AMAÇ: Eklemiçi kalkaneus kýrýklarýnýn tedavisi ve postoperatif rehabilitasyon programý tartýþmalýdýr. Bu çalýþmanýn amacý, açýk redüksiyon ve kilitli plak ile internal fiksasyon metoduyla tedavi edilen eklem içi kalkaneus kýrýklý hastalarýn radyolojik ve klinik sonuçlarýnýn retrospektif deðerlendirilmesidir. Kliniðimizde 2003-2005 yýllarý arasýnda eklem içi kalkaneus kýrýðý nedeni ile cerrahi tedavi uygulanan 13 hastanýn 15 ayaðý çalýþmaya dahil edildi. 10 erkek 3 kadýn hastanýn ortalama yaþý 29 (daðýlým; 15-47), ortalama takip süresi 24 aydý (daðýlým; 16-38). Hastalarýn pre-operatif, post-operatif ve takip radyografilerinde Böhler açýlarý deðerlendirildi. Ameliyat öncesinde bilgisayarlý tomografi çekilerek kýrýklar Sanders sýnýflamasýna göre sýnýflandýrýldýlar. Onbeþ ayaðýn 11'inde (%75) Böhler açýsý normal sýnýrlarda düzeltildi. Hastalarýn %73'ünde anatomik ve anatomiðe yakýn redüksiyon elde edildi. Klinik olarak AOFAS skorlamasý ile hastalarýn fonksiyonel iyileþmesi ve aðrýsý deðerlendirildi; son kontrollerinde ortalama AOFAS skoru 80.1 (daðýlým; 72–97) bulundu. Ýki hastada yüzeyel cilt enfeksiyonu, 1 hastada geçici, bir baþka hastada kalýcý sural sinir yaralanmasýna baðlý hipoestezi geliþti. Sonuç olarak özellikle Sanders tip II ve III kalkaneus kýrýklarýnda açýk redüksiyon ve kilitli plak ile internal fiksasyon sonuçlarýnýn tatminkar olduðu düþünüldü.
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OBJECTIVE: Management and postoperative rehabilitation programme of intraarticular calcaneus fractures are controversial. The purpose of this study was to retrospectively evaluate the radiological and clinical results of patients with intraarticular calcaneal fractures managed with open reduction and internal fixation using locking plates. Fifteen calcaneal fractures of 13 patients who were operated in our clinic between 2003-2005 were included in the study. There were 10 male and 3 female patients with an average age 29 (range; 15-47) and the mean follow up period was 24 months (range; 16-38). Bohler angle and the reduction of the posterior articular facet were evaluated on preoperative, postoperative and follow-up radiographs. The fractures were classified according to the Sanders classification sysytem based on preoperative computerized tomographic evaluation. Bohler angle could be corrected to normal ranges in 11 of 15 patients (%75). Anatomic or near-anatomic reduction of posterior articular facet could be obtained in %73 of patients. Evaluation of function and pain were also done by using AOFAS score sheets; average AOFAS score was 80.1 (daðýlým; 72–97). Superficial wound infection in 2 patients and sural nerve neuropraxia which spontaneously healed in one patient was observed. Persistent hypoesthesia due to sural nerve damage occured in one other patient. Our conclusion is that surgical treatment of calcaneal intraarticular fractures, particularly Sanders type II and III is an effective and safe method.
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AMAÇ: Kene ýsýrmasý nedeniyle 1.9.2006 ve 1.9.2007 tarihleri arasýnda çocuk acil servisine getirilen 542 çocuðun demografik, klinik ve laboratuar özellikleri retrospektif olarak deðerlendirildi. 304’ü (%56) erkek ve 238’ü (%44) kýz olan olgularýn yaþ ortalamasý 7.1±2,4 yýl (4ay-14 yaþ) olarak saptanýrken; 23’ünün (%4.2) 4-12 ay; 51’inin (%9.3) 1-2 yaþ, 179’unun (%33) 3-5 yaþ; 216’sýnýn (%40) 6-10 yaþ ve 73 olgunun (%13.5) 11-14 yaþlar arasýnda olduðu görüldü. Olgularýn tamamýna yakýnýnýn(%98.2) yaz aylarýnda baþvurduðu, ýsýrma ile hastaneye baþvuru arasýndaki zamanýn 3 saat ile 9 gün arasýnda deðiþtiði, 280 (%51.6) olgunun ýsýrýldýktan sonraki ilk 24 saat içinde, 44’ünün (%8.2) ikinci günde, 80 olgunun (%14.7) üçüncü günde, 84’ünün (%15.5) dördüncü günde, 54(%10) olgunun beþ gün ve sonrasýnda getirildikleri görüldü. Ýki yüz yirmi altý (% 42) olguda kenenin evde, 316(%58) olguda ise hastanede çýkarýldýðý saptandý. Tüm olgular tam kan sayýmý, biyokimyasal incelemeler ve kanama fonksiyon testleriyle deðerlendirildiler. Toplam 19 olgu (% 3.5) gözlem amacýyla interne edildi, kan örnekleri saðlýk müdürlüðüne gönderildi. Hastalarýn hiçbirisine ribavirin profilaksisi verilmedi. Hiçbir hastamýzda Kýrým Kongo Kanamalý Ateþi bulgularýna rastlanmadý. Hastalýk açýsýndan endemik bölgede olan ülkemizde, yapýlan tüm eðitimlere raðmen hem ýsýrýlma sayýsýnýn çokluðu hem de kenenin evde çýkarýlma oranýnýn yüksekliðine dikkat çekmek ve bu konuda toplumun daha yaygýn ve etkin olarak bilgilendirilmesi gerekliliði vurgulanmak istendi.
