AMAÇ: Klinik uygulamalara benzer þekilde sýçanlarda ozonun intestinal iskemi-reperfüzyon (I/R) hasarýnýn akut fazý üzerindeki terapötik etkilerini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: On sekiz Wistar albino sýçaný kontrol (CG, n=6), sham (SG, n=6) ve ozon gruplarýna (OG, n=6) ayrýldý. Laparatomiyi takiben SG ve OG’de süperiyor mezenterik arter (SMA) 0/0 katgut dikiþle oklüde edildi, ancak CG’de herhangi bir giriþim yapýlmadan insizyon kapatýldý. Eþit derecede baðýrsak iskemisi elde etmek için bir doku oksijenasyon monitörü kullanýldý. Ýnsizyon kapatýldý ve OG’de, reperfüzyondan 20 dakika önce ozon/oksijen karýþýmý (0.7 mg/kg) intraperitoneal olarak enjekte edildi. SG ve OG’de 60 dakikalýk iskemi sonrasý cerrahi insizyon tekrar açýldý ve reperfüzyon saðlandý. Atmýþ dakikalýk reperfüzyondan sonra tüm gruplarda baðýrsak mukozal hasarýnýn (Chiu skoru) histopatolojik deðerlendirmesi ve oksidatif stres belirteçlerinin (nitrik oksit: NO, malonildialdehit: MDA, süperoksit dismutaz: SOD) biyokimyasal deðerlendirmesi için 2 cm’lik ince baðýrsak segmenti örneklendi.
BULGULAR: Chiu skorlarý SG ve OG’de CG’ye göre istatistiksel olarak yüksekti (sýrasýyla, p=0.002 ve p=0.002). Chiu skoru OG’de SG’ye göre daha yüksekti, ancak istatistiksel olarak anlamlý deðildi (p=0.175). MDA düzeyleri SG ve OG’de CG’ye göre istatistiksel olarak daha yüksekti (sýrasýyla p=0.004 ve p=0.010). Ancak, SG ve OG arasýndaki fark istatistiksel olarak anlamlý deðildi (p=0.522). SOD ve NO düzeyleri açýsýndan gruplar arasýnda anlamlý olarak fark yoktu (sýrasýyla, p=0.451 ve p=0.056).
TARTIÞMA: Literatürün aksine, tek doz ozon tedavisi, sýçanlarda baðýrsak I/R hasarýnda oksidatif stresi azaltmadý ve iskemik hasarý iyileþtirmedi. Potansiyel bir klinik kullaným için farklý zaman aralýklarýnda farklý dozlarý içeren daha ileri deðerlendirmeler yapýlmasý gerekmektedir.

BACKGROUND: In this study, we aimed to examine the therapeutic effects of ozone on the acute phase of intestinal ischemia-reperfusion (I/R) injury in rats to resemble clinical practice.
METHODS: Eighteen Wistar albino rats were assigned to control (CG, n=6), sham (SG, n=6) and ozone groups (OG, n=6). A midline laparotomy was performed and a superior mesenteric artery (SMA) in the SG and OG was occluded with a 0/0 catgut suture, but in the CG, the incision was closed without any intervention. Tissue oxygenation was monitored with a tissue oxygenation monitor to achieve the same grade during intestinal ischemia. The incision was closed and, in the OG, ozone/oxygen mixture (0.7 mg/kg) was injected intraperitoneally, 20 minutes before reperfusion. Surgical incision was reopened and reperfusion was achieved after 60 minutes of ischemia in the SG and OG. After 60 minutes of reperfusion, 2 cm small intestine segment was sampled for histopathological assessment of the intestinal mucosal damage (Chiu score) and biochemical assessment of oxidative stress markers (nitric oxide: NO, malondialdehyde: MDA, superoxide dismutase: SOD) in all groups.
RESULTS: The Chiu scores of the SG and OG were statistically increased than that of the CG (p=0.002; and p=0.002, respectively). Chiu score in the OG was higher compared to that in the SG, but not statistically significant (p=0.175). MDA levels were statistically higher in the SG and OG than that of the CG (p=0.004; and p=0.010, respectively). However, the difference between the SG and OG was not statistically significant (p=0.522). SOD and NO levels were not significantly different between groups (p=0.451 and p=0.056, respectively).
CONCLUSION: Contrary to the literature, single-dose ozone therapy did not reduce the oxidative stress or improve the ischemic damage in intestinal I/R injury in rats. Further evaluation with different doses in different time periods is needed for potential clinical use.

AMAÇ: Sepsiste çok yüksek mortalite oraný oksidatif stres ile iliþkili olabilir. Bu çalýþma fareler üzerinde, çekal ligasyon-perforasyon (CLP) ile oluþturulan karýniçi sepsis modelinde oksidatif stresin varlýðýný ve ayrýca ß-glukanýn potansiyel koruyucu etkisini araþtýrmak için yapýlmýþtýr.
GEREÇ VE YÖNTEM: Otuz erkek sýçan eþit olarak “Sham”, “Sepsis” ve “ß-Glukan” olarak üç gruba ayrýldý. Sham grubunda sadece laparotomi yapýldý, Sepsis ve ß-Glukan gruplarýnda CLP ile sepsis oluþturuldu. ß-Glukan grubuna CLP’yi takiben intraperitonal olarak tek bir doz 4 mg ß-glukan/kg verildi. Sepsis geliþiminden sonra 48. saatin sonunda Sepsis ve ß-Glukan gruplarýndan ve Sham grubundan kan ve doku (karaciðer, akciðer ve böbrek) örnekleri alýndý. Plazma örneklerinde miyeloperoksidaz (MPO) ve ileri oksidasyon protein ürünleri (AOPP) seviyeleri belirlendi ve plazma ve dokularda malondialdehit (MDA) ölçüldü.
BULGULAR: MPO ve AOPP, Sepsis ve ß-Glukan gruplarýnda daha yüksekti; ancak plazma ve doku MDA düzeyleri sadece Sepsis grubunda Sham grubundan daha yüksekti (p<0.05). Bununla birlikte, Sepsis grubuyla karþýlaþtýrýldýðýnda, böbrek MDA deðeri hariç ölçülen tüm parametreler, ß-Glukan grubunda anlamlý olarak daha düþüktü (p<0.05).
TARTIÞMA: CLP sepsis modelinde AOPP düzeylerini araþtýrmak için yapýlan bu ilk çalýþmada; nötrofillerden salgýlanan MPO reaksiyonu ile üretilen ROS, lipitlere kýyasla proteinlerde oksidatif hasar oluþturabilir ve ß-glukan, sepsis tedavisi için alternatif bir ajan olarak kullanýlabilir.

BACKGROUND: Very high mortality rate in sepsis may be related to oxidative stress. This study was conducted on the rats to investigate the presence of oxidative stress and also the potential protective effects of the ß-glucan in the intra-abdominal sepsis model formed by cecal ligation-perforation (CLP).
METHODS: In this study, 30 Male rats were equally divided into three groups as “Sham”, “Sepsis” and “ß-Glucan”. Only laparotomy was performed in the Sham group, and sepsis was induced by CLP in Sepsis and ß-Glucan groups. Following CLP, a single dose of 4 mg ß-glucan/kg was also intraperitoneally administered to the β-Glucan group. Blood and tissue (liver, lung and kidney) samples were taken from Sepsis and ß-Glucan groups after sepsis development determined at the end of the 48th hour, also from the Sham group. The levels of myeloperoxidase (MPO) and advanced oxidation protein products (AOPP) were determined in plasma samples, and the malondialdehyde (MDA) was measured in plasma and tissues.
RESULTS: MPO and AOPP were higher in both the Sepsis and ß-Glucan groups; however, plasma and tissue MDA levels were higher only in the Sepsis group than the Sham group (p<0.05). However, when compared to the Sepsis group, all parameters measured, except kidney MDA, were significantly lower in the ß-Glucan group (p<0.05).
CONCLUSION: To our knowledge, this is the first study to investigate the AOPP levels in the CLP sepsis model, ROS produced by the reaction of MPO derived from neutrophils may form oxidative damage to the proteins, compared to the lipids, and ß-glucan may be used as an alternative agent for sepsis treatment.

AMAÇ: Kurkumin, nükleer faktör kappa B’nin (NF-kappa B) güçlü bir inhibitörü olduðu bilinen antioksidan ve antienflamatuvar bir moleküldür. Kurkumin’in 2,4,6-trinitrobenzen sülfonik asit (TNBS) ile indüklenen kolit modeli üzerindeki etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Anestezi altýnda kolit indüksiyonundan sonra, 42 sýçan altý gruba ayrýldý; kurkumin oral grup, kurkumin (20 mg/kg); mýsýr yaðý oral grubu, mýsýr yaðý (20 mg/kg) mide gavajý yoluyla, kurkumin rektal grubu, kurkumin; mýsýr yaðý rektal grubu, mýsýr yaðý. Kontrol grubuna 1 mL salin solüsyonu (%0.9 NaCl) rektal yolla uygulandý. Sham grubunda sadece rektal kateterizasyon yapýldý. Yedi gün sonunda, histopatolojik inceleme ve MPO, MDA, NO, PDGF, IL-6, TNF-alfa, NF-kappa B için kan ve baðýrsak doku örnekleri alýndý.
BULGULAR: Makroskobik hasar skoru, kurkumin oral, mýsýr yaðý oral ve salin gruplarýnda sham grubuna göre anlamlý olarak yüksek bulundu (p<0.05). Gruplar arasýndaki anlamlý fark, IL-6, NO, NF-kB, PDGF, TNF-α, MDA, MPO intestinal dokunun biyokimyasal analizinde deðerlendirildi (p<0.05). Kurkumin oral, kurkumin rektal, sham, mýsýr yaðý oral, mýsýr yaðý rektal gruplarýnda NF-kB kan seviyeleri, salin rektal grubuna göre anlamlý olarak arttý (p=0.001). Mýsýr yaðý rektal ve kontrol grubunun NF-kB serum seviyeleri (p≤0.001) sham grubundan düþük bulundu (p=0.012).
TARTIÞMA: Kurkumin’in, NF-kB sinyal yolundaki duzenleyici etkisi muhtemelen iyileþtirici özelliði ile gelecekteki çalýþmalarda tek baþýna kolite karþý veya konvansiyonel anti-kolitik tedaviler de kombinasyon halinde düþünülmelidir.

BACKGROUND: Curcumin is an antioxidant and anti-inflammatory molecule known to be a potent inhibitor of nuclear factor kappa B (NF-kappa B). In this study, we aimed to investigate the therapeutic effects of curcumin on colitis induced by a 2,4,6-trinitrobenzene sulfonic acid (TNBS).
METHODS: After the induction of colitis under anesthesia, 42 rats were divided into six groups as follows; the curcumin oral group, curcumin (20 mg/kg); the corn oil oral group, corn oil (20 mg/kg) using gastric gavage, the curcumin rectal group, curcumin; the corn oil rectal group, corn oil; the control group, 1 mL saline solution (0.9% NaCl) were administered using the rectal route. In the sham group, only rectal catheterization was performed. At the end of the seven day, the blood and intestinal tissue samples were obtained for histopathological examination and for MPO, MDA, NO, PDGF, IL-6, TNF-alpha, NF-kappaB.
RESULTS: The macroscopic damage score was significantly higher in curcumin oral, corn oil oral and saline groups when compared to the sham group (p<0.05). The significant differences between groups were evaluated using the biochemical analysis of intestinal tissue for IL-6, NO, NF-κB, PDGF, TNF-α, MDA, MPO (p<0.05). NF-κB levels of blood in curcumin oral, curcumin rectal, sham, corn oil oral, corn oil rectal groups were significantly increased when compared to saline rectal group (p≤0.001). NF-κB serum levels of corn oil rectal and control group (p≤0.001) were lower than the sham group (p=0.012).
CONCLUSION: The effects of curcumin improved possibly by modulating the NF-κB signaling pathway should be considered against colitis alone or in combination with the conventional anti-colitic therapies in future studies.

