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Volume : 11 Issue : 4 Year : 2024

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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 11 (4)
Volume: 11  Issue: 4 - October 2005
1.Surgical site infections: risk factors and methods of prevention
Ali Uzunköy
PMID: 16341964  Pages 269 - 281
Surgical site infections are the most important problems of surgery. They increase morbidity, mortality, hospital stay and hospital costs. Infection occurring within 30 days after the operation if no implant is left in place or within 1 year if implant is in place is described as surgical site infection. These infections are classified into two categories; incisional or organ/space specific infections. Incisional infections are further divided as superficial or deep incisional infections. Development of surgical site infections is mainly dependent on type of micro-organism and patients’ factors related to host resistance. The endogenous flora of the patients’ skin, mucous membranes, or hollow viscera is the main source of microorganisms responsible for surgical site infections. Development of such infections can be influenced via a lot of risk factors such as nutritional status, diabetes, smoking, altered immune response, and length of preoperative stay, skin antisepsis, preoperative shaving, duration of operation, antimicrobial prophylaxis, operating room ventilation, inadequate sterilization, the presence of foreign material in the surgical site, and surgical techniques. With the improvement of some of these factors, risk of developing surgical site infections may be decreased. The aim of this study was to discuss the risk factors and prevention measures of surgical site infections in the lightening of current literature.

2.Does sepsis impair the healing of colonic anastomosis in splenectomized rats?
Ali Nayci, Ülkü Çömelekoğlu, Eda Çıngı, Hakan Taşkınlar, Dinçer Avlan, Nurten Renda, Selim Aksöyek
PMID: 16341965  Pages 282 - 286
BACKGROUND: To investigate the effect of splenectomy on the healing of colonic anastomoses under normal and septic conditions. METHODS: Forty Wistar rats were assigned into six groups: group 1: sham, group 2: colonic anastomose, group 3: splenectomy, group 4: colonic anastomose plus sepsis, group 5: colonic anastomose plus splenectomy, group 6: colonic anastomose plus splenectomy plus sepsis. The rats underwent a standardized left colonic resection and primary anastomosis and/or splenectomy. Sepsis was produced by cecal ligation and puncture. Wound healing was evaluated by bursting pressure and hydroxiproline estimates. RESULTS: Bursting pressures were as follows: group 1: 173 ± 14 mmHg, group 2: 186 ± 7 mmHg, group 3: 168 ± 6 mmHg, group 4: 113 ± 14 mmHg, group 5: 167 ± 10 mmHg, and group 6: 183 ± 3 mmHg. Hidroksiprolin contents were: group 1: 3.5 ± 0.2 µg/mg, group 2: 3.2 ± 0.3 µg/mg, group 3: 3.4 ± 0.2 µg/mg, group 4: 2.3 ± 0.2 µg/mg, group 5: 3.0 ± 0.2 µg/mg, grup 6 3.2 ± 0.1 µg/mg. Statistical significance was found between group 4 and the other groups (p<0.05). CONCLUSION: Sepsis impairs the healing of colonic anastomoses. However, sepsis does not impair the intestinal wound healing in splenectomized rats.

3.The diagnosis of cardiac dysfunction in critically III trauma patients with blunt chest trauma and presumed myocardial contusion: the critical nature of end diastolic volume
Rade B Vukmir
PMID: 16341966  Pages 287 - 298
BACKGROUND: To evaluate prospectively the effectiveness of monitoring end-diastolic volume (EDV) vs pulmonary artery occlusion pressure (PAO) as an estimate of cardiac preload in hemodynamically unstable critically ill 23 myocardial contusion patients with blunt chest trauma admitted to a university trauma center.. METHODS: Patients were resuscitated (ATLS guidelines) with intubation and volume replacement for altered consciousness, hypoxemia or hemodynamic instability. Volume resuscitation and pulmonary artery catheterization were started to measure PAO, EDV, and oxygen utilization parameters. Myocardial performance was determined in both static (0., 24., 48., 72. hours) and dynamic condition after 500cc fluid bolus. RESULTS: A moderate injury severity (GCS 9, TS 11, ISS 34) with MVA mechanism (91%), an average ICU stay of 14 days and a 39% mortality were revealed. Correlation of PAO, EDV with CO, CI demonstrated that EDV is more reliable than PAO However, factoring heart rate into CO determination was more reliable than single preload estimates of EDV-PAO-HR, HR-EDV, and HR-PAO. EDV-PAO-HR were correlated more strongly with cardiac output from 24 to 96 hours. A higher AV02 decrease was associated with improved survival, and a nearly significant decrease in EDV. Dynamic comparison found no change in cardiac performance with a small volume challenge. CONCLUSION: Simultaneous consideration of PAO, EDV, HR allowed the most accurate determination of cardiac output.

