Mezenter iskemisine baðlý barsak hastalýðýnda demarkasyon hattýnýn net olmadýðý durumlarda intraoperatif barsak canlýlýðýnýn deðerlendirmesi ve sýnýrlarýnýn tespiti güçtür. Bu deneysel çalýþmada, deðiþik mezenterik iskemi modelleri oluþturularak barsak iskemi derecesinin intraoperatif olarak deðerlendirilmesinde yardýmcý bir taný yöntemi olan flouressein flouresansýnýn yeri araþtýrýldý.: Wistar - Albino erkek ratlarda strangülasyon, superior mezenterik arter ligasyonu ve kontrol gruplarý oluþturuldu. Ýki saat sonra intraoperatif gözlem bulgularý ile barsaklarýn canlýlýðý deðerlendirildi. Kuyruk veninden 15 mg/kg fluoressein intravenöz verildi. Ýki-üç dakika sonra karanlýk odada 3600 A Wood ýþýðý altýnda flouressein flouresans derecesine göre barsak canlýlýðý deðerlendirildi. Bütün gruplarda intraoperatif gözlem bulgularý ve flouressein flouresans bulgularý karþýlaþtýrýldý. Tüm deneklerde, transmural nekroz varlýðý düþünülen veya canlý olarak kabul edilen barsak segmentlerinden örnekler alýnarak histopatolojik deðerlendirme yapýldý. Flouressein flouresans yönteminin barsak iskemisini göstermede duyarlýlýðý % 100, özgüllüðü %92 ve doðruluk oraný %96 olarak saptandý. Klinik deðerlendirmede ayný deðerler sýrasýyla %76, %92, %83 olarak tespit edildi. Mezenter iskemisine yol açan emboli, tromboz, strangülasyon gibi barsak canlýlýðýnýn þüpheli olduðu vakalarda ucuz ve pratik bir yöntem olan flouressein flouresansýnýn kullanýlmasý rezeksiyon sýnýrlarýnýn tayininde ve gereksiz barsak rezeksiyonunun önlenmesinde faydalý olabilir.

The assessment of intraoperative intestinal viability and the determination of ischemic borders are difficult in situations where the demarcation line is not clear in intestinal disease due to mesenteric ischemia. In this experimental study, the value of fluorescein fluorescence, which is a helpful diagnostic procedure in the detection of the degree of damage in ischemic injuries of the intestine in the intraoperative period was sought by means of forming various mesenteric ischemia models. A strangulation group, a superior mesenteric artery ligation group and a control group were formed in Wistar-Albino male rats. Two hours later, intestinal viability was assessed via intraoperative observation findings. Fluorescein (Fluorescite Injection ampul 10%) was given intravenously with a dose of 15 mg/kg through the tail vein. Two-three minutes later, the intestinal viability was assessed in a dark room under wood light of 3600 A. In all groups, intraoperative observation findings and fluorescein fluorescence findings were compared. Histopathologic evaluation was performed in the samples taken from ischemic or normal intestines of all of the subjects. The accuracy of the methods was tried to be assessed by means of performing histopathologic evaluation. In the study, the sensitivity of the fluorescein fluorescense method in showing intestinal ischemia was found to be 100%, the specificity 92% and the accuracy 96%. In the clinical assessment, the same values were found to be 76%, 92%, 83%, respectively. In intestinal ischemic disorders such as embolism, thrombosis, and strangulation; if intestinal viability is questionable, fluorescein fluorescence which is a cheap and practical method can be useful in determining resection borders and preventing unwarranted intestinal resections.

