AMAÇ: Bu çalýþmada, mekanik ezilme yaralanmasý oluþturulan sýçanlarda, asetaminofen ve mannitolün böbrek fonksiyonu ve histopatolojisi üzerine etkileri araþtýrýldý.
GEREÇ VE YÖNTEM: Çalýþmada 370–400 gram aðýrlýðýnda 36 sýçan kullanýldý. Kontrol amaçlý birinci gruba bir iþlem uygulanmadý. Diðer beþ gruba ikiþer saat süresince her iki bacak gastroknemius kasý bölgesine mekanik ezilme iþlemi uygulandý. Sonra dördüncü gruba asetaminofen 100 mg/kg; beþinci gruba mannitol 1 gr/kg; altýncý gruba asetaminofen 100 mg/kg ve mannitol 1 gr/kg intraperitoneal verildi. Herhangi bir tedavi uygulanmayan ikinci grup iki saat sonra, üçüncü grup ve tedavi gruplarý ise 24 saat sonra sakrifiye edilerek kan ve doku örnekleri alýndý.
BULGULAR: Sodyum, potasyum, alanin aminotranferaz, kreatinin, ortalama kreatinin klirensi deðerleri açýsýndan asetaminofen ve mannitol tedavi gruplarý arasýnda istatistiksel olarak anlamlý fark bulunmadý. Histopatolojik olarak hidropik dejenerasyon, tübüler nekroz, enflamasyon, tubulus lümeninde immünoperoksidaz ve miyoglobin varlýðý, tubulus epitel hücre dejenerasyonu, tubulus lümeninde PAS boyanan materyel varlýðý bulgularýnýn mannitol uygulanan grupta azaldýðý, asetaminofen uygulanan grupta mannitol uygulanan gruptan daha fazla azaldýðý, asetaminofenle mannitol birlikte uygulandýðýnda ise bulgularýn tek baþýna mannitol uygulamasýndan daha iyi, ancak tek baþýna asetaminofen uygulamasýndan daha iyi olmadýðý görüldü.
TARTIÞMA: Ezilme yaralanmalarýnda oluþan böbrek hasarýnda asetaminofen histopatolojik olarak mannitolden daha etkilidir. Asetamniofen mannitolle birlikte kullanýldýðýnda ise karaciðere olan toksik etkisi daha az olmaktadýr.

BACKGROUND: The present objective was to evaluate effects of acetaminophen and mannitol on renal function and histopathology in crush injuries.
METHODS: Thirty-six rats weighing 370–400 g each were used. No surgery was performed on the first (control) group. The gastrocnemius muscle regions of each rat in the remaining 5 groups were compressed for 2 or 24 hours. In the 4th group, 100 mg/ kg acetaminophen was intraperitoneally administered. In the 5th group, 1 g/kg mannitol was administered. In the 6th group, 100 mg/kg acetaminophen and 1 g/kg mannitol were administered.
RESULTS: No statistically significant differences were observed among the treatment groups in terms of sodium, potassium, alanine aminotransferase (ALT), and average creatinine clearance values. Hydropic degeneration, tubular necrosis, presence of immunoperoxidase and myoglobin, tubulus epithelial cell degeneration, and presence of PAS-dyed material in tubular lumen was more prominently decreased in the acetaminophen group than the mannitol group. Improvement was observed in the group that was administered both drugs, compared to the mannitol-only group, though findings were still worse than those of the group administered acetaminophen only.
CONCLUSION: In crush injuries, acetaminophen improves histopathological renal damage better than mannitol. When used in conjunction with mannitol, the toxic effect of acetaminophen on the liver is decreased.

AMAÇ: Deneysel sepsis modelinde erken dönem melatonin uygulamasýnýn anastomoz yara iyileþmesi ve enflamasyon üzerine olan etkilerini göstermeyi amaçladýk.
GEREÇ VE YÖNTEM: Altmýþ Wistar-Albino sýçan iki gruba ayrýldý. Melatonin ve kontrol gruplarýna çekal ligasyon ve puncture ile kolonik rezeksiyon ve anastomoz yapýldý. Her iki gruptan 10’ar sýçana 16. saat, üçüncü ve yedinci günlerde relaparotomi yapýldý. Erken dönem sepsiste melatonin tedavisinin etkilerini incelemek amacýyla interlökin-6, interlökin-10, interferon-gama, C-reaktif protein düzeyleri, patlama basýnçlarý, anastomotik segmentlerdeki kollajen hidroksiprolin içeriði, histopatolojik iyileþme düzeyleri ve CD34 ve “transforming growth factor beta” immünhistokimyasal düzeyleri deðerlendirildi.
BULGULAR: Tedavi grubunda interlökin-6 ve interferon-gama düzeylerinin ameliyat sonrasý 16. saatte anlamlý olarak azaldýðý, üçüncü ve yedinci günlerde ise artmýþ olduðu bulundu. Ýnterlökin-10 düzeyleri ise kontrol grubunda ameliyat sonrasý 16. saatte anlamlý olarak artmýþken, üçüncü ve yedinci günlerde düþük bulundu (p<0.001). Ayný zamanda tedavi grubunda kapiller permeabilite, fibroblast proliferasyonu ve kollajen depositleri anlamlý olarak yüksek bulundu (p<0.001). CD34 ekspresyonu tedavi grubunda ameliyat sonrasý yedinci günde anlamlý olarak yüksek bulundu (p=0.005).
TARTIÞMA: Sýçan modelinde erken sepsis döneminde melatonin uygulamasýnýn kolonik anastomoz iyileþmesini anlamlý olarak artýrdýðýný düþünüyoruz.

BACKGROUND: The present objective was to identify effects of early melatonin application on healing of anastomotic wound and inflammation in an experimental sepsis model.
METHODS: A total of 60 Wistar albino rats were divided into 2 groups. Cecal ligation puncture (CLP) and colonic resection anastomosis were performed on both the control group and the melatonin treatment group. Both groups were divided into 3 subgroups consisting of 10 rats each. One subgroup from each group underwent re-laparotomy at the 16th hour, the next on the 3rd day, and the final subgroup on the 7th day. Presently evaluated were effects of melatonin treatment of early sepsis on interleukin-6 (IL-6), interleukin-10 (IL-10), interferon gamma (INF-γ), and C-reactive protein (CRP) levels, as well as burst pressures (BPs), collagen and hydroxyproline (OHP) content of the anastomotic segments, histopathologic healing, immunohistochemical expressions, CD34, and transforming growth factor beta (TGF-β).
RESULTS: IL-6 and INF-γ levels of the treatment group showed a significant decrease at the 16th hour and an increase on the 3rd and 7th postoperative days. IL-10 levels were significantly higher at the 16th hour and significantly lower on the 3rd and 7th postoperative days in the control group (p<0.001 for each). The treatment group also showed significantly higher capillary permeability, fibroblast proliferation, and collagen deposits (p<0.001 for each). CD34 expression was significantly increased in the treatment group on the 7th postoperative day (p=0.005).
CONCLUSION: Application of melatonin in early sepsis significantly improved colonic anastomotic healing in a rat model.