4.Approach to the lower gastrointestinal tract bleeding in patients with normal colonoscopic findings
Hızır Akyıldız, Cemalettin Ertekin, Orhan Alimoğlu, Çağatay Çağatay, Korhan Taviloğlu, Recep Güloğlu, Arzu Poyanlı
PMID: 16341967  Pages 299 - 305
BACKGROUND: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic examination is the first choice for diagnosis, it may not be enough to reveal the cause of bleeding in all subjects. METHODS: Eight patients who had massive lower gastrointestinal bleeding having normal colonoscopic findings were retrospectively evaluated at the Department of Trauma and Emergency Surgery, Istanbul University, Faculty of Medicine RESULTS: There were 5 male and 3 female patients with mean age of 51 (28 to 82). Patients received a mean of 13 U (range 2 to 23) with transfused erythrocyte concentrates. Four patients had found to be normal during angiographic, scintigraphy or enterocylytic examinations. Angiography was diagnostic in 4 patients, and identified bleeding from ileocolic pseudoaneurisms (n= 2) branches of jejunal artery (n=2). Embolization procedure were performed in these 4 patients and 3 of them developed intestinal necrosis and underwent surgery. One did not require further treatment. Two of the patients who underwent surgery expired due to sepsis. Patients were hospitalized for a mean of 17 days (range 5 to 37). CONCLUSION: Despite employment of all diagnostic procedures, the cause of bleeding were not detected in half of patients who had normal colonoscopic findings. If angiographic treatment is necessary, superselective arterial embolization should be performed.

5.The clinical approach to the isolated traumatic hemothorax
Levent Cansever, Gökhan Hacıibrahimoğlu, Cemal Asım Kutlu, Mehmet Ali Bedirhan
PMID: 16341968  Pages 306 - 309
BACKGROUND: The aim of this study was to evaluate the systematic approach to the isolated traumatic hemothorax. MATERIAL AND METHODS: The treatment modalities of 103 cases with isolated hemothorax was analyzed retrospectively between 1995 and 2003. RESULTS: We observed 103 isolated hemothorax cases. Eighty eight of them were male and 15 were female. The mean age was 39.4 years. The hemothorax was left sided at 41 cases, right sided at 60 cases and bilateral at 2 cases. Fifty three (51,4%) penetrating, forty nine (47,5%) blunt, and one (0,9%) iatrogenic traumas with resultant hemothoraxes were investigated. We performed tube thoracostomy in ninety nine cases. One case required an urgent thoracotomy. We operated twenty one cases and thoracoscopy was performed for six of them. The conservative approach was sufficient for eighty two patients. Mortality was seen in only one case (0,9%), because of a multiorgan failure. The mean rate of the hospital stay was 8,7 days. During operation, we explored for major pulmonary and systemic artery injury. CONCLUSIONS: The decision of exploration or conservative treatment must be made according to the patient stabilization status after the thoracostomy tube insertion. Thoracoscopic evacuation of blood clots from hemothoraxes must be attempted during the early posttraumatic stages, especially in cases refractory to classical drainage methods.

6.Pediatric head injuries: a retrospective analysis of 280 patients
Osman Şimşek, Tufan Hiçdönmez, M Kemal Hamamcıoğlu, Cumhur Kılınçer, Turgay Parsak, Mehmet Tiryaki, İmran Kurt, Sebahattin Çobanoğlu
PMID: 16341969  Pages 310 - 317
BACKGROUND: To assess etiological factors, clinical features, radiological findings and recovery rates in pediatric head injuries. METHODS: Patients (n =280) with head injuries (age range: 0 - 16 years) hospitalized in Trakya University Department of Neurosurgery between January 1995 and 2004 were analyzed statistically. RESULTS: According to Glasgow Coma Scale (GCS) the patients had minor (GCS: 13- 15 ; 70.1% ), moderate (GCS: 9- 12; 17,1% ), or severe (GCS: 3 to 8; 6,8% ). head injuries The most common etiological factor was fall from a height (34,3%); and the most frequently associated injury was extra-spinal skeletal injury (12,9%). Fifty-one patients (18,2%) underwent neurosurgical operation. 87.5% of them recovered completely, while 12,5% showed partial recovery or died, as graded by Glasgow Outcome Scale (GOS). There was a moderately strong correlation between initial GCS and GOS (r=0,53, p=0,01). CONCLUSIONS: Nearly half of the pediatric head injuries were caused by falls with good prognoses. In the school age, motor vehicle accident (MVA) was the most frequent trauma type. MVA was the most serious type of trauma as demonstrated by its low GCS and GOS scores. Polytraumas, subdural hematomas, cerebral contusions, subarachnoid or intracerebral hemorrhages, cerebral edemas, diffuse axonal injuries, and any cranial lesion which required surgery were found to be related with poor prognosis.

