Cerrahi sonrasý oluþan intraperitoneal adezyonlar, infertilite, aðrý ve barsak obstrüksüyonuna neden olan önemli komplikasyonlardýr. Bu çalýþma L-arginin ve nötrofillerin postoperatif intraperitoneal adezyon oluþumundaki etkilerini araþtýrmak amacýyla yapýlmýþtýr. 16 sýçan iki eþit gruba ayrýldý; grup I (n=8) 5gün süreyle günlük tek doz % 0.9'luk izotonik sodyum klorür (salin), grup II (n=8) 5 gün süreyle günde tek doz L-arginin aldý ve uterin boynuz ve çekuma cerrahi hasar yapýldý. Adezyon indüklenmesinden sonraki 2 haftanýn sonunda adezyon skoru belirlendi. Adezyon dokusu histolojik ve biyokimyasal olarak incelendi. Adezyon oluþumunun ilk günü nötrofil sayýsý ve nötrofil adezivite indeksi tesbit edildi. Kontrol grubundaki adezyon geliþimi, L-arginin grubuna göre belirgin olarak daha az idi (p < 0.01). Kontrol grubu ile kýyaslandýðýnda, L-arginin grubunda adezif doku hidroksiprolin ve kollajen seviyeleri belirgin olarak artmýþtý (p < 0.05 ve p < 0.001). Sonuç olarak, bu hayvan modelinde, L-arginin postoperatif adezyonlarý azaltmada yararlý bulunmamýþtýr.

Postoperative intraperitoneal adhesions are major postsurgical complications that cause infertility, pain, and intestinal obstruction. The aim of this study was to investigate the effects of L-arginine and neutrophils on the formation of postoperative intraperitoneal adhesion. Sixteen rats, equally divided into two groups; group I (n=8) received daily single dose saline for five days, group II (n=8) received daily single dose L-arginine for five days, and underwent surgical injury to the uterine horn and the cecum. The adhesion scores were determined at the end of the second week after adhesion induction. Adhesive tissue also histologically and biochemically evaluated. Neutrophil counts and neutrophil adhesivity index were determined in the first day of adhesion induction. Adhesion formation in the control group was significantly less than that of L-arginine group (p< 0.01). Hydroxyproline and collagen levels of adhesive tissue were significantly increased in the L-arginine group when compared with control group (p < 0.05 and p < 0.001). We concluded that L-arginine was not beneficial in reducing postoperative adhesions in this animal model.

Ocak 1996-Ocak 1998 yýllarý arasýnda PTT Eðitim Hastanesi Ortopedi ve Travmatoloji Kliniði'nde 70 yaþ üzerindeki intrakapsüler femur boyun kýrýklý 27 hastaya primer olarak Protek'in Protema 90 tipi modüler baþlý ve düz saplý (straight stem) protezle sementli hemiartroplasti ameliyatý yapýldý. En az 1 yýl süreyle takip edilen 21 hasta deðerlendirmeye alýndý. Ortalama takip süresi 15. 1 (en kýsa 12, en uzun 32) aydýr. Hastalarýmýzýn 14' ü kadýn, 7 si erkek olup ortalama yaþ 79.6 (en küçük 72- en büyük 86) yýldýr. Hastalar ameliyat sonrasý Harris'in fonksiyonel skorlama sistemine göre deðerlendirildiðinde 17(%80) hastada çok iyi ve iyi, 4(%20) hastada orta ve kötü sonuç elde edildi. Kullandýðýmýz parsiyel protezin modüler baþlý ve düz saplý olmasýnýn gerek ameliyat sýrasýnda cerraha kolaylýk saðlamasý gerekse ameliyat sonrasý hastaya daha fazla hareket ve stabilite kazandýrmasý önemli bir üstünlüðünü oluþturmaktadýr. Hastaya benzer faydayý saðlayan total protez ve bipolar protezlere göre fiyatýnýn oldukça ucuz olmasý en önemli üstünlüðüdür. Bu çalýþma da 70 yaþ üzerindeki hastalarda femur boyun kýrýklarýnýn düz saplý protezle baþarýlý olarak tedavi edildiði sonucuna varýlmýþtýr.

Between January 1996-January 1998, Department of Orthopaedics and Traumatology of PTT Training Hospital, hemiarthroplasties with Protek's Protema-90 straight stem endoprosthesis were performed in over 70 years old 27 patients who have femoral neck fractures. 21 of them were taken place in the study and mean follow up is 15.1 (ranging between 12-32) months. Of these, 14 were female and 7 were male. Mean age of the cases is 79.6 (72 86). According to Harris Hip Scoring System we obtained excellent, good results in 17 patients (%80) and fair, poor results in 4 (% 20) patients. The prostesis we used have two major advantage. First, it is not only able to be applied easily by surgeon but also patients have been provided more stability and motion by prosthesis. Second, Its price is much cheaper than total endoprosthesis and bipolar prosthesis which intend to achieve same purpose. It was concluded that hemiarthroplasty with straight stem which has moduler head were successfully applied for femoral neck fractures in over 70years old patients.

