Following blunt abdominal injury, liver is the most injured organ due to its big volume. In this study 278 cases of blunt liver injury were evaluated during a period of 9 years (1985 and 1993). The trauma etiology was traffic accidents in 182 patients and fall from a height in 96 patients. 64% were minor and 36% were defined as major hepatic trauma. Simple hepatoraphy was the precedure for all minor trauma. In this group 11% mortality was attributed to associated intraabdominal and extraabdominal injuries. In the major injury group; 48% had hepatoraphy, 27% partial resection and 25% died peroperatively. 49% mortality of the major trauma group can be explained with hypovolemic shock due to the bleeding of the liver. For major hepatic injuries; by the aid of pringle maneveur hepatotomy with "finger fracture" and selective vascular ligation, and limited resectional debridement is being preferred to aggressive procedues such as hepatoraphy with deep sutures, lobar hepatectomy and hepatic artery ligation. In juxtahepatic venous injuries total hepatic vascular isolation is preffered before vascular repair. The overall mortality rate was 24.8%, which was close to the average 25% literature rate.

There are great difficulties in the diagnosis and treatment of polytraumatized patients. The first aid is usually not performed by specialized doctors, and the follow-up of multiple trauma patients is generally a crucial problem. During January 1992 and January 1993 17.708 cases were admitted to the Emergency unit of Çukurova University, Balcalı Hospital. 1742 (9.8%) of these cases were traumatized patients; 909 (52.2%) of whom suffered from major trauma, and 833 patients ( 47.8%) suffered from minor trauma. The trauma mechanism was blunt in 71%, and penetrating in 29%. 312 cases with major trauma were hospitalized at the emergency observation unit, since these had to be followed by several specialties. Upon major trauma cases, the most common was combined head and extremity trauma which was detected in 392 (47%) patients. As a result, wa can state that Balcalı Hospital needs a surgical intensive care unit for the care of polytraumatized patients.

Acute pancreatitis (AP) still remains as a disease with difficulties in diagnosis and treatment. Following diagnosis the distinction between acute edematous pancreatitis (AEP) and acute necrotising pancreatitis should be made. In a 3-year period between the years of 1992 and 1994, 11 cases of ANP and 22 cases of AEP, with a total of 33 cases of AP were evaluated in retrospective manner. The etiological factor was: 53% biliary causes, 30% unknown, 15% alcohol induced, and 9% diabetes mellitus. 9 cases of AEP and 9 cases of ANP (55%) were treated by conservative means. Out of 9 operated cases with ANP; 6 underwent debridement and drainage, 2 partial pancreatic resection and I triostomy. For AEP the morbidity rate was 9%, and the mortality rate was 0%; whereas, in ANP the morbidity was 72% and mortality was 64%. These rates are 30% and 21% consecutively for the AP series. Even the etiological factor is biliary early surgical intervention is not required, and the definitive surgery should be performed in the late phase. The surgical indication in ANP is determined by means of clinical, bacteriological and morphological data. We are in favour of debridement and drainage and if necessary reoperations or relaparotomies for the treatment of ANP.

PL is challenged by USG for the premier position in the diagnosis of blunt abdominal trauma, In contrast to PL, USG allows the detection of subcapsuler, intraparenchymal and intramesenterial hematomas. In formation is also obtained about the retroperitoneal surface, bladder and kidneys, and the pleura, pericardium and aorta. In our prospective study, 8 patients of the 72 patients underwent laparatomy. PL and USG could'nt show the rupture of the diafragma. In the kidney rupture, PL was false (-). But USG showed the rupture. In the others 6 cases, both USG and PL showed the intraabdominal blood. The discussion of the advantages and disavantages of both methods shows that USG and PL are not competing but rather are complementery. Ultimately, the most important principle in the management of blunt abdominal trauma is repeat pysical examination by an experienced surgeon.

Conservative and surgical treatment have an important place in the treatment of thoracic trauma. We evaluated 48 patients who had undergone operation due to thoracic trauma at the clinic of Thoracic Surgery, The Atatürk Diseases and the center of Thoracic Surgery between 1.1.1991 and 31.10.1994. The responsible mechanism was blunt trauma in 25 (52%)patients, gunshot wounds in 6 (13%) patients and other penetrating wounds in 17 (%35) patients. Postoperative mortality was 8% (4 patients). Various special features and operative methods applied in these cases were investigated and literature knowledge was evaluated.

235patients with splenic injuries were evaluated, between 1989 and 1994. There were 190 blunt, and 45 penetrating injuries. 175 of the patients were operated, and 60 were observed nonoperatively. 95 ( 54%) of the operated patients had isolated splenic injuries and 80 patients ( 46%) had concomitant organ injuries. Liver and kidney were the major concomitantly injured organs. 165 patients (96%) had splenectomy, 7 had splenoraphy, and 3 had partial splenectomy. The mortality rate for operated patients was 11%, and overall mortality rate was 9%.

