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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 7 (4)
Volume: 7  Issue: 4 - October 2001
1.IMMUNOSUPPRESSIVE EFFECT OF BLOOD TRANSFUSION IN GENERAL SURGERY THERE ARE TOO MANY UNKNOWN YET
Gökhan Akbulut, Mustafa Altındiş, Osman Nuri Dilek
PMID: 11705074  Pages 213 - 218
Abstract |Full Text PDF

2.THE EFFECT OF PENTAGLOBIN THERAPY ON PROGNOSIS IN PATIENTS WITH SEVERE SEPSIS
Simru Tuğrul, Perihan Ergin Özcan, Özkan Akıncı, Atahan Çağatay, Nahit Çakar, Figen Esen
PMID: 11705075  Pages 219 - 223
Bu çalışmada IgM ve IgA ile zenginleştirilmiş intravenöz immunglobulin preparatı olan Pentaglobin'in ağır sepsisteki hastalarda septik şok gelişme insidansına, klinik seyire, mortalite oranlarına olan etkisi incelenmiştir. Ağır sepsis tanısı alan hastalar randomize edilerek 2 gruba ayrılmış, bir grup hastaya (n: 21) Pentaglobin solüsyonu 5 ml/kg/gün dozunda 3 gün süreyle uygulanmış, immunglobulin uygulanmayan hastalar (n=18) ise kontrol grubunu oluşturmuştur. Prokalsitonin değerleri pentaglobin uygulanan grupta istatistiksel anlamlı bir azalma göstermiştir (p = 0.001). Gruplar arasında Simplified Organ Failure Assessment (SOFA) skoru, lökosit sayısı, ağır sepsis gün sayısı, mekanik ventilasyon ve yoğun bakım kalış süresi ile septik şok gelişme insidansı ve mortalite açısından anlamlı bir fark tespit edilmemiştir. Pentaglobin grubunda 5 hasta (% 23.8), kontrol grubunda da 5 hasta (% 27.7) kaybedilmiştir. Pentaglobin tedavisi her ne kadar septik şok gelişme insidansı ve mortaliteyi değiştirmese de prokalsitonin düzeylerinde görülen istikrarlı azalma, immünoterapinin inflamatuar yanıt üzerinde olumlu etkileri olduğunu düşündürmektedir.
This study was designed to assess the effects of polyclonal immunoglobulin administration on septic shock incidence and prognosis in patients with severe sepsis. Patients with severe sepsis were randomly allocated into two groups. One group (n= 21) received 5ml/kg/day/g Menriched immunglobulin preparation (Pentaglobin) for3 days. Other group did not receive immunoglobulins (n= 18). Simplified Organ Failure Assessment (SOFA) scores, leucocyte count, duration of mechanical ventilation, ICU stay, duration of severe sepsis did not show significant differences between the groups, as regards to septic shock incidence and mortality. However, a significant decrease in procalcitonin levels were detected only in patients who received pentaglobin (p = 0.001). Mortality rate was 5/21 (23.8 %) in pentaglobin group and 5/18 (27.7 %) in the control group. Although pentaglobin therapy could not achieve a statistically significant improvement in septic shock occurrence and mortality, the constant reduction in procalcitonin levels indicated the beneficial effects of immimotherapy on the severity of inflammatory response to infection in severe sepsis.