Son 22 yýlda kliniðimizde tedavisi yapýlan 120 ortopedik travma ile birlikte oluþan damar yaralanmasý olgusu geriye dönük olarak incelendi. Yaralanmalarýn 757 (%62.5) alt ekstremitede, 45'i (%37.5) üst ekstremitedeydi. Fizik muayene ile damar yaralanmasý tanýsý ve lokalizasyonu kesinleþen olgular doðrudan ameliyata alýndý, þüpheli olgularda ek incelemeler yapýldý. Sonuç olarak ortopedik travma ile birlikte oluþan her türden arter yaralanmasýnda erken taný konulmasý, agresif debridmandan sonra primer anastomoz veya safen ven interpozisyonu yapýlmasý, ven yaralanmasý eþlik eden aðýr doku hasarý bulunan olgularda hiç çekinmeden fasiotomi yapýlmasý baþarýnýn temelini oluþturur. Damar yaralanmasý tanýsý kesin olan olgularda ilave hiçbir vasküler inceleme yapýlmadan ameliyata gidilmesi en doðru seçimdir.

One-hundred twenty patients who sustained vascular injuries together with orthopedic trauma in the last 22 years in our department were reviewed retrospectively. Seventy-Jive (%62.5) injuries involved the lower limbs, and forty-five (%37.5) injuries involved the upper limbs. In cases whose vascular injuries and locations were detected with physical examination definitely had been operated directly, on the other hand additional diagnostic modalities were used in doubtful cases. As a conclusion, the following approaches are clinical landmarks for a successful outcome in vascular injuries associated with orthopedic trauma: Early diagnosis, primary anastomosis or saphenous vein interposition after aggressive debridmant, performing fascia tomies liberally in cases with serious tissue injuries together with vein injury. It is obvious to operate immediately without any diagnostic tool when the diagnosis is certain by physical examination.

1995-1999 yýllarý arasýnda hastanemiz 2. Genel Cerrahi Kliniðine akut pankreatit tanýsý ile 27 hasta yatýrýldý. Etyoloji, taný ve tedavi yöntemleri, morbidite, mortalite ve Ranson kriterlerinin prognoza etkisi retrospektif olarak incelendi. Hastalarýmýzda en sýk akut pankreatit nedeni biliyer sistem patolojileri idi (%55.6). 21 hastada medikal, 6 hastada cerrahi tedavi uygulandý. 2 hastada (n= 1 nekrozektomi + drenaj, n = 1 medikal tedavi) pankreas psödokisti (%7.4) geliþti. Mortalite oraný %18.5 (n=3 medikal tedavi,n=1 kolesistektomi+T tüp drenaj, n=1 drenaj) idi. Ex. olan hastalarýn yaþ ortalamasý 74.2 iken taburcu edilen hastalarýn yaþ ortalamasý 43 idi (p<0.001). Ranson skoru ex. olan hasta grubunda ortalama 5.4 iken, taburcu edilen hasta grubunda 2.3 idi (p<0.001). Ex. olan hasta grubunda ortalama kalsiyum deðeri 6.76 mg./dl, laktik dehidrogenaz deðeri 1660 IU/L iken taburcu edilen hastalarda bu deðerler sýrasýyla 8.59mg/dl ve 470 IU/L bulundu (p<0.001). Çalýþmamýzda Ranson kriterlerinin akut pankreatitin prognozunu belirlemede güvenilir olduðu görülmüþtür. Özellikle yaþ, kalsiyum, laktik dehidrogenaz ve BUN deðerlerinin prognozu etkileyen önemli kriterler olduðu saptanmýþtýr.

Between 1995 and 1999, 27 patients with diagnosis of acute pancreatitis were admitted to 2nd surgical department of our hospital. Aetiology, diagnosis and treatment methods, morbidity, mortality and effect of Ranson criteria to prognosis were examined retrospectively. The most common aetiology in our patients was biliary system pathologies(55.6%). Twenty-one patients treated medically and 6 patients surgically. Pancreatic pseudocyst developed in 2 patients (n=1 necrosectomy+drainage, n=1 medical treatment). Mortality ratio was 18.5% (n=3 medical treatment, n= 1 cholecystectomy + T-tube drainage, n= 1 drainage). While the mean age was 74.2 in the patients died, it was 43 in the patients survived(p<0.001). Significant difference was found with regard to the mean Ranson score between the two groups (5.4 and 2.3, respectively) (p<0.001). Also, there was a significant difference with regard to the mean calcium and lactic dehydrogenase values between the died patients (6.76mg/dl and 1660 IU/L, respectively) and the survived patients (8.59mg/dl and 470 IU/L, respectively) (p < 0.001). In our study, Ranson criteria are found to be reliable to determine the prognosis of acute pancreatitis. Especially age, calcium, lactic dehydrogenase and BUN values are found to be important parameters effecting prognosis.