AMAÇ: Sýçanlarda oluþturulan künt göðüs travmasýna baðlý akciðer kontüzyon modelinde, ilk 24 saat içinde endojen eritropoetin düzeylerinin oksidatif stresle iliþkisi ve ekzojen eritropoietinin etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Otuz beþ sýçan üç gruba ayrýldý: Grup BC (bazal kontrolü, n=7), herhangi bir iþlem yapýlmadý; Grup PC (pozitif kontrol, n=21), sýçanlarda kontüzyon oluþturuldu fakat tedavi verilmedi; Grup EPO-24 (eritropoietin tedavi, n=7), sýçanlarda kontüzyon oluþturuldu ve künt göðüs travmasýndan hemen sonra intraperitonal (5000 lU/kg) tek bir doz eritropoietin verildi. Pozitif kontrol grubu her grupta yediþer sýçan olacak þekilde üç alt gruba ayrýldý (PC-6, PC-12, PC-24). PC-6, PC-12, PC-24 grubundaki sýçanlar, künt travmadan 6, 12 ve 24 saat sonra, EPO-24 ve BC grubundaki sýçanlar ise travmadan 24 saat sonra öldürüldü. Akciðer dokusunda malondialdehit (MDA) ve EPO düzeyleri, süperoksit dismutaz (SOD) ve katalaz (CAT) aktiviteleri ölçüldü. BC, PC-24 ve EPO-24 gruplarýnda histopatolojik incelemeyle total doku hasarý saptandý.
BULGULAR: Ortalama MDA düzeyleri, SOD ve CAT aktiviteleri BC ve EPO-24 gruplarýnda PC grubuna göre düþüktü (p<0.005). PC-6, PC-12 ve PC-24 grubunun ortalama EPO konsantrasyonu BC grubuna göre daha yüksek bulundu (p<0.005). Akciðer doku hasarý skorlarý EPO-24 grubunda PC-24 grubuna göre daha düþüktü (p<0.005).
TARTIÞMA: Eritropoietin konsantrasyonlarý, SOD ve CAT düzeyleri pulmoner kontüzyon sonrasý ilk 24 saatte akciðer dokusunda yüksek olduðu saptandý. Göðüs travmasý sonrasý akut dönemde uygulanan tek doz intraperitoneal eritropoetin (5000 IU/kg), travmanýn erken döneminde oksidatif hasarý ve doku zedelenmesini azaltmaktadýr.

BACKGROUND: The present objective was to investigate endogen erythropoietin (EPO) level and relationship to oxidative stress within the first 24 hours of blunt chest trauma-induced pulmo-nary contusion (PCn) in a rat model.
METHODS: Thirty-five rats were divided into 3 groups. In the baseline control group (BC, n=7), rats were uninjured and untreated. In the positive control group (PC, n=21) rats were injured but untreated. In the EPO-24 group (n=7), rats were injured and a single dose of intra-peritoneal EPO (5000 IU/kg) was administered immediately after lung injury. The PC group was divided into 3 subgroups: PC-6 (n=7), PC-12 (n=7), and PC-24 (n=7). The BC group was subjected to thoracotomy, and the right lung was harvested. The PC subgroups were eu-thanized at 6, 12, and 24 hours after injury, respectively. The EPO-24 group was euthanized at the 24th hour after injury. Lung samples were obtained, levels of malondialdehyde (MDA) and EPO were analyzed, and activities of superoxide dismutase (SOD) and catalase (CAT) were then measured in homogenized lung tissue samples. Histologic damage to lung tissue in the BC group, the EPO-24 group, and PC subgroup euthanized at the 24th hour after injury were scored by a single pathologist blinded to group assignation.
RESULTS: Mean MDA levels, as well as SOD and CAT activities, of the BC and EPO-24 groups were significantly lower than those of the PC group (p<0.005). Mean EPO concentra-tion of the PC group was significantly higher than that of the BC group (p<0.005). Lung tis-sue damage scores measured at 24 hours after injury were significantly lower in the EPO-24 group than in the PC group (p<0.005).
CONCLUSION: In the present PCn rat model, EPO concentrations, as well as SOD and CAT levels, were high in lung tissue, when measured at 24 hours after PCn. When administered early after chest trauma, EPO significantly attenuated oxidative damage and tissue damage in the early phase, as assessed by biochemical markers and histologic scoring.

AMAÇ: Dünya ölçeðinde özellikle geliþmiþ ülkelerdeki çocuklar arasýnda travma sakatlýk ve ölümün önemli bir nedenidir. Burada amaç travma sonucu yaralanmýþ çocuklarda mortaliteyi öngörmede Pediyatrik Travma skoru (PTS), Glasgow Koma Ölçeði skoru (GKS) ve Travma Þiddet Derecesi skorunun etkililiklerini karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Poursina Týp ve Eðitim Merkezi’nin Acil Servisi’ne 2010-2011 yýlý arasýnda toplam 588 travmalý çocuk kabul edilmiþtir. Hastalarýn hepsi için PTS, GCS ve ISS hesaplandý. Alýcý iþletim karakteristik (ROC) eðrisi kullanýlarak %95 güven aralýðýyla bu skorlarýn öngördürücü etkililiði karþýlaþtýrýldý.
BULGULAR: Hasta popülasyonunun %62.1’i erkek ve %37.9’u kýz çocuklarýndan ibaretti. Yaþ ortalamasý 7.31±3.8 yýl idi. Yaralanmanýn en sýk görülen nedeni trafik kazasýydý (%42.2). Genelde katýlýmcýlarýn % 2.4’ü ölmüþtü. Mortalitenin öngörüsü açýsýndan GKS için en iyi kestirme deðeri ≤8 olup %98.4 duyarlýlýk ve %92.3 özgüllüðe sahipti. PTS için kestirme deðer ≤0.5 olup %100 duyarlýlýk ve %31’lik özgüllüðe sahipti. ISS için bu deðer ≥16.5 olup %92.5 duyarlýlýk ve %62’lik özgüllüðe sahipti. Mortalite öngörüsüne dayalý tüm deðiþkenler istatistiksel açýdan anlamlýydý (p<0.0001).
TARTIÞMA: Çocukluk çaðý travma olgularýnda PTS ve ISS ile karþýlaþtýrýldýðýnda GKS daha iyi bir öngördürücü faktör olabilir.

BACKGROUND: Trauma is a major cause of disability and death among children worldwide, particularly in developed countries. The present aim was to compare efficacies of the Pediatric Trauma score (PTS), the Glasgow Coma Scale score (GCS), and the Injury Severity Score (ISS) in the prediction of mortality in children injured by trauma.
METHODS: A total of 588 children admitted to the emergency ward of the Poursina Medical and Educational Center from 2010–2011 with trauma were included. The PTS, GCS, and ISS were calculated for all patients. Predictive efficacy of these scores was compared using receiver operating characteristic (ROC) curve with 95% confidence interval.
RESULTS: Of the patient population, 62.1% were male and 37.9% female, with a mean age of 7.31±3.8 years. Road accident (42.2%) was the most common cause of injury. Overall, 2.4% of participants died. Regarding the prediction of mortality, the best cut-off point for the GCS was ≤8, with 98.4% sensitivity and 92.3% specificity. The same point for the PTS was ≤0.5, with 100% sensitivity and 31% specificity. For the ISS it was ≥16.5, with 92.5% sensitivity and 62% specificity. All variables based on mortality prediction were statistically significant (p<0.0001).
CONCLUSION: When compared to the PTS and ISS, the GCS may be a better predictor of mortality in cases of childhood trauma.

