AMAÇ: Mekanik obstrüksiyon nedeniyle ameliyat edilen hastalarda mukozal hasarý ve buna baðlý etkileri önlemek için sýçanlarda bir model oluþturuldu. Bazý gruplara yemleri ile probiyotik verilerek, bazýlarý ise standart yemlerle beslendi. Baðýrsak mukozasýnýn zarar görmesi ve buna baðlý olan etkilerin gruplar arasýnda farklýlýk ortaya çýkarmasý beklendi.
GEREÇ VE YÖNTEM: Kýrk sekiz diþi wistar-albino tipi sýçan rastgele beþ gruba ayrýldý. Ýlk operasyonda, kontrol grubu dýþýndaki sýçanlarýn baðýrsaklarý terminal ileum düzeyinde ipek ile baðlandý. Ýki grup 24, diðer iki grup 48 saat sonra tekrar ameliyat edildi ve terminal ileumdaki obtrüksiyonlarý kaldýrýldý. Bu süre zarfýnda, 24 ve 48 saat obstrükte kalan gruplardan her birine probiyotik verildi. Yirmi dört saat sonra, kontrol grubu ve diðer gruplar örnekleme için üçüncü kez ameliyat edildi. Terminal ileum, karaciðer, dalak, MLN (mezenterik lenf nodu) ve kan örnekleri alýndý.
BULGULAR: Kýrk sekiz saat boyunca obstrükte kalan ve probiyotiklerle beslenen araþtýrma grubunda mukozal hücre kaybý ve mukozal ödemde belirgin olarak artýþ gözlendi. Bakteriyel translokasyon, probiyotik verilmeyen gruplarda daha yaygýn bulundu. Doku GR (Glutatyon redüktaz) ve eritrosit CAT (katalaz), 24 saat boyunca týkalý ve probiyotik verilen grupta daha düþüktü.
TARTIÞMA: Probiyotiklerle beslenen gruplardaki yüksek mukozal ödem oranlarý hasar olarak görülebilir, ancak probiyotiklerin mukozal bariyer etkisi ile uyumlu olduðunu düþünüyoruz. Böylece probiyotiklerle beslenen gruplarda, bakteriyel translokasyonun daha az görülmesi ve bazý antioksidan enzimlerin daha düþük bulunmasý mümkündür. Probiyotiklerin cerrahi hastalarda yararlarýný belirlemek için ileri çalýþmalara ihtiyaç vardýr.

BACKGROUND: Created a model in the rats, to prevent mucosal damage and related effects in the patients, who were operated due to mechanical obstruction. Some groups fed fodder with probiotics, some groups fed with standard fodder. It is objected that the damage of gut mucosa and related effects on how to expose the differences of the groups.
METHODS: In this study, 48 female Wistar-albino type rats are separated into five groups randomly. In the first operation, rats’ terminal ileum was tied up with silk except for the control group. Two groups 24, the other two groups 48 hours later operated again and terminal ileum obstructions were removed. During that time, each one of those 24 and 48 hours of obstructed groups were fed with probiotic. Twenty-four hours later, the control group and other groups were operated for the third time for sampling. Terminal ileum, liver, spleen, MLN (Mesenteric lymph node) and blood samples were taken.
RESULTS: The research group, which was obstructed and fed with probiotics during 48 hours, was significantly observed in increased mucosa cell loss and mucosal edema. Bacterial translocation was found more common in groups without probiotics. Tissue GR (Glutathione reductase) and erythrocyte CAT (Catalase) were lower in the group of 24 hours obstructed and given probiotics.
CONCLUSION: The findings suggest that the high rate of mucosal edemas in the groups that are fed with probiotics can be seen as damage, but we think that probiotics are consonant with the strength of the mucosal barrier. Thus, in the groups fed with probiotics, it is possible that bacterial translocation is seen less, and some antioxidative enzymes are found less. Further studies are needed to investigate the benefits of probiotics in patients operated for obstruction.

AMAÇ: Oral alýnan probiyotikler ile baðýrsaklarda faydalý bakterilerin artýrýldýðý ve bu sayede baðýrsaklarýn enfeksiyonlar için koruyucu bariyer gücünün arttýðý bilinmektedir. Baðýrsak bariyer gücünün azalmasý ise oluþacak sepsiste tablonun kötüleþmesinde en önemli parametrelerden birisi olduðuna inanýlmaktadýr. Baðýrsak bariyer gücünün artýrýlmasýnda birçok probiyotiðin etkili olduðu gösterilmiþtir. Lactobacillus rhamnosus GG (LGG) bu konuda çalýþýlmýþ probiyotiklerden biridir. Bu çalýþmanýn amacý sepsis üzerine gastrointestinal bariyer güçlendirici etki için önemli bir probiyotik olan LGG’nin koruyucu etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmamýz Adnan Menderes Üniversitesi Hayvan Deneyleri Etik Kurulu onayý alýndýktan sonra hayvan deneyleri laboratuvarýnda yapýldý. Çalýþmada aðýrlýklarý 250–300 gram arasýnda deðiþen 24 adet genç saðlýklý erkek Wistar-Albino sýçan kullanýldý. Sýçanlar, deney öncesi tel kafeslerde, 12 saat aydýnlýk 12 saat karanlýk sirkadiyen ritimde ve sýcaklýðý 20–25 °C’de tutuldu. Yirmi dört sýçan rastgele olarak üç gruba ayrýldý ve Grup 1 (kontrol grubu, n=8), Grup 2 (sepsis grubu, n=8), Grup 3 (sepsis + probiyotik grubu, n=8) olarak çift kör þeklinde planlandý. Probiyotik olarak LGG 1x10–7 CFU/gün kullanýldý. Sepsis modeli için E. coli’nin serotiplerinden (0111: B4) ekstrakte edilen lipopolisakarit, 15 mg/kg’lýk bir dozda intraperitoneal olarak enjekte edildi ve sýçanlar iþemden 48 saat sonra sakrifiye edildi. Sakrifikasyon öncesi tüm hayvanlardan kan örnekleri alýndý ve bu örnekler biyokimya laboratuvarýna oksidan ve antioksidan parametreler deðerlendirilmek üzere gönderildi.
BULGULAR: Grup 1’in CRP deðeri Grup 2’den, Grup 3’ün de CRP deðerleri Grup 2’den anlamlý olarak düþük saptandý, Grup 2’nin total tiyol seviyeleri Grup 1’e göre anlamlý derecede düþük iken, Grup 3’ün total tiyol seviyeleri Grup 2’den anlamlý derecede yüksek saptandý. eNOS, GPX, PON1 ve MDA düzeyleri için ise gruplar arasýnda istatistiksel olarak anlamlý bir fark yoktu.
TARTIÞMA: Bakteriyel translokasyonu azaltmak ve baðýþýklýk sistemini güçlendirmek için LGG gibi probiyotiklerin proflaktik olarak kullanýmý, tedavi için ucuz ve etkili bir yöntemdir ve bu çalýþmalarýn tekrarlanarak ileriye yönelik klinik çalýþmalarla desteklenmesini öneriyoruz.

BACKGROUND: Probiotic ingestion is associated with an increase in intestinal flora of useful bacteria, which contributes to the known protective effects it has on the intestinal barrier and thereby reducing infection. The present study aims to investigate the protective effect of Lactobacillus rhamnosus gg (LGG) as an important probiotic with gastrointestinal barrier strengthening effect in sepsis.
METHODS: Our study was conducted in the Animal Experiments Laboratory after obtaining ethicalapproval to conduct this study.Twenty-four rats were randomly divided into threegroups and group 1 (control group n=8), group 2 (sepsis group, n=8), group 3 (sepsis + probiotic group, n=8) were planned as double-blind. LGG was used as a probiotic. For the sepsis model, E. coli (0111: B4) was injected intraperitoneally, and the rats were sacrificed 48 hours after treatment. Blood samples were collected from all animals before sacrification and sent to the biochemistry laboratory to evaluate oxidant and antioxidant parameters.
RESULTS: CRP values of Group 1 were significantly lower than Group 2, and CRP values of Group 3 were significantly lower. While total thiol levels of Group 2 were significantly lower than Group 1, total thiol levels of Group 3 were significantly higher than Group 2. There was no statistically significant difference between the groups for eNOS, GPX, PON1 and MDA levels.
CONCLUSION: Prophylactic use of probiotics, such as LGG to reduce bacterial translocation and strengthen the immune system, is an inexpensive and effective method of treatment, and we recommend the repetition of studies supported by prospective clinical trials.