Hasta bakýmýndaki tüm ilerlemelere raðmen, abdominal yara ayrýlma insidensi ve buna baðlý olarak geliþen mortalite yüksek seyretmektedir. Beþ yýllýk periyotta laparotomi uygulanan 1109 olguda yara ayrýlmasýnda suçlanabilecek 24 risk faktörü tek tek ele alýnarak, tam ve kýsmi yara ayrýlmasý geliþen vakalarda oranlarý bulunup, bunlarýn yara ayrýlmasýna istatiksel anlamda bir katkýlarý olup olmadýðý belirlendi. Otuzdokuz (%3.5) hastada abdominal yara ayrýlmasý geliþti. Bu hastalarýn üçü (%7.7) kaybedilmiþ olup, geri kalanlarýn hastanede kalýþ süreleri ortalama 25.5 gündü. Abdominal yara ayrýlmasý, sayý bakýmýndan dört ve daha fazla risk faktörü bulunduran hastalarda anlamlý oranda yüksekti (p<0.05). Ayrýca yaþý 60'm üzerindekilerde, predispozan sistemik patolojilerden hipoalbüminemisi olanlarda, kontamine ve kirli yarasý olanlarda, yara yeri enfeksiyonu geliþenlerde, orta hat karýn kesisi uygulananlarda, ve acil olarak ameliyat edilenlerde de abdominal yara ayrýlmasý anlamlý oranda fazla idi (p < 0.05). Sütür materyali, yara kapama þekli, diyabet, sarýlýk, hemodinamik instabilite, malignite, üremi, obesite, solunum sistemi hastalýklarý, konjestif kalp yetmezliði, hipertansiyon ve siroz yara ayrýlmasýna istatiksel olarak anlamlý oranda katkýda bulunmayan risk faktörleri idi (p>0.05). Tek baþýna ele alýndýðýnda yara ayrýlmasýna anlamlý bir katkýsý olmayan bu faktörlerden en az birinin anlamlý faktörlerle beraber bulunduklarýnda bunlarýn etkisini arttýrdýðý ve bu artýþýn da istatiksel olarak anlamlý olduðu belirlendi.

Despite the significant advances in perioperative care, the incidence of abdominal wound dehiscence and its associated mortality have not improved. In 1109 patients undergoing laparotomy during a 5 year period, 24 risk factors were analysed. Each factor was assessed as an independent statistical variable. Thirty-nine (3.5%) abdominal fascial wound dehiscences occured. In these patients the average length of hospital stay was 25.5 days and three of these cases died (7.7%). In the patients with more than four risk factors, wound dehiscence ratio was significantly high. Significant factors, which contribute abdominal wound dehiscence, were found to include age over 60, hypoproteinemia, abdominal midline incising closure, contaminated/ dirty wound, wound infection and emergency surgery (p<0.05). Risk factors not found to be statically important included suture material, diabetes, jaundice, hemodynamic instability, malignancy, uremia, obesity, pulmonary disease, conjestive heart failure, hypertension and cirrhosis (p>0.05) these are not statistically significant factors when they are accompanied to the significant factors, they significantly increased the wound dehiscence ratio in this patients (p<0.05).

1992 Þubat -1996 Nisan tarihleri arasýnda Taksim Hastanesi Ortopedi ve Travmatoloji Kliniðinde 41 hastanýn deplasmanlý olekranon kýrýðý tension band wiring (zuggurtung) tekniði ile tedavi edildi. Lezyon tipleri Colton'a göre sýnýflandýrýlarak tedavi yöntemi ve sonuçlarý çeþitli parametrelere göre deðerlendirildi. Bu parametrelerin ýþýðý altýnda her lezyon tipinde, hangi yöntemlerin baþarýlý olabilecekleri incelendi. Weseley'in kriterlerine göre 13 hastada (%31.7) çok iyi, 17 hastada (%41.46) iyi, 9 hastada orta (%21.95), 2 hastada da(%.4.89) kötü sonuç alýndý.

We operated on 41 patients with deplaced olecranon fracture, between February 1992 and April 1996 by utilizing tension band wiring (zuggurtung) technique in department Of orthopedics and traumatology, Taksim State Hospital. Lesion types were classified according to Colton classification and treatment methods and results were evaluated with various parameters. Success of different method in treatment of each lesion was evaluated. The patients were evaluated using Weseley criteria and results were highly succesfull in 13 patients, succesfull in 17 patients, moderate in 9 patients and poor in 2 patients. Our data revealed that, in deplaced olecranon fracture, open reduction and internal fixation with zuggurtung technique should be the preferred method.

Laparoskopik cerrahinin ilk yýllarýnda akut kolesistit laparoskopik yaklaþým için kontrendikasyon kabul edilirdi. Zamanla tecrübeler arttýkça akut kolesistit içinde baþarýlý sonuçlarýn yayýnlanmasý, akut kolesistitte de laparoskopik yaklaþýmýn birinci tercih olabileceðini göstermektedir. Kahramanmaraþ Devlet Hastanesinde Aralýk 1997 - Haziran 1999 tarihleri arasýnda laparoskopik kolesistektomi uygulanan 250 olgu retrospektif olarak incelendi. Olgular akut taþlý kolesistit (AK) ve kronik taþlý kolesistit (KK) olarak iki gruba ayrýldý. Her iki grup ameliyat süreleri, komplikasyon, dren kullanýmý ve açýk kolesistektomiye geçime oranlarý açýsýndan karþýlaþtýrýldýlar. Laparoskopik kolesistektomi (LK) uygulanan 250 olgudan, 46 (%18.4) olgu AK, 204 (%81.6) olgu da KK nedeniyle ameliyat edildiler. Her iki grupta da taný anamnez,fizik muayene ve ultrasonografi ile konuldu. Ortalama yaþ KK grubunda 51.3±13.9 SD, KK grubunda ise 49.2± 1.0 SD idi. Ortalama ameliyat süreleri AK grubunda 65.7±22.3 SD dakika iken, KK grubunda 53.7 ± 18.7 SD dakika idi ve aradaki fark anlamlý idi (p < 0.001). AK grubunda 2 (%4) olguda komplikasyon izlenirken, KK grubunda 6 (%3) olguda komplikasyon izlendi ve aradaki fark anlamlý deðildi (p>0.05). AK grubunda 18 (%39.1) olguda dren kullanýlýrken, KK grubunda 26(%12.7) olguda dren kullanýldý ve aradaki fark anlamlý bulundu (p<0.05). Açýk Kolesistektomiye AK grubunda 1 (%2) olguda geçilirken, KK grubunda 3 (%1.5) olguda geçildi (p > 0.05). Sonuç olarak, AK için yapýlan laparoskopik cerrahi daha uzun sürmekte ve daha fazla dren kullanýlmaktadýr. LK'nin genel avantajlarý göz önüne alýndýðýnda, akut ve kronik kolesistit nedeniyle uygulanan LK'ler arasýnda morbiditeyi arttýrýcý bir fark olmamasý, AK içinde LK, tecrübeli ellerde güvenli ve efektif bir yöntemdir.