3.OUR CONSERVATIVE MANAGEMENT RESULTS IN BLUNT ABDOMINAL TRAUMA
Cemalettin Ertekin, Hızır Akyıldız, Korhan Taviloğlu, Recep Güloğlu, Mehmet Kurtoğlu
PMID: 11705076  Pages 224 - 230
Çalışmamızda Ocak 1996 - Ocak 2001 dönemleri arasında İstanbul Üniversitesi, İstanbul Tıp Fakültesi Genel Cerrahi Ana Bilim Dalı Acil Cerrahi servisine başvuran ve intraabdominal solid organ yaralanması tespit edilerek konservatif olarak takip ve tedavi edilen 59 hasta prospektif olarak incelendi. 56 olguda künt, 3 olguda penetran travma mevcuttu. Olgulardan 23'ünde karaciğer, 14'ünde dalak, 5'inde böbrek, 6'sında karaciğer ve dalak, 4'ünde karaciğer ve böbrek, 6'sında dalak ve böbrek, Tinde karaciğer, dalak ve böbrek yaralanması tespit edilmiştir. Dalak yaralanmalarının 4'ü, karaciğer yaralanmalarının 5'i Grade IV şiddetinde yaralanma olup, olguların % 21'i Grade 1, % 45'i Grade II, % 19'u Grade 3, % 15'i ise Grade IV yaralanma idi. Yandaş yaralanma olarak 34 olguda (%57.6) kafa travması (6 olguda Glasgow 7 nin altı), 28 olguda (% 47) uzun kemik kırığı, 19 olguda (%32) toraks travması, 6 olguda (%10) pelvis fraktürü, 3 olguda (%5) ise vertebralarda kompresyon fraktürü saptanmıştır. Konservatif tedavide başarısızlık oranı bir olguda 3.3 olarak gerçekleşmiştir. Multitravmalı olan ve yoğun bakım ünitesinde takip edilen hastalardan 3'ü (% 5) kaybedilmiştir. Solid organ yaralanmalarının tedavisinde konservatif yaklaşım giderek daha çok merkezde ve daha çok sayıda hastada uygulanmaktadır. Bizim çalışmamız ve bu konudaki güncel araştırmalar, solid organ yaralanmaların takibinde fizyolojik parametreleri temel almaktadır. Ayrıca, yeterli radyolojik verilerle desteklenen, deneyimli bir cerrahi ekip tarafından yönetilen konservatif tedavi şeklinin % 98'lere varan başarı sağladığı ve hasta seçiminde hemodinamik stabilitenin olmazsa olmaz şart olduğu gösterilmiştir.
We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Service of Istanbul Medical School between January 1 996 and January 2001. Fiftysix of these cases suffered blunt and 3 penetrating trauma. Twentythree cases had injuries involving the liver, 14 spleen, 5 kidney, 6 liver and spleen, 6 liver and kidney, 6 spleen and kidney and four liver and kidney. In 4 of splenic and 5 of hepatic injuries Grade IV injuries were detected. Among the cases, 21% were Grade I, 45 % were Grade II, 19 % were Grade III, and 15 % were Grade IV. Associated injuries were: head trauma in 34 cases (57.6 % - Glasgow Coma Score under 7 in 6 rases), thoracic trauma in 19 cases (32 %), pelvic fracture in 6 cases (10%), vertebral compression fracture in 3 cases (5 %). One patient with splenic (Grade III) and hepatic (Grade II) injury, and one patient with Grade IV splenic injury required surgery during close follow-up due to hemodynamic instability. Our failure rate for conservative treatment of solid organ injuries is 3.3 %. Three patients with polytraum in the ICU died (5 % mortality rate). Conservative management in solid organ injuries is gaining more popularity every day. Our wort, and current studies accept physiologic parameters in the follow-up of solid organ injuries. Conservative treatment guided with hemodynamic stability, accounts almost a 98% success rate.

