AMAÇ: Hiperbarik oksijen tedavisi (HBOT), komplike kronik yaralarýn tedavisine yeni bir boyut eklemiþtir. Bu çalýþmanýn amacý, hiperbarik oksijen tedavisinin, taze ve donmuþ trombosit zengin plazma (TZP) ile kombine edildiðinde kronik yaralar üzerine olan etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Sýçanlar, her grupta 18 sýçan olacak þekilde hiperbarik oksijen tedavisi alan (Grup B) ve almayan (Grup A) olarak iki ana gruba ayrýldý. Her ana grup Grup 1: Kontrol, Grup 2: Taze TZP uygulanan, Grup 3: Dondurulmuþ TZP uygulanan olmak üzere üç alt gruba ayrýldý. TZP hazýrlamak için 10 adet sýçan kullanýldý. Fibrobastlar, kollajen lifler, lenfositler ve damarlarý içeren histolojik parametreler Clemeks Vision lite 3.5, yara yüzey alanlarý Image J dijital analiz programlarý ile deðerlendirildi.
BULGULAR: HBOT alan grupta (Grup B) fibrobast, kollajen lif, lenfosit ve damar sayýlarý tüm taze TZP, donmuþ TZP uygulanan ve kontrol alt gruplarýnda HBOT almayan gruptan (Grup A) anlamlý olarak yüksekti (p<0.05). HBOT alan grupta (Grup B) yara yüzey alaný ölçüm deðerleri kontrol, taze ve donmuþ TZP uygulanan alt gruplarda 5–10–15. günlerde HBOT almayan (Grup A) gruptan düþüktü.
TARTIÞMA: HBOT; taze ve donmuþ TZP ile kombine edildiðinde yara iyileþmesini hýzlandýrmaktadýr. Dondurulmuþ TZP, taze formu kadar efektiftir ve klinik uygulamalarda bir alternatif olarak düþünülebilir.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) has an added dimension to the armamentarium of treating complicated chronic wounds. The purpose of this study is to investigate the effects of HBOT on chronic wounds when combined with fresh and frozen platelet-rich plasma (PRP).
METHODS: Rats were divided into two main groups containing 18 rats in each group as HBOT received and non-received. Each group was divided into three subgroups as Group 1: Control, Group 2: Fresh, and Group 3: Frozen PRP applied. For PRP preparation, 10 rats were used. Histologic parameters including fibroblast, collagen fibers, lymphocytes, and vessels were evaluated by Clemex Vision Lite 3.5; wound sizes were evaluated by ImageJ digital analyzing program.
RESULTS: In HBOT received group, the number of fibroblasts, collagen fibers, lymphocytes, and vessels in all fresh and frozen PRP applied and control subgroups were significantly higher than hyperbaric oxygen non-received group (p<0.05). In HBOT received group, wound surface area measurement values of control, fresh, and frozen PRP applied groups at 5-10-15 days were lower than HBOT non-received group.
CONCLUSION: HBOT accelerates wound healing when combined with both fresh and frozen PRP. Frozen PRP is as effective as fresh form to be considered as an alternative in clinical setting.

AMAÇ: Majör karaciðer rezeksiyonlarý veya pringle manevrasý ile yapýlan iskemik hasar durumlarýnda, rejenerasyonu artýran veya iskemik reperfüzyon hasarýný yöneten ajanlar, araþtýrmacýlar için büyüleyici bir konu haline gelmiþtir. Bu çalýþmanýn amacý, arkasýnda kapsamlý araþtýrmalar bulunan bir antioksidan olan sistemik L-karnitinin, sýçanlarda deneysel hepatektomi (üçte iki karaciðer rezeksiyonu) modelinde majör hepatektomi sonrasý karaciðer rejenerasyonunun nasýl etkilediðini görmektir.
GEREÇ VE YÖNTEM: Bu çalýþmada, Saðlýk Bilimleri Üniversitesi Genel Cerrahi Kliniði, Hamidiye Eðitim ve Araþtýrma Hastanesi Laboratuvarý’nda geliþtirilen sýçanlarda hepatektomi modeli kullanýlarak karaciðer rejenerasyonu deðerlendirildi. Deneyde aðýrlýklarý 250 ile 300 gram arasýnda deðiþen 15 erkek ve 15 diþi Wistar Albino cinsi sýçanlar cinsiyetleri karýþtýrýlacak þekilde kullanýldý. Her grupta rastgele seçilen erkek ve diþi sýçanlar ve her biri 10 sýçandan oluþmak üzere üç grup oluþturuldu. G Kontrol: %70 hepatik rezeksiyon + intraperitoneal %0.9 salin, G Sham: laparotomi sonrasý batýn herhangi bir iþlem yapýlmadan tekrar kapatýldý, G Carnitine: %70 hepatik rezeksiyon + intraperitoneal 100 mg/kg L-karnitin uygulandý. G Sham ve G Carnitine gruplarýna sistemik olarak uygulandý ve sýçanlara ayný iþlem dört gün boyunca ayný anda herhangi bir kýsýtlama olmaksýzýn uygulandý. Beþinci gün sakrifikasyon sonrasý relaparotomi ile batýna girildi ve karaciðer rejenerasyonu makroskobik olarak deðerlendirildi ve her olgu için geliþtirilen formlara kaydedildi. Daha sonra karaciðer dokusu rezeke edildi ve mitotik indeks, binükleer hepatosit, safra kanalý proliferasyonu, santral venlerde dilatasyon, parankimde hücre proliferasyonu ölçülerek mikroskobik olarak kaydedildi. Elde edilen sonuçlar istatistiksel olarak deðerlendirildi. BULGULAR: Sonuçlara göre, L-karnitin grubu, kontrol grubuna kýyasla histopatolojik deðerlendirmede hepatektomi sonrasý genel rejenerasyon skorunda istatistiksel olarak anlamlý bir artýþa sahipti.
TARTIÞMA: Birçok olumlu etkisi deneysel ve klinik olarak gösterilen L-karnitin’nin karaciðer rejenerasyonu üzerine olumlu etkisi olduðu düþünülmekte ve bu yolun aydýnlatýlabilmesi için immünohistokimyasal araþtýrmalara ihtiyaç duyulmaktadýr.

BACKGROUND: In cases of major liver resections or ischemic damage made by the pringle maneuver, agents that increase regeneration or manage ischemic reperfusion injury have become a fascinating topic for researchers. The aim of this study is to see how systemic L-carnitine, an antioxidant with thorough research behind it, affects liver regeneration after major hepatectomy in a rat experimental hepatectomy (two-thirds liver resection) model.
METHODS: The liver regeneration was evaluated in this study using a rat hepatectomy model developed in the General Surgery Clinic of Health Sciences University, Umraniye Education and Research Hospital’s Laboratory. In the experiment, 15 male and 15 female Wistar Albino rats weighing between 250 and 300 g were used in a way that the genders were mixed. In each group, three groups were formed, including male and female rats randomly selected and ten rats. Gcontrol: 70% hepatic resection + intraperitoneal 0.9% saline, GSham: After laparotomy, the abdomen was closed again without any procedure, Gcarnitine: 70% hepatic resection + intraperitoneal 100 mg/kg L Carnitine was applied. It was applied systemically to GSham and Gcarnitine groups and the same procedure was applied to rats for 4 days at the same time without any restrictions. On the 5th day, the abdomen was entered with relaparotomy after sacrification and liver regeneration was evaluated macroscopically and recorded in the forms developed for each subject. Later, liver tissue was resected and microscopically recorded by measuring mitotic index, binuclear hepatocyte, gall duct proliferation, dilation in central veins, and cell proliferation in the parenchyma. The results obtained were evaluated statistically.
RESULTS: According to the results, the L-carnitine group had a statistically significant increase in overall regeneration scoring after hepatectomy in the histopathological assessment as compared to the control group.
CONCLUSION: It is thought that L-carnitine, whose many positive effects have been shown experimentally and clinically, has a positive effect on liver regeneration and immunohistochemical researches is required to elucidate this pathway.