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OBJECTIVE: The 542 children admitted to our pediatric emergency department between January 1st 2007 to September 1st 2007 were evaluated. Demographic, clinical and laboratory features were analysed retrospectively. The study group consisted of 304 (%56) male, 238 (%44) female children. The mean age of the patients was 7.1± 2,4 years (4 months-14 years); 23 (4.2%) of which were between 4-12 months of age, 51(9.3%) 1-2 years of age, 179 (33%) 3-5 years, 216 (40%)6-10 years and 73 (13.5%) were between 11-14 years of age. Majority of cases were encountered during June, July and August. Regarding time of admittance to emergency department, 280 (51.6%) admitted in 24 hours, 44(8.2%) in 48 hours, 80(14.7) in 72 hours, 84(15.5) in 96 hours, 54(10%) in 120 hours. In 226 (42%) patients tick was removed at home and in 316(58%) at hospital. All patients were evaluated by complete blood count, biochemical tests and coagulation studies. Of the 542 patients; 19(3.5%) were hospitalized and their serum samples were collected for virus isolation. None of them received Ribavirin. Crimean-Congo haemorrhagic fever was not observed in any of the patients. In this study, we wanted to emphasize the frequency of tick bites and the high number of efforts to remove the tick at home. Although there are many educational efforts about CCHF in our country which is in endemic region for this disease, the importance of education of not only the medical staff but also the community should be stressed.
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AMAÇ: Gastrointestinal sistemin vasküler lezyonlarý akut aþikar, akut gizli ve kronik aþikar, kronik gizli kanamaya yol açmalarý nedeniyle önemlidir. Kanser tarama programlarý nedeniyle endoskopinin sýk olarak yapýlmasý, kapsül endoskopi ve çift balon enteroskopinin yaygýnlaþmasý, BT anjiyografi ve MRI anjiyografi gibi yeni görüntüleme yöntemlerinin kullanýlmasý gastrointestinal sistemin vasküler lezyonlarýnýn daha sýk taný almasýný saðlamýþtýr.
Bu çalýþmada kliniðimizde kanama dýþý nedenle yapýlan üst ve alt gastrointestinal sistem endoskopilerinde anjiyoektazi sýklýðýný, lokalizasyonunu ve hasta profilini deðerlendirmek üzere, Ocak 2006-Temmuz 2008 arasýnda yapýlan üst ve alt gastrointestinal sistem endoskopileri retrospektif olarak incelendi.
Toplam 2837 üst gastrointestinal sistem endoskopisi ve 1220 alt gastrointestinal sistem endoskopisi deðerlendirildi. Üst gastrointestinal sistem endoskopik deðerlendirmesinde 5 (% 0.17) hastada anjiyoektazi saptandý. Anjioektazi saptanan hastalarýn 3’ü (% 60) kadýn, 2’si (% 40) erkekti ve yaþ ortalamasý 56 yýldý. Bir hastada korpusta 4, bir hastada korpusta 2, bir hastada 1 korpus 1 antrumda, bir hastada 1 antrumda ve bir hastada 1 antrum 1 bulbusta 1cm ve altýnda anjiyoektaziler saptandý.
Toplam 1220 alt gastrointestinal sistem endoskopi deðerlendirmesinde 7 (% 0.57) hastada anjiyoektazi saptandý. Anjiyoektazi saptanan hastalarýn 4’ü (% 57) kadýn, 3’ü (% 43) erkekti, yaþ ortalamasý 52 yýldý. Kolonoskopi ile deðerlendirilen iki hastada inen kolonda 2, bir hastada çekumda 1, bir hastada sigmoid kolonda 1 ≤1cm lik anjiyoektazi saptandý. Bir hastada ise çekumda 2cm’lik anjiyoektazi saptandý. Rektosigmoidoskopi ile deðerlendirilen 2 hastanýn birinde rektumda 1, diðerinde 1 sigmoidde, 1 rektumda 2 adet ≤1cm lik anjiyoektaziler bulundu.
Anjiyoektazi gastrointestinal sistemde nadir olarak görülür. Kanama dýþý nedenle yapýlan endoskopilerde daha az oranda bulunur. Anjiyoektazinin genel olarak sað kolonda daha sýk görüldüðünün bilinmesine raðmen çalýþmamýzda olduðu gibi sol kolonda da sýklýkla görülebilir.