AMAÇ: Tümör nekroz faktörü a (TNFa) için yeni nesil bir rekombinant insan monoklonal antikoru olan adalimumab (ADA), güçlü anti-enflamatuvar etkilere sahiptir. Serebral vazospazmýn geliþimi ve ilerlemesi için artmýþ enflamasyonun rolü detaylý bir þekilde belirlenmiþtir. Bu çalýþmada, tavþanlarda deneysel olarak oluþturulan serebral vazospazm modelinde ADA’nýn biyokimyasal ve histopatolojik yöntemlerle muhtemel hafifletici ve nöroprotektif etkileri araþtýrýldý.
GEREÇ VE YÖNTEM: Otuz adet erkek Yeni Zelanda beyaz tavþaný rastgele kontrol, sadece subaraknoid kanama (SAH) ve SAH artý ADA tedavi gruplarýna ayrýldý. SAH, tek sisterna magna otolog arteriyel kan enjeksiyonu ile oluþturuldu. ADA tedavisine intrasisternal kan enjeksiyonundan hemen sonra baþlandý ve günde 72 saat devam edildi. Araþtýrmalar için elde edilen SAH, serum ve beyin sapý dokusunun uyarýlmasýndan 72 saat sonra hayvanlar öldürüldü. SAK oluþumundan 72 saat sonra araþtýrma için serum ve beyin sapý doku örnekleri alýndýktan sonra hayvanlar sakrifiye edildi.
BULGULAR: Beyin sapý dokusu ve plazma TNFa ve interlökin-1β, beyin sapý dokusu matriks metaloproteinaz-9 seviyeleri SAH sonrasýnda arttý ve tedaviden sonra kýsmen azaldý. Beyin kaynaklý nörotrofik faktörün plazma seviyeleri SAH sonrasýnda azaldý ve tedaviden sonra kýsmen restore edildi. ADA tedavisi, vazospastik baziler arterlerin orta kesit alanýný önemli ölçüde arttýrdý, baziler arter duvarý kalýnlýðýný düþürdü ve ayrýca endotelyal apoptozisi düzeltti.
TARTIÞMA: Sonuçlar ADA’nýn deneysel tavþan vazospazmýnda, serebral vazospazmý iyileþtirmede etkili bir nöroprotektif ajan olduðunu göstermektedir.

BACKGROUND: Adalimumab (ADA), which is a new-generation recombinant human monoclonal antibody for tumor necrosis factor α (TNFα), has strong anti-inflammatory effects. The role of enhanced inflammation is well established for the development and progression of cerebral vasospasm. Investigated in the present study is the probable ameliorating and neuroprotective effects of ADA in rabbits using a cerebral vasospasm model with biochemical and histopathological methods.
METHODS: Thirty male New-Zealand white rabbits were randomly divided into control, subarachnoid hemorrhage (SAH) only and SAH plus ADA treatment groups. SAH was established as a single cisterna magna autologous arterial blood injection. ADA treatment was started just after intracisternal blood injection and continued for 72 hours once a day. The animals were sacrificed 72 hours after the induction of SAH, serum and brainstem tissue obtained for investigations.
RESULTS: Brainstem tissue and plasma levels of tumor necrosis factor-alpha and Interleukin-1β, brainstem tissue Matrix metalloproteinase-9 levels increased after SAH and partly decreased after treatment. Plasma levels of brain-derived neurotrophic factor decreased after SAH and partly restored after treatment. ADA treatment significantly increased the mean cross-sectional area of the vasospastic basilar arteries, reduced the basilar artery wall thickness and also ameliorates enhanced endothelial apoptosis.
CONCLUSION: Findings obtained in this study suggest that ADA is an effective neuroprotective agent for ameliorating cerebral vasospasm in experimental rabbit vasospasm.

AMAÇ: Algan hemostatik ajan (AHA), hemostatik etkinliði bilinen Achillea millefolium, Juglans regia, Lycopodium clavatum, Rubus caesius ya da Rubis fruciosus, Viscum album ve Vitis viniferea’yý standardize miktarda içeren bir bitki ekstresidir. Bu çalýþmada AHA’nýn sýçan kuyruk kanama modelinde kanama zamaný üzerine etkinliðinin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Kýrk sekiz Sprague Dawley sýçan (5–7 haftalýk, 180–210 g), altý çalýþma grubuna rastgele ve eþit sayýda randomize edildi. Çalýþma gruplarý þunlardýr: Heparin + salin (heparinize kontrol), heparin + AHA ile ýslatýlmýþ sünger, heparin + sývý AHA, salin (heparinize olmayan kontrol), AHA ile ýslatýlmýþ sünger, sývý AHA. Heparinize gruptaki sýçanlara üç gün boyunca günde üç kez intraperitoneal heparin (640 IU/kg) uygulandý. Kanama modeli oluþturmak için sýçanlarýn kuyruklarý kesildi. Çalýþma grubuna göre kanama bölgesine salin ile ýslatýlmýþ sünger, AHA ile ýslatýlmýþ sünger ya da sývý AHA uygulandý. Salin ya da AHA ile ýslatýlmýþ sünger uygulanan gruplarda, kanamanýn durumu her 10 saniyede bir kontrol edildi. Kanama 40 saniye sonra hala durmamýþ ise uygulanan tedavi baþarýsýz kabul edildi. Sývý AHA uygulanan grupta, kanama süresi kuyruk kesilmesinden kanama durana kadar geçen süre olarak tanýmlandý ve kronometre ile ölçüldü.
BULGULAR: Heparin uygulanan ve uygulanmayan kontrol gruplarýnda kanama süresi 40 saniyenin üzerinde kaydedildi. Kanama bölgesine AHA ile ýslatýlmýþ sünger uygulanan heparinize olan ve olmayan sýçanlarda ise kanama süresi anlamlý olarak kýsalarak 20 saniyenin altýna düþtü (her iki grup için de p<0.001). Sývý AHA uygulanan heparinize olan ve olmayan sýçanlarda kanama süresi sýrasýyla 5.0±1.2 saniye ve 8.0±1.3 saniye olarak ölçüldü.
TARTIÞMA: AHA, sýçan kuyruk kanama msodelinde yüksek etkinliðe sahip bir hemostatik ajandýr. Cerrahi giriþimlerde ve acil durumlarda kanama kontrolü saðlanmasý için kullanýlabilecek bir tedavi seçeneði olarak deðerlendirilebilir.

BACKGROUND: Algan Hemostatic Agent (AHA) is a multi-herbal extract containing a standardized amount of Achillea millefolium, Juglans regia, Lycopodium clavatum, Rubus caesius or Rubis fruciosus, Viscum album, and Vitis vinifera, each of which is effective in hemostasis. In this study, we aimed to investigate the effects of AHA on bleeding time in a rat tail hemorrhage model.
METHODS: Forty-eight Sprague Dawley rats (5–7 weeks old, 180–210 g) were randomly and equally allocated to six groups as follows: heparin plus saline (heparinized control), heparin plus AHA-soaked sponge, heparin plus liquid form of AHA, saline (non-heparinized control), AHA-soaked sponge and liquid form of AHA. Heparin (640 IU/kg) was administered intraperitoneally three times a day for three days in heparinized groups. For the bleeding model, the tail of rats was transected. According to the study group, either saline- or AHA-soaked sponge or liquid form of AHA was applied over the hemorrhage area. In AHA- or saline-soaked sponge groups, once the bleeding time had started, it was checked every 10 seconds. If the bleeding did not stop after 40 seconds, it was accepted as a failure. In liquid AHA group, the duration of bleeding was measured using a chronometer and defined as the time (seconds) from wounding until the bleeding stopped.
RESULTS: Bleeding time in the heparinized and non-heparinized control groups was over 40 seconds. After applying the sponge form of AHA on the wound area, bleeding time was significantly shortened to less than 20 seconds in both heparinized and non-heparinized rats (p<0.001 for both). The liquid form of AHA stopped bleeding in 5.0±1.2 seconds and 8.0±1.3 seconds in heparinized and non-heparinized groups, respectively.
CONCLUSION: AHA is a highly effective topical hemostatic agent in a rat tail hemorrhage model, thus may provide for a unique clinically effective option for control of bleeding during surgical operations or other emergencies.

AMAÇ: Kranyoserebral ateþli silah yaralanmalarý (KASY), kranyumun en ölümcül yaralanmalarýdýr. Çoðunlukla askeri çatýþmalara sekonderdir. Bu yaralanmalarýn ayrýca epilepsi, hidrosefali, enfeksiyon ve geç dönem biliþsel iþlev bozukluklarý gibi ciddi sonuçlarý da vardýr. Çalýþmamýzýn amacý, kliniðimizin KASY serisini sunmak ve bu yaralanmalarýn sonuçlarýný ve prognostik faktörlerini tartýþmaktýr.
GEREÇ VE YÖNTEM: 2011–2019 yýllarý arasýnda bölümümüzde KASY tanýsý ile tedavi edilen hastalar geriye dönük olarak incelendi. Yaralanma tipleri, yerleri, cerrahi tedavileri ve sonuçlarý analiz edildi. Radyolojik deðerlendirme de yapýldý.
BULGULAR: Otuz hasta KASY tanýsý ile tedavi edildi. Bunlarýn hepsi erkekti ve yaþ ortalamasý 27.9 idi. Frontal lob 12 (%40) hastada etkilenirken, sekiz hastada temporal lob, altý hastada oksipital lob, üç hastada parietal lob ve bir hastada posterior fossa etkilendi. Yirmi üç hastaya cerrahi tedavi uygulandý. On üç hasta (%43.3) cerrahi veya týbbi tedaviye raðmen kaybedildi.
TARTIÞMA: Kranyoserebral ateþli silah yaralarýnda ölüm oraný yüksektir. Ventriküler yaralanma, bihemisferik yaralanma, perforan yaralanma, beyin sapý hasarý ve baþvuru anýnda düþük GKS skoru prognostik faktörlerdir. Daha iyi klinik sonuçlar elde etmek için uygun ve doðru hasta yönetimi zorunludur.

