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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 3 (4)
Volume: 3  Issue: 4 - October 1997
1. 
ÜLKEMİZDE TRAVMA SONRASI ACİL YARDIM HİZMETLERİ
Ali Çalıkuşu, Şükrü Özer
Pages 251 - 257
Abstract |Full Text PDF

2. THE EFFECTS OF PROSTAGLANDIN E2 ON ISCHEMIA-REPERFUSION DAMAGE, RESULTING FROM MESENTER ARTERIAL ISCHEMIA IN SMALL INTESTINES
Ümit Topaloğlu, Mithat Güran, Mehmet Odabaşı, Neşe Karadağ, Göksel Şenel, Levent Kabasakal, Selçuk Ünalmışer
Pages 258 - 264
To observed the ischemia reperfusion damage and the effect of PGE2 resulting from mezenter arterial ischemia on 40 rats an experimental study is carried out. One-hour ischemia and two hour reperfusion model is applied by clemping the superior mesenteric artery at bifurcation site from aorta abdominal with atravmatic microvasculer in sham, ligation, experiment and ligation + PGE2 (n=10) groups. The blood samples were taken for alanine transaminase (ALT), aspartate transaminase (AST), lactic dehydrogenase (LDH), creatinin phosphokinase (CPK) analysis at 1st and 3rd hours. Intestinal tissue samples were removed for malonyldialdehyde and reduced glutathione determinations and histopathologic examination. CPK, LDH, AST and ALT values increased after the SMA ligation and there was a meaningful decrease in the group that was given PGE2. Glutation levels were rather low in the ligation group and malonyldialdehyde, the product of lipid peroxidatiton decreased in the PGE2 group. Finally; it is observed that histopathologic findings were in concordance with biochemical results and it is also found out that PGE2 lessens the ischemic damage in small intestines, furthermore, PGE2 enhances the ischemic damage to reach irreversible phase.

3. THE EFFECTS OF LEVAMIZOL ON INTESTINAL ANASTOMOSIS IN TRANSFUSED GUINEA
Yavuz S İlhan, Mustafa Erdoğan, Ziya Çetinkaya, Nurullah Bülbüller, Osman Doğru, M Ali Akkuş
Pages 265 - 269
In this experimental study, the effects of an antihelmintic and immunostimulating agent (drug) levamizol on anastomosis recovery in blood transfused and normal Guinea pigs were investigated. A total of 56 animals were divided into 4 groups of each consisted of 14 subjects. An additional 10 Guinea pigs were employed for blood transfusion. Intestinal anastomosis were performed on all subjects. Following postoperative treatments were exercised: Group A: None (control group), Group B: Blood transfusion, Group C: Intraabdominal levamizol, Group D: Transfusion+ Levamizol after recording the mortality rate of each group, relaparotomy was applied on 50% the subjects on the 3rd postoperative day, and on the remaining 50% of the subjects on the 7th postoperative day. Findings on intraabdominal sepsis, resistance of anastomosis, explosion pressure were evaluated. Statistical comparision of groups were accomplished by the variance analysis. In the transfusion group an increase in the sepsis findings were determined and the blowing pressure was found to be meaningfully lower than the control group. Intraabdominal levamizol application f allowing the blood transfusion was observed to reduce the mortality by diminishing the intraabdominal sepsis and anastomosis abscess, and to increase the anastomosis pressure and recovery (p<0.01). The histopathological recovery in levamizol administered groups were found to be better than the group received only blood transfusion. Levamizol application without blood transfusion resulted in equal mortality and morbidity to that of control group.

4. MASSIVE LOWER GASTROINTESTINAL BLEEDINGS
Ertuğrul Gazioğlu, Yusuf Çiçek, Anıl Çubukçu, Süphan Ertürk, Hasan Hansel, Tuncer Babür
Pages 270 - 274
Massive bleedings originating from lesions of lower gastrointestinal system, still have their clinical importance for Surgical Emergency Units, despite contemporary diagnostic and therapeutic modalities. Mode of surgical approach, correct choices for diagnosis and treatment directly influence mortality and morbidity. In this study, 34 patient who were diagnosed and treated in our department are retrospectively investigated. Emergency surgical intervention has been necessary in 13 cases (38%). Preoperatif diagnosis was possible in 19 of 34 patient (56%) and in 11 of 13 surgically treated patients (84,6) in which most frequent cause of bleeding was diverticular disease (26,3%). Three of 34 patients died in postoperative period. Overall and operative mortality were 8% (3/34 patient) and 23% (3/13 patient) respectively. Delayed surgical treatment in massive lower gastrointestinal bleeding that doesn't stop spontaneously or with medical measures taken, increases the mortality, particularly in elderly patients. Instead of blind limited resections, total abdominal colectomy should be preferred if pre or per-operative diagnosis is not succeeded.

