AMAÇ: Capparis ovata, alkaloidler, lipitler, polifenoller ve flavonoidler içerir. Ayrýca antioksidanlar bakýmýndan da zengindir. Türkiye’de geleneksel olarak Capparis ovata’nýn çiçek tomurcuklarý, kökü, kabuðu ve meyveleri; analjezik, anti-enflamatuvar, anti-romatizmal, tonik ve idrar söktürücü etkileri için kullanýlmaktadýr. Bu çalýþmanýn amacý, antioksidan, anti-enflamatuvar ve antibakteriyel özelliklere sahip olduðu bilinen Capparis ovata tohumu yaðýnýn yara iyileþmesi üzerindeki etkisini incelemektir.
GEREÇ VE YÖNTEM: Çalýþmada 20 adet Wistar-Albino diþi sýçan rastgele olarak 10’ar hayvanlýk iki gruba ayrýldý. Sýçanlarýn arka bölgesinde stan-dart bir tam kalýnlýkta deri defekti oluþturuldu. Her iki grupta da yaralar günlük olarak serum fizyolojik ile temizlendikten sonra kontrol grubuna serum fizyolojik dýþýnda etken madde uygulanmazken, çalýþma grubundaki sýçanlarýn yaralarýna 1 cc/gün Capparis ovata tohumu yaðý uygulandý. Ameliyat sonrasý 14. günde sýçanlara tekrar anestezi uygulandý ve yara alaný ölçümleri yapýldý. Daha sonra iyileþmeden kalan yara ve çevresindeki bir santimetrelik saðlam dokuyu içerecek þekilde eksizyon yapýldý ve histopatolojik inceleme için örnekler alýndý.
BULGULAR: Yara alanlarýndaki deðiþiklikler, 14 gün sonra kapari yaðý ile tedavi edilen gruptaki iyileþmenin (32.78; %95 güven aralýðý, 17.21–48.36) kontrol grubuna (65.41; %95 güven aralýðý, 49.84–80.98) göre belirgin olarak daha iyi olduðu saptandý (p=0.009). Histopatolojik skorlar, epitel oluþumu, enflamasyon ve fibrozis geliþimi açýsýndan gruplar arasýnda anlamlý farklýlýk gösterdi. Kontrol grubunda epitel dokusu oluþumu görülmez-ken (%90), tedavi grubunda daha fazla re-epitelizasyon ve fokal epidermal hiperplazi (%60) gözlendi. Tedavi grubunda az sayýda lenfosit, plazma hücresi ve dermiste dev hücre enflamasyonu geliþimi (%60), kontrol grubunda ise vasküler proliferasyon, plazma hücreleri, eozinofiller, nötrofiller ve dev hücre enflamasyonu tespit edilmiþtir (%50). Kontrol grubunda fibrozis geliþimi hafif ve zayýf (%70), tedavi grubunda ise þiddetli ve yoðun (%60) olarak deðerlendirildi. Tedavi grubunda perivasküler ödemin hafif derecede olduðu (%50) ve neovaskülarizasyon göstergesi olarak immatür vaskülarite (%60) bulunduðu gözlendi. Bu histopatolojik sonuçlar, kontrol grubuna göre tedavi grubunda enflamasyon aþamasýnýn tamamlandýðýný ve proliferasyon aþamasýnýn baþladýðýný göstermesinin yaný sýra kapari yaðý kullanýmýnýn yara iyileþmesinin deðerlendirilmesinde önemli histopatolojik parametreler olan epitelizasyon, anjiyogenez ve fibrozis üzerinde olan etkinliðini kanýtlamýþtýr.
TARTIÞMA: Bu çalýþmanýn sonuçlarýndan, Caparis ovata tohumu yaðýnýn tam kalýnlýktaki deri yaralarýnýn iyileþmesini önemli ölçüde artýrdýðý ve bu etkinin öncelikle anti-enflamatuvar etkisiyle iliþkili olduðu sonucuna varýldý.

BACKGROUND: Capparis ovata contains alkaloids, lipids, polyphenols, flavonoids, and also is rich in antioxidants. Conventionally, in Turkey, the flower buds, root, bark, and fruits of C. ovata are used for their analgesic, anti-inflammatory, anti-rheumatism, tonic, and diuretic effects. The aim of this study was to examine the effect on wound healing of C. ovata seed oil (COSO), which is known to have antioxidant, anti-inflammatory, and antibacterial properties.
METHODS: In the study, 20 Wistar albino female rats were randomly divided into two groups of 10 animals each. A standard full-thick-ness skin defect was created on the back area of the rats. In both groups, after cleaning the wounds with saline daily, no active substance other than saline was applied to the control group, while 1 cc/day COSO was applied to the wounds of the rats in the study group. On the post-operative 14th day, the rats were reanesthetized and wound area measurements were made. Then, excision was performed to include 1 cm of intact tissue around the wound, which remained unhealed, and samples were taken for histopathological examination.
RESULTS: The changes in wound areas showed that after 14 days, the improvement in the group treated with caper oil (32.78; 95% confidence interval, 17.21–48.36) was significantly higher than that of the control group (65.41; 95% confidence interval, 49.84–80.98) (p=0.009). The histopathological scores showed a significant difference between the groups in respect of epithelial formation, inflam-mation, and fibrosis development. No epithelial tissue formation was observed in the control group (90%), and more incomplete re-epithelization and focal epidermal hyperplasia were observed in the treatment group (60%). Fibrosis development was mild and weak (70%) in the control group and was evaluated as severe and intense (60%) in the treatment group. Perivascular edema was mild (50%) and vascularity was immature (60% – an indicator of neovascularization) in the treatment group. These histopathological results showed that the treatment group inflammation phase was completed and the proliferation phase started, as well as the effectiveness of the use of caper oil on epithelization, angiogenesis, and fibrosis, which are important histopathological parameters in the evaluation of wound healing compared to the control group.
CONCLUSION: From the results of this study, it was concluded that COSO significantly enhances the healing of full-thickness skin wounds and this effect is primarily related to its anti-inflammatory effect.

AMAÇ: Anastomoz kaçaðý kolon anastomozlarýndan sonra en korkulan komplikasyondur. Bu çalýþmanýn amacý, farklý uygulama yollarýyla uygulanan fenitoinin kolorektal anastomozlarýn iyileþme sürecine etkisini belirlemektir.
GEREÇ VE YÖNTEM: Wistar Albino sýçanlar, Ýntraperitoneal Fenitoin Grubu (ÝAP), Oral Fenitoin Grubu (OAP), Rektal Fenitoin Grubu (RAP) ve kontrol gruplarýna ayrýldý. Fenitoinin VEGF, TGF-β, FGF2 ve p53 genlerinin ekspresyonu üzerindeki moleküler etkisi mRNA ve protein düzeyinde deðerlendirildi. Fenitoinin anastomoz patlama basýncý analizi üzerindeki etkilerinin yaný sýra patohistolojik incelemeler de ölçülmüþtür. BULGULAR: Kontrol ve uygulama gruplarý arasýnda anastomoz patlama basýncý deðerlerinde istatistiksel olarak anlamlý artýþ vardýr. Enflamatuvar hücre infiltrasyonu tüm gruplarda kontrole göre baðýrsak anastomoz bölgesinde artmýþtýr. Kollajen skorlarý OAP ve RAP gruplarýnda kontrol grubuna göre anlamlý derecede yüksek bulundu. TGF-ß’nin mRNA’sý ve FGF2 ekspresyonu, fenitoin uygulamalarýnýn tüm yollarýnda artmýþtýr.
TARTIÞMA: Üç farklý uygulama yolu, patlama basýncýnda önemli bir artýþ göstermektedir. FGF2, TGF-β, p53 ve VEGF genlerinin ekspresyon sonuçlarý ile ilgili olarak, çoðu uygulama yolunda mRNA ve protein seviyesinde FGF2 ve TGF-β’de önemli bir artýþ vardýr.

BACKGROUND: Anastomotic leakage is the most feared complication after colonic anastomosis. The purpose of the study is to determine the effects of phenytoin applied by different application routes, on the healing process of colorectal anastomoses.
METHODS: Wistar Albino rats were divided into Intraperitoneal Phenytoin Group, Oral Phenytoin Group (OAP), Rectal Phenytoin Group (RAP), and control groups. The molecular effect of phenytoin on the expression of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), fibroblast growth factor 2 (FGF2), and p53 genes was evaluated at mRNA and protein level. The effects of phenytoin on anastomotic bursting pressure analysis measured as well as pathohistological examinations.
RESULTS: There are statistically significant increase in anastomotic bursting pressure values between control and application groups. Inflammatory cell infiltration of all groups increased in the intestinal anastomosis region compared to control. Collagen scores were found to be significantly higher in the OAP and RAP groups compared to the control group. mRNA of TGF-ß and FGF2 expression increased in all routes of phenytoin applications.
CONCLUSION: Three different administration routes show considerably increase on the bursting pressure. Regarding the results of the expression of FGF2, TGF-β, p53, and VEGF genes, there is a significant increase FGF2 and TGF-β at mRNA and protein level in most administration routes.

AMAÇ: Akut taþlý kolesistit en sýk karþýlaþýlan cerrahi patolojilerden biridir. Akut taþlý kolesistit tanýsýyla ilk yatýþ sýrasýnda erken kolesistektomi ilk tedavi seçeneði iken, hastane kaynaklarýnýn kýsýtlý olduðu ve saðlýk personelinin pandemi zorluklarýnýn üstesinden gelmeye çalýþtýðý COVID-19 döne-minde yaklaþým deðiþebilir. Bu ankette amacýmýz, COVID-19 pandemisi sýrasýnda akut taþlý kolesistit tedavisi için genel cerrahlarýn tercihlerini ve olasý deðiþen paradigmayý araþtýrmaktýr.
GEREÇ VE YÖNTEM: Cerrahlara özel kapalý bir sosyal medya grubunda paylaþýlan anket linki üzerinden online anket yapýlmýþtýr. Genel cerrahlarýn mesleki deneyimi, çalýþtýklarý kurum özellikleri ile birlikte COVID-19 dönemindeki akut taþlý kolesistit hastalýðýna yönelik tedavi tutumlarý 13 soruluk anket aracýlýðýyla çoktan seçmeli sorularla sorgulandý. Üç aylýk veri toplama dönemi sonrasý elde edilen cevaplar istatistiksel olarak analiz edildi. BULGULAR: Çalýþmaya katýlan 82 genel cerrahýn %56’sý COVID-19 pandemisi sýrasýnda tedavi stratejilerinin kýsmen veya tamamen deðiþtiðini ifade etmiþtir. Cerrahlarýn %48.8’i COVID-19 döneminden önce akut taþlý kolesistitli olgularda erken kolesistektomiyi tercih ederken; COVID-19 döneminde cerrahlarýn sadece %23.2’si erken cerrahi yaklaþýmý tercih ettiklerini ifade ettiler. Ancak birincil týbbi tedavi olarak antibiyotik baþlanan hastalarda týbbi tedavi baþarýsýzlýðý %40.2 olarak tespit edildi. Anket sonuçlarýmýza göre perkütan kolesistostomi uygulamasý COVID öncesi dönemde %4.9 iken, pandemi döneminde %20.7’ye yükseltilmiþtir.
TARTIÞMA: Cerrahlarýn %96.3’ü COVID-19 hastalýðýna baðlý bir komplikasyon görmemesine raðmen; COVID-19 pandemisi öncesi erken kolesis-tektomiyi tercih eden cerrahlarýn yarýsýndan fazlasý COVID-19 pandemisi sýrasýnda tedavi stratejilerini deðiþtirmiþtir. Anket sonuçlarýna göre týbbi tedavi baþarýsýzlýk oraný yüksek olmasýna raðmen, cerrahlarýn %48.8’i pandemi sonrasýnda da bu non-operatif yaklaþýma devam edebileceklerini ifade etmiþtir.