The purpose of this retrospective study was to investigate which is acute cholecystitis contraindication for laparoscopic surgery or not? Most of early articles described taparoscopic cholecystectomy for chronic cholecystitis. Acute cholecystitis was considered a contraindication to this approach. As more experience was obtained, acute cholecystitis became not a contraindication for laparoscopic cholecystectomy. The laparoscopic cholecystectomy operaLions that were performed in Kahramanmaraþ State Hospital, between December 1997-June 1999 were analyzed retrospectively. The patients were divided into two groups. The patients of first group had acute cholecystitis. The cases of second group had chronic cholecystitis. Both group compared to operation times, complications, conversion rate, and drain uses. Between December 1997-June 1999,250 patients underwent laparoscopic cholecystectomy. Of the patients, 46 (18.4%) had acute cholecystitis and 204 (81.6%) had chronic cholecystitis. When we compared two groups, we found significant differences between operation times and drain uses (p < 0.05). Laparoscopic cholecystectomy for acute cholecystitis takes longer and surgeons use more drain for acute cholecystitis. There were no differences between complications and conversion rates. In conclusion, we decided that in experienced hands, laparoscopic surgery could safely be performed in patients with acute cholecystitis. It does not increase the morbidity rate.

Travma,. Genç nüfus içindeki en önemli ölüm nedenlerindendir. Son yýllarda ilk yardým uygulamalarý ve hýzlý ulaþýmda kaydedilen geliþmeler nedeniyle, acil servislere yetiþtirilebilen penetre kalp yaralanmalý olgu sayýsý giderek artmaktadýr. Bu çalýþmada, penetre kalp yaralanmasý nedeniyle kliniðimizde cerrahi tedavi uygulanan olgular, retrospektif olarak deðerlendirilmiþtir. 1988 - 1999 yýllarý arasýnda, 12 penetre kardiyak yaralanma olgusu opere edildi. Sadece biri kadýn olan hastalarýn yaþ aralýðý ve yaþ ortalamasý, sýrasýyla 17-46 ve 28 5+9.4 olarak bulundu. Hemodinamik olarak stabil olan sekiz olguya preoperatif ekokardiyografi ile taný kondu, geri kalan dört olgu ise fizik bakýdan hemen sonra acil koþullarda öpere edildi. Tüm vakalarýn median strenotomi ile açýldýðý serimizde aperatif mortalite gözlenmedi. Bir olguda atrioventriküler blok geliþti. Postoperatif ekokardiyografi ile iki hastada, ikinci bir ameliyatý gerektiren, ventriküler septal defekt oluþtu.

Trauma is a major cause of death in young population. Penetrating trauma to the heart which delivered to the emergency rooms has seen increasing 4' in the last years, because of the improved first aid and rapid transport techniques. In this study, the results of surgically treated penetrating cardiac trauma at our department were evaluated retrospectively. Between 1988-1999, 12 cases of penetrating cardiac trauma were operated at our institution. The age range and the mean age were 17-46 and 28.5 + 9.4, respectively, in which there were only one female patient Eight patients who were stable hemodynamically diagnosed with preoperative transthoracic echocardiography, while remaining four underwent operation urgenty soon after physical examination. Median sternotomy was performed in all cases. There were no operative mortality. In one patient, atrioventricular block was occurred, and postoperative echocardiography revealed ventricular septal defect in two patients, which required a second operation.