AMAÇ: Ýyi bir estetik ve fonksiyonel sonuçla baþparmak defektlerinin rekonstrüksiyonu için en iyi tekniði belirlemek klinik olarak büyük önem taþýmaktadýr. Bu çalýþmada, birinci dorsal metakarpal arter flebinin (BDMAF) güvenirliliðini, çok yönlülüðünü, limitasyonlarýný, avantajlarýný ve fonksiyonel sonuçlarýný nicel veriler ile sunmayý ve ek olarak diðer güncel cerrahi seçeneklerle karþýlaþtýrarak baþparmak defekti rekonstrüksiyonundaki sonuçlarýný analiz etmeyi amaçladýk.
GEREÇ VE YÖNTEM: Toplam 21 hastaya baþparmak defekti rekonstrüksiyonu gerçekleþtirildi. Bu hastalar etiyoloji, yaþ, rekonstrüksiyon zamanlamasý, flep yaþamsallýðý, Semmes-Weinstein monofilament (SWM) testi, statik iki nokta ayrýmý (2NA) testi, aðrý, kortikal reoryantasyon, soðuk intoleransý anketi ve Michigan el sonuçlarý anketi gibi parametreler ile deðerlendirildiler. Fonksiyonel sonuçlar, literatürde yayýnlanmýþ diðer güncel cerrahi seçenekler ile nicel veriler üzerinden karþýlaþtýrýlarak deðerlendirildi.
BULGULAR: Ortalama takip süresi 22.3 aydý. Fleplerin ortalama aðrý skoru 0.4±0.6 idi ve hiçbir hastanýn donör bölgesinde aðrýsý yoktu (aralýk, 0–10). Duyusal sonuç, statik 2NA testine dayanarak “iyi” (8.6 mm) olarak bulundu. Ortalama SWM testi skoru 4.02 g idi. Hasta memnuniyeti ise Michigan el sonuçlarý anketine göre 4.6 idi (aralýk, 0–5). Soðuk intolerans anketi skorlarýna göre hastalar, hafif soðuk intoleransa sahipti (ortalama, 10.5; aralýk 0–100). Hastalarýn %81’inde tam kortikal reoryantasyon olduðu görüldü.
TARTIÞMA: Sonuçlarýmýz ýþýðýnda bakýldýðýnda, baþparmak defekti innervasyonunun BDMAF ile restorasyonunda yüksek memnuniyet oranlarý görülmektedir. Bu teknikteki herhangi bir mikrocerrahi damar veya sinir onarýmýnýn olmamasý ameliyatý kolaylaþtýrýr, cerrahi süreyi kýsaltýr ve morbiditeyi azaltýr. Böylelikle bu yaklaþým, daha komplike durumlar için mikrocerrahi seçenekleri potansiyel alternatif yaklaþýmlar olarak rezerve etmiþ olur. Bu doðrultuda düþünüldüðünde BDMAF, kompleks baþparmak defektleri için çok çeþitli modifikasyonlara sahip, etkili bir fleptir ve cerrahlarýn bu defektlerde hangi tekniðin kullanýlacaðýný seçerken, tekniklerin klinik sonuçlar açýsýndan birbirlerine üstünlükleri olup olmadýðýný ve artabilecek cerrahi süreyi göz önünde bulundurmalarý gerektiði sonuçlarýna varýlabilir.

BACKGROUND: It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options.
METHODS: A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature.
RESULTS: The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0–10). The sensory outcome was “good” (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0–5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0–100). Complete cortical reorientation was seen in 81% of the patients.
CONCLUSION: Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.

AMAÇ: Akut mezenterik iskemi (AMÝ) çok yüksek mortalite ve morbiditeye sahiptir ve AMÝ’nin prognozunda en önemli faktör iskeminin süresidir. Bu çalýþmanýn amacý, AMÝ’nin erken tanýsýnda sitokin ve kemokinlerin olasý kullanýmý ve iskemi süresine göre bu belirteçlerin deðiþimini deðerlendirmektir.
GEREÇ VE YÖNTEM: Yirmi bir erkek Sprague Dawley sýçaný üç eþit gruba ayrýldý. Ýlk iki grupta superior mezenterik arter ve superior mezenterik ven sýkýca baðlanarak grup 1’de iki, grup 2’de altý saat iskemiye maruz býrakýldý. Grup 3’e ise herhangi bir iþlem uygulanmayarak kontrol grubu olarak belirlendi. Grup 1’de iskemiden iki saat sonra ve grup 2 iskemiden altý saat sonar ve grup 3’te ise laparotomiden altý saat sonar intrakardiyak kan örnekleri alýnarak IL-1α, 1β, 6, 10, 12p70, 17A, 18, 33, CXCL1/KC, CCL2/MCP-1, GM-CSF, IFN-γ ve TNF-α düzeyleri flow sitometri kullanýlarak ölçüldü.
BULGULAR: IFN-γ, CXCL1, MCP-1, TNF-α ve IL-6 parametrelerinde gruplar arasýnda önemli farklýlýklar gözlendi. Mezenterik iskemi süresine göre yapýlan korelasyon analizlerinde CXCL1’de çok yüksek, MCP-1, TNF-α ve IL-6’da yüksek düzeyde korelasyon gözlenmektedir. Ayrýca IFN-γ, IL-10 ve IL-18’de orta düzeyde bir korelasyon mevcuttu.
TARTIÞMA: Mezenterik iskemi olan hastalarda iskemi süresi ile yüksek korelasyon gösteren CXCL1, MCP-1, TNF-α ve IL-6 düzeylerinin artmasý, klinisyenin taný koymasýna ve doðru tedaviyi seçmesine yardýmcý olabilir.

BACKGROUND: Acute mesenteric ischemia (AMI) has very high mortality and morbidity rates, and the most important factor in the prognosis of AMI is the duration of ischemia. This study aims to evaluate the changes of these markers according to the ischemia duration and possible use of cytokines and chemokines in the early diagnosis of AMI.
METHODS: Twenty-one male Sprague–Dawley rats were divided into three equal groups. The Superior Mesenteric Artery and Superior Mesenteric Vein were tied tightly and exposed to ischemia for 2 h for Group 1 and 6 h for Group 2. There was no intervention for Group 3, and it was selected as a control group. Intracardiac blood samples were collected after 2 h in Group 1 and 6 h in Groups 2 and 3. The IL-1α, 1β, 6, 10, 12p70, 17A, 18, 33, CXCL1/KC, CCL2/MCP-1, GM-CSF, IFN-γ, and TNF-α were measured using flow cytometry.
RESULTS: Significant differences were observed between the groups in IFN-γ, CXCL1, MCP1, TNF-α, and IL-6 parameters. In the correlation analyses performed according to the mesenteric ischemia time, a very strong correlation was observed in CXCL1, as well as a strong level for MCP-1, TNF-α, and IL-6. Furthermore, a moderate level of correlation was found in IFN-γ, IL-10, and IL-18.
CONCLUSION: The increased levels of CXCL1, MCP-1, TNF-α, and IL-6, which had a high correlation with the duration of ischemia in patients with intestinal ischemia, may help clinicians with diagnoses and treatment decision-making.

AMAÇ: Bu çalýþma, travmatik median sinir yaralanmasýndan sonra eldeki duyusal hasarýn restorasyonunda ICBN’nin olasý kullanýmýný araþtýrmayý amaçlamýþtýr. ICBN nörotizasyonunun median sinire uygulanabilirliðini deðerlendirmek için interkostobrakiyal (ICBN) sinir ve median sinirin anatomik özellikleri ve varyasyonlarý incelenmiþtir.
GEREÇ VE YÖNTEM: Sekiz kadavranýn 16 üst ekstremitesinde aksiller bölge diseksiyonu yapýldý. ICBN varyasyonlarý kaydedildi. ICBN’nin brakiyal pleksusa nörotizasyon açýsýndan uygunluðunun ölçümleri milimetrik cihazlarla yapýldý. ICBN’nin median sinirin lateral (LCMN) ve medial (MCMN) katkýlarýnýn distal ucuna olan mesafesi ve ICBN, LCMN ve MCMN çaplarý ölçüldü.
BULGULAR: On beþ aksiller diseksiyonda ICBN mevcutken kadavralardan birinin sol tarafýnda mevcut deðildi. ICBN’nin baþlangýç noktasýndaki ortalama çapý 2.0±0.7 mm ve koaptasyon noktasýndaki ortalama ICBN çapý 3.1±0.9 mm idi. LCMN’nin ortalama çapý 3.9±2.0 mm, MCMN’nin ortalama çapý 3.5±0.9 mm idi. ICBN’nin hem 45 hem de 90 derece omuz abdüksiyonunda, LCMN ve MCMN’ye uzanabilecek þekilde yeterli uzunluða sahip olduðu bulundu. LCMN ve MCMN çaplarý, hem orijin hem de koaptasyon noktasýnda ICBN’nin çapý ile anlamlý derecede iliþkili deðildi (LCMN: p=0.55–0.63 ve MCMN: p=0.89–0.85). LCMN çapý ile koaptasyon noktasýndaki ICBN çapý arasýnda (p=0.168) ve ayrýca MCMN çapý ile koaptasyon noktasýnda ICBN çapý arasýnda (p=0.232) anlamlý bir fark saptanmadý.
TARTIÞMA: Disseke edilen tüm ICBN’ler, median sinirin lateral ve medial katkýsýna doðrudan ulaþmak için yeterli uzunluk gösterdi. Tanýmlayýcý ve çýkarýmsal istatistiklere göre ICBN çapý LCMN ve MCMN’ye yakýn bulundu. Bu nedenlerIe ICBN, travmatik yaralanmalar sonrasý median sinir nörotizasyonu için uygun bir aday olabilir.