BACKGROUND: Acute calculous cholecystitis is one of the most encountered surgical pathologies. While early cholecystectomy is the first treatment choice during the first index hospitalization, it may change during COVID-19 era when hospital resources are re-stricted, and health-care personnel try to overcome pandemic difficulties. In this survey, our aim is to investigate surgeons’ preferences and possible changing paradigms for acute cholecystitis therapy during COVID-19 pandemic.
METHODS: An online survey was conducted on an internet site through private invitation by social media sent to general surgeons. The survey consisted of 13 questions, including surgeons’ hospital properties, and it questioned treatment preferences against acute calculous cholecystitis during the pandemic. After 3 months of data collection, responded answers were analyzed statistically.
RESULTS: About 56% of the surgeons stated that their treatment strategy changed during the COVID-19 pandemic partially or totally. About 48.8% of surgeons preferred early cholecystectomy for cases with acute cholecystitis before COVID-19 era; when only 23.2% of the surgeons preferred early surgery during COVID-19 era. However, patients who had received antibiotics as primary medical therapy had medical therapy failure with a range of 40.2%. Percutaneous cholecystostomy rate was raised to 20.7% from 4.9% before the COVID era.
CONCLUSION: Although 96.3% of the surgeons did not have seen any unusual complication related to the COVID-19 disease, more than half of the surgeons who preferred early cholecystectomy changed their treatment strategy during the COVID-19 pandemic. According to the survey results, although the medical therapy failure rate is high, 48.8% of the surgeons may persist in this non-operative approach after the pandemic.

AMAÇ: COVID-19 pandemisi tüm dünyayý etkisi altýna almakta ve yüksek mortaliteye neden olmaktadýr. Mortalitenin engellenmesi için takipte bazý parametreler kullanýlmakta ancak optimum takip parametreleri ve cut-off deðerleri hakkýnda daha fazla bilgiye ihtiyaç bulunmamaktadýr. Bizim çalýþmamýzda ölen ve saðkalan hastalar karþýlaþtýrýlarak, takipte kullanýlan paremetrelerin güvenilirliðinin araþtýrmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Hastalar hayatta kalan ve ölen hastalar olmak üzere iki gruba ayrýldý. COVID-19 hastalýðýnýn prognozunda izlenen parametreler deðerlendirildi.
BULGULAR: Çalýþmamýzda deðerlendirilen 144 hastadan 57’si öldü (%39.7). Ölen hastalarýn yaþ ortalmasý 67.8 idi ve saðkalan hastalardan daha yüksekti. Ölen hastalarýn %59.6’sý erkekti. Erkek cinsiyetin, hastalýk ve ölüm oraný açýsýndan yüksek risk olduðu görüldü. En sýk eþlik eden hastalýklar hipertansiyon, diabetes mellitus, kalp hastalýðý, kronik obstrüktif akciðer hastalýðý idi. Çalýþmamýzda lenfosit, troponin, D-dimer, ferritin ve laktat dehidrojenaz deðerlerinin mortalite tahmininde önemli prognostik belirleyiciler olduðu bulundu.
TARTIÞMA: Mortaliteyi tahmin etmek için prognostik belirteçlerin kullanýlmasý daha faydalý görünmektedir.

BACKGROUND: The COVID-19 pandemic affects the whole world, causing high mortality. Some clinical parameters have already been implemented to be followed up to prevent mortality, but there is still a need for further information about optimum follow-up parameters and cutoff values. We aimed to investigate the reliability of the parameters used in patient follow-up by comparing sur-vivors and non-survivors.
METHODS: Patients were divided into two groups as survivors and non-survivors.The parameters used in the follow-up of patients were evaluated for their prognostic value in the course of COVID-19.
RESULTS: Of the 144 patients evaluated in our study, 57 patients were non-survivors (39.7%). Non-survivors were older with an average age of 67.8 years. Of the non-survivors, 59.6% were men. Male gender was found out to be associated with an increased risk concerning prognosis and mortality. The most common accompanying diseases were hypertension, diabetes mellitus, cardiac disease, and chronic obstructive pulmonary disease. In our study, it has been found that lymphocyte counts and levels of troponin, D-dimer, ferritin, and lactate dehydrogenase are important prognostic predictors in estimating mortality risk.
CONCLUSION: The use of prognostic markers appears to provide benefitsin estimating mortality in COVID-19 patients.

AMAÇ: Çeþitli stres faktörlerine baðlý immün sistemin gösterdiði fizyolojik yanýt nötrofil sayýsýnda artýþ, lenfosit sayýsýnda ise azalma þeklinde olmaktadýr. Bu bilginin ýþýðýnda bazý çalýþmalar bu iki parametrenin oranýný bir enfeksiyon belirteci olarak kullanmayý önermiþlerdir. Yaptýðýmýz bu çalýþma ile maliyeti oldukça düþük ve hýzlý bir þekilde çalýþýlabilen tam kan sayýmý sonucu elde edilen nötrofil/lenfosit oranýnýn benign sebeplere baðlý geliþmiþ intestinal obstrüksiyonlarda cerrahi endikasyonun aciliyetini ve hastalýðýn progresyonunu belirlemedeki rolünün incelenmesi amaçlanmýþtýr. GEREÇ VE YÖNTEM: Baþkent Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Konya Uygulama ve Araþtýrma Hastanesinde Ocak 2010 ve Ocak 2021 tarihleri arasýnda, benign sebeplere baðlý intestinal obstrüksiyon tanýsý ile yatýrýlmýþ ve cerrahi müdahale gerekliliði olmuþ hastalarýn verileri geriye dönük olarak incelendi. Kriterlere uyan ve çalýþmaya dahil edilen 109 hastanýn verileri istatistiksel olarak analiz edildi. Baþvuru anýn-daki nötrofil/lenfosit oranýnýn ameliyatta saptanan iskemi, perforasyon, rezeksiyon gerekliliði, postoperatif morbidite ve mortalite, hastanede yatýþ süresi gibi hastalýðýn ciddiyetini gösteren faktörlerle iliþkisi incelendi. Ayrýca bu parametrenin diðer enfeksiyon belirteçlerine (CRP, lökosit gibi) bir üstünlüðünün olup olmadýðýna bakýldý.
BULGULAR: Benign sebeplere baðlý intestinal obstrüksiyon nedeni ile hastaneye baþvuru esnasýnda bakýlan nötrofil/lenfosit orandaki yüksekli-ðin ameliyat esnasýnda iskemi saptanmasý, rezeksiyon gerekliliði, postoperatif komplikasyon ve mortalite riskini anlamlý derecede artýrdýðý görüldü (p<0.05). Ayrýca artmýþ nötrofil/lenfosit oraný uzamýþ hastane yatýþý ile iliþkili bulundu. Yapýlan korelasyon analizlerinde de literatür ile uyumlu olarak nötrofil/lenfosit oraný ile hastane yatýþ süresi (p=0.03), CRP deðeri (p<0.001), iskemi (p<0.001), perforasyon (p=0.007), postop komplikasyon varlýðý (p=0.009) ve mortalite (p=0.002) arasýnda pozitif yönlü korelasyon olduðu saptandý.
TARTIÞMA: Bulgularýmýz nötrofil-lenfosit oranýnýn benign sebeplere baðlý instestinal obstrüksiyonlarda hastalýðýn gidiþatýný öngörmede oldukça önemli role sahip olduðunu göstermiþtir. Çalýþmamýzýn verileri doðrultusunda benign sebeplere baðlý intestinal obstrüksiyonlarda nötrofil/lenfosit oranýnýn hastalýðýn seyrini öngörmede ve bazý durumlarda cerrahi endikasyonu koymada önemli bir belirteç olabileceðini düþünmekteyiz.

BACKGROUND: The physiological response of the immune system to various stress factors results in an increase in neutrophil count and a decrease in lymphocyte count. In the light of this information, some studies have suggested using the ratio of these two parameters as an infection marker. The aim of this study was to investigate the role of neutrophil-to-lymphocyte ratio (NLR) derived from complete blood count, a very cost-effective and rapidly measurable parameter, in predicting the urgency of the surgical indication and disease progression in intestinal obstructions secondary to benign causes.
METHODS: The data of patients who were admitted with the diagnosis of intestinal obstruction secondary to benign causes and underwent surgical intervention between January 2010 and January 2021 in Baþkent University, Faculty of Medicine, Department of General Surgery, Konya Practice and Research Hospital were retrospectively analyzed. The data of 109 patients who met the study criteria and were included in the study were statistically analyzed. The correlation of admission NLR with factors indicating the severity of the disease such as intraoperatively detected ischemia, perforation, resection requirement, post-operative morbidity and mortality, and length of hospital stay was examined. Moreover, the diagnostic value of the NLR was compared with that of other infection mark-ers (such as C-reactive protein [CRP] and leukocyte).
RESULTS: It was observed that the high NLR during admission to the hospital due to benign intestinal obstruction causes significantly increased the risk of ischemia, resection requirement, post-operative complications, and mortality during surgery (p<0.05). Furthermore, increased NLR was found to be associated with prolonged hospitalization. In correlation analysis, consistent with the literature, a positive correlation was found between NLR and hospitalization time (p=0.03), CRP value (p<0.001), ischemia (p<0.001), perforation (p=0.007), presence of post-operative complications (p=0.009), and mortality (p=0.002).
CONCLUSION: Our results show that the NLR has a very important role in predicting the course of the disease and surgical indication in benign intestinal obstructions.

AMAÇ: Akut obstrüktif sol kolorektal kanserlerde (AOSKRK), tümörün proksimalindeki kolon segmentlerinin distansiyonu sonucu kolon duvarýnda hasar meydana gelebilir. Amacýmýz Hartmann prosedürü (HP) uygulanan hastalarda, ameliyat öncesi abdominal bilgisayarlý tomografi (BT) tarama-sýnda dilate kolon çapýnýn lomber vertebra korpus çapýna oraný ile ameliyat sonrasý komplikasyonlar arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Tümör grubu, acil þartlarda AOSKRC nedeniyle HP uygulanan 49 hastadan oluþturuldu. Kontrol grubu, gastrointestinal sistem dýþýndaki patolojiler nedeniyle abdominal BT’si olan, batýn ameliyatý öyküsü olmayan, tümör grubu ile yaþ ve cinsiyet bakýmýndan uyumlu 49 kiþiden oluþturuldu. Her iki grupta, her hastanýn aksiyel BT görüntülerinde kolon çapýnýn (KÇ) ilk lomber vertebra korpusunun çapýna (L1-VÇ) oraný ölçüldü. Ameliyat sonrasý komplikasyonlar (Clavien-Dindo sýnýflamasý -major (grade ≥III), minor (grade <III)) ile demografik özellikler, ameliyat öncesi biyokimyasal deðerler, komorbid hastalýklar, tümör patolojik evresi, operasyon süresi ve kolon segmentlerinin KÇ/L1-VÇ oranlarý arasýndaki iliþki deðerlendirildi.
BULGULAR: Tümör grubunda KÇ/L1-VÇ oraný, kontrol grubuna göre anlamlý derecede yüksekti (p<0.001). Tümör grubunda ameliyat öncesi transvers ve inen kolon KÇ/L1-VÇ oranýnda artýþ, majör ameliyat sonrasý komplikasyonlar için prognostik parametre olarak bulundu (sýrasýyla p<0.001, p=0.015). KÇ/L1-VÇ oranlarýnýn cut-off deðerleri sýrasýyla 1.52 ve 1.21 (p=0.013, p=0.042) tespit edildi. Ameliyat öncesi transvers kolon KÇ/L1-VÇ oranýndaki artýþ da kan üre düzeyindeki artýþla iliþkili bulundu (p=0.044). Ameliyat öncesi kan üre düzeyleri ile ameliyat sonrasý komplikasyonlar arasýnda pozitif korelasyon gözlendi (p=0.015).
TARTIÞMA: AOSKRK’de ameliyat öncesi transvers ve inen kolon KÇ/L1-VÇ oranlarý, majör ameliyat sonrasý komplikasyonlar için umut verici prognostik parametrelerdir.

