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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 1 (2)
Volume: 1  Issue: 2 - September 1995
1. 
TRAVMALI HASTAYA İLK YAKLAŞIM VE RESÜSİTASYON
Cemalettin Ertekin, Saman Belgerden
Pages 117 - 125
Abstract |Full Text PDF

2. SURGICAL APPROACH TO GASTROINTESTINAL TRACT TRAUMA
Korhan Taviloğlu, Kayıhan Günay, Ali Şahin, Cemalettin Ertekin, Ömer Türel
Pages 126 - 134
250 patients with gastrointestinal tract trauma, who underwent surgery between the years 1989'and 1994 were evaluated in this study. 180 of the trauma cases were penetrating, and 70 were blunt. Main causes of penetrating trauma were: stabbing and shot-gun wounds. The main cause for blunt trauma were traffic accidents. Major injured organs were: small intestine, colon, and stomach. Major concomitant organ injuries were: liver, spleen, and head; respectively. 88% of the patients were transported to our center within the first hour following trauma. Peritoneal lavage remained in the first setting, among diagnostic methods. Ultrasound and CT were the major screening methods. Diagnostic laparoscopy was favored during the last year. The overall morbidity and mortality rates were 17.6% and 12%, respectively. Concomitant trauma constituted the major death cause.

3. AN APPROACH TO ORTHOPEDIC INJURIES OF LOWER EXTREMITIES COMPLICATED WITH VASCULAR INJURIES. AMPUTATION? RECONSTRUCTION?
Cemalettin Ertekin, Ali Emin Aydın, Cengiz Dibekoğlu, Mehmet Kurtoğlu
Pages 135 - 139
In this study between years 1990 and 1994, 25 combined lower extremity vascular and orthopedic trauma patients were examined retrospectively. The aim of the study is to determine some factors which show the prognosis of the patients. By a score system, the patients, who would not get benefit from the treatment, will be determined previously, and their limb amputation would be performed without spend more time. As a result, we saw that in the patients whose score is 7 or over 7; amputation will be needed. (p<0.001).

4. OPERATIVE AND RADIOLOGICAL METHODS IN THE TREATMENT OF INTRAABDOMINAL ABSCESS
İhsan Diler Özaçmak, Bülent Öner, İshak Özaçmak, Erdur Serin, Mustafa Baloğlu
Pages 140 - 144
22 patients with radiologically proven (CT, US) intraabdominal abscess were prospectively evaluated within the context of a dual treatment protocol allowing the patient cither to a radiologically controlled catcheter drainage or classical open operative abscess drainage. The trial was conducted between may 1990 and december 1994 in the First Surgical and Radiology Clinics of the Taksim Hospital. Patients were categorised as having simple or complicated intraabdominal abscess formation. 7 patients received radiologically assisted puncture and drainage, whereas 15 were primarily operated for abscess drainage. Prognostic evaluations were done with APACHE II scoring system. The results of surgical and radiological procedures were not statistically different in cases with simple intraabdominal abscess (0.1

5. BLUNT ABDOMINAL TRAUMA: THE VALUE OF ULTRASONOGRAPHY (USG) AND DIAGNOSTIC PERITONEAL LAVAGE (DPL) IN DIAGNOSIS
Ragıp Taş, İrfan Coşkun, A Rahmi Hatipoğlu
Pages 145 - 150
Diagnostic peritoneal lavage and ultrasonography are widely used two methods in the diagnosis of blunt abdominal trauma. 31 (25 male, 6 female) patients admitted to our clinic due to blunt abdominal trauma who had abdominal signs between the period of January 1991 and January 1994. The value of USG and DPL was compared in the diagnosis of blunt abdominal trauma. All patients were hemodynamically stable when first seen at the emergency department. Mean age was 31.4. The most frequent cause of blunt abdominal trauma was traffic accident which was seen in 27 (%87.1) patients. The signs most often seen were abdominal pain and defense musculare during palpation. Firstly USG was done to all patients and then DPL. According to results 26 patients (%84) were operated and 5 cases (%16) were closely observed. At the end of the period of operation and observation DPL was found true positive in 25 cases (%80.6), true negative in 5 cases (%16) and false positive in 1 case (%3.2). USG was true positive in 24 cases (%77.4), true negative in 3 cases (%9.7), false positive in 3 cases and false negative in 3 cases. Sensitivity, specificity and accuracy rate were found %100, %83,3 and %96.7 for DPL and %96, %50 and %87 for USG respectively. In conclusion, diagnostic peritoneal lavage was found more valuable than ultrasonography in the diagnosis of the blunt abdominal trauma.