4.EVALUATION OF 572 CASES WITH BLUNT AND PENETRATING TRAUMA
Recep Demirhan, Hasan F Küçük, A Bülent Kargı, Mehmet Altıntaş, Necmi Kurt, Mustafa Gülmen
PMID: 11705077  Pages 231 - 235
Ocak 1997-Şubat 2000 tarihleri arasında Kartal Eğitim ve Araştırına Hastanesi II. Genel Cerrahi Acil Polikliniğine başvuran 2163 travmalı olgudan, 572 toraks travmalı olgu retrospektif olarak değerlendirildi. 572 olgudan 501'i (%87.5) erkek, 71'i (%2.5) kadın olup, yaş aralığı 2-84 arasında, yaş ortalaması 32.2 idi. Serimizdeki 337 (%59) olguda künt toraks travması, 235 (%41) olguda penetre toraks travması saptandı. Künt toraks travmalarında en sık (%72) gözlenen etiolojik faktör trafik kazaları iken, penetre toraks travmalarında ise delici-kesici alet yaralanmaları en sık (%82) etkendi. Olguların % 37.5'inde yandaş travma saptandı. 332 (%58) olguda, tüp torakostomi, 185 olguda (%32.5) konservatif tedavi, 41 olguda (%7.1) torakotomi, 14 olguda (%2.4) mekanik ventilasyon uygulanmıştır. Morbidite % 6.8, mortalite % 3.3 olarak saptanmıştır. Toraks travmalı olgularda erken tanı, uygun ve hızlı tedavi sağ kalımı arttırmaktadır.
We retrospectively evaluated 572 patients with thoracic trauma from total of 2163 trauma patients who admitted to 2nd General Surgery Emergency Service of Kartal Education and Research Hospital from January 1997 to February 2000. 501 of the patients (87.5%) were male and 71 (12.5%) were female. The range of ages 2-84 and mean age was 32.2. 337 (59%) patients had blunt and 235 (41%) had penetrating thoracic trauma. While traffic accidents (72%) were, determined as the most common aethiological factor for blunt thoracic trauma, penetrating and cutting instruments injuries (82%) were the most common factor for penetrating thoracic trauma. Accompanying trauma were observed in 37.5% of cases. 332 (58%) tube thoracostomy, 185 (32.5%) conservative treatment, 41 (7.1 %) thoracotomy 14 (2.4%) mechanical ventilation were carried out. The rates of mortality were 6.8% and of morbidity 113%. Early diagnosis and immediate appropriate treatment in thoracic trauma increases the survival.

5.THORACIC TRAUMA: ANALYSIS OF 987 PATIENTS
Alpaslan Çakan, Gökhan Yüncü, Güven Olgaç, Timuçin Alar, Serpil Sevinç, Şeyda Örs Kaya, Kenan Can Ceylan, Ahmet Üçvet
PMID: 11705078  Pages 236 - 241
İzmir Göğüs Hastalıkları ve Cerrahisi Eğitim Hastanesi, I.Göğüs Cerrahisi Kliniği'nde, 1988-1998 yılları arasında, göğüs travması nedeniyle yatarak tedavi gören 987 olguyu kapsayan bu çalışmada, hastalar retrospektif olarak; yaş, cins, travma etkeni, eşlik eden organ yaralanması, uygulanan tedavi, komplikasyon gelişimi ve mortalite açısından incelendi. Yaralanmaların 710' u (%72) künt 277 si (%28) penetran travmaya bağlıydı. 402 (%41) olguya tüp torakostomi, 32 (%3) hastaya torakotomi, diğer 553 (9656) hastaya ise konservatif tedavi uygulandı. Tüm olgulardaki komplikasyon oranı %4.6 olarak bulunup, en sık izleneni atelektazi idi. Mortalite 13 hasta ile %1.3 olarak saptandı. Morbidite ve mortalite oranları açısından, künt ve penetre travmalılar arasında, istatistiksel açıdan anlamlı fark yoktu (sırasıyla p = 0.29 ve p = 0.10). Ortalama yatış süresi 9.6 ± 8.6 gün iken, travması künt olanlarda bu süre 10.01 ± 8.5, penetre olanlarda ise 8.4 ± 8.6gün olup, aradaki fark istatistiksel olarak anlamlıydı (p= 0.0068).
In İzmir Chest Diseases and Thoracic Surgery Training Hospital, Department of 1st Thoracic Surgery, between 1988 and 1998, 987 patients who were treated for their chest trauma were retrospectively reviewed in regard to their age, sex, cause of trauma, associated organ injuries, treatment modality, complication rate and mortality. In 710 (72%) cases of chest injuries were related to blunt trauma and 277 (28%) patients sustained penetrating trauma. 402 (41 %) patients underwent tube thoracostomy only. While majority of patients (553 pts, 56%) were managed conservatively, only 32 (3%) underwent thoracotomy. Complication rate in our series was 4.6% and the most frequently atelectasis was seen. 13 patients died due to trauma related causes (mortality: 1.3 %). There was no difference between blunt and penetrating trauma patients in view of morbidity and mortality rates (p = 0.29 and p=0.10, respectively). Mean hospital stay among all patients was 9.6 ± 8.6 days. This period was 10.0 ± 8.5 days in blunt trauma group, and 8.4 ± 3.6 days in penetrating trauma group. However this difference has reached statistical significance at a p value of 0.0068.

