AMAÇ: Bu çalýþmada, midesi dolu ve boþ sýçanlarda künt karýn travmasý (KBT) sonucu karýn organlarýnda yaralanma farklýlýðý olup olmadýðý, travmanýn yönüne göre hangi karýn organýn daha fazla etkilendiði araþtýrýldý.
GEREÇ VE YÖNTEM: Literatürde kullanýlacak travma kuvvetiyle ilgili veri bulunmadýðýndan deneysel çalýþmaya geçilmeden önce pilot çalýþma yapýldý. Sýçanlarda ani ölüme neden olmayan ölçülebilir travma kuvvetini belirlemek amacýyla kurulan düzenekle 40 cm ve 45 cm’den 200 gr. ve 250 gr. aðýrlýklar sýçanlarýn karýn bölgesine isabet edecek þekilde serbest düþmeye býrakýldý. En uygun travma kuvveti (F=69.978 N) ve absorbe edilen enerji (E=½.m.v2= 0.979 Joule), 40 cm’den býrakýlan 250 gr aðýrlýkla elde edildi. Otuz altý sýçan çalýþmaya alýndý. Sýçanlara ketamin ile anestezi uygulandý. Midenin dolu ya da boþ olmasýna, travmanýn önden, saðdan veya soldan gelmesine göre karýn organlarýnda meydana gelen yaralanmalarda istatistiksel farklýlýk olup olmadýðý araþtýrýldý.
BULGULAR: En sýk karaciðer, dalak ikinci ve ince baðýrsaklarýn üçüncü sýklýkta yaralandýðý tespit edildi. Karaciðer ve dalak yaralanmalarý açýsýndan gruplar arasýndaki fark anlamlý bulundu (p<0.05). Diger organ yaralanmalarý açýsýndan farklýlýk olmakla birlikte istatistiksel olarak anlamlý deðildi.
TARTIÞMA: Midenin dolu ya da boþ olmasýna ve travmanýn yönüne göre karýn içi organlarda farklýlýk olduðu tespit edildi.

BACKGROUND: The aim of study was to investigate whether there is a difference in injury in intra-abdominal viscera due to blunt abdominal trauma sustained by rats with empty or full stomach and to examine which viscera is affected most, based on the direction of the trauma.
MEHTOHDS: Since there is no data in the literature on the force of trauma, a pilot study was carried out before commencing the experimental study. An apparatus was built to determine the trauma force that would not cause sudden death, and rats were allowed free fall from a height of 40 and 45 cm so that they would land on their abdomen. The most appropriate force of trauma (F= 69,978 N) and absorbed energy (E= ½mv2= 0,979 Joules) were obtained in rats weighing 250g that fell from a height of 40 cm.
RESULTS: Thirty six rats were included in the study. Rats were allocated into one of six groups. We investigated if there were statistically significant differences between groups with regard to the stomach being empty/full and the direction of the trauma (anterior, right/left sided).
DISCUSSION: It was observed there were differences in injuries sustained by the internal organs depending on the fullness/emptiness of the stomach and the direction of the trauma.

AMAÇ: Suboptimal anastomozun nasýl sonuçlanacaðý bilinmemektedir. Kolon rezeksiyonlarý sonrasý anastomoz kaçaðýnýn erken tanýsý hastanýn doðru yönetiminde çok önemlidir.
GEREÇ VE YÖNTEM: Yirmi altý sýçan “kontrol”, “kaçak” ve “suboptimal anastomoz” adýyla üç gruba ayrýldý. Sýrasýyla gruplara sham laparotomi, çekum ligasyonu-perforasyon ve kolon rezeksiyonu sonrasý dört dikiþle anastomoz yapýldý. Beþinci saatte, üçüncü ve dokuzuncu günlerde periferden kan örnekleri ve relaparotomi sonrasý periton yýkama örnekleri alýndý. Karnýn içi makroskopik anastomoz kaçaðý varlýðý için incelendi. Alýnan yýkama örneklerinden aerobik ve anaerobik kültürlerle beraber 16 RNA ve E. Coli’ye özgü primerler kullanýlarak polimeraz zincir reaksiyonu (PZR) yapýldý.
BULGULAR: Deðiþik vücut sývýlarýnda 16 s RNA ve E. coli’ye özgün primerler kullanýlarak yapýlan PZR’nin sensitivitesi ve spesifisitesi sýrasýyla %100 ve %78 olarak bulundu. Üçüncü ve dokuzuncu günlerde alýnan periton yýkama sývýlarýnda hem kültürde hem de PZR’de bakteri varlýðý gösterildi. Karýn içinin incelenmesinde 8 (%80) sýçanda anastomoz kaçaðý iþaretleri gözlenirken, anastomozla iliþkili mortalite sadece 2 (%20) sýçanda saptandý.
TARTIÞMA: Kolon rezeksiyonu sonrasý suboptimal anastomoza baðlý anastomoz kaçaðý oraný yüksektir ve 72 saat gibi erken bir sürede periton örneklerinden yapýlan PZR ile taný koymak olasýdýr.