6. LAPAROTOMY FOR ABDOMINAL TRAUMA
Ümit Topaloğlu, Mehmet Odabaşı, Ali Yılmazcan, Selçuk Ünalmışer
Pages 151 - 154
We reviewed 274 patients retrospectively for a 7 years period that we made laparotomy for abdominal trauma. The most trauma cause was motor vehicle accident (50.3%) and the indications for operation were peritoneal lavage (50.4%) and shock (28.9%). The most commonly injured organ by blunt trauma was spleen (48.8%); in the penetrating trauma (32.6%) and the stab wounds (36%) was small intestine. The false laparotomy rate for blunt trauma was 2.4%, while for stab wounds it was 20.4%, and for shotgun wounds 8%. The mortality rate for blunt trauma was 16.9%, for stab wounds 1.2% and f or shotgun wounds 12%.

7. TRAUMATIC DIAPHRAGMATIC HERNIAS
Salih Selman, Rıza Küpelioğlu, Davut Aydemir, Servet Karahan, Yaşar Doğan
Pages 155 - 157
In this case report, we want to present two patients with strangulated hernia, which retained silent for. a long period. Consequently a developing strangulated hernia would make the situation even more complicated. To effect the morbidity and the mortabidity and the mortality rates positively in the patients who have thoracic trauma, silent ruptures of the diaphragm must be considered.

8. AN AIR GUN INJURY CASE
Zerrin Erkol, Sait Bilal, Metin Bayram
Pages 158 - 162
Injuries from air guns have been seen in Turkey since 1992. Although air gun injuries are rare and generally not serious, if the pellet hits the eye region, it can penetrate the skin and the wall of the orbit. So visional loss may occur at different degrees on victim. In this paper, a case of air gun injury, which perforated the left eye and rested in lobus temporalis of cerebrum, is reported.

9. SELECTIVE OBSERVATION IN PENETRATING ABDOMINAL WOUNDS
Salih Selman, Rıza Küpelioğlu, Davut Aydemir, Servet Karahan, Zafer Önder
Pages 163 - 165
In Haseki Hospital, Department of General Surgery, laparotomy were performed between the years 1990-1994 for 56 penetrating abdominal wound. 21 cases (%37) were negative laparotomies. Since the ratio of negative laparatomies in stab wounds of the abdomen is too high, it has been thought that, the indications for exploration in these cases must be reviewed as has been proposed by many authors and a more selective approach must be made.