AMAÇ: Bu çalýþmanýn amacý, Yasal Týp Teþkilatý (LMO) içerisinde ölümcül yaralanmalarýn mevcut kayýt sisteminin bütünlüðünü hesaplamak ve Ýran’da ulusal düzeyindeki ölümcül yaralanmalarýn ekonomik yükünü tahmin etmektir.
GEREÇ VE YÖNTEM: 22 Haziran 2015–21 Haziran 2016 tarihleri arasýnda Hamedan Bölgesi’nde (HC) Yasal Týp Teþkilatý, saðlýk departmanlarý ve trafik polisi arasýnda üç kaynaklý yakalama-yeniden yakalama yöntemi kullanýlarak kaydedilen ölümcül yaralanmalarýn bütünlüðünü deðerlendirildi. Ayrýca, bir yýl boyunca Kaybedilmiþ Yýllar (KY) ölçütü kullanarak ölümcül yaralanmalarýn ekonomik yükü de deðerlendirildi. Ardýndan, uygun istatistiksel yöntemleri kullanarak tahminleri ulusal düzeyde genelleþtirdik.
BULGULAR: Hamedan Bölgesi LMO’sunda 487 kayýtlý ölümcül yaralanma vardý. Erkek/kadýn oraný 2.89 idi. Karayolu Trafik Kazalarý (RTC) ve intihar, ölümlerin sýrasýyla yüzde 45 ve yüzde 21’ini oluþturmaktaydý. Ölümcül yaralanma kayýt bütünlüðünün %86.9 olduðu tahmin edilmektedir. Hamedan Bölgesi’nin LMO bilgilerine dayanarak, ulusal düzeydeki ölümcül yaralanma numaralandýrma hatalarýnýn yüzdesinin, ayný dönemde LMO tarafýndan bildirilenin 1.1 katý olduðu tahmin edilmektedir (41.936’e karþý 36442). Kaybedilmiþ yýllar ve ölümcül yaralanmalarýn ekonomik yükünün ulusal düzeyde sýrasýyla 1.706.373 yýl ve 8.692.264.432 ABD dolarý olduðu tahmin edilmektedir.
TARTIÞMA: Ölümcül yaralanmalara ait mevcut kayýt sisteminin bütünlüðü iyidir. Ýran’da özellikle motorlu taþýt kazalarý nedeniyle ölümcül yaralanmalarýn ekonomik yükü büyüktür. Ülkemizdeki ölümcül yaralanma sayýsýný azaltmak için stratejiler, yasal eylemler ve önleyici programlar göz önünde bulundurulmalýdýr.

BACKGROUND: The present study aims to calculate completeness of the current registration system of fatal injuries in the legal Medicine Organization (LMO) and to estimate the economic burden of fatal injuries at the national level of Iran.
METHODS: We estimated the completeness of registered fatal injuries using a three-source capture-recapture method among the Legal Medicine Organization, health departments and Traffic police in Hamedan County (HC) from June 22, 2015 to June 21, 2016. We also estimated the economic burden of fatal injuries using Years of Life Lost (YLL) during one year. Then, using appropriate statistical methods, we generalized the estimates to the national level.
RESULTS: There were 487 registered fatal injuries in the LMO of HC. The male to female ratio was 2.89. Road Traffic Crashes (RTC) and suicide pertained 45 and 21 percent of deaths, respectively. The completeness of fatal injuries registration was estimated at 86.9%. Based on LMO information of HC, the percentage of fatal injuries numbering errors at the national level was estimated 1.1 times that was reported by LMO in the same period (41,936 vs. 36442). YLL and the economic burden of fatal injuries were estimated 1,706,373 years and 8,692,264,432 US$ at the national level, respectively.
CONCLUSION: The completeness of the current registration system of fatal injuries is good. The economic burden of fatal injuries, especially due to motor vehicle crashes in Iran, is substantial. Strategies, legislative actions, and preventive programs should be considered to decrease the number of fatal injuries in our country.

AMAÇ: Malign mide çýkýþ týkanýklýðý palyatif tedavisinde konvansiyonel gastrojejunostominin palyatif etkinliði tartýþmalýdýr. Bu çalýþmanýn amacý, konvansiyonel gastrojejunostomi ile mide bölücü gastrojejunostominin sonuçlarýný karþýlaþtýrmak ve malign mide çýkýþ týkanýklýðý olan hastalarda cerrahi sonrasý gecikmiþ mide boþalmasýný etkileyen faktörleri araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþma grubu midenin bölünüp bölünmeme durumuna göre konvansiyonel gastrojejunostomi ve mide bölücü gastrojejunostomi olarak iki gruba ayrýldý. Tüm demografik veriler; hasta özellikleri ve gecikmiþ mide boþalma derecesi ile 30 günlük komplikasyonlarý içeren ameliyat sonrasý sonuçlar toplandý. Klinik sonuçlarýn karþýlaþtýrýlmasýnýn ardýndan, gecikmiþ mide boþalmasý için risk faktörleri regresyon modelleri kullanýlarak belirlendi.
BULGULAR: Elli üç hasta çalýþmaya alýndý. Otuz yedi hastaya konvansiyonel gastrojejunostomi, 16 hastaya ise mide bölücü gastrojejunostomi uygulandý. Hastalarýn demografik ve temel özellikleri gruplar arasýnda benzerdi. Konvansiyonel gastrojejunostomi grubunda 10 (%27) hastada grade B-C gecikmiþ mide boþalmasý mevcut iken, mide bölücü gastrojejunostomi grubunda hiçbir hastada bu durum gözlenmedi. Gruplar arasýnda hastanede yatýþ süresi ve komplikasyonlar açýsýndan fark yoktu. Çok deðiþkenli regresyon analizinde uzak metastaz varlýðý (OR=0.156, %95 GA 0.034–0.720, p=0.017) ve mide bölünmesi (OR=0.127, %95 GA 0.025–0.653, p=0.014) gecikmiþ mide boþalmasý için baðýmsýz faktörler olarak bulundu.
TARTIÞMA: Malign mide çýkýþ týkanýklýðý olan hastalarda, mide bölücü gastrojejunostomi konvansiyonel gastrojejunostomi ile karþýlaþtýrýldýðýnda, mide boþalmasýný iyileþtirerek olumlu klinik sonuçlar saðlayabilir.

BACKGROUND: Palliative efficacy of conventional gastrojejunostomy in palliation of malignant gastric outlet obstruction is debatable. This study aims to compare the outcomes of conventional gastrojejunostomy and stomach-partitioning gastrojejunostomy and to explore the factors influencing the delayed gastric emptying after surgery in patients with malignant gastric outlet obstruction.
METHODS: The study subjects were divided into the following two groups based on whether the stomach was partitioned or not: Conventional gastrojejunostomy and stomach-partitioning gastrojejunostomy. All demographic data, patient characteristics, postoperative outcomes, including delayed gastric emptying grade and 30-day complications were collected. Following the comparison of the clinical outcomes, risk factors for delayed gastric emptying were determined by regression models.
RESULTS: Fifty-three patients were included in this study. Of these, 37 patients underwent conventional gastrojejunostomy, whereas 16 patients underwent stomach-partitioning gastrojejunostomy. Patient demographics and baseline characteristics were comparable between groups. Although 10 (27%) patients in the conventional gastrojejunostomy group had delayed gastric emptying grade B-C, no patient in the stomach-partitioning gastrojejunostomy group experienced this condition. There was no difference between the groups concerning hospital stay and complications. In multivariate regression analysis, having distant metastasis (OR=0.156, 95%CI 0.034–0.720, p=0.017) and stomach-partitioning (OR=0.127, 95%CI 0.025–0.653, p=0.014) were found as independent factors for the delayed gastric emptying.
CONCLUSION: In patients with malignant gastric outlet obstruction, compared with conventional gastrojejunostomy, stomach-partitioning may provide favorable clinical outcomes by improving gastric emptying.

AMAÇ: Coronavirus Hastalýðý 2019 (COVID-19) acil servis baþvurularýnýn temelini oluþturmuþtur. Bu çalýþma pandeminin acil servise baþvuran genel cerrahi hastalarýna etkisini deðerlendirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Mart 2020–Mayýs 2020 (pandemi dönemi) ile Mart 2019–Mayýs 2019 (pandemi olmayan dönem) tarihleri arasýnda acil servise baþvuran genel cerrahi hastalarýnýn kayýtlarý hastane bilgisayar tabanlý veritabanýndan geriye dönük olarak incelendi. Birincil sonuç acil servis baþvuru oranlarýdýr. Ýkincil sonuçlar hastalarýn baþvuru þikayetleri, taný ve tedavileri, tedavi red oranlarý, triyaj kategorileri, yaþ ve cinsiyetin acil servis baþvuru oranlarýna etkisi ve hastanede yatýþ oranlarýdýr. Sonuçlar her iki dönemde karþýlaþtýrýlmýþtýr.
BULGULAR: Çalýþma pandemi döneminde 265 hasta, pandemi olmayan dönemde 353 hasta olmak üzere toplam 618 hastayla yapýldý. Pandemi döneminde kadýn hastalarýn baþvuru oraný, erkek hastalara göre daha düþüktü (sýrasýyla, %45.5’e karþý %55.5, p=0.045). Pandemi döneminde hastaneye baþvuran hastalarýn triyaj kategorilerinin sarý ve kýrmýzý olma oraný daha yüksek, yeþil olma oraný ise daha düþüktü (p<0.01). Pandemi dönemindeki hastalarda cerrahi patoloji görülme oraný daha fazlaydý (p=0.019). Pandemi döneminde tanýsý gastrointestinal sistem hastalýklarý olan hastalarýn oraný daha yüksekti (p=0.011). Pandemi döneminde açýk ameliyat oraný pandemi olmayan döneme göre daha yüksekti (sýrasýyla, %80.5’e karþý %32.7, p<0.01). Tedavi red oraný pandemi döneminde pandemi olmayan döneme göre daha yüksekti (sýrasýyla, %20’ye karþý %3.7, p<0.01). Hastanede yatýþ süreleri pandemi döneminde daha düþüktü (p=0.021).
TARTIÞMA: COVID-19 salgýný sýrasýnda cerrahi hastalarýn acil servis baþvurularýnda %25 oranýnda azalma saptandý. En büyük düþüþ yeþil alan baþvurularýnda ve kadýn hasta baþvurularýnda görüldü. Pandeminin acil servise baþvuran cerrahi hastalar üzerindeki etkisini deðerlendirmek hem salgýn sonrasý dönemde hem de olasý gelecek salgýn dönemlerine hazýrlýk açýsýndan önemlidir.

BACKGROUND: The novel Coronavirus Disease 2019 (COVID-19) formed the basis for emergency department visits. This study aims to evaluate the effects of the pandemic on emergency department visits of surgical patients.
METHODS: The hospital database records of general surgery patients who presented at the emergency department in the period of March 2020-May 2020 (pandemic period) and March 2019–May 2019 (non-pandemic period) were retrospectively analyzed and compared. The primary outcome of this study was the emergency department visit rate of patients requiring a general surgery consultation. Secondary outcomes of this study were patient complaints, diagnosis and treatments, treatment rejection rate, triage category data, the effects of age and gender, and the hospitalization rate.
RESULTS: In this study, 618 patients were included: 265 patients from the pandemic period and 353 patients from the non-pandemic period. The analysis and comparison revealed that during the pandemic period, the presentation rate of female patients was lower than that of male patients (45.5% vs. 55.5%, respectively, p=0.045). The triage category rates of patient visits to the hospital during the pandemic period were higher in yellow and red, and lower in green (p<0.01). The incidence of a surgical pathology finding was higher during the pandemic period (p=0.019). The incidence of diseases related to the gastrointestinal tract was higher during the pandemic period (p=0.011). The rate of open surgery in the pandemic period was higher than that of the non-pandemic period (80.5% vs. 32.7%, respectively; p<0.01). The treatment rejection rate was also higher in the pandemic period compared with the non-pandemic period (20% vs. 3.7%, respectively; p<0.01, r). In addition, the hospitalization period was shorter in the pandemic period (p=0.021).
CONCLUSION: A 25% reduction in the number of surgical patient visits to the emergency department was observed during the COVID-19 outbreak. The biggest decrease was seen in patients with a green triage code and female patients. It is significant to evaluate the effects of the pandemic on surgical patients visited the emergency department to manage the post-epidemic period and to prepare for possible future epidemic periods.

AMAÇ: Torakstaki kesici ve delici alet yaralanmalarý (SW) kardiyak yaralanma þüphesini akla getirmekle beraber bunlara iliþkin tomografik açýklamalar deðiþkenlik gösterir. Bu çalýþma, toraks içindeki farklý tomografik tanýmlamalarý deðerlendirilmesi ve SW’nin penetran kardiyak travmasýndaki taný deðerlerinin saptanmasý amaçlanmaktadýr.
GEREÇ VE YÖNTEM: Ocak 2013 - Haziran 2016 tarihleri arasýnda merkezimize torasik SW ile baþvuran tüm hastalarýn týbbi kayýtlarý bu çalýþmaya alýndý. Bunlarýn taný deðeri potansiyelleri literatürde açýklanan farklý toraks alanlarý kullanýlarak ölçüldü.
BULGULAR: Üç yüz altý olgu analiz edildi. Otuz sekiz (%12.4) hastada cerrahi olarak yönetilen kalp yaralanmasý vardý. Kardiyak yaralanma nedeniyle ölüm 7 (%18.4) hastada meydana geldi. Sað ön klavikula çizgisi ile sol ön aksiller çizgiye kadar, 2. ve 6. interkostal boþluklar arasýnda tanýmlanan kalp alaný daha doðruydu. Penetran kardiyak travmada %97.3, özgüllük %72, pozitif prediktif deðer %33, negatif prediktif deðer %99.4 ve %75.1 hassasiyete sahiptir. ROC 0.894 IC %95 (0.760–0.901) idi.
TARTIÞMA: Torasik bölgeler arasýnda, sað orta klavikula çizgisi ile sol ön aksiller çizgisi ve 2. ve 6. interkostal boþluklar arasýndaki topografik sýnýrlamalar daha kesindir ve toraks ile SW hastalarýnda kalp yaralanmasýnýn yüksek göstergesidir.