BACKGROUND: This study focused on the anatomical characteristics and variations of intercostobrachial (ICBN) nerve and median nerve to investigate the possible use of ICBN in restoration of sensory damage of hand after traumatic median nerve injury and to evaluate the feasibility of ICBN neurotization to median nerve.
METHODS: Variations of ICBN were noted in 16 axillary region dissections of eight cadavers. Measurements for ICBN’s suitability in terms of neurotization to brachial plexus were done with millimetric devices. The distance of ICBN to the distal end of the lateral (LCMN) and medial (MCMN) contributions of the median nerve and the diameters of ICBN, LCMN, and MCMN were measured.
RESULTS: Fifteen axillary dissections exhibited ICBN, whereas it was absent on the left side of one of the cadavers. The mean diameter of ICBN at its origin was 2.0±0.7 mm and the mean diameter of ICBN at its coaptation point was 3.1±0.9 mm. The mean diameter of the LCMN was 3.9±2.0 mm, the mean diameter of MCMN was 3.5±0.9 mm. The length of ICBN was found to be adequate at both 45 and 90° of shoulder abduction to be extended to both LCMN and MCMN. The diameters of LCMN and MCMN were not significantly correlated with the diameter of ICBN both at origin and at coaptation point (LCMN: p=0.55–0.63 and MCMN: p=0.89–0.85). There is no significant difference between the diameter of LCMN and the diameter of ICBN at its coaptation point (p=0.168) and also between the diameter of MCMN and the diameter of ICBN at its coaptation point (p=0.232).
CONCLUSION: All ICBNs dissected showed adequate length to reach the lateral and medial contribution of the median nerve directly. The ICBN could be a feasible candidate since its diameter was close to LCMN and MCMN according to the descriptive and inferential statistics.

AMAÇ: Periferik sinir yaralanmalarý, özellikle genç nüfusu etkilemekte, yüksek maliyetlere sebep olmakta ve sýk görülmektedir. Bu çalýþmada, tavþan modelinde siyatik sinir üzerinde oluþturulan akut bir hasar ile sinir rejenerasyonunda EGF’nin histolojik rolünün belirlenmesi amaçlandý.
GEREÇ VE YÖNTEM: On sekiz adet Yeni Zelanda türü tavþan; dokuz adet kontrol grubu, dokuz adet deney grubu olacak þekilde kullanýldý. Kontrol ve deney gruplarý kendi içlerinde dört ve beþ tavþan içeren iki gruba ayrýldý. Dört tavþan içeren gruplarda alan ölçümleri yapýlýrken, beþ tavþan içeren gruplarda çap ölçümleri yapýldý. Her bir tavþana sað kalçasýndan siyatik sinir eksplorasyonu, tam kat sinir hasarý ve ardýndan epinöral tamir tek bir araþtýrmacý tarafýndan uygulandý. Deney grubuna 10 µg/kg EGF bölgeye enjekte edildi. Deney grubuna ameliyat sonrasý günaþýrý olacak þekilde beþ enjeksiyon daha yapýldý. Kontrol grubunda ayný miktarlarda serum fizyolojik kullanýldý. Tavþanlar sekiz hafta boyunca gözlendi. Takipler sýrasýnda iki tavþan öldü. Sekiz hafta sonunda hayvanlardan alýnan siyatik sinir dokularý histolojik ve morfolojik olarak deðerlendirildi.
BULGULAR: Beþ tavþan içeren EGF (+) grupta ortalama bað doku (epinöryum + mezonöryum) çapý 156.867 µm; beþ tavþan içeren kontrol grubunda ise 25.170 µm idi. Diðer gruplarda yapýlan karþýlaþtýrmalý alansal ölçümlerde ise EGF (+) grubunda bað doku (epinöryum+ mezonöryum) alanlarýnda kontrol grubuna göre artýþ gözlendi. EGF verilen grupta epinöryum ve mezonöryumda geniþleme izlendi. Bað dokusunda adiposit ve kapiller artýþý görüldü.
TARTIÞMA: EGF, akut periferik sinir yaralanma rejenerasyonunda çevre bað dokuda epinöryum ve mezonöryum çaplarýný arttýrmaktadýr. Fakat bu etkinin klinik ve fizyolojik açýdan anlamlandýrýlabilmesi için ileri çalýþmalara ihtiyaç duyulmaktadýr.

BACKGROUND: Peripheral nerve injuries are one of the most common and costly injuries especially in the young population. In this study, it is aimed to determine the histological role of epidermal growth factor (EGF) in nerve regeneration with an acute damage made on sciatic nerve in the rabbit model.
METHODS: We used 18 New Zealand rabbits (nine in control group and nine in experimental group). Each group was divided into two groups consisting of five rabbits planned for diameter measurement and four rabbits planned for spatial measurement. The sciatic nerve exploration in the right flank of each animal, full-thickness nerve damage, and then epineural repair was made by a single researcher. 10 µg/kg EGF was given to the repair area of the experimental group and five more EGF injections were given to the experimental group every other day postoperatively. In the control group, we used saline solution. Rabbits were observed for 8 weeks. During follow-up, two rabbits died. At the end of 8 weeks, the nerve tissue of each animal was evaluated histologically and morphologically.
RESULTS: In the experimental group consisting of five rabbits, the mean thickness of connective tissue (epineurium+ mesoneurium) was 156,867 µm; while, in the control group, the thickness was 25,170 µm. In the other groups, the numerical increase in epineurium and mesoneurium areas was detected in the EGF (+) group as a result of the comparative spatial measurements. Epineurium and mesoneurium enlargement was observed in the EGF-given group. Adipocyte and capillary increase was observed in connective tissue.
CONCLUSION: EGF increases epineurium and mesoneurium diameters in peripheral connective tissue in acute peripheral nerve injury regeneration. However, further studies are needed to understand this effect clinically and physiologically.

AMAÇ: Akut apandisit, en yaygýn abdominal cerrahi acil durumdur. SARS-CoV-2’de koronavirüsün bu yeni tipi ciddi akut solunum yolu sendromuna neden olmaktadýr ve bu durum küresel çapta bir pandemiye dönüþmüþtür. COVID-19 pandemi döneminde apendektomi ve komplike apandisit ile iliþkili risk faktörlerini belirlemek akut apandisit cerrahi tedavisi ve sonuçlarý üzerindeki etkilerini deðerlendirmeyi amaçlanmýþtýr. Mevcut karþýlaþtýrmalý çalýþma, COVID-19 pandemisi sýrasýnda ve ayný dönemi kapsayan geçen yýl apandisitli hastalarda apendektomi yöntemi ve komplike apandisit üzerine etkileri analiz edildi.
GEREÇ VE YÖNTEM: Bu çalýþmadaki hastalar 1 Mart–31 Aðustos 2020 COVID-19 pandemisi döneminde (Grup B) ve 2019 yýlýnýn ayný döneminde (Grup A) Kartal Dr. Lütfi Kýrdar Þehir Hastanesi Genel Cerrahi Kliniði Acil Cerrahi Bölümü’ne baþvuran akut apandisitli yetiþkin hastalardan oluþmaktadýr. Bu çalýþma, karþýlaþtýrmalý ve geriye dönük bir çalýþma olarak planlandý. Çalýþmaya akut apandisit ile baþvuran toplam 658 hasta alýndý. Grup A 347 hastadan oluþurken, Grup B 311 hastayý içeriyordu.
BULGULAR: Çalýþma popülasyonunun demografik özellikleri ve klinik özelliklerinde anlamlý bir farklýlýk görülmedi. Hasta þikayetlerinin baþvuru süresi, hastanýn hastaneye geliþ ile ameliyata alýnma süresi, ameliyat esnasýndaki bulgular ve ameliyat sonrasý komplikasyonlarda da Grup A ve B arasýnda da anlamlý bir fark görülmedi. Genel apendektomi patolojilerinde benzer özellikler mevcuttu ancak çalýþmamýzda Grup B de yani COVID-19 pandemi döneminde kataral apandisitte istatistiksel olarak anlamlý derecede azalma görüldü (p=0.04).
TARTIÞMA: COVID-19 pandemisi sýrasýnda komplike apandisitte önemli artýþ görülmedi ancak negatif apendektomilerde önemlide derecede azalma görüldü. Bu sonuç pandemi döneminde hastalarýn gereksiz acil cerrahi birimine gelmediklerini ve zamanýnda ve uygun cerrahi bakým aldýklarýný göstermektedir.