BACKGROUND: Craniocerebral gunshot wounds (CGW) are the most lethal injuries of the cranium. CGW is mostly secondary to military conflicts but may also be seen in civilian life. These injuries also have severe consequences, such as epilepsy, hydrocephalus, infection and late-term cognitive dysfunctions. The present study aims to present our series of CGW and to discuss the prognostic factors and consequences of these injuries.
METHODS: The data of patients who were treated in our department for CGW between 2011 and 2019 were retrospectively reviewed in this study. The injury type, wounding site, surgical management and outcomes were analyzed. Radiological evaluation was also performed.
RESULTS: Thirty patients were treated with the diagnosis of CGW. All of the patients were male and the mean age was 27.9 years. The frontal lobe was affected in 12 (40%) patients, while temporal lobe in eight, occipital lobe in six, parietal lobe in three, and posterior fossa in one patients. Twenty-three patients underwent surgical treatment, seven patients were treated conservatively. Thirteen (43.3%) patients died despite the treatment.
CONCLUSION: Mortality in CGW is high. Ventricular injuries, bihemispheric or midline injuries, perforating injuries, brain stem injuries and low GCS score at admission are prognostic factors for CGW. Appropriate management is mandatory to obtain a better clinical outcome.

AMAÇ: Açýk kýrýklar tüm kas-iskelet sistemi yaralanmalarý arasýnda önemli bir mortalite ve morbidite nedenidir ve sosyal, ekonomik birçok problemi beraberinde getirir. Gerek uzun tedavi süreleri gerekse iþe dönüþün gecikmesi ile oluþan maliyet, bu durumlarý daha komplike hale getirmiþtir. Bu çalýþmada alt ve üst ekstremite açýk kýrýklarýnda eksternal fiksatör uygulanmýþ internal fiksasyona geçilen olgularda görülebilen komplikasyonlarýn geriye dönük olarak olarak deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþmaya 2007–2013 yýllarý arasýnda tedavi görmüþ 49 hasta alýndý. Bu hastalarýn 32’sine ilk yaralanmalarý itibariyle kliniðimizde eksternal fiksatör uygulandý, geri kalan 17’si dýþ merkezde ilk tedavileri olan eksternal fiksatör uygulandýktan sonra kliniðimize baþvurdular. Tüm hastalarýn yaralanma mekanizmalarý, eksternal fiksatör ile takip periyodlarý, eksternal fiksatör sonrasý debritman uygulanýp uygulanmadýðý, eksternal fiksayondan internal fiksasyona geçerkenki süre, pin dibi enfeksiyonu, kaynama zamaný, geç kaynama, kaynamama, internal fiksasyon sýrasýnda greft kullanýmý, internal fiksasyon türü, reoperasyonu, osteomyelit varlýðý ve takip zamanlarý kaydedildi.
BULGULAR: Radius, humerus, tibia ve femur kýrýklarý için sonuçlar ayrý ayrý deðerlendirildi. Kýrk dokuz hasta içinde 39 erkek,10 kadýn mevcuttu. ortalama takip zamaný tibia için 28.6 ay, femur için 34, humerus için 26.9, radius için 27 aydý. Kýrk dokuz hastanýn 34’ü alt ekstremite (25 tibia, 9 femur), 15’i üst ekstremte (11 humerus, 4 radius) yaralanmasýydý. Kýrk dokuz hastanýn 32’sinde pin dibi enfeksiyonu, 11 olguda nonunion, 11 olguda gecikmiþ kaynama, iki hastada ise osteomyelit bulgularý mevcuttu.
TARTIÞMA: Açýk kýrýklarý tedavi etmek daima zordur. Eksternal fiksasyon sonrasý internal fiksasyona geçilen açýk kýrýklarda komplikasyonlara açýktýr ve klinisyenlerin bu konunun bilincinde olup çýkabilecek sorunlara göre plan yapmalarý gerekir.

BACKGROUND: Open fractures constitute an important mortality and morbidity cause among all musculoskeletal system injuries and bring along many social and economic problems. The cost occurring due to both long treatment duration and the delay in returning to work made these conditions more complicated. The present study aims to evaluate of the complications which may occur in cases with an application of internal fixation following external fixator in upper and lower extremity open fractures retrospectively.
METHODS: Forty-nine patients, who applied to the emergency service between 2007 and 2013, participated in this study. Thirty-two of these patients consisted of the patients to whom external fixator was first placed, and then internal fixation was performed by us, while 17 patients were treated in another center with the external fixator, and then their treatments were performed by us. All patients’ injury mechanism, duration of follow-up with an external fixator, whether debridement was performed after external fixator, the period between external fixation and internal fixation, pin site infection, duration of the union, delayed union, nonunion, whether bone graft was used during internal fixation, internal fixation type, reoperation, development of osteomyelitis and follow-up parameters were recorded.
RESULTS: Results were evaluated separately for radius, humerus, tibia and femur fractures. Of the 49 patients, 39 were male, and 10 were female. Mean follow-up time for tibia 28.6 months, for femur 34, for humerus 26.9, for Radius 27 months. Of the 49 patients who participated in this study, 15 applied with upper extremity (11 humeri, 4 Radius) injury and 34 applied with lower extremity (25 tibias, 9 femora) injury. Of the 49 patients, 32 had pin tract infection, 11 had nonunion, 11 had delayed union, two had osteomyelitis.
CONCLUSION: Open fractures are always hard to treat. After external fixation to the internal fixation process have some complications, phsycians should be aware of all these problems and plan according to the situation.

AMAÇ: Eksternal ventrikül drenajý (EVD) nöroþirürjide hayat kurtarýcý ve acil uygulanan bir giriþimdir. Ancak enfeksiyon, EVD uygulanan hastalarda temel sorundur. Bu çalýþmanýn amacý, EVD’li hastalarýn enfeksiyon oranlarýný analiz etmek ve enfeksiyon ve mortalite oranlarýna katkýda bulunan faktörleri belirlemektir.
GEREÇ VE YÖNTEM: 2018–2019 yýllarý arasýnda acil EVD prosedürü uygulanan hastalarýn verileri geriye dönük olarak incelendi. Hastalarýn demografik özellikleri kaydedildi. Yaþ, cinsiyet, EVD endikasyonu ve süresi ile enfeksiyon ve mortalite oraný arasýndaki iliþki araþtýrýldý.
BULGULAR: Toplam 47 hastaya iki yýllýk dönemde acil EVD uygulandý. Otuz (%63.83) hasta erkek, 17’si kadýn olup ortalama yaþ 28.02 idi. Ortalama drenaj süresi 6.2 gündü. Drenaj döneminde 58 beyin omurilik sývýsý (BOS) örneði analiz edildi ve 14 (%24.14) örnekte BOS kültürü pozitif bulundu. En yaygýn mikroorganizma Staphylococcus epidermidis idi. Altý günden daha uzun süren yaþlý ve erkek hastalarda enfeksiyon oraný yüksekti. Dokuz (%19.15) hasta tedavi süresince öldü ve altýsýnda intraventriküler kanama vardý.
TARTIÞMA: Altmýþ beþ yaþ üstü ve intarventriküler kanamasý olan hastalarda EVD süresi daha kýsa olmalýdýr. Bu hasta grubunda mortalite daha yüksektir.

BACKGROUND: External ventricular drainage (EVD) is a life-saving and emergent procedure in neurosurgery. However, infection is the main problem in patients with EVD. The present study aims to analyze the infection rate of patients with EVD and to investigate the factors that contribute to infection and mortality rates.
METHODS: The data of patients who underwent emergent EVD procedure between 2018 and 2019 were retrospectively analyzed in this study. The demographic features of the patients were recorded. The correlation between age, gender, indication and duration of EVD, and the infection and mortality rate were investigated.
RESULTS: In this study, 47 patients underwent emergent EVD in two years. Thirty (63.83%) patients were male, and 17 were female with a mean age of 28.02 years. The mean duration of drainage was 6.2 days. Fifty-eight cerebrospinal fluid (CSF) samples were analyzed during the drainage period and CSF culture was positive in 14 (24.14%) samples. The most common microorganism was Staphylococcus epidermidis. The infection rate was high in older and male patients with duration longer than six days. Nine (19.15%) patients died during the treatment period and six of them had IVH.
CONCLUSION: The duration of EVD should be shorter in patients older than 65 years with the diagnosis of intraventricular hemorrhage, which is mostly related to dea