6.THE EVALUATION OF DIAGNOSTIC ACCORDANCE BETWEEN PLAIN RADIOGRAPHY AND BONE SCINTIGRAPHY FOR THE ASSESSMENT OF STERNUM AND RIB FRACTURES IN THE EARLY PERIOD OF BLUNT TRAUMA
Yamaç Erhan, İlhami Solak, Seden Kocabaş, Murat Sözbilen, Kamil Kumanlıoğlu, Ali Reşat Moral
PMID: 11708290  Pages 242 - 245
Amaç. Künt toraks travmasında erken dönemde sintigrafi ve direkt grafi arasındaki tanısal uyumun değerlendirilmesi Tasarım. Çift kör, prospektif klinik çalışma Yöntem. Acil Servise künt toraks travmasıyla başvuran 34 erişkin hasta travmayı takip eden ilk 24 saat içinde toraks sintigrafisi ve direkt akciğer grafisiyle incelendiler. Bulgular. Konvansiyonel radyografi 25 hastada (%73,5), Tc-99m kemik sintigrafisi ise 24 hastada (%70,5) patoloji belirledi. Radyografiyle 16 hastada (%47), sintigrafiyle 17 hastada (%50) kot fraktürü saptandı. Sternum fraktürü şüphesi olan 19 hastanın 10'unda (%52,6) lateral sternum grafisinde ve 14'ünde (%73,6) sintigrafide sternum kırığı izlendi. Tartışma. Çalışmamızda, travmanın erken döneminde sternum kırıklarının saptanmasında sintigrafi direkt grafiye göre daha iyi sonuç vermiştir. Ancak acil koşullarda konvansiyonel radyografi hem hızı, hem de kemik patolojilerinin yanı sıra plevral boşluğun da değerlendirilebilmesi açısından daha pratiktir.
Objective. To evaluate the diagnostic accordance between scintigraphy and radiography in the early period following blunt thoracic trauma. Design. Double-blind, prospective clinical study Methods. Thirty-four adult patients with blunt thoracic trauma were examined by plain radiography and scintigraphy within 24 hours of trauma. Results. Radiography displayed pathologies in 25 (73,5%), while scintigraphy suggested pathologies in 24 (70,5%) patients. Rib fractures were identified radiographically in 16 (47%) and scintigraphically in 17 (50%) patients. Lateral radiograph of the sternum showed fracture in 10 (52,6%), while scintigraphy suggested fracture in 14 (73,6%) patients with suspected sternal trauma. Conclusion. Scintigraphy gave better results in the evaluation of sternal fractures during the early period of thorax trauma. Conventional plain radiography is thought to be the initial imaging modality, because it saves time and shows hemothorax orpneumothorax besides the osseous abnormality

