BACKGROUND Trapidil has been shown to possess the protective effects in the treatment of ischemia and reperfusion injury in the peripheral nervous system. The purpose of this study was to determine the effects of low dose trapidil on peripheral nerve regeneration with electrophysiological method. METHODS The sciatic nerve was compressed for 20 sec by using a jeweler’s forceps. Trapidil treatment groups were administrated a single dose of trapidil (8 mg/kg) intraperitoneally just after the injury. Electrophysiological recordings were performed in crush and crush + trapidil treatment groups on the 2nd, 7th, 15th, 30th and 45th days following the nerve injury. RESULTS EMG recordings on the second day following the crush injury showed low values of compound motor action potentials in the gastrocnemius muscle when compared to normal values obtained in intact animals; also, the values on the second day following the crush injury were significantly different between control and trapidil-treated groups. The action potential values for both groups did not yet reach baseline values at the end of the experiment. There was no difference in the action potential amplitude, area and distal latency values between rats with crush and crush+trapidil on all days. CONCLUSION We could not prove a neuroprotective effect of a single low dose of trapidil in rat crush injury model using electrophysiological method.

BACKGROUND This study was conducted with the mothers of 1-3 year old children as a quasi-experimental study for the purpose of examining the effect of home safety education on taking precautions and the incidence of home accidents. METHODS The research sample was composed of 60 mothers of 1-3 year old children who were living in Çivril municipality of Denizli province, had no difficulty in communication, agreed to participate in the research, were not working and could read and write. RESULTS The tools used for data collection were “0-6 Year Old Children’s Mothers’ Knowledge of Safety Precautions for the Prevention of Home Accidents Scale” and “Frequency of Encountering Home Accidents Form”. The effect of education was evaluated with pre-test and post-test utilization. A significant difference was seen in the mothers’ mean conduct score and in the frequency of children’s accidents before and after education. CONCLUSION It is recommended that individual home visits should be made to determine the risks in the home environment and the educational needs of mothers. Education and counseling should be given based on these needs and adult education should be provided on the subject of child development.

BACKGROUND We investigated the changes of bone mineral density at distal radius and ulna in patients with volar wrist clean-cut tendon(s) injuries that were treated by early primary repair and passive mobilization. METHODS Fifteen patients with non-dominant hand injury (group I), 12 patients with dominant hand injury (group II) and 15 healthy volunteers serving as the control group (group III) were enrolled into this study. Side to side bone mineral component differences (SSD) of the proximal, middle and ultradistal radius that were obtained at 6th week and 4th month after operation were statistically compared. RESULTS In comparison with the control group, SSD measurements of the middle and proximal subregions of group II at the 6th week were significantly decreased (p<0.01 and p<0.001). The decreases were 8.9 and 8.6% respectively. Similarly, the 4th month SSD measurements of the middle and proximal subregions of group II were also significantly decreased compared to group III (p<0.001). The decreases were 10.2% and 7.7%, respectively. In group I, except a 7.4% decrease at the middle subregion of the radius at 4th month, there was no significant difference in SSD measurements as compared with the control group. CONCLUSION Results of our study indicate that there is a considerable bone loss of distal radius in patients who are surgically treated for acute clean-cut tendon(s) injuries at the volar wrist level.

Background. To compare accuracy and to check the suitability of the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS) and the Trauma and Injury Severity Score (TRISS), the scoring systems widely used in international trauma studies, in the evaluation of the “life threatening injury” concept established by the Turkish Penal Code.
Methods. The age, sex, type of trauma, type and localizations of wounds, GCS, RTS, ISS, NISS and TRISS values, the decision of life threatening injury of 627 trauma patients admitted to Emergency Department of the Uludag University Medical School Hospital in year 2003 were examined.
Results. A life-threatening injury was present in 35.2% of the cases examined. GCS, RTS, ISS, NISS and TRISS confirmed the decision of life threatening injury with percentages of 74.8%, 76.9%, 88.7%, 86.6% and 68.6%, respectively. The best association was determined with ISS in the cut-off point 14 with 79.6% sensitivity and 93.6% specificity. All of the cases with sole linear skull fracture officially decided as life threatening injury had an ISS of 5, a NISS of 6 and the best scores of GCS (15), RTS (7.8408), and TRISS (100%).

BACKGROUND The aim of this study was to evaluate our clinical findings and results of cardiac injuries. METHODS We reviewed the records of patients who were admitted to our clinic between 1996 and 2005 and operated due to penetrating cardiac injury. RESULTS Eighteen patients (17 male, one female; mean age 25.9; range 17-45 years) (all penetrating stab wounds) with cardiac injuries were operated. The clinical aspects were: agonal status in 5 patients (27.8%), profound shock in 7 patients (38.9%). The remaining 6 patients (33.3%) were in mild shock (hypotension 60-90 mmHg) and 3 of them (16.7%) had a diagnosis of cardiac tamponade preoperatively. Emergency room thoracotomy was made in 2 patients (11.1%). Mortality rate was %80 in agonal patients whereas overall mortality was 44.5%. CONCLUSION Cardiac injuries have high mortality. The mortality rate of the patients, who can arrive to the hospital alive, is c l o s ely related to the vital signs and general condition. The mortality can be reduced by quick evaluation and prompt surgical intervention.

BACKGROUND The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma.
METHODS Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. RESULTS There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1±1.6 and 9.2±1.7) and the number of rib fractures (4±1.1 and 6.8±2.7) were higher in thoracic epidural analgesia group (p<0.05). Pain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (p<0.05). Length of intensive care unit stay (15.6±5.9 and 12.1±4.4 day) was found to be shorter in thoracic epidural analgesia group (p<0.05). There were no differences between the groups regarding mechanical ventilation requirement, pulmonary and cardiac complications. CONCLUSION We suggest that the use of thoracic epidural analgesia with infusion of local anesthetics and opioids are more appropriate as they provide more effective analgesia and shorten length of intensive care unit stay in chest trauma patients with more than three rib fractures who require intensive care.