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. This new type of coronavirus, also called SARS-CoV-2, causes severe acute respiratory syndrome, and this has turned into a pandemic. We aimed to determine the risk factors associated with appendectomy and complicated appendicitis during the COVID-19 pandemic period and to evaluate the effects on the surgical treatment of acute appendicitis and its outcomes. In the current comparative study, we analyzed its effects on appendectomy management and complicated appendicitis in patients with appendicitis during the COVID-19 pandemic and past year covering the same period.
METHODS: The patients in this study consisted of adult patients with acute appendicitis who applied to the Emergency Surgery Department of Kartal Dr. Lütfi Kýrdar City Hospital General Surgery Clinic between March 1, and August 31, 2020 (COVID-19 pe-riod) (Group B) and the same period of 2019 (Group A). A comparative and retrospective study was planned. A total of 658 patients who presented with acute appendicitis were included in the study. Group A and Group B consist of 347 and 311 people, respectively.
RESULTS: No significant difference was found in the demographic and clinical characteristics of the study population. There was no significant difference between Group A and B in terms of the duration of the application of patient complaints, the duration of the procedure, the time the patient was admitted to the hospital, the time of the patient being taken to the surgery, the findings during the operation, and the post-operative complications. There were similar features in general appendectomy pathologies, but in our study, a significant decrease in catarrhal appendicitis was observed in Group B, namely, during the COVID-19 pandemic period (p=0.04).
CONCLUSION: During the COVID-19 pandemic, there was no significant increase in complicated appendicitis, but a significant reduction in negative appendectomies. This result shows that during the pandemic period, patients do not come to the emergency surgery unit unnecessarily and receive timely and appropriate surgical care.

AMAÇ: 2019 koronavirüs hastalýðý (COVID-19) pandemisinin Türkiye’de pediatrik oftalmoloji acil servisine (POAS) baþvuran hastalarýn demografik özelliklerini ve tanýlarýný nasýl etkilediðini deðerlendirmek.
GEREÇ VE YÖNTEM: 15 Mart–31 Mayýs 2020 (ilk evde kalma süresi) ve 15 Kasým–31 Aralýk 2020 (ikinci evde kalma süresi) arasýnda POAS’ye baþvuran 18 yaþýndan küçük hastalarýn elektronik týbbi kayýtlarý, geriye dönük olarak tarandý. Bu dönemlere ait demografik veriler ve klinik tanýlar 2019 yýlýnýn ayný dönemleriyle karþýlaþtýrýldý.
BULGULAR: Sekiz yüz otuz dokuz pediyatrik hastanýn dosyasý incelendiðinde POAS’yi 2019 yýlýnda ziyaret edenler (n=510) ile 2020 yýlýnda ziyaret edenler (n=329) arasýnda yaþ (p=.067) veya cinsiyet (p=.268) açýsýndan anlamlý bir fark bulunmadý. 2019 ile karþýlaþtýrýldýðýnda, ilk evde kalma döneminde (yani, 322’ye karþý 159) POAS’yi ziyaret eden hasta %50.63 daha az ve ikinci dönemde (yani, 188’e karþý 170) %9.66 daha az hasta ziyaret etti. 2019 ve 2020’deki tanýlar benzerdi; en sýk taný yabancý cisimdi ve ikinci en sýk taný oküler travmaydý.
TARTIÞMA: COVID-19 pandemisinin ortasýnda, fark ikinci dönemde daha az olmasýna raðmen, birinci ve ikinci evde kalýþ dönemlerinde 2019’un ayný dönemlerine göre daha az pediatrik hasta POED’yi ziyaret etti. Bununla birlikte, yýldan yýla demografik veriler ve teþhisler benzerdi. Bu bulgular, pandemiler gibi olaðanüstü durumlarda POAS yönetimi için yeni stratejiler ve kýlavuzlar geliþtirmede klinisyenlere yardýmcý olabilir.

BACKGROUND: This study aims to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted the demographics and diagnoses of patients presenting at a pediatric ophthalmology emergency department (POED) in Türkiye.
METHODS: The electronic medical records of patients <18 years old who presented at the POED from March 15 to May 31, 2020 (first stay-at-home period), and from November 15 to December 31, 2020 (second stay-at-home period), were retrospectively scanned. The demographic data and clinical diagnoses from those periods and the same periods in 2019 were compared.
RESULTS: No significant differences emerged regarding age (p=0.067) or sex (p=0.268) among the 839 pediatric patients who visited the POED in 2019 (n=510) versus 2020 (n=329). Compared with 2019, 50.63% of fewer patients visited the POED in the first stay-at-home period (i.e., 322 vs. 159) and 9.66% fewer visited in the second period (i.e., 188 vs. 170). The diagnoses in 2019 and 2020 were similar, with foreign body being the most common diagnosis, followed by ocular trauma.
CONCLUSION: Amid the COVID-19 pandemic, fewer pediatric patients visited the POED during the first and second stay-at-home periods than during the same periods in 2019, although the difference was less during the second period. Demographic data and diagnoses from year to year, however, were similar. These findings could aid clinicians in developing new strategies and guidelines for POED management in extraordinary situations such as pandemics.

AMAÇ: Akut apandisit karýn aðrýsý ile acile baþvurularýn sýk sebeplerinden biri olup, tanýsýnda radyolojik görüntülemelerde ilerlemelere raðmen, daha basit, ucuz ve güvenli bir biyobelirteç arayþý devam etmektedir. Bizde çalýþmamýzda akut apandisit perforasyonunda, þiddetli enflamatuvar süreçlerde prognozu ön gören bir biyobelirteç olan nötrofil sayýsý ile albümin oranýnýn biyobelirteç olarak kullanýlabilirliðini saptamaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýz geriye dönük, kesitsel bir çalýþmadýr. Çalýþmaya Ocak 2018–Aralýk 2020 tarihleri arasýnda acil servisine baþvuran ve akut apandisit ön tanýsý ile hastaneye yatýrýlan hastalar arasýnda yapýldý. Olgular önce “apandisit deðil” ve “akut apandisit” þeklinde iki gruba ayrýldý, ardýndan “akut apandisit” olduðu saptanan hastalar “perfore olan” ve “perfore olmayan” þeklinde iki alt gruba ayrýldý. Hastalarýn demografik verileri, semptomlarý, fizik muayene bulgularý, operasyon kararýnýn hangi þekilde verildiði not edildi. Olgularýn acil servise baþvuru anýnda alýnan kan örneklerinde saptanan nötrofil sayýsý ve albümin seviyeleri kaydedildi. Sonrasýnda nötrofil/albümin oraný hesaplandý ve saptanan deðerler için akut apandisit tanýsýný öngörmedeki yeri ile perforasyon geliþimini öngörmede kestirim seviyesi belirlendi.
BULGULAR: Akut apandisit geliþmeyen hasta grubundaki periumbilikal bölgede aðrý þikâyeti olma oraný akut apandisit grubundaki hastalara göre anlamlý olarak daha fazla idi (%70.6 ve %40.3, p=0.034). Lökosit sayýsý, nötrofil sayý ve yüzdesi ve nötrofil/albümin oraný akut apandisit grubunda anlamlý olarak daha yüksek iken lenfosit sayýsý anlamlý olarak daha düþük olarak bulundu (p=0.005). Buna karýþýn nötrofil/albumin oraný ile perforasyon geliþimi arasýnda anlamlý bir iliþki tespit edilmedi (p=0.697).
TARTIÞMA: Nötrofil/albümin oraný akut apandisit tanýsýnda kullanýlabilir bir orandýr. Bununla birlikte perforasyonu saptamada yeterli bir biyobelirteç deðildir.

BACKGROUND: Acute appendicitis (AA) is one of the most common causes of abdominal pain in patients presenting to the emergency department with abdominal pain, and despite developments in radiological imaging for its diagnosis, researchers are still in pursuit of a simpler, cheaper, and safer biomarker. Our study investigated the usability of the neutrophil–albumin ratio, a biomarker that predicts prognosis in cases with severe inflammation, in diagnosing AA and anticipating perforation.
METHODS: Our study is a retrospective and cross-sectional study. The study was conducted with patients who presented to the emergency department between January 2018 and December 2020 and were hospitalized with a preliminary diagnosis of AA. The cases were first divided into two groups as “Not appendicitis” and “AA,” and then the patients with “AA” were divided into two subgroups as “Perforated” and “Non-perforated.” The demographic data of the patients, their symptoms, physical examination findings, and the decision-making process for surgery were noted. The neutrophil count and albumin levels detected in the blood samples obtained at the time of admission to the emergency department were noted. Afterward, the neutrophil-albumin ratio (NAR) was calculated and the cutoff level was determined to predict the diagnosis of AA and the development of perforation.
RESULTS: The rate of complaints of pain in the periumbilical region was significantly higher in the patient group without AA compared to the patients in the AA group (70.6% and 40.3%, p=0.034). Although the leukocyte count, neutrophil count and percentage, and NAR were significantly higher in the AA group, the lymphocyte count was found to be significantly lower (p=0.005). However, no significant correlation was found between the NAR and the development of perforation (p=0.697).
CONCLUSION: The NAR is useful for the diagnosis of AA. Nevertheless, it is not a sufficient biomarker for detecting perforation.