7.ACUTE SUBDURAL HEMOTOMAS ANALYSIS OF 73 CASES
Erkan Kaptanoğlu, İhsan Solaroğlu, M Davut Uçar, M Özerk Okutan, Etem Beşkonaklı, Yamaç Taşkın
PMID: 11705079  Pages 246 - 249
Akut subdural hematomlar (ASDH), gelişmiş tanı ve tedavi yöntemlerine rağmen halen mortalite ve morbiditesi yüksek patolojilerdir. Çalışmamızda 1995-2000 tarihleri arasında ASDH tanısı ile opere edilen 73 olgunun retrospektif analizi yapıldı. Mortalite ve morbidite oranları ile yaş, başvuru esnasındaki Glasgow koma skalası puanı ve travma ile operasyon arasında geçen süre ile olan ilişkileri araştırıldı. Yaş ile mortalite ve morbidite oranları arasındaki ilişkinin istatistiksel olarak anlamlı olmadığı, başvuru GKS puanının önemli bir prognostik faktör olduğu ve erken cerrahi uygulanmasının mortaliteyi azalttığı sonucuna varıldı.
The mortality and morbidity of acute subdural hematomas are still high although advanced diagnostic and treatment techniques. We evaluated 73 patients who were operated between 1995 and 2000 for acute subdural hematoma. The relation between mortality and morbidity rates and age, timing of surgery and Glasgow coma scala scores were analized. There was not statistically significant relation between age and mortality and morbidity rates. We concluded that Glasgow coma scala score at admission is were important prognostic factor and early surgery decreases mortality rate.

8.SPLENIC TRAUMA AND ITS TREATMENT (SURGICAL TREATMENT METHODS USED IN HASEKI EDUCATIONAL AND RESEARCH HOSPITAL IN SPLENIC TRAUMA)
Soykan Arıkan, Ahmet Fikret Yücel, Gökhan Adaş, Deniz Çulcu, Mehmet Gülen, Onat Arınç
PMID: 11705080  Pages 250 - 253
Hastanemize, 1992-98 yılları arasında 184 dalak travmalı hasta başvurmuştur. Hastaların 13' ü (%71) erkek, 53'ü (%29) kadındır. Hastaların yaş ortalaması 20.4 yıldır. Hastalardaki dalak yaralanması 176 (%95) tanesinde künt, 8 (%5) tanesinde de penetran karın travmasına bağlı idi. Dalak travmalı hastaların 164'üne (%89) splenektomi, 12'sine (%7) splenorafi ve 8'ine (%4) kısmi splenektomi yapıldı. 172 (%93) hastada izole dalak travması varken, 12 (%7) hastada diğer organ yaralanmaları da mevcuttu. Hastanede ortalama kalış süresi, splenektomilerde 7.9, kısmi splenektomilerde 7 ve splenorafilerde 6 gündü. Ameliyat sonrası komplikasyon oranları splenektomilerde %2, kısmi splenektomide %0.5 saptanmış olup, splenorafide komplikasyon saptanmamıştır. Tüm gruplarda mortaliteye rastlanmamıştır.
184 patients were admitted with splenic injuries, between 1992 and 1998. 131(71%) patients were male and 53 (29%) patients were female. The avarage age of patients were 20.4 years. There were 176 (95%) blunt and 8 (5%) panetrating injuries. The management of our cases involved splenectomy in 164 (89%), splenorraphy in 12 (7%) and partial splenectomy in 8 (4%). 172 (93%) of the operated patients had isolated splenic injuries and 12 (7%) concomitant organ injuries. The lenght of hospital stay of splenectomies; partial splenectomy and splenorraphy were 7.9, 7 and 6 days respectively. The complication rate of splenectomy, partial splenectomies; and splenorraphy after the operation were 3 (2%), 1 (0.5%) and 0. No deaths occurred as a result of splenic injury and operation.