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann’s Procedure (HP) and post-operative complications.
METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade <III)) and demographic characteristics, pre-operative biochemical values, comorbid diseases, tumor pathological stage, opera-tion time, and colon segments’ CD/L1-VD ratios was evaluated.
RESULTS: The CD/L1-VD ratio in the tumor group was significantly higher than that of the control group (p<0.001). An increase in the pre-operative transverse and descending colon CD/L1-VD ratios in the tumor group were found to be a prognostic parameter for the development of major post-operative complications (p<0.001 and p=0.015, respectively), with the cut-off values as 1.52 and 1.21 (p=0.013 and p=0.042), respectively. The increase in the pre-operative transverse colon CD/L1-VD ratio was also associated with the increase in the blood urea level (p=0.044). A positive correlation was observed between the pre-operative blood urea levels and post-operative complications (p=0.015).
CONCLUSION: Pre-operative transverse and descending colon CD/L1-VD ratios in AOLCRC are promising prognostic parameters for major postoperative complications.

AMAÇ: Çalýþmamýzda travma skorlarý kullanýlarak adli makamlara yansýyan iþ kazasý olgularýnda yaralanma özellikleri, nedenleri, sonuçlarý ve hastane maliyetinin travma skorlarý kullanýlarak deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþma adli makamlardan izin ve yerel etik kurulundan onay alýndýktan sonra yapýldý. 2015–2019 yýllarý arasýnda Bolu ilinde adli makamlara yansýyan tüm iþ kazasý olgularý çalýþmaya dahil edildi. Gruplar Ki-Kare testi, Mann-Whitney U Testi ve the Kruskal-Wallis Testi ile karþýlaþtýrýlmýþtýr. P deðeri <0.05 istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Çalýþmaya toplam 3599 olgu dahil edildi. Olgularýn büyük çoðunluðu (%74.70) erkek olup yaþ ortalamasý 34.90±10.50’dir. Ýþ kazasý en sýk 8–16 saatleri (n=1982; %55.10) arasýnda, cuma günü (n=595, %16.53), Nisan (n=356; %9.89) ayýnda ve ilkbahar (n=971; %26.98) mevsiminde meydana gelmiþtir. Ýþ kazasýna baðlý ölüm 29 olguda (%0.80) gerçekleþmiþtir. En sýk yaralanma gýda sektöründe (n=1256, %34.90) meydana gelmiþ-ti. En sýk iþ kazasý tipi künt cisim yaralanmasý (%30.90) olup, maðdurlar en sýk üst ekstremiteden (%54.93) yaralanmýþtýr. Olgularýn AIS ortalamasý 0.94±.74, ISS ortalamasý 1.79±4.47 ve NISS ortalamasý 2.11±5.28’dir. Erkeklerde, yaþamý tehdit eden yaralanmalarda, inþaat ve tarým-ormancýlýk sektörlerinde, yüksekten düþme, trafik kazasý ve makineye sýkýþma þeklindeki iþ kazalarýna ISS ve NISS ortalamasý istatistiki olarak anlamlý derecede daha yüksektir. Toplam tedavi masrafý 1.351.339,10 TL olup, ortalamasýnýn ise 380.30±2418.90 TL’dir. Ýnþaat ve tarým-orman sektöründe tedavi masraflarý anlamlý derecede daha yüksektir.
TARTIÞMA: Adli makamlara yansýyan tüm iþ kazalarýnýn her il bazýnda ayrý olarak deðerlendirilmesi, iþ kazalarý için alýnacak önlemlerin belirlenmesinde yararlý olabilir. Travma skorlarýnýn kullanýmý, aðýr travmalara neden olan sektörlerin ve yaralanma mekanizmalarýnýn tespiti ve tedavi masraflarýnýn belirlenmesinde önemli bir argüman niteliði taþýmaktadýr.

BACKGROUND: This study was aimed to evaluate the injury characteristics, causes, results, and hospital charges in cases of occu-pational accidents that were reported to judicial authorities using trauma scores.
METHODS: The study was performed after obtaining permission from the judicial authorities and approval from the local ethics committee. All occupational accident cases that were reported to the judicial authorities in Bolu Province between 2015 and 2019 were included in the study. The groups were compared with the Chi-Square test, Mann-Whitney U Test, and the Kruskal-Wallis Test. P<0.05 was considered statistically significant.
RESULTS: This study included 3599 cases. The majority of the cases (74.70%) were male, with a mean age of 34.90±10.50 years. Occupational accidents occurred most frequently between 8 and 16 h (n=1982; 55.10%), on Friday (n=595, 16.53%), in April (n=356; 9.89%), and in spring (n=971; 26.98%). Occupational accident-related death occurred in 29 cases (0.8%). The most common injury due to occupational accidents occurred in the food industry (n=1256, 34.90%). Blunt object injury (n=1112, 30.90%) was the most com-mon type of occupational accident; and the upper extremity (n=2049, 54.93%) was the most common injury localization. The mean Abbreviated Injury Scale of the cases was 0.94±0.74, the mean Injury Severity Score (ISS) was 1.79±4.47, and the mean New-Injury Severity Score (NISS) was 2.11±5.28. The means of ISS and NISS were statistically significantly higher for males, life-threatening injuries, work accidents in the Construction and Agriculture-Forestry sectors, fall from height, traffic accidents, and caught-in-machinery. The total hospital charge was 1,351,339.10 TL and its average was 380.30±2418.90 TL. The mean of treatment costs was significantly higher in the agriculture-forestry and construction sectors.
CONCLUSION: The evaluation of all occupational accidents that are submitted to the jurisdiction on a provincial basis may provide more useful information in the prevention of work accidents. The use of trauma scores in the evaluation of occupational accidents is a useful argument for understanding the sectors and injury types that cause severe trauma. Furthermore, trauma scores may be an important predictor of hospital costs.

AMAÇ: Zor havayolu saptanmasýnda kullanýlan prediktif faktörler ile ilgili çalýþmalar, özellikle beklenmeyen zor entübasyon insidansýný azaltmak, hasta güvenliðini saðlamak ve kaynak israfýný önlemek için yapýlmaktadýr. Bu çalýþmada, sýklýkla kullanýlan hava yolu deðerlendirme testlerinin yanýnda, endokrin, kas-iskelet sistemi hastalýklarý ve intraoral kavitede kitle varlýðýnýn zor havayolu deðerlendirmesinde prediktif deðerlerinin araþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþma iç içe vaka kontrol (nested case-control) çalýþmasý olarak tasarlanmýþtýr. Dahil edilme kriterlerine uyan, 92’si zor entübasyon, 920’si zor olmayan entübasyon hastasý (1: 10 oraný) olmak üzere toplam 1012 hasta verisi toplandý. Hastalarýn yaþ, cinsiyet, vücut kitle indeksleri (VKÝ), Mallampati, Cormack-Lehane Skoru (CLS), sternomental mesafe (SMM), kesici diþler arasý boþluk (KDB), cerrahinin tipi, endokrin, kas-iskelet sistemi ve kardiyo-pulmoner hastalýklar ve aðýz içi kitle varlýðý gruplar arasýnda karþýlaþtýrýlmýþtýr.
BULGULAR: Yaþ >52 yýl, erkek cinsiyet, ASA 3–4, yüksek VKÝ, CLS 3–4, Mallampati 3–4, KDB <4 cm ve SMM <10 cm olmasý zor entübasyon açýsýndan istatistiksel olarak anlamlý bulunmuþtur. Ayrýca, aðýz içi kitle varlýðý (17.57 kat daha fazla, p<0.05), endokrin hastalýklarý (3.51 kat daha sýk, p<0.05) ve kas-iskelet sistemi hastalýklarý (4.5 kat daha yüksek, p<0.05) varlýðýnda gruplarýn karþýlaþtýrýlmasýnda istatistiksel olarak anlamlý bir iliþki bulunmuþtur.
TARTIÞMA: Bu çalýþmada, diyabet ve endokrin bozukluklarý gibi endokrin hastalýklarýn, kas-iskelet sistemi hastalýklarýnýn ve aðýz içi kitle varlýðýnýn yaygýn olarak kullanýlan hava yolu deðerlendirme testleri ile birlikte zor entübasyon için prediktif faktör olarak kullanýlabileceði gösterilmiþtir.

BACKGROUND: The predictive factors of difficult airway have been studied to reduce especially the incidence of unanticipating difficult intubation, provide patient safety, and avoid wasting resources. In this study, it was aimed to investigate whether endocrine, musculoskeletal diseases, presence of intraoral mass, and demographic factors have predictive values in the evaluation of difficult air-way as well as frequently used airway assessment tests.
METHODS: This study was designed a nested-case control study. After eligibility criterions, totally 1012 patient data were collected, 92 of them were difficult intubation, 920 of them were non-difficult intubation patients (1: 10 ratio). Demographic characteristics of the patients (age, gender), body mass index (BMI), Mallampati, Cormack-Lehane Score (CLS), sternomental distance (SMD), inter incisor gap (IIG), type of surgery, endocrine, musculoskeletal and cardio-pulmonary diseases, and the presence of intraoral mass were compared between groups.
RESULTS: Age >52 years, male gender, ASA 3–4, higher BMI, CLS 3–4, Mallampati 3–4, IIG <4 cm, and SMD <10 cm were found statistically significant in terms of difficult intubation. Besides, a statistically significant relationship was found when the groups were compared in the presence of intraoral mass (17.57 times higher, p<0.05), endocrine diseases (3.51 times more common, p<0.05) and musculoskeletal system diseases (4.5 times higher, p<0.05).
CONCLUSION: In this study, it was demonstrated that endocrine disorders such as diabetes mellitus and thyroid disorders, musculoskeletal system diseases, and the presence of intraoral cavity mass should be used as predictors for difficult intubation with commonly used airway assessment tests.