5. THE PROBLEM OF NEGATIVE LAPAROTOMY IN ABDOMINAL TRAUMA
Orhan Demircan, Emin U Erkoçak, Özgür Yağmur, Fatih Kaya, Yalçın Kekeç
Pages 275 - 280
In this retrospective study, the records of 888 patients whom were treated because of abdominal trauma in Çukurova University, School of Medicine, Department of General Surgery between 1985 and 1994 were reviewed and the incidence of negative laporotomy was investigated. Three hundred-ninty-nine(%45) patients had blunt abdominal trauma 499(55%) had penetrating abdominal trauma. Penetrating abdominal trauma included 171 (35%) gunshot wounds, 318(65%) stab wounds. Of 399(35%) patients with blunt abdominal trauma, the incidence of negative laporotomy was 66 (16.5%) and 9 (2.3%) patients had nontherapeutic laparotomy. The incidence of negative laporotomy was 12(7%) and 2 (1.2%) patients had nontherapeutic laparotomy in 171(35%) patients with gunshot wounds. Of 388 (65%) patients with stab wounds, the incidence of negative laparotomy was 72(22.7%) and 8(2.5%) patients had non therapeutic laparotomy. The incidence of negative laparotommy was found similar with literature in the patients with blunt abdominal trauma and gunshod wounds. The patients with stab wounds, the incidence of negative laporotomy was higher than patients managed by selective conservative treatment. We believe that the incidence of negative laparotomy will reduce by careful physical examination, local wound exploration and diagnostic peritoneal lavage and also prevent to morbidity in patients with stab wounds.

6. PROGNOSTIC FACTORS IN RECTAL INJURIES
Suavi Özkan, Özgür Yağmur, Fulya Can Özkan, Haluk Demiryürek, Okay Ergenoğlu, Ömer Alabaz, Hakan Demirhindi
Pages 281 - 287
Current management of civilian rectal injuries mandates complete fecal diversion and presacral drainage of the presacral drainage of the presacral tissues to prevent fatal septic complications. Routine distal colon washout and primary repair of the rectum still remains challenging problems in the management. In an effort to elucidate these issues, we reviewed 19 patients with rectal trauma over the last 10 years. Rectal injury was due to gunshot wounds in 7 (36.8) patients, blunt trauma in 12 (62.2) patients. The mean Revised Trauma Score 5.5, Abdominal Trauma Index 24.3, and Injury Severity Score 32.6. Proximal colostomy was done in all patients and presacral drains were placed in 18 (94.7%). Broad spectrum antibiotics were administered for a minimum 5 days. Primary rectal repair was performed in 7 (36.8%) and distal rectal washout in 6 (31.5) patients. Patients were evaluated with respect to injury mechanism, shock on arrival, missing time from injury to therapy, rectal wound severity, associated injuries, perioperative blood transfussions, trauma scores and surgical procedures by using uni-and multi-variate analysis. Total morbidity rate was 52.6%, mortality rate 10.4%. Delayed surgery more than 24 hours and high trauma scores (ATI>27 and ISS>40) were the significant factors on morbidity. Although based on a small group of patients, surgical procedures such as distal rectal washout and primary repair of the rectum had no significant effect on prognosis. Ultimate resolution of these issues demands a multicenter prospective randomized trial.

7. SMALL INTESTINAL INJURIES
Harun Analay, M Şehsuvar Gökgöz, Cihan Yıldırır, Mustafa Turan, Baha Aker
Pages 288 - 290
50 patients with small intestinal injury were examined, between January 1991 and January 1996 in Cumhuriyet University Medidal Faculty General Surgery Department. Patients with duodenal traumas were excluded from this study, because of their different properties in diagnosis and treatment. 47 of the patients were men and 30 of them were women with a mean age of 34.6 (11-65) years. 27 (%54) of the injuries were due to blunt traumas and 20 (%40) were penetrating traumas. Five of the penetrating traumas were due to knife and 15 of them were due to gunshot. In 3 (%6) of them, traumas were because of the iatrogenic lacerations. In diagnosis direct X-Ray and computerized tomography were used. When there were hypotension and tachycardia diagnostic peritoneal lavage and parasenthesis were performed. Physical examination was often done to detect the peritoneal irritation. In 24 (%48) patients observed associated injuries observed. 29 (%58) of the perforations had simple closure while in 19 (%38) of them resection+anastomasis and in 2 (%4) of them resection + anostomasis + simple closure were performed. In this study morbidity was 16 (%32), and mortality 4 (%8). 3 of the 4 exitus patients had blunt traumas and two of them had generalized peritonitis and there was no associated injury. As a result we can say that high level of the mortality in small intestinal injuries was to delay in diagnosis.