Background: The fate of suboptimal anastomosis is unknown and early detection of anastomotic leakage after colon resection is crucial for the proper management of patient. Methods: 26 rats were assigned to “Control”, “Leakage” and “Suboptimal anastomosis group” groups where they underwent either sham laparotomy, cecal ligation and puncture or anastomosis with 4 sutures following colon resection, respectively. At 5 hours, 3rd and 9th days; peripheral blood samples, peritoneal washing samples through relaparotomy were obtained. The abdomen was inspected macroscopically for the anastomotic healing. PCR with 16s rRNA and E.coli-specific primers were run on all samples along with aerobic and anaerobic cultures.
Results: The sensitivity and specificity of PCR on different body fluids with 16s rRNA and E.coli-specific primers were 100 % and 78 % respectively. All samples of peritoneal washing fluids at 3rd and 9th days showed presence of bacteria in both PCR and culture. The inspection of abdomen showed signs of anastomotic leakage in 8 rats (80%), whereas mortality related with anastomosis detected in 2 rats (20 %).
Conclusions: Anastomotic leakage with suboptimal anastomosis after colon resection is high and the early detection is possible by running PCR on peritoneal samples as early as 72 hours.

AMAÇ: Bir sinir koruyucu ilaç olan sitikolinin fetuin-A ve matriks Gla-protein (MGP) gibi kalsifikasyon modülatörlerini tetikleyerek posttravmatik nörogenez ve anjiyogenez sonrasý bilinçlilik düzeyini iyileþtirdiði, ikincil beyin hasarýný ve ektopik vasküler kalsifikasyonu hafiflettiði ileri sürülmüþtür. Bu çalýþma aðýr travmatik beyin hasarlý hastalarda sitikolinin bilinçlilik, serum fetuin-A ve MGP düzeyleri üzerine etkilerini araþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: Bu çift-kör randomize kontrollü çalýþma (RKÇ) yaygýn aksonal hasar tanýlý GK skoru ≤8 olan hastalarda yapýldý. Olgular 15 gün sitikolinle (6 saatte bir 500 mg i.v.) tedavi edildi. Hem hastalar hem de kontroller günlük GCS deðerlendirmesinden geçti, belli aralarla kan analizleri yapýldý.
BULGULAR: Çalýþmaya 58 hasta katýldý. Çalýþma dönemi boyunca her iki grupta Glaskov Skala skorlarý iyileþmiþ olduðu gibi gruplar arasýndaki farklýlýk hatýrý sayýlýr derecede deðildi (p>0.05). Sitikolinle tedavi edilen grupta bir negatif faz reaktaný olan serum fetuin-A düzeyleri artmýþken (p=0.012), kontrollerde bu deðiþiklikler anlamlý deðildi (p=0.455). Bir kalsifikasyon inhibitörü olan serum MGP düzeyleri hastalarda yükselmiþti (p=0.046). Kontrol grubundaki deðiþiklikler anlamlý deðildi (p=0.405).
TARTIÞMA: Bulgularýmýz sitikolinin bilinçlilik düzeyi ve GKS üzerine nötr etkileri olduðunu düþündürtmektedir. Sitikolin fetuin-A ve MGP düzeylerini yükselterek kafa travmasýna baðlý enflamatuvar hasar ve vasküler kalsifikasyona karþý koruyucu etkilere sahip olabilir.