AMAÇ: Malign baðýrsak obstrüksiyonu (MBO) ileri evre tümörlerin karýniçi metastatik yayýlýmýna sekonder oluþan bir durumdur. Tedavi yaklaþýmýnda hekimler arasýnda tam bir konsensüs yoktur. Bu yazýda, MBO tanýsý konulan hastalarda týbbi tedavi ile palyatif cerrahi tedavi uygulanmýþ olan hastalarýn karþýlaþtýrmalý sonuçlarýný deðerlendirerek hekimlerin dikkatine sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 2010–2017 yýllarý arasýnda kanser tanýsý ile tedavi gören ve cerrahi kliniðinden MBO semptomlarý nedeniyle konsültasyon istenen hastalar belirlenerek kaydedildi. Küratif amaçla ameliyat yapýlan hastalar ile kliniðe konsülte edilen hastalardan obstrüksiyon semptomlarý olmayan hastalar çalýþmadan çýkarýldý. Çalýþmaya dahil edilen hastalara uygulanmýþ olan tedaviye göre cerrahi veya týbbi tedavi olarak ikiye ayrýldý. Cerrahi tedavi gören ve týbbi tedavi gören hastalar sað kalým, oral gýda alýmý ve semptomlarýn düzelmesi açýsýndan karþýlaþtýrýldý.
BULGULAR: Çalýþmaya yaþlarý 60.5±12.8 (27–88) olan 76 (30 kadýn, 46 erkek) hasta alýndý. Kýrk sekiz (%64.9) hastaya cerrahi tedavi uygulanýrken 28 (%35.1) hastaya týbbi tedavi uygulandý. Cerrahý tedavi uygulanan hastalar ile týbbi tedavi uygulanan hastalarýn yapýlan istatistiksel karþýlaþtýrmasýnda cerrahi tedavi uygulanan hastalarýn hastanede yatýþ süresi uzun (median 16 güne karþýlýk 4 gün; p<0.001), komplikasyon oraný yüksek (%27.1’e karþý %3.5; p=0.003) iken cerrahi sonrasý oral gýda alýmýnda rahatlama (%97.9 karþý %78.6; p=0.005) ve tedavi sonrasý yaþam süresi daha uzun (median 105 güne karþýlýk 43 gün; p=0.035) olduðu gözlendi.
TARTIÞMA: Çalýþma, palyatif bakým da dahil olmak üzere multidisipliner ekip tarafýndan deðerlendirilen malign baðýrsak týkanýklýðý olan hastalarda cerrahi tedavinin yaþam kalitesi parametreleri için daha iyi sonuçlara yol açtýðýný ortaya koymuþtur.

BACKGROUND: Malignant bowel obstruction (MBO) is a condition secondary to intra-abdominal metastatic spread of advanced-stage tumors. There is no consensus for the treatment approach of MBO. This study aims to present the results of medical treatment and palliative surgery in patients diagnosed with MBO.
METHODS: The patients who were treated for advanced-stage tumors between 2010 and 2017 and for whom consultation was requested from the surgical clinic for MBO symptoms were identified. A selective approach together with palliative care for the indication of surgery was instituted. The patients with surgical treatment and medical treatment were compared concerning survival, oral food intake and symptom relief.
RESULTS: Seventy-six patients (30 female, 46 male) aged 60.5±12.8 years (range: 27–88) were included in this study. Forty-eight of the patients (64.9%) underwent surgical treatment, while 28 (35.1%) had medical treatment. Although the patients with surgery had longer duration of stay in the hospital (median 16 days vs. 4 days) (p<0.001) and higher complication rates (27.1% vs. 3.5%) compared to medically treated patients; the restoring oral food intake was better (97.9% vs. 78.6%) (p=0.005) and the survival was longer (105 days vs. 43 days).
CONCLUSION: This study revealed that surgical treatment resulted in better outcomes for life quality parameters in highly selected patients with malignant bowel obstruction evaluated by multidisciplinary team, including palliative care.

AMAÇ: Primer apendajitis epiploica (PAE) akut bir hastalýk olmasýna raðmen, standart bir birinci seçenek tedavi konusunda fikir birliði yoktur. PAE için farklý cerrahi ve cerrahi olmayan giriþimler mevcuttur.
GEREÇ VE YÖNTEM: 2013–2018 yýllarý arasýnda PAE tanýsý almýþ toplam 39 hasta geriye dönük olarak hastalýðýn nüksü, týbbi müdahale ve hastanede yatýþ gereksinimi açýsýndan deðerlendirildi. Ultrasonografi ve abdominal bilgisayarlý tomografi taný aracý olarak kullanýldý. Hastalar ayrýca bir aylýk ve uzun süreli takipler için deðerlendirildi.
BULGULAR: Otuz dokuz hastanýn 29’u erkek, 10’u kadýndý. En erken altý ayda üç hastada nüks görüldü. Bu hastalarýn tümü nüks edenler dahil týbbi tedaviye cevap verdi.
TARTIÞMA: Görüntüleme yöntemlerinin geliþmesi ile doðru tanýn konulabilmesi mümkün olabilmekte ve sonuç olarak, cerrahi müdahale gerektirmeden týbbi tedavi ile PAE tedavisinde uygulanabilir bir seçenek haline getirmektedir.

BACKGROUND: Although primer appendagitis epiploica (PAE) is an acute condition, there is no consensus about a standard first-choice treatment. Different non-surgical and surgical interventions for PAE are available.
METHODS: In this study, a total of 39 patients who were diagnosed as PAE between 2013–2018 were evaluated retrospectively concerning recurrences of the disease, medical intervention, and the requirement of hospitalization. USG and abdominal CT were used as diagnostic tools. Patients were also evaluated for a one-month and long-term follow-up.
RESULTS: Of the 39 patients, 29 were male and 10 were female. Recurrence was seen in three patients at the earliest six months. These patients responded to medical treatment.
CONCLUSION: Accurate diagnosis with the help of developing imaging methods has made non-surgical treatment a viable option in the treatment of PAE.

AMAÇ: Anorektal apse (ARA) yaygýn görülen cerrahi bir durumdur. Amacýmýz ARA’da nötrofil lenfosit oraný (NLO) ve platelet lenfosit oranýný (PLO) deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2014–Mart 2019 tarihleri arasýnda ARA tanýlý hastalar geriye dönük olarak analiz edilip hasta grubu oluþturuldu. Kontrol grubu için saðlýklý bireyler çalýþmaya dahil edildi. Gruplarýn demografik özellikleri, tam kan sayýmý (CBC), C-reaktif protein (CRP) deðerleri olarak analiz edildi. Hastalarýn apse lokalizasyonu için bilgisayarlý tomografi sonuçlarý deðerlendirildi. CBC’teki parametrelerden beyaz küre sayýsý (WBC), NLO ve PLO deðerleri saptandý. Receiver operating characteristic (ROC) analizi ile verilerin kestirim deðerleri, duyarlýlýk ve özgüllüðü saptandý.
BULGULAR: Hasta grubunda WBC, CRP, NLO ve PLO deðerleri istatistiksel olarak anlamlý derecede yüksek saptandý (p<0.001). Hastalarýn supralevator apse lokalizasyonu ile diðer ARA lokalizasyonlarý karþýlaþtýrýldýðýnda WBC’de istatistiksel olarak anlamlý fark saptanýrken (p=0.003), CRP, NLO ve PLO’da istatistiksel olarak anlamlý fark saptanmadý (p>0.05). ROC analizinde, ARA tanýsý için, WBC’de 9.99 103/μL kestirim deðerinin %95 duyarlýlýk, %95 özgüllüðe; CRP’de 2.5 mg/dL kestirim deðerinin %88 duyarlýlýk, %95 özgüllüðe; NLO’da 3.96 cutoff deðerinin %82 duyarlýlýk, %95 özgüllüðe; PLO’da 112.84 cutoff deðerinin %71 duyarlýlýk ve %68 özgüllüðe sahip olduðu belirlendi.
TARTIÞMA: ARA tanýsýnda NLO’nun tanýya yardýmcý bir belirteç olarak kullanýlabileceðini fakat PLO’nun ise düþük sensitive ve spesiviteye sahip olduðunu düþünmekteyiz.

BACKGROUND: Anorectal abscess (ARA) is a commonly observed surgical situation. Our aim is to evaluate neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in ARA.
METHODS: From January 2014 to March 2019, patients diagnosed with ARA were retrospectively analysed, and a patient group was formed. Healthy individuals were included in this study as a control group. The demographic characteristics, completed blood count (CBC) and c-reactive protein (CRP) values of patients were analysed. Localisation of abscess in patients was assessed using computed tomography results. From CBC parameters, white blood count (WBC), NLR and PLR values were identified. The cut-off values for data, sensitivity and specificity were identified using the receiver operating curve (ROC) analyses.
RESULTS: In the patient group, WBC, CRP, NLR and PLR values were identified to be statistically significantly increased (p<0.001). When supralevator abscess localisation was compared with other ARA localisations, there was a statistically significant difference for WBC (p=0.003), but no statistically significant differences were identified for CRP, NLR and PLR (p>0.05). ROC analysis found WBC had cut-off value of 9.99 103/μL for ARA diagnosis with 95% sensitivity and 95% specificity, a CRP had 2.5 mg/dL cut-off value with 88% sensitivity and 95% specificity, NLR had a cut-off of 3.96 with a sensitivity of 82% and specificity of 95% and PLR had a cut-off value of 112.84 with a sensitivity of 71% and specificity of 68%.
CONCLUSION: We believe NLR may be used as a helpful diagnostic marker for ARA diagnosis; however, PLR has low sensitivity and specificity.