Büyüyen Kafa Kýrýklarý (BKK) çocukluk dönemi kafa travmalarýnýn nadir bir komplikasyonudur. Eriþkin döneminde taný konan olgular daha da nadirdir ve baþlýca neden yeterli tedavinin uygulanmamýþ olmasý ya da gecikmiþ tanýdýr. Bu çalýþmada, beþi eriþkin döneminde olmak üzere onbeþ BKK olgusu sunulmaktadýr. On olguda leptomeningeal kist ile birlikte ya da olmaksýzýn kafa kýrýðýnda geniþleme tesbit edildi. Bu gruptaki (Grup I) olgularýn 7si erkek, üçü bayan ve olgularýn ortalama yaþý 14.9 ay idi. Yýrtýlmýþ olan duraya baðlý olarak kýrýk kemik kenarlarý birbirinden ayrýlmýþ ve beyin omurilik sývýsý ile dolu araknoid boþluk bir leptomeningeal kiste dönüþmüþ idi. Dokuz olgu kafada þiþlik ve þekil bozukluðu, bir olgu ise nöbet þikayeti ile baþvurdu. Taný konmamýþ ya da taný konmakta gecikilmiþ olgularda kist geniþlemekte, ensefalomalazi ve parankim dokusu kaybý oluþmakta ve kist ventrikül ile birleþmektedir. Böylece bir porensefalik kist ortaya çýkmaktadýr. Eriþkin döneminde taný konan beþ olgumuz ise bu patolojik ilerlemeyi göstermekte idi (Grup II). Bu olgularýn 4ü erkek, biri bayan ve ortalama yaþlarý 14.6yýl idi. Sadece nöbet dört olguda, sol hemiparezi ile birlikte nöbet ise bir olguda tesbit edildi. Grup l olgular kranyotomi ve duraplasti ile tedavi edildiler. Kemik büyümesi tamamlandýktan sonra iki olguya kranyoplasti uygulandý. Grup II olgular kranyotomi, duraplasti ve kranyoplasti ile tedavi edildiler. Bu grubun iki olgusu daha sonra þant uygulamasýný gerektirdi. Olgularýn tedavi sonrasý ortalama takip süresi 37 ay olarak tesbit edildi. Eriþkin olgularda tedavi sonuçlarý yetersiz kaldý ve beþ olgudan sadece birinde nöbetler önlenebildi. Sonuç olarak, BKKda erken taný, uygun tedavinin seçimi, yeterli iyileþme ve geç baþarýsýz sonuçlarýn önlenmesi için kafa travmasý sonrasý oluþan lineer kýrýklarýn en az iki sene düzgün aralýklar ile takibi esas olmalýdýr.

Growing skull fractures (GSF) are rare complications of childhood head trauma. Cases diagnosed after childhood are extremely rare and lack of proper treatment or delayed diagnosis is the main reason. Fifteen cases, five of them diagnosed in adulthood, are reported in this study. After separation of bone edges with torn dura, the arachnoid pouching filled with cerebrospinal fluid changes to a leptomeningeal cyst. These stages develop in childhood. Ten childhood cases demonstrated enlargement of skull fracture with/without leptomeningeal cyst (Group I: male/female: 7/3, mean age: 14.9 months). At admission, nine cases had only skull deformity or bulging, one additional case with seizures. In untreated or late diagnosed cases with enlargement of the cyst, development of encephalomalacia and loss of parenchymal tissue, the cyst communicates with ventricles. The final step is a porencephalic cyst. Five cases diagnosed in adulthood presented with these last two stages (Group II: male/female: 4/1, mean age: 14.6 years). Four of them had seizures and one case with left hemiparesis and seizure. Group I was treated with craniotomy and duraplasty. After bone growing had been completed, cranioplasty was performed in two. Group II was treated with craniotomy, duraplasty and cranioplasty. Two of them required a shunt procedure later. Mean follow-up of fifteen cases is 37months. The results in adults were unsatisfactory. From five cases only one had the seizure resolved. In conclusion, follow-up of the patients with linear fractures after head trauma at least two years should be essential for early diagnosis and treatment, proper healing and avoidance of late disappointing results in GSF.

Ameliyat sonrasý karýn içi yapýþýklýklar halen cerrahinin önemli problemlerindendir. Cerrahi veya travma sonrasý periton dokusunun iyileþmesi farklý mekanizmalarý içeren, henüz tamamý ile çözümlenmemiþ bir konudur. Artýk periton yaralanmasýnýn tipi ne olursa olsun, inflamasyon ve bunun iyileþmesi ile ilgili moleküllerin bu mekanizmalarda yer aldýðý bilinmektedir. Periton dokusunda fibrin oluþumu ve yýkýmýn periton iyileþmesinde temel olay olduðu kabul edilmektedir. Periton iyileþmesi sýrasýnda salýnan bazý sitokinlerin bu temel olayý farklý yönlerde etkileyebileceði düþünülmektedir. Sitokinlerin periton dokusu iyileþmesinde düzenleyici etkileri gösterilebilirse ameliyat sonrasý yapýþýklýktan sadece önlemek deðil, kontrol edebilmek mümkün olacaktýr. Bu makalede periton iyileþmesinde düzenleyici ve aracý rolü oynayan moleküller belirleyicileri gözden geçirmeyi amaçladýk.

Postoperative intraabdominal adhesions is still one of the major problems of surgery. Peritoneal tissue repair after surgery or trauma is yet to be a defined subject that concerns different mechanisms. Regardless of the type of injury it is known that molecules related to inflammation and restoration take place in these mechanisms. It has been accepted that fibrin deposition and degradation is the basic event in peritoneal tissue repair. Some cytokines that released during peritoneal tissue repair may affect this basic event in different ways. If modulatory effects of cytokines in peritoneal tissue repair can ultimately be shown, it will be possible not only to prevent postoperative adhesions but also to control them. We aimed in this article to review the markers that play a modulator and mediator role peritoneal tissue repair.

