Çalýþmamýz, sýçanlarda infraruj ýþýnýnýn primer yara iyileþmesine etkisini araþtýrmak amacýyla planlanmýþtýr. Deney ve kontrol grubundaki sýçanlarda oluþturulan insizyonel yaranýn iyileþmesi, histolojik analiz skalasý ve yaranýn kopma kuvveti yöntemi ile incelenmiþtir. Post-operatif ilk 3 gün, ilk 7 gün ve post-operatif 3. günden sonra baþlamak suretiyle 7 gün boyunca, günde bir seans ve 10 dakika süreyle uygulanan infraruj ýþýný sonrasýnda deney ve kontrol gruplarý arasýnda biomekanik inceleme sonucunda yaranýn kopma kuvveti açýsýndan istatistiksel fark bulunmazken (p > 0.05), deney ve kontrol gruplarýnýn kendi aralarýndaki kýyaslamada yara iyileþmesi yönünden ileri düzeyde anlamlý fark bulunmuþtur(p<0.001). Ayrýca histopatolojik inceleme sonucunda, deney grubunda kontrol grubuna göre doku tamirinin hýzlandýðý görülmüþtür.

This experimental study was planned to explore the effectiveness of infrared beam on primary wound healing in rats. The healing of incisional wound was studied by the mean of the scala of histologic analyses and wounds strength breaking off in both experiment and control groups. The biomechanical study was done between experimental and control groups starting from first post operative three days, seven days and from the third post operative day for continuous seven days, where one session of 10 minutes duration of infrared radiation was performed daily. There was no significant statistical difference in the biomechanical study between the above mentioned groups (p < 0.001). But the tissue healing was noticed to be quicker in the experimental group than the control group. Healing of the wound was also correlated between the two groups, and showed a significant difference(p>0.05). In the histopathologic analyse it is also observed that the tissue healing is speeded up according to the experimental and control groups.

Bu çalýþmada Dicle Üniversitesi Týp Fakültesi Araþtýrma Hastanesi Nöroþirurji Kliniðinde 1990- 1996 yýllarý arasýnda ki 6 yýllýk bir süre içerisinde yatýrýlarak tedavi edilen (C4 altý) alt servikal spinal yaralanmasý olan 43 olgu incelendi. Yaþlarý 10-66 arasýnda deðiþen 43 olgunun 32'si (% 74,4) erkek, 11'i (%25,6) bayandý. Bu 43 hastanýn 24'ü (%55,8) düþme, 11'i (%25,5) trafik kazasý, 8'i (%18,6) ateþli silah yaralanmasý sonucu baþvuranlardý. Olgularýn 17si (%39,5) ölümle sonuçlanmýþtýr. Çalýþmamýzda yüksek mortalite ve morbiditeye neden olan servikal spinal yaralanmalarda mortaliteyi etkileyen faktörler incelendi. Lezyonlar önce direkt grafilerle, sonra bilgisayarlý tomografi ile görüntülendi. Sonuç olarak bu tip yaralanmalarda tedaviye ve mortaliteye etki eden faktörlerin; hastalarýn yaþlarý, nörodefisitlerinin varlýðý, ilave travmatik patolojilerinin olmasý, alt birim saðlýk istasyonlarýnda bu konuda eðitim eksikliði, uygun olmayan koþullarda transfer, taný ve uygun müdahalelerinin gecikmesi gibi faktörlerin tedaviyi ve mortaliteyi etkilediði saptandý.

In the study, we investigated a total of 43 cases with lower cervical spinal injury, admitted and treated at the Department of Neurosurgeiy, Research Hospital of Medical Faculty, Dicle University, between 1990-1996. Of 43 patients whose ages varied between 10-66,32 (74.4%) were male and 7 I (25.6%) were female. Of these patients, 24 (55.8%) applied to our clinic due to fall-down, 11 (25.5%) traffic accident, 8 (18.6%) gun-shot injury. Seventeen of the cases (39.5%) died. In our study, the factors affecting mortality in cervical spinal injuries leading to high mortality and morbidity were investigated. Lesions were imaged first by direct radiography and later by computerized tomography. The results of this study demonstrated that such factors as patients age, existence of neuro-deficits, presence of additional traumatic pathologies, lack of training in primary health care units on this matter, transfer under inadequate conditions, delay of diagnosis and proper intervention affected mortality and morbidity in this type of injuries.