9.TREATMENT WITH LEINBACH ENDOPROTEZ OF INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENCE
Cumhur Kesemenli, Mehmet Subaşı, Hüseyin Arslan, Turgut Kırkgöz, Serdar Necmioğlu
PMID: 11705081  Pages 254 - 257
İntertrokanterik kırıklar özellikle ileri yaş grubunda görülmekte ve daha çok basit travma ile oluşmaktadır. Mortalite ve morbidite oranı yüksektir. Tedavide internal tespit, eksternal tespit yöntemleri uygulanabilmektedir. 1995-1999 yılları arasında kliniğimizde Leinbach tipi endoprotez uygulanarak tedavi edilen, yaş ortalaması 78(71-95) olan 27 intertrokanterik kırıklı hasta değerlendirildi. Hastaların 14'ü (%51) kadın, 13'ü (%49) erkek idi. Olgular genel durumları uygun olduğu en erken dönemde ameliyata alındılar. Hastaların 2'si (%7) ameliyat bitiminde, 1'i (%3.7) postoperatif birinci hafta içinde kaybedildiler. Ortalama 14(5-21) ay izlenen hastalar Amerikan Ortopedi Cerrahları Akademisi kriterlerine göre değerlendirildi ve %80 iyi sonuç elde edildiği görüldü. İleri yaşlarda basit travma ile oluşan intertrokanterik kırıklarda ek patolojiler ve bunlara bağlı komplikasyonların yanı sıra immobilizasyon sonucu oluşan komplikasyonlar da sıktır. Bu komplikasyonları azaltmak, hastayı en erken dönemde mobilize etmek için protez uygulamanın yardımcı olduğu düşüncesindeyiz.
Intertrochanteric fractures are seen in elderly ages and occur mostly by minor trauma. Mortality and morbidity rates high and internal fixation and external methods are used for the treatment. Twenty-seven patients with intertrochanteric fractures who were at the mean age of 78 ranging between 71-95 and were treated by Leinbach type endoprosthesis during 1995-1999 were evaluated. Fourteen (%51) patients were female and 13 (%49) were male. The patients underwent operation as early as they were convenient. If they could, they were advised to walk at the second or third day of the operation. Two (%7) patients died at the end of the operation and 1 (%3.7) patient died during the first week after the operation. The patients were followed up mean 14(5-21)months and evaluated according to the criteria of American Academy of Orthopedic Surgeons which displayed good results in %80 of patients. In elderly patients with intertrochanteric fractures due to pathologies and related complications and also complications due to immobilization are seen frequently. Treatment with endoprosthesis is thought to be helpful in decreasing these complications and early mobilization of the patients.

10.ABDOMINAL GUNSHOT WOUNDS: RETROSPECTIVE ANALYSIS OF 164 PATIENTS
Orhan Çelen, Serhat Oğuz, Murat Doğan
PMID: 11705082  Pages 258 - 261
Şırnak 30 Yataklı Seyyar Cerrahi hastanesinde karına yönelik ateşli silah yaralanması nedeniyle ameliyat edilen 164 olgu retrospektif olarak değerlendirildi. Yüzyirmidokuz olguda izole abdominal yaralanma mevcut iken, 28 olguda karın yaralanmasına toraks yaralanması da eşlik etmekteydi. Olguların 7si nanterapötik laparotomi olarak değerlendirildi. Yaralanma ile acil servise başvuru arasında geçen süre olguların %69'unda 2 saatten azdı. Olgularda en sık yaralanan ilk 3 organın ince barsak (67 olgu), kolon (63 olgu) ve karaciğer (49 olgu) olduğu gözlendi. Postoperatif dönemde 34 olguda (%20.7) komplikasyon gözlenirken, 10 olguda (%6) ölümle sonuçlandı. Gelişen teknoloji ve ameliyat tekniklerine rağmen, ateşli silah yaralanmaları yüksek morbidite ve mortalite oranları ile günümüzde de önemini korumaktadırlar.
The medical reports of 164 patients who were operated for abdominal gunshot wounds at Şırnak Military hospital were reviewed retrospectively. One hundred and twenty-nine patients had isolated abdominal injury whereas, 28 had associated thoracic injuries. Seven of these laparotomies revealed no intraperitoneal injury and were considered as non-therapatic lapamtomy. The time for transportation to the emergency department were less than 2 hours in 69% of the patients. The most commonly injured organs were the small bowel in 67, the colon in 63 and the liver in 49 patients. Postoperative complications occurred in 34 patients (20.7%) and mortality rate was 6% (10 patients). In spite of the developing technology and operative techniques, gunshot wounds are still very important with high morbidity and mortality rates.