10. EMERGENCY LAPAROSCOPY IN THE DIAGNOSIS AND TREATMENT OF ACUTE ABDOMEN AND ABDOMINAL TRAUMA
Rıfat Tokyay, Gülüm Altaca, Ersin Özdemir, Kadir Kılıç
Pages 166 - 168
Diagnostic laparoscopy (DL) can be employed in emergency conditions either to assess the patient with abdominal trauma or in abdominal diagnostic dilemma. We performed 20 urgent of emergent DL in a period of 15 months. The indication of DL was right lower quadrant pain (RLQP) in 15 and blunt abdominal trauma in 6 patients. Appendicitis was diagnosed in five of the fourteen patients who had undergone DL for RLQP. Laparoscopic appendectomy was done in all five and conventional appendectomy (due to multiple adhesions from previous surgery) was done in one patient. In 8 patients, the origin of the RLQP was gynecological and only one patient who had tubal pregnancy needed surgical intervention. Emergent DL was performed in six patients who had. blunt abdominal trauma. All six had concomitant head injury and four of these had, in addition, unexplained hypotension. Two of these patients had blood in the abdomen and underwent laparotomy, one retroperitoneal hematoma. In one patient with RLQP laparoscopy was not diagnostic due to multiple abdominal adhesions from previous surgery. In this series DL was successful in establishing a definite diagnosis in 19/20 (95%) of the cases. Only one complication was encountered in these 20 patients and it was a wound infection at the trocar site in a patient who underwent appendectomy for a perforated appendix. In conclusion, emergency DL can diagnose dilemmas, establishes priority of treatment in the multiple injured patient and eliminates unnecessary laparatomies and expensive and time consuming laboratory examinations.

11. ENDOSCOPIC CORRECTION OF SIGMOID COLON VOLVULUS
H Serdar Yazıcı, Yavuz İlhan, M Ali Akkuş
Pages 169 - 171
This report discusses 34 patients with non-gangrenous sigmoid volvulus attempted sigmoidoscopic decompression in University of Fırat Faculty of Medicine Department of General Surgery between 1990 and 1994. Decompression procedures were successful in 21 patients (%61,7). In 3 of these patients early recurrences were occurred in 72 hours and was managed endoscopically. 12 patients did not undergo surgery and 3 of these patients had late recurrent volvulus and was managed endoscopically. Elective resection was performed in 9 patients. Endoscopic attemps at decompression were unsuccessful in 13 patients. Emergency resection was required in these patients. We conclude that elective operation that was performed after successful endoscopic decompression would decrease mortality and morbidity rates.

12. UNCONTROLLABLE HAEMORRHAGE FOLLOWING PENETRATING GLUTEAL INJURY
Kayıhan Günay, Korhan Taviloğlu, Ergun Eskioğlu, İzzet Rozanes, Mehmet Kurtoğlu
Pages 172 - 174
Penetrating gluteal trauma, although increasingly common, has not been widely discussed in the surgical literature. Four cases of life-threatening sequelae of relatively minor penetrating injuries of the gluteal region, involving the superior gluteal (two cases), and inferior gluteal (two cases) arteries, are reported. Two of the patients were in hemorragic shock. After being resuscitated, the bleeding could be controlled by packing in all patients. Thereafter, angiographic assessment was used in these cases and the bleeding vessels were embolized with fibrin. Angiography after embolization showed complete occlusion of the aneurysms and their feeding vessels. We believe that the advent of angiographic embolization offers the opportunity for safe definitive treatment.

13. SERUM PHOSPHORUS LEVEL CHANGES AND BACTERIAL TRANSLOCATION IN MESENTERIC ISCHEMIA
Recep Güloğlu, Cemalettin Ertekin, Ahmet Necefli, Sinan Yol, Mehmet Kurtoğlu, Nezahat Gürler, Uğur Çevikbaş
Pages 175 - 180
Early diagnosis and treatment of mesenteric ischemia are still significant problems. The changes in the serum phosphorus level and the bacterial translocation rate were investigated in a rat model of mesenteric ischemia. (Superior mesenteric artery ligation). The animals were sacrificed 0,2,3,4 and 6 hours after ligation. The serum phosphorus level and the bacterial translocation rate were increased in this model.

14. SURGICAL TREATMENT OF PERFORATED DUODENAL ULCER
Acar Aren, Bayram Kaya, Semra Günay, Hakan Evrüke, Akif Feyizoğlu, Kazım Sarı
Pages 181 - 184
In this study, clinical and surgical treatment of 303 cases of perforated duodenal ulcer were evaluated during a period of 5 years (1990-1995). As a result, we can state that surgeons less often prefer acid-decreasing surgical procedures in the surgical treatment of patients after closure of perforated duodenal ulcer. The effect of H2 antagonists and proton inhibitors may explain why mostly simple closure for perforated duodenal ulcers is preferred by the surgeons.