AMAÇ: Dünya genelinde sayýca artýþ gösteren 65 yaþ üzeri, travmatik yaralanmalarýn morbidite ve mortalitesi diðer yaþ gruplarýna göre daha yüksektir. Çalýþmamýzda, 65 yaþ ve üzeri olgularý, cinsiyet, yaþ, travma öyküsü, travmatik yaralanmanýn türü, yaralanma sonrasý klinik progres, yaþlý istismarý ve kiþinin yaþadýðý ortam bakýmýndan inceleyerek, travma sonucu yaralanmalarýn morbidite ve mortalite düzeyleri ile yaþlý istismarý gibi medikolegal yönleriyle irdelemek amaçlanmaktadýr.
GEREÇ VE YÖNTEM: Araþtýrmanýn yapýsý kesitsel tanýmlayýcý bir çalýþma niteliðinde olup, Karadeniz Teknik Üniversitesi Týp Fakültesi Farabi Hastanesi Acil Sevisi’ne 2019–2020 yýllarý arasýnda baþvuru yapmýþ 65 yaþ ve üzeri hasta dosyalarýnýn elektronik ve fiziki ortamda geriye dönük olarak incelenmesi ile yapýlmýþtýr.
BULGULAR: Travma nedeniyle baþvuran 647 hastadan 384 hastanýn (%59.4) erkek, 263 hastanýn (%40.6) kadýn olduðu görüldü. Travma oluþ þekillerinde; 244 (%37.7) olgu ile kendi seviyesinden düþme ilk sýrada görülürken, delici kesici alet yaralanmasý 123 (%19.0) ve yüksekten düþme 80 (%12.4) olgu ile takip etti. Kendi seviyesinden düþme ve yanýk kadýn cinsiyette istatistiksel olarak anlamlý yüksek saptandý (p<0.001).
TARTIÞMA: Geriatrik travmanýn en sýk nedeni olan düþmeler baþta olmak üzere tüm travma oluþ mekanizmalarý ve yaþlý istismarý, adli týbbi açýdan ele alýnmasý gereken bir konudur. Travmayý önleyici tedbirler yaþlýlar için düzenlenmeli ve gözden geçirilmeli, adli travmatik yaralanmalarda saðlýk personeli adli bildirim yükümlülüðünü yerine getirmelidir.

BACKGROUND: The morbidity and mortality of traumatic injuries are higher in individuals aged >65 years, which are a population group showing an increase worldwide, compared to other age groups. The aim of this study was to compare the medicolegal aspects, such as abuse of the elderly with the morbidity and mortality rates of injuries resulting from trauma by examining the age, gender, trauma history, type of traumatic injury, clinical progress following injury, elderly abuse, and the care environment of the person in cases aged 65 years and older.
METHODS: In this cross-sectional and descriptive study, a retrospective examination was made of the electronic and physical patient files of patients aged 65 years and older who presented at the Emergency Department of Blacksea Tecnical Univercity Medical Faculty Farabi Hospital between 2019 and 2020.
RESULTS: Of the 647 patients who presented because of trauma, 384 (59.4%) were male and 263 (40.6%) were female. The leading cause of trauma was a same-level fall in 244 (37.7%) cases, followed by piercing or cutting injuries in 123 (19.0%), and a fall from height in 80 (12.4%) cases. Same-level falls and burns injuries were determined at a statistically significantly higher rate in females (p<0.001).
CONCLUSION: Abuse of the elderly and the mechanisms of all traumas, primarily falls as the most common cause of geriatric trauma, are a subject that should be addressed in terms of forensic medicine. Preventative measures against trauma should be implemented and reviewed for the elderly, and health-care personnel should take responsibility for the legal reporting of forensic traumatic injuries.

AMAÇ: Bu çalýþmada, abdominal travmasý olan hastalarda Yaralanma Þiddet Skoru (ISS), Klinik Abdominal Skorlama Sistemi (CASS), Yeni Yaralanma Þiddet Skoru (NISS) dahil olmak üzere çeþitli travma skor sistemleri ile laparotomi, hastane içi mortalite (IHM) ve uzun hastanede kalýþ süresi (LS) dahil klinik sonuçlar arasýndaki korelasyonlar araþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: Ocak 2009 ile Aralýk 2019 tarihleri arasýnda abdominal travma geçiren 749 hastanýn verileri geriye dönük olarak incelendi. Týbbi kayýtlardan elde edilen veriler arasýnda yaþ, cinsiyet, baþlangýç yaþamsal bulgular, travma tipi ve mekanizmasý, hastanede kalýþ süresi, laparotomi ve hastane içi mortalite (IHM) yer almaktadýr. Yaralanmýþ organlar ve derecelerine ait bilgiler bilgisayarlý tomografi kullanýlarak toplandý. Skor sistemi ile klinik sonuçlar arasýndaki korelasyonlar, Alýcý Çalýþma Karakteristikleri (ROC) eðrisinin Eðri Altýndaki Alaný (AUC) kullanýlarak analiz edildi. BULGULAR: Hastalarýn ortalama yaþý 40.14±19.47 yýldý. Yedi yüz dört hastada (%94.0) en sýk travma tipi künt travma, 475 hastada (%63.4) ise trafik kazasý en sýk görülen nedendi. Yaralanmýþ organlar arasýnda karaciðer (%45.1) ve dalak (%25.1) mevcuttu. Toplam 179 hastaya (%23.9) laparotomi uygulanmýþ ve 35 hastada (%4.6) IHM bildirilmiþti. ISS, NISS ve CASS için ROC’nin AUC’si laparotomi ile anlamlý þekilde iliþkiliydi (0.682; p=0.001, 0.713; p=0.001; 0.845; p=0.001). AUC’ler, IHM için istatistiksel olarak anlamlýlýk gösterdi (0.606; p=0.034, 0.626; p=0.012, 0.701; p=0.001). Uzun hastanede kalýþ süresi (LS) için AUC’ler 0.554 (p=0.041), 0.549 (p=0.062) ve 0.581 (p=0.002) idi.
TARTIÞMA: Klinik Abdominal Skorlama Sistemi (CASS), abdominal travmalý hastalarda laparotomi, IHM ve LS’yi öngörmek için mükemmeldir. Yeni Yaralanma Þiddet Skoru (NISS), laparotomi ve IHM’yi öngörmek için ISS’den daha uygundur.

BACKGROUND: This study investigated the correlations between several trauma scoring systems, including the injury severity score (ISS), clinical abdominal scoring system (CASS), new injury severity score (NISS), and clinical outcomes, including laparotomy, in-hospital mortality (IHM), and long hospital stay (LS) in patients with abdominal trauma.
METHODS: Data of 749 patients with abdominal trauma between January 2009 and December 2019 were reviewed retrospectively. Data from medical records included age, sex, initial vital signs, type and mechanism of trauma, hospital stay, laparotomy, and IHM. Injured organs and grades were collected using computed tomography. Correlations between the scoring system and clinical outcomes were analyzed using the area under Curves (AUC) of the receiver operating characteristic (ROC) curve.
RESULTS: The mean age of the patients was 40.14±19.47 years. Blunt trauma was the most common type of trauma in 704 patients (94.0%), and traffic accident was the most common mechanism in 475 (63.4%). Injured organs included liver (45.1%) and spleen (25.1%). A total of 179 patients (23.9%) underwent laparotomy and IHM was reported in 35 (4.6%). The AUC of ROC for ISS, NISS, and CASS was significantly associated with laparotomy (0.682; p=0.001, 0.713; p=0.001; 0.845; p=0.001). The AUCs showed significant for IHM (0.606; p=0.034, 0.626; p=0.012, 0.701; p=0.001). The AUCs for LS were 0.554 (p=0.041), 0.549 (p=0.062), and 0.581 (p=0.002).
CONCLUSION: The CASS is excellent for predicting laparotomy, IHM, and LS in patients with abdominal trauma. The NISS is more appropriate than the ISS for predicting laparotomy and IHM.