AMAÇ: Bu çalýþmadaki ilk amaç, zor hava yolunu tahmin etmede STOP-BANG anketinin kullanýmýný deðerlendirmektir. Çalýþmada ikincil olarak deðerlendirmek istenen zor hava yolunu tahmin etmede anketin ve diðer zor hava yolu belirleyici testlerin korelasyonunu deðerlendirmektir. GEREÇ VE YÖNTEM: Bu ileriye yönelik randomize çalýþmaya genel anestezi altýnda opere olacak iki yüz Amerikan Anesteziyologlar Derneði (ASA) skoru I, II ve III olan hastalar alýndý. Hastalarýn yaþý, boyu, vücut aðýrlýðý, vücut kitle indeksi, boyun çevresi, aðýz tam açýkken interinsizör mesafesi, sternomental ve tiromental mesafe, mandibular uzunluk, boyun uzunluðu, üst dudak ýsýrma testi, STOP-BANG skoru, mallampati ve Cormack Lehane derecesi notlarý kaydedildi. Ýlk olarak bulmak istediðimiz zor hava yolunun bir göstergesi olarak STOP-BANG anketinin kullanýlabilirliðini tespit etmektir. Zor hava yolunu diðer parametrelerle karþýlaþtýrmak ikincil hedefimizdi. Hastalar zor ve kolay yüz maskesi ventilasyonu ile zor ve kolay entübasyon olarak iki gruba ayrýldý. Veriler bir SPSS istatistik 16.0 programý kullanýlarak analiz edildi. Ýstatistiksel analiz Ki-kare ve Spearman korelasyon analizi testi kullanýlarak yapýldý.
BULGULAR: Ýki yüz hastadan 45’inin entübasyonda, yetmiþ üçünün ise maske ventilasyonunda zorluk görüldü. Zor hava yolu ile yüksek STOP-BANG skoru arasýnda orta derecede pozitif korelasyon vardý (p<0.05). Ayrýca anormal diþ yapýsý, büyük kafa çevresi, büyük boyun çevresi, mallam-pati, Cormack Lehane sýnýflandýrmasý zor hava yolu ile anlamlý pozitif korelasyon gösterdi (p<0.05).
TARTIÞMA: Çalýþmamýzda, STOP-BANG anketinin zor hava yolunu tahmin etmede önemli olduðu görülmüþtür ve bu test diðer zor hava yolu parametreleri gibi kullanýlabilir olduðu tespit edilmiþtir.

BACKGROUND: The primary objective of this study was to evaluate the use of STOP-BANG questionnaire in prediction of difficult airway. The secondary aim of this study is to evaluate the correlation of the questionnaire and other difficult airway determinant tests in predicting difficult airway.
METHODS: Two hundred American Society of Anesthesiologists’ Status I, II, and III patients under general anesthesia were enrolled in this prospective randomized study. Patients’ age, height, body weight, body mass index, neck circumference, inter-incisor distance when the mouth is fully open, sternomental and thyromental distance, mandibular length, neck length, biting the upper lip, STOP-BANG score, and Mallampati and Cormack–Lehane (C–L) grades were recorded. The first thing we want to find is to determine the usability of the STOP-BANG questionnaire as an indicator of the difficult airway. Comparing difficult airway with the other parameters was secondary objectives. The patients were divided into two groups as difficult and easy intubation with difficult and easy facial mask ventilation. The data were analyzed using an SPSS statistics 16.0 program. Statistical analysis was performed using, Chi-square and Spearman correlation analysis test.
RESULTS: Forty-five out of 200 patients had difficulty in intubation and 73 out of them had difficulty in mask ventilation. Between difficult airway and high STOP-BANG score was a moderate positive correlation (p<0.05). Furthermore, unnatural dental status, greater head circumference, greater neck circumference, Mallampati, and C–L classification were significantly positive correlated with a difficult airway (p<0.05).
CONCLUSION: In our study, the STOP-BANG questionnaire was found to be important in predicting the difficult airway and this test was found to be usable like other difficult airway parameters.

AMAÇ: Fournier gangreni, genital ve perineal bölgenin hýzla ilerleyen ve yaþamý tehdit eden nekrotizan fasiitidir. Fournier gangreni ile ilgili deneyimlerimizi paylaþmak ve klinik verilerin tam kan sayýmý parametreleri, enflamasyon hücreleri ve sistemik enflamasyon belirteçleri ile iliþkisini analiz etmek. GEREÇ VE YÖNTEM: Fournier gangreni tanýsý ile Ocak 2016–Aralýk 2020 arasýnda takip edilen ve tedavi edilen yetiþkin hastalarýn dijital týbbi kayýt-larý geriye dönük olarak analiz edildi. Veriler yaþ, cinsiyet, toplam hastanede kalýþ süresi, predispozan faktörler, etiyolojik faktörler, toplam debridman sayýsý, cerrahi iþlemler ve antibiyotik olarak belirlendi. Hastaneye yatýþýn ilk günü ile debridman sonrasý birinci ve yedinci günlerde ölçülen serum glikoz düzeyleri, tam kan sayým parametresi düzeyleri, serum inflamasyon göstergeleri ve C-reaktif protein düzeyleri ölçüldü.
BULGULAR: Yaþ ortalamasý 56.42 (22–86) yýl olan 36 erkek hasta alýndý. En yaygýn predispozan faktör diabetes mellitusdu (n=13; %36.1). En sýk görülen etiyolojik neden skrotal apseydi (n=19; %52.8). Debridman öncesi, debridman sonrasý birinci ve yedinci günlerde WBC sayýsýnda, nötrofil seviyesinde, NLR deðerinde ve CRP seviyesinde istatistiksel olarak anlamlý azalma saptandý (p<0.05). Ýlk baþvuru anýndaki debridman sayýsý ile yaþ, NLO, PLO ve CRP deðerleri arasýnda pozitif korelasyon vardý (p<0.05).
TARTIÞMA: Ürogenital bölge enfeksiyonlarý, Fournier gangreninin temel etiyolojik kökenidir. Nadir bir ürolojik acil durum olan Fournier gangreninde klinik verilerde ve kan sayýmý parametrelerinde önemli deðiþiklikler gözlendi.

BACKGROUND: Fournier’s gangrene (FG) is rapidly progressing and life-threatening necrotizing fasciitis of genital and perineal regions. The aim of the study was to share our experience with FG and to analyze the relationship of clinical data with whole blood count parameters, inflammation cells, and systemic inflammation markers.
METHODS: The digital medical records of the adult patients followed-up and treated with diagnosis of FG between January 2016 to December 2020 were retrospectively analyzed. Data were as age, gender, total length of hospital stay, predisposing factors, etiological factors, total number of debridement’s, surgical procedures, and antibiotherapy were collected. Serum glucose levels, complete blood count parameter levels, serum inflammation indicators and C-reactive protein (CRP) levels measured at the initial day of hospital admission, post-debridement 1st and 7th days were measured.
RESULTS: Thirty-six male patients were included, with a mean age of 56.42 (22–86) years. The most common predisposing factor was diabetes mellitus (n=13; 36.1%). The most frequently seen etiological cause was scrotal abscess (n=19; 52.8%). A statistically significant decrease was found in White blood cell count, neutrophil level, neutrophil-to-lymphocyte ratio (NLR) value and CRP level measured before debridement, post-debridement 1st and 7th days (p<0.05). There was a positive correlation between the number of debridement’s and age, NLR, platelet-to-lymphocyte ratio, and CRP values at the initial admission time (p<0.05).
CONCLUSION: The infections of urogenital region are the essential etiological origin of FG. As a rare urological emergency, significant changes were observed in clinical data and blood count parameters during the course of FG.

AMAÇ: Ciddi travmatik yaralanmalar çocuk yoðun bakým hasta popülasyonunun önemli bir parçasý olduðu gibi mortalite ve morbiditenin de önemli nedenleri arasýndadýr. Çocuk yoðun bakým unitesinde mortalite riskinin deðerlendirilmesi, hasta bazlý tedavi kararlarýnýn alýnmasý ve kalite deðerlendirmesi açýsýndan önemli bir konudur. BIG skor (Baz açýðý+[2.5 x INR] + [15- GKS]) ve Pediatrik Travma Skoru pediatrik travma merkezlerinde travma ciddiyetinin deðerlendirilmesi amacýyla kullanýlmaktadýr. Bu çalýþmadaki amacýmýz, pediatrik yüksek enerjili travma olgularýnda travma þiddeti skorlarý, pediatrik mortalite risk skoru (PRISM – 3) ve yatýþ laboratuvar verilerinin mortaliteyi belirlemedeki rollerini tespit etmektir.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma 2018–2020 yýllarý arasýnda 3. basamak bir çocuk yoðun bakým ünitesinde yürütüldü. Yüksek enerjili çoklu travma olgularý çalýþmaya dahil edildi. Yeni geliþen mental ya da motor bozukluklar, posttravmatik epilepsi, trakeostomi ihtiyacý ve ekstremite kaybý olmasý morbidite olarak tanýmlandý. Pediatrik travma skoru, BIG skor, PRISM – 3 skoru ve baþvuru laboratuvar incelemeleri mortalite ve morbidite tahmininde kullanýldý.
BULGULAR: Ortanca yaþlarý 66 (25–134) ay olan 155 olgu çalýþmaya dahil edildi. Altmýþ (%45.2) olgu yüksekten düþme nedeniyle 85 (%54.8) olgu ise motorlu taþýt kazasý nedeniyle yatýrýlmýþtý. On üç (%8.5) olguda taburculukta morbiditeler tespit edilirken beþ (%3,2) olgu yatýþ sýrasýnda hayatýný kaybetti. Lojistik regresyon analizinde BIG skoru (p=0.01), pediatrik travma skoru (p=0.003), pediatrik mortalite risk skoru (p=0.02), yatýþ D-dimer deðeri (p=0.01) ve yatýþ albumin deðeri (p=0.001) mortaliteyle anlamlý olarak iliþkili bulundu. ROC analizinde ise BIG skoru (kestirim deðeri >21.5, AUC: 0.984 %95 GA: 0.943–0.988), pediatrik mortalite risk skoru (kestirim deðeri >18, AUC: 0.997 %95 GA: 0.970–1), pediatrik travma skoru (kestirim deðeri ≤3, AUC: 0.969 &95 GA: 0.928–0.990,) baþvuru albumin düzeyi (kestirim deðeri ≤3 g/dL, AUC: 0.987 %95 CI: 0.953–0.998) ve baþvuru D-dimer düzeylerinin (kestirim deðeri >13100 mcg/L, AUC: 0.776 %95 GA: 0.689–0.849) mortalite açýsýnda yüksek düzeyde prediktif olduðu görüldü.
TARTIÞMA: BIG skoru, pediatrik yüksek enerjili travma hastalarýnda güçlü bir mortalite ve morbidite prediktörü olarak görünmektedir. Pediatrik mortalite risk skoru, BIG skoruyla benzer prediktif deðere sahip görünse de çok daha erken ve hýzla deðerlendirilebilir olmasý nedeniyle BIG skoru daha kullanýþlý ve güçlü bir prediktör olarak ön plana geçmektedir.