BACKGROUND: Stab wounds (SW) to the thorax raises suspicion for cardiac injuries; however, the topographic description is variable. The present study aims to evaluate different topographical descriptions within the thorax and establish their diagnostic value in penetrating cardiac trauma by SW.
METHODS: Medical records of all patients admitted to our center with thoracic SW from January 2013 to June 2016 were included in this study. Diagnostic value potential was measured using different areas of the thorax described in the literature.
RESULTS: In this study, we analyzed 306 cases. Thirty-eight (12.4%) patients had a cardiac injury managed surgically. Death by cardiac injury occurred in seven (18.4%) patients. The cardiac area defined between the right mid-clavicle line until the left anterior axillary line, and between 2nd and 6th intercostal spaces was the more accurate. It has sensitivity of 97.3%, specificity 72%, positive predictive value 33%, negative predictive value 99.4% and accuracy 75.1% for penetrating cardiac trauma. ROC was 0.894 IC 95% (0.760–0.901).
CONCLUSION: Among the thoracic areas, topographical limits between the right mid-clavicle line and the left anterior axillary line, and between 2nd and 6th intercostal spaces are the more accurate and are highly indicative of cardiac injury in patients with SW to the thorax.

AMAÇ: Apandisit en sýk görülen cerrahi acillerden biridir. Çocuklarda apandisitin erken tanýsý önemlidir, çünkü tedavideki herhangi bir gecikme büyük ölçüde komplike apandisite yol açar. Bu çalýþmada, akut apandisitli çocuklarda pentraksin 3 (PTK3) düzeyinin tanýsal deðerini ve hastalýðýn ilerlemesi ile PTK3 seviyesi arasýnda bir iliþki olup olmadýðýný araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmaya 70 çocuk alýndý. Çocuklar 3 gruba ayrýldý: Grup 1 (apandisit; n=37), grup 2 (karýn aðrýsý; n=25), grup 3 (kontrol; n=8). Demografik veriler, týbbi öykü, semptomlarýn baþlangýcýndan kan örneklemesine kadar geçen süre, hastalarýn ameliyat ve patolojik bulgularý kaydedildi ve beyaz küre (BK), C-reaktif protein (CRP) ve PTK3 deðerleri ölçüldü.
BULGULAR: Apandisit grubunda ortalama BK, CRP ve PTK3 deðerleri anlamlý olarak yüksek bulundu (p<0.001). Apandisit grubunda PTK3 en yüksek taný deðerine (AUC=0.828), özgüllüðe (%88) ve pozitif öngörü deðerine (%90) sahipti. BK deðerleri zaman dilimleri ile anlamlý bir korelasyon göstermedi (p=0.999). Apandisit grubunda 24–48 saatteki ortalama CRP deðeri, 0–24 saattekinden daha yüksek bulundu, ancak bu sýnýrda anlamlý idi (p=0.068). Diðer taraftan, PTK3 deðeri zaman dilimleri ile anlamlý olarak korele idi (p<0.05).
TARTIÞMA: Bu çalýþma, PTK3’ün akut apandisit tanýsýnda deðerli bir enflamatuvar biyobelirteç olduðunu göstermiþ ve ayrýca hastalýðýn ilerlemesini tahmin etmek için de yararlý olduðunu belgelemiþtir.

BACKGROUND: Appendicitis is one of the most common surgical emergencies. Early diagnosis of appendicitis is important in children because any delay in treatment substantially leads to complicated appendicitis. In this study, we aimed to test the diagnostic value of pentraxin 3 (PTX3) level in children with acute appendicitis and to investigate whether there is a relationship between the progression of the disease and PTX3 level.
METHODS: This prospective study included 70 children. They were divided into three groups as follows: group 1 (appendicitis; n=37), group 2 (abdominal pain; n=25), group 3 (control; n=8). Demographic data, medical history, the time from the onset of symptoms to blood sampling, operative and pathological findings of the patients were noted, and white blood cell (WBC), C-reactive protein (CRP) and PTX3 values were measured.
RESULTS: The mean WBC, CRP and PTX3 values were found to be significantly increased in the appendicitis group (p<0.001). PTX3 has the highest diagnostic value (AUC=0.828), specificity (88%) and positive predictive value (90%) in the appendicitis group. WBC values did not show a significant correlation with the time periods (p=0.999). The mean CRP level of the appendicitis group in 24–48 hours was found to be higher than in 0–24 hours, but this was marginally significant (p=0.068). On the other hand, PTX3 value was significantly correlated with the time periods (p<0.05).
CONCLUSION: This study showed that PTX3 is a valuable inflammatory biomarker in the diagnosis of acute appendicitis and also documented that PTX3 is useful for predicting the progression of the disease.

AMAÇ: Bu çalýmanýn amacý akut apandisit ön tanýsýyla apendektomi olmuþ karaciðer transplantlý ve transplant dýþý hastalarý karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Posttransplant dönemde akut apandisit ön tanýsýyla apendektomi yapýlan 13 karaciðer transplantlý hasta (transplant grubu) ile ayný dönemde apendektomi olmuþ transplant dýþý 52 hasta (non-transpalnt grubu) demografik ve klinikopatolojik özellikler yönünden karþýlaþtýrýldý. Transplant ve non-transplant gruplar 1: 4 rastgele eþleþtirme yöntemi kullanýlarak oluþturuldu. Devamlý deðiþkenlerin karþýlaþtýrýlmasýnda Mann-Whitney U-testi kullanýlýrken kategorik deðiþkenlerin karþýlaþtýrýlmasýnda Fisher kesin testi kullanýldý. P deðeri <0.05 istatistiksel anlamlýlýk sýnýrý olarak kabul edildi.
BULGULAR: Bu çalýþmaya yaþlarý 1 ile 84 yýl arasýnda deðiþen toplam 65 hasta alýndý. Non-transplant grubundaki 52 hastanýn (32 erkek ve 20 kadýn) 17 ile 84 yýl arasýnda deðiþirken transplant grubundaki 13 hastanýn (9 erkek ve 4 kadýn) yaþlarý 1 ile 64 yýl arasýnda deðiþmekteydi. Gruplar arasýnda WBC (p=0.002), nötrofil (p=0.002), lenfosit (p=0.032), trombosit (p=0.032), RDW (p=0.001), CRP (p=0.009), PNR (p=0.042), WNR (p=0.03) ve apendiks uzunluðu (p<0.001) açýsýndan istatistiksel olarak anlamlý farklýlýklar saptandý. Negatif apendektomi oraný transplant grubunda nisbeten daha yüksek olmakla birlikte bu farklýlýk istatistiksel olarak anlamlý deðildi (%30.8 ve %21.2; p=0.477). Perfore apandisit transplant grubunda çok daha sýk görülmekle birlikte bu farklýlýk istatistiksel olarak anlamlý deðildi (%30.8 ve %9.6; p=0.070).
TARTIÞMA: WBC ve nötrofil LT grubunda daha düþüktü; CRP ve RDW LT grubunda daha yüksekti. Perforasyon ve negatif apendektomi oranlarý LT grubunda daha yüksekti, ancak bu fark istatistiksel olarak anlamlý bulunmamýþtýr.

BACKGROUND: This study aims to compare liver transplant and non-liver transplant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis.
METHODS: Demographic and clinicopathological features of 13 liver transplant recipients (transplant group) who underwent posttransplant appendectomy with a presumed diagnosis of acute appendicitis were compared with the features of 52 non-liver transplant patients (non-transplant group). They underwent appendectomy with a presumed diagnosis of acute appendicitis during the same time period. The transplant group was matched at random in a 1: 4 ratio with the non- transplant group. While the continuous variables were compared using the Mann Whitney-U test, categorical variables were compared with Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant.
RESULTS: A total of 65 patients aged between one year and 84 years were included in this study. While the age of the 52 patients (32 male and 20 female) in the non- transplant group ranged from 17 years to 84 years, the age of the 13 patients (nine male and four female) in the transplant group ranged from one year to 64 years. Statistically significant differences were noted between both groups concerning WBC (p=0.002), neutrophil (p=0.002), lymphocyte (p=0.032), platelets (p=0.032), RDW (p=0.001), CRP (p=0.009), PNR (p=0.042), WNR (p=0.03), and appendiceal length (p<0.001). The negative appendectomy rate was relatively higher in transplant than the non-transplant group but this difference was not statistically significant (30.8% vs. 21.2%; p=0.477). Perforated acute appendicitis occurred more frequently in the transplant group; however, this difference was not statistically significant (30.8% vs. 9.6%; p=0.070).
CONCLUSION: WBC and neutrophil were lower in the LT group; however, the CRP and RDW were higher in the LT group. Further, perforation and negative appendectomy rates were higher in the LT group, although this difference was not statistically significant.

AMAÇ: Türkiye çok sayýda Suriyeli göçmene ev sahipliði yapmasýna raðmen, saðlýk sorunlarýnýn yorumlanmasý yetersiz ve anlaþýlmamýþ gibi görünmektedir. Mülteci olmanýn, peptik ülser perforasyonu (PUP) hastalýðý için prognostik bir faktör olup olmadýðýný araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Türkiye Cumhuriyeti vatandaþý ve mülteci olan hastalarýn PUP açýsýndan prognozlarýný karþýlaþtýrmak için retrospektif bir çalýþma tasarlandý. PUP nedeniyle ameliyat edilen 130 erkek ve 13 kadýndan oluþan 143 hastanýn 105’i Türk, geri kalan 38’i mülteci idi. Hastalarýn dosyalarý, ameliyat notlarý ve poliklinik verileri deðerlendirildi.
BULGULAR: Sekiz (%7.6) Türk vatandaþý ve bir (%2.6) mülteci hastada mortalite saptandý ve iki grup arasýnda mortalite açýsýndan istatistiksel bir anlamlýlýk saptanmadý (p=0.445). Yaþ, perforasyon çapý ve lokalizasyonu, reoperasyon ihtiyacý, nazogastrik dekompresyon süresi, CRP, hematokrit, albümin, kreatinin, BUN düzeyleri mortalite açýsýndan istatistiksel olarak anlamlý bulundu.
TARTIÞMA: Bir mülteci olmak, peptik ülser hastalýðýnýn etiyopatogenezinde bir risk olarak tanýmlanmýþ olmasýna raðmen, Türkiye’de mülteci olmanýn PUP için negatif bir prognostik faktör olmadýðýný tespit ettik.

BACKGROUND: Although Turkey hosts the largest number of Syrian immigrants, the interpretation of their health problems seems to be inadequate and understudied. In this study, we aimed to investigate whether being a refugee is a prognostic factor or not for peptic ulcer perforation (PUP).
METHODS: A retrospective study was designed in Turkish Citizen patients and the refugees to compare the prognosis who underwent surgery for PUP. After ethical committee approval, the data of 143 patients, constituting 130 males and 13 females, operated for PUP, were collected. Patients’ files, surgery notes and outpatient policlinic data were evaluated.
RESULTS: In this study, 105 patients were Turkish Citizen, while the remaining 38 patients were refugees. Eight (7.6%) Turkish and one (2.6%) refugee patient died. There was no statistical significance between the two groups concerning mortality (p=0.445). Age, perforation diameter and localization, need of reoperation, nasogastric tube detention time, CRP, hematocrit, albumin, creatinine, BUN levels were found statistically significant for mortality.
CONCLUSION: Although being a refugee has been identified as a risk in the etiopathogenesis of peptic ulcer disease, we found that being a refugee in Turkey is not a negative prognostic factor for PUP.

AMAÇ: Ýstenmeyen perioperatif hipotermi vücut sýcaklýðýnýn 36°C’nin altýna düþmesi olarak tanýmlanýr. Türk Anesteziyoloji ve Reanimasyon Derneði (TARD) 2013 yýlýnda “Ýstenmeyen Perioperatif Hipoterminin Önlenmesi Rehberini” yayýnladý. Amacýmýz rehber önerilerini içeren bir protokol oluþturmak ve hastanemizde perioperatif hipotermi insidansýný azaltmaktýr.
GEREÇ VE YÖNTEM: Cerrahi geçiren hastalarda perioperatif hipotermi insidansýný azaltmaya yönelik oluþturulan protokol ile ileriye yönelik bir kalite iyileþtirme çalýþmasý yaptýk. Hastalarýn perioperatif hipotermi insidansýný; implementasyondan önce (24 Kasým 2015–15 Ocak 2016) ve implementasyondan sonra (6 Nisan 2016–21 Temmuz 2017) ölçtük ve karþýlaþtýrdýk.
BULGULAR: Ýstenmeyen perioperatif hipotermi (<36°C) insidansý preimplementasyon kolunda %35, postimplementasyon kolunda %23.8 olarak bulundu ve bu farkýn istatistik olarak anlamlý olduðu görüldü (p=0.002).
TARTIÞMA: Kanýta dayalý uygulamalar ile yapýlan müdahaleler sonucunda istenmeyen perioperatif hipotermi insidansý belirgin olarak azaltýlabilir.