Interleukins which are members of the cytokine family are secreted from cells of the immune system and effect cells from the same system. Interleukin-6 ( IL -6 ) takes place in the acute immune response to an infectious or an inflamatory insult and is an important mediator in the secretion of the acute phase proteins. We investigated the change in IL-6 levels in patients with complications and the correlations between IL-6 and CRP levels. The experimental group consisted of randomly chosen 15 people undergoing minor surgery. Serum samples were taken preoperatively and postoperatively at the 4th, 24th, 48th, 72nd hours and preserved at-20 C. IL-6 levels were 4pg/ml, 500pg/ml, 250pg/ml, 88pg/ml, 50pg/ml in the control group. Median IL-6 levels were the highest at the 24th hour in the complicated cases. IL-6 levels were the highest at the 24th hour in the complicated cases. IL-6 levels were also elevated in complicated groups after 48th hour (p<0.005). CRP' levels were the highest at the 48th hour (180mg/L, 125mg/L respectively ) at both of the groups. IL-6 levels made a higher peak at the 4 th hour in the experimental group than the control group. An exaggerated IL-6 level after the 24 th hour was associated with the subsequent risk of complications. It is thought that IL-6 is an earlier and more sensitive parameter than CRP.

Between 1990 and 1994, 7 duodenal injuires were evaluated retrospectively in order to emphasize the difficulty in diagnosis especially in blunt trauma victims and the high mortality rate in delayed cases. Male to female ratio was 6/1 and the mean age was 28. Three of the patients were injured by gun-shoot, two were injuired by penetrating objects and two were injuired by traffic accidents. We did not have any difficulties in diagnosis in our patients at all; five cases were penetrating injuries and fortunately peritoneal tenderness arose early in other two cases. In the majority of cases, primary repair or primary repair with decompression was performed mean while Whipple operation was done in only one case. None of the patients were lost. We claim that, early diagnosis and treatment in these patients is essential for low morbidity and mortality.

During a 7-year period (1988-1995), 57 patients with penetrating wounds to the heart were treated at the Surgical Emergency Unit of Istanbul Medical Faculty. Seven patients (18.9%) had complex cardiac stab wounds, 5 had through and through stab wounds, 2 had two-entrance wounds. Twenty-three wounds were to the right ventricle, 16 wounds were to the left ventricle, and 11 wounds involved the atrial chambers. Fifteen patients required emergency thoracotomy, because of arriving pulseless in the emergency department. The other patients' were stable enough to allow immediate surgery. There were 18 in-hospital deaths (%31.5). Cardiopulmonary bypass was not used during primary surgical repair. The prehospital care and rapid transportation of victims of penetrating heart trauma influence patients survival markedly.

The magnitude of trauma as a major public health problem is well established. It causes death in young adults than any other disease. The multiply injured patient has by definition multiple problems, and adequate treatment necessitates a team approach. The principles of management in all cases of extensive trauma are simultaneous assessment and resuscitation, complete physical examination, diagnostic studies if the patient becomes hemodynamically stable, and life saving surgery. A well equipped emergency department and rescue system, training and education in resuscitation of trauma, excellent trauma organisation will decrease preventable trauma deaths.

In this study 35 patients who were treated because of acute diaphragmatic rupture at Atatürk University, School of Medicine Department of General Surgery between 1.1.1988-31.12.1994 were analized. Diaphragmatic ruptures were due to penetrating trauma in 25 (71.4%) patients and blunt trauma in 10 (28.6%) patients. There were 11 (44%) left, 11 (44%) right and 3 (12%) bilateral diaphragmatic ruptures in blunt trauma group. Diagnostic value of PA chest x-ray was found to be 28.5. The most frequent concomitant organ traumas were spleen (42.8%), liver (40%) and stomach (31.4%). The most frequent postoperative complications related to lungs (54.3%). There were 8 (22.8%) postoperative mortalities. Diaphragmatic ruptures because of concomitant organ traumas have high morbidity and mortality rates. In diagnosis the most important step is to remember this entity. Diaphragma must be examined carefully in multysystem trauma patient.