AMAÇ: Çocuklarda yanýk travmasý mortalite ve morbiditesi yüksek acil bir sorundur. Bu hastalarýn ilk 24 saat içindeki yönetimi prognozu önemli oranda etkiler. Amacýmýz acil serviste çalýþan doktorlarýn çocuk yanýk travmalý hasta yönetimi bilgi düzeyini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþma acil serviste çalýþan 229 doktor (acil týp uzmaný=80, pediatrist=84 ve pratisyen=65) ile yapýldý. Sorular Türkiye Saðlýk Bakanlýðý Yanýk Algoritma Rehberi, Amerikan Yanýk Derneði kriterleri ve güncel literatür esas alýnarak altý baþlýkta hazýrlandý; 1- Etiyoloji ve yanýk derecesi, 2- acil týbbi müdahale, 3- yanýk alanýný hesaplama ve sývý-elektrolit tedavisi, 4- yanýk tedavi birimleri yatýþ endikasyonlarý, 5- adli ve týbbi sorumluluk, 6- eðitim yeterliliði ve talebi. Çoktan seçmeli 25 soru Whatsapp uygulamasý ile katýlýmcýlara iletildi. Sonuçlar 100 puan üzerinden >%75 iyi, %50–75 orta, <%50 düþük þeklinde deðerlendirildi.
BULGULAR: Acil serviste çalýþan doktorlarýn çocuk yanýklarý toplam bilgi düzeyi 57.65±10.13 (Acil Týp: 60.11, Pediatrist: 57.56, Pratisyen: 54.75) puan ile orta idi. Acil týbbi müdahale puaný (35.02±22.43) ve yanýk tedavi birimleri ve yatýþ endikasyonlarý puaný (38.6±18.96) düþüktü. Acil týp uzmanlarýnýn týbbi müdahale puaný pediatrist ve pratisyenlerden istatistiksel olarak anlamlý derecede yüksek olmakla birlikte bu gurupta da düþüktü. Yanýk eðitimini yeterli bulanlarýn oraný: %15.3, düzenlenecek eðitime katýlmak isteyenlerin oraný ise %96.9 idi.
TARTIÞMA: Acil serviste çalýþan doktorlarýn çocuk yanýklarý bilgi düzeyi düþüktür. Acil serviste çalýþan doktorlara uygulamalý eriþkin ve çocuk yanýk eðitimi verilmelidir.

BACKGROUND: Prognosis of burned child is heavily influenced by how they are treated in the first 24 h. This study aimed to assess the degree of knowledge of emergency department physicians about the pediatric burn patients.
METHODS: The study included 229 physicians (80 emergency medicine specialists, 84 pediatricians, and 65 general practitioners). The questions were organized into six categories, each based on the Turkish Ministry of Health’s Burn Treatment Algorithm, American Burn Association criteria, and current literature: 1 – Etiology and Degree of Burn, 2 – Emergency Medical Intervention, 3 – Calculation of Burn Area and Fluid-electrolyte Treatment, 4 – Indications for Hospitalization in Burn Treatment Units, 5 – Judicial and Medical Liability, and 6 – Training Sufficiency and Demand for Burn Injury Training. Questionnaire form was sent to the participants through the WhatsApp application. The outcomes were rated as 75-100% good, 50%–75% moderate, and <50% poor.
RESULTS: The overall knowledge level of physicians about pediatric burns was moderate, with a score of 57.65±10.13 (emergency medicine specialists: 60.11, pediatricians: 57.56, and general practitioners: 54.75). Emergency medical intervention scores (35.02±22.43) and burn treatment units and hospitalization indications scores (38.6±18.96) were both low. Despite having a statistically significant higher medical intervention score than the pediatricians and general practitioners, the knowledge level of the emergency medicine specialists was poor.
CONCLUSION: As result, physicians practicing in the emergency department have a poor knowledge level about pediatric burns. Hence, pediatric burn education should be provided to all emergency department physicians.

AMAÇ: Akut pankreatitin (AP) sistemik komplikasyonlarýndan biri akut böbrek hasarýdýr (ABH). Akut pankreatitli hastalarda ABH geliþimi mortalite, morbidite ve tedavi maliyetini artýrmaktadýr. Bu nedenle ABH’nIn erken teþhisi ve önlenmesi önemlidir. Çalýþmamýzýn amacý, AP’li hastalarda geliþen ABH’nin biyobelirteçlerini ve olgu yönetimini sunmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmanýn katýlýmcýlarýný akut pankreatit tanýsý ile takip edilen 582 hasta oluþturdu. Akut pankreatitin tanýsýnda ve þiddetinin belirlenmesinde Atlanta sýnýflamasý kullanýldý. Hastalarýn acil servise ilk baþvuru anýndaki laboratuvar deðerleri kaydedildi. Kýrk sekiz saat sonra kan testleri yapýldý. Kan testleri taburcu olduklarý güne kadar günlük olarak izlendi.
BULGULAR: Akut pankreatit tanýsý ile baþvuran 582 hastanýn 344’ü kadýndý. AP tanýsý ile baþvuran hastalarýn 147’sinde (%25.2) ABH saptandý. ABH geliþen hastalarýn ortalama yaþý, ABH geliþmeyenlere göre daha yüksekti. ABH geliþen hastalarda albümin ve kalsiyum düzeyleri ABH olmayan gruba göre anlamlý derecede düþüktü. ABH olan grupta, ABH olmayan gruba göre CRP/albümin ve nötrofil/lenfosit oranlarý istatistiksel olarak anlamlý derecede yüksekti. ABH olan grup ile ABH olmayan grup arasýnda AST ve ALT düzeylerindeki artýþ deðerleri istatistiksel olarak anlamlý deðildi. ABH olan hastalarda, AKI’si olmayan hasta grubuna göre ortalama lökosit, CRP, prokalsitonin düzeyleri ve % IG oraný daha yüksekti. ABH olan hasta grubunda, AKI olmayan hasta grubuna göre lenfosit, hematokrit ve trombosit düzeylerindeki azalma daha yüksekti. ABH olan grubun baþvuru sýrasýndaki üre ve kreatinin düzeyleri, ABH olmayan gruba göre daha yüksekti. AP tanýsý ile takip ettiðimiz hastalarýn 13’ünde klinik tablo ölümle sonlandý. TARTIÞMA: Akut pankreatitli hastalarda hastaneye yatýþ anýnda bakýlan hematokrit, trombosit, lökosit, lenfosit, albümin, CRP, CRP/albümin oraný, nötrofil/lenfosit oraný, IG%, prokalsitonin, üre, kreatinin deðerleri ABH geliþimini öngörmede faydalý biyobelirteçler olabilir. Ayrýca eþlik eden hastalýklar ve yaþ da ABH geliþimini etkileyen faktörler arasýndadýr.

BACKGROUND: One of the systemic complications of acute pancreatitis (AP) is acute kidney injury (AKI). AKI development in patients with AP increases mortality, morbidity, and the cost of treatment. Therefore, early diagnosis and prevention of AKI is important. The purpose of our study was to present biomarkers and case management of AKI developing in patients with AP.
METHODS: The participants of this retrospective study consisted of 582 patients who were followed up with the diagnosis of AP. Atlanta classification was used for the diagnosis and the identification of severity of AP. The laboratory values of patients at the time of first application to the emergency room were recorded. Blood tests were checked 48 h/l. Their blood tests were monitored daily until the day of discharge.
RESULTS: Of the 582 patients who were admitted with the AP diagnosis, 344 were female. AKI was detected in 147 patients (25.2%) of the patients admitted with AP diagnosis. The mean age of patients developing AKI was higher than those who did not develop AKI. The albumin and calcium levels in patients developing AKI were significantly lower than the group without AKI. The C-reactive protein (CRP)/albumin and neutrophil/lymphocyte ratios were statistically significantly higher in the group with AKI than the group without AKI. The increase values in AST and ALT levels between the group with AKI and the group without AKI were not statistically significant. The mean leukocyte, CRP, procalcitonin levels, and immature granulocyte percentage (IG%) ratio were higher in patients with AKI in comparison to the patient group without AKI. The decrease in the lymphocyte, hematocrit, and platelet levels was higher in the patient group with AKI compared to the patient group without AKI. Urea and creatinine levels of the group with AKI at the time of admission were higher than the group without AKI. The clinical picture in 13 of the patients we followed up with AP diagnosis was mortal.
CONCLUSION: The values of hematocrit, platelet, leukocyte, lymphocyte, albumin, CRP, CRP/albumin ratio, neutrophil/lymphocyte ration, IG%, procalcitonin, urea, and creatinine that were examined at the time of hospital admission can be useful biomarkers in predicting the development of AKI in patients with AP. In addition, accompanying diseases and age are among the factors affecting AKI development.

