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1. | Frontmatters Pages I - V |
EXPERIMENTAL STUDY | |
2. | The determination of the protective role of sildenafil administration in rats with sepsis-induced liver injury Serkan Cerrah, Elif Cadirci, Nihat Okcu, Özcan Deveci PMID: 36748765 PMCID: PMC10198326 doi: 10.14744/tjtes.2022.45605 Pages 133 - 139 BACKGROUND: Sepsis is a complex syndrome which comes out after infection, characterized by activation of inflammation and infection and has a high morbidity and mortality. Sildenafil (SLD) is a selective phosphodiesterase Type 5 enzyme inhibitor and is used in the treatment of erectile dysfunction effectively all over the world. In this study, we investigated whether SLD had protective effect or not by studying the effect of SLD on reactive oxygen species and antioxidants in cecal ligation and puncture (CLP) polymicrobial sepsis model in rat liver histopathologically and biochemically. METHODS: Rats were divided into four groups: (1) 10 mg/kg SLD given CLP group; (2) 20 mg/kg SLD given CLP group; (3) CLP group; and (4) SHAM operated group. CLP polymicrobial sepsis model was applied to the rats. All rats in our study were sacrificed by overdose general anesthetic after 16 h (thiopental sodium, 50 mg/kg). Specimens of rat liver were analyzed histopathologically and biochemically. In the study, superoxide dismutase (SOD) and glutathione (GSH) parameters were measured to indicate the antioxidant activity in liver during sepsis. To evaluate the oxidant activity, myeloperoxidase (MPO) and lipid peroxidation (LPO) parameters were measured in liver tissue. RESULTS: SOD and MPO activities and GSH and LPO levels were high in CLP polymicrobial sepsis model when compared to SHAM group (p<0.05). In all SLD groups, GSH levels were high when compared to CLP group. In 20 mg/kg SLD given sepsis group, high GSH levels were observed according to SHAM group. In addition, while all SLD dose groups had a significant decrease versus CLP group in LPO levels (p<0.05), they had a significant increase in MPO activities. In 20 mg/kg SLD administrated rats, an improvement observed in biochemical parameters. In this study, SOD and MPO activities which were low in SHAM group increased in CLP polymicrobial sepsis model. When SLD administrated, MPO activity increased in both SHAM and CLP groups. In this study, GSH and LPO levels also increase in septic liver tissue. When SLD administrated to SHAM group, it increased VI protective GSH level and decreased detrimental LPO level. In histopathological examination, it was observed that 10 mg/kg SLD administration had a curative effect in liver tissue partly. CONCLUSION: It was shown that acute SLD administration decreased liver damage in septic rats dose-dependently in this study. In addition, it was observed that it corrected the broken oxidant-antioxidant balance. This might mediate the protective effect of SLD in liver. However, we believe that new experimental and clinical studies should be in the future to understand the protective effect of SLD in liver. |
3. | Histopathological investigation of the effect of chitosan on oral mucous wound healing in experimentally established diabetic rats Reha Gür, Nevin Büyükakyüz, Barış Altuğ Aydil, Mustafa Ayhan PMID: 36748767 PMCID: PMC10198325 doi: 10.14744/tjtes.2022.55726 Pages 140 - 148 BACKGROUND: In our study, it was aimed to histopathologically investigate the effects of chitosan on wound healing in the oral mucosa by applying the gel form of experimentally induced diabetes mellitus. METHODS: In our study, 42 male Sprague Dawley rats weighing 340±20 g, 14–16 weeks old, were used. Diabetes induction was achieved by administering 55 mg/kg streptozotocin intraperitoneally (i.p.) to 32 of the subjects. Those with blood glucose levels above 250 mg/dl as measured at the end of the 2nd and 7th days were considered diabetic and included in the study. Afterwards, a wound of 5 mm in diameter and 1 mm in depth was created in the buccal mucosa of the experimental animals with a disposable punch biopsy tool. Wound healing was evaluated on the 2nd and 5th days after the surgical operation. The samples were evaluated histopathologically in terms of inflammation, fibrosis, epithelial regeneration, necrosis, and foreign body reaction. RESULTS: As a result of the statistical analysis, a significant difference was found between the groups in terms of inflammation levels on the 2nd and 5th days (p<0.05). In the intragroup evaluations, the rate of severe inflammation on the 2nd day in the diabetes+chitosan group was found to be statistically significantly higher than the 5th day (p<0.05). While there was no statistically significant difference between the groups in terms of fibrosis levels on the 2nd day (p>0.05), a statistically significant difference was found in terms of fibrosis levels on the 5th day (p<0.05). CONCLUSION: It was observed that chitosan did not cause foreign body reaction in any of the groups on the 2nd and 5th days. |