AMAÇ: Mortaliteyi belirlemede akut fizyoloji ve kronik saðlýk deðerlendirme II (APACHE II) skorlama sistemi gibi birçok skorlama sistemi kullanýlmasýna raðmen travmatik beyin hasarýna özgü deðildir. INCNS travmatik beyin hasarý için Gao ve ark. tarafýndan geliþtirilmiþ yeni bir skorlama sistemidir. INCNS skorlama sistemi, enflamasyon, nutrisyon, bilinç, nörolojik fonksiyonlar ve sistemik durumu deðerlendirmektedir. Çalýþmamýzýn amacý travmatik beyin hasarýnda mortaliteyi tahmin etmede APACHE II ve INCNS’nin performansýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Travmatik beyin hasarý nedeniyle anestezi yoðun bakým ünitesinde tedavi edilen 78 hasta çalýþmaya alýndý. Hastalarýn týbbi kayýtlarý geriye dönük olarak incelendi. On sekiz yaþýndan küçük olanlar, yabancýlar, eksik verileri olan hastalar çalýþma dýþý býrakýldý. Hastalarýn ilk 24 saat içindeki verileri ile APACHE II ve INCNS skorlarý hesaplandý ve kayýt edildi.
BULGULAR: Yetmiþ sekiz hastanýn 45’i (%57.7) erkek, 33’ü (%42.3) kadýndýr. Mortalite oraný %34.6 (27/78) olarak hesaplanmýþtýr. APACHE II ve INCNS skorlarýnýn ortalamasý sýrasýyla 23.85±9.44 ve 14.43±8.75’dir. ROC eðrisi altýnda kalan alan APACHE II için 0.797, INCNS için 0.84’dür.
TARTIÞMA: INCNS skorlama sistemi; yoðun bakým ünitesinde travmatik beyin hasarý mortalitesini belirlemede APACHE II skorlama sistemine göre daha güçlüdür ve Türk hasta popülasyonuna uygun olduðu söylenebilir.

BACKGROUND: Some scoring systems, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), are used to predict mortality, but they are not specialized for traumatic brain injury. INCNS is a new scoring system for traumatic brain injury developed by Goa et al. INCNS score evaluates inflammation, nutrition, consciousness, neurological function and systemic condition. The present study aims to evaluate performances of Acute Physiology and Chronic Health Evaluation II (APACHE II) and INCNS to predict mortality in traumatic brain injuries.
METHODS: In this study, 78 patients who were treated in anaesthesiology intensive care unit with the diagnosis of traumatic brain injury were included. Patients under the age of 18, foreigners, patients with incomplete data were excluded from this study. Medical records were examined retrospectively. APACHE II and INCNS scores in the first 24 hours were counted up.
RESULTS: Of the 78 patients, 45 (57.7%) were males and 33 (42.3%) were females. The overall mortality was 34.6% (27/78). The mean APACHE II, INCNS score was 23.85±9.44 and 14.43±8.75, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.797 for the APACHE II and 0.847 for the INCNS.
CONCLUSION: The INCNS scoring system had higher discriminatory power than the APACHE II in predicting the mortality of TBI in the ICU. INCNS can be considered as a usable prognostic model for Turkish people.

AMAÇ: Elin yüksek basýnçlý enjeksiyon yaralanmalarý ciddi, nadir yaralanmalardýr. Bu yazýda, mevcut ve olasý prognostik faktörlerin, tedavi yöntemlerinin ve deðerlendirme kriterlerinin geriye dönük analizi sunuldu.
GEREÇ VE YÖNTEM: Çalýþmaya 2005–2018 yýllarý arasýnda üst ekstremitede yüksek basýnçlý enjeksiyon yaralanmasý olan 10 hasta alýndý. Tüm hastalar kompartman sendromu açýsýndan deðerlendirildi; varsa fasiyotomi ve geniþ debridman yapýldý. Ýlk debridmandan sonra ilk 24 saat içinde ikinci debridman yapýldý.
BULGULAR: On hasta (ort. yaþ 30) geriye dönük olarak deðerlendirildi. Enjekte edilen materyaller hayvan aþýsý, tiner, yað, dizel, su, plastik ve boya olarak bulundu. Ameliyat öncesi ve sonrasý ortalama WBC düzeyleri sýrasýyla 14.73 K/µL ve 9.62 K/µL idi. Ameliyat öncesi ve sonrasý ortalama nötrofil düzeyleri sýrasýyla 11.4 K/µL ve 6.49 K/µL idi.
TARTIÞMA: Erken ve seri debridmanlar ve kompartman sendromu deðerlendirmesi gereklidir. Tüm önlemlere raðmen amputasyon ile sonuçlanabilir. Malzeme, enjeksiyon kuvveti ve geçen süre prognozdaki ana belirleyicilerdir. Yüksek basýnçlý enjeksiyon yaralanmalarýnda agresif debridman gereklidir. Ancak, debridmanýn yeterliliði deðerlendirilmelidir çünkü dokuyu dizel veya tiner gibi materyallerden tamamen temizlemek imkansýzdýr. On olguluk çalýþmadan edindiðimiz tecrübeye göre klinik ve makroskobik olarak debridman yeterliliði gözlendiðinde eþzamanlý olarak WBC ve nötrofil seviyelerinin de düþtüðü belirlenmiþtir. Bu nedenle WBC ve nötrofil seviyeleri debridmanýn yeterliliði için bir indikatör olabilir, ne var ki bu yaralanmalar çok nadir yaralanmalar olsa da bu yorumu yapabilmek için daha geniþ çalýþmalara ihtiyaç vardýr.

BACKGROUND: High-pressure injection injuries of the hand are rare severe injuries. This study aimed to present a retrospective analysis of current and possible prognostic factors, treatment modalities and evaluation criteria.
METHODS: Ten patients who had high-pressure injection injury to their upper extremity between 2005–2018 were included in this study. All patients were evaluated for the compartment syndrome; if exists fasciotomy and wide debridement were performed. After the first debridement, the second debridement was considered within the first 24 hours.
RESULTS: In this study, 10 patients (mean age: 30) were evaluated retrospectively. The injected materials were the animal vaccine, thinner, oil, diesel, water, plastic and paint. Preoperative and postoperative mean WBC levels were 14.73 K/µL and 9.62 K/µL, respectively. Preoperative and postoperative mean neutrophil levels were 11.4 K/µL and 6.49 K/µL, respectively.
CONCLUSION: Early and serial debridement and compartment syndrome evaluation are required. Despite these cautions, amputation may occur. Material, injection force and the time elapsed are the main determinants in prognosis. Aggressive debridement is required in high-pressure injection injuries. However, the adequacy of debridement should be evaluated because it is mostly impossible to completely clean the tissue from diesel or thinner. According to the experience of 10 cases in our series, when clinical and macroscopic debridement adequacy was observed, a decrease in WBC and neutrophil levels was observed simultaneously. For this reason, WBC and neutrophil levels may be an indicator of the adequacy of debridement, although these injuries are very rare, larger series are needed for this interpretation.

AMAÇ: Travmatik el yaralanmalarýnda, majör sinir etkilenimi ile yaralanma þiddeti ile psikolojik morbidite, el fonksiyonlarý ve iþe dönüþ zamaný arasýndaki iliþkiyi araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmaya majör sinir tutulumu olan 32 hasta alýndý. Yaralanma sonrasý hastalarýn demografik ve klinik özellikleri kaydedildi. Yaralanmanýn þiddeti, El Yaralanmasý Ciddiyet Skoru (EYCS) kullanýlarak deðerlendirildi. El fonksiyonunu deðerlendirmek için Kol, Omuz ve El (Q-DASH) skorlarý ve Duruöz El Ýndeksi (DEÝ) kullanýldý. Psikolojik morbidite Beck Anksiyete Envanteri (BAE), Beck Depresyon Envanteri (BDE) ve Olay Etkisi Ölçeði-Revize (OEÖ-R) ile deðerlendirildi. Bu deðerlendirmeler yaralanmadan sonra ve ilk yýlýn sonunda yapýldý. Ýþe dönüþ zamaný yaralanmadan sonraki ilk yýlda kaydedildi. El ve parmak kavrama kuvvetinin ölçümü için Jamar El Dinamometresi ve pinçmetre kullanýldý.
BULGULAR: Yýl sonunda OEÖ-R, BDE, BAE, Q-DASH ve DEÝ skorlarýnda baþlangýç skorlara göre önemli iyileþmeler oldu. EYCS ile iþe dönüþ zamaný, Q-DASH ve el ve parmak kuvvetleri arasýnda anlamlý bir korelasyon bulundu. ECYS ile OEÖ-R, BDE, BAE ve kavrama kuvveti arasýnda anlamlý bir iliþki bulunmadý.
TARTIÞMA: Majör sinir tutulumu olan travmatik el yaralanmalarýnda yaralanmanýn þiddeti el fonksiyonlarý, kavrama kuvvetleri ve iþe dönüþ zamaný ile önemli ölçüde iliþkilidir. Bu çalýþmada, yaralanmanýn þiddeti ile psikolojik morbidite arasýnda bir iliþki bulunmamýþtýr.