Karýniçi infeksiyonun sistemik yayýlýmý, cerrahi pratiðinde sýk görülen ve hayatý tehdit eden bir durumdur. Bu çalýþmada, deneysel peritonit esnasýndaki septik cevap oluþumunda lenfatik sistemin rolünü araþtýrdýk. Çalýþma eþit olarak üç gruba ayrýlan 30 rat üzerinde gerçekleþtirildi. Grup1, "sham" laparotomi. Grup 2, çekum delinmesiyle peritonit oluþturuldu. Grup 3, lenfatik aðýzlarýný fibrotik reaksiyonla týkamak için bir tabaka sentetik materyal diyafragmanýn abdominal yüzeyine yerleþtirildi. Altý hafta sonra önceki gruptaki gibi peritonit oluþturuldu. Çekum delinmesinden altý saat sonra, histopatolojik inceleme, periton sývýsý ve kanýn mikrobiyolojik analizi, ve plasma endotoksin ve serum tümör nekroz faktörü (TNF) ölçümleri için örnekler toplandý. Bakteriyel peritonit grup 2 ve 3'teki tüm 20 sýçanda mevcuttu. Kan kültür sonuçlarý 2. gruptaki 7,3. gruptaki 2 sýçanda pozitif idi (p=0.035). Sýrasýyla grup 2 ve 3'teki plasma endotoksin seviyeleri 8.3 ve 1.8 EU/ml (p < 0.001), serum TNF seviyeleri 432 ve 129 pg/ml (p<0.001) ölçüldü. Diyafragma abdominal yüzeyindeki lenfatik aðýzlarýnýn týkanmasý, deneysel peritonit esnasýndaki septik cevap þiddetini anlamlý olarak düþürdü. Sonuç olarak, bakteriler ve endotoksin periton boþluðundan organizmaya lenfatik kanallarla hýzla yayýlmakta, ve karýniçi infeksiyonun erken döneminde ciddi septik cevabý uyarmaktadýr. Karýniçi infeksiyonun sistemik yay ýlýmýnda lenfatik sistemin majör rolü vardýr.

Systemic spread intraabdominal infection is a common life-threatening condition in surgical practice. In the present study we investigated the role of lymphatic system in the occurrence of septic response during experimental peritonitis. The study was carried out on 30 rats equally separated into three groups. Group 1, sham laparotomy. Group 2, peritonitis was induced with cecal puncture. Group 3, a sheet of synthetic material was placed on the abdominal surface of the diaphragm in order to occlude lymphatic openings by a fibrous reaction. After six weeks peritonitis was created as in previous group. Samples were collected six hours after caecal puncture for: histopatological examination, microbiological analysis of peritoneal fluid and blood, and measurements of plasma endotoxin and serum tumor necrosis factor (TNF) levels. Bacterial peritonitis was present in all 20 animals of groups 2 and 3. Results of blood cultures were positive in 7/10 rats of group 2 and in 2/10 rats of group 3 (p=0.035). Mean plasma endotoxin levels were 8.3 and 1.8 EU/ml, and mean serum TNF levels 432 and 129 pg/ml in groups 2 and 3 respectively (p < 0.00 1). The occlusion of lymphatic openings on the abdominal surface of the diaphragm has significantly reduced the intensity of septic response during experimental peritonitis. We concluded that bacteria and endotoxin have promptly disseminated from the peritoneal cavity through lymphatic channels, and induced severe septic response in the early period of intraabdominal infection. The lymphatic system has a major role in systemic spread of intraabdominal infection.

Pek çok organ sisteminin iskemik hasarýnda mediyatör rol oynayan Platelet Aktivatör Faktör (PAF) ün testis torsiyonu sonrasý oluþacak iskemik hasarda da etkin olduðu bildirilmektedir. Bu çalýþmada torsiyon sonucu, testiste geliþecek iskemik hasarýn önlenmesinde bir PAF antagonist olan EGB-761 Ginkgo biloba'nýn etkinliði araþtýrýldý. Çalýþmada, her grupta 6 rat olmak üzere toplam 24 eriþkin Sprague-Dawley ratý kullanýldý. Birinci gruptaki ratlara herhangi bir manipülasyon yapýlmadý, ikinci gruba ise sham operasyonu uygulandý. Üçüncü gruptaki ratlara 720° sol testiküler torsiyon, son gruptaki ratlara ise EGB-761 Ginkgo biloba verildikten 20 dakika sonra torsiyon uygulandý. Grup 1 ve 2' de herhangi bir iskemik hasar saptanmazken, grup 3 ve 4'deki ratlarda hem makroskopik hem de histolojik olarak iskemik deðiþiklikler belirlendi. Ancak torsiyon öncesi EGB-761 uygulanan grupta iskemik hasarýn, sadece torsiyon uygulanan gruptan daha az oranda olduðu saptandý. Testis torsiyonu sonrasý oluþacak iskemik hasarýn, bir PAF antagonisti olan EGB-761 ginkgo biloba ile anlamlý ölçüde azaltýlabileceði belirlendi.