AMAÇ: Triyaj, kitlesel yaralanmalarýn meydana geldiði kaza, deprem, yangýn ve sel gibi olaylarýn yönetiminin büyük bir bölümüdür. Bu çalýþmanýn amacý, 5 Þubat 2020 tarihinde Ýstanbul Sabiha Gökçen Havalimaný’nda 183 hasta ile meydana gelen uçak kazasýnda triyajýn hasta sonuçlarý, yaralanmalar, travma mekanizmasýnýn rolü ve spinal immobilizasyonu üzerindeki etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Komuta kontrol merkezi verileri, ambulans ve týbbi çizelgeler geriye dönük olarak incelendi. Sonuçlar acil müdahaleler ve nakil sýrasýnda spinal immobilizasyon, yaralanma tipi, triyaj kodlarý ve ISS deðerleri açýsýndan deðerlendirildi.
BULGULAR: 05.02.2020 tarihinde 18: 19’da inen ve düþen uçakla ilgili ilk bildiri 18: 21’de sisteme düþtü ve ilk ekip 18: 26’da güvenlik kapýsýna ulaþtý. Ýlk ekip enkaz alanýna geldi ve triyaj yaptý. Havalimanýnýn hava tarafýnda ilk kurbanlar 18: 32’de alýnarak 18: 36’da transfer edildi ve 18: 41’de hastaneye transfer edildiler. Ýlk vaka 18: 35’te enkaz alanýndan alýnarak hastaneye kaldýrýldý. Uçakta bulunan 183 yaralýdan üçü olay yerinde çýkýþ yaptý. Kurbanlarýn %43.7’si kadýn iken, yaþ ortalamasý 35.0±15.7’dir. Kurbanlarýn ortalama sistolik kan basýncý 122.0±17.4 idi. Hastanelere ortalama uzaklýk, ulaþým süresi, müdahale süresi, kalp hýzý ve ISS seviyeleri 55.0 (23.0–79.0) km; 780.5 (390.0–1540.0) sn; 817.0 (552.0-1200.0) sn; 86.0 (78.0–1000.0); 4.5 (1.0–9.0), sýrasýyla. ISS ile yatýþ günleri arasýnda pozitif yönde anlamlý iliþki bulundu (r=0.577; p<0.001).
TARTIÞMA: Takip ve tedavi sýrasýnda hiçbir hastanýn kaybedilmemesi baþta uçaðýn inerken düþmesinin yanýnda triyajýn, uygun hastanýn uygun hastaneye sevkinin, birinci ve ikinci basamak bakýmýn iyi yapýldýðýnýn bir göstergesidir. Havaalaný ve 112 Acil Saðlýk Hizmetleri’nin koordineli hareketi ve uygun triyaj hem hastane öncesi hem de hastane ölümlerini azalttý.

BACKGROUND: Triage is the most important part of the management of events, such as accidents, earthquakes, fires, and floods, in which mass injuries occur. The aim of this study is to evaluate the effects of triage on patient outcomes, injuries, the role of trauma mechanisms, and spinal immobilization during transportation following the plane crash at the Ýstanbul Sabiha Gökçen airport that involved 183 patients on February 5, 2020.
METHODS: Command control center data and ambulance and medical charts were examined retrospectively. The results were evaluated in terms of spinal immobilization, injury type, triage codes, and ISS values during emergency interventions and transportation.
RESULTS: We received the first notice at 18: 21 about the plane that had landed and crashed at 18: 19 on February 5, 2020, and the first team reached the security gate at 18: 26. The first team arrived at the debris field and performed triage. On the airside of the airport, the first victims were taken at 18: 32, transferred at 18: 36, and reached the hospital at 18: 41. The first case was taken from the debris field at 18: 35 and transferred to the hospital. Of the 183 patients on the plane, three became exitus at the scene, 43.7% of the victims were female, and the mean age was 35.0±15.7. The mean systolic blood pressure of the victims was 122.0±17.4. The mean distance to hospitals, transportation time, intervention time, heart rate, and ISS levels were measured as 55.0 (23.0–79.0) km; 780.5 (390.0–1540.0) s; 817.0 (552.0–1200.0) s; 86.0 (78.0–100.0); and 4.5 (1.0–9.0), respectively. A positive significant correlation was found between ISS and the days of hospitalization (r=0.577; p<0.001).
CONCLUSION: The fact that no patient was lost during the follow-up and treatment is an indication that triage, appropriate patient referral to the appropriate hospital, and primary and secondary care are well performed, as well as the crash of the plane while landing. Coordinated acts of the airport and 112 emergency health services and guidance for appropriate triage reduced both pre-hospital and hospital mortality.

AMAÇ: Üst gastrointestinal (GÝ) kanama acil servislerde (AS) en sýk görülen ziyaret nedenlerinden biridir. Bu çalýþmanýn amacý AS’i ziyaret edip üst GÝ kanama tanýsý alan hastalarda AIMS65 ve pre-endoscopy Rockall skorunun hastane içi mortalite tahmininde tahmin güçlerini deðerlendirmektir. GEREÇ VE YÖNTEM: Çalýþma süresi boyunca Kartal Dr. Lütfi Kýrdar Þehir Hastanesi Acil Servis’ine baþvuran 18 yaþ ve üzeri üst GÝ kanamalý hastalarýn verileri geriye dönük olarak analiz edildi. Veriler elektronik tabanlý bir hastane bilgi sisteminden elde edildi. Her puanlama sistemi, alýcý iþletim eðrisi (ROC) kullanýlarak karþýlaþtýrýldý.
BULGULAR: Çalýþma 592 hasta ile tamamlandý. Bu hastalarýn yaþ ortalamasý 63.5±19.0 olup bunlarýn %68.6’sý erkekti. Total hastane içi morta-lite oraný %5.2 idi. AIMS65 skorunun hastane içi mortaliteyi kestirmedeki ROC analizi sonucunda eðri altýnda kalan alan (AUC) 0.822 (%95 GA 0.788–0.852), Pre-endoscopy Rockall skorunun hastane içi mortaliteyi kestirmedeki ROC analizi sonucunda AUC 0.777 (%95 GA 0.741–0.810) olarak hesaplandý. Skorlar kendi aralarýnda karþýlaþtýrýldýðýnda ise skorlarýn hastane içi mortaliteyi kestirmede birbirlerine istatistiksel olarak anlamlý bir üstünlüðü saptanmadý.
TARTIÞMA: AIMS65 ve pre-endoscpy Rockall skorlarýnýn GÝ kanamasý olan hastalarda in-hospital mortalite tahmininde kullanýlabilir. Ancak AIMS65 skorunun sadece beþ deðiþkenden oluþmasý ve bu deðiþkenlerin AS’lerde kolayca hesaplanabilmesi nedeniyle klinik pratikte kullanýmýný öneriyoruz.

BACKGROUND: Upper gastrointestinal (GI) bleeding is one of the most common reasons for emergency department (ED) visits. This study aimed to evaluate the predictive power of the AIMS65 and pre-endoscopy Rockall scores in predicting in-hospital mortality in patients that presented to ED and were diagnosed with the upper GI bleeding.
METHODS: Data of patients aged 18 years and older, who visited ED of Kartal Dr. Lütfi Kýrdar City Hospital during the study period and were diagnosed with upper GI bleeding, were obtained from the electronic-based hospital information system and analyzed retrospectively. Each scoring system was compared using the receiver operating characteristic (ROC) curve analysis.
RESULTS: The study was completed with 592 patients. The mean age of the patients was 63.5±19.0 years, and 68.6% were male. The total in-hospital mortality rate was 5.2%. In the ROC analysis of the AIMS65 and pre-endoscopy Rockall scores in the prediction of in-hospital mortality, the area under the curve values was calculated as 0.822 (95% confidence interval [CI]: 0.788–0.852) and 0.777 (95% CI: 0.741–0.810), respectively. When these two scoring systems were compared, neither had statistically significant superiority over the other in predicting in-hospital mortality.
CONCLUSION: The AIMS65 and pre-endoscopy Rockall scores can be used to predict in-hospital mortality in patients with GI bleeding. However, since the AIMS65 score consists of only five variables that can easily be calculated in ED, we recommend its use in clinical practice.

AMAÇ: Çocuðun fiziksel istismarý; bakým veren tarafýndan yapýlan, kaza dýþý ve önlenebilir her türlü fiziksel þiddet ve yaralanmayý kapsar.
GEREÇ VE YÖNTEM: Çalýþmaya 2017–2021 yýllarý arasýndaki beþ yýllýk süreçte, 0–3 yaþ grubu kafa içi kanama bulgusu ile acil servisine baþvuran çocuklarýn, yaþ, cinsiyet, baþvuruyu yapan kiþi, klinik taný, kanama dýþý bulgularý yönleriyle geriye dönük deðerlendirilerek, baþvurularýn çocuðun fiziksel istismarý açýsýndan dikkat edilmesi gereken bulgularý literatür eþliðinde ortaya konulmuþtur.
BULGULAR: Çalýþmaya dahi edilen 32 olguda en sýk rastlanan kraniyal bulgu subdural hematom iken, en sýk gözlenen ekstrakranial bulgu ekimozlar olarak tespit edilmiþtir. Olgularýn yüzde 9.37’sinin ise acil servise baþvurusun iki gün daha geç sürede yapýldýðý görülmüþtür.
TARTIÞMA: Çocuðun fiziksel istismarýna iliþkin bulgular ile karþýlaþan hekim, ayrýntýlý bir anamnez ve muayene sonucu elde ettiði veriler ile istismar lehinde kanaat oluþturduðunda mutlaka adli ve sosyal bildirimi yapmalýdýr. Aksi halde davranan ya da bildirimden kaçýnan hekim, ilerleyen süreçte hem hukuki hem de vicdani sorumluluk içinde kalacaktýr.