Introduction: Citicoline, a neuroprotective drug, has been suggested to improve level of consciousness, mitigating secondary brain damage and ectopic vascular calcification, following post-traumatic neurogenesis and angiogenesis, inducing calcification modulators, like fetuin-A and matrix Gla-protein(MGP). This study aimed to investigate effects of citicoline on levels of consciousness, serum levels of fetuin-A and MGP in patients with severe traumatic brain injury.
Materials & Methods: This double blind randomized controlled trial(RCT), on patients with diagnosis of diffuse axonal injury(DAI) and GCS≤8. The cases were treated with citicoline (500mg every 6 hours), intravenously, for 15 days. Daily GCS assessment and intermittent blood sampling were done for both cases and controls.
Results: 58 patients were included. During study period, mean GCS levels improved in both groups; however, the difference was inconsiderable(P>0.05). Serum levels of fetuin-A, a negative phase reactant, increased in group treated with citicoline(P=0.012); while these changes were insignificant for controls(P=0.455). Serum levels of MGP, a calcification inhibitor, increased in cases(P=0.046); The alterations were inconsequential in control group(P=0.405).
Conclusion: Our findings suggest neutral effects of citicoline on level of consciousness and GCS. Via increasing levels of fetuin-A and MGP, citicoline may have protective effects against inflammatory damage and vascular calcification secondary to head trauma.

AMAÇ: Çalýþmamýzda künt baðýrsak ve mezenter yaralanmalarýnda (KBMY), çok kesitli bilgisayarlý tomografinin (ÇKBT) tanýsal etkinliðinin ve farklý düzeydeki radyolog tecrübesinin tanýya katkýsýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Çalýþma grubuna travma nedeniyle cerrahi uygulanan ve klinik önemli KBMY olduðu doðrulanan ve ameliyat öncesi BT incelemeleri mevcut olan 27 hasta (23 erkek, 4 kadýn, ort. yaþ 40.77±16.2 yýl; daðýlým 18-76 yýl) alýndý. Kontrol grubu olarak da yine ayný dönemde BT incelemesi mevcut olan ve cerrahi sonrasý KBMY olmadýðý doðrulanmýþ 21 hasta (16 erkek, 5 kadýn, ort. yaþ 38.9±14.5; daðýlým, 20-68) alýndý. Cerrahi öncesi 16 kesitli ÇKBT ile yapýlan incelemeler ameliyat bilgileri bilinmeksizin tekrar yorumlandý. ÇKBT bulgularý ameliyat bulgularý ile karþýlaþtýrýldý.
BULGULAR: Çok kesitli bilgisayarlý tomografi bulgularý içinde; intraperitoneal serbest hava, mezenterik hava, baðýrsak duvarýnda kalýnlaþma (>4-5 mm), baðýrsak duvarýnda kontrastlanma artýþý, baðýrsak duvarýnda defekt ve mezenterik hemanjiom bulgusu, doðruluk, özgüllük ve pozitif öngörü deðer bakýmýndan yüksek bulundu (p<0.01). KBMY doðru taný koyabilmede kýdemli radyoloji asistaný ve abdomen tecrübeli radyolog arasýnda duyarlýlýk ve özgüllük sýrasýyla %74, %71 ve %85, %100 bulundu.
TARTIÞMA: Çok kesitli bilgisayarlý tomografi, KBMY’yi yüksek duyarlýlýk ve özgüllük ile gösterebilir ve cerrahi gerekliliðini öngörebilir. Radyolojideki tecrübe ÇKBT’nin doðru raporlanmasýnda önemli bir faktördür.

Introduction
The purpose of this study was to investigate the diagnostic efficiency of multidetector computed tomography (MDCT) in the detection of blunt bowel and mesenteric injuries (BBMI), and the role of different experience levels in using MDCT.
Methods
This study included a test group of 27 patients with surgically important BBMI in whom the diagnoses were confirmed after surgical intervention (23 men and 4 women; mean age, 40.7 ± 16.2; range 18–76), and a control group of 21 matched patients without BBMI underwent laparotomy for trauma during the same time period (16 men and 5 women; mean age, 38.9 ± 14.5;range, 20–68) and 16-detector computed tomography prior to surgery. Intraoperative findings were compared with MDCT findings.
Results
We found high accuracy, specificity, and positive predictive values in MDCT findings with respect to intraperitoneal free air, mesenteric air, thickened (>4–5 mm) and defected bowel wall, increased contrast enhancement on bowel wall, and mesenteric hematoma among others (p < 0.01).
Sensitivities and specificities of the diagnosis of BBMI by the resident and staff radiologist was 74% and 71%, and 85% and 100%, respectively.
Conclusion
MDCT displays BBMI with high sensitivity and specificity, and can predict the need for surgery. Experience in radiology is an important factor for appropriate interpretation of the MDCT findings.