BACKGROUND The aim of this study was to evaluate the fall-related trauma cases who were admitted to our pediatric emergency unit. METHODS We retrospectively evaluated the files of 161 cases (100 males [62.1%], 61 females [37.9%]) who had sustained falls and were admitted to our pediatric emergency unit. Data on the patients’ age, sex, arrival type, type of fall, height fallen, type of injuries, radiological findings and hospitalization rates were investigated. RESULTS Of 161 cases mean age was 4.29±3.33 years and height fallen was 135±95 centimeters. The common types of fall were from furniture (35.4%), stairs (17.4%) and balconies and windows (11.2%). Major injuries included head trauma (84.4%), soft tissue (72.7%) and extremity (37.9%). Thirty cases (18.6%) were hospitalized, while 112 cases (69.6%) were treated as outpatient and 11.8% of them were discharged due to their own demand. CONCLUSION
The majority of fall-related injuries in childhood mostly occurs in private houses and head trauma is the most frequent injury. To decrease the frequency of the fall injuries, strategies should include parents’ education about the mechanism of falls and increase prevention strategies.

BACKGROUND We aimed to present our experience on computed tomography (CT) findings of small bowel obstruction due to bezoar impaction. METHODS CT scans of seven patients (3 males, 4 females, age range; 30-93 years) who were diagnosed as small bowel obstruction due to bezoars were reviewed. RESULTS In each patient, an intraluminal mass with a mottled gas pattern on CT enabled specific preoperative diagnosis of bezoars, and postoperative changes such as anastomotic lines and afferent-efferent loops.CONCLUSION CT imaging is useful in making the diagnosis of bezoar associated with small bowel obstruction, and greatly helps assessing the detailed abdominal anatomy.

BACKGROUND Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. METHODS Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma’s Organ Injury Scaling System. RESULTS Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. CONCLUSION For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.

Lipomas are rare but well-recognized tumours of the small and large intestines. They usually arise from the submucosa and may occasionally protrude into the lumen, thus causing abdominal pain resulting from obstruction or intussusception or they may become evident through haemorrhage. Intestinal lipomas should be removed either endoscopically or surgically because they can cause severe symptoms and usually a tissue diagnosis is indicated in intestinal tumours to exclude a malignancy. We describe two cases of symptomatic intestinal lipoma and review some aspects of diagnosis and treatment.

Paraduodenal hernias, or so called “congenital intraperitoneal hernias” are rare cause intestinal obstruction. These hernias are caused by variations in intestinal rotation and the patients present with symptoms ranging from intermittent abdominal pain to acute obstruction. We report two cases of obstructive paraduodenal hernias which are at left and right each and review of its clinical features and surgical management.

Small bowel neoplasms are usually diagnosed when patients are referred with complications such as hemorrhage or obstruction. Intestinal lipomas are the third most frequent benign tumors among all intestinal neoplasms and their definite diagnosis is usually obtained after histopathological examination of the resected specimen. A 76 year-old male patient with partial intestinal obstruction and rectal bleeding at admittance was found to have an abdominal mass on ultrasound. The density pattern of the mass at abdominal CT was supporting a jejunal lipoma leading an intussusception. Then an enteroclysis localized and reduced the jejunojejunal intussusception. The diagnosis of lipoma was confirmed with histopathological examination of the mass removed by an elective intestinal resection. This case was reported as the intestinal lipoma leading a jejunojejunal intussusception associated with bleeding, could be diagnosed preoperatively.

As demonstrated in various studies, with mortality and morbidity rates reaching 90%-100%, penetrating brain injuries are among the most devastating subjects of neurosurgery. Shell and sharapnell fragments are the most common cause of this type injuries; although rarely reported in “modern times”, transcranial arrow injuries may also be the cause. In this report, a 37 year-old male patient, who was shot by an “arrow” accidentally, was evaluated regarding clinical presentation, treatment and clinical progress.

A 39-year-old man was admitted with a stab wound to left lower neck. Chest X-ray revealed a left hydropneumothorax. Thoracentesis was performed and analysis of the fluid revealed chyle. Patient was treated conservatively by closed chest drainage and total parenteral nutrition. On the basis of this clinical report and review of the literature, it is concluded that thoracic duct injury should be kept in mind in penetrating neck trauma and conservative treatment should be the first line therapy.

Posttraumatic pseudoaneurysm and arteriovenous fistula are rarely observed. Because of the imminent clinical course, early operation is usually indicated. In this study, we present a case of pseudoaneurysm in the left superficial femoral artery and arteriovenous fistula between the left superficial femoral artery and vein in the left thigh, as a result of a gunshot injury. Magnetic resonance angiography and color Doppler ultrasound were used for diagnosis. The patient underwent a successful aneurysmectomy, saphenous vein interposition and venous repair and was discharged on the eighth postoperative day.

Subcutaneous emphysema is the inadvertent introduction of air into tissues under the skin covering the chest wall or neck. The common causes of subcutaneous emphysema are rib fracture, parenchymal lung wound and esophageal trauma. Rarely, it occurs after oral and nasal surgery or maxillofacial trauma. We observed subcutaneous emphysema spread out from periorbital region to upper mediastinum in a patient presented to emergency department following minor maxillofacial trauma and admitted due to a simple fracture at his frontal maxillary wall. We present this present case to emphasize early initial management and close observation of minor facial traumas which can prevent further unexpected complications.