BACKGROUND: Unintended Perioperative Hypothermia (UPH) is defined as a core body temperature less than 36°C. The Turkish Society of Anesthesiology and Reanimation [Türk Anesteziyoloji ve Reanimasyon Derneði (TARD)] published a “Guideline for the Prevention of the Unintended Perioperative Hypothermia” in 2013. This study aims to decrease the incidence of unintended UPH in our hospital using a protocol, which is prepared according to the recommendations in the Guideline for the prevention of unintended perioperative hypothermia.
METHODS: A prospective quality improvement study was conducted with the protocol, which was prepared to decrease the incidence of unintended perioperative hypothermia in patients undergoing surgery. We measured and compared the perioperative hypothermia incidence before the implementation (November 24th, 2015 – January 15th, 2016) and after the implementation (April 6th, 2016 – July 21st, 2017).
RESULTS: The incidence of unintended perioperative hypothermia was 35% and 23.8% in the pre-implementation and postimplementation sections, respectively, and the difference was statistically significant (p=0.002).
CONCLUSION: The incidence of unintended perioperative hypothermia can be significantly decreased with the evidence-based implementations.

AMAÇ: Travmatik beyin hasarlý (TBH) çocuklarda kafa içi basýncýnýn (KÝB) takibi prognoz ve tedavi açýsýndan önemlidir. Optik sinir kýlýf çapý (OSKÇ) ölçümleri kafa içi basýncýnýn monitorizasyonunda önerilen yöntemlerden birisidir. Bu çalýþmada, TBH olan pediatrik olgularýn takibinde beyin bilgisayarlý tomografideki (BT) OSKÇ deðiþiminin pediatrik Glasgow Koma Skoru (pGKS) ile korelasyonunu deðerlendirmeyi ve ayný zamanda KÝB göstergesi olan OSKÇ’nin hasta takibinde kullanýlabilirliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2016–Ocak 2018 tarihleri arasýnda acil servise kafa travmasý ile baþvuran 921 pediatrik hasta geriye dönük olarak deðerlendirildi. Yaþ, cinsiyet, travma tipi, beyin BT bulgularý, pGKS, serebral hemoraji tipleri ve izole kafatasý kýrýklarý (ÝKK) incelendi. Hastalar BT bulgularýna dayalý; parankimal beyin hasarý, ÝKK ve normal beyin BT’si olanlar þeklinde üç grupta deðerlendirildi. OSKÇ ölçümü BT ile yapýldý. Hastalarýn OSKÇ ölçüm sonuçlarýnýn klinik verilerle uyumu karþýlaþtýrýldý.
BULGULAR: Çalýþmamýzda hastalarýn yaþ ortancasý 36 (IQR=64) ay olup, hastalarýn %64.2’si erkekti. Parankimal yaralanmasý hastalarýn OSKÇ’si ve pGKS’si, ÝKK olan ve normal beyin BT’si olan hastalardan anlamlý olarak yüksek saptandý (p<0.05). Çalýþmamýzda pGKS’nin birinci ve ikinci ölçüm OSKÇ deðerleri arasýnda negatif yönlü anlamlý korelasyon verdiði saptandý (p<0.05). Çalýþmamýza almýþ olduðumuz ve kontrol beyin BT’si çekilen gruplarda, ikinci beyin BT’de saptanan OSKÇ düzeyleri anlamlý olarak yüksek saptandý (p<0.05).
TARTIÞMA: Beyin BT bulgularý ve pGKS birlikte deðerlendirildiðinde OSKÇ ölçümleri klinik takipte güvenilir ve anlamlý parametrelerdir. Tekrarlayan OSKÇ ölçümlerinin, ikincil yaralanmalarýn olasý olumsuz etkilerini ve baþvuru esnasýnda yaþanan travmanýn þiddetini belirlemede faydalý olacaðýna inanýyoruz.

BACKGROUND: Intracranial pressure (ICP) monitoring is of profound importance concerning prognosis and treatment among children with traumatic brain injury (TBI). Measurements of the optic nerve sheath diameter (ONSD) are one of the methods recommended for ICP monitoring. In this study, we aimed to evaluate the correlation of ONSD change in brain computed tomography (CT) with pediatric Glasgow Coma Score (pGCS) in the follow-up of pediatric cases with TBI, and also to evaluate the usability of the ONSD, which is the indicator of ICP.
METHODS: The data of 921 pediatric patients who were admitted to the emergency department with head injury between January 2016 and January 2018 were retrospectively evaluated in this study. Age, gender, trauma type, brain CT finding, pGCS, type of intracranial hemorrhage (ICH), and isolated skull fracture (ISF) were investigated. The patients were evaluated in three groups based on CT findings: (i) patients with parenchymal brain injury, (ii) patients with ISF, and (iii) patients with normal brain CT results. The measurements of ONSD were performed using CT. Whether the ONSD measurement results of the patients were compatible with the clinical data was investigated.
RESULTS: The median age of the patients was 36 months (interquartile range [IQR] = 64) and 64.2% were male. The ONSD values and pGCSs of the patients with parenchymal injury were found to be significantly higher than patients with ISF and normal brain CT findings (p<0.05). The pGCSs showed a significant negative correlation with the first and second measurement results of ONSD (p<0.05). In groups undergoing control brain CT, ONSD levels in the second brain CT were found to be significantly high (p<0.05).
CONCLUSION: In the clinical follow-up, ONSD measurements are reliable and significant parameters when evaluated with brain CT findings and pGCSs. We think that repeated ONSD measurements will be useful in determining possible adverse effects of secondary injury, as well as in determining the severity of the trauma during admission.

AMAÇ: Akut karýn cerrahisi sonrasý yüksek oranda mortalite ve morbidite görülmekte, postoperatif dönemde sýklýkla yoðun bakým ihtiyacý olmaktadýr. Yoðun bakým ünitelerinde, prognoz ve mortaliteyi belirlemek amacýyla çeþitli skorlama sistemleri kullanýlmakta ancak mortalite ve prognozu öngörmede yeterli olmamaktadýr. Bu amaçla kolay uygulanabilir, etkin yöntemler araþtýrýlmaktadýr. Biz bu çalýþmada, akut karýn cerrahisi geçiren hastalarda nötrofil-lenfosit oraný (NLO), trombosit-lenfosit oraný (TLO) ve ortalama trombosit hacmi (OTH) gibi kan parametrelerinin mortalite ile iliþkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmaya, akut karýn ameliyatý geçiren 249 hasta alýndý. Hastalar sað kalan (n=126) ve ölenler (n=123) olarak iki gruba ayrýldý. Hasta verileri retrospektif olarak incelendi. NLO, TLO ve OTH deðerleri gruplar arasýnda karþýlaþtýrýldý. Yaþ, cinsiyet, Akut Fizyoloji ve Kronik Saðlýk Deðerlendirmesi II-IV skorlarý (APACHEII-IV), Sýralý Organ Yetmezliði Deðerlendirme skorlarý (SOFA), Glasgow Koma Skalasý gibi veriler deðerlendirildi.
BULGULAR: Çalýþmamýzda mortalite oraný %49.4 idi. NLO ve TLO deðerlerinde gruplar arasýnda istatistiksel olarak anlamlý fark yoktu. Ancak, OTH ölenler grubunda anlamlý olarak yüksek bulundu (p<0.004).
TARTIÞMA: Çalýþma sonuçlarýmýz akut karýn cerrahisi sonrasý hayatýný kaybedenlerde OTH deðerlerinin anlamlý derecede yüksek olduðunu ve NLO ve TLO’nýn mortalite ile iliþkili olmadýðýný göstermiþtir.

BACKGROUND: Acute abdominal surgery has a high rate of mortality and morbidity, and intensive care is often needed in the postoperative period. In intensive care units, various scoring systems are used to determine prognosis and mortality but are not sufficient to predict mortality and prognosis. For this purpose, easily applicable, effective methods are being investigated. In this study, we aimed to investigate the relationship between mortality and blood parameters, such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV), in patients undergoing acute abdominal surgery.
METHODS: This study included a total of 249 patients who underwent acute abdominal surgery. The patients were divided into two groups as survivors (n=126) and non-survivors (n=123). The patient data were retrospectively analysed. The NLR, PLR, and MPV values were compared between the groups. Data including age, sex, Acute Physiology and Chronic Health Evaluation II-IV scores (APACHEII-IV), Sequential Organ Failure Assessment scores (SOFA), Glasgow Coma Scale were assessed.
RESULTS: The mortality rate was 49.4% in our study. There was no statistically significant difference in the NLR and PLR values between the groups. However, MPV was significantly higher in the non-survivors group (p<0.004).
CONCLUSION: Our study results showed that MPV values were significantly higher in the non-survivors following acute abdominal surgery, and NLR and PLR were not associated with mortality.

AMAÇ: Akut apandisit, hýzla ilerleyen bir iltihabi hastalýk olup, standart tedavisi acil cerrahi giriþimdir. Bununla birlikte, son zamanlarda bazý olgularda yarý elektif olarak apendektomi planlanabileceði konusunda görüþler belirtilmektedir. Bu çalýþmamýzdaki amacýmýz zorunlu nedenlere baðlý ameliyatýn ertelendiði durumlarda ve komplike olmayan olgularda sývý ve antibiyotik tedavisi altýnda güvenli olarak apendektomi uygulanabileceðini ortaya koymaktýr.
GEREÇ VE YÖNTEM: Çalýþmamýz Ekim 2014–Þubat 2015 tarihleri arasýnda akut apandisit ön tanýsý ile apendektomi yapýlmýþ 160 olguyu içermektedir. Hastalar, ameliyat öncesi bekleme süresi 10 saat altý ve üstü olacak þekilde iki gruba ayrýldý ve patoloji sonuçlarý, komplikasyon oranlarý ve hastanede kalýþ sürelerine göre karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 160 hasta alýndý. Grup A’da 79, Grup B’de 81 hasta vardý. Hastalarýn demografik verileri, patoloji raporlarý ve komorbid durumlarý incelendiðinde istatistiksel anlamlý fark yoktu. Ortalama ameliyat öncesi bekleme süresi ve ameliyat süreleri karþýlaþtýrýldýðýnda gruplar arasýnda anlamlý fark saptandý. Hastaneden kalýþ süreleri, yara yeri enfeksiyonu ve karýniçi apse açýsýndan her iki grup arasýnda anlamlý fark saptanmadý.
TARTIÞMA: Komplike olmayan akut apandisit tanýsý alan hastalarýn, acil serviste ameliyat öncesi uygun medikal tedavi ve gözlem altýnda geçirdiði bekleme süresinin, komplikasyon ve hastanede yatýþ süresi üzerine olumsuz etkisi yoktur.

BACKGROUND: The standard treatment of acute appendicitis, which is a rapidly progressive inflammatory disease, remains surgery. However, several studies have suggested antibiotics treatment for acute appendicitis, especially in centers where surgery at all hours is not possible. Therefore, in this study, we investigated the relationship between the preoperative waiting period and postoperative complications in patients who underwent interval surgery following conservative management during the same admission.
METHODS: All patients who were diagnosed with uncomplicated acute appendicitis between October 2014 and February 2015 and underwent surgery at a single center were included in this retrospective study. Patients were divided into two groups based on the waiting period between the diagnosis and the time of surgery: group A (emergency, waiting period <10 h) and group B (urgency, waiting period ≥10 h). The demographic features, preoperative waiting period, antibiotics use, pathological diagnosis, postoperative complications, length of hospital stay, and readmission were compared between the two groups.
RESULTS: This study comprised 160 patients, including 79 and 81 patients in groups A and B, respectively. The demographic features, comorbidities, and pathological diagnosis were comparable between the two groups. The average preoperative waiting period was significantly longer in group B than in group A. However, the mean length of hospital stay and the rate of postoperative complications, including infections at the surgical sites and intra-abdominal abscesses, were similar between the two groups.
CONCLUSION: Our analyses revealed that there were no disadvantages associated with a longer preoperative waiting period in patients diagnosed with uncomplicated appendicitis.