15. EFFECTS OF GRANULOCYTE COLONY STIMULATING FACTOR ON BACTERIAL TRANSLOCATION DUE TO BURN INJURY
Orhan Yalçın, Gürsel Soybir, Emine Er, Ferda Köksay, Hakkı Er, Recep Öztürk
Pages 185 - 188
Certain defects of cellular and humoral immunity have been established in burn patients. Likewise translocation of enteric bacteria to mezenteric lymph nodes and to distant organs has been observed following serious thermal injury and this translocation has shown relationship with burn mortality. Bearing this factors in mind effects of Granulocyte Colony Stimulating Factor (G-CSF), a leukocyte function improving drug on bacterial translocation has been investigated. 24 Wistar Albino rats weighing 250gr have been scalded 30% and the lesion infected by 1x103 cfu Pseudomonas Aeruginosa. The control group (n-12) has been treated with 5% Dextroz solution subcutaneously starting two days preburn, and the study group (n-12) with 100ug/kg human G-CSF (Neupogen - Roche) subcutaneously. On the 4th post burn day translocation to mesenteric lymph nodes (MLN), liver and spleen has been investigated. Translocation in the control group was 12/12 in MLN, 12/12 in liver an 12/12 in spleen where as in the study group the values were 5/12 in MLN (p<0.01), 6/12 in liver (p<0.01) and 6/12 in spleen (p<0.01). Translocation values in MLN were 986 349 cfu/gr (p<0.05) in the study group. It has been observed that G-CSF is significantly effective in reducing bacterial translocation due to burn injury infection.

16. OUR TETANUS EXPERIENCE (ANALYSIS OF 19 CASES)
Melek Çelik, Ceyhun Solakoğlu, Ebru Taştan, Emine Erol, Nur Akgün Şenel
Pages 189 - 191
19 generalized tetanus cases that have been treated between 1990-1944 in HNH Reanimation Clinic are reviewed. The patients with an average age of 48+18 had tetanus due to simple wounds. Pain, trismus, neck stiffness, disphagia were the initial symptoms encountered. After 24 hours muscle spasms were seen. Treatment was carried out with mechanical ventilation, MgSO4 sedation and supportive therapy in our clinic and our mortality rate was63%.

17. AN ISOLATED TRACHEOBRONCHHIAL RUPTURE CAUSED BY BLUNT TRAUMA
Suat Tayan, Ali Burak Çulhaoğlu, Mehmet Mihmanlı, Uğur Dikmen
Pages 192 - 193
Midthorasic tracheobronchial rupture case caused by blunt injury, treated at the emergency ward of Şişli Etfal Hospital Because of the location of the injury and the rarity of the mechanism, we try to present the case by summarizing the relevant literature. After blunt thorax injury, failure of the lung to expand after thoracostomy tube insertion should suggest tracheobronchial rupture and delay in diagnoses can be fatal.

18. INCIDENCE OF ASSOCIATED INJURIES WITH FEMORAL SHAFT FRACTURES
Kemal Durak, Ömer Faruk Bilgen, Ufuk Aydınlı, Tufan Kaleli, A Ufuk Tokcan
Pages 194 - 196
Forty-two patients with femoral shaft fractures treated in the University of Uludağ Medical School. Orthopaedics and Traumatology Department were evaluated for associated injuries. Thirty-two (76.20%) patients were men and ten (23.80%) were women with an average age of 32 years. The major cause of the injuries were traffic accidents (85.71%). Seventy four percent of these patients had associated injuries. Majority of them were head (35.72%) and abdominal (16.66) injuries. In conclusion, keeping in mind of the associated injuries, patients with femoral shaft fractures should be carefully evaluated and treated.

