Mesenteric ischemia may result from a wide range of pathological processes, each having different clinical features. Regardless of etiology, one of the pathophysiologic mechanisms that develop as a result of mesenteric ischemia is bacterial translocation. In this study, we evaluated the effect of ceftriaxon on bacterial translocation of enteric organisms in animal models of mesenteric ischemia was formed as a result of ligating superior mesenteric artery. Qualitative cultures of blood, liver, lungs and mesenteric lymph nodes have been taken.

Neutrophils are an important factor in the organ injury associated with ischemia and reperfusion (I-R). In experimental conditions, besides many chemicals, immunosuppressive agents like cyclosporineA (CsA) and FK 506 were also used to prevent I-R injury. But effect of immunosuppressives on neutrophils still remains unclear. We designed an experimental study to investigate the role of CsA in organ injury after hemorrhagic shock and reperfusion in rats. Forty Wistar albino rats were divided into 4 groups. G 1: Control, G2: Shock, G3: Shock + Reperfusion, G4: CsA. Shock was induced by with drawing of 2,5 ml blood viafemoralvein. The shed blood was then reinfused after 20 min in reperfusion groups. In G4, CsA (20 mg/kg) was given by a single IV injection just before (5 min) the perfusion. Rats were sacrified24 hours after operation. Plasma malondialdehyde (MDA) levels of all groups and, MDA and myeloperoxidase (MPO) levels of liver, lung, small bowel and kidney were measured. In addition, neutrophil counts were obtained from all organs. After I-R, MDA levels of plasma and all organs increased and then returned to normal by CsA administration. This observations revealed the role of free oxygene radicals in I-R injury. But CsA-induced MPO decrease was obtained in only small bowel. In addition, reduction in neutrophil infiltration by CsA was seen in small bowel and kidney. We concluded that, CsA has a beneficial effect on I-R-induced organ injury. But, at least in liver and lung, these results couldn't attributed to reduced neutrophil infiltration. However, increase of CsA dose may cause widespread reduction in neutrophil counts. Further investigations are necessary to clarify the exact role of CsA on I-R injury.

This study has been carried out to evaluate the knowledge, attitude, and behaviour of bus and lorry drivers on first aid. Questionnaire was given to 84 drivers (37 bus drivers, 47 lorry drivers). It has been found out that the great majority of the study group did not know what to do in cases of respiratory problems, bleeding, penetrating abdominal injuries, fractures, burns and freezing. The knowledge of the drivers who have been working for 10 years and less was found to be more than the drivers who have been working for mere than 10 years. 70% of the drivers had a drivers license without training on first aid. It was found that 90.5% of the vehicles had a first aid bag. Among the drivers in the study group, 8.3 % believed that their knowledge on firs aid was sufficient, 40.5 % of them believed that their knowledge was partially sufficient, and 51.1% of them believed that their knowledge was not sufficient. 64.3 % of the drivers said they would be willing to attend a training programme on the first aid. It can be concluded that all people, particularly drivers at first, must be trained on the first aid to reduce incidence of deaths related to traffic accidents. Lectures on first aid and prevention of accidents must be included in curricumulus of training and education instutions of various levels. Press organs such as TV and radio must allocate more time and opportunities for training of people on these subjects.

Injuries of columna vertebralis had increased together with high energy traumas related with advanced technology. Because of unsatisfactory results of conservative therapies and for rapid rehabilitation aggresive surgical procedures have been widely accepted in last fifteen years. In this study, 14 cases with thoracolumbar traumas were reported. The clinical status of the patients have been according to Frankel classification. Biomechanics of trauma was classified according to Denis classification. For posterior stabilization we applied pedicle screw plating in 8 patients, rod-hook system in 2 patients classified. For anterior stabilization we used anterior instrumentation in 2 cases and we also used combined techniques together with anterior-posterior stabilization in 2 patients. In addition, we performed total laminectomy in 8 patients and corpectomy in 2 cases. All the patients have been mobilized with thoracolumbar brace after 3 days postoperatively in this manuscript. We discussed various techniques of stabilization in thoraco-lumbar injuries according to trauma biomechanics.

In this study we reviewed the related literature about Fournier s gangrene with 18 patients admitted to our clinic with this entity. The records of Ý 8 patients with Fournier gangrene treated in our clinic were retrospectively reviewed. Diabetes mellitus was a predisposing factor in 10 patients. Extensive debridments were made to 17 patients, seconder suturing to three patients whereas 3 patients required secondary reconstructive surgery. 16 patients recovered primarily. With early diagnosis, treating predisposing factors, broad spectrum antibiotic therapy and extensive surgical debridment, Fournier's gangrene, a lethal disease, can easily be managed.

We evaluated Cervical Spine Injuries (QSI) of 70 patients admitted to Trauma and Emergency Surgical Unit at Istanbul Medical School between January 1991-December 1995. The cause of injury was motor vehicle accident in (57%) and fall in (21 %). In addition to plain cervical radiography performed in all patients, computerized Tomography (80 %) and Magnetic Resonance Imaging (MRI) (10%) were performed. Conservative treatment was performed in 92.8 % and surgical treatment to 7.1% of the cases. Of the total 70 patients, 38 (55,7 %) were discharged, 10 (5.7 %) were lost and 22 were referred to other clinics for treatment. Because CSI cause high mortality and morbidity patients with multiple trauma should undergo a complete neurological examination following stabilization of the respiratory and hemodynamic status and CSI should be considered unless otherwise is proven by radiological methods.