Platelet activating factor (PAF) is known to play a mediator role in the development of ischemic injury in many organ systems. It was reported that PAF is also effective in the development of ischemic injury induced by testicular torsion. In this experimental study, the effects of EGB-761 ginkgo biloba (a PAF antagonist) in the prevention of testicular damage were assessed. Four groups, each comprising 6 adult male Sprague-Dawley rats were used. The first group was not manipulated and the second group underwent sham operation. The rats in third group had 720° left testis torsion and finally the last group received pretreatment of EGB-761 ginkgo biloba 20 minutes prior to testicular torsion. Groups 1 and 2 showed no evidence of disruption however, groups 3 and 4 had significant changes both macroscopically and histologically. However, rats pretreated with EGB-761 were less severely affected from the ischemia. It was determined that pretreatment with a PAF antagonist, EGB-761 ginkgo biloba significantly diminishes the ischemic injury induced by the testicular torsion.

Peritona penetre kesici delici alet yaralanmalarýnda konservatif tedavi uygulamasý negatif laparotomi oraným azaltmaktadýr. Peritona penetre kesici delici alet yaralanmasý olan 36 olgu retrospektif olarak incelendi. Ameliyat kararý fizik muayene bulgularý esas alýnarak verildi. Ancak radyografi ve ultrasonografiden de yararlanýldý. Ýki vakaya diagnostik laparoskopi uygulandý. 27 olguya (%75) laparotomi uygulandý. Geri kalan 9 olgu (%25) konservatif olarak tedavi gördü ve yeterli bir takip süresinden sonra taburcu edildi. Laparotomi, olgularýn ikisinde nonterapötikti. Diðer 25 olguda en fazla ince barsak olmak üzere deðiþik karýn içi organlarda yaralanma saptandý. Laparotomi uygulanan olgularýn ikisinde komplikasyon görüldü. Ortalama hastanede yatýþ süresi laparotomi uygulanan olgularda 8.4 gün, konservatif tedavi uygulananlarda ise 2.7 gün oldu. Sonuç olarak; peritona penetre kesici delici alet yaralanmalarýnda hastanýn durumuna göre konservatif yaklaþým yanýnda, gerekli olgularda diagnostik laparoskopi uygulamasý negatif laparotomi oranýný azaltmaktadýr.

Conservative management of stab wounds penetrating the peritoneum reduces the incidence of negative laparatomy. The records of 36 cases with penetrating abdominal stab wounds were reviewed. Decision of operation was based on evolving physical signs with radiographic findings.. Diagnostic laparascopy was performed on two cases with penetrating abdominal stab wounds. Laparatomy was performed on 27 cases (75%), remaining 9 cases(25%) were treated conservatively and discharged after an observation period. In two cases (5.6%), laparatomy were non-therapeutic. There were various intraabdominal injuries in the remaining 25 cases. The most injured organ was small intestine. The average length of hospitalisation was 8.4 days for cases underwent laparatomy and 2.7 days for conservative approached cases. In conclusion; our results show that the rate of negative laparatomy was lowered to 5.6 percent when compared with classical approach in which mandatory laparotomy was made for every stab wound penetrating the peritoneum. In some of these cases diagnostic laparascopy may be helpful in selection of patients for operation.

Seksen yaþ üstündeki hastalarýn sayýsý giderek artmaktadýr. Bu yaþ grubundaki hastalarýn cerrahi özellikleri ise yeterince araþtýrýlmamýþtýr, 1/2/1997-28/2/1999 tarihleri arasýnda Cerrahpaþa Týp Fakültesi Acil Kliniðinde abdominal cerrahi giriþim geçiren hastalarýmýzýn özelliklerini ve mortalite nedenlerini retrospektif olarak inceledik. Toplam 23 hastadan 7si fýtýk, 5'i týkayýcý mezenter damar hastalýðý, 4'ü akut kolesistit, 2'si duodenal ülser delinmesi ve birer hastada mide kanser delinmesi, duodenal ülser kanamasý, sigmoid kolon perforasyonu, akut appendisit, aort anevrizma rüptürü nedeniyle ameliyat edildiler. Dört hasta eþlik eden hastalýklarý nedeniyle kaybedildiler. Fýtýk ve safra taþý hastalýðý gibi uygun koþullarda tedavi edilebilecek olan hastalarýn ve týkayýcý mesenter damar hastalýðýnýn sýklýðý dikkat çekicidir. Yaþ, fýtýk ve safra taþý hastalýðýnda majör kontrendikasyon olarak düþünülmemeli hastalarýn tedavileri geciktirilmemelidir. Akut batýn tablosuyla baþ vuran hastalarda mezenter damar hastalýðýnýn sýklýðý hatýrlanmalýdýr.