Kranyoserebral ateþli silah yaralanmalarý sýklýkla savaþ dönemlerinde görülmekle birlikte, sivil hayatýn da nadir kafa travmasý sebeplerinden biridir. Bu çalýþmada, son dört yýl içinde ateþli silah yaralanmasý sonucu kafa travmasý geçiren 29 sivil yaralanma olgusu taný, tedavi ve takip sonuçlarý ile birlikte literatür gözden geçirilerek özetlendi. Kurþun yaralanmasý 21 olguda, saçma ile yaralanma ise 8 olguda tesbit edildi. Olgularýn kliniðe kabulleri esnasýndaki Glasgow Koma Skalalarý (GKS) 12 olguda 3-7 arasý, 11 olguda 8-11 arasý ve 6 olguda 12-15 arasý idi. Travmatik subaraknoid kanama (SAK) 27 olguda (%93), pnömosefalus 26 olguda (% 83), ayrýca 6 olguda intraserebral hematom, 4 olguda geniþ kranyal defekt ve 2 olguda intraventriküler kanama tabloya eþlik etmekte idi. Ondokuz olguda mermi çekirdeðinin ya da saçmanýn kafayý terk etmiþ olduðu, on olguda ise kranyum içinde kalmýþ olduðu tesbit edildi. Cerrahi giriþim 10 olguya uygulandý. Sadece bir olguda mermi çekirdeði çýkartýldý, ancak bu olguda cerrahi endikasyon kurþunun çýkarýlmasý deðil intraserebral hematomun boþaltýlmasý idi. Ýki olguda geç dönemde abse tesbit edildi. Bu serinin mortalite oraný % 34 olarak tesbit edildi. Hayatta kalan 19 olgunun ortalama takip süresi 26 ay idi ve sadece 2 olgu hiçbir nörolojik defisit veya sekel olmaksýzýn yaþamýný devam ettirmektedir. Ayrýca iki olguda zaman içinde kranyum içindeki kurþunun yer deðiþtirmiþ olduðu tesbit edildi.

Even though craniocerebral gunshot wounds frequently occur during wars, they are one of seldom causes of civil life head injuries. This study includes the results of diagnosis, treatment and follow-up of 29 civil injury cases, including also detailed literature review. Twenty-five cases had missile injuries, and 8 cases had buck-shots. The Glasgow Coma Scales during admission were between 3-7 in 12 cases, between 8-11 in 11 cases, and between 11-15 in 6 cases. Traumatic subarachnoid hemorrhage was observed in 27 cases (%93), and pneumocephalus in 26 cases (%83). Additionally, 6 cases had intracerebral hematomas, 4 cases large cranial defects, and 2 cases intraventricular hemorrhages. In 19 cases the missile had left the cranial cavity, in 10 cases it stayed inside. Ten cases needed surgical procedure. Only in one case the missile was taken out. But the surgical indication was not the removal of the missile, it was the evacuation of an associated intracerebral hematoma. Later, in two cases abscess formation was observed. The mortality rate of this series is 34 %. The mean follow-up period of survived 19 cases was 26 months, and only two of them have been living without any neurological deficit or sequel. Additionally, the movement of the missile from its initial position was observed in two cases during late follow-up period.