BACKGROUND: Severe traumatic injuries not only constitute an important population of pediatric intensive care unit (PICU) but they also play a major role in mortality and morbidity. Mortality risk assessment of traumatic injuries in the PICU is a delicate issue as it influences the treatment decisions. BIG score (Base Deficit +[2.5 × INR] + [15-GCS]) and the Pediatric Trauma Score (PTS) are utilized in pediatric trauma centers for the assessment of trauma severity. In this research, we aimed to elucidate the predictivity of trauma severity scores, the PRISM-3 (pediatric risk of mortality), and admission laboratory parameters in pediatric patients with high-energy traumas.
METHODS: Children who had been exposed to high-energy polytraumas between 2018 and 2020 and treated in a tertiary care PICU were included in this retrospective analysis. Newly developed mental or motor disabilities, post-traumatic acquired epilepsy, requirement for tracheostomy, and/or extremity loss at PICU discharge were defined as morbidity. The PTS, the BIG score, PRISM-3 score, and admission laboratory parameters were utilized for mortality and morbidity prediction.
RESULTS: A total of 155 patients were included in the study. The median age of the participants were 66 months (25–134). The origin of trauma was fall from height in 45.2% (n=70) of the subjects and traffic accident 54.8% (n=85) of the cases. New morbidities had occurred in 8.7% (n=13) and 3.2% (n=5) of the patients deceased in the ICU. The results of logistic regression analysis indicated that BIG score (p=0.01), PTS (p=0.003), PRISM-3 (p=0.02), admission D-dimer (p=0.01), and albumin levels (p=0.001) were significantly associated with mortality. The receiver operating characteristics curve analysis denoted that BIG score (cutoff >21.5, area under the curve [AUC]: 0.984 95% CI: 0.943–0.988), PRISM-3 score (cutoff >18, AUC: 0.997 95% CI: 0.970–1), the PTS (cutoff ≤3, AUC: 0.969 95% CI: 0.928–0.990), admission albumin level (cutoff ≤3 g/dL, AUC: 0.987 95% CI: 0.953–0.998), and D-dimer level (cutoff >13,100 mcg/L, AUC: 0.776 95% CI: 0.689–0.849) all had high predictive values for mortality.
CONCLUSION: Regarding the results of this research, one can conclude that BIG score is a strong predictor of mortality and morbidity in high-energy pediatric traumas. Although PRISM-3 score has a similar predictive capability, the earlier and easier calculation as-sets of BIG score positions itself as a more useful and powerful predictor for mortality and morbidity in pediatric high-energy traumas.

AMAÇ: Akut tip A aort diseksiyonu (ATAAD) en ölümcül kardiyovasküler hastalýklardan biridir ve acil taný ve ameliyat gerektirir. Hastanýn klinik bulgularý, komplikasyonlarý ve hastalýðýn geçmiþi ölüm oranlarý ile yakýndan iliþkilidir. CASUS, kalp cerrahisi geçiren hastalarýn özel patofizyolojik durumlarý dikkate alýnarak hesaplanan ve ameliyat sonrasý sonuçlarý yüksek doðrulukla öngören bir skorlama sistemidir.
GEREÇ VE YÖNTEM: Kurumsal etik kurul (ID: 2021/7/496) onayý alýndýktan sonra 1 Ocak 2019–31 Aralýk 2020 tarihleri arasýnda hastanemizde acil cerrahi uygulanan 50 ATAAD hastasýnýn verileri deðerlendirildi. SOFA ve CASUS skorlarý hem acil servise baþvuru hem de YBÜ takibi süresince günlük laboratuvar ve nörolojik durumun en kötü deðerleri kullanýlarak hesaplandý. Bu skorlarýn ortalama ve toplam deðerleri ameliyat öncesi, ameliyat sonrasý ilk gün için kaydedildi ve kategorik veriler frekans ve yüzde olarak tanýmlandý. Baðýmsýz sürekli veri karþýlaþtýrmalarý için Mann-Whitney U testini ve kategorik veri karþýlaþtýrmasý için Pearson ki-kare veya Fisher kesin testini kullandýk. Sürekli veriler medyan ve çeyrekler arasý aralýklar (25–75) olarak sunuldu.
BULGULAR: Çalýþma 50 hastadan oluþuyordu, ölüm oraný %34 (n=17) idi. Toplam grupta hipertansiyon (HT) %72 (n=36), diabetes mellitus %24 (n=12), baþlangýç hemoglobin 12.5 g/dL (10.7–14.1, 25.–75.), kreatinin 1.09 mg/dL (0.85–1.33, 25.–75), bu hastalarýn %72’si (n=36) erkekti. CASUSortalama, SOFAortalama skoru hayatta kalan hastalara göre ölen hasta grubunda daha yüksekti (12.9 (9.5–13.8, 25.–75.), 3 (2–5, 25.–75.); 8 (6.1–9.2, 25.–75.), 2.6 (2–4.5, 25.–75.), p<0.001 sýrasýyla). CASUSortalama, model 1’de bir aylýk mortalite ile baðýmsýz olarak iliþkili bulundu (HR 1.25 (1.14–1.37) (p<0.001).
TARTIÞMA: Sonuç olarak, CASUSortalama’daki artýþ, bir aylýk mortalitenin temel prediktörüdür. CASUSortalama deðeri 8.3’ün üzerinde, hastalar ölüm dahil önemli istenmeyen olaylar açýsýndan daha dikkatli izlenmelidir.

BACKGROUND: Acute type A aortic dissection (ATAAD) is one of the most mortal cardiovascular diseases and requires urgent diagnosis and surgery. The patient’s clinical findings, complications, and patient’s history are closely related to mortality rates. Cardiac surgery score (CASUS) is a scoring system which is calculated by considering the special pathophysiological conditions of patients undergoing cardiac surgery and predicts post-operative results with high accuracy.
METHODS: Following the ethical approval from institutional ethics committee (ID: 2021/7/496), the data of consecutive 50 ATAAD patients who underwent emergent surgery in our hospital between January 1, 2019, and December 31, 2020, were evaluated. The Se-quential Organ Failure Assessment and CASUS scores were calculated using the worst values of the daily laboratory and neurological status for both in admission to emergency department and during intensive care unit (ICU) follow-up period. The average and the total values of these scores were recorded for pre-operative, post-operative 1st day, and for the categorical data were defined as frequency and percentage. We used the Mann–Whitney U test for the independent continuous data comparisons and Pearson Chi-Square or Fisher ex-act test for categorical data comparison whole ICU period. Continuous data were presented as median and interquartile ranges (25–75th).
RESULTS: The study comprised 50 patients, the rate of death was 34% (n=17). In total group, there were hypertension 72% (n=36), diabetes mellitus 24% (n=12), initial hemoglobin 12.5 g/dL (10.7–14.1, 25–75th), creatinine 1.09 mg/dL (0.85–1.33, 25–75th), and 72% (n=36) of these patients were male. The CASUSmean and SOFAmean scores were higher in the death-group when compared with the group who survived (12.9 [9.5–13.8, 25–75th], 3 [2–5, 25–75th]; 8 [6.1–9.2, 25–75th], 2.6 (2–4.5, 25–75th], p<0.001, respectively]. CASUSmean was independently associated with the 1-month mortality in model 1 (HR 1.25 [1.14–1.37] (p<0.001).
CONCLUSION: According to our results increase in CASUS mean was the main predictor of 1 month mortality. When CASUS mean exceeds 8.3 the patient should be followed up more carefully for major adverse events including death.

AMAÇ: Akut kolesistit nedeniyle baþvuran hastalarda yatýþ anýnda yapýlan (erken kolesisitektomi) ile gecikmiþ kolesistektomi arasýndaki komplikasyon oranlarýný karþýlaþtýrmak, ayný zamanda kolesistit þiddetinin kolesistektomi zamanlamasýna etkisi olup olmadýðýný incelemeyi amaçladýk. GEREÇ VE YÖNTEM: Çalýþma geriye dönük olarak planlandý ve hastanemiz etik kurul onayý alýndý. Üçüncü basamak hastanemize akut kolesistit ile baþvuran hastalarýn bilgileri hastane veri tabanýndan tarandý. Hastalar akut kolesistit nedeniyle acile baþvuran, erken ve geç dönem kolesistektomi yapýlan gruplar olarak ikiye ayrýldý. Akut kolesistit þiddetini belirlemek için Tokyo 2018 akut kolesistit rehberi kullanýldý. Hastalarýn ameliyat öncesi-sonrasý verileri incelendi ve komplikasyonlarý deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilme kriterlerini karþýlayan 158 hastanýn verileri geriye dönük olarak incelendi. Geç dönem kolesistektomi ile karþýlaþtýrdýðýmýzda, erken dönem kolesistektomi yaptýðýmýz hastalarda komplikasyon oranlarý artmýþtýr (sýrasýyla %8.1, %32.2 p<0.001). Tokyo 2018 rehberine göre akut kolesistit þiddeti Tokyo 1, 2 ve 3 olarak gruplandýrýldýðýnda Tokyo 1 olan hastalarda erken dönemde, geç dönem kolesistektomi yapýlanlara göre daha fazla komplikasyon gözledi (sýrasýyla, %22.6, %4.2, p=0.004). Komplikasyonlar incelendiðinde özellikle pulmoner emboli, pnömoni, intra abdominal apse geliþimi, sepsis ve yara yeri enfeksiyonunun erken dönem ameliyat edilenlerde anlamlý olarak daha yüksek olduðu görülmüþtür. Komplikasyonlar üzerine etkili olan etkenler incelendiðinde Tokyo skorunun 2 ve üzeri olmasý (OR: 4.161), kreatin yüksekliði (OR: 5.496) ve ek hastalýk varlýðý (OR: 4.238) komplikasyon geliþim riskini arttýrmaktadýr.
TARTIÞMA: Tokyo 2 ve üzeri hastalar, Tokyo 1 olan hastalarla karþýlatýrýldýðýnda kolesistektomi sonrasý daha fazla komplikasyon geliþmektedir. Erken dönem ameliyat edilen hastalarda ise Tokyo 1 kolesistitli hastalarda daha fazla komplikasyon geliþtiði görülmüþtür. Kolesitektomi zamanlamasýný belirlemede akut kolesistit þiddetinin etkisini belirlemek için ileri çalýþmalara ihtiyaç vardir.

BACKGROUND: In our study, we aimed to compare the complication rates of patients presenting with acute cholecystitis and undergoing surgery at the time of hospitalization (early cholecystectomy) and delayed cholecystectomy and also to examine whether the severity of cholecystitis has an effect on the timing of cholecystectomy.
METHODS: The study was planned retrospectively and the approval of the ethics committee of our hospital was obtained. The patient files of the patients who were admitted to our tertiary hospital with acute cholecystitis were accessed through the hospital archive system. The patients were divided into two groups, those who were admitted to the emergency department for acute chole-cystitis and who underwent early cholecystectomy and delayed cholecystectomy. The Tokyo 2018 acute cholecystitis guideline was used to determine the severity of acute cholecystitis. Pre-operative and post-operative data of the patients were examined and their complications were evaluated.
RESULTS: The data of 158 patients who met the inclusion criteria were retrospectively analyzed. Compared with delayed chole-cystectomy, complication rates increased in patients who underwent early cholecystectomy (8.1% and 32.2%, respectively, p<0.001). According to the Tokyo 2018 guideline, patients with acute cholecystitis were grouped as Tokyo 1, 2, and 3; and of Tokyo 1 patients, more complications were observed in those who underwent early cholecystectomy (22.6% and 4.2%, respectively, p=0.004). When the complications were examined, it was observed that pulmonary embolism, pneumonia, intra-abdominal abscess development, sepsis, and wound infection were significantly higher in those who were operated early. When the factors affecting complications are examined, having a Tokyo score of 2 and above (OR: 4.161), high creatinine levels (OR: 5.496), and presence of additional disease (OR: 4.238) increase the risk of developing complications.
CONCLUSION: More complications occur after cholecystectomy in patients with Tokyo 2 and above, when compared with patients with Tokyo 1. It was observed that more complications developed in patients with Tokyo 1 cholecystitis who were operated in the early period. Further studies are needed to determine the effect of acute cholecystitis severity in determining the timing of cholecystectomy.