4. | Radiological examination of the relationship between the pterygomaxillary junction and fracture pattern Mustafa Ayhan, Sedef Ayşe Taşyapan, Abdulsamet Kundakçıoğlu, Metin Berk Kasapoğlu, Sabri Cemil İşler, Barış Altuğ Aydil, Ilknur Özcan, Gülce Ecem Doğancalı PMID: 36748778 PMCID: PMC10198336 doi: 10.14744/tjtes.2022.45995 Pages 149 - 154 BACKGROUND: Le Fort 1 (LF1) osteotomies are widely used to correct midface deformities. To move the maxilla freely, the ptery-gomaxillary junction (PMJ) must be separated. When performing this osteotomy, the pterygoid plate must remain intact. The objective of this study was to evaluate relationship between the anatomical features of the PMJ and fracture patterns in LF1 osteotomy. METHODS: Pre-operative and post-operative cone-beam computed tomography images of 41 patients (82 samples) who have undergone LF1 osteotomy surgery were radiologically evaluated. Morphologic measurements of the pterygomaxillary fissure area and pterygoid plate were carried out. Moreover, pterygomaxillary separation was divided into the clean-cut, maxillary sinus, and pterygoid plate fracture types. RESULTS: Statistically significant difference was observed between clean-type fracture and pterygoid plate fracture groups’ thickness of the pterygoid process and thickness of the pterygomaxillary region. CONCLUSION: Anatomical variations make it difficult to separate the PMJ properly. Low thickness of PMJ increases the risk of unwanted fractures; however, according to our experience, the use of an osteotome with an incorrect angle, excessive force, and inexperienced surgeons can also cause undesirable pterygoid plate fractures. |
5. | Histopathological efficacy of tacrolimus in an experimental head trauma study Ali Atadağ, İbrahim Erkutlu, Ahmet Sarper Bozkurt, Ömer Eronat, Yıldız Büyükdereli Atadağ, Necati Üçler, Abidin Murat Geyik PMID: 36748776 PMCID: PMC10198338 doi: 10.14744/tjtes.2023.33644 Pages 155 - 162 BACKGROUND: This study aimed to investigate the protective effect of tacrolimus (FK506), an immunosuppressive agent, on secondary brain damage in rats with experimental head trauma. METHODS: 40 Sprague-Dawley rats, aged 10–12 weeks and weighing 250–350 g, were used without gender selection. The subjects that were divided into five groups of 8 rats per group (sham control, negative control, positive control, vehicle control, and treatment) were sacrificed 1 month after head trauma was induced under appropriate conditions, their brains were then removed en bloc and evaluated histopathologically. Secondary brain injury was evaluated with the immunoreactive score (IRS) after Glial Fibrillary Acid Protein staining of gliosis that would occur in brain tissue. RESULTS: The evaluation of the histopathological IRS values of all groups showed significant statistical differences between all groups. The pairwise group comparison revealed the highest increase in IRS value in the treatment group (p<0.05), with no statistical significance despite the increase in the negative control, positive control, and vehicle control groups. The sham group had the lowest rate of severe histopathological reaction score. CONCLUSION: It was observed that the group treated with FK506 had a statistically significant increase in gliosis in the traumatic area compared to the other control groups. This shows that FK506 cannot prevent and even increase gliosis by a mechanism that has not yet been clarified. In conclusion, it is obvious that the FK506 immunosuppressive agent does not reduce post-traumatic brain injury; on the contrary, it increases gliosis. |
ORIGINAL ARTICLE | |
6. | Correlation of important prognostic factors and CT scores in invasive and non-invasive ventilation of COVID-19 patients Ayfer Kaya Gök, Aygen Turkmen, Emine Köse, Ferhat Çengel, Serpil Şehirlioglu PMID: 36748772 PMCID: PMC10198330 doi: 10.14744/tjtes.2022.92770 Pages 163 - 168 BACKGROUND: Intensive care workers received the largest share of the COVID-19 pandemic, which caused nightmares to the whole world. In COVID-19 pneumonia cases which had high mortality rates, many prognostic factors and laboratory examinations were tried to evaluate the clinical severity quickly and accurately.This study was planned to investigate a correlation between the initially ventilation strategy and major prognostic parameters and CT scores in patients admitted to intensive care unit (ICU). METHODS: In our study, we reviewed 50 consecutive non-invasive mv and 50 consecutive invasive mv treatment of COVID-19 pneumonia patients between March 23, 2020,and May 23, 2020, in the ICUs of our hospital. Patients who were divided into twogroups (non-invasive mechanical ventilation [NIMV] and invasive mechanical ventilation [IMV]) as an initial ventilation strategy according to clinical severity and P/F ratios were evaluated comparatively; demographic data, admission and lowest P/F ratios, admission and highest SOFA scores, comorbidity status, scores on CT at diagnosis, length of ICU stays, hospitalization periods, and mortality rates were examined. RESULTS: About 85% of all patients were 46 years and older. No significant difference was found in terms of gender and comorbidity status. The lowest P/F ratio was significantly lower in IMV group. The admission and highest SOFA values were higher in the IMV group. There was no significant difference between the CT scores and the number of lobes involved. The mortality rate in the IMV group was significantly higher. CONCLUSION: Patients who started treatment with NIMV had relatively low poor prognostic factors, their mortality was lower. However, the total CT score at diagnosis was expected to be higher in those who were performed IMV, no significant difference was found in our study. We concluded that the severity classification of the patients cannot be made according to CT scores. CT results should be evaluated as a whole according to the patient’s clinic, predisposing factors, and response to treatment. |
7. | Construction of a nomogram predictive model for patients with liver rupture undergoing surgical intervention Gen-fei Zhu, Xiao-Qing Wu, Yang Chen, Feng Jiang PMID: 36748770 PMCID: PMC10198341 doi: 10.14744/tjtes.2022.67669 Pages 169 - 175 BACKGROUND: The incidence of blunt abdominal injury has significantly increased, and the liver is one of the most commonly damaged organs. In this study, we explored and established a nomogram model for patients with liver ruptures undergoing surgical treatment. METHODS: A retrospective analysis was conducted for 66 adult patients with liver rupture, who were admitted to our hospital from January 2011 to October 2018. These patients were classified into two groups, according to whether the patient had surgery: surgery group (41 cases) and non-surgical group (25 cases). The following data were collected from these two groups of patients: gender, age, injury mechanism, liver damage, laboratory test results, and hospitalization. Multivariate logistic regression analysis was performed to screen the risk factors of patients who require surgical treatment, establish a predictive model based on the selected indicators, and draw the nomogram. Receiver operating characteristic curves and the calibration curve were used to evaluate the predictive value of the model. RESULTS: Compared to the non-surgical group, the body temperature decreased, the heart rate increased, the injury severity score grade increased, the blood urea nitrogen, blood uric acid, creatinine (Cr), arterial partial pressure of oxygen, alkali excess, blood lactic acid and creatine kinase isoenzymes MB (CK-MB) increased, and the HCO- and Glasgow Coma Scale (GCS) coma scores decreased for patients in the surgical group (all, p<0.05). The logistic regression analysis revealed that Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, and the Glasgow coma score were the influencing factors for surgical intervention for liver rupture. The nomo-gram model constructed based on these five indicators had a good degree of discrimination (area under the curve = 0.971, 95% CI: 0.896–0.997) and accuracy. CONCLUSION: A nomogram model established based on Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, the GCS, and other parameters can accurately predict the surgical treatment of patients with liver rupture. |
8. | Bullet trajectory detection in the lung: Multiplanar reformatted imaging of multidetector computed tomography in children Mehmet Emin Boleken, Abdurrahim Dusak, Tansel Günendi, Osman Hakan Kocaman, Veysel Kaya, Mustafa Erman Dörterler PMID: 36748771 PMCID: PMC10198328 doi: 10.14744/tjtes.2022.72733 Pages 176 - 182 BACKGROUND: Trauma is a leading cause of childhood injuries. Although blunt traumas in children are more common in penetrating traumas, children in civilian life and near conflict areas can often be affected by gunshot wounds. Among all gunshot wounds, thoracic injuries constitute a significant proportion. In our study, we detected bullet trajectory in children with gunshot wounds penetrating the thorax by analyzing reformatted images of multidetector computed