BACKGROUND: We aimed to investigate the association between the severity of the injury and psychological morbidities, hand functions, and return to work (RTW) in traumatic hand injury (THI) with major nerve involvement.
METHODS: Thirty-two patients had THI with major nerve involvement were enrolled in this study. The demographic and clinical characteristics of the patients were recorded after the injury. The severity of the injury was evaluated using the modified Hand Injury Severity Score (MHISS). The Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score and Duruöz Hand Index (DHI) were used to assess the hand function. Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Impact of Event Scale-Revised (IES) were performed to assess psychological morbidity. These assessments were performed after injury and at the end of the first year. Time to RTW was recorded in the first year after the injury. Jamar Hand Dynamometer and pinch meter were used for the measurement of hand and finger grip strength at the end of the first year.
RESULTS: There were significant improvements in IES-R, BDI, BAI, Q-DASH, and DHI scores at the end of the first year compared with baseline scores. We found a significant correlation between MHISS and time of RTW, Q-DASH, and pinch strengths. We found no significant correlation between MHISS and IES-R, BDI, BAI, and grip strength.
CONCLUSION: The severity of the injury is significantly associated with hand functions, pinch strengths, and RTW in THIs with major nerve involvement. The findings showed that there was no association between the severity of the injury and psychological morbidities in the present study.

AMAÇ: Bu çalýþmada, asfalt yol yüzeyinden seken saçma tanelerinin 35 yaþýndaki erkeðe isabet etmesi sonucunda ölüm olayý gerçekleþmiþtir. Savcýlýk makamý, saçma tanelerinin sektiði noktanýn tespit edilmesi için iki farklý sekme noktasýndan saçma tanesi daðýlým kalýbý analizini talep etmiþtir.
GEREÇ VE YÖNTEM: Hedeften 2 metre (A noktasý) ve 1 metre (B noktasý) uzaklýkta bulunan iki sekme noktasýna 10’ar adet test atýþý yapýlmýþtýr. Atýþlar sonrasýnda hedefte oluþan saçma tanesi daðýlým kalýplarýnýn alanlarý Gauss metodu ile hesaplanmýþtýr. Ardýndan, test sonuçlarý ile otopsi sonuçlarý, hedefe isabet eden saçma tanesi sayýsý, daðýlým kalýbý alanlarý ve sekme açýlarý bakýmýndan karþýlaþtýrýlmýþtýr. Ayrýca, hedefe isabet eden saçma sayýsý ile saçma daðlým kalýbý alanlarýnýn otopsi verileriyle olan benzerlikleri iki kuyruklu Mann-Whitney U testi ile incelenmiþtir.
BULGULAR: Kurbanýn vücudundan 81 adet saçma tanesi elde edilmiþtir ve saçma tanesi daðýlým kalýbýnýn alaný 2134 cm2’dir. A sekme noktasýna yapýlan atýþlarda hedefteki ortalama saçma tanesi sayýsý 82.1 ve saçma tanesi daðýlým kalýbýnýn alaný 2700 cm2’dir. B sekme noktasýna yapýlan atýþlarda hedefteki ortalama saçma tanesi sayýsý 132.6 ve saçma tanesi daðýlým kalýbýnýn alaný 4928 cm2’dir. Ýki kuyruklu Mann-Whitney U testi sonuçlarýna göre A noktasýndan saçma tanelerinin daðýlýmý ile otopsi sonuçlarý arasýnda düþük seviyede (p<0.05 level Sig. 0.023; z=-2.424) benzerlik bulunmaktadýr. Bununla beraber A noktasýndan seken saçma tanesi sayýsý ile kurbanýn vücudundan elde edilen saçma tanesi sayýsý arasýnda benzerlik (p<0.05 level Sig. 0.481; z=-0.808) bulunmaktadýr.
TARTIÞMA: Test sonuçlarýna göre saçma taneleri kurbana 2 metre mesafeden sekerek isabet etmiþtir.

BACKGROUND: In this study, a 35 years old man was killed with the ricocheted shotgun pellets wounds from the asphalt road surface. The Public Prosecutor to define the ricochet point requested the ricocheted pellet pattern examination in two different ricochet distances.
METHODS: The ten ricochet tests were performed for at 2 meters (point A) and 1 meter (point B) from the target, and the pellet distribution and pattern area were calculated using the gauss method. Then, the test and autopsy results were compared in the pellet number, calculated pellet pattern area and ricocheted angle. Furthermore, the similarity of the pellet number and the pellet pattern areas were examined using the two-tailed Mann-Whitney U test.
RESULTS: In this study, 81 pellets recovered from the victim’s body and the distribution pattern of pellets area was 2134 cm2. At the ricochet point A, the average number of pellets on the target was 82.1 and the distribution pattern of pellets area was 2700 cm2. At the ricochet point B, the average number of pellets on the target was 132.6 and the distribution pattern of pellets area was 4928 cm2. According to the two-tailed Mann-Whitney U test, there was low-level similarity (p<0.05 level Sig. 0.023; z=-2.424) on the pellet pattern area between autopsy and the ricochet point A. However, as regards the pellet number on the target, there was a similarity (p<0.05 level Sig. 0.481; z=-0.808) between autopsy and the ricochet point A.
CONCLUSION: Test results showed that the pellet ricochet occurred two meters from the victim.

AMAÇ: Künt toraks travmasýnýn deðerlendirilmesi için hala kabul edilmiþ bir radyografik kural yoktur. Acil hekimleri tecrübelerine ve muayene bulgularýna göre radyografi istemektedirler. Bu konuda çeþitli çalýþmalar yapýlmýþ ve bu çalýþmalarýn bir kýsmýnda radyografi kurallarýnýn ilk adýmlarýný destekleyebilecek sonuçlarda tespit edilmiþtir. Bunlardan biri Nexus toraks radyografi kuralýdýr. Çalýþmamýzda, Nexus toraks radyografi kurallarýnýn doðruluðunu belirlemeyi amaçlýyoruz.
GEREÇ VE YÖNTEM: Çalýþmamýz üniversite hastanemiz acil servisinde yapýlan ileriye yönelik bir kohort çalýþmasýdýr. Çalýþmada 690 hasta deðerlendirildi.
BULGULAR: Çalýþmamýz sonucunda göðüs aðrýsý, palpasyonla toraksta hassasiyeti, ani yavaþlama mekanizmasý nedeniyle daha fazla toraks grafisi çekildiðini ve tüm görüntülemenin yaklaþýk %25’inde patoloji tespit edildiði gözlenmiþtir. En sýk rastlanan patolojiler kaburga kýrýðý idi. Hastalarýn yaklaþýk %45’ine toraks bilgisayarlý tomografi (BT) çekildi ve toraks BT en sýk olarak detaylý inceleme için istendi. Hastalarý Nexus toraks radyografi kurallarýna göre deðerlendirdiðimizde ani yavaþlama, zehirlenme ve rahatsýz edici aðrýlý yaralanma mekanizmasýnýn diðer parametrelerden daha önemli olduðu görülmektedir. Nexus toraks radyografilerinin genel duyarlýlýðý ve özgüllüðü sýrasýyla %98 ve %38 olarak bulundu.
TARTIÞMA: Künt toraks travmasýnýn deðerlendirilmesinde, Nexus toraks radyografisi kurallarý patolojik taný açýsýndan faydalý olarak deðerlendirilmektedir.

BACKGROUND: There is still no agreed radiographic rule for the evaluation of blunt thoracic trauma. Emergency physicians want radiography according to their experience and examination findings. Various studies have been carried out on this subject and some of these studies have reached findings that can support the initial steps of the rules of radiography. One of them is the rule of Nexus thorax radiography rules. In this study, we aim to determine the accuracy of nexus thorax radiography rules.
METHODS: Our study was a prospective cohort study performed in the emergency department of our University Hospital. In this study, 690 patients were evaluated.
RESULTS: As a result of our study, we observed that patients were asked for more thoracic trauma because of chest pain, palpation tenderness in the thorax and sudden deceleration mechanism and pathology was found in approximately 25% of all imaging. The most common pathology we observed was rib fracture. Approximately 45% of the patients underwent thorax CT, and thorax CT was the most frequently requested for the detailed examination. When we evaluate the patients according to nexus thorax radiography rules, it was seen that the mechanism of sudden deceleration, intoxication and the disturbing, painful injury was more important than other parameters. The overall sensitivity and specificity of Nexus thorax radiographs were found to be 98% and 38%, respectively.
CONCLUSION: In the evaluation of blunt thoracic trauma, the rules of nexus thorax radiography are considered useful concerning pathological detection.

AMAÇ: Farklý bir konservatif yaklaþýmla özofagus kaçaðý nedeniyle tedavi edilen hastalarýn sonuçlarýný sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Kliniðimizde Þubat 2013–Ocak 2018 tarihleri arasýnda trakeoözofageal fistüllü özofagus atrezisi (EA) nedeniyle ameliyat edilen olan 98 hasta geriye dönük olarak incelendi. Anastomoz kaçaðý olan hastalarda gebelik haftasý, cinsiyet, vücut aðýrlýðý, baþvuru günü, iyileþme süresi ve stenoz kaydedildi. Kaçak tespitinden sonra, nazogastrik kateter floroskopik olarak bir kýlavuz tel kullanýlarak nazojejunal katetere dönüþtürüldü ve beslenme devam etti.
BULGULAR: Anastomoz kaçaðý 18 (%18.3) hastada geliþti. Ortalama gebelik yaþý yaþý 35.4 haftaydý; hastalarýn onu kýz ve sekizi erkekti. Ortalama aðýrlýk 2.41 kg idi. Baþvuru günü doðumdan sonra ortalama 2.1 gün ve ortalama ameliyat zamaný doðumdan sonra 2.4 gün idi. Ortalama iyileþme süresi 21.1 gündü (8–60 gün). Sekiz hastada dilatasyon ile iyileþen darlýk geliþti.
TARTIÞMA: Nazojejunal kateter kullanýlarak yapýlan konservatif tedavi yaklaþýmýmýzýn diðer tedavi yaklaþýmlarýna kýyasla komplikasyonlarý azaltýp, erken beslenmeyi saðlayacak ve maliyeti düþürecek etkili bir yöntem olduðuna inanýyoruz.

