarak deðerlendirilmeleri gerekmektedir. Cerrahi risk ve ASA skorlamasýna göre hýzlýca peroperatif risk belirlenip hasta yakýnlarý bilgilendirilmelidir. Bu çalýþmada, acil batýn cerrahisi geçiren hastalarda mortalite ve morbiditeyi etkileyen faktörleri deðer-lendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Bir yýl içinde acil batýn cerrahisi geçiren 18 yaþ ve üzeri toplam 1065 hasta çalýþmaya dahil edildi. Bu çalýþmanýn amacý, ilk 30 gün ve bir yýl içindeki mortalite oranlarýný ve bu oranlarý etkileyen deðiþkenleri tespit edebilmekti.
BULGULAR: 1065 hastanýn 385’i (%36.2) kadýn, 680’i (%63.8) erkek idi. En yaygýn prosedür apendektomi (%70.8) olup, ardýndan tanýsal laparotomi (%10.2), peptik ulcus perforasyonu (%6.7), herniografi (%5.5), kolon rezeksiyonu (%3.6), ince baðýrsak rezeksiyonuydu (%3.2). Hastalarýn yaþý ile mortalite arasýnda anlamlý fark bulundu (p<0.05). ASA skorlarý, peroperatif komplikasyon, peroperatif kan ürünü kullanýmý, reoperasyona alýnma, yoðun bakýma yatýþ, hastane yatýþ süresi ve peroperatif komplikasyon ile 30. gün mortalite ve bir yýllýk mortalite arasýnda istatistiksel açýdan anlamlý iliþki bulundu. Travma ile sadece 30. gün mortalite arasýnda anlamlý bir iliþki vardýr (p=0.030).
TARTIÞMA: Acil þartlarda opere edilen hastalarýn morbidite ve mortaliteleri, özellikle 70 yaþ üzerinde elektif cerrahi operasyonlara göre artýþ göstermiþtir. Acil karýn ameliyatý geçiren hastalarýn 30 günlük mortalite oraný %3 iken bir yýllýk mortalite oraný %5.5’dir. ASA risk skoru yüksek olan hastalarda mortalite oranlarý daha yüksektir. Ancak çalýþmamýzdaki mortalite oranlarý ASA risk skorlamasýndaki mortalite oranlarýna göre daha yüksek olarak bulunmuþtur.

BACKGROUND: Patients operated under emergency conditions have a higher risk of death and complications than those per-formed under elective conditions. Especially the patient group with high comorbidity needs to be evaluated more specifically. Accord-ing to the surgical risk and American Society of Anesthesiologists (ASA) scoring, the perioperative risk should be determined quickly, and the relatives of the patients should be informed. This study aimed to evaluate the factors affecting mortality and morbidity in patients undergoing emergency abdominal surgery.
METHODS: A total of 1065 patients aged 18 years and older who underwent emergency abdominal surgery in 1 year were included in the study. The primary aim of this study was to determine the mortality rates in the first 30 days and 1 year and the variables af-fecting these rates.
RESULTS: Of 1065 patients, 385 (36.2%) were female and 680 (63.8%) were male. The most common procedure was appendectomy (70.8%), followed by diagnostic laparotomy (10.2%), peptic ulcus perforation (6.7%), herniography (5.5%), colon resection (3.6%), and small bowel resection (3.2%). There was a significant difference between the age of the patients and mortality (p<0.05). There is no statistically significant relationship between gender and mortality. A statistically significant correlation was found between ASA scores, perioperative complication, perioperative blood product use, reoperation, intensive care unit admission, hospitalization time, periop-erative complication, and 30-day mortality and 1-year mortality. There is a significant relationship between trauma and only 30-day mortality (p=0.030).
CONCLUSION: The morbidity and mortality of patients operated on under emergency conditions increased compared to elective surgical operations, especially those over age 70. The 30-day mortality rate of patients who underwent emergency abdominal surgery is 3%, while the 1-year mortality rate is 5.5%. Mortality rates are higher in patients with a high ASA risk score. However, mortality rates in our study were found to be higher than the mortality rates in ASA risk scoring.