tomography (CT). METHODS: Nineteen pediatric patients with thoracic gunshot wounds were evaluated retrospectively. After all patients admitted the emergency service, their hemodynamics were stabilized first. Then, PA-AC radiography and thorax CT were taken and necessary imaging studies of other body parts were performed. CT scans were performed with multi-detector CT. RESULTS: Using reformatted axial, sagittal, and coronal and oblique images of multidetector CT, we detected projectile trajectory in the lung parenchyma in 74% of patients. In 26% of the patients, the projectile trajectory could not be detected due to excessive parenchymal hemorrhage, hemothorax, and pneumothorax. CONCLUSION: In our study, a standard could not be made due to the fact that the types of weapons used could not be determined, the firing distances could not be known, different ages and different bullet entry and exit angles. However, detecting the trajectory of the bullet in the lungs will assist the physician in making the treatment plan and following up the patient. In addition, the evaluation of the data obtained will be beneficial to forensic medicine physicians and scientists interested in wound ballistics. |
9. | Evaluation and clinical significance of predictors for strangulation and intestinal resection in emergency anterior abdominal wall hernia surgery Mehmet Zeki Buldanlı, Sacit Altuğ Kesikli, Şebnem Çimen, Burak Uçaner PMID: 36748775 PMCID: PMC10198342 doi: 10.14744/tjtes.2022.20093 Pages 183 - 192 BACKGROUND: Emergency anterior abdominal wall hernia surgery plays a pivotal role in emergency general surgery practice. In this study, the predictive value of laboratory and imaging findings as well as demographic information and comorbidities of the patients for the recognition of strangulation and intestinal resection was investigated. METHODS: Patients over the age of 18 who were operated consecutively with an indication for emergency anterior abdominal wall hernia surgery between January 2017 and December 2019 in a single tertiary hospital were included in this retrospective cohort study. The patient population was divided into two groups according to the pre-operative findings during the emergency anterior abdominal wall hernia surgery. Group 1 consisted of cases with incarceration but without strangulation, whereas Group 2 consisted of cases with strangulation in addition to incarceration. Moreover, in evaluation for the requirement for intestinal resection, patient Group 2 was divided further into two groups, namely, as Group (1 or 2) a and Group (1 or 2) b, defining the need for intestinal resection. RESULTS: A total of 106 patients who had emergency anterior abdominal wall repair surgery due to incarcerated hernias were included in the study. The evaluation of the indices related to systemic inflammation revealed that lactate dehydrogenase to white blood cell ratio was significantly lower but neutrophil to platelet and neutrophil to albumin ratios were significantly higher in patients with strangulation, showing the significance of those systemic inflammation indices in detecting strangulation (p=0.027, p=0.035 and p=0.030, respectively). Moreover, the analysis of the patients in whom intestinal resection was required (Group 2a vs. 2b) exposed that neutrophil to albumin ratio was significantly higher in the patients with intestinal resection (p=0.036). CONCLUSION: Indices of systemic inflammation such as lactate dehydrogenase to white blood cell ratio, neutrophil to platelet ratio, and particularly neutrophil to albumin ratio may be potentially beneficial to prevent complications and improve clinical outcomes in emergency hernia surgery. |
10. | Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis Muharrem Öztaş, Baki Türkoğlu, Bediye Öztas, Ümit Alakuş, Ulvi Mehmet Meral PMID: 36748764 PMCID: PMC10198327 doi: 10.14744/tjtes.2022.28430 Pages 193 - 202 BACKGROUND: Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain. METHODS: The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature. RESULTS: The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings. CONCLUSION: POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient’s clinical condition. |