BACKGROUND: In this study, we aimed to present the results of patients treated for esophageal leakage with a different conservative approach.
METHODS: Ninety-eight patients with esophageal atresia and tracheoesophageal fistula (EA) who underwent surgery in our clinic between February 2013 and January 2018 were retrospectively reviewed in this study. Patients’ anastomosis leakage, gestational week, gender, body weight, referral date, recovery time and stenosis were recorded. After leakage detection, the nasogastric catheter was fluoroscopically converted into a nasojejunal catheter using a guidewire and feeding continued.
RESULTS: Anastomotic leakage developed in 18 (18.3%) patients. The average gestational age at birth was 35.4 weeks; the patients included ten girls and eight boys of average weight 2.41 kg; the average referral period was 2.1 days after birth and the average time of surgery was 2.4 days after birth. The average recovery time was 21.1 days (range: 8–60 days). Eight patients developed stenosis that recovered with dilatation.
CONCLUSION: Our findings suggest that our conservative treatment approach, which uses a nasojejunal catheter, is an effective method that would reduce complications, enable earlier feeding, and reduce the cost compared to other treatment approaches.

AMAÇ: Akut biliyer pankreatit, acil cerrahi hastalýklarda genel cerrahlar arasýnda en sýk karþýlaþýlan hastalýklardan biridir. Hekimden hekime deðiþen bu hastalarýn taný ve tedavi yönetimindeki farklýlýklar klinik uygulamada sýk görülür. Bu farklýlýklarý sunmayý ve sonuçlarý literatürdeki güncel kýlavuzlar ýþýðýnda tartýþmayý amaçladýk.
GEREÇ VE YÖNTEM: Akut biliyer pankreatit tanýsýnda, takibinde ve tedavisinde hekimlerin yaklaþýmlarýna iliþkin 21 soru hazýrlandý (Ek-A). Anketler, 20. Ulusal Cerrahi Kongresi’nde 94 genel cerrahi uzmanýyla yüz yüze görüþülerek dolduruldu.
BULGULAR: Anketi cevaplayan hekimlerin 38’i (%40) eðitim ve araþtýrma hastanesinde, 27’si (%29) devlet hastanesi’nde, 19’u (%20) üniversite hastanesinde ve 9’u özel saðlýk kuruluþunda çalýþmakta idi. Hekimlerin %85’i 10 yýllýk deneyime sahip genel cerrahi uzmanlarýydý. Cerrahlarýn %53’ü (50) her ay beþten az akut biliyer pankreatit vakasý gördüðünü ve %35’i (34) takip için günlük olarak amilaz deðeri istediklerini belirtti. Ultrasonografi ve bilgisayarlý tomografi en sýk kullanýlan görüntüleme yöntemleri idi ve yanýt verenlerin %15’i her hastaya manyetik rezonans kolanjiyopankreatografi yaptýðýný belirtti. Cerrahlarýn %45’i pankreatit tanýsý sýrasýnda antibiyotik baþladýðýný belirtti. Hafif-orta þiddette pankreatitli hastalarda erken dönemde kolesistektomi yapmayan cerrahlarýn oraný %60 idi. Erken dönemde ameliyatý tercih etmeme nedeni %40 ile en sýk ameliyat zorluðu ve ameliyatý erken dönemde desteklememe fikri idi.
TARTIÞMA: Tutum anketi sonuçlarýna göre akut biliyer pankreatit tanýsý, takibi ve tedavisinde genel cerrahi uzmanlarý arasýnda farklýlýklar bulunmaktadýr.

BACKGROUND: Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature.
METHODS: In this study, 21 questions were prepared regarding the physicians’ approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress.
RESULTS: In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period.
CONCLUSION: According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.

AMAÇ: Travma olgularýnda en önemli mortalite nedeni kanamadýr. Yaralýlarýn hýzlý deðerlendirmesi ve uygun transfüzyonu hayat kurtarýcýdýr. Bu çalýþmanýn amacý, mevcut verilere dayanarak, kan/kan ürünü transfüzyon deneyimlerini analiz etmek, transfüzyon gereksinimi ile yaralanma þiddeti skoru (injury severity score-ISS), ve yaralanma bölgesinin anatomik yerleþimi arasýnda iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya 30 Temmuz 2014–30 Temmuz 2016 tarihleri arasýnda, saha hastanesine baþvuran ve en az bir ünite kan/kan ürünü transfüzyonu yapýlan yaralýlar alýndý. Hastane transfüzyon kayýt defterinden, hastalarýn yaþý, yaralanma mekanizmasý, yaralanmanýn anatomik yerleþimi, hastaneye kabul hemoglobin (g/dL) deðeri, ISS, transfüze edilmiþ eritrosit süspansiyonu, sýcak taze tam kan, taze donmuþ plazma gibi kan ürünleri miktarý ve masif transfüzyon (MT) oraný ile ilgili veriler elde edildi.
BULGULAR: Tüm hastalar erkekti, ortalama yaþ 28.7±7.8 yýl idi. Toplamda 579 hastadan 59’una (%10) 458 ünite RBC (ES+WFWB) transfüzyonu yapýldý. Transfüzyon uygulanan yaralýlarýn %61’inde gövde (toraks±karýn) yaralanmasý vardý ve bu hastalarýn %93’üne masif transfüzyon uygulandý. Hastalarýn % 71’inde ISS >15 idi ve bu hastalarda istatistiksel olarak anlamlý yüksek kan/kan ürünleri kullanýmý ve MT oraný vardý (p=0.021, p=0.006).
TARTIÞMA: Yaralanmalarýn ve ISS’nin anatomik yeri, MT’nin hýzlý bir þekilde belirlenmesinde ve kazazedelerin hayatta kalma oranlarýnda deðerlidir. Özellikle gövde yaralanmalarýnda kanama kontrolü zordur ve transfüzyon gereksinimi ve mortalite oranlarý yüksektir. Ayrýca bu makale bir saha hastanesindeki, kentsel arazi çatýþmasýyla ilgili transfüzyon verilerini sunmaktadýr.

BACKGROUND: Blood loss is the most significant cause of mortality in trauma cases. In injured patients, rapid evaluation and appropriate transfusion is lifesaving. The present study aims to analyze the blood/blood products requirement based on available data and find any associations between the transfusion requirements and injury severity scores (ISS) and anatomical locations of injuries of transfused patients.
METHODS: Between 30 July 2014 and 30 July 2016, casualties admitted to the urban terrain hospital (UTH) and transfused at least one unit of red blood cell (RBC) were included. UTH Transfusion Record Notebook data included patients’ age, mechanism and anatomical location(s) of the injury, admission hemoglobin (g/dL) level, injury severity score (ISS), transfused units of erythrocyte suspension (ES), warm fresh whole blood (WFWB), fresh frozen plasma (FFP), and massive transfusion (MT) rate.
RESULTS: In this study, all patients were male; the mean age was 28.7±7.8 years. Overall, 59 of 579 (10%) patients were transfused 458 units of RBC (ES+WFWB). Torso (thorax ± abdomen) injury was present in 61% of the casualties who underwent transfusion, and 93% of these patients underwent massive transfusion. In 71% of patients, the ISS was >15, and there was statistically significant high blood/blood products use and MT rate in these patients, respectively (p=0.021, p=0.006).
CONCLUSION: Anatomical location of injuries and ISS are valuable in the rapid determining of MT and survival rates of casualties. Especially in torso injuries, bleeding control is difficult and transfusion requirement and mortality rates are high. This study presents the trauma of urban terrain conflict-related transfusion data from a UTH.

AMAÇ: Ayak bileði kýrýklý çýkýðý kemik ve ayak bileðini çevreleyen yumuþak doku için büyük travmatik bir olaydýr. Kemik stabilizasyonu, eklem immobilizasyonu, anatomik redüksiyon ve yumuþak doku korumasý için müdahale mümkün olduðunca erken yapýlmalýdýr. Bu çalýþmanýn amacý, ayak bileði kýrýklý çýkýðý olan hastalarda ameliyat sonrasý görülebilen majör komorbiditelerin sýklýðýný ve travma mekanizmasý ile bu komorbiditelerin klinik durumu arasýndaki iliþkiyi belirlemektir.
GEREÇ VE YÖNTEM: Mayýs 2014–Þubat 2017 tarihleri arasýnda ayak bileði kýrýklý çýkýðý olan 30 hasta (25 erkek, 13 kadýn) geriye dönük olarak incelendi. Tüm hastalar ameliyat sonrasý en az 24 ay klinik ve radyolojik olarak deðerlendirildi. Tüm hastalarda artroz, sinostoz, kondral lezyon varlýðý araþtýrýldý ve AOFAS skorlarý ile fonksiyonel sonuçlar incelendi.
BULGULAR: Açýk ayak bileði kýrýklý çýkýklarýnda ortalama AOFAS skoru kapalý kýrýklý çýkýklardan daha düþüktü (p=0.044). Eþlik eden bir osteokondral lezyonun (OCL) ve artmýþ hasta yaþýnýn artroz geliþimi ile güçlü bir þekilde iliþkili olduðu bulundu (sýrasýyla, p=0.005 ve p=0.017). Primer cerrahi uygulanan 29 hastanýn dördü ve basamaklý cerrahi uygulanan dokuz hastanýn dördünde AOFAS skorlarý kötü saptandý (p=0.071). Çýkýk yönü ile AOFAS skorlarý arasýnda anlamlý iliþki bulunmadý (p=0.087).
TARTIÞMA: Açýk ayak bileði kýrýklý çýkýðý olan hastalarda klinik ve fonksiyonel sonuçlarýn daha kötü olduðu, artroz oranýnýn yaþla arttýðý ve sindezmosis vida kullanýmýnýn klinik ve fonksiyonel sonuçlar üzerinde istatistiksel olarak anlamlý bir etkiye sahip olmadýðý gözlenmiþtir.