AMAÇ: Ultrason eþliðinde venöz eriþim, acil týpta önemli bir beceridir. Ticari ultrason fantomlarýnýn fahiþ fiyatlarý, asistanlarý yeterince eðitme yeteneðini sýnýrlamaktadýr. Týp eðitiminde basit ev yapýmý fantomlarýn klinik yararýný araþtýrdýk.
GEREÇ VE YÖNTEM: Acil asistanlarýnýn yarýsý, toplam 14 penrose drenli, iki basit ev yapýmý ultrason fantomu kullanýlarak yapýlan bir eðitim kursu öncesi ve diðer yarýsý kurs sonrasýnda vasküler giriþim yapmýþtýr, 18 acil týp asistanýnýn her biri hastalar üzerinde ultrason eþliðinde 10 IV giriþimde bulunmuþtur. Hastalar üzerinde IV giriþimlerinin güven ve baþarý oranlarýný karþýlaþtýran eðitim öncesi ve sonrasý anketleri kullanarak ileriye yönelik bir fizibilite çalýþmasý yaptýk.
BULGULAR: Asistanlar, ultrason eþliðinde baþarýlý periferik venöz kanülasyonlarýnda ilk beþ denemede ortalama %47.8’den son 5 denemede %71.1’e kadar bir iyileþme gösterdiler. Ýlk ile beþinci denemelerden veya altý ila onuncu giriþimlerden hiçbir yarar saptanmadý, bu da erken dönem deneyimden minimum fayda saðladýðýný göstermektedir. Asistanlar, hastalara ultrason eþliðinde venöz kanülasyon uygulanmasý, doðru probu belirleme, kuvvet ve derinliði ayarlama, damarlarý kýsa ve uzun eksende görselleþtirme, arterleri damarlardan ayýrt etme ve fantom model üzerinde venöz kanülasyon gerçekleþtirmesi konusunda artan güven bildirdiler.
TARTIÞMA: Basit ev yapýmý ultrason fantomlarý uygun maliyetlidir, güveni artýrýr ve acil týp asistanlarýnýn ultrason eþliðinde venöz kanülasyonu yapma becerisini geliþtirir.

BACKGROUND: Ultrasound-guided vein cannulation is an essential skill in emergency medicine. Prohibitive costs of commercial ultrasound phantoms limit the ability to adequately train residents. We assess the clinical utility of homemade phantoms for medical education.
METHODS: Eighteen emergency medicine residents each performed 10 ultrasound-guided IV attempts on patients, half of the attempts before and half after a training course using two homemade ultrasound phantoms with 14 total Penrose drains. We conducted a prospective feasibility study using pre- and post-training surveys comparing confidence and success rates of IV cannulation attempts on patients.
RESULTS: Residents demonstrated an improvement in successful ultrasound-guided peripheral vein cannulations from an average of 47.8% during the first five attempts to 71.1% in the last five attempts. No benefit was noted from the first to the fifth attempts, nor from the six to the tenth attempts, suggesting minimal benefit from experience early on. Residents reported increased confidence in performing ultrasound-guided venous cannulation on patients, identifying the correct probe, adjusting gain and depth, visualizing veins in short and long axis, differentiating arteries from veins, and vein cannulation on a phantom model.
CONCLUSION: Homemade ultrasound phantoms are cost effective, increase confidence, and improve emergency medicine resi-dents’ ability to perform ultrasound-guided vein cannulation.

AMAÇ: Ýnvajinasyon, 6 ay ile 36 ay arasýnda en sýk görülen intestinal obstrüksiyon nedenidir. Hastalarýn %75–90’ýnda tanýmlanmýþ bir etiyoloji yoktur. Tüm invajinasyonlarýn %5–16’sýnda tekrarlayan invajinasyon görülür ve bu hasta grubunda tedavi stratejisi tartýþmalýdýr. Tekrarlayan invajinasyonun tedavisi, herhangi bir lead point bulunamadýðýnda zorlu bir problemdir.
GEREÇ VE YÖNTEM: Tekrarlayan invajinasyondaki 10 yýllýk deneyimimizi gözden geçirmeyi ve herhangi lead point olmayan tekrarlayan invajinasyon olgularý için yeni bir ameliyat tekniði tanýmlamayý amaçladýk.
BULGULAR: 2007–2017 yýllarý arasýnda çocuk cerrahisi kliniðimizde tekrarlayan invajinasyonlu hastalarýn verilerini geriye dönük olarak inceledik. Tüm hastalara ultrason eþliðinde hidrostatik redüksiyon (UGHR) uygulandý. Akut karýn ve tam baðýrsak týkanýklýðý bulgularý olan veya taný amaçlý iki baþarýsýz UGHR giriþimi olan hastalara, bulgulara ve yaþýna göre patolojik bir lead pointten þüpheleniliyorsa cerrahi uygulandý. Cerrahýn tercihi ve tecrübesine göre laparoskopi veya laparotomi uygulandý. Toplam 87 UGHR gerçekleþtirildi. Otuz üç hasta tekrarlayan invajinasyon nedeniyle kliniðimize baþvurdu. Yaþ ortalamasý 12.75±14.14 (6–84) ay olup, 19’u erkek, 14’ü kadýndý. Karýn aðrýsý, ajitasyon ve kusma yaygýn semptomlardý. Otuz üç hastanýn tamamýna en az iki farklý durumda UGHR uygulandý. Birinci ve ikinci UGHR tedavileri arasýndaki süre 42.6±186.19 (0–899) gündü. Ýkinci UGHR’nin baþarý oraný 33 hastadan 27’si (%81.8) idi. Tekrarlayan invajinasyonlarý olan bir hastaya laparoskopi yardýmlý ileal katlama ve çekum duvarýna fiksasyon uygulandý. Önce apendektomi, ardýndan 4/0 poliglaktin sütürlerle çekal fiksasyon ile ileal katlama yapýldý. Dikiþler, komþu terminal ileal anslarýn serozal tabakalarý ile çekal duvar arasýna yerleþtirildi.
TARTIÞMA: Tedaviye dirençli çoklu tekrarlayan invajinasyonlarý olan hastalarda kalýcý çözümler bulmaya çalýþýlmalýdýr. Lead pointin cerrahi olarak çýkarýlmasý, tekrarlayan invajinasyonu önlemeye yardýmcý olacaktýr. Yineleyen hastalarda bile ultrason eþliðinde hidrostatik redüksiyon ile tatmin edici sonuçlar elde edilebilir. Laparoskopi, tekrarlayan invajinasyonun tanýsýnda, lead point saptanmasýnda ve tedavisinde yardýmcýdýr. Bu yeni ameliyat tekniði, herhangi bir lead point olmayan tekrarlayan invajinasyonlar için tatmin edici olabilir.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75–90% of patients. Recurrent intussusception occurs in 5–16% of all intussusceptions and the treatment strategy is controversial in this patient group. The treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence.
METHODS: We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points.
RESULTS: We, retrospectively, reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction (UGHR) was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or two failed attempts of UGHR for diagnos-tic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6–84) months, and 19 were male and 14 were female. Abdominal pain, agitation, and vomiting were common symptoms. UGHR was performed on all 33 patients on at least two different occasions. The time between the first and second UGHR treatments was 42.6±186.19 (0–899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on six patients. Laparoscopy-assisted ileal folding and fixation to the cecal wall was performed on one patient with recurrent intussusceptions. Appendectomy was performed first, and then, ileal folding with cecal fixation was performed using 4/0 polyglactin sutures. The sutures were placed between the serosal layers of the adjacent terminal ileal loops and the cecal wall.
CONCLUSION: Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by UGHR even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points, and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.

AMAÇ: Bu çalýþmada intravenöz traneksamik asidin açýk redüksiyon ve internal fiksasyon ile tedavi edilen pelvis-asetabulum kýrýklarýnda kan kaybý ve transfüzyon oranlarý üzerine etkisini araþtýrmak amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2017–Ocak 2019 tarihleri arasýnda pelvis-asetabulum kýrýðý nedeniyle açýk redüksiyon ve internal fiksasyon yapýlan hastalar bu çalýþmanýn hedef popülasyonunu oluþturdu. Dahil etme ve dýþlama kriterleri uygulandýktan sonra hastalar iki gruba ayrýldý: perioperatif olarak 15 mg/kg traneksamik asit verilenler (Grup 1) ve verilmeyenler (Grup 2). Yaþ, cinsiyet, yaralanma mekanizmasý, kýrýk tipi, ek yaralanmalarýn varlýðý veya yokluðu, yatýþ ve ameliyat arasýndaki zaman aralýðý, insizyoni, ameliyat öncesi ve sonrasý hemoglobin seviyeleri, ameliyat sýrasýnda tahmini kan kaybý (EBL), transfüze edilen kan ünitesi sayýsý verileri ve komplikasyonlar kaydedildi. Bu parametreler açýsýndan iki grup karþýlaþtýrýldý. BULGULAR: Çalýþma grubu 58 hastayý içeriyordu. Grup 1’de 30 hasta, Grup 2’de 28 hasta vardý. Analizimiz, Grup 2’de transfüzyon yapýlan kan ünitesi sayýsýnýn Grup 1’e göre anlamlý olarak daha yüksek olduðunu ortaya koydu (p=0.016). Bununla birlikte, intraoperatif EBL, ameliyat öncesi ve sonrasý hemoglobin düzeyleri ve baþvuru ile cerrahi arasýndaki zaman aralýðý açýsýndan iki grup arasýnda anlamlý bir fark yoktu.
TARTIÞMA: Ýntravenöz traneksamik asit uygulamasý, açýk redüksiyon ve internal fiksasyon ile tedavi edilen pelvis-asetabulum kýrýklý hastalarda kan transfüzyonu ihtiyacýný azaltmaktadýr. Bu yaklaþým, kan nakline baðlý olasý komplikasyonlarý önleyebilir.

BACKGROUND: This study aimed to investigate intravenous tranexamic acid’s (TA) effect on blood loss and transfusion ratios in pelvis-acetabulum fractures treated with open reduction and internal fixation.
METHODS: Patients who underwent open reduction and internal fixation due to pelvis-acetabulum fractures between January 2017 and January 2019 constituted this study’s target population. After applying inclusion and exclusion criteria, patients were divided into two groups: Those who were perioperatively given 15 mg/kg TA (i.e., Group 1) and those who were not (i.e., Group 2). Data including age, gender, mechanism of injury, fracture type, presence or absence of additional injuries, the time interval between admission and surgery, incision site, pre-operative and post-operative hemoglobin levels, intraoperative estimated blood loss (EBL), number of blood units transfused, and complications were recorded. Two groups were compared regarding these parameters.
RESULTS: The study cohort included 58 patients. There were 30 patients in Group 1 and 28 patients in Group 2. Our analysis re-vealed that the number of blood units transfused was significantly higher in Group 2 than Group 1 (p=0.016). However, there was no significant difference between the two groups regarding intraoperative EBL, pre-operative and post-operative hemoglobin levels, and the time interval between admission and surgery.
CONCLUSION: Administration of intravenous TA reduces blood transfusion requirement in patients with pelvis-acetabulum frac-tures treated with open reduction and internal fixation. This approach can prevent potential blood transfusion-related complications.