AMAÇ: Bu çalýþmanýn amacý komplike olmayan apandisitlerin tanýsýnda ve komplike apandisitlerin belirlenmesinde lökosit sayýsý ve nötrofil oranýnýn tanýsal deðerlerini belirlemektir.
GEREÇ VE YÖNTEM: Bu çalýþmada Ocak 2011 ile Aralýk 2012 tarihleri arasýnda akut apandisit tanýsýyla apandektomi yapýlmýþ olan hastalar geriye dönük olarak deðerlendirildi. Lökosit sayýlarý, nötrofil yüzdeleri ve fiziksel inceleme bulgularý deðerlendirildi. Lökosit sayýlarýnýn ve nötrofil oranlarýnýn duyarlýlýk ve özgüllükleri hesaplandý.
BULGULAR: Akut apandisit tanýsýyla 159 hasta ameliyat edilmiþtir. Hastalarýn %82.4’ünde komplike olmayan, %17.6’sýnda komplike apandisit tespit edilmiþtir. Lökosit sayýsýnýn apandisit tanýsýnda düþük duyarlýlýk ve özgüllüðünün olduðu görüldü (sýrasýyla %67.5 ve %36.3). Nötrofil oranýnýn duyarlýlýðý %60.1, özgüllüðü ise %90.9 olarak bulundu. Komplike apandisit erkeklerde daha sýk görülmektedir. Lökosit sayýsý komplike apandisitli hastalarda istatistiksel olarak anlamlý yüksek bulundu.
TARTIÞMA: Akut apandisit tanýsýnda lökosit sayýlarý ve nötrofil oranlarý deðerlendirilmiþtir. Nötrofil oranýnýn daha yüksek duyarlýlýk ve özgüllüðe sahip olduðu görülmüþtür. Ayný zamanda erkek cinsiyetin ve lökosit sayýsýndaki yüksekliðin komplike apandisit açýsýndan birer risk faktörü olduðu görülmüþtür.

BACKGROUND: The aim of this study was to establish the diagnostic value of leucocyte count and neutruphil percentage in both diagnosing simple appendicitis and predicting complicated appendicitis.
MATERIAL AND METHOD: The patients who underwent appendectomy with a clinical diagnosis of AA between January 2011 and December 2012 were studied retrospectively. Analysis of the data of total WBC count, neutrophil ratio, physical findings were performed. Sensitivities and specificities of leucocyte count and neutrophil ratio were calculated.
RESULTS: 159 patients were operated with the diagnosis of acute appendicitis. Simple appendicitis was detected in 82.4% and complicated appendicitis was detected in 17.6%. Leucocyte count has low sensitivity and specificity for diagnosing acute appendicitis (67.5 % and 36.3% respectively). Neutrophil ratio has a sensitivity rate of 60.1% and specificity rate of 90.9%. The complicated appendicitis was more common in male patients. Leucocyte count was statistically higher in patients with complicated appendicitis.
CONCLUSION: Two inflammatory markers, leucocyte count and neutrophil ratio were evaluated for diagnosis of acute appendicitis.Neutrophil ratio has higher sensitivity and spesificity for acute appendicitis. On the other hand increased leucocyte count and male gender was found to be a risk factor for complicated appendicitis.

AMAÇ: Uzun segment üretral darlýklarda penil fasyokutanöz flep üretroplastinin baþarýsýný incelemek.
GEREÇ VE YÖNTEM: Çalýþmamýza uzun segment üretral darlýðý olan 17 hasta alýndý. Darlýk segmentinin uzunluðuna göre, vertikal veya sirküler penil deri fasyokutanöz flep, 18 F üretral kateter üzerinden anastomoz edildi. Hastalar, üretral kateterin alýnmasýnýn ardýndan birinci haftada ve altýncý ayda üroflovmetri ve ultrasonografi eþliðinde yapýlan iþeme sonrasý rezidüel idrar hacmi ölçümleri ile deðerlendirildi.
BULGULAR: Hastalarýn ortalama yaþý 52 (17-67) yýl, ortalama takip süresi 60 (12-96) ay idi. Ortalama darlýk uzunluðu 105 (40-150) mm olarak saptandý. Vertikal ve sirküler penil fasyokutanöz flepler sýrasý ile dört ve 13 hasta için kullanýldý. Üretral kateterin alýnmasýnýn ardýndan birinci haftada yapýlan maksimum idrar akým hýzý ve iþeme sonrasý rezidüel idrar ölçümleri sýrasý ile 19.1 (9-31) ml/sn ve 12.9 (0 - 40) cm3 idi. Ayný parametreler ameliyat sonrasý altýncý ayda 17.4 (8-25) ve 15.2 (0-40) olarak ölçüldü.
TARTIÞMA: Uzun dönem sonuçlarýmýz penil fasyokutanöz flep üretroplastinin uzun segment üretral darlýklarda uygun bir tedavi seçeneði olduðunu göstermektedir.