11. | Is it necessary to use specimen retrieval bag for reducing surgical site infection in laparoscopic appendectomy?A randomized controlled trial Mustafa Sami Bostan, Celil Uğurlu PMID: 36748777 PMCID: PMC10198332 doi: 10.14744/tjtes.2022.97828 Pages 203 - 211 BACKGROUND: The aim of the study was to investigate the comparison the effects of the extraction of specimen by using a specimen retrieval bag (SRB) or direct extraction through trochar in terms of surgical site infection (SSI) in patients who underwent laparoscopic appendectomy. METHODS: A total of 165 patients were randomly allocated into two groups. A SRB was used in 77 patients (Group 1, 46.7%) and not used in 88 patients (Group 2, 53.3%). Demographics, comorbid diseases, laboratory results, preoperative diameter of appendix, intraoperative observations, intraoperative procedures, hospitalization times, SSIs, pathology results, culture results, and findings of the patients who developed complications and the treatments given to the patients due to complications during the post-operative period were recorded. RESULTS: The mean age of the patients was 33.95 SD 13.25 (min-max: 18–78) years. No significant difference was observed in the demographics, hospitalization times, distribution of the incidence rates of diabetes mellitus, perioperative perforation, perioperative fluid/abscess, drain insertion, aspiration-irrigation, superficial incisional SSI, drainage requirement, leakage, positive culture results, and post-operative intra-abdominal infection (p>0.05) between the groups. Neutrophil and leukocyte values were statistically significantly different between the groups (p=0.044 and p=0.012, respectively). There was a significant difference between the two groups in terms of the complicated appendicitis (p=0.040). There was no significant difference in terms of the positive culture results and incidence of post-operative intra-abdominal infection between the patients in Group 1 and Group 2 in both the complicated and uncomplicated appendicitis groups (p>0.05). The difference between the patients in Group 1 and Group 2 regarding the incidence of superficial incisional SSI was significant in the uncomplicated appendicitis group (p=0.037), whereas not significant in the complicated appendicitis group (p=1.000). In the multivariate model, only perioperative perforation was observed to be the effective parameter on post-operative intra-abdominal infection at the p<0.05 level (p=0.045). CONCLUSION: The results of the present study revealed that the use of SRB does not prevent microbial seeding in patients who underwent laparoscopic appendectomy; therefore, it was concluded that using SRB is not associated with SSI at laparoscopic appendectomy. |
12. | The effect of a new topographic classification on determining the prognosis of nasal fracture and treatment modality Seckin Aydin Savas, Ismail Erkan Aydin PMID: 36748762 PMCID: PMC10198329 doi: 10.14744/tjtes.2022.09406 Pages 212 - 217 BACKGROUND: Classifications of nasal fracture are based on clinical findings or radiological findings. The classification systems of nasal fracture usually determine the type of nasal fracture. It is important that a classification gives information about treatment modality and prognosis rather than determining the type of fracture. The objective of this study was to show the effect of the new topographic classification on determining the parameters of prognosis and deciding on treatment modality of the nasal fracture. METHODS: We reviewed patients with nasal fracture that was referred from emergency department between December 2018 and September 2020. The views of lateral nasal radiography, the facial view of computed tomography (CT), and/or the views of three-dimensional CT were examined to analyze 120 patients with nasal bone fractures. The length of the nasal bone from the top to the base was divided into equal three levels by two lines perpendicular to the length of the nose. The location of fracture was determined as level I, II, and III, respectively, from caudal part to cranial part of the nasal bone. The demographic features of patients, the side of the fracture, the pattern of fracture, accompanying fractures, and the treatment modality were noted. RESULTS: The frequencies of location of nasal fractures were 44%, 28%, and 27% at level I, level II, and level III, respectively, in 120 cases. It was an expected result that the frequency of fractures was low in parts with the thick bone. Considering the rates of being bilateral or unilateral, it was found that the frequency of unilateral was higher in group of level I, where the thickness of nasal bone was thin, but it was less in group of level III (p<0.05). Non-depressed/minimal-depressed pattern of fracture in group of level I accounted for 92.6% which was the highest frequency (p<0.05). Depressed/elevated fracture patterns were more common in group of level II (p<0.05). Comminuted pattern was mostly observed in group of level III. The rate of accompanying fractures and the applied treatment modality was consistent with anatomic feature of fracture’s level. CONCLUSION: We believe that the new topographic classification evaluates the parameters of clinical prognosis such as accompanying fracture, site of fracture and pattern of fracture, and also requirement of closed or open reduction better than other classifications. |