8. THE EPIDEMIOLOGY OF HEAD TRAUMA: DATA OF 1450 CASES
Ali İhsan Ökten, Rüçhan Ergün, Gökhan Akdemir, Önder Okay, Mehmet Duyar, Hüseyin Anasız, Fikret Ergüngör, Yamaç Taşkın
Pages 291 - 297
The 1450 head injury patients, which were hospitalized in Ankara Numune Hospital Neurosurgery Department between January 1990-June 1996 have been included in this study. The cases have been grouped in to three according to their ages; pediatrics (0-16 ages), adults (17-60 ages), elders (61 age and above). The 75% of the cases were male, and 25% were woman. Adults and pediatric groups compromised the 89.5% of all cases. The age range was 1 days-92 age. The commonest etiology of trauma were falling (54%) in children, traffic accidents in adults (61%) and elders (50%). Approximately 1/3 of the traumas were come true in summer. According to Glasgow coma scale (GCS), 66% of the cases in mild (GCS: 13-15), 16.5% were moderated (GCS: 9-12), and 17.5% were in severe (GCS: 3-8) trauma groups. According to Glasgow outcome scale (GOS) 71% of the cases were good recovered. The mortality rate was 15.7% and 62% of them were adults. The commonest reason of trauma in died cases was traffic accident (56.1%). In this study; the aim is to obtain statistical datas which are not actually enough to constitute the epidemiology of head trauma in country.

9. SURGICAL MANAGEMENT ISOLATED SMALL BOWEL INJURIES DUE TO BLUNT TRAUMA
Erdoğan M Sözüer, Abdulkadir Bedirli, İbrahim İkizceli, Yaşar Yeşilkaya
Pages 298 - 302
Between January 1985-February 1996 38 patients with isolated small bowel injuries due to blunt trauma were evaluated in Erciyes University Medical School General Surgery department The most frequent reason of the trauma was traffic accident with 23 patients (60.5%). 27 patients (71.1%) had acute abdomen in physical examination. Ultrasonography of the abdomen was performed in all patients, and was positive for intraabdominal fluid in eight patients. Diagnostic peritoneal lavage performed to 19 patients (50%) and showed two false negative results. One or more extraabdominal organ injuries occured in 21 patients (55.3%). 27 patients (71.1%) were accepted to the operation in the initial 12 hours of the trauma. The site of injury was jejunum 15 (39.5%), ileum 17 (%44.7%), multiple sites 6 (15.8). In operation debridement of devascularized tissue and primary sutur performed to 23 patients (60.5%) while 14 patients (36.9%) had resection + primary anastomosis. After resection, ileostomy was performed to one patient (2.6%). In the postoperative period, in one patient intraabdominal abscess and in two patients wound infection occurred. Five patients (13.2%) died because of extraabdominal major trauma. Diagnosis of the small bowel injuries due to blunt trauma is dificult. Peritoneal lavage is valuable a diagnostic method. Debridement of devascularized tissues and primary sutur or resection + primary anastomosis is the goal of the treatment. Mortality usually depends on the extraabdominal injuries.

10. SURGICAL INTERVENTION IN VASCULAR INJURIES
Mutasım Süngün, Enver Duran, Fatih Peker, Bilal Kaan İnan, Melih Hulusi Us
Pages 303 - 307
Vascular injuries require urgent surgical interventions in order to prevent serious complications of (mortality and morbidity. This study retrospectively reviews ten years experience of the vascular traumas managed at the Department of Cardiovascular Surgery, GATA Training Hospital between 1987 and 1996. Amongst these cases, (59) 59.3% were arterial, 5.1% were venous and 21% combined arterial and venous traumas. 52.5% of cases were managed by primary surgical repair, 44% of cases by graft interpositioning and 3.4% of cases were managed by ligation. Overall complication rate was 10.3%. As we investigated the complications; 1.7% (n=1) early fistula, 3.5% (n=1) the most serious complication which was an amputation at metatarsal level. The most important prognostic factor of the outcome of surgical treatment was the time period between the traumatic injury and surgical intervention. Shorter the time elapsed after the injury, after better the results in terms of prognosis. Additionally, appropriate intervention by an experienced surgical team and intensive postoperative care were the important points to consider.