Background: To evaluate the succes of penil fasciocutaneous flap urethroplasty in treatment of long segment urethral stricture.
Methods: In this study, 17 patients with long segment urethral stricture were included. According to lenght of the narrow segment, vertical or circular penile skin fasciocutaneous flap was anastomosed on 18 F urethral catheter. In first week and 6th month after removal of urethral catheter, patients were controlled by uroflowmetry and postvoiding residual urine volume measurement by ultrasound.
Results: The mean age of the patients were 52 (range; 17 to 67) years. The mean follow up-time was 60 (12-96) months. Mean length of stricture was 105 (40-150) mm. Vertical and circular penile fasciocutaneous flaps were used in 4 and 13 patients, respectively. Maximum urine flow rate and postvoiding residual urine assessment in first week after removal of urethral catheter were 19.1 (range; 9 to 31) ml/s and 12.9 (range; 0 to 40) cm3, respectively. Same parameters in postoperative 6th months were 17.4 (range; 8 to 25) ml/s and 15.2 (range; 0 to 40) cm3 respectively.
Conclusion: Our long term results showed that penile fasciocutaneous flap urethroplasty method seems to be a reasonable treatment option in treatment of long segment urethral stricture.

AMAÇ: Bu çalýþmanýn amacý, beyin BT taramasýnda minör kafa travmasý (MHI) bulgularý olan hastalarda baþ aðrýsýnýn morfine yanýtýný incelemek ve BT taramasý gereken hastalarý tanýmlamak için yeni bir risk göstergesini önermektir.
GEREÇ VE YÖNTEM: Baþ aðrýsý ve GCS skoru 14 veya 15 ile gelen 15 yaþ ve üstü toplam 1857 MHI hastasý çalýþmaya alýndý. Ýntravenöz morfin sülfat yapýldý ve hastalar daha sonra baþ aðrýsýnýn geçmesi veya süregelmesine göre deðerlendirildi. Daha sonra tüm hastalarýn beyin BT taramasý çekildi.
BULGULAR: Hastalar 15-60 ve 60 yaþ üstü olmak üzere iki yaþ grubuna ayrýldý. Her iki grupta BT sonucu ile morfine yanýt arasýnda önemli bir iliþki mevcuttu (p<0.001). On beþ ile 60 yaþ arasýnda, baþ aðrýsý morfine yanýt vermiþ olanlarýn hiçbirinin BT taramasýnda herhangi bir anormal bulgu görülmedi (duyarlýlýk= %100). Altmýþ yaþ üstü grupta anormal BT bulgusu ve nöroþirürji giriþim endikasyonu açýsýndan morfine yanýtýn duyarlýlýk dereceleri sýrasýyla %58.3 ve %71.4 idi.
TARTIÞMA: Bu çalýþma morfinle geçmeyen baþ aðrýsýnýn kafa içi travmasý için bir risk göstergesi olduðunu düþündürmektedir. BT’ye eriþimin sýnýrlý olduðu kýrsal alanlarda, BT taramasý endike MHI hastalarýnýn seçimine iliþkin mevcut kriterlere ek olarak bu protokol kullanýlabilir.

Objective: The aim of this study was to examine the association of the response of headache to morphine with the findings of brain CT scan in minor head injury (MHI), and to propose a new risk indicator to identify patients that require CT scanning.
Methods: A total of 1857 MHI patients ≥15 years old, presenting with headache and a GCS score of 14 or 15 were enrolled. Intravenous morphine sulfate was administered and patients were assessed for the relief or persistence of headache thereafter. Subsequently, a brain CT scan was obtained from all patients.
Results: Patients were divided into two age groups: 15-60 and >60 years. There was significant association between the response of headache to morphine and the result of CT in both groups (p<0.001). In patients aged 15-60, none of those whose headache had responded to morphine showed any abnormal findings in the CT scan (sensitivity=100%). In the >60 group, sensitivity was 58.3% for abnormal CT and 71.4% for neurosurgical interventions.
Conclusion: This study suggests that a headache not relieved by morphine is a risk indicator for intracranial injury. This protocol can be used in rural areas with limited access to CT as an adjunct to the existing criteria for selecting the patients with MHI for CT scanning.