BACKGROUND: Physical abuse of children covers all types of non-accidental and preventable physical violence and injury perpetrated by the caregiver.
METHODS: The study included children in the 0–3 years age group who presented at the Emergency Department (ED) with the finding of intracranial hemorrhage during the 5-year period of 2017–2021. These children were evaluated retrospectively, and findings that should be considered were revealed.
RESULTS: In the 32 cases included in the study, the most common cranial finding was subdural hematoma, and the most common extracranial finding was ecchymoses. Presentation at the ED was seen to be 2 days after the trauma in 9.37% of the cases.
CONCLUSION: Any physician who encounters findings related to physical abuse of a child must make a forensic and social services report. Physicians who do not make the necessary reports or act to the contrary have both a legal and moral responsibility in the subsequent process.

AMAÇ: Fournier gangreninde (FG) mortaliteyi etkileyen faktörleri araþtýrarak, saðkalýmý arttýrabilecek yöntemleri geliþtirmek amaçlanmýþtýr. GEREÇ VE YÖNTEM: Ýstanbul Prof. Dr. Cemil Taþçýoðlu Þehir Hastanesi Cerrahi Kliniði’nde 01.02.2012–30.06.2021 tarihlerinde FG tanýsýyla yatan 73 olgu geriye dönük incelendi. Saðkalanlar (Grup 1: 56), ölenler (Grup 2: 17) olarak ayrýldý. Gruplar cins, yaþ, enfeksiyonun geniþliði, Uludað Fournier Gangreni Þiddet Ýndeksi (UFGSI), Fournier Gangreni Þiddet Ýndeksi (FGSI), enfeksiyonun kaynaðý, yandaþ hastalýklar, stoma varlýðý, Vacuum Assisted Closure süresi, yattýðý gün sayýsý, yoðun bakým süresi (YBS), bakteri türleri açýsýndan karþýlaþtýrýldý. Sonuçlar, SPSS 21.0 programý kullanýlarak deðerlendirildi.
BULGULAR: Mortalite %23’dü, 31 kadýn, 42 erkek içeriyordu. Gruplar arasýnda cinsiyette anlamlý fark bulundu (p=0.001). Toplamda ortalama yaþ 57.29±13.36, Grup 1’dekilerin ortalama yaþý (53.66±11.185) Grup 2’dekilerin ortalamasýndan (69.24±13.264) anlamlý küçüktü (p=0.000). Enfeksiyonun geniþliði Grup 1’de anlamlý düþüktü (p=0.011). UFGSI ve FGSI skorlarý Grup 1’de Grup 2’den anlamlý düþüktü (sýrasýyla p=0.00, p=0.009). Hematokrit, bikarbonat deðerleri Grup 2’de anlamlý düþüktü (p=0.000, p=0.015). UFGSI ve FGSI, mortalitenin öngörülmesinde sýrasýyla %100 ve %82 duyarlýlýk ve sýrasýyla %68 ve %58 özgüllüðe sahipti. UFGSI ve FGSI eþik deðerleri 8 ve 6 bulundu. Grup 1’dekilerin 29’unda, Grup 2’dekilerin tamamýnda yandaþ hastalýklar vardý, anlamlý fark bulundu (p=0.000). YBS Grup 2’de anlamlý uzundu (p=0.000).
TARTIÞMA: UFGSI 8’den küçük hastalarda saðkalým yüksek, nadiren yoðun bakým gerektirir. UFGSI 8’den büyük hastalarda mortalite yüksektir. Bu hastalar genel cerrahi, plastik cerrahi, yoðun bakým uzmanýndan oluþan deneyimli bir takým tarafýndan yoðun bakým ünitesinde tedavi edilmelidir.

BACKGROUND: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier’s gangrene (FG) and develop methods to increase the survival rate.
METHODS: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taþçýoðlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species.
RESULTS: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively.
CONCLUSION: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

AMAÇ: Karaciðer travmasýna yaklaþýmýn tarihsel geliþimine bakýldýðýnda ameliyatýn zorunlu, ameliyat dýþý tedavinin ise seçilerek uygulandýðý bir dönemden günümüzde ameliyat dýþý tedavinin yaygýn uygulandýðý ve ameliyatýn seçilerek uygulandýðý bir döneme doðru ilerleme olduðu görülmektedir. Karaciðer travmasýnýn tedavisinde karaciðer rezeksiyonunun kýsýtlý bir rolü bulunmaktadýr. Ancak, aðýr karaciðer travmasýnda cerrahi tedavi hayat kurtarmak için tek seçenektir.
GEREÇ VE YÖNTEM: Sekiz yýllýk süre zarfýnda merkezimizde tedavi edilen aðýr seviyedeki beþ künt karaciðer yaralanmasý olgusunun verileri geriye dönük olarak sunuldu.
BULGULAR: Hastalarýn ortanca yaþý 30.8 (23–43), en sýk yaralanma mekanizmasý ise aracýn yayaya çarpmasýydý (%60). Ýki hasta merkezimize baþka merkezlerde kanama kontrolüne yönelik yapýlan ameliyat sonrasýnda transfer edildi. Karaciðer hasarýnýn derecesi çoðunlukla V. dereceydi (%80). Tüm olgularda karaciðer sað lobda deðiþen geniþlikte hasar olduðu gözlemlendi. Dört hastada eþlik eden büyük damar yaralanmasý saptandý. Hemostazý saðlamak için sað hepatektomi (n=1), segment 5, 6 ve 7’nin rezeksiyon yolu ile debritmaný (n=1), posterior sektörektomi (n=2) ve segment 7 rezeksiyonu (n=1) uygulandý. Ýnferior vena kava ile sað hepatik ven bileþkesi (n=1), sað hepatik venin ön yüzeyi (n=1), segment 7’nin hepatik veninin sað hepatik vene açýldýðý bölge (n=1), ana portal ven (n=1) ve sað renal ven (n=1) yaralanmalarý vasküler teknikle onarýldý. Ortanca ameliyat süresi 162 dakikaydý (120–180 dk). Ameliyat mortalite oraný %20 bulundu. Yaþayan dört hastada üçünde tekrar ameliyata gerek duyuldu. Dört hastanýn ikisinde komplikasyonlar görüldü. Yoðun bakým ve hastanede kalýþ ortanca süreleri sýrasý ile 12.4 gün (1 ile 48 gün arasý) ve 28.2 gündü (1 ile 65 gün arasý). TARTIÞMA: Paketleme (packing) uygulamasýnýn hemostazý saðlayamadýðý aðýr karaciðer yaralanmasý varlýðýnda cerrah, kanamanýn ancak vasküler kontrol manevralarý ve karaciðer rezeksiyonu ile durdurulabileceðini aklýndan çýkarmamalýdýr.

BACKGROUND: The management of hepatic trauma has a historical progress from mandatory operation with selective non-operative treatment, to non-operative treatment with selective operation. Liver resection (LR) seems to have a minimal role in the management of liver injury. However, surgical treatment becomes the only life-saving treatment in cases with severe liver trauma.
METHODS: It is a retrospective presentation of five cases with severe blunt liver injury whose were admitted at our center during the 8-year period.
RESULTS: The median age of patients was 30.8 (23–43). The most frequent mechanism of injury was pedestrian struck (60%). Two of five cases were transferred to our hospital from rural state hospitals after initial attempt to achieving hemostasis. The majority of liver injury was grade V (80%). The right lobe of the liver was injured in different extensions. Major vascular injury was associated to liver injury in four of five cases. The right hepatectomy (n=1), resectional debridement of segments 5, 6, and 7 (n=1), posterior sectorectomy (n=2), and segment 7 resection (n=1) were performed for hemostasis. Vascular injuries in the junction of inferior vena cava and right hepatic vein (n=1), the anterior surface of the right hepatic vein (n=1), the junction of segment 7 hepatic vein and right hepatic vein (n=1), the main portal vein (n=1), and the right renal vein (n=1) were repaired. Median operation time was 162 min (120–180 min). Operative mortality was 20%. Reoperation was needed in three of four survived cases. In-hospital complications were observed in two of four survived cases. Median stay in intensive care unit and hospital was 12.4 days (1–48 days) and 28.2 days (1–65 days), respectively.
CONCLUSION: When a severe liver injury is unresponsive to packing, the surgeon must always keep in mind that extensive maneuvers for vascular control and LR are required for bleeding control.