The number of people over the age of 80 years increases as western population in our country. The objective of this retrospective study was to investigate the features of abdominal emergencies in Octogenarians. Review of the operating room log of Cerrahpaþa Medical School, Emergency department indicated that 23 abdominal emergency operation were performed between February 1997 and February 1999. The median age of the patients was 86 (80-104). The most frequent cause of admission was hernia (30%), and the second most common was occlusive mesenteric vascular disease (21%). Acute cholesystitis constituted third place (17%). There were two cases duodenal ulcer perforation, and one case of bleeding duodenal ulcer, gastric tumor perforation, sigmoid colon perforation, rupture of aortic aneurisma and acute appendicitis. Four patients died in hospital, an overall mortality rate of 17 per cent of operations. Avoidable disease such as hernia and biliary stones should not have been postponed because of age and should be electively treated early before complications develop. Occlusive mesenteric vascular disease was second most common emergency in this study and must be remembered in elderly patients with acute abdomen.

Günümüzde penetran boyun travmalarýnýn tedavisinde çok farklý yaklaþýmlar tartýþýlmaktadýr. Bu tartýþma rutin eksplorasyona ilave olarak endoskopi ve anjiografinin mutlak uygulanmasýný isteyenlerden fizik muayene temelinde konservatif kalýnmasýný savunanlara kadar geniþ bir yelpaze oluþturmaktadýr.Bu çalýþmada penetran boyun travmasý nedeni ile baþvuran 32 hastanýn deðerlendirmesini yaparak tedavi yaklaþýmýmýzý disipline etmeðe çalýþtýk. Bu klinik çalýþmada Ocak 1987 - Aralýk 1998 tarihleri arasýndaki dönemde Taksim Eðitim ve Araþtýrma Hastanesi Acil Cerrahi kliniklerine baþvuran 32 hasta çalýþma kapsamýna alýnarak retrospektif olarak incelendi. Hastalar için fizik muayene ve klinik bulgular temelinde tedavi yöntemi belirlendi. Opere edilenler ve konservatif kalýnanlar olmak üzere iki grupta deðerlendirildiler. Uygulanan eksplorasyon, endoskopi ve Doppler USG sonuçlarý kaydedildi. Hastalarýn %59'u (19 olgu), klinik bulgular ve fizik muayene sonrasý operasyona alýndý. Bir hasta (% 3) semielektif olarak opere edildi. % 38(12 olgu) hastada konservatif kalýndý. Operatif mortalite % 3 (1 olgu) oldu. Konservatif kalýnan hastalarda mortalite geliþmedi. % 18 (4 olgu) hastada negatif eksplorasyon kaydedildi. Takip edilen hastalarda % 43 (13 olgu) morbidite ve mortalite görülmedi. Elde ettiðimiz bulgular ve literatür çerçevesinde fizik muayenenin, penetran boyun travmalarýnda tanýda ve tedavinin belirlenmesinde önemli bir unsur olduðu ve diðer taný yöntemlerinden fizik muayene temelinde yararlanýlmasý gerektiði inanandayýz.