11.THE ANALYSIS OF TRAUMATIZED PATIENTS WHO ADMITTED TO THE ULUDAĞ UNIVERSITY MEDICAL SCHOOL HOSPITAL AFTER THE MARMARA EARTHQUAKE
Mehtap Bulut, Gülay Turanoğlu, Erol Armağan, Şule Akköse, Halil Özgüç, Rıfat Tokyay
PMID: 11705083  Pages 262 - 266
Bu çalışmada Marmara depremi sonrası Uludağ Üniversitesi Tıp Fakültesi hastanesine başvuran depremzedelerden travmalı ve özellikle de crush sendromlu olguların tıbbi analizini yapmak amaçlanmıştır. Hastanemize deprem nedeniyle toplam 645 olgu başvurmuştur. Bunlardan 330'u yatırılmıştır. Olgular tanılarına göre beş gruba ayrılmış (crush sendromu, vital organ yaralanması, pelvis veya vertebra kırığı, diğerleri, bilinmeyen) ve mortalite oranları saptanmıştır. Mortalite oranı en yüksek grup crush sendromudur (%21). Bunu; tanısı bilinmeyen grup (%20) ve vital organ yaralanması (%20) izlemektedir. Tüm mortalite oranı ise %8'dir. Sonuç olarak deprem sonrası görülen travmalı olgularda crush sendromu ve vital organ yaralanması yüksek morbidite ve mortalite ile seyrettiği görülmüştür. Bu nedenle birçok kliniğin (Genel Cerrahi, Acil Tıp, Ortopedi ve Travmatoloji, Plastik ve Rekonstrüktif Cerrahi, Nefroloji, İnfeksiyon Hastalıkları gibi) birbirleriyle uyumlu bir işbirliği içerisinde çalışmaları gerekmektedir.
The aim of this study was to analyze the victims of the Marmara earthquake who injured, especially had the crush syndrome. Our hospital received a total of 645 victims after the earthquake and admitted 330. Victims were classified into five different groups according to their diagnosis (crush syndrome, vital organ injury, vertebral and pelvic injuries, others and unknown) and their mortality rates were determined. Mortality was highest (21%) in the crush syndrome group. Second and third highest mortality were in the unknown (20%) and vital organ injury (20%) groups. The overall mortality rate was 8 %. In conclusion the earthquake victims with crush syndrome and vital organ injury had the highest mortality and morbidity rates. Because of that so many departments (General Surgery, Emergency Medicine, Orthopedics Surgery, Plastic Surgery, Nephrology, Infection Disease etc.) had to be study in a great harmonious.

12.HEMOTHORAX AND RETROPERITONEAL BLEEDING CAUSED BY WARFARIN IN POLITRAUMATIZED PATIENT
Cuma Yıldırım, Bülent Tunçözgür, Cumhur Sivrikoz, Levent Elbeyli
PMID: 11705084  Pages 267 - 269
If some medical problems are not noticed to in politraumatized patients at the right time, they may be caused by serious complications. The haematological parameters, especially bleeding and coagulation factors, are very important for them. If they use warfarin, heparin or saliycilates, they should be cared intensively. In this paper, a traffic accident case, a 48-year-old woman has been reported. She broke her iliac bone and made her hemothorax. In the first health centre the patient was admitted, Hemothorax was not recognized since chest graphics was not diagnosed at an earlier stage. When dyspnoea was began, pulmonary embolism diagnosis was made and warfarin was applied which caused retroperitoneal bleeding. In fact, it is not known whether hemothorax was caused by the first trauma or by the use of warfarin. In our hospital, with the team work of emergency room, thorax surgery, orthopaedics, internal medicine and chest department, correct diagnosis was made and correct treatment was applied, and the patient got out of the hospital in good health. In conclusion, patients with multiple traumas should be followed with a multidisciplinary approach. There are a lot of considerations in the follow-up and treatment of this class of patients. If the traumatized patients are used warfarin, they should be observed more carefully.