Posttraumatic leptomeningeal cysts are rare complications of diastatic skull fracture, occurring almost in childhood and parietal region. Disruption of the underlying dura is necessary in pathogenesis. The normal growth of the brain, cerebral pulsations and cystic lesion cause to enlargement of the fracture edges. Surgical repair is the treatment of choice. In the last 4 years, we have managed 7 cases of growing skull fracture. All patients had a history of falling from a height. The time interval between the trauma and presentation was variable between 20 days to 20 years. The most common clinical feature was local swelling in children, while seizure and atypical headache in adults. Dural repair and cranioplasty was performed in all patients.

Elderly population is increasing every year in our country. Reasons of trauma and response to trauma changes with age. Files of the patients who applied to our hospital for trauma between January 1997 and June 1998 have been examined. Patients were divided into two groups: Those who are 55 to 64years old and those who are 65years old and over. In addition, patients of 35 to 44 years have been included in the study as control group. 5.5% of 9450 patients who were admitted to the hospital for trauma were 55 years old and over. The most frequent trauma was head trauma in each of the 3 groups. While most frequent trauma reason was traffic accident in control and early elderly group, in the late elderly it was fall. Average ISS in control, early elderly and late elderly groups have been found 9,9 and 16 respectively. Average hospitalization periods in control, early elderly and late elderly groups have been founds 5,7,9 days, respectively. While mortality was 5.9% in control group, it was 10.7% in early elderly group, and 23.7% in the late elderly group. As a conclusion, the fact that elderly patients physiological reserves are less and their insufficient metabolic and endocrine response to trauma might have reduced their survival chance after trauma.

A prospective study was performed on patient with abdominal pain to evaluate of plain abdominal radiographs and to determine the differences of registrar and radiologist and general surgeon in diagnosis. Eighty eight patients with acute abdominal pain who admitted to department of emergency medicine were evaluated. The plain abdominal radiography were obtained in all of them. In first step, case and radiograph were evaluated by registrar and later, radiologist and surgeon assessment was done. Radiograph was classified by the authors into one of the following groups a) of no help in diagnosis b) diagnostic c) of help in diagnosis and d) wrong diagnosis. Seven acute abdominal conditions were considered a) acute appendicitis (25 patients) b) intestinal obstruction (13 patients) c) acute cholecystitis (18 patients) d) non-spesific abdominal pain (11 patients) e) urolithiazis (5 patients) f)perforation (4 patients) g) miscellaneous diagnosis (11 patients). In registrar evaluation radiograph were no help diagnosis in 73 percent of cases, help diagnosis in 21 percent of cases, helpful in 3.4 percent. This assessment had became respectively 75,19,68, percent in radiologist and surgeon evaluation. Our results suggest that for the 75 percent of all patients with acute abdominal pain there is little value in taking a plain abdominal radiograph. Registrar had assessment as right as radiologist and surgeon assessment.

Spondiloptosis, spondilolistesisin en ileri þeklidir ve subaksiyal servikal bölgede çok nadirdir. Literatürde günümüze kadar servikal spondiloptosis'li sadece 2 olgu bildirilmiþtir. Bu çalýþmada, travma sonrasý C3-4 mesafesinde spondiloptosis geliþmiþ, nörolojik bulgusu olmayan 67 yaþýnda bir erkek olgu sunulmaktadýr. Olgu anterior ve posterior kombine cerrahi yaklaþýmla tedavi edilerek 3 ay halofiksasyon ortezi ile tespit edilmiþ ve takibinde füzyon saðlanmýþtýr.

Clivus fractures are classified in three groups as longitudinal, transverse and oblique types according to CT appearance. Due to advance in high resolution CT techniques, they can be easily diagnosed. It is known that in these kind of fractures, complication, morbidity and mortality rates are high. In this manuscript, a case of transverse fracture of dims caused by falling a heavy object of 500 kg, over the patient's head will be reported.

Trans cranial perforating injuries are uncommon. Recently we treated a 14 year old boy, who sustained a trans cranial spanner injury. The patient was admitted to our emergency department without any neurological dysfunction. He was operated urgently and the spanner was removed. During the hospital stay and in his follow-up of 18 months he did not develop any complication. In this study we presented the case and discussed the topic in the view of recent literature.

Paraözefageal fýtýklar genelde ileri yaþlarda ortaya çýkan, bazen hayatý tehdit edebilen olgulardýr. Gastrik volvulusa neden olmalarý dolayýsýyla cerrahi olanak tedavileri gerekir. Bu çalýþmanýn amacý, cerrahi tamir yöntemlerini gözden geçirmek ve Akut Karýn sendromu belirtileriyle kliniðimize müracaat eden bir olguyu incelemektir. Cerrahi yaklaþýmda seçilecek olan yöntem mevcut cerrahi metodlarýn birini seçmekten çok hastanýn aperatif ve medikal bulgularýna dayandýrýlmýþ, hastaya özgün bir yöntem olmalýdýr.

Currently, diagnostic and therapeutic intravascular approach increased with some complications behind. Complications like hemorrhagia, pseudoanerysms and arteriovenous fistula could be noticed after the procedure. We had operated a 3 years old patient who had pseudoaneurysm of subclavian artery 3 weeks after subclavian vein hemodialysis catheter access trial. Expetielfy after proximal vascular approach surgeon could meet complication especially hemorrhagia which may cause mortality. Patients with hemorrhagical problems should be followed up for complications desalted above and early surgical intervention may be life saving.