Our results indicated limited success to DAIR- treated patients with infected HA. The high failure rate of DAIR treatment after 2 weeks from the implantation should be taken into consideration.

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Dislocation Interphalengeal Finger a b s t r a c tBackground: Simultaneous dislocation of the proximal and distal interphalangeal joints of

Ipsilateral proximal, diaphyseal and distal femur fractures are very rare. These fractures are seen especially in the adult population following motorcycle or in-vehicle traffic accidents. Treatment of ipsilateral multiple femur fractures are difficult and controversial. Variable types of fixation techniques and implants are proposed for these types of fractures, however, no evidence could be submitted for preference of any specific implant. The sequence of fracture type to be fixed first and type of implant to be used are questions yet to be answered.In this case report, we aim to draw attention to the diagnosis, treatment and follow up and also discuss complications which could be encountered during the treatment of these ipsilateral multiple femur fractures. (JAREM 2012; 2: 120-3) Key Words: Femur, multiple, fracture, fixation ÖZET Aynı taraf proksimal femur, femur cisim ve distal femur kırığı birlikteliği son derece nadir görülen bir durumdur. Bu güne kadar literatürde sadece 18 olgu bildirilmiştir. Bu tür yaralanmalar sıklıkla motorsiklet veya araç içi trafik kazaları gibi yüksek enerjili travmalar sonrasında özellikle genç toplumda meydana gelmektedir. Bu tip yaralanmaların tedavisi için birçok tespit yöntemi ve materyal önerilmiş fakat tercih nedeni olabilecek kanıtlar öne sürü-lememiştir. Bu tip kırıklarda tespitin sırası ve önemi ise günümüzde halen cevap bekleyen sorular arasındadır. Araç içi trafik kazası sonrası acil servise başvuran 28 yaşındaki erkek hastada aynı taraf proksimal femur, cisim ve distal femur kırığı saptandı. Hasta proksimal ve distal femur kırıklarının kanüle vidalarla, cisim kırığının da retrograd femur çivisi kullanılarak intramedüller tespiti ile tedavi edildi ve ameliyat sonrası 8. ayda değerlendirildi. Literatür ışığında ipsilateral proksimal femur, cisim ve distal femur çoklu yaralanmalarına yaklaşım, tedavi prensipleri ve karşılaşılabilecek muhtemel sorunlar bu yazıda değerlendirmiştir. (JAREM 2012; 2: 120-3)

Objective:The effects of perioperative blood transfusion on renal functions have been studied in various studies. In this study, we investigated the effects of blood transfusion on postoperative kidney functions in patients who underwent orthopaedic surgeries.Method:Total 136 patients who were operated for several orthopedic pathologies between June 2013 and December 2014 were evaluated. The patients were divided into two groups according to the amounts of blood transfusion. Ninety five patients (69.8%) who were transfused less than 3 units were included in Group 1 and 41 patients (30.2%) who received 3 and more units of blood were included in Group 2.Results:There were no statistical difference between the two groups in terms of preoperative gender, hypertension, diabetes mellitus, chronical renal failure and smoking habbits (P > 0.05). No statistical differences between the groups were seen in terms of postoperative hospital stay, pulmonary and other complications as well as mortality (P > 0.05). When the two groups were compared for blood parameters showing postoperative renal and other system functions, no statistical differences were detected (P > 0.05).Conclusion:Blood transfusion does not have negative effects on postoperative BUN and creatinine levels in patients operated for orthopaedic pathologies.

Background:Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues.Case Description:An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable.Conclusion:Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.

Özet Bu çalışmada, hastane işletmelerinde iç denetimin hile denetimi ile ilişkisi incelenmiştir. Hastane işletmelerinin fonksiyonları ve özelliklerinden bahsedilmiştir. Çalışmanın amacı; hile ve yolsuzlukların hastane işletmelerinde nasıl yapıldığı ve hile ve yolsuzlukta mücadelede iç denetim ve iç kontrolün rolünün ne olduğudur. Çalışma, derleme yöntemi ile yapılmıştır. Sağlık alanındaki gelişmeler ve bu gelişmelerin büyük bir çoğunluğunun teknolojik kökenli olması, hastanelerin sadece sağlık birimi olarak değil, önemli bir ekonomik birim haline gelerek, hastane işletmeciliğinin önemi daha da artmıştır. Hastanelerde personel ücret ödemeleri, sigortalar ve ihaleler gibi alanlarda hile yapma olasılıkları yüksektir. İşletmelerin iç kontrol yapısının güçlü olması ve buna bağlı olarak etkin bir iç denetim, hastanelerde hile ve yolsuzluklarla mücadelede etkili olacaktır. Çalışma, hastanelerde yapılması muhtemel hileler ile iç denetimin hileler üzerinde etkisine ve yararlarına değinilmiştir.

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