Ocak 1992 ile Eylül 1998 tarihleri arasýnda mezenterik vasküler oklüziv hastalýk tanýsý ile ameliyat edilen 74 olgunun dokuzunda barsak nekrozunun tam olarak yerleþmemesi nedeniyle superior mezenter arter (SMA) eksplorasyonu uygulanarak sorunun emboli olduðu olgularda embolektomi yapýldý. Dokuz olgunun 2'sinde barsaktaki iskemi tamamen düzeldi ve rezeksiyon gerekmedi (%22.2). Ýki olguda ise iskemik bölgenin bir bölümünde reperfüzyon saðlandý ve masif barsak rezeksiyonu gerekmedi (%22.2). Kalan 5 olgu ise embolektomiden yarar görmedi (%55.6). Altý olguda sepsis geliþti (%66.6), üç olgu ise kaybedildi (%33.4). Fizik muayene ve laboratuvar bulgularý desteklemese bile, akut mezenter oklüziv hastalýk olabilme riski yüksek, þiddetli karýn aðrýsý olan olgularda anjiografi olanaðý yoksa laparotomiden kaçýnýlmamasý, barsakta nekroz yerleþmemiþ ise SMA'in ekplore edilmesi ve sorun emboli ise embolektomi yapýlmasý gerektiði kanýsýndayýz. Reperfüzyondan sonra serbest oksijen radikallerine baðlý reperfüzyon hasarý ve bakteriyel translokasyona baðlý sepsis olasýlýðýnýn da göz ardý edilmemesi gerektiði görüþündeyiz.

Between January 1992 and September 1998, 74 patients were operated with the diagnosis of mesenteric vascular occlusion. Superior mesenteric artery exploration were performed in 9 of these patients since necrosis of the bowel were not established completely. In two patients the ischemia on the effected segments of the bowel were completely perfused and resection was not necessary (22.2%). In two patients part of the ischemic area could be reperfused and limited resection was performed (22.2%). In five patients embolectomia was unsuccessful (55.6%). Six patients (66.6%) developed sepsis. Three patients died (33.4%). In patients with severe abdominal pain and in whom acute mesenteric vasculary occlusive disease risk is high if angiography can not be performed, laparotomy must be done immediately and in patients in the ischemic period superior mesenteric artery must be explored and if the thrombus is detected, embolectomy must be performed. The possibility of sepsis should also be kept in mind due to the translocation of bacteria and free radicals after the reperfusion.

S.B. Haseki Hastanesi Ortopedi ve Travmatoloji polikliniðine Ocak 1988 Aðustos 1996 tarihleri arasýnda 866 humerus üst uç kýrýðý ve kýrýklý-çýkýk olgusu müracaat etti. Bu olgulardan 53(%6)'ü yatarak tedavi edildi. Yatarak tedavi edilen olgularýn 32(%60)'si erkek, 21 (% 40)'i kadýn olup, yaþ ortalamasý 39 (min. 7 - maks. 79)'du. Bu olgularýn 21 (% 40'i konservatif olarak, 32 (% 60) 'si cerrahi olarak tedavi edildi.Ortalama 16.8 ay (min.6 - maks.40 ay) izlenen 27 olguda kýrýk iyileþmesi radyolojik olarak, hasta omuzun fonksiyonlarý ise Constant Skorlama sistemine göre deðerlendirildi. Kýrýk fragmanlarýnda deplasman derecesi ve fragman sayýsýnýn artmasýnýn, uygulanan cerrahi tekniðin,sonuçlar üzerinde etkili olabileceði, iyi bir fonksiyonel sonuç için rehabilitasyonun, uygulanan ortopedik tedavi y önlemleri kadar gerekli olduðu sonucuna varýldý.

866 patients with proximal end fracture and fractured dislocation of the humerus, were accepted to the Department of Orthopaedics and Traumatology, in Haseki Hospital of Ministry of Health, between January 1988 and August 1996.53 cases (6%) were treated in the in patient clinic. 32 (60%) of those were men and 21 (40%) were women, the average age of whom was 39 (ranged between 7 and 79). Conservative treatment was applied to 21 (40%), and surgical treatment was performed to 32 (60%) of those cases. 27 patients were followed up averagely 16,8 months (minimum 6, maximum 40 months). Healing of the fracture was evaluated radiologically and functions of the fractured shoulder was evaluated according to Constant Scoring System. The increase in the degree of deplacement of the fragments of fracture and the number of fragments, and the surgical technique performed, were concluded to affect the results; and rehabilitation was essential as well as the orthopaedic treatment methods performed in order to obtain satisfactory functional results.