AMAÇ: Endoskopik retrograt kolanjiyopankreatografi (ERCP) perforasyonu nadir görülen, fakat mortalitesi yüksek seyredebilen bir komplikasyondur. Bu çalýþmada, cerrahi veya týbbi tedavi edilen ERCP perforasyonlarýna insidans, klinik veriler ve taný zamanýna göre klinik deðerlendirme yapýldý. ERCP perforasyonlarýnýn azaltýlabilmesi için klinik özelliklerinin ortaya konulmasý, literatür ile karþýlaþtýrýlmasý ve mortalitenin azaltýlmasý hedeflendi.
GEREÇ VE YÖNTEM: Bu klinik geriye dönük çalýþmada 8 yýlda yapýlan tüm ERCP iþlemleri (n=8676) içinde 51 perforasyon saptandý. Erken taný konulan [Grup 1: 40], geç taný konulan [Grup 2: 11] gruplar primer tanýlarý, ERCP öncesi kan ve biyokimyasal incelemeleri, perforasyon tipi, tedavi yöntemi, klinik özellikleri, yatýþ süresi, mortalite yönünden karþýlaþtýrýldý. Ek olarak ERCP sýrasýnda papillotomi, stent yerleþtirilmesi, koledok dilatasyonu, ERCP iþlemi sayýsý yönünden karþýlaþtýrýldý.
BULGULAR: Hastanemizde ERCP perforasyonu oraný %0.59’du. Hastalarýn çoðunluðu koledokolitiazis ve periampuller tümörlerdi. Hastalarýn yaþý 62.78±17.13 (24–89); %56.9'u (n=29) kadýndý. En sýk stapfer tip II perforasyonlar (%49) görüldü. Ancak mortalitenin %62.5’i stapfer tip I’di. Toplam mortalite %13.72 (n=7) idi. Cerrahi tedavi edilen hastalarýn (n=24) yatýþ süresi (13.38±10.09 gün) daha fazla idi. Týbbi tedavi edilenlere (%74.1) daha çok koledok stenti yerleþtirilmiþti (p=0.039). Grup 1, ERCP sýrasýnda görsel olarak veya kontrast madde kaçaðý (13/40) ile veya þüphe nedeniyle tomografi ile tespit edildi. Grup 2 hastalarýn Pre-ERCP lökosit seviyesi daha yüksekti (p=0.044). Acil cerrahi gereksinimi %72.7 ve mortalite %36.4 idi. Perforasyonunun erken ve geç farkedilmesi arasýnda mortalite açýsýndan farklýlýk belirlendi (p=0.014).
TARTIÞMA: Erken taný konulanlarda, tip I perforasyonlar hariç, daha az cerrahi gereksinim olmuþtur. Tip II perforasyonlar, akut karýn ve sepsis bulgularý yok ise, çoðunlukla non-operatif güvenli bir þekilde tedavi edilebilmektedir. Erken taný ve tedavi mortaliteyi azaltmaktadýr.

BACKGROUND: Although ERCP (Endoscopic retrograde cholangiopancreatography) perforation is a rare complication, it results in high morbidity and mortality. In this study, clinical evaluation was performed concerning the incidence, clinical data and time of diagnosis for ERCP perforations that were either surgically or medically treated. To reduce the ERCP perforations and related mortality, in this study, we aimed to reveal the clinical features and compare them with the literature.
METHODS: In this clinical retrospective study, 51 perforations were detected in 8676 ERCP procedures performed in the past eight years in our hospital. We compared the two groups: early diagnosed patients [Group 1: n=40] and the delayed diagnosed patients [Group 2: n=11] concerning primary diagnosis, blood and biochemical tests before ERCP, perforation type, treatment method, clinical features, length of stay, and mortality. These groups were compared concerning stent placement, papillotomy choledochal dilatation and the number of ERCP procedures.
RESULTS: The ERCP perforation rate in our hospital was 0.59%. The majority of patients who underwent ERCP procedures was due to the choledocholithiasis and periampullary tumors. The mean age was 62.78±17.13 (24–89 years old) and 56.9% of the patients (n=29) were women. Stapfer type II perforations (49%) were the most common type of perforation. However, 62.5% of the total mortality occurred in patients with type I perforation. The overall mortality rate was 13.72% (n=7). The duration of hospitalization (13.38±10.09 days) was higher in the patients who were treated surgically (n=24). Choledochal stents were utilized mostly in the medically treated patients (74.1%) (p=0.039). The patients in Group 1 were detected visually by the operator during the ERCP by leakage of contrast substance (13/40) or by abdominal tomography due to clinical suspicion. Patients in Group 2 had higher pre-ERCP leukocyte levels (p=0.044). The urgent surgery requirement in Group 2 was 72.7%, while the mortality rate was 36.4%. Significant mortality difference was observed between the early and late detection of perforations, indicating a higher rate in Group 2 (p=0.014).
CONCLUSION: In the patients who were diagnosed early, fewer surgical interventions were required, except for the type I perforations. Type II perforations can often be safely treated non-surgically if there are no signs of acute abdomen and sepsis. Early diagnosis and treatment significantly reduce ERCP-related mortality.

AMAÇ: Erken teþhis ve tedavi edilmezse retinal dekolmana ve körlüðe neden olabilen prematüre retinopatisinin (PR) tedavisinde uygulanan laser fotokoagülasyon tedavisi (LFT) cerrahi bir prosedürdür. LFT’de uygulanan anestezi yöntemi sedo-analjeziden genel anesteziye, havayolu yönetimi spontan ventilasyondan endotrakeal entübasyona kadar deðiþkenlik göstermektedir. Bu çalýþma ile kýrýlgan popülasyon olan prematüre bebeklerde entübasyon ve mekanik ventilasyondan kaçýnarak sedoanaljezi uygulamalarýmýzýn etkinliðini, bu anestezi yöntemini intraoperatif ve postoperatif komplikasyonlar açýsýndan deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma, PR nedeniyle anestezi altýnda lazer fotokoagülasyon uygulanmýþ 89 olguyu içermektedir. Hastalarýn demografik özellikleri, preoperatif risk faktörleri, anestezi tekniði, özellikle havayolu yönetimi, cerrahi süresince ventilasyon durumundaki deðiþiklikler, intraoperatif komplikasyonlar, postoperatif komplikasyonlar, yoðun bakým takip süreci kayedildi ve istatistiksel olarak analiz edildi.
BULGULAR: Lazer fotokoagülasyon uygulanan 89 hastadan ikisi entübe halde takip edildiði için çalýþma dýþý býrakýldý. Ýntraoperatif komplikasyon geliþmesi sonucu maske ventilasyon uygulanan hasta sayýsý 12 (%13.8) idi. Ortalama operasyon süresi 36.2±10.1 dakika idi. Hastalarýn %86.2’sinde (n=75) cerrahi iþlem spontan ventilasyon korunarak sedoanaljezi ile tamamlanandý.
TARTIÞMA: Erken taný ve acil tedavi gerektiren PR hastalarýnýn cerrahi müdahalesi sýrasýnda sedoanaljezi uygulamasý intraoperatif ve postoperatif komplikasyonlarý azaltabilir. Anestezi yöntemi olarak sedoanaljezi yaklaþýmýnýn spontan ventilasyonu koruyarak etkili bir alternatif yöntem olarak uygulanabileceði kanýsýndayýz.

BACKGROUND: Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population.
METHODS: This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients’ demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically.
RESULTS: Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation.
CONCLUSION: Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

AMAÇ: Bu çalýþmada, CRP lenfosit oranýnýn akut apandisit (AA) ve perfore apandisit (PA) ayrýmýnda radyolojik tetkiklerin tanýyý netleþtirmede yetersiz kaldýðý vakalarda rutin kullanýlan laboratuvar parametrelerine göre üstünlüðünü araþtýrmak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Kesitsel ve ileriye yönelik olarak plananlanan bu çalýþmada hastalar perfore ve non-perfore akut apandisit olarak iki gruba ayrýldý. Her iki gruptaki hastalarýn yaþý, cinsiyeti, yatýþ süresi, taný anýndaki lökosit, nötrofil, lenfosit, C reaktif protein (CRP), lenfosit oraný (CLR) deðerleri kayýt altýna alýndý. Tek deðiþkenli analiz ile istatistiksel olarak anlamlý sonuçlar saptanan deðerler arasýnda regresyon analizleri yapýldý.
BULGULAR: Çalýþmaya 131 hasta alýndý (AA grubunda 111 hasta ve PA grubunda 20 hasta). Yaþ (p=0.03), cinsiyet (p<0.001), hastanede kalýþ süresi (p<0.001), CRP (p<0.001), NLR (p=0.004), CLR (p<0.001) deðerleri her iki grup arasýnda anlamlý olarak farklý tespit edildi. Ancak yapýlan regresyon analizinde sadece CLR anlamlý bir risk faktörü olarak bulundu (p=0.016). ROC analizinde CLR’de en yüksek AUC deðeri gösterildi (0.83). PA’nin kestirim deðeri 0.45 olarak bulundu.
TARTIÞMA: Bu çalýþma CLR’nin AA ve PA hastalarýnýn ayýrýmý için önemli bir parametre olduðunu gösterdi. Ayrýca, bu hastalarýn preoperatif risk sýnýflandýrmasýnda deðerli bir belirleyicidir.

BACKGROUND: This study aimed to investigate the superiority of C-reactive protein (CRP) lymphocyte ratio (CLR) in acute appendicitis (AA) and perforated appendicitis (PA) compared to routine laboratory parameters in patients where radiological tests were insufficient to clarify the diagnosis.
METHODS: In this cross-sectional and retrospective study, the patients were divided into two groups as PA and AA. Age, sex, length of hospital stay, leukocytes, neutrophil, lymphocyte, CRP, and CLR were recorded at the time of diagnosis. Regression analyses were performed for the parameters, which were found to be statistically significant in univariate analysis.
RESULTS: One hundred thirty-one patients were included in this study (111 patients in the AA group, and 20 patients in the PA group). Age (p=0.03), gender (p<0.001), length of hospital stay (p<0.001), CRP (p<0.001), NLR (p=0.004) and CLR (p<0.001) were significantly different between both groups. However, only CLR was found as a significant risk factor in PA cases (p=0.016). The ROC analysis showed the highest AUC value in CLR (0.83). The cut-off value for predicting PA was found 0.45.
CONCLUSION: This study provided that the CLR is an important parameter for the differentiation of AA and PA patients. Besides, it is a valuable predictor in the preoperative risk classification of these patients.

AMAÇ: Pediyatrik kafa travmalarý çalýþmamýzý sunmak ve sonuçlarýmýzý güncel literatürle tartýþmaktýr.
GEREÇ VE YÖNTEM: 2010 ve 2019 yýllarý arasýnda kliniðimizde kafa travmasý nedeniyle tedavi gören çocuklarýn verileri geriye dönük olarak incelendi. Baþvuru sýrasýndaki klinik durumu, radyolojik bulgular, tedavi yöntemleri ve sonuçlarý analiz edildi.
BULGULAR: Doksan çocuk kafa travmasý nedeniyle tedavi edildi, bunlarýn 60’ý erkek, 30’u kýz idi. Yaþ ortalamasý 6.6 idi. Elli beþ hastada lineer kafatasý kýrýðý, 15 hastada epidural hematom görüldü. Yirmi hastaya cerrahi tedavi uygulandý, 70 hastaya konservatif tedavi uygulandý. Çalýþmamýzda hiçbir hasta kaybedilmedi, üç hastaya taburcu olduktan sonra nörolojik defisit nedeniyle fizik tedavi ve rehabilitasyon uygulandý.
TARTIÞMA: Çocuklar kafa travmasýna daha eriþkinlere göre yatkýndýr, ancak mortalite yetiþkinlerden daha azdýr. Konservatif tedavi ilk hedef olmalý, ancak önemli boyutlarda hematomlu ve kötüleþen nörolojik tablosu olan çocuklar için cerrahi tedavi düþünülmelidir.

BACKGROUND: We aim to present our series on pediatric head traumas and discuss our results with the current literature.
METHODS: The data of children who underwent treatment for head trauma in our department between 2010 and 2019 were retrospectively reviewed. Their clinical condition at admission, radiological findings, treatment methods and outcomes were analyzed.
RESULTS: Ninety children underwent treatment for head trauma, 60 of them were male and 30 were female. The mean age was 6.6 years. Linear skull fracture was seen 55 patients, while epidural hematoma in 15 patients. Twenty patients underwent surgical treatment, while 70 patients underwent conservative treatment. No patient died in our series, three patients underwent rehabilitation due to neurological deficits after discharge.
CONCLUSION: Children were more prone to head trauma, but their mortality was less than the adults. Conservative treatment should be the first goal, but surgical management should be reserved for children with significant hematoma and declining neurological conditions.