AMAÇ: Bu çalýþmada, yýlan ýsýrmasý nedeni ile acil servise getirilen hastalarýn klinik evreleri, geliþen komplikasyonlar, yapýlan tedaviler ve sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM: Bu amaçla acil servise yýlan ýsýrmasý nedeni ile getirilen 132 olgu hastane kayýtlarýndan geriye dönük olarak incelendi.
BULGULAR: Hastalarýn %42.9’u (n=57) Evre 0 düzeyindeydi. En sýk görülen lokal komplikasyon aðrý (n=56; %42.4) iken sistemik komplikasyon International Normalized Ratio (INR) deðerinde uzama %5.3 (n=7) idi. Lokal komplikasyonlar her evrede görülebilirken sistemik komplikasyonlar ileri evrelerde görüldü. Yýlan antivenomu %46.4 (n=61) hastaya uygulandý. Altmýþ dokuz hasta (%52.2) hastaneye yatýrýlýrken, 63 hasta (%47.7) acil servisteki 6–12 saatlik gözlem sonrasý þifa ile taburcu edildi. Ölüm olgusu görülmedi. Olgulardan altý aylýk ve bir yýllýk sürede olumsuz geri bildirim alýnmadý.
TARTIÞMA: Yýlan ýsýrmasý olgularýnda yýlan zehirinde bulunan toksinlere göre oluþabilecek komplikasyonlar deðerlendirilmeli ve uygun tedavi evrelere göre zamanýnda baþlanmalýdýr. Bu yaklaþým komplikasyonlarýn geliþimini engeller veya azaltýr.

BACKGROUND: The present objective was to evaluate clinical stages, complications, treatment modalities, and termination of treatment in patients who presented to the emergency department with snakebite.
METHODS: A total of 132 snakebite cases were retrospectively examined using emergency department records.
RESULTS: The majority of patients, 42.9% (n=57), had grade 0 snakebite. The local complication most frequently observed was pain (42.4%, n=56); the most common systemic complication was prolonged international normalized ratio (INR) level (5.3%, n=7). Local complications were observed in patients at all stages, while systemic complications were observed only in patients at advanced stages. Antivenom was administered in 46.4% (n=61) of patients, 52.2% (n=69) of patients were hospitalized, and 47.7% (n=63) of patients were discharged after 6–12 hours of monitoring. No negative outcome was observed during 6-month or year-long follow-up.
CONCLUSION: Complications should be evaluated based on type of toxin, and appropriate treatment should be initiated efficiently, according to clinical stage. This approach reduces or prevents the development of complications.

AMAÇ: Akut apandisit etiyolojisinde en önemli fizyopatolojik sürecin apandiks lümeninin bir nedenle obstrüksiyonu ve enflamasyonu olduðu bilinmesine raðmen, bu enflamasyon ile endotelial nitrikoksit sentaz (eNOS) gen polimorfizmi arasýnda yapýlan bir araþtýrma bulunmamaktadýr. Oysaki enflamasyon ile endotelial nitrikoksit sentaz iliþkisi birçok çalýþmada gösterilmiþtir. Literatürdeki eksik yerini hala koruyan akut apandisit ve endotelial nitrikoksit sentaz gen polimorfizmi muhtemel iliþkisi hipotezi araþtýrýlmaða deðer bulunmuþtur.
GEREÇ VE YÖNTEM: Araþtýrma için 201 akut apandisitli ve 201 kontrol grubu olmak üzere 402 birey incelemeye alýndý. Acil servise baþvuran akut apandisitli hastalardan çalýþma grubu oluþturulurken, yakýnlarýndan da kontrol grubu belirlendi. Çalýþmada eNOS gen polimorfizmine ait genotipleri analiz edildi.
BULGULAR: Ýntron 4b/4a’nin 119 bireyde pozitif olduðu görüldü. Genotiplerden G894T-GT’nin 71 ve nitrikoksit sentaz 786-1’in 71 akut apandisitli olguda pozitif olduðu saptanarak, bu sonuçlar ile AA hastalarý ve kontrol grubu eNOS 4a/b, G894-GT ve 786-1 genotipleri arasýnda anlamlý bir fark bulunmadý.
TARTIÞMA: Akut apandisit ve eNOS gen polimorfizmi muhtemel iliþkisi olarak hipotezi kurulan bu çalýþmadan elde edilen sonuçlarda eNOS ile akut apandisit arasýnda istatistikî bir iliþki kurulmamýþtýr. Ancak, böyle bir iliþkinin olmadýðýný bu çalýþma ile iddia etmek mümkün gözükmemektedir. Metodolojik açýdan elde edilen veriler önem taþýmakta ve yapýlacak daha geniþ çalýþmalar ile bu konu hakkýnda daha detaylý bilgiler elde edilebilecektir.

BACKGROUND: Obstruction and inflammation of the appendix lumen is the leading physiopathological process during acute appendicitis (AA). Although the relationship between inflammation and endothelial nitric oxide synthases (eNOS) has been well described, no recent data describing the relationship between inflammation during AA and polymorphism of the eNOS gene has been reported. Given the limited data available, we believed that defining the relationship between AA and eNOS would be a beneficial contribution.
METHODS: A total of 201 patients admitted to the emergency department with AA and 201 healthy volunteers selected from among the relatives of patients were included. Polymorphism of the eNOS was assessed.
RESULTS: Intron 4a/4a was positive in 119 participants, genotype G894T GT was positive in 71 patients with AA, and 786-1 was positive in 71 patients with AA. These results suggest that no statistically significant correlation exists between genotypes of AA patients and control subjects regarding 4a/b, G894-GT, and 786-1 eNOS polymorphisms.
CONCLUSION: Though the present results suggest that no statistically significant correlation exists between AA and eNOS gene polymorphism, to claim otherwise is also impractical. We believe that the present results will lay the groundwork for future, larger studies.

AMAÇ: Akut mezenterik iskemi (AMI) olgularýnýn %50–70’i ölümcül olup, hýzlý ve etkili bir klinik deðerlendirme ve tedavi gerektiren bir vasküler acil olarak kabul edilmektedir. Mevcut geriye dönük çalýþmada, biz AMI erken tanýsýnda nötrofil/lenfosit oranýnýn (NLR) olasý yararýný ve bu oranýn AMI ile non-vasküler baðýrsak nekrozu (NVBN) ayýrýcý tanýsýnda etkili olup olmadýðýný araþtýrdýk.
GEREÇ VE YÖNTEM: Bu çalýþmada 1 Mayýs 2010–30 Nisan 2015 tarihleri arasýnda 58 AMI, 62 NVBN ve 62 kontrol hastasý incelendi. Akut mezenterik iskemi tanýsýyla laparotomi ve/veya baðýrsak rezeksiyonu yapýlan hastalar çalýþma grubuna alýndý. Ýnkarsere ve strangüle herni nedeniyle segmenter baðýrsak rezeksiyonu yapýlan hastalar NVBN grubuna alýndý. Kontrol grubu hastalarý non-spesifik karýn aðrýsý nedeniyle acil servise baþvuran hastalarda oluþturuldu.
BULGULAR: Mortalite oraný AMI grubunda %51.7, NVBN grubunda %4.8 idi. Akut mezenterik iskemi grubunda lökosit (WBC) sayýsý, C-reaktif protein (CRP) ve eritrosit daðýlým aralýðý diðer gruplardan daha yüksekti. Nötrofil/lenfosit oraný, AMI ve NVBN grubunda kontrol grubundan daha yüksekti (p<0.001), ancak AMI ve NVBN gruplarý arasýnda fark yoktu. Ayrýca, NVBN grubunda WBC sayýsý ve CRP control grubundan daha yüksekti (p<0.001).
TARTIÞMA: Ameliyat öncesi NLR düzeyinin AMI tanýsýnda yardýmcý olacaðýný ve AMI ile baðýrsak nekrozu ile seyreden NVBN gibi durumlarla ayrýcý tanýda kullanabileceðini düþünmekteyiz. Bundan dolayý, bu tür hastalarda NLR klinik muayeneye ek olarak hesaplanmalýdýr.