AMAÇ: Akut travmatik kalça çýkýðý olan altý çocuk hasta geriye dönük olarak incelendi. Bu hastalarda çýkýðýn tipi, iliþkili lezyonlar, tedavi yöntemleri, komplikasyonlar, klinik ve radyolojik sonuçlar deðerlendirildi.
GEREÇ VE YÖNTEM: Kliniðimizde 2007 ile 2011 tarihleri arasýnda travmatik kalça çýkýðý nedeniyle tedavi edilmiþ olan altý çocuk hasta çalýþmaya alýndý. Hastalarýn beþi erkek, biri kýz, ortalama yaþ 8 yýl 8 ay (daðýlým; 5 yýl 9 ay-10 yýl 11 ay). Olgularýn ortalama takip süreleri 25.2±10 aydý. (daðýlým 12-40 ay). Beþ olguda posterior çýkýk, bir olguda ise transepifizyal kýrýklý çýkýk mevcuttu. Dört olgu kapalý, iki olgu ise açýk redüksiyon yöntemiyle tedavi edildi.
BULGULAR: Hastalarýn son takibinde, bir hastada osteokondral kýrýða baðlý eklem mesafesinde asimetrik geniþleme saptandý, diðer bir hastada koksa magna geliþti. Transepifizyal kýrýklý çýkýðý olan bir olguda avasküler nekroz geliþti. Beþ olguda Harris hip skoru deðerlendirmesi mükemmel, kýrýklý çýkýk olgusunda ise kötü olarak bulundu.
TARTIÞMA: Bu oldukça nadir karþýlaþýlan olgular mümkün olan en kýsa sürede öncelikle kapalý yöntemle tedavi edilmelidir. Tekrarlayan kapalý redüksiyon denemelerinden kaçýnýlmalý, redükte olmayan olgularda eþlik eden lezyonlarýn önceden tanýnmasý için mümkünse BT ve MR görüntüleme gibi ileri incelemeler yapýldýktan sonra açýk redüksiyona geçilmelidir.

BACKGROUND: We retrospectively analyzed six acute traumatic hip dislocations in pediatric patients. We reviewed types of dislocations, associated lesions, treatment methods, complications, clinical and radiological outcomes.
METHODS: Six child patients treated due to traumatic hip dislocation between 2007 and 2011 in our clinic were included the study. Five of the patients were male; one of them was female, average age was 8 years and 8 months. The mean follow-up was 25.2±10 months. There were posterior dislocation in five cases and transepiphyseal fractured dislocation in one case. Four cases were treated by closed reduction while two cases were treated with open reduction method.
RESULTS: In the last control of the patients, asymmetric widening in the hip joint was found due to osteochondral fracture in one patient and coxa magna occurred in one patient. Avascular necrosis developed in one case with transepiphyseal fractured dislocation. Harris hip score evaluation was found excellent in five cases and bad in the case with fractured dislocation.
CONCLUSION: Traumatic hip dislocation is a rare condition. It should be treated with preferably closed method as soon as possible. Repetitive reduction trials should be avoided. Open reduction should be performed to recognize accompanying lesions after advanced radiologic examinations such as computerized tomography and magnetic resonance imaging.

AMAÇ: Daha önce tanýmlanmýþ, fakat az kullanýlan “ekstended” veya vertical rektus abdominis muskulokutan (“Ekstended” RAM, VRAM) fleplerinin çok nadir endikasyonlardaki kullanýmlarý incelendi.
GEREÇ VE YÖNTEM: Beþ hastada, 28x8 ile 35x10 cm ebatlarýnda cilt adasý içeren flepler kullanýldý. Dört flep uyluk ve diz proksimal bölgedeki defekt onarýmlarý için inguinal ligamentin altýndan, bir flep lomber gölgedeki defekt onarýmý için transabdominal olarak defekt alanlara taþýndý.
BULGULAR: Hiçbir olguda flep kaybý görülmedi. Bir olguda yara yeri enfeksiyonu geliþti ve cerrahi ile tedavi edildi. Uyluk ve lomber bölge defektleri onarýmlarýnda düþük komplikasyon oranlarýyla “ekstended” RAM ve VRAM fleple baþarýlý transfer gerçekleþtirildi ve çok güvenli ve uygun bir seçenek olduðu sunuldu.
SONUÇ: Avantajlarý bol miktarda ve iyi kanlanan doku taþýmasýný saðlar, flep kolay ve hýzlý hazýrlanýr ve mikrocerrahi deneyimi gerektirmez.