AMAÇ: Subdural ampiyemler çoðunlukla sinuzite sekonder geliþen nadir intrakranyal enfeksiyonlardýr. Yýllýk insidanslarý %5–%25 arasýnda raporlan-mýþtýr. Ýnterhemisferik yerleþimli subdural ampiyemler ise daha da nadir olup tanýlarý ve tedavileri zordur. Agresif cerrahi giriþimler ve geniþ spekt-rumlu antibiyotikler tedavinin bel kemiðini oluþturmaktadýr. Geriye dönük çalýþmamýzda, antibiyoterapinin yaný sýra cerrahi tedavi uygulanmýþ olan interhemisferik subdural ampiyemli hastalarýn irdelenmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Ýnterhemisferik subdural ampiyem tanýsýyla opere edilen 12 hastanýn klinik ve radyolojik özellikleri, týbbi ve cerrahi tedavile-rinin detaylarý ve prognozlarý geriye dönük olarak incelenmiþtir.
BULGULAR: 2005 ve 2019 seneleri arasýnda interhemisferik subdural ampiyem tanýlý 12 hasta tedavi edilmiþtir. Hastalarýn onu (%84) erkek ve ikisi (%16) kadýndýr. Ortalama yaþ 19 (7–38)’dur. En sýk þikayet baþ aðrýsýdýr (%100). Hastalarýn beþi ampiyem tanýsýndan evvel frontal sinuzit tanýsý almýþlardýr. Ýlk cerrahi giriþim açýsýndan üç (%27) hastaya burrholeden aspirasyon ve on (%83) hastaya kranyotomi uygulanmýþtýr. Bir hastada her iki cerrahi yöntem ayný seansta uygulanmýþtýr. Takiplerinde altý (%50) hastada ikinci cerrahi ihtiyacý olmuþtur. Hasta takibinde haftalýk manyetik rezonans görüntüleme ve kan testleri kullanýlmýþtýr. Tüm hastalar en az altý hafta boyunca geniþ spektrumlu antibiyotik kullanmýþtýr. Mortalite yoktur. Ortalama takip süresi 10 aydýr.
TARTIÞMA: Ýnterhemisferik subdural ampiyemler nadiren rastlanan ve tedavisi zor intrakranyal enfeksiyonlar olup geçmiþte yüksek mortalite ve morbidite ile iliþkilendirilmiþtir. Tedavi seçenekleri arasýnda cerrahi ve antibiyoterapi bulunmaktadýr. Cerrahi tekniðin dikkatle seçilmesi ve ihtiyaç duyulan olgularda ikinci cerrahiden kaçýnýlmamasý, uygun antibiyotik rejimeni ile beraber, sað kalýmý iyileþtirmektedir.

BACKGROUND: Subdural empyemas (SDEs) are rare intracranial infections mostly secondary to sinusitis. Incidence of SDEs is 5–25%. Interhemispheric SDEs are even rarer, which makes their diagnosis and treatment difficult. Aggressive surgical interventions and wide-spectrum antibiotics are needed for treatment. In this retrospective clinical study, we intended to evaluate the results of surgical management supported by antibiotics in patients with interhemispheric SDE.
METHODS: Clinical and radiological features, medical and surgical management and outcomes of 12 patients treated for interhemi-spheric SDE have been evaluated.
RESULTS: 12 patients were treated for interhemispheric SDE between 2005 and 2019. Ten (84%) were male, two (16%) were female. Mean age was 19 (7–38). Most common complaint was headache (100%). Five patients were diagnosed with frontal sinusitis prior SDE. Initially, three patients (27%) underwent burr hole aspiration and ten patients (83%) underwent craniotomy. In one patient both were done in the same session. Six patients were reoperated (50%). Weekly magnetic resonance imaging and blood tests were used for follow-up. All patients received antibiotics for at least 6 weeks. There was no mortality. Mean follow-up period was 10 months.
CONCLUSION: Interhemispheric SDEs are rare, challenging intracranial infections that have been related to high morbidity and mor-tality rates in the past. Both antibiotics and surgical interventions play role in treatment. Careful choice of surgical approach and repeated surgeries if necessary, accompanied by appropriate antibiotic regimen, leads to good prognosis reducing morbidity and mortality.