BACKGROUND: Acute mesenteric ischemia (AMI) remains fatal in 50–70% of cases. AMI is recognized as a vascular emergency, requiring rapid and efficient clinical evaluation and treatment. In the present retrospective study, the possible utility of the neutrophillymphocyte ratio (NLR) in the early diagnosis of AMI was explored. The potential use of this ratio to distinguish AMI from non-vascular bowel necrosis (NVBN) was investigated.
METHODS: A total of 58 AMI, 62 NVBN, and 62 control patients were enrolled between May 1, 2010 and April 30, 2015. Patients who underwent laparotomies and/or bowel resections to treat AMI were included, as were NVBN patients who underwent segmental bowel resection to treat incarcerated and strangulated hernias. Controls were patients who presented to the emergency room with non-specific abdominal pain.
RESULTS: Mortality rate was 51.7% in the AMI and 4.8% in the NVBN groups. White blood cell (WBC) count, C-reactive protein (CRP) level, and red cell distribution width (RDW) were highest in the AMI group. NLR was higher in the AMI and NVBN groups than in the control group (p<0.001), though no difference in NLR was found between the AMI and NVBN groups. In addition, WBC count, CRP level, and NLR were higher in the NVBN group than in the controls (p<0.001).
CONCLUSION: We suggest that preoperative NLR aids in the diagnosis of AMI, and can be used to distinguish this condition from NVBN. NLR should be calculated, in addition to clinical examination.

AMAÇ: Bu çalýþmada, çocukluk çaðýnda görülen suprakondiler humerus kýrýklarýnda medial mini açýk teknikle perkütan tekniði karþýlaþtýrýldý, floroskopi zamaný, cerrahi süre ve iyatrojenik ulnar sinir hasarý araþtýrýldý.
GEREÇ VE YÖNTEM: 2011 ve 2013 yýllarý arasýnda ameliyat edilen 104 adet Gartland tip III suprakondiler humerus kýrýðý ileriye yönelik olarak incelendi. Birinci gruptaki (Grup A) 41 hastaya medial mini açýk insizyonla medialden bir ve lateralden iki adet pin ile fiksasyonu yapýldý. Ýkinci gruptaki (Grup B) 63 hastaya tüm pinler perkütan yerleþtirildi. Ortalama takip süresi Grup A’da 14.1±1.2 ay ve Grup B’de 14.6±2.1 aydýr. Cerrahi sonrasý hastalar sinir yaralanmasý açýsýndan motor ve duyu muayeneleri yapýldý. Cerrahinin süresi, toplam floroskopi süresi, medial pin için floroskopi süresi, Baumann açýsý, humerokapitallar açý, son taþýma açýsý ve eklem hareket açýklýðý deðerlendirildi.
BULGULAR: Duyu incelemesinde Grup A’da üç kötü ve bir orta sonuç, Grup B’de iki kötü ve bir orta sonuç elde edildi. Ýstatististiksel olarak fark saptanmadý. Gruplar arasýnda cerrahi süre ve toplam floroskopi süresi açýsýndan fark saptanmadý. Medial mini açýk yapýlan grupta medial pin fiksasyonu sýrasýnda floroskopi süresi daha kýsa saptandý.
TARTIÞMA: Medial mini açýk teknik ve perkütan tekniðin her ikisin dede iyatrojenik ulnar sinir yaralanma riski mevcuttur. Medial mini açýk teknikte medial pin yerleþtirme iþlemi daha kýsa süre floroskopi kullanýmý açýsýndan avantajlýdýr.

BACKGROUND: The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury.
METHODS: A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously. In Group B (63 patients), all pins were inserted percutaneously. Mean follow-up time was 14.1±1.2 months in Group A, and 14.6±2.1 months in Group B. All patients were postoperatively evaluated for nerve injury with both motor and sensory function assessment. Length of surgery, total fluoroscopy time, fluoroscopy time for medial pin insertion, Baumann’s angle, humeral capitellum angle, final carrying angle, and range of motion were recorded.
RESULTS: Sensorial evaluation showed that Group A had 3 poor, and 1 fair results, and Group B had 2 poor, and 1 fair results. No statistically significant differences were observed, including no differences in either surgery or total fluoroscopy times between groups. However, fluoroscopy time during medial pin placement was significantly lower in the mini-open group.
CONCLUSION: In conclusion, similar results of both techniques were observed, and both carry risk of iatrogenic ulnar nerve injury. Medial pin placement is easier and less demanding when used with mini-open technique.

AMAÇ: Travmatik posterior fossa epidural hematomlarý ender görülmelerine karþýn mortalite ve morbiditesi suratentorial yerleþimli epidural hematomlardan daha yüksektir. Belirti ve bulgularý silik ve belirsiz olmalarýnýn yanýnda hýzlý bir kötüleþme göstererek bilinç bozukluðundan komaya ve sonuçta ölüme yol açabilir. Bilgisayarlý tomografinin (BT) kullanýmýnýn posterior fossa travmasý geçirmiþ kranium kýrýðý bulunan olgularda yaygýnlaþmasý ile erken taný konulabilmektedir. Ancak ilk çekilen tomografide görülmeyip seri çekimlerde yakalanan hematomlara geç geliþen epidural hematom’lar denmektedir. Çalýþmamýzda supratentorial-infratentorial kompartmanlarda geliþmiþ epidural hematomlarýn (EDH) lineer kýrýk varlýðý ile iliþkisi ve geç dönemde geliþen epidural hematomlarla iliþkisi incelendi.
GEREÇ VE YÖNTEM: Bu çalýþmada 1995–2005 yýllarýnda kliniðimizde 212 supratentorial epidural hematom (SEDH) ve 22 posterior fossa epidural hematomu (PFEDH) tanýsý ile tedavi edilen olgular sunuldu. PFEDH olgularýndan 21’i ameliyat edildi, 1 olgu konservatif takip edildi, bu grubun içinden 4 olgu ise gecikmiþ posterior fossa epidural hematomu (GPFEDH) nedeniyle ameliyat edildi.
BULGULAR: Posterior fossa epidural hematomu nedeniyle tedavi ettiðimiz hastalarýn yaþ ortalamalarý 12, SEDH nedeniyle tedavi ettiðimiz hastalarýn yaþ ortalamalarý 18 idi. Hematomlar, parietal bölgede %27, temporal bölgede %16 ve posterior fossada %8 oranlarýnda görülmekteydi. Supratentorial epidural hematom olan 212 hastanýn %48’inde, PFEDH olgularýnýn %68’inde lineer kýrýk mevcuttu. Posterior fossada geç geliþen eipdural hematom görülme sýklýðý %2 idi. Ýnfratentorial kompartmanda geç geliþen epidural hematom görülme olasýlýðý ileri derecede supratentorial kompartmana nazaran anlamlýydý (p=0.007). Çalýþmamýzda lineer kýrýðý olupta posterior fossada EDH geliþme oraný 10.27 kat daha bulundu (p<0.05).
TARTIÞMA: Geç geliþen posterior fossa epidural hematomlarý klinik detoryantasyonla beraber hastayý ölümcül sonuçlara götürebilmektedir. Gecikmiþ posterior fossa epidural hematomlarýnýn tanýsý ve cerrahi modalite hayat kurtarýcý olmakla beraber posterior fossa direkt grafilerinde kýrýk hattý tespit edilen hastalarda yüksek oranda EDH geliþebileceði göz önünde bulundurulmalý, bu tarzda olan hastalarý yakýn gözlem altýnda tutmalý gerektiðinde seri BT çekimleri yapýlmalýdýr.