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OBJECTIVE: The vascular lesions of gastrointestinal tract are important since they may cause acute or chronic, overt or silent bleeding.Introduction of new imaging techniques have led to easier diagnosis of vascular lesions of gastrointestinal tract.
In this study we evaluated the patient profile and the incidence and localization of angioectasis in upper and lower gastrointestinal endoscopies performed between January 2006 and July 2008 retrospectively.
2837 upper gastrointestinal and 1220 lower gastrointestinal endoscopies were performed. Angioectasias was discovered in 5 patients (% 0.17) in upper gastrointestinal endoscopies. Three of the patients were females (%60) and 2 (40%) males with a mean age of 56 years. One of the patients had four lesions in corpus, one patient had two lesions in corpus, one patient had one lesion in antrum and one lesion in corpus, one patient had one lesion in antrum, and the last had one lesion in antrum and another in bulbus while all the lesions were measuring less than 1 cm.
In 1220 lower gastrointestinal endoscopies 7 patients(% 0.57) had angioectasias. Four females and 3 males with a mean age of 52 years were identified. Angioectasias were in descending colon in two patient, in caecum in another, in sigmoid colon in another and were measuring equal or less than 1 cm. Only one patient had an angioectasia as large as 2 cm in caecum. In rectosigmoidoscopy we found an angioectasia in rectum in one patient and in sigmoid colon and rectum in the second patient each measuring equal or less than 1 cm.
Angioectasias are rare in gastrointestinal system. In endoscopies done for indications other than bleeding, it is even more rare. Although angioectasias are reported to be more in the right hemicolon, it can also appear in left hemicolon as in our study.