AMAÇ: Suprakondiler humerus kýrýklarý (SKHK), çocuklarda en sýk görülen dirsek kýrýðý tipidir. Kapalý redüksiyon perkütan tespit (KRPT), SKHK tedavisinde ilk olarak tercih edilen yöntemdir. Kapalý redüksiyon ile tedavi edilemeyen durumlarda açýk redüksiyon ve internal fiksasyon (ARIF) ile tedavi gereklidir. Bu çalýþmanýn amacý, pediatrik SKHK olgularýnda posterior yaklaþýmla yapýlan ARIF ile KRPT sonuçlarýný klinik ve fonksiyonel açýdan karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya Ocak 2013 ile Aralýk 2016 tarihleri arasýnda kliniðimizde posterior yaklaþýmla ARIF veya KRPT uygulanan Gartland tip III SKHK olan hastalar dahil edildi. Cerrahi tedavi uygulanan, hastane veri tabanýmýzda verileri mevcut olan ve ek yaralanmasý olmayan toplam 60 hasta çalýþmaya dahil edildi. Hastalarýn yaþ, cinsiyet, kýrýk tipi gibi demografik verileri ile nörovasküler hasar varlýðý ve cerrahi tedavi iliþkili verileri analiz edildi. Ek olarak, hastalarýn 1 yýllýk takiplerinde ön-arka ve yan grafileri incelenerek Baumann (humerokapitellar) açýsý (BA) ve taþýma açýsý (TA) ölçüldü. Gonyometre deðerlendirmesi ile dirsek hareket açýklýðý (ROM) kontrol edildi. Kozmetik ve fonksiyonel sonuçlar, Flynn kriterleri kullanýlarak belirlendi.
BULGULAR: Yaþlarý 2–15 arasýnda deðiþen 60 hastanýn demografik, ameliyat öncesi ve sonrasý verileri analiz edildi. Bu hastalarýn 46’sýna KRPT ve 14’üne posterior ARIF yapýlmýþtý. Kýrýk dirsek ve kontralateral dirsek için TA, Baumann açýsý ve lateral kapitellohumeral açý (LKHA) ölçüldü ve elde edilen veriler istatistiksel olarak karþýlaþtýrýldý. TA (p=0.288), Baumann açýsý (p=0.951) ve LKHA (p=0.578) açýsýndan iki cerrahi yaklaþým arasýnda istatistiksel olarak anlamlý fark yoktu. Bir yýllýk takip sonunda dirsek EHA ölçüldü ve iki grup arasýnda istatistiksel olarak anlamlý fark bulunmadý (p= 0.190). Ayrýca iki cerrahi yaklaþým arasýnda hem kozmetik (p=0.814) hem de fonksiyonel (p=0.319) sonuçlar açýsýndan istatistiksel olarak anlamlý bir fark yoktu.
TARTIÞMA: Pediatrik SKHK ile ilgili kapsamlý bir literatür taramasý, cerrahlarýn kapalý redüksiyon ile tedavi edilemeyen Gartland tip III kýrýklarýnda posterior insizyonlarý sýklýkla tercih etmediðini göstermektedir. Ancak posterior açýk redüksiyon, distal humerus üzerinde daha fazla kontrol saðla-dýðý, her iki korteksi de içeren tam bir anatomik redüksiyona olanak saðladýðý, sinir eksplorasyonu sayesinde ulnar sinir yaralanmasý riskini azalttýðý, kozmetik ve fonksiyonel sonuçlar üzerinde olumsuz etkisi olmadýðý için tercih edilebilecek güvenli ve etkili bir yöntemdir.

