NormNormalization is an essential step in data analysis and for MCDM methods. This study aims to outline the positive and negative features of the normalization techniques that can be used in MCDM problems. In order to compare the different normalization techniques, fourteen sets representing different scenarios of decision problems were used. According to the results, if the decision-maker chooses to take the alternative with the highest value in the criteria and avoid the one with the lowest value, or vice versa, optimization-based normalization techniques should be preferred, whereas the reference-based normalization techniques are considered appropriate for situations where there are ideal values determined by the decision-maker for each criterion. However, if the decision-maker believes that the values in the criteria do not represent the monotonous increasing or decreasing benefit/cost, then non-linear normalization techniques should be used. Also, in the event of a change in the conditions mentioned above, the decision maker may opt for mixed normalization techniques. However, some data structures, such as the presence of zero, and negative values in the decision matrix, can prevent the use of some normalization techniques. The choice of the normalization technique may also be affected by the problem of rank reversal, the range of normalized values, obtaining the same optimization aspect for all criteria, and the validity of results.

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The extravasation of many agents during administration by way of the peripheral veins can produce severe necrosis of the skin and subcutaneous tissue. The incidence of an extravasation injury is elevated in the populations prone to complications, including the younger age groups. The severity of the necrosis depends on properties of the extravasated agent (vinca alkaloids, antracyclines, catecholamines, cationic solutions, osmotically active chemicals) including the type, concentration, and the quantity injected. In general, the primary diseases were chronic diseases such as hepatic or ischaemic encephalopathies, cardiac or pulmonary diseases, diabetes mellitus, and oncological diseases. The aim of this article was to explore the prevention, diagnosis, and treatment of extravasation injuries with a review of the literature. From January 2009 to August 2011, 22 patients were reviewed. Ten patients were children, and the others were adults. The surgical interventions were delayed until the development of the necrosis. A topical boric acid 3% solution was applied to all wounds with repetitive debridement. Debridement was performed once every 2 days and was continued until healthy tissue was obtained. The wounds of eight patients were repaired with split-thickness skin grafts, the wounds of six patients were reconstructed with randomised fasciocutaneous flaps, and the wounds of five patients healed by secondary intention. The wounds of three patients with massive swelling of the forearms were treated with only conservative modalities and limb elevation for 24-48 hours. Boric acid was found to promote granulation tissue in the wounds. The extravasation injuries can be prevented by using appropriate measures, such as the avoidance of perfusion under pressure, patient participation in pain follow-up, wound management by experienced health professionals, and preference for large and suitable veins.

Most malignant rectal tumors are histopathologically characterized as adenocarcinoma and generally metastasize to distant organs such as the lungs or the liver. Metastasis of rectal carcinomas to the skull is extremely rare. This study reports the initial diagnosis of rectal adenocarcinoma recurrence in a 65-year-old female with scalp metastasis. The patient's history indicated a colorectal adenocarcinoma that was resected five years earlier. A skull metastasis from a rectal adenocarcinoma has not yet been reported in the literature as an initial symptom for recurrence. This paper suggests that skull metastasis from any part of the body must be considered in the differential diagnosis of soft tissue tumors in the skull even in the absence of intestinal symptoms.

The authors describe a modification of the classic gluteal bilateral V-Y advancement flap for sacral defect closure. After initial debridement, the V-Y design is marked on both sides of the defect. The incision is carried down to the fascia of the underlying gluteus maximus muscle. The upper and lower arms of the flaps are elevated and advanced on the gluteal muscle toward the midline, interdigitating each opposing arm. The overall result is a zigzag, broken midline suture. This procedure was carried out in 14 patients with sacral pressure sores and in 1 patient with a chronic pilonidal sinus. All flaps survived without major problems. There were no recurrences during the 6 to 16 months of follow-up. The interdigitating fasciocutaneous V-Y gluteal flap design is effective in breaking the midline vertical scar and preserving the gluteus maximus muscle.

AMAÇBu çalışmamızda amacımız, yılan sokmalarına bağlı gelişen kompartman sendromlarının tedavisinde, klasik kompartman sendromu kriterlerinden uzaklaşarak yapılan erken fasyotominin hem klinik iyileşmeyi hızlandırdığı hem de ilerleyici doku hasarını azalttığını vurgulamaktır. GEREÇ VE YÖNTEMYılan ısırması nedeniyle başvuran 14 hasta geriye dönük olarak incelendi. Hastaların 5'i rutin tedavi ile takip edilerek iyileştirildi. Tedaviye yanıt vermeyen 6 hastaya ekstremitede artan ödem, ağrı, peteşi-ekimoz, bül formasyonu, ilerleyici deri nekrozu ve gerilemeyen klinik ve laboratuvar bozukluklar nedeniyle ilk 48 saat içerisinde erken fasyotomi yapıldı. Geç dönemde kompartman tanısı ile kliniği-mize sevk edilen 3 hastaya ise başvurduklarında fasyotomi yapıldı. Fasyotomi insizyonları 4 ila 6 gün sonra kapatıldı. BULGULARErken fasyotomi uygulanan 6 hastada ödemin hızla azaldığı, ekstremite derisindeki lokal nekrozların ilerlemediği gözlendi. Ayrıca bu hastalarda lokal ısı artışı veya ateş gibi toksik belirtiler hızla geriledi. Geç fasyotomi yapılan 3 hastada ise iyileşme hızı erken cerrahi yapılanlarla kıyaslandı-ğında oldukça yavaştı ve kas ve derideki nekrotik ilerleme kısmen geriledi. SONUÇFasyotomi yılan ısırıklarında özel bir yere sahip olup kompartman sendromu olgularında gerekli tüm tedaviler uygulanmalı kliniğin tam olarak oturmasını veya kompartman basıncının eşik değere ulaşmasını beklemeden erken fasyotomi yapılmalıdır.Anahtar Sözcükler: Fasyotomi; kompartman sendromu; yılan ısırıkları.

In MCDM problems, the decision maker is often ready to adopt the closest solution to the reference values in a choice or ranking problem. The reference values represent the desired results as established subjectively by the decision maker or determined through various scientific tools. In a criterion, the reference value could be the maximum value, the minimum value, or a specific value or range. Also, the acceptances degrees of ranges outside the reference may differ from each other in a criterion. Furthermore, measurements in a criterion may have been obtained with any of the nominal, ordinal, interval, and ratio scales. For the decision problems, including qualitative criteria, the solution cannot be achieved without scaling of criteria with the existing MCDM methods. The purpose of this study is to propose the Nearest Solution to References (REF) Method, a novel reference-based MCDM method, for the solution of decision problems having mixed data structure where references can be determined for criteria.

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