BACKGROUND: Though traumatic posterior fossa epidural hematoma (PFEDH) is rare, the associated rates of morbidity and mortality are higher than those of supratentorial epidural hematoma (SEDH). Signs and symptoms may be silent and slow, but rapid deterioration may set in, resulting in death. With the more frequent use of computed tomography (CT), early diagnosis can be achieved in patients with cranial fractures who have suffered traumatic injury to the posterior fossa. However, some hematomas appear insignificant or are absent on initial tomography scans, and can only be detected by serial CT scans. These are called delayed epidural hematomas (EDHs). The association of EDHs in the supratentorial-infratentorial compartments with linear fracture and delayed EDH (DEDH) was presently investigated.
METHODS: A total of 212 patients with SEDH and 22 with PFEDH diagnosed and treated in Göztepe Training and Research Hospital Neurosurgery Clinic between 1995 and 2005 were included. Of the PFEDH patients, 21 underwent surgery, and 1 was followed with conservative treatment. In this group, 4 patients underwent surgery for delayed posterior fossa epidural hematoma (DPFEDH).
RESULTS: Mean age of patients with PFEDH was 12 years, and that of the patients with SEDH was 18 years. Classification made according to localization on cranial CT, in order of increasing frequency, revealed of EDHs that were parietal (27%), temporal (16%), and located in the posterior fossa regions (approximately 8%). Fracture line was detected on direct radiographs in 48% of SEDHs and 68% of PFEDHs. Incidence of DPFEDH in the infratentorial compartment was statistically significantly higher than incidence in the supratentorial compartment (p=0.007). Review of the entire EDH series revealed that the likelihood of DEDH development in the infratentorial compartment was 10.27 times higher in patients with linear fractures than in patients with supratentorial fractures (p<0.05).
CONCLUSION: DPFEDH, combined with clinical deterioration, can be fatal. Accurate diagnosis and selection of surgery modality can be lifesaving. The high risk of EDH development in patients with a fracture line in the posterior fossa on direct radiographs should be kept in mind. These patients should be kept under close observation, and serial CT scans should be conducted when necessary.

AMAÇ: Ottawa ayak bileði kurallarýnýn ülkemizde devlet hastanesinde görevli pratisyen hekimler tarafýnca kullanýlmasýnýn etkinliðini araþtýrmak.
GEREÇ VE YÖNTEM: Ýki yüz yataklý devlet hastanesi ikinci basamak acil servise, ayak-ayakbileði travmasý ile müracaat eden 405 hasta çalýþmaya dahil edildi. Tüm hastalar pratisyen hekim tarafýnca muayene edilerek Ottawa pozitif veya negatif olarak sýnýflandýrýldý. Tüm hastalara ön-arka ve yan, ayak ve ayak bileði grafisi çekildi. Grafiler, hastanýn Ottawa grubunu bilmeyen ortopedi ve radyoloji uzmanlarýnca deðerlendirilerek klinik olarak anlamlý kýrýk olup olmadýðý saptandý. Takiben sonuca göre Ottawa ayakbileði kuralý için duyarlýlýk, özgüllük, pozitif ve negatif kestirim deðerleri hesaplandý.
BULGULAR: Ýki yüz elli bir (%61.97) hasta Ottawa (+), 154 hasta (%38.02) Ottawa (–) olarak saptandý. Altmýþ iki (%15.3) hastada klinik olarak anlamlý kýrýk tespit edildi. Kýrýk olan 62 hastanýn 61’inde (%98.4) Ottawa (+) idi. Deplase olmamýþ birinci metatars kýrýðý tespit edilen bir (%1.6) hastada Ottawa (–) idi. Bununla birlikte kýrýk saptanmayan 190 (%55.4) hasta Ottawa (+), 153 (%44.6) hasta Ottawa (–) idi (p<0.001). Duyarlýlýk, özgüllük, pozitif ve negatif kestirim deðerleri sýrasýyla %98.39, %44.61, %24.30 ve %99.35 idi. Eðri altýnda kalan alan 0.71 olarak hesaplandý. Bu sonuçlara göre Ottawa ayakbileði kurallarýnýn olasý radyolojik tetkik azaltma oraný %38.02 olarak tespit edildi.
TARTIÞMA: Ottawa ayak bileði kurallarý (OAR) akut ayak bileði ve ayak orta bölüm yaralanmalarý geçiren hastalarda yüksek derecede duyarlý tarama testidir. Ýyi eðitimli pratisyen hekimlerin OAR’yi uygulamasý çekilen radyogramlarýn sayýsýnýn anlamlý derecede azalmasýný saðlayarak, hasta ve personelin zamandan tasarruf saðlamasýna ek olarak tedavi maliyetini ve radyasyona maruziyeti de azaltýr.

BACKGROUND: The present objective was to assess implementation of the Ottawa ankle rules (OAR) as a method of fracture prediction in the emergency department (ED) of a Turkish state hospital.
METHODS: Patients who presented to the ED of our hospital with acute ankle injury were evaluated. All were examined by a general practitioner, after which a series of ankle and foot x-rays (anteroposterior and lateral) were performed. Radiography was examined by a radiologist and an orthopedic surgeon, both of whom were blinded to OAR results. Radiographic results were compared to results of OAR implementation. Sensitivity and specificity of the OAR in the diagnosis of fracture was calculated.
RESULTS: A total of 251 (61.97%) patients were diagnosed as positive (+) for fracture after OAR implementation, 154 (38.02%) as negative (–). Clinically significant fracture was detected in 62 (15.3%) patients. A total of 61 (98.4%) patients with significant fracture were OAR (+); 1 (1.6%) was OAR (–). However, 190 (55.4%) patients without fracture were OAR (+); 153 (44.6%) were OAR (–) (p<0.001). Sensitivity, specificity, and positive and negative predictive values of OAR implementation in the prediction of fracture were 98.39%, 44.61%, 24.30%, and 99.35%, respectively. Area under the curve (AUC) was 0.71. According to these results, it was determined that use of radiography could be reduced by 38.02% if the OAR were implemented.
CONCLUSION: The OAR are a highly sensitive means of screening of patients with acute ankle and mid-foot injuries. Application of the OAR by well-trained general practitioners can lead to significant reduction in the number of x-rays performed, thereby reducing cost of treatment and radiation exposure, in addition to saving time for patients and staff.