BACKGROUND: The ankle fracture-dislocations are a significant traumatic incident for the bone and the soft tissue surrounding the ankle. Bone stabilization, joint immobilization, anatomic reduction and intervention for soft tissue protection should be performed as early as possible. The present study aims to determine the frequency of major comorbidities that can be seen after surgery in patients with ankle fracture-dislocations and the relationship between the trauma mechanism and clinical status with these comorbidities.
METHODS: Thirty-eight patients (25 males, 13 females) who underwent surgery with ankle fracture-dislocations between May 2014 and February 2017 were evaluated retrospectively in this study. All patients were evaluated clinically and radiologically at least 24 months postoperatively. Arthrosis, synostosis, presence of the chondral lesion and AOFAS scores were detected for all patients.
RESULTS: Mean AOFAS score was lower in open ankle fracture-dislocations than in closed dislocations (p=0.044). An accompanying osteochondral lesion (OCL) and increased patient age were found to be strongly associated with the development of arthrosis (p=0.005 and p=0.017; respectively). Four of 29 patients who received primer definitive surgery and four of nine patients who received step-by-step surgery had poorly calculated AOFAS scores (p=0.071). There was no significant relationship between dislocation direction and AOFAS scores (p=0.087).
CONCLUSION: Clinical and functional results were found to be worse in patients with open ankle fractures, the rate of arthrosis increased with age, and the use of syndesmosis screw had a positive but not a statistically significant effect on clinical and functional outcomes.

Ekinokokkosiz, genellikle Echinococcus granulosus helmintinin neden olduðu zoonotik bir enfestasyondur. Köpek ve kedi gibi etoburlar kesin konakçý iken sýðýr, koyun keçi gibi otoburlar ara konakçýdýrlar. Ýnsanlar ara konakçý olup onlarda kistik ekinokokkosize neden olurlar. Ülkemizde insidansý %14’dür. Hastalýk %70 oranýnda karaciðerde yerleþir. Kist hidatiðin pankreasa yerleþmesi sýra dýþý olup %0.2–0.6 oranýnda rastlanýr ve nadiren akut pankreatite neden olur. Bu sunumda, akut pankreatit ataðý ile kendini gösteren pankreas kist hidatiði saptanýlan 45 yaþýnda bir erkek olgu sunuldu. Ýncelemelerinde pankreas gövde-kuyruk bölgesinde 97 mm çapýnda wirsung kanalý ile iþtirakli, WHO sýnýflandýrmasýna göre CE2 tipinde evre III kist hidatik, akut pankreatit ve splenomegali saptandý. Ýndirekt hemaglütinasyon testi >1: 2560 idi. Albendazol tablet ile dört hafta týbbi tedavi sonrasýnda hastaya distal pankreatektomi ve splenektomi yapýldý. Hastanýn üçüncü ayýnda IHA sonucu 1/32 olarak bulundu. Özellikle hastalýðýn endemik olduðu coðrafi bölgelerde, pankreastaki tüm kistik kitlelerin ayýrýcý tanýsýnda kist hidatik göz önünde bulundurulmalýdýr. Ayrýca pankeas kist hidatiðinin nadir görülmesine raðmen akut pankreatite neden olabileceði akla getirilmelidir.

Echinococcosis is a zoonotic infestation, most commonly arises from Echinococcus granulosus helminth. The definitive hosts are carnivora, such as dogs and cats, and the intermediate hosts are herbivores, including cattle, sheep and goats. Humans are intermediate hosts, causing cystic echinococcosis. In our country, the incidence of echinococcos is 14%. The disease is localized in the liver by 70%. Cyst hydatid localized in the pancreas is unusual, with an incidence of 0.2–0.6%, and rarely causes acute pancreatitis. In this report, we present a 45-year-old male patient with cyst hydatid, which manifested by an acute pancreatitis attack. In the examination, there was a CE2 type according to WHO classification stage III cyst hydatid of 97 mm diameter with septa associated with Wirsung duct, acute pancreatitis and splenomegaly. The indirect hemagglutination test was >1: 2560. The patient underwent pancreatectomy and splenectomy following medical therapy with Albendazole tablet for four weeks. IHA of the patient was found as 1/32 in the third month. Cyst hydatid should be considered in the differential diagnosis of all cystic masses, especially in the regions where the disease is endemic. In addition, it should be remembered that although rarely seen, pancreatic cyst hydatid may cause acute pancreatitis.

Ýnce baðýrsak lenfomalarý oldukça nadir görülmekte olup gastrointestinal malign tümörlerin yaklaþýk %1’ini oluþturmaktadýr. Ancak, eriþkin çölyak hastalýðýnda malign hastalýk riski yaklaþýk %8–10 arasýndadýr ve en sýk non-Hodgkin lenfoma geliþmektedir. Literatürde çölyak hastalýðý ve ince baðýrsak lenfomasýnýn birlikte görüldüðü olgular bildirilmekle birlikte acil cerrahi gereksinimi üzerine vurgu son derece nadirdir. Biz bu olgu sunumunda gastrointestinal perforasyon bulgularý ile acil servisimize baþvuran ve özgeçmiþinde çölyak hastalýðý ve dermatitis herpetiformis öyküsü bulunan 55 yaþýndaki bir erkek hastada operasyon sonrasý tanýsý konulan primer ince baðýrsak lenfomasýný sunuyoruz. Bu sunumun amacý, bu klinik durumu kýsaca gözden geçirmek ve literatür ýþýðýnda tartýþmaktýr.

Small bowel lymphomas are rare and constitute approximately 1% of the malignant gastrointestinal tumors. However, the risk of malignant disease in adult celiac disease is about 8–10%, and non-Hodgkin lymphoma is the most common. In the literature, cases with celiac disease and small bowel lymphoma have been reported, but the emphasis on emergency surgery is extremely rare. We herein present a case of primary small intestinal lymphoma diagnosed after surgery in a 55-year-old male patient who presented to our emergency department with findings of gastrointestinal perforation and had a history of celiac disease and dermatitis herpetiformis. The purpose of this report is to review this situation briefly and discuss it in the light of literature.

Yað embolisi sendromu, klasik olarak akut solunum yetmezliði, nörolojik anormallikler ve peteþiyal döküntü kombinasyonu ile ortaya çýkar. Kýrk altý yaþýnda kadýn hasta acil servise ajitasyon, bilinç deðiþikliði ve uykuya meyil þikayetleri ile baþvurdu. Hastanýn acil servise gelmeden saatlerce önce bir güzellik merkezinde, kalçalarýna estetik amaçlý hyalüronik asit (HA) enjeksiyonu yapýldýðý öðrenildi. Cilt bulgularý yoktu ancak hipoksemi ile akciðer bilgisayarlý tomografisinde (BT) iki taraflý buzlu cam opasiteleri ve plevral efüzyon bulgularý mevcuttu, ayrýca beyin manyetik rezonans görüntülerinde (MRG) çok sayýda beyaz lezyon vardý. Acil servise bilinçte ani deðiþiklikler ile baþvuran hastalar, geçirilmiþ cerrahi veya invaziv estetik prosedürler için sorgulanmalýdýr. Yað embolisi sendromu, hastanýn peteþial döküntüleri olmasa bile düþünülmelidir. Beyin MR ve akciðer BT bu hastalarda tercih edilen görüntüleme yöntemi olmalýdýr.

Fat embolism syndrome (FES) occurs classically characterized by the combination of acute respiratory failure, neurologic abnormalities, and a petechial rash. Forty-six-year-old female presented to our emergency department with agitation, altered mental status, and drowsiness. We learned that the patient had received a hyaluronic acid (HA) injection into her buttocks at a beauty center a few hours before her admission. She had no skin findings, but she was hypoxemic. She had lung computed tomography (CT) findings bilateral ground-glass opacities and pleural effusion and had multiple cerebral white lesion on brain magnetic resonance images (MRI). Patients presenting to the emergency department with sudden alteration in mental status should be questioned for recent surgical or invasive aesthetic procedures. Fat embolism syndrome should be considered even if the patient has no petechial rash. Brain MRI and lung CT should be the imaging modality of choice in these patients.