A series of previously described but rarely used variation of the pedicled extended or vertical rectus abdominis musculocutaneous flap (Extended RAM, VRAM) was reviewed. Skin paddle dimensions ranged from 8 to 28 cm in width and from 10 to 35 cm in length in 5 consecutive patients. Four flaps were placed through deep to the inguinal ligament to repair the thigh as far as the proximal to the knee region; the remaining one flap was passed transabdominally to cover the defect of the lumbar region. No flaps necroses were seen, and one case wound healing problems required minimal operative intervention.
Successful transfer of the VRAM and extended RAM with low rate of complication for the thigh and lumbar region defects was demonstrated to be safe and reasonable option of flap reconstruction. The flaps had the advantages of being robust and a well vascularized flap, easy and fast to harvest, and not requiring microsurgery experience.

Ateþli silah yaralanmalarý yaygýn bir medikal-legal sorun teþkil eden konulardan biridir. Bu tür yaralanmalarýn oluþturduðu atipik trakt hatlarý taný ve tedavide zorluklar çýkarabilmektedir. Bu yazýda. sað uyluk ön bölgesinden meydana gelen ateþli silah yaralanmasýnýn sað hemitoraksa uzanan atipik seyrini sunduk. Ateþli silah yaralanmasý nedeniyle 67 yaþýndaki Suriyeli mülteci erkek hasta acil servise getirildi. Sað uyluk ön medial bölgesinde mermi giriþ deliði tespit edildi, ancak çýkýþ deliði yoktu. Toraks tomografisinde mermi sað hemitoraksda tespit edildi, hasta diyafragma rüptürü ve akciðer parankim hasarý nedeniyle operasyona alýndý. Ateþli silah yaralanmalarýnda mermi çekirdeðinin saptanamamasý durumunda diðer vücut kýsýmlarýnýn radyolojik görüntülemesi mutlak yapýlmalýdýr.

Gunshot injuries are common medical-legal issues. Atypical tract lines which are resulted from this type of injuries cause difficulties in diagnosis and treatment. In this paper, we presented gunshot injury at right anterior thigh extending to the right hemithorax. Syrian refugee patient who was 67 years old was brought to emergency service because of gunshot injury. Bullet entrance hole was determined at right anterior thigh region, but exit side could not be seen. Bullet was determined at right thorax at tomography, and patient was taken to operation because of diaphragma rupture and lung paranchymal injury. Other body parts must be examined radiologically for bullet which can not be determined at gunshot injury side.

Nekrotizan fasiit deri ve yumuþak dokularý etkileyen, künt karýn travmasýndan sonra geliþebilen, karýn duvarý hernisine neden olan ve doktorlar için büyük bir sorun oluþturan kritik önemde bir hastalýktýr. Elli iki yaþýndaki erkek bir trafik kazasý ardýndan acil servise künt karýn travmasýna baðlý sað alt karýn bölgesinde redükte edilemeyen büyük bir kitle ile getirildi. Ýlk BT herhangi bir komplikasyon bulgusu olmayan bir abdominal herniyi göstermiþti. Yoðun bakým ünitesine kabulden üç saat sonra, hastada hemodinamik instabilite geliþtiðinden yeniden bir BT taramasý istendi. Ameliyathaneye getirildi ve ameliyatta ileal baðýrsak segmentinin tümüyle enine yarýlmýþ olduðu saptandý. Cerrahiden beþ saat sonra deri ve yumuþak doku enfeksiyonu belirtileriyle birlikte yeni bir hemodinamik instabilite ataðý geçirdi. Yüksek bir klinik nekrotizan fasiit geliþme kuþkusu nedeniyle geniþ bir debridman yapýldý. Karýn duvarý hernisi ardýndan hastalar karýn organlarýnda kuþkulanýlmaayan yaralanmalarla gelebilir. Ýlk dakikalarda çekilen spiral BT yalancý negatif sonuçlara ve neticede yanlýþ tanýya yol açabilir. Nekrotizan fasiit ölümcül olabilen bir enfeksiyon olduðundan sonuçta resüsitasyon önlemleri, geniþ spektrumlu antibiyotikler ve erken dönemde cerrahi debridman gerekir. Bu tip fasiit künt karýn travmasýna baðlý deri bütünlüðünün bozulmadýðý karýn duvarý hernisi sonrasý bu tip fasiit geliþebilir.