13.CLINICAL APPROACH TO TWO CASES WITH INTERNAL ILIAC ARTERY TRAUMATIC ANEURISMS
Melih Hulusi, Kaan İnan, Osman Rodop, Sezai Özkan, Mutasım Süngün, Enver Duran, Ömer Yüksel Öztürk
PMID: 11705085  Pages 270 - 273
Penetrating injuries to abdomen and especially deep gluteal injuries causes vascular and non vascular injuries which necessitates emergency surgery. Surgical management of the penetrating injuries is very difficult, especially exploration of the gluteal region is very difficult. Management of the injury of iliac artery branches is extremelly difficult. Two cases with penetrating injury to the gluteal region in 1998 and 2000 one was operated emergently and the other was operated electivelly. Coil embolization was tried to be performed for elective case but intervention was unsuccsessful. In both cases internal iliac artery was ligatated and aneurism was repaired. There were no complications in postoperative period. In postoperative angiographic controls, aneurism in the internal iliac artery was regressed and there were no vascular complications at this region such as hematoma. Penetrating injuries at gluteal region causes injury to the internal iliac artery branches which seriously necessitates emergency management, internal iliac artery ligation and impairment.

14.GASTROINTESTINAL HEMORRHAGE DUE TO TRAUMATIC SUPERIOR MESENTERIC ARTERYANEURYSM (A CASE REPORT)
Nazif Zeybek, Hüseyin Taş, Nihat Kaymakçıoğlu, Sadettin Çetiner, Ertuğrul Özal, Derviş Şen
PMID: 11705086  Pages 274 - 276
We report the case of a 21-year-old male patient with superior mesenteric artery aneurysm due to missed arterial injuries, its complications of enteric fistula and results of surgical treatment. The aneurysm was excised, entreric fistula was closed and aorta-mesenteric bypass using saphenous vein graft was performed. The hemorrhage became masked because of the tamponade in the mesentery during penetrating abdominal injury and initial surgery, and the late complication of false aneurysm came on the scene in follow up. Aortomesenteric by-pass by a transmesenteric approach provides successful result in surgical treatment of superior mesenteric artery aneurysm.

15.DETERMINATION OF BLOOD ALCOHOL LEVEL OF THE PEOPLE WHO ARE INVOLVED IN A JUDICIAL EVENT: A CASE REPORT
Nevzat Alkan, Tunç Demircan
PMID: 11705087  Pages 277 - 278
In some cases, determination of blood alcohol level is very important. The alcohol level at the time of an event, can affect the court decision and may lead to aggrivate the penalty or on the contrary an acquittal. In this article, a criminal action, in one of Turkish High Criminal Court is examined. The case was about the death of a drunk person who have fallen down from the window of his girl friend's house which is on the third floor of an apartment. This person's parent applied to public prosecutor saying that their child did not fall down but murdered by his girl friend. During this trial, In the victim's autopsy, no alcohol detected in blood in contrast with his girl friend's testimony. Because of this contradiction, a reasonable doubt has emerged that she was the murderer in this suspicious death. However, in the further stages of trial, the reasons of no alcohol detection in the autopsy is investigated. In the basis of this case, the importance and techniques of alcohol detection in blood is discussed with literature.

16.RARELY SEEN FRACTURES
Mehmet Subaşı, Ahmet Kapukaya, Cumhur Kesemenli, Vafı Çoban
PMID: 11705088  Pages 282 - 284
Rarely seen fractures are presented in this study. One case was a calcaneal spur, 2 cases osteochondrom pedicule fractures and talus posteromedial tubercle fracture due to direct trauma. Calcaneal spur and osteochondromas were removed surgically and posteromedial tubercle was treated by short-leg cast immobilization. In conclusion, we think that fractures of osteochondroma and calcaneal spur may be treated by surgical removal which do not cause any functional disorders after this operation, but fractures like the talus posteromedial tubercle should be treated conservativelly by short-leg immobilization in the early period.