The Importance of The Physical Examination and A New Treatment Algorhytm in Cases of Penetrating Neck Injury Many differing views ranging between obligatory use of angiographie following routine exploration and being conservative on the basis of physical examination only, are currently popular in the treatment of penetrating neck injuries. With the aim of disciplinising our approach in cases of penetrating neck injuries in the light of the current literature we conducted a retrospective analyse of 32 patients with penetrating neck injuries who attended our surgical emergency unit. 59 % (19 cases) were operated on clinical findings elucidated by physical examination only. %38 (12 cases) were managed conservatively. Of the conservative group one patient (%3) was operated later semielectively. After admittance to the emergency surgical unit two patients were lost, one in the pre the other in the peroperative period. There were no deaths in the group of patients treated conservatively. We had four cases (%18) with negative neck exploration. During follow-up period no mortality or morbidity were recorded in %43 (13 cases) patients. Conclusively on the grounds of both, our findings and that of the recent literature we think that the physical examination remains to be the cornerstone in the diagnosis and management of penetrating neck injuries. The necessity for further diagnostic modalities should be decided upon the findings of physical examination only.

Amaç: Toraks travmalarýný içeren geniþ bir serinin sonuçlarýný incelemek. Yöntem: Dicle Üniversitesi Týp Fakültesi Göðüs Kalp ve Damar Cerrahisi Kliniði'nde 1989 1998 yýllarý arasýnda toraks travmalý 1642 olgu retrospektif olarak incelendi. Olgularýn bir kýsmý Yaralanma Aðýrlýk Skoru (YAS) ve akciðer perfüzyon ve ventilasyon sintigrafileriyle izlendi. Sonuçlar: Toplam 1642 hastadan 917'si (% 56) künt, 725'i (% 44) penetran yaralanmaydý. Yandaþ yaralanma 432 hastada vardý (% 26.3). Morbidite oraný 515 hastayla % 31.4 ve en sýk morbidite nedeni intratorasik hemotomdu. Hastalarýn 1509'una (% 92) konservatif tedavi verildi, 133'üne torakotomi yapýldý (% 8.1). Torakotomilerin 56'sý acil (% 3.4), 77si (% 4.7) geç torakotomiydi. Mortalite %7 (116/1642) olup, künt travma grubunda % 9.5 (87/917), penetran travma grubunda % 4 (29/725) bulundu. YAS 25'in üzerinde olanlarda ve künt travmalarda mortalite daha yüksekti. En sýk mortalite nedeni Eriþkinin Sýkýntýlý Solunum Sendromuydu. Torakotomi mortalitesi % 25.5 (34/133) idi ve bunun % 15 (20 hasta)'ini acil, % 10.5 (14 hasta)'ini geç torakotomi oluþturmaktaydý. Torakotomi yapýlmayan grubun mortalitesi % 5.1 (78/1509) idi. Hafif travma olgularýnda ventilasyon/perfüzyon bozulmuþtu ve ortalama düzelme süresi 7-10 gündü.

Object: To examine a broad serial which includes thoracic trauma. Method: Between 1989 and 1998, 1642 patients with thoracic trauma were studied retrospectively in Thoracic and Cardiovascular Surgery Department of Dicle University School of Medicine. Some cases were followed with Injury Severity Score (ISS) and lung perfusion and ventilation scans. Results: The patients with penetran trauma were 917(% 56), blunt trauma were 725 (% 44) of total 1642. Injuries associated with thoracic trauma were present in 532 patients (% 26.3). Morbidity rate was % 31.4 and the most frequent cause was clotted hemothorax. Conservative therapy was given to 1509 patients (% 92). Thoracotomy was performed in 133 patients (% 8.1). Fifty-six thoracotomy was immediate (% 3.4) and 77 was late (% 4.7). Mortality rate was %7(116/1642), % 9.5 (87/917) in blunt trauma group, % 4 (29/725) in penetran trauma group. If ISS > 25 and in blunt trauma, mortality was significantly higher (p<0.05). The most frequent mortality cause was ARDS. Thoracotomy mortality was % 25.5 (34/133) and % 15 (20 patients) in immediate, % 10.5 (14 patients) in late thoracotomy group. In non - thoracotomy group, mortality was % 5. / (78/1509). Ventilation/perfusion scans was broken down and mean recovery time was 7-10 days in mild trauma group.