AMAÇ: Genel cerrahi, komplikasyon ile hata karþýlaþtýrmasýnda karar vermenin zor olduðu dallardan biridir. Çalýþmamýzda týbbi uygulamada hata iddiasý bulunan genel cerrahi ölüm olgularýnda, týbbi uygulama hatasýnýn deðerlendirilmesi için göz önüne alýnan temel adli týbbi parametrelerin sunulmasý ve bu kavramlarýn literatür üzerinden tartýþýlmasý amaçlandý.
GEREÇ VE YÖNTEM: 01.01.2012–31.12.2013 tarihleri arasýnda, genel cerrahi branþý hekimleri hakkýnda týbbi uygulamada hata iddiasý nedeniyle Adli Týp Kurumu Birinci Adli Týp Ýhtisas Kurulu’na gönderilmiþ ve týbbi uygulama ile ölümün illiyetli olduðu belirlenmiþ olgular geriye dönük olarak incelendi.
BULGULAR: Toplam 105 olgunun %21.9’unda (n=23) týbbi uygulama hatasý olduðu ve en sýk primer hastalýk tanýlarýnýn sýrasýyla travma–yaralanma (n=32, %30.5), kolesistit (n=25, %23.8) ve apandisit (n=8, %7.6) olduðu görüldü. Tedavi þekilleri, týbbi uygulamada hata kararý açýsýndan karþýlaþtýrýldýðýnda, sadece medikal tedavi olan olgularda hata gözlenme oraný, cerrahi+medikal tedavi gören olgulara göre istatistiksel olarak anlamlý düzeyde yüksek bulundu (p=0.003; p<0.01). Ancak, acil ve elektif cerrahi tedaviler, týbbi uygulamada hata kararý açýsýndan karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý farklýlýk saptanmadý (p>0.05). Klinik taný ile otopside belirlenen taný arasýndaki iliþkinin týbbi uygulamada hata kararý üzerindeki etkisi deðerlendirildiðinde; klinik taný ve -otopsi var olduðunda- otopsi tanýsýnýn uyum durumu ile týbbi uygulamada hata kararý arasýnda istatistiksel olarak anlamlý farklýlýk tespit edildi (p=0.031; p<0.05). Klinik tanýnýn otopsi ile doðrulandýðý olgularda, hata olduðu yönünde karar verilme oraný istatistiksel olarak anlamlý düzeyde düþük olarak bulundu (p=0.028; p<0.05).
SONUÇ: Elde edilen sonuçlar yorumlandýðýnda, Adli Týp Kurumu’nun týbbi uygulama hatasý deðerlendirmesinde otopsi verileri kadar klinik takip verilerini de dikkate aldýðý, genel cerrahide medikal tedavinin doðru uygulanmasýna önem verilmesi gerektiði ve hekimlerin acil þartlarda elektif þartlar kadar baþarýlý olduklarý unsurlarý dikkat çekici bulunmuþtur.

BACKGROUND: General surgery is one of the branches in which the distinction between complication and malpractice is difficult to distinguish. In this study, presentation of the main forensic medical parameters considered for the evaluation of medical malpractice in cases of general surgery deaths in which medical malpractice has been alleged and discussing related concepts through the literature are aimed.
METHODS: Allegations of medical malpractice against general surgery physicians sent to the First Forensic Expertise Board of the Council of Forensic Medicine between January 1, 2012 and December 31, 2013 for which the relation of casuality between medical malpractice and death had been determined were retrospectively evaluated.
RESULTS: Medical malpractice was ruled in 21.9% (n=23) of 105 cases. The most common primary disease diagnoses were trauma-injury (n=32, 30.5%), cholecystitis (n=25, 23.8%) and appendicitis (n=8, 7.6%). When treatment types were compared according to malpractice decision, rate of malpractice in medicine-only treatment was found to be significantly higher compared to surgery + medical treatment (p=0.003, p<0.01). No statistically significant difference was found regarding the rate of malpractice between cases of emergency and elective surgery (p>0.05). When incidence of medical malpractice was compared between cases with clinical diagnosis and diagnosis determined by autopsy, a statistically significant difference was found (p=0.031, p<0.05). Malpractice was ruled at a significantly lower rate in cases in which diagnosis was confirmed with autopsy (p=0.028, p<0.05).
DISCUSSION: It can be concluded that physicians are as successful in emergency conditions as in elective conditions and correct administration of medical treatment is of vital importance. Moreover, the Council of Forensic Medicine considers the clinical follow-up data as well as the autopsy data in medical malpractice evaluation.

AMAÇ: Çocukluk çaðýnda düþük dereceli künt böbrek yaralanmalarýnda konservatif tedavi yöntemleri kullanýlýr. Ancak dördüncü derece yaralanmalarda tedavi protokolleri tam olarak belirlenememiþtir. Çalýþmamýzýn amacý, kliniðimize ürinom ile baþvuran veya üriner ekstravazasyon saptanan hastalarda tedavi yöntemlerini tartýþmaktýr.
GEREÇ VE YÖNTEM: Kliniðimize 2003–2012 yýllarý arasýnda baþvurmuþ olan ve dördüncü derece renal travma saptanmýþ olan sekiz olgu (K/E=1/7, ortalama yaþ: 6 yaþ) uygulanan tedavi yöntemleri açýsýndan geriye dönük olarak incelendi.
BULGULAR: Dört olguda yüksekten düþme, üç olguda batýna künt travma ve bir olguda kereste makinesine sýkýþma nedeniyle renal yaralanma vardý. Dört olguda sað, dört olguda sol renal travma saptandý. Hiçbir olguda hemodinamik instabilite nedeniyle acil eksplorasyon gerekmedi. Bir olgunun ilk incelemelerinde üriner ekstravazasyon gösterilmiþ olmasýna raðmen izlemde ürinom saptanmadý. Ürinom geliþen yedi olgunun beþi drenaj yöntemleri ile (üç olguda JJ kateter, bir olguda perkütan drenaj (PD) kateteri, bir olguda PD sonrasýnda JJ kateter yerleþtirilerek) tedavi edildi. Geri kalan iki olguda ilk tedavi olarak PD uygulanmasýna raðmen üriner sistem bütünlüðünün bozulmuþ olmasý nedeniyle alt pol nefrektomi ve pelviplasti uygulandý. Bir olguya bulgularý geriledikten sonra üreteropelvik darlýk nedeniyle piyeloplasti uygulandý. Tüm kateterler üriner sistemde ekstravasyon olmadýðý gösteridikten sonra çekildi. JJ kateter çekilme süresi ortalama dört ay, PD kateter çekilme süresi 1.5 ay idi.
SONUÇ: Çocukluk çaðýndaki dördüncü derece renal yaralanmalar minimal invaziv yöntemlerle baþarýyla tedavi edilebilmektedir. Cerrahi uygulanan olgularda bile öncelikle minimal invaziv yöntemlerin seçilmesi böbreðin korunma þansýný artýrmaktadýr.

BACKGROUND: Conservative management procedures are implemented in cases of low-grade pediatric blunt renal trauma, but procedures for grade 4 injuries are not clearly defined. The present objective was to discuss treatment procedures in patients who presented with or developed urinoma during follow-up.
METHODS: Treatment procedures implemented in 8 patients (female: male ratio=1: 7; average age: 6) with grade 4 renal trauma who presented to the clinic between 2003 and 2012 were retrospectively analyzed.
RESULTS: Cause of renal injury was fall in 4 cases, blunt abdominal trauma in 3 cases, and being trapped in a harvesting machine in 1 case. Right renal trauma was diagnosed in 4 cases, left renal trauma in 4. Emergent exploration due to hemodynamic instability was not necessary. Although urinary extravasation was observed upon investigation in 1 patient, urinoma did not form during follow-up. Five of the 7 patients with urinoma were treated with drainage procedures (double-J catheter ( JJ) in 3, percutaneous drainage (PD) in 1, followed by JJ catheter placement). In spite of initial PD, inferior pole nephrectomy and pyeloplasty were performed in the remaining 2 cases due to decomposition of the integrity of the urinary system. In 1 patient, pyeloplasty was performed following regression of symptoms due to ureteropelvic obstruction. Catheters were removed when extravasation was not detected in the urinary system. Average time of removal was 4 months for JJ catheters and 1.5 months for PD catheters.
DISCUSSION: Pediatric grade 4 renal trauma can be successfully treated with minimally invasive procedures. Initial implementation of these procedures increases the chance of kidney salvage, even when surgical intervention is eventually performed.