19. INTRAORBITAL FOREIGN BODY
Tamer Koldaş, Gün Ersu, Fatih Şirin, Bedrettin Görgün
Pages 197 - 198
Attention should be made on penetrating injuries of the orbit. Forcing bodies, that can cause vision loss and even enucleation, should be detected carefully. Different imaging techniques, ranging from conventional radiographs to magnetic resonance imaging should be used. In this paper, we report an orbitocranial penetration case. Diagnosis, evaluation of the patient and treatment are diseased in this case report.

20. THE DEMOGRAPHIC EVOLUTION OF 179 PATIENTS WHO HAD EXTREMITY LESION BESIDES HEAD INJURY
Sacit Turanlı, Ercan Dinçel, Aylin Sepici
Pages 199 - 204
During the period from 1st of April to 31st of December 1994, we had examined the demographic data's and clinical aspect of 791 patients in Ankara Dr. M.Ülker Emergency and Traumatology Hospital, Emergency department that were an suffering from head injuries and 179 of those had an extremities problems. All identity knowledge's, causes of injuries and whetner the patients had used alcohol or drug was noted. Besides vital functions of patients at first arrival to the emergency department, neurologic examination, scores of Glasgow coma scales, and other pathologies were added to the forms. Additionally, patients who had extremity problems and vertebrae's fractures were examined again and classified related to the localization of the fractures.

21. A STUDY OF EPIDEMIOLOGY AND MORTALITY IN BURN PATIENTS
Kayıhan Günay, Korhan Taviloğlu, Ergun Eskioğlu, Cemalettin Ertekin
Pages 205 - 208
This is a retrospective study of 985 patients with burn injuries admitted to the Emergency Surgery Department of Istanbul Medical School during a period of 7 years (1989-1995). There were 689 males and 296 females (mean age 22.4). The mean burn extent was 19 percent of the total body surface (16%in minor burns, 55%in major burns) and the most common cause was in the group of 0-14 years. Patient mortality was 1,5 %in minor burns, 45,5% in major burns, a great number of these cases could be prevented by the education of parents and school children. Burn extent, its depth and patient age are the factors on which the surgeon's attention should concentrate in the immediate treatment of burn victims in order to decrease the mortality.

22. UPPER GASTROINTESTINAL HAEMORRHAGE
Rıza Küpelioğlu, Salih Selman, Servet Karahan, Davut Aydemir, Yaşar Aydın
Pages 209 - 211
58 cases with upper gastrointestinal haemorrhage treated surgically at Haseki Hospital from 1990 through 1994 have been investigated being compared with datas in recent literature. Mortality was observed to be higher in patients who are old, delayed and not resuscitated adequately.

23. ADVANCES OF THE MANAGEMENT OF PANFACIAL FRACTURES
Oğuz Çetinkale, Nuri Battal, Fadıl Ayan, Gökalp Özer, Sunay Dikici, Cem Karağit, Muzaffer Altıntaş
Pages 212 - 220
Many problems have been appeared if severe panfacial fractures are not treated in proper timing and good reconstructive techniques. The use of craniofacial surgical techniques in facial fractures and immediate surgical intervention are purposed for the reconstruction of seven the most complicated injuries. According to this approach; the facial injuries are repaired immediately or within the first few days even in multitraumatized patients whenever possible. It is a common approach today to treat the facial injuries in one stage by open reduction and rigid fixation, and if necessary by using bone grafts. In this study, the techniques of diagnosis and treatment of 10 patients with panfacial injury who were admitted to emergency for last 3 years agter reorganization of the unit were presented including advantages and disadvantages of the used methods. Three dimensional and functional reconstruction have been obtained by using rigid fixation successfully. This approach results in good appearance aesthetically and prevents late interventions for secondary deformities which are extremely difficult to treat later adequately.