Between 1990 and 1993, penetrating abdominal wound cases examined for investigating the effect of the etiological factors on progress of the disease. %73.8 of the cases were penetrating stab-wounds and %26.2 of the cases were gun-shot wounds. In % 63.7 of the gun-shot wound cases there was multiple organ injury. In other group this rate was %31.3. There was no peritoneal involvement in %5.6 of cases and in %8.7 of cases there was no organ pathology. Liver, colon and small intestine were the most injured organs. Overall mortality was %2.4. In gun-shot and stab-wounds mortality was %9.1 and %0 respectively. The most important reason of mortality was hypovolemia. Complication and mortality of gun shot wounds are higher and we have come to a conclusion that early laparatomy in penetrating abdominal wounds lead o decreased complications and mortality.

39 patients who underwent splenectomy were investigated to determine whether early postoperative injection risk increases after splenectomy. Patients, ranging in age from 2 months to 64 years, were divided into two groups. 1) infected (n=15) and 2) noninfected (n=24). There were 21 episodes of infection: 11 respiratory tract infections, 3 urinary tract infections, 3 bacteremias, 2 intraabdominal abscesses and 2 wound infections. Pneumococcus were cultured from 8 (26.6%) of the septic foci, Enterobacter aerogenes were cultured from (20%), Staphylococcus coagulase positive were cultured from 6 (20%)beta hemolytic streptoccus were cultured from (13.3%), E. Coli were cultured from 4 (13.3%) and Candida were cultured from 2 (6.6%) of the septic foci. Group average alternate daily WBC (white blood cell) counts and daily maximum body temperature of 37.35 C. In the noninfected group, these values were 10509.00/mm3 and 36.75 C, respectively. Only one patient developed overwhelming postspnenectomy sepsis. We concluded that the frequency of septic complications after removal of the spleen is considerable, and WBC count predicts infection in the postoperative period not physiologic.

The use of selective nonoperative management of blunt splenic and liver trauma in adults is based on the undeniable benefits on this approach in children. Proper patient selection requires hemodynamic stability, lack of generalized peritoneal irritation, and minimal blood transfusion needs. The increased use of sophisticated imaging techniques (radionuclide scintigraphy, ultrasonography, computerized tomography) and peritoneal lavage in the last decade, has contributed to improved characterization of the extent of injury. But the decision for laparotomy is based on clinical grounds. 144 patients with blunt splenic injury and 140 patients with blunt liver injury admitted to Gevher Nesibe Hospital were included in this retrospective study. 702 consecutive adults with serious blunt abdominal or multisystem trauma were evaluated between January 1985 and December 1994. Penetrating and iatrogenic splenic and liver injuries were not included. Patients were seperated into categories based on age, sex, mechanism of injury, diagnostic modality and treatment option employed. Out of the total series, 69 patients were not operated, 42 patients had exploratory laparotomy, and in 12 patients splenic repair, in 30 patients liver repair and drainage, in 60 patients liver resection and 113 patients splenectomy were performed. None of the nonoperatively treated patients had generalized irritation. Blood transfusion requirements were significantly less in the nonoperative groups (average 2.4 U). Fourteen of these 69 patients (20.2%) developed complications. Eleven of these 69 patients (15.9%) died and these were secondary to severe complications. Consequently, liver and splenic injuries in adults can be safely managed nonoperatively in selective patients.

Early assessment of severe pancreatitis is of major importance in the treatment and prognostic evaluation. The prediction of severity and prognostic capacity of RANSON, IMRIE, BANK and AGARWAL scoring systems were analyzed in a consecutive series of 120 cases presented with 122 acute attacks during the previous 6 years. 79 patients were female and 43 were male. Of the 122 attacks, 21 were severe (17.2%) and 101 were mild pancreatitis (82.8). The sensitivity of these four systems in assessment of severe pancreatitis were 85.7%, 76.2%, 66.7% and 71.4% respectively. The specificity was found to be 96.1%, 94.1%, 80.2% and 82.2% respectively. Although no statistically significant difference in the assesment of disease severity and prognostic capacity was observed between the groups; there existed a statistical trend in sensivity favoring Ranson and Imrie scoring systems.

In this study; the records of 130 patients whom were treated because of blunt abdominal trauma in Çukurova University Faculty of Medicine General Surgery Department between 1987 to 1993 were reviewed. The aim of study was defined the factors which were affecting postoperative mortality. Of these 130 patients, 110 were male, 20 were female, and mean age was 32 years. Major cause was traffic accidents in 80%. Spleen was the most injured organ in our study group. Mortality rate was 19.2% and major complication was developed in 26 (20%) patients. In conclusion, the presence of head trauma, hypotension (less than 90mmHg), multiple intraabdominal organ injuries, blood tranfusion more than 3 units were considered major factors affecting postoperative mortality.