11. TRAUMATIC EPIDURAL HEMATOMAS: ANALYSIS OF FACTORS AFFECTING MORTALITY
Süleyman R Çaylı, Etem Beşkonaklı, Önder Okay, Uğur Bostancı, Yamaç Taşkın
Pages 308 - 313
One hundred and four consecutive cases operated for epidural hematoma over 6 years period were analyzed. This series included patients from both before and after the advent of cumputed tomography (CT). CT scans were obtained in 88 cases. Angiography and exploratory burr holes were performed in 16 cases. The overall mortality was 14.4 %. The mortality rates were 10.2% in CT group and 37.5% in the angiography and exploration group. The glasgow coma scores (GCS) of all patients who died in this series less than 8. We concluded that the thickness of hematoma, the degree of shift of midline structures and the time interval between the trauma and diagnosis affected the GCS of the patients. And there were correlations between GCS and presence of associated intradural lesions with mortality.

12. THORACIC TRAUMA: IMPACT OF AGE ON MORBIDITY AND MORTALITY
İlhan İnci, Cemal Özçelik, Refik Ülkü, Şevval Eren, Nesimi Eren, Gökalp Özgen
Pages 314 - 320
1749 thoracic trauma patients were divided into 3 groups according to age and type of injury. Blunt thoracic trauma comprised 54% of children, 47% of adults and 71% of elderly (p<0.001). Penetrating trauma was the cause in 48% of children, 53% of adults and 29% of elderly. Laparotomy was performed more frequently in the adult patients with penetrating injury and was found significant compared to children and elderly (p<0.00l and p<0.05). For penetrating injury thoracotomy rate was not significant among the groups. For blunt injury mortality rate significant in the elderly compared to adults (p<0.00l) and to children (p<0.05). For penetrating injury mortality was significant between elderly and children (p<0.05) and between children and adults (p<0.05). Thoracotomy rate was 8.75% for penetrating and 7.9% for trauma. Overall mortality rate was 7.9% for blunt and 5.2% for penetrating injuries.

13. UNPLANNED RELAPAROTOMIES IN THE EARLY POSTOPERATIVE PERIOD
Ergün Erdem, Birol Bostancı, Cihat Tetik, Akın Özden, Mehmet Neşşar
Pages 321 - 323
Relaparotomies carried out within 30 days after abdominal operations have been named early relaparotomies. Early relaparotomies have resulted in high mortality rates. They have been mostly caused by septic complications. Mortality rates have not been decreased significantly, although imaging methods and treatment modalities other than operation have advanced in the recent years. In this study, 22 relaparotomies after 771 laparotomies done in 18 months in the department of general surgery, Medical Faculty of Pamukkale University have been evaluated. We have concluded that the most frequent and the most mortal relaparotomies were those done for septic complications.

14. PENILE FRACTURE, AN UNCOMMON UROLOGIC TRAUMA: EARLY SURGICAL REPAIR AND RESULTS
Ahmet Danışman, Sağfettin Kaya, Erdal Kukul, Sahir Kılıç, Metin Sevük
Pages 324 - 327
In this study, we present our experience in the management of 7 patients with penile fracture. All the patients were managed by immediate surgical repair, consisting complete evacuation of the hematoma and repair of the tear in the tunica albuginea. Urethral injury associated with penile fracture was seen in one patient. Mean follow-up time was 9 months. The results were excellent with early recovery of erectile function. Painful erections were observed in one patient. Because of these good results and the reported high complication rate of conservative treatment, the need f or immediate surgical repair is emphasized.

15. SPONTANEOUSLY RESOLVED HIGH CERVICAL EPIDURAL HEMATOMA: CASE REPORT
Murat Döşoğlu, Metin Orakdöğen, Sait Miyandoabci, Ö Faruk Ünal
Pages 328 - 331
A 8-year-old boy was admitted after traffic accident with any neurologic symptoms. An epidural hematoma was observed at the high cervical region on CT. No fracture and dislocation was detected. Any volume differences of hematoma was detected on control CT. Epidural hematoma has been disappeared with conservative treatment after 6 months. This case was reported due to high cervical location and rarity of the hematoma, asymptomatic presentation because of the anatomical characteristics. Conservative treatment has to be choice with radiological control in the patients with minor neurologic findings, stable or improved status. However, emergency decompression has to be performed in neurologically deteriorated patient.