Ateþli silah yaralanmalarýna baðlý defektli ve defektsiz psödoartroz tedavisi oldukça güç ve tartýþmalý bir konudur. Bu çalýþmada GATA Ortopedi ve Travmatoloji A.D'de Ocak-1986 Aralýk-1997yýllarý arasýnda sirküler eksternal fiksatör (CEF) ile tedavi edilen toplam 151 psödoartrozlu olgunun tedavi sonuçlarý sunulmuþtur. Olgularýmýzýn ortalama yaþý 24 olup, 95(%62.9)'si defektli psödoartroz ve 56 (%37.1)'u defeksiz psödoartrozdur. Ortalama takip süresi 64.2 (24-132) aydýr. Klinik ve radyolojik olarak elde ettiðimiz baþarýlý sonuçlar özellikle yüksek enerjili ateþli silah yaralanmasýna baðlý psödoartroz sorununun, CEF cihazý ve tekniði ile baþarýlý bir þekilde çözümlenebileceðini göstermiþtir.

The treatment of pseudoarthrosis with defected or without defected due to gunshot injuries is rather difficult and controversial subject. In this study, we evaluated the treatment of 151 pseudoarthrosis cases treated with circular external fixator(CEF) at Gülhane Military Medical Academy, Department of Orthopaedics and Traumatology between Jan-1986 and Dec1997. Mean age of our cases was 24, 95(62.9%) of those was pseudoarthrosis with defected and 56(37.1%) of those was pseudoarthrosis without defected. Mean follow-up period was 64.2(24-132). Because of obtaining successful clinical and radiological results, pseudoarthrosis due to gunshot injuries with high-velocity can be managed by means of circular external fixator.

Kliniðimizde Ocak 1992 ile Þubat 1998 tarihleri arasýnda künt batýn travmasýna baðlý renal yaralanma tanýsý konulan 14'ü (%29.16) kadýn, 34'ü (%70.84) erkek toplam 48 hastanýn kayýtlarý retrospektif olarak incelendi Yaralanma þekli bakýmýndan yüksekten düþme 22 hasta (%45.8) ile ilk sýrada yer almaktaydý. Hastalarýn yaþ ortalamasý 27.8 yýldý (minimum 6 - maksimum 71). Hastalarýn 41'inde %85.4 minör, 7 'sinde %14.6 majör renal yaralanma olduðu görüldü. 41'inde minör, 3'ünde majör renal yaralanma olan toplam 44 hastaya, (%91.7) konservatif tedavi uygulanmýþ olup, bunlarýn 43'ü (%97.7) baþarýlý bir þekilde tedavi edilirken, majör yaralanmasý olan bir (%2.3) hasta geç eksplorasyon sonrasý konservatif kalýnarak tedavi edildi. Acil eksplorasyon uygulanan 4 (%8.3) hastada majör renal yaralanma vardý ve bunlarýn 3' üne nefrektomi yapýlýrken kalan bir hastaya konservatif kalýnmasýna karar verildi. Takiplerine devam eden hastalarýn hiçbirinde geç dönem komplikasyonlarý (retroperitoneal apse, ürinom, sepsis) geliþmedi. Genel beden travmalarýnda renal yaralanma oraný %3-10 arasýnda meydana gelmektedir. Son yýllarda renal yaralanmalarýn taný ve tedavisinde önemli geliþmeler olmuþtur. Giderek daha fazla konservatif yaklaþýma doðru artmýþ bir eðilim görülmektedir. Bu geliþmeler doðrultusunda kendi deneyimlerimizi yeniden gözden geçirdik ve bu konuda batýn travmalarýyla ilgili uzmanlýk dallarýnýn deneyimlerini gözden geçirmelerinin gerekli olduðunu gördük.