13. | The relationship between the presence of scapula fracture and mortality and morbidity in cases with blunt thoracic trauma Fatoş Kozanlı, Özlem Güler PMID: 36748761 PMCID: PMC10198335 doi: 10.14744/tjtes.2022.02362 Pages 218 - 223 BACKGROUND: Scapula fractures (SFs) occur as a result of high-energy trauma and are significant in terms of life-threatening injuries. There are few studies showing the relationship between SFs and mortality and morbidity in patients with blunt thoracic trauma (BTT). Our study aims to investigate the relationship between SF and mortality and morbidity in BTT. METHODS: Adult patients admitted to the emergency department of Kahramanmaras Sutcu Imam University, School of Medicine with BTT between January 2019 and April 2021 were retrospectively scanned from hospital records. Patients’ age, gender, trauma mechanism, additional organ injuries, need for intensive care, length of hospital stay, morbidity, and mortality rates were recorded. Statistical results were expressed as frequency, percentage, and mean±standard deviation (min–max). In comparisons between groups, p<0.05 was accepted as the significance level. RESULTS: Two hundred and thirty-eight cases were included in our study. The scapular fracture was present in 86 cases (36.1%). About 43% of the cases with SFs were falling from a height. Intrathoracic injuries accompanying SF were determined as rib fracture, lung contusion, pneumothorax, hemothorax, and sternum fracture, respectively (91.9%, 80.2%, 41.9%, 37.2%, and 15.1%). Extrathoracic injuries associated with SF were vertebral fractures, intracranial injuries, clavicle fractures, extremity fractures, and intra-abdominal injuries (18.6%, 16.3%, 12.8%, 10.5%, and 5.8%), respectively. When the groups with and without SF were compared, a statistically significant relationship was found between SF and the number of rib fractures, lung contusion, pneumothorax, and hemothorax (p<0.001, p=0.001, p=0.001, p=0.001). In extrathoracic injuries, there was a significant relationship between SFs and vertebral fractures, intra-cranial injuries, and clavicle fractures (p=0.004, p<0.001, p=0.005). There was no difference observed between the groups regarding sternum fractures, extremity fractures, and intra-abdominal organ injuries (p=0.288, p=0.682, p=0.261). In cases with accompanying SF, there was a significant difference in terms of length of hospital stay, need for intensive care, and mortality (p<0.001, p=0.001, p=0.002). CONCLUSION: The most common intrathoracic injuries accompanying SFs were rib fractures and lung contusion, and the most common extrathoracic injuries were vertebral fractures and intracranial injuries. Moreover, it was found that SF was highly correlated with length of hospital stay, need for intensive care, and mortality. The most common cause of mortality was found to be intracranial hemorrhage. Imaging of other systems is important in cases with SFs. Particular attention should be paid to head-and-neck injuries. |
14. | The predictive effect of neutrophil-lymphocyte and platelet-lymphocyte ratios in the post-operative recurrence of temporomandibular joint ankylosis Erol Kozanoğlu, Bora Edim Akalın, Ömer Berköz, Hüseyin Can Yücel, Mehmet Yıldıran, Mehmet Solmaz, Ufuk Emekli PMID: 36748774 PMCID: PMC10198337 doi: 10.14744/tjtes.2023.01801 Pages 224 - 229 BACKGROUND: Reankylosis is a frequent pathology in patients who are operated for post-traumatic temporomandibular joint (TMJ) ankylosis. In the current practice, ankylosing spondylitis attacks are monitored with the increases in neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). In this study, such a relation between TMJ reankylosis and increase in these ratios was evaluated. METHODS: Patients who were operated between January 2010 and December 2019 for unilateral or bilateral TMJ ankylosis were included in this study. Temporomandibular gap arthroplasty with an interpositional silicone block was performed for each patient by the same operative team. Each patient had standard physiotherapy. All ages and genders were included in the study. Due to the complete blood count differences between children and adults, 18 years of age was used as a cutoff between the groups. A need for reoperation was accepted as reankylosis. The NLR and PLR of children without and with reankylosis and adults without and with reankylosis were compared. RESULTS: Twenty-nine children and 38 adults were included in the study. Mean age of the children and adults were 10.8 and 37.3 years, respectively. Eleven children and eight adults had reankylosis. In patients with reankylosis, NLR and PLR were high significantly, regardless of age. In children, PLR was significantly higher in reankylosis patients. In adults, NLR was significantly higher in reankylosis patients. CONCLUSION: PLR and NLR may be utilized for predicting reankylosis, respectively, in children and adults who were operated for ankylosis due to TMJ fractures. |