BACKGROUND: Supracondylar humerus fractures (SCHFs) are the most common types of elbow fractures in children. Closed reduction percutaneous pinning (CRPP) is the primary surgical treatment of SCHFs. In cases that cannot be managed with closed reduction, treatment with open reduction and internal fixation (ORIF) is necessary. We aimed to compare CRPP and ORIF through a posterior approach regarding clinical and functional outcomes in pediatric SCHF cases.
METHODS: Patients with Gartland type III SCHF who underwent CRPP or ORIF with posterior approach at our clinic between January 2013 and December 2016 were included in this retrospective study. A total of 60 patients who underwent surgical treatment and had available data on our hospital database and no additional injuries were included in the study. We analyzed their data concerning age, gender, fracture type, neurovascular damage, and surgical treatment. In addition, we inspected the patients’ anteroposterior and lateral radiographs at 1-year follow-up visits for Baumann (humerocapitellar) angle (BA) and carrying angle (CA) and checked their go-niometer assessments of elbow range of motion (ROM). The cosmetic and functional outcomes were determined using Flynn’s criteria.
RESULTS: Demographic, preoperative, and post-operative data of 60 patients between the ages of 2–15 were analyzed. 46 of these patients had CRPP, and 14 had posterior ORIF. CA, Baumann angle, and lateral capitello-humeral angle were measured for fractured elbow and contralateral elbow and compared statistically. There was no statistically significant difference between the two surgical ap-proaches in terms of CA (p=0.288), Baumann’s angle (p=0.951) and LHCA (p=0.578). At the end of 1-year follow-up, elbow ROM was measured, and there was no statistically significant difference between the two groups (p=0.190). Furthermore, there is no statistically significant difference between the two surgical approaches in terms of both cosmetic (p=0.814) and functional (p=0.319) outcomes.
CONCLUSION: A comprehensive literature review of pediatric SCHF shows that surgeons do not frequently prefer posterior incisions in Gartland type III fracture that cannot be managed with closed reduction. However, posterior open reduction is a safe and effective method since it provides more control over the distal humerus, allows for a complete anatomical reduction involving both cortices, reduces the risk of ulnar nerve injury, thanks to the nerve exploration, and yields positive cosmetic and functional outcomes.

AMAÇ: El tendon yaralanmasý olan hastalar, acil servislerde muayene edildikten sonra geç dönemde el cerrahisi kliniðine baþvurabilirler. Bu hastalarda fizik muayenede yaklaþýk bir fikir elde edilmiþ olsa bile, rekonstrüktif yaklaþým ve cerrahi kesilerin doðru planlanmasý ve medikolegal nedenler için genellikle tanýsal görüntüleme istenir. Bu çalýþmanýn birincil amacý, geç baþvuran tendon yaralanmasýnýn olan hastalarda USG (Ultrasonografi) ve MRG’nin (Manyetik rezonans görüntüleme) genel doðruluðunu belirlemektir.
GEREÇ VE YÖNTEM: Kliniðimizde geç dönem tendon yaralanmasý tanýsý ile cerrahi eksplorasyon, geç sekonder tendon onarýmý veya rekonstrüksiyon uygulanan 60 hastanýn (32 kadýn, 28 erkek) cerrahi bulgularý ve görüntüleme raporlarý deðerlendirildi. 39 ekstansör ve 21 fleksör tendon yara-lanmasý için ameliyat öncesi 47 USG (18-874 gün) ve 28 MRG (19-717 gün) sonucu karþýlaþtýrýldý. Görüntüleme raporlarý kýsmi rüptür, tam rüptür, iyileþmiþ tendon ve adezyon oluþumu olarak yorumlandý ve cerrahi raporlarla doðruluk açýsýndan karþýlaþtýrýldý.
BULGULAR: Ekstansör tendon yaralanmalarýnda USG için duyarlýlýk ve doðruluk deðerleri %84, MRG için %44 ve %47 idi. Fleksör tendon yaralan-malarýnda MRG için duyarlýlýk ve doðruluk deðerleri %100 ve USG için sýrasýyla %50 ve %53 idi. 4 duyusal sinir yaralanmasýndan 4’ü USG’de ve 1’i MRI’da gözden kaçmýþtýr. Bu çalýþmada geç baþvuran hastalarda USG ve MRG ile elde edilen sonuçlar, literatürde daha önce USG ve MRG çalýþma-larýnda bildirilenlerden daha düþüktür.
TARTIÞMA: Tendon iyileþmesi ile birlikte skar oluþumu anatomide deðiþikliðe neden olmakta ve bu da doðru deðerlendirmeyi engelleyebilmektedir. Bu nedenle cerrahlarýn hastalarýný kolay ulaþýlabilen ultrasonografi ile deðerlendirmeye baþlamalarý faydalý olacak ve cerrahi morbidite azalacaktýr.