The records of total 48 patients (14(29%) female, (34(71%) male); which were interned with the diagnosis of blunt renal trauma between January 1992 and February 1998 were reviewed. According to type of trauma deaccelaration was the most common (22 patients 45.8%). There were 41 patients (85.4%) minor and 7patients (14.6%) with major renal trauma. A total of 44 (91.7%) patients which 41 were minor and three were major treated with coservative methods. Coservative methods were succesfull in 43 (97.7%) patients where as one patient (2.3%) underwent a late exploration. In all of 4 patients who underwent surgical exploration had major renal traumas and 3 of them treated by nephrectomy and in one patient coservative methods were used after the exploration. None of the patients in the follow-up period late complications were seen as retroperiteonal abcess, urinoma and sepsis. Renal traumas are seen at a persentage of 3-10 in general body traumas. In recent years several improvements made in the diagnosis and treatment of renal traumas which gives a common use of conservative methods. Within the lights of these improvements we re-evaluated our experiences and also concluded that the other experts who treats trauma patients must do the same also.

Bu yazýmýzda, preoperatif tanýsý zor olan ve genellikle yandaþ yaralanmalarla birlikte görülen diyafragma yaralanmalý olgulardaki deneyimlerimizin aktarýlmasý amaçlanmýþtýr. Yetmiþ beþ olgunun hastane kayýtlarý, ameliyat öncesi ve ameliyat bulgularýyla, tedavi sonuçlarý deðerlendirilmek amacýyla retrospektif olarak incelenmiþtir. Olgularýn % 87si erkek ve ortalama yaþ 32'dir. Diyafragma yaralanmalarýnýn % 63'ü penetran travmalara baðlýdýr. Preoperatif taný oraný % 28, taný ve tedavi gecikmesi oraný % 9 bulunmuþtur. Laserasyon 50 (% 67) olguda diyafragmanýn sol yansýnda yerleþiktir. Künt yaralanmalarýn % 82'si, penetranlarýn % 57si Diyafragmanýn sol yarýsýndadýr (p=0.031). Olgularýn % 84'ünde yandaþ yaralanmalar saptanmýþtýr. Olgularýn %79'unda 2 ve 3. Derece diyafragma hasarý vardýr. Biri hariç tüm laserasyonlar primer dikiþ ile baþarýlý olarak onarýlmýþtýr. Erken dönemde mortalite % 9'dur ve hepsi yandaþ sistem ve organ yaralanmalarýna baðlýdýr. Mortalite künt travmalarda % 14, penetranlarda % 6'dýr (p=0.23). Travmatik diyafragma yaralanmalarýnýn preoperatif tanýsý güç olmaktadýr. Ancak diyafragma hasarlarýnýn cerrahi onarým sonuçlarý baþarýlýdýr. Ölüm genellikle yandaþ yaralanmalara baðlý geliþmektedir. Künt ve penetran göðüs ve karýn travmalarýnda diyafragma yaralanmasýnýn düþünülmesi ve dikkatli cerrahi eksplorasyon tedavinin baþarýsý için esastýr.

In this paper we aimed to present our experiences on the cases of diaphragmatic ruptures which were seen generally with associated injuries. Hospital records of 75 patients were analyzed retrospectively in order to evaluate preoperative and intraoperative findings, and the results of their management. Eighty-seven percent of patients were male with a mean age of 32 years. Sixty-three percent of diaphragmatic injuries were secondary to penetrating trauma. The rate of preoperative diagnosis was found as 28 %, and of delayed diagnosis and treatment as 9 %. Lacerations were localized in the left hemidiaphragm in 50 (67 %) patients. The left hemidiaphragm harbored 82 % of blunt and 57 % of penetrating injuries (p=0.031). Associated injuries were determined in 84 % of our cases. Seventy-nine percent of the cases have grade 2 and 3 diaphragmatic lacerations. All ruptures, but one, have been repaired successfully with primary suture. The overall perioperative mortality was 9 %, and all of them were related to associated injuries. The mortality was 14 % after blunt, and 6 % after penetrating trauma (p=0.23). Preoperative diagnosis of traumatic diaphragmatic injuries is usually difficult. However the results of surgical repair of diaphragmatic lacerations is satisfactory. The death generally occurs secondary to associated injuries. To take into account diaphragmatic injuries after blunt or penetrating trauma of the thorax and the abdomen, and careful surgical exploration is essential for proper and successful management.