Künt toraks travmalarýnda ikincil geliþen kardiyak kontüzyonlarýnýn doðru tanýsý için çok sayýda parametre mevcut olup bunlar arasýnda EKG bulgularý, EKO çalýþmalarý ve radyonükleid anjiografi sayýlabilir. Bu çalýþmada künt toraks travmalý hastalarda kardiyak kontüzyonun tespit edilmesi için CPK, CK-MB deðerleri ile EKG bulgularý araþtýrýlmýþtýr. Altý aylýk bir süre içinde hastanemiz acil týp kliniðine baþvuran 58 künt toraks travmalý hasta çalýþmaya dahil edildi. Baþvuran hastalarda künt kardiyak kontüzyo tanýsý için anormal EKG bulgularý ile CPK ve CK-MB seviyeleri araþtýrýldý. 43 hastada (%74.14) CPK ve CK-MB deðerleri yüksek bulunurken, 28 hastada (%48.26) anormal EKG bulgularý görüldü. Anormal EKG bulgularý olan hastalarýn tümünde CPK ve CK-MB deðerleri yüksek bulundu. Kardiyak kontüzyonun saptanmasýnda anormal EKG bulgularýnýn daha duyarlý olduðu saptandý (p=0.0000).

In a blunt thorax trauma, seconder evolving of cardiac contusion; there are a lot of parameter for correct recognition. For example laboratory and ECG findings, ECHO studies, radionudeid angiography etc. In this study, patients of blunt thorax traumas for correct diagnosis of cardiac contusions, CPK, CK-MB levels with ECG findings are researched. In six months time 58 patients of blunt thorax trauma were brought to emergency department of our hospital by mobil paramedical system. ECG findings, CPK and CPK-MB levels were researched for cardiac contusion recognition in patients. The CPK and CK-MB levels were found high in 43 patients (%74.14) and ECG findings have seen abnormal in 28 patients (%48.26). CPK and CK-MB levels have found high, too, in the patients whose ECG findings have seen abnormal. It is more sensitive to use abnormal ECG findings than the increase of CPK and CK-MB levels for determinate the diagnosis of cardiac contusion in blunt thorax trauma. (P-0.0000).

Trafik polisleri kaza yerine en kýsa sürede ulaþan kiþiler olduklarý için, kazazedelere yapacaklarý bilinçli ilkyardým ile ölüm ve sakatlýk durumlarýmý azaltabileceklerdir. Bu çalýþmada Samsun Ýl Emniyet Müdürlüðünde, görev yapan trafik polislerinden "Trafik ve Ýlkyardým Kursuna" katýlan 275'inin eðitim öncesi ve sonrasý bilgi düzeyleri, 35 soruluk anket formu ile deðerlendirilmiþtir. Çalýþmada polislerin %59.3'ü, daha önce ilkyardýmla ilgili bir eðitim aldýklarýný belirtmiþlerdir. Polislerin eðitim öncesi %19,4'ü eðitim sonrasý %76.0'sý kendilerini ilkyardým konusunda yeterli görmüþlerdir. Eðitim öncesi ilkyardým konusundaki bilgi düzeyleri puan ortalamasý 36.2 ± 12.1 iken eðitim sonrasý 61.7 ± 11.0 puan olmuþtur. (P<0.001). Bu sonuçlarla trafik polislerine yapýlacak hizmet içi eðitimlerin önemi ortaya çýkmýþtýr.

Death and physical disability of the victims in an accident can be decreased by the proper first aid given by the police because they are the first to arrive at the scene. The study group consisted of 275 policemen working in Samsun Police Headquarter. A test consisting of 35 questions was applied to the study group before and after the training programme. While 19.4 % of the policemen felt themselves sufficiently qualified to give first aid before the training programme, 76.0 % felt themselves sufficiently qualified after the programme. Mean pre and post training test scores were 36.2 ±12.1 and 61.7±11.0 points, respectively (p<0.001). These results suggest that in-service first aid training of the policemen is very important.

Bu çalýþma, Temporal fraktür tipleri ile klinik bulgular arasýndaki iliþkiyi incelemek amacýyla KBB ve Acil Kliniðimize Aralýk 1996-Mart 1999 tarihleri arasýnda travma öyküsü ile baþvuran, otoraji, fasial paralizi, vertigo ve iþitme kaybý nedeniyle çekilen temporal BTde temporal kemik fraktürü saptanan 24 olgu üzerinde yapýldý. Temporal kemik fraktürlerinin 18'i longitudinal (11'i anterior, yedisi ise posterior yerleþimli), altýsý transvers ve üçü ise kompleks fraktür olarak deðerlendirildi. Membrana timpani perforasyonu ve kemikçik zincir dislokasyonu sonucu iletim tipi iþitme kaybý en sýk longitudinal fraktürlerde saptandý. Nörosensoryel iþitme kaybý ve kalýcý fasiyal paralizi ise en sýk transvers ve kompleks fraktürlü hastalarda mevcuttu.