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AMAÇ: Deplase olekranon kýrýklarý, eklem içi kýrýklardýr ve tedavisi hemen her zaman cerrahidir. Bu çalýþmanýn amacý, kliniðimizde germe bandý tekniði ile opere edilen olekranon kýrýklý hastalarýn sonuçlarýný retrospektif inceleyerek hastalarýn subjektif þikayetlerini ve fonksiyonel sonuçlarýný etkileyen faktörleri belirlemektir. 2001- 2005 tarihleri arasýnda kliniðimizde cerrahi olarak tedavi edilen ve en az 1 yýllýk takibi bulunan 28 hasta çalýþmaya dahil edildi. Hastalarýn 18’i erkek, 10’u kadýn, ortalama yaþ 37 (16-58), ortalama takip süresi 32 aydý (13-62). Gustillo-Anderson sýnýflamasýna göre 4 hastada Tip I, 1 hastada Tip II açýk kýrýk vardý. Kýrýklar Schatzker-Schmeling morfolojik sýnýflamasýna göre sýnýflandýrýldýlar. Son kontrollerinde hastalar radyolojik olarak eklemde basamaklanma miktarý, dejeneratif deðiþikliklerin varlýðý, fonksiyonel açýdan da Broberg ve Morrey indeks skoruna göre ve karþý dirsek hareketleri ile karþýlaþtýrýlarak deðerlendirildiler. Hastalarýn tamamýnda ortalama 8 (6-10) haftada kaynama saðlandý. Hastalarýn 10’unda (%36) deðiþik düzeyde dejeneratif artrit bulgularý, dirsek hareket açýklýðýnda da karþý tarafa göre ortalama 10°’lik kayýp (5-12°) gözlendi. Broberg ve Morrey endeksine göre 21 hastada mükemmel ve iyi, 6 hastada orta ve 1 hastada kötü sonuç alýndý. Stabil olekranon kýrýklarýnda uygun cerrahi teknikle yapýlmýþ modifiye germe bandý tekniði ve erken rehabilitasyonun, iyi sonuçlar üzerinde etkili olduðu bulundu.
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OBJECTIVE: Displaced fractures of the olecranon are almost always managed surgically. The aim of this study was to retrospectively evaluate the results of patients with displaced olecranon fractures who had been operated with tension band wiring method and to understand the subjective complaints and factors influencing the overall functional outcomes. Twenty eight patients who had been operated at our clinic for displaced olecranon fractures between 2001-2005 with at least one year of follow up have been retrospectively evaluated. Eighteen of the patients were male and 10 were female. The mean age of the patients was 37 (range;16-58) and the mean follow up was 32 months (range; 13-62). Four patients had Gustillo-Anderson Type I and one patient had Gustillo-Anderson Type II open fracture. Schatzker-Schmeling morphological fracture classification was used. The patients were radiologically evaluated for the presence of any articular step off or any degenerative changes, and were clinically evaluated according to the Broberg - Morrey index scores; operated side elbow range of motions were compared with the contralateral extremity. All cases had a solid union of the fracture. Degenerative changes of the elbow joint at the varying degrees were observed in 10 (%36) of the patients and an average of 10° (range; 5-12) loss of elbow motion was observed in the study. According to the Broberg – Morrey classification, 21 patients (%75) had perfect or good, 6 patients (%21) had fair and one patient (%4) had poor result. The retrospective evaluation of the patients with fair and poor results showed that these fractures were high energy, unstable, comminuted fractures of whom postoperative rehabilitation program could not be started immediately. Modified tension band wiring method with good surgical technique in combination with early postoperative rehabilitation seemed to be effective on overall functional results of stable displaced olecranon fractures.
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Olgu I: Otuzbeþ yaþýndaki erkek hasta þuur kapalý olarak yakýnlarý tarafýndan acil servise getirildi. Ýlk muayenesinde; Genel durum kötü, pupil ýþýk refleksi bilateral alýnýyor, kirpik refleksi mevcuttu. Kalp sesleri ritmik, tansiyon arteriyel: 110/70 mmHg, kalp tepe atýmý: 121/dk idi. Spontan solunum mevcut, akciðerlerde dinlemekle bilateral yaygýn ronküsler mevcuttu. Labaratuvar bulgularýnda; karboksi hemoglobin düzeyi(COHb): %56.3 olarak tespit edildi. nörolojik muayenede Glaskow Koma Skoru: 3 olarak deðerlendirildi. Hasta entübe edilerek yoðun bakým ünitesine alýndý. Tidalvolüm: 5ml/kg, frekans: 12/dk, PEEP: 5cmH2O, PSV: 15 mbar, FÝO2: %100 olarak SÝMV+ PSV modunda respiratöre baðlandý. Kranial tomografide (CT) patolojik bulguya rastlanmadý. Yatýþýnýn ilk 6. saatinde hiperbarik oksijenizasyona gönderildi. Ýki kez hiperbarik O2 uygulandý. 4. gün sonunda alýnan kan gazý deðerinde COHb’nin %1,4 e düþmesi ve hastanýn kan gazlarýnýn düzelmesi üzerine önce CPAP moduna alýndý. Daha sonra easy breath denendi. 4. günde ekstübe edildi ve ilgili kliniðe þifa ile devredildi.