Bu çalýþma 1991-1998 yýllarý arasýnda toraks travmasý nedeniyle Ege Üniversitesi Týp Fakültesi Kalp Damar ve Göðüs Cerrahisi Anabilim Dallarý'na acil olarak yatýrýlan 286 hasta arasýndan ateþli silahlar ile oluþturulmuþ 29 yaralanma olgusunu kapsamaktadýr. Ýncelenen olgularýn erkek/kadýn oraný 3.1 olup yaþ aralýðý ve ortalamasý sýrasýyla 19-64 ve 36.4 olarak bulundu. Yaralanmalarýn 11'i av tüfeði (%37) ile oluþturulmuþtu. Yandaþ yaralanmalar arasýnda majör vasküler yaralanmalar (%66) ilk sýrada yer almakta iken, olgularýn dokuzuna (%31) torakotomi, birine (%3) median sternotomi ile müdahale edildi. Bu müdahalelerden altýsý (%60) acil koþullarda gerçekleþtirildi. Ortalama yatýþ süresi 13.6 gündü. Morbidite %57 oranýnda izlenirken, mortalite iki olgu ile %7 oranýnda saptandý. Diðer yaralanma türleri ile kýyaslandýðýnda, bu yaralanmalarýn morbidite ve yatýþ süresine etkisi istatistiksel olarak anlamlý bulundu (sýrasýyla p < 0.001 ve p < 0.05).

The trial comprises 29 cases of thoracic gunshot wounds among 286 thoracic trauma patients urgently hospitalized at the Department of Thoracic and Cardiovascular Surgery of Ege University Medical Faculty, between 1991-1998The male/female ratio was 3.1, age range and the mean age were 19-64 and 36.4, respectively. Eleven (37%) of the cases were injured by shotguns. Among the associated lesions, major vascular injuries were encountered most frequently. Thoracotomy was required in nine (31%), and median sternotomy in one of the cases. Six patients (60%) were operated under emergent conditions. The mean hospital stay was 13.6 days. Morbidity rate was 57%, representing 16 patients and mortality was seen in two patients. The effect of gunshot wounds to the morbidity and to the length of stay was determined to be statistically significant (p<0.001 and p<0.05, respectively).

Acil servislere baþvuran hastalarýn çoðuna süratli bir þekilde ve emniyetli bir damar yolu açmak gerekmektedir. Travma, þok, yanýk gibi vakalarda etkili resüsitasyon ihtiyacý ortaya çýkmaktadýr. Bu hastalarýn bir çoðunda periferik vasküler kollaps olduðundan periferik damar yolu açmak zor olduðu gibi, istenilen derecede etkili replasman saðlanamamaktadýr. Ayrýca, bu hastalarýn bir kýsmýnda mayi replasmanýnýn etkili olup olmadýðýný anlamak için santral venöz basýnç takibi de gerekli olmaktadýr. Dolayýsý ile çoðu kez santral venöz kateterizasyon kaçýnýlmaz bir ihtiyaç olmaktadýr. Bu çalýþmada 1998 yýlý içindeki 12 aylýk zaman periyodunda acil serviste santral venöz kateter takýlan 186 hastanýn dosyalarý retrospektif olarak incelendi. Santral venöz kateterizasyon için en sýk subklavian ven kullanýldý (%50). Hastalarýn büyük çoðunluðunda kateterizasyon endikasyonu mayi replasmaný ve santral venöz basýnç ölçümü idi (%92). Cerrahi acil olgularda en sýk acile baþvuru nedeni trafik kazasý (% 26), dahili olgularda ise Serebrovasküler hastalýklar (%9) idi. Subklavian kateterizasyonda %10; Ýnternal juguler kateterizasyonda %4; femoral kateterizasyonda ise %26 komplikasyon geliþmiþtir. En sýk görülen komplikasyonlar femoral yolda enfeksiyon ve subklavian yolda arter kateterizasyonudur.Sonuç olarak; Santral kateter uygulamasý özellikle acil servisler için vazgeçilmez bir uygulamadýr. Tecrübesiz ellerde bazý komplikasyonlarý vardýr. Ancak bu komplikasyonlar santral kateter takýlmasýna engel deðildir. Sadece mayi transfüzyonu için santral kateter uygulamasýna gerek yoktur.