In this study, we aimed to plan the relations between type of temporal fractures and clinical findings. 24 patient with temporal bone fractures were seen in the department of Ear-Nose-Throat and Emergency between june 1996-March 1999. Patients applied with otorrhagia, facial paralyses, vertigo, and hearing loss and diagnosed with temporal computerized tomography. Temporal fractures were evaluated as 18 longitudinal fractures (11 anterior and 7 posterior), 6 transverse fractures, and 3 complex fractures. Conductive hearing loss was most commonly encountered in longitudinal bone fractures due to tympanic membrane perforation and ossicle dislocation. Neurosensorial hearing loss and permanent facial paralyses were common in transverse and complex type temporal bone fractures.

Karaciðer absesi, subfrenik abseler yada safra yolu obstrüksiyonlarý torakobiliyerfistül oluþumunun baþlýca nedenleridir. Torakoabdominal yaralanma sonucu oluþan hepatik travmaya baðlý torakobiliyer fistül oluþumu ise oldukça nadirdir. Bu tür travmalarda meydana gelen hepatik ve diyafragma yaralanmalarýnýn tanýsý ve tedavisindeki gecikmeler morbidite ve mortalitenin artmasýna neden olmaktadýr. Ayný zamanda travmatik torakobiliyer fistüllerin nadir görülmesinden dolayý bu konuda yeterli tecrübeye sahip cerrah sayýsý da oldukça azdýr. Makalemizde torakoabdominal yaralanma nedeniyle yapýlan takip ve tedavilerinde torako-biliyer fistül saptanan 3 hasta Ýngilizce literatürde þimdiye kadar yayýnlanan 35 olgu eþliðinde incelenmiþtir.

Thoracobiliary fistulas are commonly reported complications of subphrenic or liver abscesses and biliary tract obstruction. However, they are a rare and unusual complication of hepatic trauma due to traumatic thoracoabdominal wounds. Errors in diagnosis and management of the initial injury involving the diaphragm and liver may increase morbidity and mortality. Due to rarity, the experience of any one surgeon is minimal, and there is a paucity of information available in the literature regarding their treatment. In this report three patients with post-traumatic thoraco-biliary fistula are presented and thirty-five cases previously described in the English literature are reviewed.

A 17 year-old boy, attending to the emergency department with a continuous right lower quadrant abdominal pain, nausea and vomiting during three days, was reported. The patient had peritonitis signs at the right lower quadrant on phsyical examination, whose laboratory findings were all within the normal values except for leucocytosis. The patient underwent an emergency exploration with Me Burney incision. There was duplication of appendix, one of which was perforated appendicitis, the other was normal. Both appendices were excised in the usual manner. This case was presented because it was a rare anomaly of appendix.

Pneumatosis cystoides intestini (PCI) is a rare condition. Generally it is associated with other diseases. In this paper, a PCI case, a 24 year-old-woman has been reported. She has suffered from stomach-ache, nausea lasting for the 24 hours. In the physical examination there was tenderness and rigidity on her right upper quadrant. There was free gas in the subdiafragmatic space on direct roentgenogram. She was operated on as a patient with perforation at the peptic ulceration.

Obturator hernia is a rare pelvic hernia but the outcome may be serious when it is associated with difficult in diagnosis. A 83 year old male attending to the emergency department with mechanical intestinal obstruction and hipovolemic shock was managed with small bowel obstruction due to strangulated obturator hernia during laparotomy. Partial ileum resection and hernia repair were performed at the same session. The patient died 2 days after the operation because of pulmoner failure. Obturator hernia, which is a rare cause of the small bowel obstruction, should be kept in mind in elderly emaciated patients with chronic disease who have signs with mechanical intestinal obstruction.