AMAÇ: Ýntertrokanterik kýrýklarýn AO/OTA 31-A2.2/A2.3 kýrýk tiplerinde kullanýlan Verbrugge minimal invaziv tekniðinin klinik ve radyolojik sonuç-larýný, traksiyon masasýnda yapýlan kapalý redüksiyon tekniði ile kýyaslamaktýr.
GEREÇ VE YÖNTEM: Çalýþma geriye dönük olarak dizayn edildi. 2017–2020 yýllarý arasýnda kliniðimize intertrokanterik kýrýk nedeniyle baþvuran 671 hasta deðerlendirildi. Bu hastalardan; 70 yaþ üzeri olan, bir yýldan uzun takipleri mevcut olan, kýrýk tipi AO/OTA 31-A2.2/A2.3 olan ve tarafýmýzca intramedüller çivileme uygulananlar çalýþmaya dahil edildi. Bu kriterleri saðlamayan, patolojik kýrýðý olan, açýk kýrýðý olan, geçirilmiþ kalça operasyonu hikayesi olan hastalar çalýþma dýþý býrakýldý. Toplam 177 olgunun bu çalýþmaya uygun olduðu tespit edildi. Hastalar; operasyonda Verbrugge minimal invaziv tekniði ile redüksiyon saðlananlar (Verbrugge reduction group, VRG) ve traksiyon masasý ile kapalý redüksiyon saðlananlar (convantionel reduction group, CRG) olarak iki gruba ayrýldý. Radyolojik olarak redüksiyon kalitesi modifiye Chang yöntemi ile deðerlendirildi, varus redüksiyon oranlarý karþýlaþtýrýldý. Klinik sonuçlarda ise tam yük ile mobilizasyon zamaný, komplikasyon oranlarý, Harris Kalça Skoru (HHS) karþýlaþtýrýldý. BULGULAR: Verbrugge minimal invaziv tekniði ile redüksiyon saðlanan olgularda, traksiyon masasýnda redüksiyon saðlanan gruba göre varus mal-redüksiyonunun daha az görüldüðü, daha baþarýlý redüksiyon kalitesi elde edildiði, hastalarýn daha erken dönemde mobilize edilebildiði ve HHS’nin daha yüksek olduðu tespit edildi. Ameliyat süresi ve komplikasyonlar arasýnda anlamlý fark tespit edilmedi.
TARTIÞMA: Verbrugge yönteminin, traksiyon masasi ile kapalý redüksiyonun yeterli görülmediði tüm AO/OTA 31-A2.2 /A2.3 intertrokanterik fe-mur kýrýklarýnda kullanýlabilecek; kýrýk redüksiyonunun kalitesini arttýran ve ameliyat boyunca korunmasýný saðlayan, komplikasyon oranlarý açýsýndan konvansiyonel redüksiyon yöntemi ile benzer, efektif bir teknik olduðu düþünülmektedir.

BACKGROUND: The aim of the study was to compare the clinical and radiological results of the Verbrugge minimally invasive technique used in AO/OTA 31–A2.2/A2.3 intertrochanteric fracture types with those of the closed reduction technique performed on a traction table.
METHODS: A retrospective evaluation was made of 671 patients treated in our clinic for intertrochanteric fracture between 2017 and 2020. The patients included in the study were those aged >70 years, applied with intramedullary nailing for an AO/OTA 31–A2.2/A2.3 fracture type, with >1 year of follow-up. Patients were excluded if they did not meet these criteria, if they had a pathological fracture, an open fracture, or a history of hip surgery. A total of 177 patients were accepted for analysis in the study. The patients were separated into two groups as those where reduction was provided with the Verbrugge minimal invasive technique Verbrugge reduction group (VRG) and those with closed reduction applied on a traction table Conventional reduction group (CRG). The reduction quality was evaluated radiologically with the modified Chang method and the varus reduction rates were compared. The clinical results of the groups were compared in respect of time to full weight-bearing mobilization, complication rates, and Harris Hip Scores (HHS).
RESULTS: Varus malreduction was seen less often in the VRG compared to the CRG, the reduction quality was more successful, the patients could be mobilized earlier and the HHSs were better. No significant difference was determined in terms of operating time and complications.
CONCLUSION: The Verbrugge method can be used in all AO/OTA 31–A2.2/A2.3 intertrochanteric fractures where closed re-duction applied on a traction table is not sufficient. This method can be considered to be an effective technique that increases the quality of the fracture reduction, provides protection throughout the operation, and has similar complication rates to those of the conventional reduction method.

AMAÇ: Bu çalýþmanýn amacý, 24 Ocak 2020 Elazýð/Türkiye depremine baðlý kas-iskelet yaralanmalarý ve tedavi protokollerini deðerlendirmektir. GEREÇ VE YÖNTEM: Ýnönü Üniversitesi Týp Fakültesi Hastanesi, Elazýð Eðitim ve Araþtýrma Hastanesi ve Malatya Eðitim ve Araþtýrma Hastanesi acil servislerine depremden sonraki ilk 48 saat içerisinde baþvuran hastalarýn verileri geriye dönük olarak deðerlendirildi. Yaþ, cinsiyet, yumuþak doku yaralanmalarý ve bölgeleri, kýrýk bölgeleri ve tipleri, kýrýk etiyolojisi ve tedavi yöntemleri deðerlendirildi.
BULGULAR: Ýki yüz kýrk yedi hasta deðerlendirildi. Yüz on sekizi kadýn, 139’u erkekti. Yirmi dört (%9.7) pediatrik hasta vardý. Ortalama yaþ 37.3 (1–92) yýldý. Yaralanmalarýn çoðu basit yumuþak doku yaralanmalarýydý. Seksen altý hastada 103 kýrýk vardý. Otuz sekiz hastanýn kýrýðý cerrahi olarak tedavi edildi.
TARTIÞMA: Her büyük afet, geçmiþe dönük çalýþmalarý hakeder, böylece acil saðlýk hizmetlerinin tüm seviyelerini nasýl iyileþtireceðimizi öðrenebiliriz. Depremzedelerin büyük bir kýsmýnda burkulma, yýrtýlma veya kontüzyon gibi sadece basit yumuþak doku yaralanmalarý vardý. Depremin getirdiði yýkýmla dolaylý olarak ilgili nedenlerle birçok hasta yaralandý. Depremin neden olduðu panik, getirdiði yýkýmdan daha fazla yaralanmaya neden oldu.

BACKGROUND: The aim of this study is to evaluate the musculoskeletal injuries related with 24 January 2020 Elazig/Türkiye earthquake and their treatment protocols.
METHODS: Data of patients applied to Ýnönü University Medical Faculty Hospital, Elazýð Training and Research Hospital and Malatya Training and Research Hospital emergency departments within 48 h after the earthquake, were evaluated retrospectively. Age, gender, soft tissue injuries and sites, fracture sites and types, fracture etiology, and treatment methods were evaluated.
RESULTS: 247 patients were evaluated. 118 were women and 139 were men. There were 24 (9.7%) pediatric patients. Mean age was 37.3 (1–92) years. Waist majority of injuries were simple soft-tissue injuries. There were 103 fractures in 86 patients. Thirty-eight patients’ fractures were treated surgically.
CONCLUSION: Every major disaster warrants retrospective studies so we can learn how to improve all levels of Emergency Medical Services. Great proportion of Elazýg earthquake victims had only simple soft tissue injuries such as sprain, laceration, or contusion. Many patients were injured due to reasons indirectly related to the destruction brought by the earthquake. Panic caused by the earth-quake caused more injury than the destruction it brought.

AMAÇ: Ekstansiyon Tip II suprakondiler humerus kýrýklarýn optimal tedavi yöntemi seçimi üzerindeki tartýþmalar sürmektedir. Çoðu hasta kapalý redüksiyon ve alçýlama ile baþarýlý þekilde tedavi edilse de bir grup hastanýn baþlangýçta elde edilen redüksiyonu alçýda kaldýðý süre boyunca kaybedilir. Bu çalýþmanýn amacý redüksiyon kaybýna neden olan risk faktörlerinin tespitidir.
GEREÇ VE YÖNTEM: 2012–2018 yýllarý arasýnda kapalý redüksiyon ve alçý tespiti ile tedavi ettiðimiz 103 Tip II ekstansiyon suprakondiler humerus kýrýðý hastasýnýn verilerini geriye dönük olarak inceledik. Redüksiyon kaybýna neden olan hasta deðiþkenleri, kýrýk oblisitesi ve metafiz parçalanmasý gibi kýrýk karakter özellikleri, tespit yöntemi ve alçýya ait parametreleri deðerlendirdik.
BULGULAR: Ýncelenen 103 hastanýn 62’si erkek, 41’i kýz yaþ ortalamasý ise 5.4±2.5 (aralýk, 2–11.6) yýl idi. Seksen bir hasta (%79) kapalý redüksiyon ve alçý tespiti ile baþarýlý þekilde tedavi edilirken, 22 (%21) hastada redüksiyon kaybý izlendi. Sagittal planda high oblique kýrýklarýn redüksiyon kaybý oraný transvers olanlara göre 3.17 kat yüksekti (%95 CI: 0.99–10.03, p<0.05). Metafizer parçalanma olan kýrýklarda redüksiyon kaybý riski 6.5 kat yüksek bulundu (%95 CI: 1.6–26.5, p<0.01). Redüksiyon kaybý ile Gartland subtipi, cinsiyet, yaþ, baþlangýçtaki rotasyon varlýðý, alçý açýsý ve yumuþak doku/alçý iç çap geniþliði oranlarý arasýnda anlamlý iliþki bulunmadý.
TARTIÞMA: Çalýþma grubumuzdan elde ettiðimiz sonuçlara göre ekstansiyon Tip II kýrýklar kapalý redüksiyon ve alçýlama ile %79 oranýnda baþarýlý þekilde tedavi edilebilir. Sagittal plan oblisitesi ve metafiz parçalanmasý redüksiyon kaybý için Gartland subtipinden baðýmsýz risk faktörleridir.

BACKGROUND: Controversies continue about the optimal treatment method for extension Type II supracondylar humerus fractures (SCHFs). Although most patients are successfully treated with closed reduction and plaster casting, in some patients, the reduction initially obtained is lost during the time in the plaster cast. The aim of this study was to determine the risk factors causing reduction loss.
METHODS: A retrospective examination was made of the data of 103 patients with Type II extension SCHF treated with closed reduction and plaster cast fixation between 2012 and 2018. Reduction loss was evaluated in respect of patient variables, fracture char-acteristics as obliquity and metaphyseal fragmentation, fixation method, and plaster cast parameters.
RESULTS: The 103 patients evaluated comprised 62 males and 41 females with a mean age of 5.4±2.5 years (2–11.6 years). Successful treatment was achieved with closed reduction and plaster cast fixation in 81 (79%) patients and reduction loss was observed in 22 (21%) patients. The reduction loss of fractures showing high oblique in the sagittal plane was 3.17-fold higher than low sagittal oblique fractures (95% CI: 0.99–10.03, p<0.05). The risk of reduction loss in fractures with metaphyseal fragmentation was found to be 6.5-fold higher (95% CI: 1.6–26.5, p<0.01). No statistically significant relationship was determined between reduction loss and Gartland subtype, age, gender, the presence of rotation initially, plaster cast angle, and the soft-tissue/inner cast width ratio.
CONCLUSION: According to our study group, 79% of extension Type II fractures can be successfully treated with closed reduction and plaster casting. Sagittal plane obliquity and metaphyseal fragmentation are risk factors for reduction loss independent of Gartland subtype.