BACKGROUND: Patients with hand tendon injuries may present to the hand surgery clinic in the late stage after being examined in emergency departments. Even if an approximate idea has been obtained in physical examination of these patients, diagnostic imaging is usually requested for reconstructive approach, correct planning of surgical incisions and medicolegal reasons. The primary purpose of this study was to determine the overall accuracy of Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in patients with late presentation of a tendon injury.
METHODS: The surgical findings and imaging reports of 60 patients (32 females, 28 males) who underwent surgical exploration, late secondary tendon repair or reconstruction with a diagnosis of late-presenting tendon injury in our clinic were evaluated. Comparisons were made of 47 preoperative USG images (18-874 days) and 28 MRI (19-717 days) results for 39 extensor and 21 flexor tendon injuries. The imaging reports were interpreted as partial rupture, complete rupture, healed tendon and adhesion formation and these were compared with the surgical reports in terms of accuracy.
RESULTS: In extensor tendon injuries, the sensitivity and accuracy values were both 84% for USG and 44% and 47% for MRI, respec-tively. In flexor tendon injuries, the sensitivity and accuracy values were 100% for MRI and 50% and 53%, respectively, for USG. Of the 4 sensory nerve injuries, 4 were missed on USG and 1 on MRI. The results obtained with USG and MRI in the late-presenting patients in this study were lower than those reported in previous USG and MRI studies in the literature.
CONCLUSION: Scar formation with tendon healing causes a change in anatomy, which could prevent accurate evaluation. There-fore, it would be beneficial for surgeons to start evaluating their patients with easily accessible ultrasonography; thus, surgical morbid-ity should be reduced.

Konjenital diafram hernileri nadirdir ve çoðunlukla neonatal dönemde taný alýr. Bochdalek hernisi olarak da bilinen konjenital diafram defekti genel-likle diafram sol posterolateral bölgesinde embriyolojik dönemde bulunan plöroperitoneal kanalýn persistan olarak kalmasýyla ortaya çýkar. Eriþkinde nadir olarak görülse de konjenital diafram defektiyle birlikte olan intestinal volvulus, strangülasyon veya perforasyon gibi tablolar yüksek morbidite ve mortalite ile seyreder. Bu çalýþmada konjenital diafram hernisi ile birlikte intratorasik mide perforasyonu sebebiyle opere ettiðimiz olgumuzu raporladýk. Hastanýn hastane baþvurusunda atipik bir karýn aðrýsý, belirgin sýrt aðrýsý ve þüpheli respiratuvar þikayetleri bulunmaktaydý. Radyolojik gö-rüntülemelerde diafram hernisine baðlý midenin dilate vaziyette ve dalaðýn sol hemitoraksta bulunduðu görülmekteydi. Hastanýn servise internasyonu sonrasý yatýþýnýn ikinci gününde taþikardi ve hipotansiyon geliþmesi saturasyon düþüklüðü sonrasý yapýlan kontrol görüntülemelerinde sol hemito-raksta; midenin kollabe ve etrafýnda hidropnömotoraks ile uyumlu görünüm olmasý üzerine acil laparotomi kararý verildi. Operasyonda radyolojik bulgularýn da gösterdiði gibi diafram sol posterolateralinde diafram defekti görüldü ve bu defektten mide ve dalak sol hemitoraksa herniye olmuþtu. Mide ve dalak karýn içine redükte edildi. Sol hemitoraks 2000 cc izotonik ile yýkandý, sol tüp torakostomi uygulandý ve diafram onarýldý. Mide ön yüzü primer onarýldý. Ameliyat sonrasý takiplerinde yara yeri enfeksiyonu dýþýnda bir komplikasyon görülmeyen hastanýn toraks tüpü çekildi. Enteral gýdayý tolere eden hasta þifa ile taburcu edildi.