AMAÇ: Gebelik esnasýnda en sýk obstetrik dýþý cerrahi müdahaleye neden olan hastalýk akut apandisittir (AA). AA tanýsý laboratuvar testleri eþliðinde anamnez ve fizik muayene ile birlikte konulmaktadýr. Gebelikte gözlenen fizyolojik ve anatomik deðiþiklikler nedeni ile AA tanýsý gebe olmayan hastalara göre daha zordur. Bu çalýþmada, hamilelik esnasýnda AA tanýsýnda beyaz küre (WBC), nötrofil/lenfosit oraný (NLR), CRP/albümin oraný (CAR) ve lenfosit/CRP oraný (LCR) önemini araþtýrdýk.
GEREÇ VE YÖNTEM: Çalýþmada, Eylül 2015–Aralýk 2019 yýlarý arasýnda genel cerrahi kliniðinde AA ön tanýsý ile yatýþý yapýlarak takibi yapýlan gebe hastalar “International Statistical Classification of Diseases and Related Health Problems-10” (ICD-10) taný kodu kullanýlarak retrospektif olarak belirlendi. Hastalar iki gruba ayrýlarak I. Gruba AA nedeni ile apendektomi uygulanan, patolojik deðerlendirme sonucuna göre süpüratif apandisit tanýsý konulan hastalar, II. Gruba AA ön tanýsý ile yatýrýlan ve takiplerinde ameliyat edilmeden þifa ile taburcu edilen gebe hastalar dahil edildi. Kontrol grubuna (Grup III) ise hastanemiz kadýn doðum polikliniðinde takibi yapýlan çalýþma kriterlerine uygun, rastgele seçilmiþ, çalýþmaya katýlmayý kabul eden 32 saðlýklý gebe prospektif olarak belirlenerek dahil edildi.
BULGULAR: Çalýþmaya, yaþ ortalamasý 29.20±4.47 olan 96 gebe hasta (32 saðlýklý gebe, 32 akut batýn müþahede ile takip edilen gebe, 32 apendektomi uygulanmýþ gebe) alýndý. Bu hastalardan ameliyat ve histopatolojik bulgulara göre süpüratif apandisit olmayan üç olgu (negatif apendektomi) ile perfore apandisit tespit edilen iki olgu çalýþma dýþý býrakýldý. Yapýlan deðerlendirmelerde Grup I oluþturan hastalarýn WBC deðeri (p=0.001), CAR deðeri (p=0.001), NLR deðeri (p=0.001) grup II ve III’den anlamlý düzeyde yüksek iken, LCR deðerinin düþük olduðu gözlendi (p=0.001).Yapýlan çok deðiþkenli lojistik regresyon analizine göre; WBC, CAR, NLR yüksekliði ile LCR düþüklüðü gebe hastalarda AA tanýsýnda baðýmsýz deðiþken olduðu gözlendi.
TARTIÞMA: Týbbi öykü, fizik muayene ve görüntüleme tekniklerine ek olarak, gebe kadýnlarda AA tanýsý için WBC, NLR, CAR ve LCR deðerlerinin göz önünde bulundurulmasý klinisyene karar vermede kolaylýk saðlayabilir.

BACKGROUND: Acute appendicitis (AA) is the most common extra-obstetric condition requiring surgery during pregnancy. AA diagnosis is made by laboratory tests along with anamnesis and physical examination findings. Due to the physiological and anatomical changes during the pregnancy, AA diagnosis is more challenging in pregnant women compared to non-pregnant patients. The present study evaluated the significance of white blood cell counts (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) to diagnose acute appendicitis during pregnancy.
METHODS: Pregnant patients admitted to General Surgery Inpatient Clinic with AA pre-diagnosis in September 2015-December 2019 period were screened using International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) diagnosis code (K35= acute appendicitis, Z33= pregnancy), and AA patients were identified retrospectively. The patients were divided into two groups. The Group I included the patients who had appendectomy due to AA and had a suppurative appendicitis diagnosis based on the pathological evaluation. On the other hand, Group II had the patients admitted as an inpatient with AA pre-diagnosis, but discharged from the hospital with full recovery without operation. Group III, i.e., the control group, on the other hand, was constituted by 32 randomly and prospectively recruited healthy pregnant women who were willing to participate in the study and who had matching study criteria among the patients followed in Obstetrics and Gynecology outpatient clinic of our hospital.
RESULTS: This study included 96 pregnant women with an average age of 29.20±4.47 years (32 healthy pregnant women, 32 pregnant women followed for acute abdominal observation and 32 pregnant women who underwent appendectomy). Of these patients, three cases who turned out not to have suppurative appendicitis (negative appendectomy) and two cases found to have perforated appendicitis based on intraoperative and histopathological evaluations were excluded from this study. The results showed that Group I patients had significantly higher WBC (p=0.001), CAR (p=0.001) and NLR (p=0.001), but significantly lower LCR values (p=0.001) compared to the Groups II and III. Besides, based on logistic regression analysis, it was revealed that higher WBC, CAR and NLR values and lower LCR values were independent variables that could be used for the diagnosis of AA in pregnant women.
CONCLUSION: Considering WBC, NLR, CAR and LCR parameters in addition to medical history, physical examination and imaging techniques could help clinicians diagnose acute appendicitis in pregnant women

AMAÇ: Yanýklar, hasta ve ailelerine ciddi fiziksel ve psikolojik morbidite meydana getirmeleri yanýnda önemli bir mortalite nedenidir. Ayrýca bu tür yaralanmalar, tedavi süreçleri ve býraktýðý sekeller nedeniyle önemli mali yükler de getirmektedir. Bu çalýþmada amaç, yanýk mortalitesini etkileyen faktörleri belirlemektir.
GEREÇ VE YÖNTEM: Yanýk merkezimize Eylül 2008–Aralýk 2016 yýllarý arasýnda yanýk nedeni ile baþvuran hastalarýn kayýtlarý incelendi. Hastalarýn mortaliteleri deðerlendirilirken yaþ, cinsiyet, yanýk yüzey alaný yüzdesi, sevk durumu, yanma yeri, yanýk derecesi, hastaneye baþvuru için geçen süre, yanma etyolojisi, kan ve kan ürünleri alýp almamasý, tam kan sayýmý, rutin biyokimya, kuagülasyon parametreleri, C-reaktif protein (CRP), sedimentasyon hýzý, nötrofil lenfosit oraný (NLR) ve trombosit-lenfosit oraný (PLR) gibi bazý laboratuvar deðerleri incelendi.
BULGULAR: Toplam 133 hasta çalýþmaya dahil edildi. Hastanýn yaþý (p=0.001), yanýk derecesi (p<0.001), yanýk yüzey alaný (p<0.001), hastaneye baþvuru süresi (p<0.001), yanma etiyolojisi (p<0.001), eritrosit süspansiyonu, Taze Donmuþ Plazma ve albümin transfüzyonu verilmesi (p<0.001), MPV (p<0.001), NLR (p<0.001) ve PLR (p<0.001) deðerlerinin yanýk hastalarýnda mortalite ile iliþkili olduðu tespit edildi.
TARTIÞMA: Bu çalýþmada, hastanýn yaþý, yanýk derecesi, yanýk yüzey alaný, hastaneye baþvuru süresi, yanma etiyolojisi, eritrosit, TDP ve albümin transfüzyonu, MPV, NLR ve PLR deðerlerinin yanýk hastalarýnda mortalite ile iliþkili olduðu tespit edildi. Yaptýðýmýz bu çalýþma ile yanýk hastalarý deðerlendirilirken mortalite ile iliþkili tespit edilen bu parametreler göz önünde bulundurularak hastalarýn mortalitesini azaltacak tedavi rehberlerinin oluþturulmasý saðlanabilir.

BACKGROUND: Burns are a primary cause of mortality along with the severe physical and psychological morbidities in patients and their families. Such kinds of injuries bring about considerable financial burdens due to the treatment processes and sequels. The present study aims to investigate the factors that affect the mortality of burns.
METHODS: The archives files of the patients admitted because of burn injuries in our burn centre between September 2008 and December 2016 were examined in this study. Some of the lab values, such as age, sex, percentage of total burn surface area (TBSA), referral status, burning site, degree of burns, time of admission to hospital, aetiology of burning, blood and blood products collection, complete blood count, routine biochemistry, coagulation parameters, C-reactive protein (CRP), sedimentation rate, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were examined while evaluating the patients’ mortalities.
RESULTS: A total of 133 patients were included in this study. The patient’s age (p=0.001), the degree of burns (p<0.001), surface area of burns (p<0.001), the time of hospital admission (p<0.001), burning aetiology (p=0.006), erythrocyte suspension, fresh frozen plasma, along with the administration of albumin transfusion (p<0.001), mean platelet volume (MPV) (p=0.028), NLR (p<0.001) and PLR (p<0.030) values were found to be associated with mortality in patients with burns.
CONCLUSION: In this study, age, burn grade, TBSA, hospital admission time, burn aetiology, erythrocyte, fresh frozen plasma and albumin transfusion, MPV, NLR and PLR values were found to be associated with mortality in patients with burns. With this study, it is possible to produce the treatment guidelines to reduce mortality by taking these parameters into consideration, which were determined to be associated with mortality while evaluating the patients with burns.

AMAÇ: Kliniðimizde yatýrýlarak kontinü lomber drenaj (KLD) uygulanan posttravmatik beyin omurilik sývýsý (BOS) fistülü olan hastalarýn klinik sonuçlarýný araþtýrmak ve bunu non-travmatik nedenlerle KLD uygulanan hastalarla karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak 2018–Aralýk 2019 tarihleri arasýnda beyin ve sinir cerrahisi kliniðine yatýrýlan ve KLD takýlan hastalarýn dosyasý incelendi. Bu hastalarýn tanýsý, demografik özellikleri, BOS sonuçlarý ve klinik sonuçlarý deðerlendirildi. Travma nedeniyle dura defekti ve BOS fistülü olan hastalarýn sonuçlarý diðer sebeplerle BOS fistülü olan ve lomber drenaja alýnan hastalarla karþýlaþtýrýldý.
BULGULAR: Toplam 45 hastaya 51 kez KLD uygulandý. Hastalardaki yaþ ortalamasý 38.84 yýl olup hastalarýn 27’si (%60) erkek idi. Yedi (%15.55) hastaya posttravmatik BOS fistülü nedeniyle, 38 hastaya ise tümör veya malformasyon cerrahisi sonrasý KLD uygulandý. Beþ hastada ateþli silah yaralanmasý (ASY) sonrasý dura defektine baðlý BOS fistülü geliþmiþ iken iki hastada trafik kazasý sonrasý BOS fistülü gözlenmiþtir. Staphylococcus epidermidis posttravmatik BOS fistülü olan bir hastada, Serratia marcescens ise posterior fossa tümörüne sekonder BOS fistülü olan hastada üremiþtir. Posttravmatik KLD uygulan yedi hastadan hiçbirisi takip sürecinde ölmemiþ iken tümörlere baðlý KLD uygulan hastalarda bir tanesi takip sürecinde sepsisden dolayý kaybedilmiþtir.
TARTIÞMA: Posttravmatik BOS fistüllerinde KLD uygulamasý güvenli ve etkili bir tedavi yöntemidir. Özellikle ateþli silah yaralanmalý hastalarda BOS fistülünün tedavisinde revizyon cerrahisi yapýlmadan önce mutlaka KLD uygulanmalýdýr. Daha geniþ travma gruplarýnda daha farklý parametreler ile yapýlacak çalýþmalara ihtiyaç vardýr.

BACKGROUND: This study aims to investigate the clinical outcomes of patients who underwent closed continuous lumbar drainage (CLD) for post-traumatic cerebrospinal fluid (CSF) fistula and to compare with those of non-traumatic patients.
METHODS: The data of patients who were treated in the department of neurosurgery between January 2018 and December 2019 and underwent CLD were analyzed. The diagnosis, demographic characteristics, CSF results and clinical outcomes of these patients were evaluated. The outcomes of the patients with dura defect and CSF fistula due to trauma were compared with patients who underwent CLD for other diagnoses.
RESULTS: In this study, 45 patients underwent CLD for 51 times. The mean age was 38.84 years, and 27 (60%) of the patients were male. Seven (15.55%) patients underwent CLD due to post-traumatic CSF fistula and 38 patients after tumor or malformation surgery. While five patients developed CSF fistula due to dura defect after gunshot injury, two patients developed CSF fistula secondary to motor vehicle accident. Staphylococcus Epidermidis was isolated in one patient among post-traumatic CSF fistula patients while Serratia Marcescens was isolated in patients with CSF fistula secondary to posterior fossa tumor surgery. While none of the seven patients died during the follow-up period in post-traumatic group, one of the 38 patients with CLD secondary to tumor surgery was lost due to sepsis in the follow-up period.
CONCLUSION: CLD in post-traumatic CSF fistulas is a safe and effective treatment method. Especially in patients with gunshot wounds, CLD should be performed before revision surgery in the treatment of CSF fistula. Studies with different parameters are needed in larger trauma populations.