Background:
Necrotising fascitis is a critical illness involving skin and soft tissues, which may develope after blunt abdominal trauma trauma causing abdominal wall hernia, representing a great challenge for physicians.
Case Report:
A 52-year-old man was brought to the emergency department after a road accident presenting blunt abdominal trauma, with a large non-reducible mass in the lower-right abdomen. A first CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore a new CT scan was requested, which showed signs of hernia complication. He was moved to the operating room, where a complete transversal section of an ileal loop was identified. Five hours after the surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotising fascitis developing, wide debridement was performed.
Conclusions:
Following Traumatic Abdominal Wall Hernia (TAWH) patients can present unsuspected injuries in the abdominal organs. Helical CT can be falsely negative in the early moments leading to a misdiagnosis. Necrotising fascitis is a potentially fatal infection, and consequently resuscitation measures, wide-spectrum antibiotics and early surgical debridement are required. This type of fascitis can be developed after blunt abdominal trauma following wall hernia without skin disruption.

Bu yazýda, künt boyun travmasý sonrasý seyrek görülen ve sað kalan bir komplet trakeal transeksiyon olgusu sunuldu. Altmýþ altý yaþýnda erkek hasta bir motosiklet kazasý sonrasý, boynunu bir halata kaptýrmýþ vaziyette acil servise getirildi. Bilinci açýk olmasýna raðmen solunum sýkýntýsý çekiyordu. Bilgisayarlý tomografi taramasý servikal trakea transeksiyonunu gösteriyordu. Acil boyun eksplorasyonu trakea laserasyonunun trakea anteriorda 3. halkadan posteriorda 1, halkaya uzandýðýný ve ön özofagus duvarýnýn yýrtýlmýþ olduðunu gösteriyordu. Larengektomi, trakeostomi ve özofagofarengeal anastomoz yapýldý. Bu olgularýn saðkalýmý için acilen havayolunun açýlmasý ve hemen boyun eksplorasyonu yapýlmasý önemlidir.

We report the survival of a rare case of complete tracheal transection following blunt neck trauma. A 66-year-old man presented at emergency room after a motorcycle accident in which his neck was caught in a rope. He was alert but in respiratory distress. A computed tomographic scan showed a transection of the cervical trachea. Emergency neck exploration revealed that the tracheal laceration had cut from the tracheal anterior 3rd ring to the posterior 1st ring and the anterior esophageal wall had ruptured. A laryngectomy, tracheostomy, and esophagopharyngeal anastomosis were performed. Prompt airway management and immediate neck exploration is important for survival in these cases.

Travmatik diyafram rüptürü genellikle motorlu araç kazasýna baðlý penetran travmalar sonucunda meydana gelir. Olgularýn %90’ýnda diðer organ yaralanmalarý ile beraberdir. Direkt grafi, bilgisayarlý tomografi, manyetik rezonans görüntüleme, kontrastlý üst gastrointestinal sistem incelemesi ve torakoskopi/laparoskopi klinikte taný amaçlý kullanýlan yöntemlerdir. Biz bu olguda diyafram rüptürü sonrasý karaciðer herniasyonuna sekonder geliþen sað ventrikül kollapslý bir hasta sunduk. Hastanýn tanýsý arka-ön akciðer grafisi ve bilgisayarlý tomografi ile konuldu. Hemodinamisi kötü olan hastaya acil cerrahi planlandý. Sað ventrikül üzerindeki mekanik basýnç ortadan kaldýrýldýðýnda eþ zamanlý hemodinamik iyileþme gözlendi.

The traumatic diaphragm rupture occurs frequenty after the motor vehicle accidents via penetrating traumas. In 90 % of patients, traumatic diaphragm rupture commonly coexists with other organ injuries. Posteroanterior chest x-ray, computed tomography, magnetic resonance imaging, upper gastrointestinal system contrast-enhanced examinations and thoraxoscopy /laparoscopy are several modalities can be used for diagnosing traumatic diaphragm rupture in clinical practice.
We present a case of right ventricle collaps secondary to hepatothorax caused by diaphragm rupture. Patient was diagnosed by posteroanterior chest x-ray and computed tomography. Emergency surgery was planned due to the hemodynamic instability. When the mechanical pressure on right ventricle was disappeared, at the time hemodynamic improvement was observed.