Congenital diaphragmatic hernias are rarely seen and they are usually diagnosed in the neonatal period. Congenital diaphragmatic de-fect, also known as Bochdalek hernia, usually occurs with the persistence of the pleuroperitoneal canal in the left posterolateral region of the diaphragm in the embryological period. Although it is rarely seen in the adults, conditions such as intestinal volvulus, strangulation, or perforation with congenital diaphragm defect progress with high mortality and morbidity. In this study, we reported our case that we operated for intrathoracic gastric perforation with congenital diaphragmatic defect. When the patient admitted to the hospital, he had an atypical abdominal pain, significant back pain, and suspicious respiratory complaints. Radiological imaging showed that the stomach and the spleen were located in the left hemithorax due to diaphragmatic hernia also stomach was very dilated. Tachycardia, hypotension, and low saturation developed on the 2nd day of the patient’s hospitalization. In the control imaging of the patient, in the left hemithorax, stomach was collapsed and the surrounding appearance compatible with hydropneumothorax, after that findings emergency laparotomy was decided. During the operation, as demonstrated by the radiological findings, a diaphragm defect was seen in the left posterolateral region of the diaphragm. The stomach and spleen were herniated to the left hemithorax from this defect. The stomach and spleen were reduced into the abdomen. The left hemithorax was lavaged with 2000 cc isotonic, left tube thoracostomy was applied, and the diaphragm was repaired. The anterior stomach was primarily repaired. In post-operative follow-up, there were no complications other than wound infection and thoracic tube of the patient was removed. The patient who tolerated enteral food was discharged from hospital with full recovery.

Travmatik asfiksi, yüzde ödem, siyanoz, subkonjonktival kanama ve göðsün üst bölümü, boyun ve yüzde peteþiler ile karakterize olup çocuklarda çok nadir görülen bir klinik sendromdur. Eriþkinlerdeki insidansý 1/18,500 olarak rapor edilmiþtir ancak çocuklardaki oran tam olarak bilinmemektedir. Travmatik asfiksi, torako-abdominal bölgedeki ani kompresyona baðlý mekanik hipoksinin sonucu olup bu sendromun ortaya çýkmasý için Valsalva manevrasý gereklidir. Bu yazýda, ekimoz maskesi görünümü olan 14 yaþýndaki travmatik asfiksi olgusu sunuldu.

Traumatic asphyxia, which is manifested by facial edema, cyanosis, subconjunctival hemorrhage, and petechiae on the upper chest and abdomen, is a very rare clinical syndrome in children. In adults, the incidence of traumatic asphyxia was reported as 1 case/18,500 accidents, but the actual incidence is not known for pediatric population. Traumatic asphyxia is a mechanical cause of hypoxia resulting from sudden compression of the thoracic-abdominal region and the valsalva maneuver is necessary for the development of this syn-drome. Here, we describe a case of traumatic asphyxia with an ecchymotic mask in a 14-year-old boy who was referred to our pediatric emergency department.