A Rapid and safe intravenous access is necessary in almost all patients applying to emergency department (ED) Effective administration of fluids is unavoidably required in certain cases such as polytrauma, shock and burns. Obtaining a peripheral intravenous access and effective fluid administration are generally difficult in these cases due to vascular collapse. In many of these cases, monitorisation of central venous pressure is mandatory. For these reasons, central venous catheterization usually turns out to be an unavoidable procedure in these patients. 186 patients who required central venous catheterization in our ED during the year of 1998 were reviewed. Subclavian vein route was the most common route for central venous catheterization (50%). The indications for central venipuncture was fluid administration and measurement of central venous pressure in the majority of the patients (92%). Traffic accident were the leading cause in the surgical cases (26%) While cerebrovascular accidents were the most common cause in the medical cases (9%). The rates of complications related to the routes used were as follows: Subclavian vein route (10%) internal juguler vein route (4%), femoral vein route (26%). The most common complications were infection around the insertion site in femoral vein route and arterial puncture in subclavian vein attempt. As a result, central venous catheterization is a necessary intervention in EDS. Some complication may occur when applied by inexperienced hands yet, these complications are not contraindications for these insertion. Requirement of fluid administration alone is not an indication for central venous catheter insertion.

Minör kafa travmasýna (Glaskow Koma Skoru: 15) baðlý retrograd amnezi olgularý acil hekimlerinin çok sýk rastladýðý bir durumdur. Bu nedenle herhangi bir nörolojik bulgu taþýmayýp sadece retrograd amnezisi olan olgularda Bilgisayarlý Beyin Tomografjsinin (BBT) ne kadar gerekli olduðunu araþtýrmak amacý ile bu çalýþma yapýlmýþtýr. Retrograd amnezi dýþýnda herhangi bir nörolojik defisiti bulunmayan ardýþýk 100 olguya BBT çekilmiþtir. Bu olgularýn 5'inde patoloji saptanmýþ, 95 BBT normal bulunmuþtur. Bu bulgular literatürle uyumludur (%4-6). Bu nedenle retrograd amnezinin yandaþ semptom ve bulgular olmadan da tek baþýna BBT endikasyonu olarak devam etmesi gerektiði sonucuna varýlmýþtýr.

Retrograde amnesia due to minor head injury (Glasgow coma score=15) is frequently encountered in the emergency services. The aim of this study is to find out if cranial computerized tomography (CT) is necessary in patients with pure retrograde amnesia and without any other neurological findings and/or symptoms of increased intracranial pressure. We performed cranial CT in WO consecutive such patients with retrograde amnesia. 95 CT scans were normal and 5 abnormal (5%). These findings are in accordance with the literature (4-6%). We, therefore think that we must continue to consider retrograde amnesia, by itself, as an indication for computerized cranial tomography.

Karaciðer kist hidatiði eski bir hastalýk olup Hipocrates zamanýndan beri bilinmektedir. Dünyanýn bazý bölgelerinde ve ülkemizde yaygýn olan hastalýðýn önemli komplikasyonlarý vardýr. Zamanýnda ve uygun tedavi edilmeyen hastalýk komplikasyonlarýnýn ortaya çýkmasýyla öldürücü olabilir. Endemik bölgelerde genellikle uzun süre semptomsuz seyredebilir. Makalemizde çeþitli nedenlerle karaciðer kist hidatiði perforasyonuna baðlý meydana gelen üç akut karýn tablosu literatür ýþýðýnda irdelendi.