AMAÇ: Bu çalýþmanýn amacý intraperitoneal hidatik kist rüptürü geliþen hastalarla ilgili merkezimizin deneyimlerini literatür verileri ýþýðýnda sunmaktýr.
GEREÇ VE YÖNTEM: Ocak 2003 ile Temmuz 2020 tarihleri arasýnda kliniðimiz tarafýndan intraperitoneal hidatik kist rüptürü sebebiyle ameliyat edilen 29 hastanýn demografik, klinik, radyolojik ve postoperatif takip verileri retrospektif olarak incelendi.
BULGULAR: Yaþlarý 16 ile 79 yýl (median: 39, IQR=25.5) arasýnda deðiþen 29 hastanýn 16 (55.2%)’sý erkek ve 13’ü kadýn idi. Hastalarýn 21(72.4%)’inde spontaneous, 7’sinde travmatik (iatrogenic=2) ve birinde ateþli silah yaralanmasýna baðlý hidatik kist rüptürü geliþti. Hastalarýn çoðu semptom ve bulgularýn baþlamasýndan sonraki ilk 24 saat içinde acil servise baþvurmuþtu. WBC sayýlarý 8.600 ile 30.900/mm3 (median=12.100, IQR=5.7) arasýnda deðiþmekteydi. Rüptüre kistlerin 25 (86.2%)’i karaciðer, 2’si dalak ve geriye kalan 2’si pelvis lokalizasyonundaydý. Karaciðerde rüptüre olan kistlerin 19 (76%)’u sað lob lokalizasyonundaydý. Rüptüre kistlerin çaplarý 40 ile 200 mm (median= 90, IQR=50) arasýnda deðiþmekteydi. Karaciðer yerleþimli rüptüre kistlerin 20 (80%)’sine konservatif cerrahi (partial pericystectomy gibi) iþlem uygulanýrken geriye kalan 5 (20%) hastaya radikal cerrahi (pericystectomy gibi) iþlem uygulandý. Cerrahi iþlem sýrasýnda karaciðer yerleþimli rüptüre kistlerin 12 (48%)’inde kist kavitesinde veya karaciðer kesi yüzeyinde safra orifisi tespit edildi. Koledok çapý geniþ olan veya kist kavitesinde geniþ safra orifisi olan 6 (24%) hastaya koledok explorasyonu ve t-tube drenaj iþlemi uygulandý. Bir hasta kist rüptürüne sekonder kardiopulmoner komplikasyonlar sebebiyle postoperatif birinci günde kaybedildi. Postoperatif median 1416 günlük takipte 7 (24.1%) hastada nüks geliþti.
TARTIÞMA: Intraperitoneal rüptür hidatik kist hastalýðýnýn hayatý tehdit eden bir komplikasyonudur. Hýzlý taný ve cerrahi tedavinin zamanlamasý hayati önem arz eder. Anaflaktik komplikasyon geliþen hastalarda allerjik reaksiyonlara yönelik medikal tedaviye olabildiðince hýzlýca baþlanmalýdýr. Her ne kadar skolosidal ajanlar kullanýlsa bile rüptür sonucunda periton boþluðuna dökülen kýz veziküller daha sonra nüks geliþmesi için en önemli risk faktörüdür. Bu yüzden tüm karýn boþluðu itina ile kontrol edilmelidir.

BACKGROUND: The primary aim of this study was to present our experience on intraperitoneal rupture of the hydatid cyst in guidance of literature data.
METHODS: Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with an indication of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retropectively.
RESULTS: Among the 29 patients with an age range of from 16 to 79 years ( median= 39, IQR=25.5), 16 were male (55.2%) and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in 7 (24.13%) (2 of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median= 90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in right lobe. Among the ruptured cysts of liver, 20 (80%) of them underwent conservative surgery (partial pericystectomy etc), remaining 5 patients (20%) underwent a radical surgical treatment (pericystectomy etc). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence.
CONCLUSION: Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock cases require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity account for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.

AMAÇ: Pilon kýrýklarý az görülmesine raðmen tedavisi zor olmasý nedeniyle ortopedik cerrahlar tarafýndan önemsenmiþtir. Deðiþen cerrahi yöntemlere raðmen kötü sonuç ve yüksek komplikasyonlar görülmektedir. Bu çalýþmanýn amacý, pilon kýrýðý nedeniyle açýk redüksiyon ve iç fiksasyon (ORIF) yaptýðýmýz hastalarda ayak fonksiyonlarý ve hayat kalitesini etkileyen deðiþkenleri incelemek ve komplikasyonlarla iliþkilendirmek.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2010–Aralýk 2016 tarihleri arasýnda, pilon kýrýðý nedeniyle ORIF uygulanan 45 hasta demografik verileri, kýrýk sýnýflamasý ve cerrahi tekniðe göre toplam 10 kategoriye göre AOFAS ve SF-12 ile deðerlendirildi. Hastalar fonksiyonel deðerler haricinde komplikasyonlar olarak enfeksiyon, yumuþak doku defekti, dizilim bozukluðu, kaynamama, artroz ve Sudeck atrofisi açýsýndan da hastalarýn kayýtlarý incelendi. AOFAS 85 altý olan ve düþük SF12 olan hastalarýn deðiþkenleri incelendi ve komplikasyonlarla iliþkisi deðerlendirildi.
BULGULAR: Ortalama takip süresi 3.7 yýl olup (2–7 yýl). AOFAS deðerlerine bakýldýðýnda, Ruedi-Allgower sýnýflamasý arttýðýnda (p=0.010), AO sýnýflamasý arttýðýnda (p=0.020), eþlik eden lateral malleol kýrýðýnda (p=0.028) ve Ovadia-Bell kriterleri’ne göre non-anatomik olmasý durumunda (p=0.031) AOFAS deðerleri 85’in altýna düþmektedir. SF-12 PCS deðerlerine bakýldýðýnda, Ruedi-Allgower sýnýflamasý arttýðýnda (p=0.018), Ovadia-Bell kriterleri’ne göre non-anatomik olmasý durumunda (p=0.012) SF-12 PCS deðerlerinde düþme gözlendi. SF-12 PCS ile AOFAS deðerlerinde korelasyon gözlendi (p=0.000).
TARTIÞMA: Tibia pilon kýrýklarýnda ORIF ile baþarýsýzlýk nedeni Ruedi 3, lateral malleol kýrýðý, cerrahi anatomik olmayan redüksiyon olarak bulundu. Ayak fonksiyonlarýndaki baþarýsýzlýk hem erken dönem hem de orta dönemde hayat kalitesini doðrudan etkilemektedir.

BACKGROUND: Although pilon fractures are uncommon, they are of importance to orthopaedic surgeons because of the difficulty of treatment. Poor outcomes and high complication rates are seen despite various surgical methods. This study aims to examine the changes affecting the quality of life and foot functions in patients applied with open reduction and internal fixation (ORIF) for a pilon fracture.
METHODS: In this study, a total of 45 patients treated with ORIF for a pilon fracture in our clinic between January 2010 and December 2016 were evaluated with AOFAS and SF-12 in a total of 10 categories according to demographic data, fracture classification and surgical technique. In addition to functional values, patient records were examined regarding complications, including infection, soft-tissue defect, malalignment, non-union, arthrosis and Sudeck atrophy. In patients with AOFAS <85 and low SF-12 scores, variables were examined and the relationship with complications was evaluated.
RESULTS: The mean follow-up period was 3.7 years (range 2 to 7). The AOFAS value was determined to fall to <85 when the Ruedi Allgower classification increased (p=0.010), when AO classification increased (p=0.020), when there was a concomitant lateral malleolar fracture (p=0.028), and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.031). The SF-12 PCS value was observed to decrease when the Ruedi Allgower classification increased (p=0.018) and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.012). A correlation was determined between the SF-12 PCS and the AOFAS values (p=0.000).
CONCLUSION: The reasons for the failure of ORIF in tibia pilon fractures were found to be Ruedi 3 classification, concomitant lateral malleolar fracture, and non-anatomic surgical reduction. Failure in foot functions has a direct effect on quality of life in both the short and mid term.

AMAÇ: Torakolomber yaralanma sýnýflamasý ve ciddiyet skoru 4 (TLICS = 4) olan nörolojik intakt torakolomber vertebra kýrýklý hastalarda cerrahi tedavi ve korse tedavisinin klinik ve radyografik sonuçlarýnýn karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Travmatik torakolomber kýrýk (T11-L2), TLICS 4 skoru ve en az 24 ay takip edilen hastalar alýndý. Hastalar cerrahi ve korse gruplarýna ayrýldý. Gruplar klinik ve demografik özellikler, lokal kifoz açýlarý (LKA), vertebra yükseklik kaybý yüzdesi (VYK), Oswestry Engellilik Ýndeksi (ODI), Visual Analog Skala (VAS) ve iþe geri dönme süresi açýsýndan karþýlaþtýrýldý.
BULGULAR: Cerrahi grubunda 74 hasta (71 erkek, 3 kadýn), korse grubunda 76 hasta (58 erkek, 18 kadýn) vardý. Cerrahi grupta ameliyat sonrasý ilk altý ay içinde VAS skorlarýnda daha iyi olsa da 24. ayda gruplar arasýnda anlamlý bir fark gözlenmedi (sýrasýyla, p<0.001 ve p=0.270). ODI, LKA ve VYK cerrahi grubunda anlamlý olarak düþüktü (sýrasýyla, p<0.001, p<0.001 ve p<0.001). Ýþe geri dönüþ süresi ameliyat grubunda anlamlý olarak daha kýsa idi (p<0.001).
TARTIÞMA: Torakolomber kýrýklarý olan nörolojik olarak intakt TLICS 4 hastalarýn cerrahi tedavisinin, korseye göre daha iyi klinik ve radyografik sonuçlarý olduðunu saptandý. Ayrýca, hastalarýn iþe dönüþ sürelerinin cerrahi tedavi ile kýsaltýldýðý gösterildi. TLICS 4 torakolomber vertebral kýrýklarýn tedavisinde cerrahi tedavi ilk ve uygun seçenek olarak görünmektedir.

BACKGROUND: This study aims to compare clinical and radiographic outcomes of surgical treatment and conservative treatment with bracing in neurologically intact patients with score 4 of TLICS thoracolumbar vertebra fractures.
METHODS: Patients with traumatic thoracolumbar junction fractures (T11-L2), the score of TLICS 4, and minimum 24-month follow-up were included in this study. Patients were divided into surgery and bracing groups. The groups were compared concerning clinical and demographical features, local kyphotic angles (LKA), vertebra height loss percentage (VHL), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and time to return to work.
RESULTS: There were 74 patients (71 males, 3 females) in the surgery group and 76 patients (58 males, 18 females) in the bracing group. Although the surgery group showed better improvement in VAS scores within six months postoperatively, no significant difference was observed at the 24th-month evaluation (p<0.001 and p=0.270, respectively). ODI, LKA and VHL were significantly lower in the surgery group (p<0.001, p<0.001 and p<0.001, respectively). In addition, return to work was significantly earlier in the surgery group (p<0.001).
CONCLUSION: The findings obtained in this study suggest that the surgical treatment for TLICS 4 patients with thoracolumbar fractures has better clinical and radiographic outcomes than the bracing. Moreover, returning time to the work of patients is shortened with surgical treatment. The surgical treatment seems to be the first and the appropriate choice in the management of TLICS 4 thoracolumbar vertebral fractures.

AMAÇ: Dinamik hip screw (DHS) ve proksimal femoral çivi-antirotasyonu (PFN-A) implantlarý ile tedavi edilen hastalarýn klinik ve fonksiyonel sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmaya Kýrýkkale Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý’nda femur intertrokanterik kýrýðý nedeniyle DHS ve PFN-A kullanýlarak ameliyat edilen, en az 12 ay takibi olan 66’sý erkek, 56’sý kadýn olan toplam 122 hasta alýndý. Hastalarýn erken postoperatif grafilerinde kýrýðýn redüksiyonu deðerlendirilmesi, boyun cisim açýsý ve tip apeks mesafesi ölçümleri yapýldý. Postoperatif 1. ay, 3. ay, 6. ay, 12. ay yapýlan takiplerinde kalça eklem hareket açýklýðý, uyluk-kalça aðrýsý, Trendelenburg pozitifliði bakýldý ve takiplerdeki ve kaynama sonrasý çekilen grafilerinde redüksiyon, fiksasyon kaybý, boyun cisim açýsý ve tip apeks mesafesi ölçümleri yapýldý. Hastalar kaynama sonrasý dönemde Kalça Harris Skoru ile deðerlendirildi.
BULGULAR: Kullanýlan implanttan baðýmsýz olarak implant yetmezliði görülen grupta erken postoperatif ölçülen tip apeks mesafesi ortalamasý 27.6 iken implant yetmezliði görülmeyen grupta 21,6 idi ve istatistiksel olarak anlamlý bir fark saptandý. Kullanýlan implanttan baðýmsýz olarak implant yetersizliði görülen grupta erken postoperatif ölçülen boyun cisim açýsý ortalamasý 123 iken implant yetersizliði görülmeyen grupta 130 idi ve istatistiksel olarak anlamlý bir fark saptandý. Ýmplant yetersizliði görülen hastalarýn tümünde erken postoperatif ölçülen boyun cisim açýsýnýn 128 derecenin altýnda olduðu saptandý. Ýmplant yetersizliði görülmeyen hastalarýn %94’ünün erken postoperatif ölçülen boyun cisim açýsýnýn 128 derecenin üstünde olduðu saptandý.
TARTIÞMA: Ýmplant yetersizliði olan hastalarýn tümünde erken postoperatif boyun cisim açýsýnýn 128° altýnda olmasý ve implant yetersizliði görülmeyen hastalarýn %94’ünde erken postoperatif boyun cisim açýsýnýn 128° ve üzerinde olmasý cerrahi sýrasýnda bu açýnýn anatomik þekilde restore edilmesinin önemini ortaya çýkarmaktadýr. Ýmplant yetersizliði görülen grupta TAD’nin ortalama 27.5 mm ve implant yetersizliði görülmeyen grupta ortalama 21.7 olmasý, bu sistemlerin implantasyonunda tedavi baþarýsý açýsýndan tekniðin en az seçilen implant türü kadar önemli olduðunu göstermektedir.