15. | New interlocking intramedullary nail for treating acute midshaft clavicular fractures in adults: A retrospective study Birkan Kibar, Ali Cavit, Abdullah Örs, Oktay Polat, Ridvan Mete Oral, Mert Kahraman Maraslı PMID: 36748766 PMCID: PMC10198339 doi: 10.14744/tjtes.2022.50517 Pages 230 - 235 BACKGROUND: The aim of this study was to retrospectively examine the radiological and functional results of midshaft clavicle fractures that were treated with a new, interlocking intramedullary nail, and employing a different locking option. METHODS: Between January 2018 and January 2020, 24 displaced midshaft clavicle fractures were operated with new, interlocking intramedullary nail. Fractures were classified according to the AO/orthopedic trauma association classification, according to which there were 22 15.2.B (wedge) and 2 15.2.C (comminuted) fractures. The mean patient age was 35.5±14.2 (range: 18–63) years. Eighteen (75%) of the patients were male and six (25%) were female. RESULTS: Follow-up data were recorded at a minimum of 1 year (range 12–36 months), with an average of 21.5 months (SD±8). The mean interval between the injury and surgery was 4.1 (SD±2.3; range: 1–9) days. Full shoulder movements had been achieved by all patients, relative to the contralateral side. The mean constant score was 95.6 (SD±4.2; range 90–100), and the mean visual analog scale score was 0.8 (SD±0.8; range: 0–3). Union was achieved in all patients. The mean union time was 9.5 (SD±1.8; range 6–12) weeks as assessed by radiograph. Average shortening of the clavicle relative to the contralateral side was 3.4% (SD±1.1; range 1.1–6.3). One patient experienced implant irritation, implant removal was performed after 14 months. No implant migration, hardware loosening, implant breakage, or neurovascular damage occurred. One hypertrophic scarring developed. One wound detachment developed at the 3rd post-operative week. CONCLUSION: We think that this new intramedullary nail is a good alternative for wedge type fractures in adult, acute, displaced, and midshaft clavicle fractures. |
16. | A comparative study of digital nerve and digital arterial repairs performed using running versus interrupted suture techniques in finger replantations Bülent Özdemir, Abdullah Kucukalp PMID: 36748763 PMCID: PMC10198333 doi: 10.14744/tjtes.2022.23012 Pages 236 - 246 BACKGROUND: The present study aimed to retrospectively analyze replantations and compared the success rates of different suturing techniques. METHODS: The data of 54 patients who underwent 82 finger replantations between January 2016 and April 2020 were retrospectively analyzed. Patients who underwent traumatic total finger amputations were included in the study. Arteries were repaired with two techniques, the simple running suture technique and the simple interrupted suture technique. Demographic patient data, comorbidities, operative data, post-operative care, the length of hospital stay, mechanism of injury, and site of injury were recorded. The groups were statistically analyzed. Functional outcomes were evaluated according to the Quick DASH score. RESULTS: A total 54 patients with a mean age of 32.5±18.4 (range 1–75) who underwent finger replantation were included in the study. The mean duration of follow-up was 30.9±16.1 months. The mechanism of injury was guillotine-style injury in 29 (35.4%) fingers, avulsion injury in 15 (18.3%) fingers, and crush injury in 38 (46.3%) fingers. Forty-six fingers were repaired using a simple running suture technique, and 36 fingers were repaired using a simple interrupted suture technique. There was no statistically significant difference in terms of failure between the suture techniques (p=0.569). Further, although there was no statistically significant difference in Quick DASH scores according to the type of trauma in the simple running suture technique group (p=0.109), a comparison could not be made within simple interrupted suture technique group because of the small sample size. There was no statistically significant difference in failure rates between cases with an ischemia duration of <6 h and those with ischemia duration of 6–12 h (p>0.05). No statistically significant difference was found between the groups