ÖZETPenil fraktür, ereksiyon halindeki penisin zorlanması ve/veya künt travmaya maruz kalması sonucu korpus kavernosumun yırtılması ile oluşur. Klasik bulguları; peniste kırılma sesi ile beraber ani baş-layan şiddetli ağrı, ereksiyon halinin süratle kaybı, şişlik, ekimoz ve deviasyondur. Tanısı, dikkatli anamnez ve fizik muayene ile konulabilir. Olguların çoğunda ek tanı yöntemlerine ihtiyaç duyulmaz. Tedavide cerrahi onarım altın standart olarak kabul edilmektedir. Bu yazıda acil servisimize başvuran beş penil fraktür olgusu sunulmuş, tanı ve tedavi yöntemleri güncel literatür bilgileri eşliğinde tartışılmıştır.Anahtar Kelimeler: Penil fraktür, üretral rüptür, acil servis Geliş Tarihi: 16.12.2010 Kabul Tarihi: 01.03.2011 ABSTRACTPenile fracture is caused by rupture of the corpus cavernosum with increased internal pressure due to straining of the erectile penis and/or exposure to an obtuse trauma. Its classical findings are sudden intense pain in the penis following a rupture sound, sudden loss of erection, swelling, ecchymoses and deviation. Diagnosis of penile fracture can be made with a careful history and physical examination. There is no need for additional diagnostic tests for most of the patients. Surgical intervention is accepted as the golden standard for the treatment of penile fracture. In our paper, five cases of penile fracture who were admitted to our emergency department are presented, and the diagnostic and treatment methods are discussed according to the recent literature.Keywords: Penile fracture, urethral rupture, emergency medicine Received: 16.12.2010 Accepted: 01.03.2011 GirişPenil fraktür, ereksiyon halindeki penisin zorlanması ve künt travmaya maruz kalması ile içindeki basıncı artmış olan korpus kavernosumun yırtılması sonucu oluşmaktadır. Penis fraktürünün en sık nedeni cinsel ilişkide pozisyon değişimi sırasındaki travma olduğu bildirilmektedir (%33-60). Klasik bulguları; peniste kopma sesi, ani başlayan ağrı, ereksiyon halinin anında kaybolması, peniste şişlik, ekimoz ve deviasyonun ortaya çıkmasıdır. Penil fraktür vakalarının tedavisi tartışılmakla birlikte standart tedavisi acil cerrahi girişimdir. Bu yazıda acil servisimize başvuran beş penil fraktür olgusu sunulmuş, tanı ve tedavi yöntemleri güncel literatür bilgileri eşliğinde tartışılmıştır. Olgu SunumlarıHastane bilgisayar kayıt sistemi 1998-2010 yılları arasında acil servise başvuran ve penil fraktür tanısı alan hastalar için taranmış, sadece 5 olgu saptanmıştır. Belirtilen tarihlerde acil servise toplam başvuru sayısı 550 bindir. Penil fraktür tanısı almış hastaların tümü Türk vatandaşı olup, yaşları 29-49 arasında değişmekte idi (yaş ortalamaları: 37). Dört hastada penil fraktür cinsel ilişki sıra-sında ortaya çıkmışken, bir vakada etiyolojide künt travma söz konusu idi. Olgu 1Yirmi dokuz yaşındaki hasta penisinde ani ortaya çıkan ağrı, şişlik, eğrilik ve şekil bozukluğu şikâyetleri ile müracaat etti. Anamnezinde cinsel ilişki sırasında penisinde kırılma sesi duyduğunu, takiben bahsedilen semptomların ortaya çıktığını söyled...

In this report, we tried to discuss the pathologic mechanisms of abdominal pain and describe correct modalities of diagnosis by defining clinical findings and symptoms of patients admitted with abdominal pain.Evaluating abdominal pain requires an approach that relies on the probability of disease, patient history, physical examination, laboratory tests, and imaging studies. The location of pain is a useful starting point and will guide further evaluation.

Dislocations of the atlantooccipital junction are rarely encountered fatal injuries, and occur with high energy traumas. Although atlantoaxial rotational instabilities are mostly seen after upper respiratory tract infections in children, trauma and congenital causes should be considered as possible conditions.. Atlas fractures comprise 10% of all cervical and 25% of upper cervical injuries. While posterior arch fractures are the most frequently encountered among atlas fractures, Jefferson fractures and burst fractures are less common and the rare type is massa lateralis fractures. Atlantoaxial instability (AAI) and, less often occipitoatlantal instability (OAI) is a part of the spectrum of Down syndrome. As a very important issue, cervical trauma patients presenting to the emergency department should be carefully treated to prevent mortality and morbidity is very important. Computed Tomography is sufficient for diagnosis in suspected cases of cervical fracture and dislocation. However, MRI imaging may be required in conditions of ligament damage and spinal cord compression. In our case with Down Syndrome; the patient had tactile sensitivity on the spinous process on cervical examination. Immoblization was achieved with a collar. In computed tomography, post-traumatic fracture of the C1 vertebral arch was considered. In Down Syndrome, although history, clinical examination and imaging are evaluated as the presence of a C1 fracture, atlantoaxial instability and cervical dysmorphology should be kept in mind in Down syndrome. In these cases, AAI should be ruled out by radiological imaging methods. The most important part of the treatment is making a correct diagnosis. The deterioration of the neurological picture and new pathologies that may be caused by cardiovascular system or respiratory system failures should be prevented.

INTRODUCTION: Head trauma is the most common cause of traumatic death between the ages 1 and 44 and especially among 15-24 year- old males. Most frequent causes of head trauma are car accidents, sports injuries, work accidents, assaults, and terrorism. When classification is based on Glasgow Coma Scale head injuries are divided into 3 groups as minimal-minor, mild and severe head traumas. The most important points in the early diagnosis, and treatment of the patient with head trauma are detailed anamnesis, physical, neurological, and radiological examination.Diagnostic evaluation of patients with head trauma has been a great problem for physicians for years. Introduction of brain CT into medical practice has created revolution in this field. Brain CT is a diagnostic tool for the evaluation of traumatic brain injuries, because it has a rapid acquisition time, it is universally available, easy to interpret, and reliable. METHODS: The cases brought to the Emergency Medicine Clinic due to head trauma and underwent brain CT in June 2015 were included in our study. The data of the patients were evaluated retrospectively. For this purpose, emergency service files, hospitalization files and records entered into the hospital automation system with ICD-10 codes were analyzed. RESULTS: A total of 353 patients with head trauma applied to our emergency department between the specified dates, and 177 of these patients had undergone brain CT. The female/male ratio of these patients was 40/64 and the most common application was in the 18-59 age group. According to the brain CT results, 89 patients did not have any pathological findings, while indicated number of patients had atrophy (n=8), intracranial hemorrhage (n=2), contusion (n=2), subdural hematoma (n=1), hydrocephalus (n=1) and chronic ischemia (n=1). DISCUSSION AND CONCLUSION: In this study, the benefit of using online technology in interpreting tomography of patients who admitted to emergency department with head trauma and underwent brain CT during off-hours was emphasized.

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