BACKGROUND: We aimed to compare clinical and functional outcomes between patients treated with Dynamic hip screw (DHS) and Proximal Femoral Nail-Antirotation (PFN-A) implants.
METHODS: This study included 122 patients (66 men [54.1%] and 56 women [45.9%]) who underwent surgery with DHS and PFN-A for an intertrochanteric femur fracture and had at least 12 months follow-up. Reduction assessment, femoral neck-shaft angle and tip-apex distance measurements were performed in early postoperative radiographs. On control visits in months 1, 3, 6 and 12, range of motion, thigh or hip pain, and Trendelenburg positivity were assessed in clinical examination and reduction assessment, femoral neck-shaft angle and tip-apex distance measurements were performed on radiographs after the union. Patients were assessed using Hip Harris Score after the union.
RESULTS: Regardless of implant type used, mean tip-apex distance measured at the immediate postoperative period was 27.6 in patients with implant failure, whereas 21.6 in patients without, indicating a significant difference. Again, mean femoral neck-shaft angle measured at the immediate postoperative period was 123 degree in patients with implant failure, whereas 130 degree in those without, indicating a significant difference. It was found that the femoral neck-shaft angle was <128 degree in all patients with implant failure whereas it was >128 degree in 94% of patients without implant failure at immediate postoperative period.
CONCLUSION: The findings regarding femur neck-shaft angle at the immediate postoperative period was <128 degree in all patients with implant failure and that it was ≥128 degree in 94% of patients without implant failure emphasize the importance of anatomic restoration in femur neck-shaft angle during surgery. The finding that mean tip-apex distance was 27.6 mm in patients with implant failure and 21.6 mm in patients without implant failure indicates that the technique is as important as implant type selected for treatment success of the implantation.

AMAÇ: Mevcut sýnýflandýrmalarda ve literatürde çýkýðýn eþlik ettiði ayak bileði kýrýklarýna ayrýca önem verilmemiþtir. Çalýþmamýzda, ayak bileði kýrýklarýna eþlik eden çýkýklardaki yaralanma mekanizmasý, fonksiyonel sonuçlar ve komplikasyonlar açýsýndan farklýlýklarý belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2012–Aralýk 2018 tarihleri arasýnda, ayak bileði kýrýðý nedeniyle ameliyat edilen 285 hasta geriye dönük olarak incelendi. Kýrýklara eþik eden çýkýklar kaydedildi. Çýkýðýn eþlik ettiði ayak bileði kýrýklarý (AF-D) ile çýkýðýn eþlik etmediði ayak bileði kýrýklarý (AF-WD) arasýnda fonksiyonel skorlar ve komplikasyonlar karþýlaþtýrýldý. Mevcut sýnýflamalar (Lauge-Hansen ve Danis-Weber sýnýflamalarý) ile çýkýðýn birlikteliði ve fonksiyonel sonuçlara etkisi de deðerlendirildi. Hastalar fonksiyonel deðerler haricinde takiplerdeki enfeksiyon, yumuþak doku defekti, dizilim bozukluðu, kaynamama, artroz ve Refleks Sempatik Distrofi Sendromu (RSD) açýsýndan da incelendi.
BULGULAR: Hastalarýn yaþ ortalamasý 44.7±12.04 (18–72), takip süresi 3.2 yýl idi. Hastalarýn 88’inde (%30.8) ayak bileði kýrýklarý çýkýkla birlikte gözlendi. Çýkýk hastalarýnýn hepsinde koronal planda çýkýk gözlenirken, 37’sinde sagital planda da anteriora çýkýk gözlendi. AF-WD ve AF-D gruplarýnda sýrasýyla AOFAS 84.05±10.5, 80.33±9.47 (p=0.379), VAS deðerlendirmesi ise 1±0.5, 1.23±0.48 (p=0.117) olmak üzere benzer fonksiyonel sonuçlar gözlendi. AOFAS deðerleri Lauge-Hangene ve Danis-Webere göre deðerlendirildiðinde altgruplar arasý fark gözlenmedi (p=0.562, 0.723). AF-WD grubunda 2, AF-D grubunda 7 artroz gözlendi (p=0.004). AF-WD grubunda 2, AF-D grubunda 10 hastada RSD gözlendi (p=0.000).
TARTIÞMA: Ayak bileði kýrýðýna eþlik eden çýkýklarýn, fonksiyonel skorlarda kötüleþmeye neden olmadýðý gözlenmekle birlikte artroz ve RSD bu hastalarda daha sýk bulundu. Mediko legal açýdan artroz hakkýnda hastalarýn bilgilendirilmesi gerekmekte ve RSD de bu hastalarda önemli bir sorun olarak karþýmýza çýkmaktadýr.

BACKGROUND: In the existing classifications, no importance is given to dislocations accompanying ankle fractures. The present study aims to investigate differences in injury mechanisms of ankle fractures with concomitant dislocation injury in respect of functional outcomes and complications.
METHODS: A retrospective evaluation was carried out of 285 patients who underwent surgery in our clinic for an ankle fracture between January 2012 and December 2018. A comparison was made of functional scores and complications between the patients with ankle fracture with dislocation (AF-D group) and patients with ankle fracture without dislocation (AF-WD). The correlation of dislocation with current classifications (Lauge-Hansen and Danis-Weber) and the effects on functional outcomes were also evaluated. In addition to functional scores, a record was also made for each patient of infection during follow-up, soft-tissue defect, malalignment, non-union, arthrosis and Reflex Sympathetic Dystrophy Syndrome (RSD).
RESULTS: The mean age of the patients was 44.7±12.04 years (range, 18-72 years) and the mean follow-up period was 3.2 years. Ankle fracture with dislocation was observed in 88 (30.8%). Similar functional results were determined in the AF-WD and AF-D groups with mean AOFAS 84.05±10.5, and 80.33±9.47, respectively (p=0.379), and mean VAS scores of 1±0.5 and 1.23±0.48, respectively (p=0.117). When the AOFAS values of the dislocation function results were evaluated according to the Lauge-Hansen and Danis-Weber subgroups, no significant difference was observed (p=0.562, 0.723). Arthrosis was seen in two of the AF-WD group and seven of the AF-D group (p=0.004). RSD was determined in two of the AF-WD group and in 10 of the AF-D group (p=0.000). From a medico-legal perspective, patients should be informed about arthrosis, and RSD is another significant problem encountered in this patient group.
CONCLUSION: Although dislocation accompanying ankle fracture was not seen to worsen functional results, arthrosis and RSD were determined more often in these patients.

Tansiyon gastrotoraks, abdominal içeriðin toraksa yer deðiþtirmesi ve intratorasik bölgeye uygulanan baský sonucu mediastinal kayma ile seyreden klinik bir durumdur. Genellikle doðuþtan veya edinilmiþ (cerrahiye sekonder) diyafragma defekti nedeniyle olup, nadiren travmaya sekonder görülür.Kýrk yaþýnda erkek hasta, araç içi trafik kazasý sonrasý acil servise baþvurdu. Hafif göðüs aðrýsý dýþýnda aktif bir þikayeti yoktu. Oskültasyonda sol akciðer tabanýnda solunum sesleri ile birlikte baðýrsak sesleri duyuldu. Çekilen bilgisayarlý toraks tomografisinde sol taraflý diyafragma hernisi izlendi. Kýsa süre sonra desatürasyon ve juguler venöz dolgunluk geliþen hastaya nazogastrik dekompresyon uygulandý. Ardýndan açýk cerrahi giriþim amaçlý ameliyata alýndý. Akut baþlangýçlý ciddi solunum yetersizliðinin ayýrýcý tanýsýnda travmatik tansiyon gastrotoraks düþünülmelidir. Hýzlý klinik ve radyolojik deðerlendirme ile taný konulabilir.

In tension gastrothorax, the abdominal contents are displaced into the thorax, leading to a mediastinal shift that arises from the pressure placed on the intrathoracic region. This condition is often due to a congenital or acquired (secondary to surgery) diaphragmatic defect and is rarely seen secondary to trauma. A 40-year-old man presented to the emergency department after an in-vehicle traffic accident. He had no active complaint other than mild chest pain. On auscultation, breath sounds were audible in the left lung base and bowel sounds were heard. Computed tomography of the thorax revealed left-sided diaphragmatic hernia. The jugular vein was distended, and the patient became desaturated in the emergency room. Nasogastric decompression was performed, and the saturation improved. The patient underwent open surgery. Traumatic tension gastrothorax should be considered in the differential diagnosis of acute-onset severe respiratory failure. It can be diagnosed by rapid clinical and radiological evaluation.

Miyelolipomlar, matür yað dokusu ve hematopoetik elementlerden oluþan nadir iyi huylu tümörlerdir. Travmatik adrenal yaralanma ile iliþkili adrenal miyelolipomlar, bezin sýnýrlý boyutu ve iyi korunan pozisyonu nedeniyle sol tarafta nispeten nadirdir ve daha az yaygýndýr. Elli dokuz yaþýnda kadýn hasta, altý saat önce yataktan düþtükten sonra sol karýn bölgesine yayýlan aralýklý sol yan aðrýsý þikayeti ile acil servise baþvurdu. Vital bulgularý stabildi ve sol yan bölgede ve sol karýn bölgesinde hassasiyeti mevcuttu. Baþlangýç hemoglobin düzeyi 12.9 g/dL idi. Travma için ultrason ile yatak baþý deðerlendirmede sol böbrek sýnýrlarý belirsiz olarak saptandý. Kontrastlý abdominal bilgisayarlý tomografide (BT) sol suprarenal bölgede 11.6×10.4×8.8 cm boyutunda yer kaplayýcý bir kitle ile birlikte alt polde aktif kanama saptandý. Anjiyografide herhangi bir aktif kontrast madde ekstravazasyonu saptanmadý. Anjiyografi ile eþ zamanlý olarak BT eþliðinde biyopsi baþarýlý bir þekilde gerçekleþtirildi. Biyopsi örneðinin patolojik deðerlendirmesi, az sayýda eritrosit ve lökosit içeren çoðunlukla yað dokusunun varlýðýný ortaya koymuþtur. Hastaya adrenal miyelolipom tanýsý konuldu ve tümör rezeksiyonu ile sol adrenalektomi için üroloji servisine yatýrýldý. Tüm künt abdominal yaralanmalarýn %5’inden azýnda tesadüfen bulunan adrenal miyelolipomun olaðandýþý bir sunumu olan travmatik adrenal yaralanma, karýn travmasýna baðlý kanama olgularýnda acil tedavi için dikkate alýnmalýdýr.

Myelolipomas are rare benign tumors comprised of mature adipose tissue and hematopoietic elements. Adrenal myelolipomas associated with traumatic adrenal injury are relatively rare and less common on the left due to the limited size and well-protected position of the gland. A 59-year-old female admitted to the emergency department with intermittent left flank pain radiating to the left abdomen after falling from the bed six hours earlier. Her vital signs were stable, and she had tenderness over the left flank area and left abdomen. Her initial hemoglobin level was 12.9 g/dL. Bedside focused assessment with sonography for trauma revealed unclear left kidney margins. Contrast abdominal computed tomography (CT) revealed a space-occupying mass, 11.6×10.4×8.8 cm in dimension, in the left suprarenal region with active bleeding in the lower pole. Angiography did not reveal any active contrast medium extravasation. The CT-guided biopsy, was well performed concomitantly with angiography. Pathological assessment of the biopsy specimen revealed the presence of mostly adipose tissue with few erythrocytes and leukocytes. She was diagnosed with adrenal myelolipoma and admitted to the urology ward for left adrenalectomy with tumor resection. Traumatic adrenal injury, an unusual presentation of adrenal myelolipoma incidentally found in less than 5% of all abdominal blunt injuries, should be considered in cases of bleeding with trauma to the flank for prompt treatment.