according to age, body mass index, arterial hypertension, or diabetes mellitus (p>0.05). Statistically significant differences were found in univariate analysis according to surgery time per digit, smokers, or vein repair (p<0.05). In total, 65 (79.3%) out of 82 finger replantations were successful. A total of 17 out of 30 fingers that could not undergo venous repair survived because of treatment with medicinal leeches. CONCLUSION: Finger replantation is a difficult-to-perform surgical procedure requiring consideration of the surgical indications and the presence of an experienced surgical team. Regardless of the suture technique in finger amputations, performing venous anastomosis after arterial anastomosis is essential to restore circulation. |
17. | Fracture lines and comminution zones of traumatic sacral fractures Sinan Oguzkaya, Yasin Semih Güvercin, Turan Bilge Kızkapan, Gokay Eken, Feridun Arat, Abdulhamit Misir PMID: 36748773 PMCID: PMC10198334 doi: 10.14744/tjtes.2022.15163 Pages 247 - 251 BACKGROUND: Sacral fractures are uncommon and understanding three-dimensional morphology is needed to obtain proper treatment. The purpose of this study was to identify the repeatable fracture patterns and comminution zones for traumatic sacral fractures and create fracture maps. METHODS: Computerized tomography images of 72 patients with traumatic sacral fracture were included in the study. For each fracture, fracture lines were identified and digitally reduced. All fractures were superimposed over a template and fracture maps; comminution zones and heatmaps were created for each zone. RESULTS: There were 40 males and 32 females with a mean age of 46.5±19.9. Fifty-three (73.6%) patients sustained major trauma, and 19 (26.4%) had minor trauma. There were 37 (51.4%) Zone 1, 22 (30.6%) Zone 2, and 13 (18.1%) Zone 3 fractures. Each Denis zone showed certain fracture patterns. In Zone 1 fractures, most of the fracture lines were vertical and oblique (up to 45°) orientation on both sides. In Zone 2 fractures, fracture lines were concentrated on the S1 and S2 levels. Anterolateral and posterolateral parts of the sacrum were less affected in right-side fractures. In Zone 3 fractures, fractures were concentrated in S1, S2, and S3 levels around the sacral canal. The median sacral crest and midline remained mostly unaffected. CONCLUSION: Sacral fractures showed specific repeatable patterns for each zone. These findings may be helpful for pre-operative planning, placement of fixation material, design of new implants, and modification of current fracture-classification systems. |
CASE REPORTS | |
18. | Double peptic ulcer perforation in a Covid-19 patient, extremely rare entity Kayhan Ozdemir, Baris Mantoglu, Guner Cakmak, Ugurcan Dulger, Zulfu Bayhan, Erhan Eroz PMID: 36748769 PMCID: PMC10198331 doi: 10.14744/tjtes.2021.56346 Pages 252 - 254 Peptic ulcer perforation is one of the leading causes of acute abdomen, presenting with acute abdominal pain and severe distress for the patient. In one-third of patients, the presentation is less dramatic, resulting in significant delays in diagnosis. Herein, we present a very rarest case operated on for diffuse purulent peritonitis with double perforation of the stomach in a COVID-19-positive patient, which had a depressing outcome. |
19. | Out-of-hospital cardiac arrest due to cervical spine injury by uncertain trauma: A study of two cases Hosub Chung, Duk Hee Lee, Keon Kim, Yoon Hee Choi, Sung Jin Bae PMID: 36748768 PMCID: PMC10198340 doi: 10.14744/tjtes.2021.56055 Pages 255 - 258 Cervical spinal cord injury is a well-known cause of cardiac arrest in trauma victims. Unless trauma is definitively suspected, emergency medical services teams perform resuscitation in the pre-hospital stage without cervical spine immobilization. During advanced cardiovascular life support (ACLS), intubation with cervical spinal immobilization causes difficulty in accessing the airway, thus, immobilization tends to not be performed, unless the patient is a clear case of trauma. We report two patients with out-of-hospital cardiac arrests (OHCA) due to cervical fractures that have occurred without clear trauma. In these cases, pre-existing cervical spine lesions was additional informed and identification of the cervical spine fractures was delayed. Emergency medical physicians tend to neglect cervical spine injury when the likelihood of trauma is unclear in a patient presenting with OHCA. These cases urge physicians to consider the possibility of cervical spinal injuries, even in cases of minor trauma. If there is a possibility of cervical spinal injury, imaging should not be delayed and should be followed by appropriate treatment. |