Çocuk femur cisim kýrýklarý çoðunlukla konservatif olarak tedavi edilmektedir. Traksiyon ve pelvipedal alçý uygulamasý da bu yöntemlerden biridir. Bu çalýþmada 1992-1999 yýllarý arasýnda, Atatürk Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý'nda, fraksiyon ve pelvipedal alçý ile konservatif olarak tedavi edilen femur þaft kýrýklý 82 çocuktan kontrolleri yapýlabilen ve tek taraflý kýrýk olan 50'sinin sonuçlarý deðerlendirilmiþtir. Yaþlan 4 gün 13yýl (ortalama 4.2 yýl) olan olgularýn 11'i (%22) kadýn, 39'u (%78) erkektir. Traksiyonda kalma süresi 10-25 (ortalama 18.1) gün, alçýda kalma süresi ise 20 gün ile 12 hafta arasýnda, ortalama 8.4 haftadýr. Olgular 5 ay ile 6yýl arasýnda, ortalama 3.5 yýl takip edilmiþlerdir. Olgularýn %94'ünde baþarýlý sonuç elde edilmiþtir. Çalýþmanýn sonucunda, çocuk femur cisim kýrýklarýnýn fraksiyon ve pelvipedal alçý ile tedavisinin iyi sonuç veren bir yöntem olduðu kanaatine varýlmýþtýr.

Children's femoral shaft fractures are usually treated conservatively. One of the conservative methods is the treatment with traction and spica cast. In The Department of Orthopaedics and Traumatology of Atatürk University Medical School, between 1992-1999 years, 82 children with femoral shaft fractures were treated with traction and spica cast, and of the cases, 50 with unilateral fracture could be done control. Of 50 cases, 11 (22%) were females and 39 (78%) males. The average age was 4.2 years, ranging from 4 days to 13 years. The traction period was 10-25 (average 18.1) days, and the cast period was from 20 days to 12 weeks (average 8.4 weeks). The cases were followed up with an average period 3.5 years (5 months-6 years). The satisfactory outcomes were showed in 47 (94%) cases. In the result of this study, it was concluded that the treatment with traction and then a spica cast after stabilization of the fracture by callus was the successful method.

Grup davranýþý ve kiþiler arasý etkileþim örgüt davranýþýný etkileyen güçlü kuvvetlerdir. Acil servis, bir organizasyonun (örgütün) organik ve matriks yapýlarýnýn özelliklerine sahiptir. Acil servisin performansý, diðer birçok örgütte olduðu üzere, önemli ölçüde, yöneticinin kiþileri gözlemlemesine ve örgüt davranýþýnýn analizine dayanýr. Bireyin davranýþýný doðrudan etkileyen üç temel deðiþken, kiþisel, psikolojik ve örgütsel olarak sýnýflandýrýlýr. Bu çalýþmanýn amacý, etkinlik ve verimliliði arttýrmak için acil serviste de var olan görev gruplarýnýn yönetiminde esas oluþturan grup dinamiði öðelerinin deðerlendirilmesidir. Sunulan çalýþmaya Kocaeli Üniversitesi Hastanesi Acil Servis'indeki doktor, hemþire+saðlýk memuru, teknisyen ve görevlilerden oluþan 31 kiþi katýlmýþtýr. Kýrk maddeden oluþan bir anket formu araþtýrma aracý olarak kullanýlmýþtýr. Özdeþlik, karþýlýklý baðýmlýlýk, sosyal mesafe, çatýþma ve müzakere süreci anket yoluyla araþtýrýlan grup dinamiði öðeleridir. Sonuçlar Acil Servis takým üyeleri arasýnda çatýþma ile karakterize bir iletiþim sorunu bulunduðunu ve bunun takýmýn etkinlik ve verimliliði etkilediðini göstermektedir. Bu bulgular bize, bir acil servis yöneticisinin çatýþma ve deðiþim yönetiminde yetkin olmasý gerektiðini göstermektedir. Bu nedenle, görevlendirilen yöneticiler grup dinamiklerini etkileyen alanlarda takýmlarý için disiplinler arasý destek ve eðitim almalarý konusunda cesaretlendirilmelidirler.

Group behavior and interpersonal influence are powerful forces affecting organizational behavior. An emergency room has particular characteristics of organic and matrix structures of an organization. The performance of the emergency room relies heavily upon the manager's observation of individuals and analysis of organizational behavior, as in many other organizations. The three sets of variables that directly influence individual behavior are classified as being individual, psychological, and organizational. The aim of is this study is to evaluate elements of group dynamics that are essential in management of a task group for enhancement of efficiency and productivity, that takes place in an emergency room. In the present study, 31 subjects who were physicians, nurses, technicians and personnel in Kocaeli University Hospital Emergency Room were used. A questionnaire that composed of 40 items was used as the research instrument. Identification, interdependence, social distance, conflict and negotiation were the elements of group dynamics investigated through the questionnaire in this study. The results indicate that a communication problem, which is characterized by the conflict among members of the emergency room team, exists and affects the team's efficiency and productivity. This finding allows us to argue that the manager of an emergency room team has to be efficient min conflict and change management. Therefore, the assigned managers need to be encouraged to receive training and interdisciplinary support for the team in the areas that affect group dynamics.