Hydatid disease of the liver has been known since Hipocrates. The disease, which occurs in Turkey and many other countries, has serious complications. The disease could be symptom free for long time. In this issue 3 patients who have acute abdomen due to perforation of hydatid cysts of the liver are reported.

Künt toraks travmasý sonrasýnda geliþen tansiyon pnömoperikardiyum nadir gözlenen bir patolojidir. Burada künt toraks travmasý sonrasýnda geliþen göðüs patolojilerine ek olarak klinik, hemodinamik ve radyolojik olarak tanýsý karakteristik bulgularla konan bir pnömoperikardiyum vakasý sunulmaktadýr. Önce Sað daha sonra sol pnömotoraks oluþmasý nedeniyle ardýþýk olarak yerleþtirilen iki taraflý toraks tüpleriyle, muhtemelen pleuroperikardiyal laserasyona baðlý olarak geliþen pnömoperikardiyum ve tamponad bulgularý perikarda müdahaleye gerek kalmadan gerilemiþtir.

Tension pneumopericardium after blunt chest trauma is a rare pathology. We present one of these cases here. Pneumopericardium occurred after blunt chest trauma was diagnosed with his characteristic clinical, hemodynamic and radiological findings. Because of the bilateraly pneumothoraces sequentially bilateraly chest tubes inserted to the patient and then tension pneumopericardium and pneumopericardium reggressed without needing any intervention.

Epiteloid gastrik stromal tümörler, gastrik tümörlerin ayrý bir patolojik alt grubunu oluþturur. Malign ve metastatik potansiyelleri, prognozlarý tartýþmalýdýr. Bu tümörlerin klinik davranýþlarýný tayin edebilmek çoðu zaman güçtür, ancak hastalarýn büyük bir kesimi semptomatiktir ve en sýk görülen semptom gastrointestinal hemorajidir. Diðer bazý neoplazmalarla, özellikle gastrik adenokarsinom, birliktelik bildirilmiþtir. Bu olgu sunumunda, akut masif gastrointestinal ve intraperitoneal kanama ile baþvuran, senkron olarak multiple primer malign tümörlerle birliktelik gösteren bir gastrik stromal tümörün kendisine özgü klinik özellikleri, histolojik bulgularý ve prognozu tartýþýlmýþtýr.

Epithelioid gastric stromal tumors form a distinct pathologic subset of gastric tumors whose malignant and metastatic potential and prognosis are controversial. The clinical behavior of these tumors is often difficult to predict, however, a significant number of patients are symptomatic and the most common symptom is gastrointestinal hemorrhage. The association of other neoplasms, particularly carcinoma of stomach have been noted in patients with epithelioid leiomyomatous tumors. Here we report the bizarre clinical features, histologic findings, and prognosis of a gastric stromal tumor presented with acute massive gastrointestinal and intraperitoneal bleeding and with other multiple primary malignant tumors.

Asýlan adam kýrýðý üst servikal bölgenin nadir olmayan kýrýklardandýr. Son derece instabil kýrýklar olup konservatif tedaviye iyi yanýt verirler. Konservatif tedaviyi reddeden, cevap vermeyen vakalarda cerrahi müdahale endikasyonu vardýr. Burada sunulan olguda asýlan adam kýrýðý cerrahi tedavisi literatürde gözden geçirilerek tartýþýlmýþ ve posterior C2-3 plak vida fiksasyonunun zor ama yapýlmasý gereken müdahale olduðu vurgulanmýþtýr.

Traumatic spondylolisthesis of axis (Hangman's fracture) is not a rare pathology. Although it is a very unstable fracture, healing can be achieved by conservative treatment. In case of rejection of medical treatment or persisting instability following Halo brace, surgery can be a necessity for the treatment of this pathology. In this presentation, surgical treatment of hangman1 s fracture was discussed reviewing the literature and posterior C2-C3 transpedicular plate screw fixation is emphasised as the best approach for treatment.