Sixty-four patients with blunt small bowel injury determined during 8 years were retrospectively reviewed. Causes of trauma were traffic accident in 40 (62.5%), falling down in 13 (20.3%) and blow trauma in 11 (17.7%) cases. The most frequent complaints and physical findings were abdominal pain and tenderness. Peritoneal lavage was positive in 33 (97%) of 34 suspected patients. Isolated blunt small bowel injury was found in 31 (48.4%) patients. The other patients had multiple system injuries. All simple and small perforations and complete rupture were resected with primary anastomosis. The most serious complications related to blunt intestinal injury were anastomotic leakage and intraabdominal abscess. Our morbidity and mortality rates were 17.1%and 10.9% respectively.

The splenic injuries are usually caused by blunt trauma, and high mortality rate is generally reported. In this study we reviewed the management and outcome of 122 patients with splenic injury. The reason of splenic injury were traffic accidents at all blunt trauma cases. Twenty-two patients were classified as simple splenic injury and managed by splenoraphy with a mortality rate of 8.5percent. In this group, associated injuries were found to be the most important factor, upon the mortality. The rest of the patients were classified as Grade 3,4 and 5 injuries. Nine-teen of the patients died and the mortality rate was 15.7 percent. Injury severity score was 14 in the group which splenoraphy was performed, but this score was better than that of survivor and non-survivor groups. We determined five important prognostic criteria in these blunt splenic injuries. These factors were age, heamatocrit, associated extraabdominal injuries, shock index and injury severity score. These factors can be easily determined and patient and his/her injury easily and rapidly managed.

We have reviewed 101 cases of electrical burns treated at the Emergency Medical School of Istanbul Medical Faculty during the past 6 years (1989-1995). There were 985 acute burns admissions during this period, the incidence of electrical burns being 10.2 percent. Low-voltage electrical burns occured in 59 of the 101 patients (58.5 percent). These were caused mostly by household electricity suplies, occured in children, and were preventable. The surgical management of these burns was similar to other thermal burn injuries. The incidence of high-voltage elected injuries 41.5percent in our series. These tended to occur outside the home in young adult males and were also frequently preventable. Amputations constituted the single largest category of complications. Being neccessary in 22(52 percent). Seventy-six percent of the amputations were in the upper extremity, while twenty-four percent in the lower. The overall mortality rate was 11.8 percent (12 cases) and the mean hospital stay was 25 days. We attribute these high amputation and mortality rates in our series to late transfer of patients to our Burn Unit. 11 of the 42 patients were transferred to our unit after their 1st day and seven of them were in their 5th day. This delay prevented us from providing an aggresive fluid resuscitation, continuous haemodynamic and metabolic support, and early agressive surgical intervention.

The reported incidence of acute traumatic diaphragmatic ruptures (TDR) varies between 4.5% and 5.8.% Inadequacy of diagnostic procedures along with the associated severe organ injuries are the main reasons of late diagnosis and increasing mortality rates in these patients. TDR was diagnosed during the period of June 1990-January 1994. The diagnosis of TDR was established in these patients within the first 6 hours of their admittance. The diagnostic value of physical examination and chest x-rays were found to be 5% while the incidence of pathologic findings' were evaluated to be 45-50%, Prompt laparatomy was found to have an early diagnostic value in 45% of the cases. Mortality was calculated to be 30% in our cases all of them resulting from the associated severe other organ injuries.

We had conducted surgery on 22 patients with popliteal arterial injury. Popliteal injuries were related to blunt trauma in 12 patients (%54.54); in 9 patients (40.90%) the injury were related to the gun shut; in one case (4.54%) the injury was caused by a saw. In 14 cases (63.63%) saphenous vein interposition; in 6 cases (27.27%) resection and to end anastomosis; in two cases (9.09%) primary repair had been done. We had no mortality and the amputation rate was 13.63%.

The patients that have been operated with the diagnosis of acute mechanical intestinal obstruction (AMIO) in the 3rd General Surgery Department of Şişli Etfal Hospital between 1990-1994 were reviewed retrospectively. In these five years, 2367 operations were performed, and AMIO occured in 10 patients (4%). Among the causes (45%), followed by adhesions (16%), colonic carcinoma (15%), sigmoid volvuli (5%), a segmental organic lesion of the small intestine (5%), bezoar (4%), intussusception (3%) and others.

Over a 4 year period 311 patients were admitted with blunt injury to the abdomen. Twenty-one of these (%6.7percent) were found to have small bowel rupture. The blunt injuries are mostly result of vehicular trauma. The major of intestinal trauma was repaired by simple closure or resection. The mean time from admission to laparotomy was 17 h. inital clinical and radiological evidence of bowel perforation can be misleading and reliance on such indicators may result in significant diagnostic delay. Frequently repeateted clinical examination is advocated; progression of abdominal sings should alert the clinician to proceed to laparatomy.