AMAÇ: Bu çalýþmada, fiksasyon veya hemiartroplasti ile tedavi edilmiþ olan parçalý proksimal humerus kýrýklarýnda hastalarýn fonksiyonel sonucuna etki eden faktörleri geriye dönük olarak deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýza 2007–2012 yýllarý arasýnda kliniðimizde Neer tip 3 ve 4 proksimal humerus kýrýðý nedeniyle ameliyat edilen ve ameliyat sonrasý en az iki yýl takibi sürdürülen 58 (19 kadýn, 39 erkek; ort. yaþ; 51.04 yýl; daðýlým 22–78 yýl) hasta dahil edildi. Hastalarýn 35’ine açýk redüksiyon ve anatomik plak fiksasyon, 23’üne parsiyel omuz protezi uygulandý. Hastalar son kontrollerinde Constant-Murley’in omuz skorlamasýna göre deðerlendirildi. Hastalarýn yaþ, cinsiyet, ASA skoru, travma enerjisi, kýrýk tipi ve ameliyat öncesi sürenin fonksiyonel sonuçlar üzerine etkisi incelendi.
BULGULAR: Hastalar ortalama 47.25±13.29 (25–76) ay takip edildi. Hastalarýn tümünde ortalama Constant-Murley puaný 58.65±18.62 olarak tespit edildi. Fonksiyonel puan fiksasyon grubunda 65.77±18.67 iken, hemiartroplasti grubunda 47.82±12.52 olarak saptandý (p=0.001). Baðýmsýz deðiþkenlerin birden fazlasýnýn fonksiyonel sonuçlara etkisi incelendiðinde, fiksasyon grubunda ASA skoru ve kýrýk tipi, hemiartroplasti grubunda ise travma enerjisi ile fonksiyonel sonuçlarý anlamlý düzeyde etkilediði tespit edildi. Son takipte 20 hastada (%34.5) komplikasyon saptandý ve bunlarýn 14’ü (%70) rotator cuff yetmezliðiydi.
SONUÇ: Çok parçalý proksimal humerus kýrýklarýnýn cerrahi tedavisinde plak fiksasyonu ile daha yüksek fonksiyonel sonuç elde edilebilirken her iki cerrahi yöntemde rotator cuff yetmezlik oranýnýn yüksek oluþu göz önünde bulundurulmalýdýr.

BACKGROUND: The present objective was to retrospectively evaluate factors affecting functional outcome of multipart proximal humeral fracture treated with fixation or hemiarthroplasty.
METHODS: Included were 58 patients (19 women, 39 men; average age: 51.04 years; range 22–78 years) who underwent surgery for Neer type III or IV proximal humeral fractures between 2007 and 2012. All participants attended follow-up of at least 2 years. A total of 35 patients underwent open reduction and anatomical plate fixation; 23 underwent partial shoulder replacement. Patients were evaluated according to Constant-Murley shoulder scoring at final follow-up examination. Evaluated impacts on functional outcome included age, gender, American Society of Anesthesiologists (ASA) Physical Status classification, trauma energy, type of fracture, and time to surgery.
RESULTS: Mean follow-up duration was 47.25±13.29 (25–76) months. Mean Constant-Murley score was 58.65±18.62 (65.77±18.67 for the fixation group, 47.82±12.52 for the hemiarthroplasty group; p=0.001). When impact of independent variables on functional scores was assessed, ASA score and type of fracture were found to significantly affect functional outcome in the fixation group, and trauma energy was found to significantly affect functional outcome in the hemiarthroplasty group. Complications were detected in 20 patients (34.5%) upon final examination, 14 of whom (70%) had rotator cuff deficiency.
DISCUSSION: Though improved functional results may be obtained using plate fixation in the surgical treatment of multipart proximal humeral fractures, the high rates of rotator cuff failure associated with both surgical methods should be considered.

AMAÇ: Bu çalýþmanýn amacý humerus alt uç eklemi ilgilendiren parçalý kýrýklý hastalara uyguladýðýmýz cerrahi tedavilerdeki 90° ve 180° açýlý çift plak uygulamalarýnýn sonuçlarý deðerlendirilerek birbirlerine olan üstünlüklerini saptamaktýr.
GEREÇ VE YÖNTEM: Kliniðimizde 2009 Ocak ile 2013 Ocak tarihleri arasýnda AO sýnýflandýrmasýna göre tip C eriþkin distal humerus parçalý kýrýðý tanýsýyla cerrahi tedavi uygulanan, en az 6 ay izleme süresi olan 17 hasta, geriye dönük olarak deðerlendirildi. Hastalarýn poliklinik kontrollerinde ön-arka ve yan grafiler ile radyolojik deðerlendirmeleri ve Mayo Dirsek Performans Skorlama sistemi kullanýlarak dirsek iþlevleri gözden geçirildi.
BULGULAR: Olgularýn 14’ü (%82.3) erkek, üçü (%17.7) kadýn olup yaþ ortalamasý (22–65) 40.5 yýl idi. AO/ASIF humerus distal uç kýrýk sýnýflandýrmasýna göre; kýrýklarýn üçü (%17.7) tip C1, dokuzu (%52.9) tip C2, beþi (%29.4) tip C3 kýrýk þeklindeydi. Bu kýrýklarýn altýsý (%35.3) açýk olup, bunlarda Gustillo-Anderson’a göre dördü (%23.5) tip 1, ikisi (%11.7) tip 2 idi. Onbir hastada (%64.7) 90°, altý hastada ise (%36.3) 180° açýlarla çift plak kullanýldý. Tüm hastalara chevron osteotomisi uygulandý. Hastalar ortalama (6–52) 25.6 ay takip edildi. Hastalarýmýzýn en son kontrollerinde yapýlan deðerlendirmelerinde ortalama dirsek fleksiyonunun 105º (daðýlým 85º–130º), ortalama ekstansiyon kaybýnýn 10º (daðýlým 0º–20º) olduðu saptandý. Mayo dirsek performans skorlama sistemine göre; 12 (%70.5) çok iyi, beþ (%29.5) iyi sonuç elde edildiði görüldü. Doksan ve 180 derece plak yerleþtirilen olgularýn klinik sonuçlarý arasýnda istatistiksel fark saptanmadý (p=0.169).
SONUÇ: Eriþkin distal humerus C tipi kýrýklarda plaklarýn hangi açýlarla yerleþtirileceðine ameliyat öncesi dönemde çekilen grafiler ve operasyon sýrasýnda cerrahýn seçimi neticesinde karar verilmelidir. Özellikle lateral kolondaki parçalanmanýn plaklarýn hangi açýyla uygulanacaðýný belirtmesi açýsýndan önemi vardýr. Lateral kolonda parçalanma yoksa 90° açýyla uygulanan çift plak eðer parçalanma varsa 180° açýyla uygulanan plaklama sonuçlar açýsýndan yeterli olmaktadýr.