AMAÇ: Ýnatçý kýrýk kaynamamasý tedavisi zor, birden çok cerrahi gerektirebilen, bazen periost flepleriyle tedavi gerektirebilen bir durumdur. Periost flepleri kullanýmý henüz yaygýn olmayan kemik defekti bulunmayan kaynamalar için tercih edilebilen bir yöntemdir. Bu çalýþmanýn amacý, üst ekstremite uzun kemiklerin inatçý kaynamamalarýnýn tedavisi için medial femoral kondil periost flebi ile ilgili deneyimimizi sunmaktýr.
GEREÇ VE YÖNTEM: 2015–2019 yýllarý arasýnda üst ekstremitede kemik kaynamamasý olan serbest medial femoral kondil periosteal flep ile tedavi edilen yedi hasta geriye dönük deðerlendirildi. Daha önce implant revizyonu ve nonvasküler greftleme iþlemleri yapýlmýþ ve baþarýsýz olunmuþ atrofik kaynamama görülen hastalardan oluþmaktadýr. Bunlarýn ikisi humerus, üçü ulna, biri radius ve biri klavikula daydý. Hastalarýn demografik verileri, kay-namama özellikleri, komplikasyonlarý ve radyografik bulgularý deðerlendirildi. Fonksiyonel sonuçlar kol, omuz ve el skorlarýna göre deðerlendirildi. BULGULAR: Ortalama yaþ 41 (23–60), ortalama takip süresi 33 aydý (16–56). Kaynamama süresi 9–24 ay arasýnda deðiþiyordu. Ek cerrahi prose-düre gerek duyulmadý. Bir hastanýn donör bölgesinde hematom geliþti ve cerrahi drenaj gerektirdi. Bir hastada diz medial kollateral bað yaralanmasý meydana geldi. Hastalarýn hepsinde ortalama üç aylýk bir sürede (2–7) kaynama görülmüþtür. Ameliyat öncesi Q-DASH skoru 56 (33–95) ve ameliyat sonrasý kontrol Q-DASH skoru 5 (0–33) idi ve istatistiksel olarak anlamlýydý (p=0.017). Tüm hastalarýn fonksiyonel sonuçlarý, kol, omuz ve eldeki engellerle doðrulandýðý üzere iyileþmiþtir.
TARTIÞMA: Medial femoral kondil periosteal flep inatçý kaynamama durumlarýnda tercih edilen bir tedavi seçeneði sunar. Bu flep, diðer fleplere göre komorbiditesi düþük, atrofik kaynamamalarda yeniden kanlanma ve kemik oluþumu için uygun bir seçenektir.

BACKGROUND: Recalcitrant fracture non-union is a condition that is difficult to treat and may require multiple surgeries, some-times requiring treatment with periosteal flaps. The use of periosteal flaps can be preferred for the treatment of non-unions that do not yet have extensive bone defects. This study aims to share our experience with medial femoral condyle periosteal flap for the treatment of recalcitrant non-union in long bones of the upper limb.
METHODS: Seven patients who underwent treatment for upper limb non-union with a free medial femoral condyle periosteal flap be-tween 2015 and 2019 were retrospectively evaluated. Patients who had previously underwent implant revision and non-vascular grafting procedures and with failed atrophic non-union were included in the study. Non-union was in the humerus in two patients, ulna in three, radius in one, and clavicula in one patient. Demographic data, non-union features, complications, and radiographic findings of the patients were evaluated. Functional results were evaluated according to Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) scores.
RESULTS: Mean patient age was 41 (23–60) years and the mean follow-up time was 33 months (16–56). Non-union time ranged from 9 to 24 months. Additional surgical procedures were not required. One patient developed a hematoma in the donor site and required surgical drainage. Medial collateral ligament injury of the knee occurred in one patient. Union was observed in all patients in an average of 3 (2–7) months. Mean pre-operative Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) score was 56 (33–95), while mean post-operative control Q-DASH score was 5 (0–33); the improvement was statistically significant (p=0.017). The functional outcomes of all patients improved, as confirmed by Q-DASH score.
CONCLUSION: The medial femoral condyle periosteal flap offers a viable treatment option for recalcitrant non-unions. This flap has low comorbidity compared to other flaps and is a feasible option for revascularization and bone formation in atrophic non-unions.

AMAÇ: Bu çalýþmada aðýr akut pankreatit (AP) olgularýnda hangi hastalarýn geç dönem komplikasyon geliþtireceðini ön görebilmek hedeflendi. Böylece bu hastalarda tartýþmalý olan kolesistektomi zamanlamasý ile ilgili karar alma sürecini kolaylaþtýrabiliriz. Diðer taraftan aðýr AP hastalarýnda geliþen lenfopeninin mekanizmasý ve bunun prognoza etkisi aydýnlatýlmaya çalýþýldý.
GEREÇ VE YÖNTEM: Ocak 2013 ve Ocak 2018 tarihleri arasýnda hastanemizde yatarak tedavi edilen aðýr bilier pankreatit tanýlý 163 hastanýn kayýtlarý geriye dönük olarak incelendi. Hastalarýn demografik verileri, geliþ ve 48. saat lenfosit yüzdeleri kayýt edildi. Yatýþ tarihinden itibaren 7–10. günler arasý çekilen ÝV-Oral kontrastlý bilgisayarlý batýn tomografileri ile birinci ay ve takip tomografileri incelendi. Bu verilerden herhangi biri eksik olan hastalar çalýþma dýþý býrakýldý. Hastalar komplikasyon geliþen ve geliþmeyen olarak 2 gruba ayrýldý; Group 1 herhangi bir geç dönem komplikasyon bulgusu olmayan hastalar, grup 2 ise 1. ay BT’de WON (Walled of Necrosis) veya psödokist geliþtiren hastalar olarak tanýmlandý. Grup 1’de 134, grup 2’de 29 hasta yer aldý. Çalýþmada yer alan hastalarýn 89’u kadýn, 78’i erkekti.
BULGULAR: Gruplar arasýnda cinsiyet ve yaþ açýsýndan fark saptanmadý (p>0.05). Grup 2’nin hastane yatýþ sürelerinin grup 1’den anlamlý ölçüde uzun olduðu saptandý. Gruplar arasýnda geliþ lenfosit deðerleri açýsýndan istatistiksel olarak anlamlý bir farklýlýk bulunmadý (p>0.05). Grup 2’in 48. saat lenfosit deðerleri, Grup 1’den istatistiksel olarak anlamlý düzeyde düþük bulundu (p=0.000; p<0.05). 48. saatte belirgenleþen lenfopeni geç dönem komplikasyon geliþtirme riski ile iliþkili olarak deðerlendirildi.
TARTIÞMA: Aðýr biliyer pankreatitte ilk 48 saatte görülen lenfopeni ile geç dönem geliþen komplikasyonlar arasýnda anlamlý bir iliþki vardýr. 48. saatte lenfopeni görülmüyor ise geç dönem komplikasyon geliþmeyeceðini ve bu hasta gurubunda da erken kolesistektominin güvenle yapýlabileceðini söyleyebiliriz. Aðýr pankreatitte 48. saatte görülen lenfopeni ile geç dönem komplikasyon geliþimi arasýnda anlamlý bir iliþki vardýr.

BACKGROUND: In this study we aimed to predict patients who would develop late stage acute pancreatitis related complications. So we would be able to ease the decision making process about the timing of cholecycstectomy. On the other hand we also suggest a possible insight into the mechanisms which lead development of lyphopenia in severe acute pancreatitis and its possible effects on prognosis.
METHODS: In this study, 163 severe acute pancreatitis case who has been treated as inpatient between January 2013 and January 2018 has been involved. Patients charts and all documented data has been analysed retrospectively. According to the existence or ab-sence of late complications of severe acute pancreatitis, patients have been divided into two groups; Group 1 had no late complication, Group 2 had either pseudocyst or WON (Walled of Necrosis) at 1st month CT.
RESULTS: The difference between two groups in terms of 48th hour lymphocyte percentage was significant (p=0.000; p<0.05). Group 2 had remarkably longer duration of hospital stay (p=0.000; p<0.05). 48th hour CRP level of group 2 was significantly higher than of group 1 (p<0.000).
CONCLUSION: There is a statistically significant relation between the presence of lymphopenia, at 48th hour of presentation in severe biliary pancreatitis patients and development of delayed complications. We can strongly say that there would be no late term pancreatitis related complications if there was no lymphopenia at 48 hour and an early cholecystectomi can be performed in such cases. Lymphopenia seen around 48. hr of admission is highly related to development of late complications in severe acute pancreatitis.

Kýrýk sekeli sonrasý oluþan fizyel barýn neden olduðu ayak bileði deformitelerinin tedavisi karmaþýktýr. Her hasta, deformite ve bar konumunun þiddetine göre ayrý ayrý tedavi edilmelidir. Biz distal tibial epifizde geçirilmiþ travmaya baðlý meydana gelen varus deformitesi ve bar oluþumu olan 11 yaþýndaki erkek hastanýn bar rezeksiyon tekniði ile baþarýlý tedavisini sunduk. Tibia distal açýk kama osteotomi, fibula kapalý kama osteotomi, bar rezeksiyonu ve otojenik yað dokusu interpozisyonu uygulandýðýmýz hasta herhangi bir komplikasyon olmaksýzýn dördüncü yýlýný doldurdu. Bar rezek-siyon tekniðinin ciddi ayak bileði deformitesinde bile olumlu sonuçlar verdiðini düþünüyoruz.

Treatment of ankle deformities caused by the physeal bar after a fracture sequel is complicated. Each patient should be treated individually depending on of the severity of the deformity and bar location. We presented a case report of a successful treatment of an 11-year-old male patient with progressive varus deformity and bar formation due to trauma in the distal tibial physis. Tibia distal open wedge osteotomy, fibula closed wedge osteotomy, bar resection, and autogenic adipose tissue interposition were performed. The patient is at 4 year follow-up without any complication. We think that bar resection technique provides favorable results even in severe ankle deformity.

Akut karýn aðrýsýnýn birçok nedeni vardýr. Bunlardan birisi de dalak torsiyonudur. Distal pankreas ve dalaðýn birlikte torsiyone olduðu ve splenektomi uygulanan bir olguyu literatür ýþýðýnda tartýþmayý amaçladýk. On dokuz yaþýnda erkek hasta ani baþlangýçlý karýn aðrýsý sonucu baþvurusunun ardýndan fizik muayene ve görüntüleme sonucunda dalak torsiyonu saptanmasý üzerine hasta acil ameliyata alýnarak splenektomi yapýldý. Dalak torsiyonu sonucu yaþamý tehdit eden komplikasyonlar geliþebileceðinden erken taný önemlidir. Dalak iskemisi olan hastalarda acil cerrahi yapýlmalýdýr. Dalak ile birlikte pankreasýn da torsiyone olabileceði unutulmamalýdýr. Cerrahlarýn pankreasýn yaralanmasýný önlemek için splenektomi sýrasýnda dikkatli olmalarý gerekir.

There are many causes of acute abdominal pain. One of them is wandering splenic torsion. We aimed to discuss a case in which the distal pancreas and spleen were torsion together and underwent splenectomy in the light of the literature. A 19-year-old male patient with sudden onset of abdominal pain underwent splenectomy after physical examination and imaging revealed splenic torsion. Early diagnosis is important as life-threatening complications may develop. Emergency surgery should be performed in patients with splenic ischemia. It should be kept in mind that the pancreas may be torsioned along with the spleen. Surgeons need to be careful during splenectomy to avoid injury to the pancreas.