Bu çalýþmada, 1992-1997 yýllarý arasýnda Ege Üniversitesi Týp Fakültesi Genel Cerrahi Kliniði, Kolorektal Cerrahi Bölümünde acil ya da elektiv olarak opere edilerek loop kolostomi uygulanan 56 olgu, loop kolostominin total fekal diversiyonu saðlama yönündeki etkinliðinin deðerlendirilmesi amacýyla prospektif olarak incelendi. Kadýn - erkek oranýnýn 14/42 olarak belirlenen olgularýn yaþ ortalamasý 56.8 idi. 49 hastaya transvers loop kolostomi uygulanýrken, 7 hastaya sigmoid loop kolostomi uygulandý. Etiyolojik faktörler olarak olgularýn 22'inde rektovajinal fistül, birinde anorektal kanser, 16'ýnda travma, 4'ünde benign rektal darlýk, 9'unda Fournier gangreni, 2'inde rektovajinal fistül, birinde anorektal kanser, birinde kistoenterik fistül ve bir olguda da divertikülite baðlý abse söz konusu idi. Olgular, postoperatif 7. gün ve 12. ay arasýndaki zamanda oral baryum içirilmek suretiyle radyolojik olarak tetkik edildi. Baryum alýmýndan 24 saat sonra çekilen filmlerde kolonun distaline geçip geçmediði araþtýrýldý. Dört olguda baryumun distaline geçiþi gözlendi. Sonuç olarak, loop kolostominin fekal diversiyonda etkin olduðu ve daimi diversiyon amacýyla kullanýlabileceði kanýsýndayýz.

In the study, 56 patients to whom emergency or elective loop colostomies were performed at the Colorectal Surgical Unit of General Surgery Department of Ege University Medical School Hospital between February 1992 and May 1998, were studied prospectively to evaluate the efficacy of loop colostomy in maintaining total fecal diversion. The female/male ratio of the patients was 14/42 with mean age of 56.8. While transverse loop colostomy was performed in 49 patients, seven patients underwent sigmoid loop colostomy. The etiologic factors included colorectal cancer in 22 patients, colonic trauma in 16, benign rectal stricture in four, Fournier's gangrene in nine, rectovaginal fistula in two, anorectal cancer in one patient, cystoenteric fistula in one patient and diverticulitis with abscess in one patient. The patients were evaluated radiologically after barium meal was given orally between the seventh day and twelfth month postoperatively. The passage of barium into the distal limb of the colon was detected in the last x-rays of the 56 patients 24 hours passed from the time of barium intake. However, only f our patients showed passage of barium into the distal colon in the x-ray. As a result, we consider that loop colostomy is efficacious in diverting fecal stream and can be used for permanent diversion.

Amaç: Bu çalýþmanýn amacý, Kýrýkhan ilçesindeki motorsiklet ve moped kazalarý sonucu ortaya çýkan yaralanma örneklerini, mortalite oranlarýný deðerlendirmek, motorsiklet kazalarýnýn ortaya çýkmasýnda rolü olabileceði düþünülen faktörleri ortaya koymak ve Saðlýk Bakanlýðý (S.B.) Kýrýkhan Devlet Hastanesinde motorsiklet kazalarý sonucu ortaya çýkan yaralanmalara uyguladýðýmýz tedavi sunmaktýr. Hastalar ve Yöntem: Çalýþmaya 01.01.1997 06.01.1998 tarihleri arasýnda S.B. Kýrýkhan Devlet Hastanesi Acil Polikliniðini baþvuran motorsiklet kazasý sonucu travma geçirmiþ 110 olgu prospektif olarak incelendi. Her olgu için ýnotorsiklet kazalarýna yönelik olarak hazýrlanmýþ bir form dolduruldu. Form içeriðinde, yaralýnýn yolcu, sürücü veya yaya mý olduðu, kazanýn oluþ þekli, yolcu veya sürücünün kask takýp takmadýðý, kazaya sebep olan sürücünün alkollü olup olmadýðý, kazazede de saptanan patolojiler, yaralanma þiddeti skoru (YÞS) (1) deðerleri gibi bilgiler yer aldý. Bulgular: 93 motorsiklet kazasý sonucu travma geçiren 110 olgunun 96'sý (% 87.27) erkek, 14'ü (%12.73) kadýndý. Olgular sürücü (n: 65), yolcu (n: 25) veya (n: 20) olarak gruplandýrýldý. Sürücülerin yaþ ortalamasý 30.9 ± 12.7 (min: 15, med: 27, maks: 69); yolcularýn yaþ ortalamasý 28.6 ± 17.3 (min: 10, med: 23, maks: 65); yayalarýn yaþ ortalamasý 20.7 + 20.6 (min: 3, med: 12.5, maks: 68) þeklindeydi. Sürücülerin % 3'ünün kask kullandýðý.yolcularýn ise hiç birisinin kask kullanmadýðý; sürücülerin 13 tanesinin (%20) ehliyetsiz olduðu, yaz mevsiminde kazalarýn daha fazla olduðu saptandý. Sürücülerde en fazla klavikula, radius-ulna distal uç, ayak bileði kýrýklarý; yayalarda ise tibia-fibula açýk kýrýklarýnýn daha sýk görüldüðü belirlendi.65 sürücüde 77 patoloji, 25 yolcuda 25 patoloji ve 20 yayada 22 patoloji saptandý. Bu patolojilerin (n: 124) % 85.5'i ayaktan, % 5.6 si yatarak operasyonla tedavi edildi. 3 olgu nöroþirurji uzmanýna sevk edilirken 2 olgu ise kafa travmasý sonucu kaybedildi. Sonuç: Sürücülerin eðitimi ve daha sýký denetimi ile, daha iyi yol koþullarý oluþturulmasýnýn kaza oranlarýný düþüreceði; yolcu ve sürücülerin kask kullanýmýnýn kafa travmasý ve buna baðý olarak geliþen ölümleri azaltacaðý sonucuna varýldý.