BACKGROUND: The present objective was to compare 90° and 180° double-plate constructions for complex distal humerus fractures, as well as to evaluate superiority of construction type.
METHODS: Retrospectively evaluated were 17 patients treated for type C distal humerus fracture according to AO/ASIF classification between January 2009 and January 2013. All attended minimum 6-month follow-up. Elbow function was assessed with anteroposterior and lateral x-ray, and Mayo elbow performance score evaluation at outpatient clinics.
RESULTS: Patient population included 14 males (82.3%) and 3 females (17.7%). Mean patient age was 40.5 years. According to AO/ASIF distal humerus classification, 3 (17.7%) type C1, 9 (52.9%) type C2, and 5 (29.4%) type C3 fractures were included. Six were open fractures (35.3%). According to Gustilo-Anderson classification, 4 (23.5%) fractures were type 1, and 2 (11.7%) were type 2. Construction performed was 90° in 11 cases (64.7%) and 180° in 6 cases (36.3%). Chevron osteotomy was performed in all cases. Mean follow-up period was 25.6 (6–52) months. Upon final examination, mean elbow flexion was 105º (85º–130º), and mean extension loss was 10º (0º–20º). According to Mayo elbow performance scoring system, 12 (70.5%) results were excellent, and 5 (29.5%) were good. No statistically significant clinical difference was found between 90° and 180° plate construction groups (p=0.169).
DISCUSSION: Surgeons should determine the construction type appropriate to individual cases of adult distal humerus type C fractures using preoperative x-rays and intraoperative means. Choice of construction type has particular importance in cases of lateral columnar fracture complexity. If no comminution is present in the lateral column, 90º double-plating leads to satisfactory outcome, while 180º plating leads to satisfactory outcome when comminution is present in the lateral column.

Omentum majusun torsiyonu akut karýnýn nadir bir nedenidir. Etiyopatogenezine dayanarak primer ve sekonder olarak sýnýflandýrýlabilir. Ancak, sonuçta nedene baðlý olmaksýzýn segmenter veya yaygýn omentum nekrozu oluþacaktýr. Ameliyat öncesi taný kolay olmamasýna raðmen karýnýn ultrason ve bilgisayarlý tomografi (BT) taramalarý omentum torsiyonunu düþündüren özgün özellikleri gösterebilir. Seçilecek tedavi etkilenmiþ omentumun laparoskopik rezeksiyonudur. Bu olgu sunumunda, kapsamlý literatür derlemesine ilaveten primer omentum torsiyonu bildirilmiþtir.

Torsion of the greater omentum is a rare cause of acute abdomen. Based on etiopathogenesis, it can be classified as primary or secondary. However, regardless of the cause, segmentary or diffuse omental necrosis will follow. Preoperative diagnosis is not easy, though abdominal ultrasound and computed tomography (CT) scans may show peculiar features suggestive of omental torsion. Laparoscopic resection of the affected omentum is the treatment of choice. Presently reported was a case of primary omental torsion, in addition to a comprehensive literature review.

Kardiyak saçma embolisi penetran travmalardan sonra görülen nadir ancak ciddi bir komplikasyondur. Ateþli silah yaralanmasý sonrasý yabancý cisimlerin vasküler sistem aracýlýðý ile uzak migrasyonu dikkate alýnmalýdýr. Gecikmiþ tanýnýn sebep olabileceði yetersiz tedavi ve takip eden komplikasyonlar, kötü prognoz nedeni olabilir. Bu yazýda, konservatif olarak yaklaþýlan semptomsuz kardiyak saçma embolisi olgusunu sunduk. Bu olgu sunumu penetran ateþli silah yaralanmasý sonrasý saçma taneciðinin uzak migrasyon olasýlýðýný ve semptomsuz hastalarda konservatif yaklaþýmýn önemini vurgulamaktadýr.

Bullet embolism to the heart is a rare but serious complication of penetrating trauma. Distant migration of foreign bodies via the vascular system must be taken into consideration following penetrating gunshot trauma. Delays in diagnosis may result in poor management and subsequent complications that may lead to grave prognosis. Presently described was a conservatively managed case of asymptomatic intracardiac pellet embolization. Highlighted was the importance of serial scanning for intravascular migration of pellet following penetrating gunshot injury, in addition to conservative management in asymptomatic patients.

Yabancý cisim yutulmasý bilinçsiz ya da bilinçli olabilmektedir. Bilinçsiz olanlarýn çoðu, üç ay–altý yaþ arasý çocuklarda, çok ileri yaþlarda, kazayla veya mental problemli kiþilerde halüsinasyon gibi bir nedenle olabilmektedir. Bu cismlerin çoðu doðal yoldan atýlmaktadýr. Ýki gündür sað lomber bölgede hareketle artan aðrý þikayeti ile acil servise getirilen, 29 yaþýndaki mental retarde kadýn hastanýn fizik incelemesinde palpasyonla sað lomber hassasiyet dýþýnda bir özellik yoktu. Yapýlan radyolojik deðerlendirmede sað üst kadranda retroperitona oblik olarak uzaným gösteren ve endoskopik olarak çýkartýlamayan metal çivi laparotomi yapýlarak çýkarýldý. Yabancý cisim yutulmasý birçok nedenle olabilmektedir. Mental retarde hastalarda halüsinasyonla yabancý cisim yutulmasý bildirilmekte ve ayný þekilde bizim hastamýz da mental retarde idi. Ancak yutulan cisimin akut karýn oluþturmadan sað yan aðrýsýna neden olmasý olasý bir komplikasyon olarak akýlda tutulmalýdýr. Özellikle mental retarde hastalarda olmak üzere sað yan aðrýsý ile gelen hastalarda yabancý cisim yutulmasý akýlda tutulmalýdýr.

Foreign body ingestion can be caused by many factors, including hallucination in patients with mental retardation. Most ingested foreign bodies are naturally discharged, though surgical intervention is necessary in some cases. Endoscopic intervention often leads to successful outcome, though open surgery may be required in certain instances. A 29-year-old mentally retarded woman presented to emergency services with a 2-day history of right lumbar pain that increased with movement. Physical examination revealed no specific sign beyond palpable tenderness in the right lumbar region. Radiological examination revealed a metal nail in the upper right quadrant, stretching obliquely toward the retroperitoneum. Endoscopy failed, and the nail was extracted via laparotomy. Foreign body ingestion may occur in patients of any age, but is more common in the pediatric population and in patients with mental retardation. Commonly ingested foreign bodies include daily objects, toys, and dentures, though they may differ in patients with mental retardation. The treatment of such cases requires a diversity of methods and experience. Foreign body ingestion should be kept in mind when a patient presents with pain in the right lumbar region, particularly in patients with mental retardation.

Faringeal yabancý cisimlere kulak burun boðaz hastalýklarý pratiðinde sýk rastlanýlýr. Ancak özellikle delici yabancý cisimlerde büyük damar yaralanmasýna yol açarak ciddi morbidite ve mortalite sebebi olabilirler. Bu hastalarýn yönetimi havayolunun korunmasý, kanamanýn kontrolü, büyük damar yaralanmasýnýn görüntülenmesi ve profilaktik antibiyotiði içerir. Yazýda, iki yaþýnda bir delici faringeal yabancý cisim olgusu ve eþliðinde bu olgulara yaklaþým sunulmuþtur.

Pharyngeal foreign bodies are commonly encountered in otolaryngological practice. However, in certain instances, particularly in cases of penetrating injuries, major vascular damage leads to severe morbidity and mortality. Management of these cases includes airway protection, bleeding control, imaging of major vascular injury, and prophylactic antibiotics. The case of a 2-year-old patient with penetrating pharyngeal foreign body is described in the present report.