Olgu II: On dokuz yaþýnda bayan hasta sobadan sýzan gazdan zehirlenerek bilinç deðiþiklikleri ve dezoryante davranýþlarý olmasý üzerine acil servise getirilmiþ. Ýlk muayenesinde; Genel durum orta, pupil ýþýk refleksi bilateral alýnýyor, kirpik refleksi mevcut. Kalp sesleri ritmik, TA: 120/70 mmHg, KTA: 70/dk idi. Spontan solunum mevcut, akciðer sesleri dinlemekle eþit ve doðaldý. Labaratuvar bulgularýnda; karboksi hemoglobin (COHb): % 34,6 olarak bulundu. Nörolojik muayenede GKS: 15 olarak tespit edildi ve maske O2 ile YBÜ’ne alýndý. Yatýþýnýn ilk gününde hiperbarik oksijenizasyona gönderildi. Bir kez hiperbarik O2 uygulandý 2. gün sonunda COHb’nin % 1’e düþmesi ve hastanýn kan gazlarýnýn normal olmasý üzerine ilgili kliniðe þifa ile devredildi.

Sonuç olarak; CO zehirlenmesinde erken dönemde hiperoksijenizasyon uygulamak ve akut dönemde hiperbarik O2 tedavisine baþlanmasýnýn mortalite açýsýndan olduðu kadar ileri dönemde oluþma ihtimali olan nöropsikolojik sekellerin önlenmesinde önemli bir uygulama olduðu hatýrlanmalýdýr.

Case I: 35 year old male patient with closed concious was brought to hospital emergency service by his relatives.Ýn first examination;general condition was bad,pupil light reflex was +/+, eyelash reflex was existing.Heart sounds were rithmic, tension arterial (TA): 110/70 mmHg, heart rate (HR): 121/min. Spontaneus respiration was existing and there were bilateral diffuse roncuses by listening lungs. Carboxy hemoglobine (COHb) was founded %56,3 in labrotory analysis. In neurological examination, GCS was evaluated as 3. Patient was intubed and taken to the intensive care unit. He connected to the respirator as, Tidal volume: 5ml/kg, frequency: 12/min, PEEP: 5 cmH2O, PSV: 15 mbar, FÝO2: %100 in SÝMV+ PSV mode. Patological finding wasn’t determined in Cranial tomographie(CT).The patient was sent to hyperbaric oxygenation treatment in first 6 hours of taking dose. Hyperbaric O2 was applied 2 times.According to decreasing of COHb to % 1,4 in blood gases value and recovering of the blood gases into normal, the patient was taken to the CPAP mode at first,then easy breath tried at the end of the 4th day.He was extubed in 4th day and sent to the related clinic with a good health.

Case II: 19 year old female patient was brought to emergency service with the conscious changes and unoriented motions because of the poisoning from the gases that pass out from the stove. Ýn first examination; general condition was average,pupil light reflex was +/+, eyelash reflex was existing.Heart sounds were ritmic, TA: 120/70 mmHg, KTA: 70/min.Spontaneus respiration was existing and lung sounds were bilateral equal to listening and natural. Carboxy hemoglobine (COHb) level was founded %34,6 in labarotory analysis.In neurological examination GCS was evaluated as 15 and then patient was followed by a mask with %100 O2 and taken to the intensive care unit. She was sent to hyperbaric oxygenation in the first day of taking. Hyperbaric O2 was applied one time. Because of the blood gases value recovered to the normal level, the patient was sent to the related clinic with a good health at the end of the 2 nd day.
As a result, administration of hyperoxygenisaton in early period and begining to the hyperbaric O2 treatment in acute period must be remembered as an important application for mortality and also preventing of neurophysicological sequels that have a probability of being in post period.