Aim: The aim of this study is to evaluate both wounding of people who were hurt by motorcycle accidents and the rate of mortality. We also tried to uncover the factors which were supposed to take role in the motorcycle accidents, and presented our treatments in Kýrýkhan State Hospital of Ministry of Health to the injuries occured in those accidents. Material and Methods: 110 victims who were appointed to the emergency service of Kýrýkhan State Hospital of Ministry of Health following a motorcycle accident between 1.1.1997 and 6.1.1998 were included to the study. A standard form prepared for the motorcycle accidents was filled out for each case. Some of the parameters that were included in the form were as follows: Was the victim a rider or a passenger or a pedestrian, how did the accident happen, was the rider or passenger using a helmet, was the rider drunk, were there any established pathologies in the victims, what was the injury severity score (ISS) ?Results: 110 victims were accepted to the emergency room following 93 motorcycle accidents. Of these. 96 (87.27 %) were male and 14 (12.73 %) were female. Victims were grouped as driver ( n: 65), passenger and pillon passenger ( n: 25) and pedestrian (n: 20). The average ages were found as 30.9 + 12.7(min: 15, med: 27, max: 69) for drivers, 28.9 + 17.3(min: 10, med: 23, max: 65) for passengers and 20.7 + 20.6 (min: 3, med: 12.5, max: 68) for pedestrians. Only3%of the drivers and none of the passengers were using helmet. 13 drivers were found not having driver's license and the occurrence of motorcycle accidents was more likely in summer. Fractures of the clavicle, distal end of the radius and ulna and ankle were mostly diagnosed in the drivers; open fractures of the tibia and fibula were seen frequently in the pedestrians. 77 pathologies were diagnosed in 65 drivers, 25 pathologies were found in 25 passengers and 22 pathologies were seen in 20 pedestrians. Of those pathologies ( n: 124), 85.5 % were treated in the outpatient clinic and 5.6% were treated in the hospital by surgical operation. 3 patients were directed to the neurosurgery specialist and 2 died due to the trauma of the brain. Conclusion: Education and strictly control of the drivers and better road conditions will decrease the rate of accidents. The use of helmet both by drivers and passengers will reduce the risk of brain injury and consequent fatal cases.

A private request for expertise before application to official institutions and during any stage of juridical investigation, is a fact seen in malpractice cases. Although expertise reports prepared upon private applications haven't been foreseen to be taken into account in trials, judges are legally authorised to make a decision upon whether to take them into consideration. However, such reports have at least a significance to guide in evaluation of the status and the loss of the victim as well as to pave to a legal process. The most crucial problem in these phenomena is that the medical documents presented are often insufficient and it is sometimes difficult to reach the hospital files. The case presented belongs to a patient admitted to Istanbul Medical Faculty, Forensic Medicine Department upon private request with the claim of malpractice. This patient surgical operationed twice with 12 days interval went into coma for 18 days and was diagnosed with "Grade 3 hepathic ansephalopathy. The patient suffering from liver insufficiency was applied a liver transplantation in abroad. In pathological assessment of the live pieces from the patient, hepatitis consistent with "halothane" was diagnosed. Expert approaches to the events with the claim of malpractice were examined and discussed in several aspects because of the phenomenon with negative viral hepatisis markers, clinical and biochemical findings of which and histopathological features of the liver are both consistent with "toxic hepatitis".

Chilaiditi Sendromu kolonun sað subfrenik mesafeye semptomatik interpozisyonudur ve nadir görülmektedir (%0.02-0.22). Çoðu zaman cerrahi bir öneminin olmadýðý düþünülmektedir. Ancak, "yanýltýcý psödopnömoperitonyum" tablosu oluþturarak yanlýþ taný konmasýna ve gereksiz cerrahi giriþimlere neden olabilir. Acil cerrahi giriþim gerektiren Chilaiditi sendromu oluþturmuþ sigmoid kolon karsinomlu nadir bir olgu tartýþýlmýþtýr.

Splenic infarct is an unusual altitude. Generally it arises from hemathologic diseases, vascular and thromboembolic disorders. In this article a 57 year old female with splenic infarction is presented. She was admitted to the hospital with abdominal pain, fever, nausea, vomiting, weakness. She was taking warfarin for the last 3 years due to chronic atrial fibrillation. Abdominal tenderness was found in left upper quadrant in physical examination. CT scans showed an infarcted area in the spleen. Splenectomy was applied. Pathologic examination revealed splenic tuberculosis (the) and the arteritis. We think that splenic infarction should not be forgetten and it should be put into the list of pre-diagnoses of cases with left upper quadrant abdominal pain under the predisposingfactors.