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Kondroid siringoma ter bezi glandlarýndan köken alan, genellikle altýncý veya yedinci dekatta ortaya çýkan, nadir görülen bir tümördür. Bu nadir görülen tümörün spesifik bir makroskobik görünümü olmadýðýndan, sýk görülen diðer tümöral lezyonlarla karýþtýrýlabilir. Çalýþmamýzda üst dudaðýnda kondroid siringoma olan otuzyedi yaþýnda erkek bir olgu sunularak bu nadir tümörün taný ve tedavisi hakkýnda literatürdeki bilgiler gözden geçirilmiþtir.

Chondroid syringoma is a rare tumor which is derived from the sweat glands. It is usually encountered in the sixth or seventh decade of life. Since it is rare and has no spesific macroscopic appearance, it may be confused with the other frequent skin lesions. In this article, a case of a 37 year-old male patient who had a chondroid syringoma on his upper lip was presented and the literature about the diagnosis and the tretment of this rare tumor is rewieved.

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Osteokondrom kemik dokunun sýk görülen iyi huylu primer tümörüdür. Sýklýkla 1. – 3. dekatta görülür. Genellikle uzun kemiklerin kartilajenöz bölgelerinde görülmektedir. Nadiren kafatasý tabaný, vertebral kolon, kosta, skapula ve pelvis yerleþimli olabilir. On yaþýndaki erkek olgumuzda sað üçüncü kosta ve çevresindeki yumuþak dokuda kitle tespit edilmesi üzerine sað aksiller torakotomi insizyonu ile 3. kosta ve kitle rezeke edildi. Patolojik deðerlendirme sonucu osteokondrom olarak raporlandý. Bir yýldýr takipte olan olgumuzda herhangi bir patoloji saptanmadý. Bu makalede osteokondrom için nadir yerleþim yeri olan kosta kökenli osteokondrom olgusu literatür bilgisi ile sunulmaktadýr.

Osteochondroma is a frequently seen primary tumuor of skeletal system. This pathology is usually observed between first and third decade, and generally originates from cartilaginous part of the long bones. Rarely skull base, columna vertabrales, ribs, scapula and pelvic bones can be involved. A 10-year-male child was diagnosed as having a mass on the right third rib. He underwent resection of the mass and the third rib through a right axillary thoracotomy. Pathologic evaluation of the lesion revealed the diagnosis of osteochondroma. The patient was observed for one year with a favorable outcome after surgery. This report presents a rare pathology of an osteochondroma originating from a rib in the view of the literature.

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Dalaðýn sekonder kistleri künt travmalarý takiben geliþebilen nadir lezyonlardýr. Dalaðýn gerçek kistleri, pankreas psödokistleri, karaciðerin sol lateral segmente ait basit kistleri ve hidatik kistlerle ayýrýcý taný yapýlmalýdýr. Komplike ve semptomatik kistlerde splenektomi, cerrahi tedavi seçeneklerinden biridir. Diðer seçenekler parsiyel dekapsülasyon ve parsiyel splenektomidir. Cerrahi dýþý tedavi seçeneklerinden perkütan drenaj, hasta için en konforlu olanýdýr. Çalýþmamýzda 20 cm yi aþan çapa sahip posttravmatik semptomatik psödokisti olan bir olgu sunulmuþtur. Kist komplikasyonsuz olarak perkütan drene edilmiþ ve rekürrens geliþmemiþtir.

Secondary cysts of the spleen are rare lesions which can occur following blunt traumas. Differential diagnosis should be made with true cysts of the spleen, pancreatic pseudocysts, simple liver cysts of the left lateral segment and hydatid cysts. Splenectomy is surgical choice for the treatment of symptomatic or complicated cysts. Partial decapsulation and partial splenectomy are other methods. Percutaneous drainage is mostly comfortable for the patient. We present a case of posttraumatic, symptomatic pseudocyst which is over 20 cm. in diameter.The cyst has been drained percutaneously without any complication and no recurrens was detected.

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