7.An evaluation of civilian aviation accidents in Turkey from 1955 to 2004
Mehmet Özdoğan, Nihat Tosun, Fatih Ağalar, Mehmet Eryılmaz, Kuzey Aydınuraz
PMID: 16341970  Pages 318 - 323
BACKGROUND: Documentation and analysis of aviation accidents is very important to improve aviation safety and post-accident survival. In this study we aimed to evaluate the civilian aviation accidents between 1955 and 2003 in Turkey to identify the risk factors for fatal and non-fatal injuries. METHODS: Records of Civilian Aviation Office of The Turkish Ministry of Transportation were retrospectively analyzed. RESULTS: A total of 562 aviation accidents occurred within the boundaries of Turkey in the 48-year study period. There was at least one casualty in 237 of these accidents. There were 27 major accidents with more than 5 casualties. There were more major accidents with survivors than without survivors. Major accidents occurred more frequently within the near vicinity of an airport. There are significantly more accidents with survivors in the accidents occurring near the airports. The mean number of accidents with more than 50 casualties is 0.167 (8/48) per year. CONCLUSION: Accidents occurring near the airports have a more chance of having survivors. Emergency disaster preparedness plans should be on hand and drills with no more than 50 injured should be regularly exercised in all airports.

8.Crush injuries of the hand
Ramazan Erkin Ünlü, Elmas Abacı Ünlü, Hakan Orbay, Ömer Şensöz, Turgut Ortak
PMID: 16341971  Pages 324 - 328
BACKGROUND: To carry out a pilot study on the epidemiology of the crush injuries of the hand in our country and to obtain valuable data that will be used for construction of a protective program in the future. METHODS: 124 patients with crush hand injuries were observed retrospectively based on medical records in terms of age, sex, field of work, parts of body affected by the injury, mechanism and underlying causes of the injury. RESULTS: Most of the patients were in 0-18 year- age group and inserting the hand into the working machine was the leading cause of injuries. Eighty seven male (70,16% ) and 37 (29,84 %) female patients were included in the study.
Most of the patients (44,1%) were working in wood industry at the time of the accident. Interestingly only one hand of all patients were injured. Most commonly injured finger was the middle finger. Most commonly encountered pathology was the tendon laceration in injured fingers. CONCLUSION: Most of the cases were due to lack of attention and education and could be prevented by simple precautions and by wide-spread work education programs leading to a marked decrease in health expenses and loss of man power.

9.The results of surgical management of ankle fractures
Yüksel Özkan, Alpaslan Öztürk, Recai Özdemir, Teoman Atıcı, Şener Özbölük
PMID: 16341972  Pages 329 - 335
BACKGROUND: The results of surgical treatment of ankle fractures and influential factors were evaluated. METHODS: The study ( 1999-2003) included 40 patients (28 men, 12 women) with a mean age of 37.7 years (15-83) who underwent surgical treatment for ankle fractures. The mean follow-up period was 29.6 months (5-66) According to Lauge-Hansen classification, the mechanism of occurence was supination-external rotation in 21 (52.5%), pronation-external rotation in 8 (20%) and supination-adduction in 5 (12.5%) patients, while 6 patients (15 %) were not assessed. Fractures were also classified (Danis-Weber ) as Type A (n= 8; 20%) , B (n = 22; 55%) and C (n =10; 25%) , including 35 (87.5%) bimalleolar fractures. Roberts criteria were used for the final evaluation of the patients. RESULTS: Satisfactory union was obtained in all fractures. According to objective criteria, the results were good in 33 (82.5%) , moderate in 3 (7.5%) and poor in 4 (10%) patients, while corresponding subjective results were obtained in 34 (85%), 3 (7.5%) and 3 (7.5%) patients respectively. CONCLUSIONS: Improved outcomes can be obtained by anatomical reduction and restoration of the ankle joint, and the tilt of talus, fibular shortening and the dysfunction of the syndesmotic joint can be prevented. In our opinion our method of surgical treatment influenced better outcomes obtained.

10.Critical care management of severe head injury in children
Soner Şahin, Ahmet Bekâr, Şeref Doğan, Hasan Kocaeli, Kaya Aksoy
PMID: 16341973  Pages 336 - 343
BACKGROUND: Our aim was to analyze prognostic factors and their association with outcome among children with severe head injury. METHODS: We conducted a retrospective study among children (n=55) with severe head injury [Glasgow Coma Score (GCS) ?8] who were admitted to our Neurosurgical Intensive Care Unit (ICU) from January 1996 to September 2003. The patients were immediately evaluated with cranial computed tomography (CT) for the severity of head injury as well as for the causes of secondary insults such as hypoxia and hypotension, metabolic and hematological alterations. Outcome analysis was assessed according to Glasgow Outcome Scale Score (GOS) six months after the injury. RESULTS: A poor result occurred in 31 patients (57%) while 24 patients (43%) had favourable results. Multivariate analysis showed significant independent prognostic effect for admission mean systolic blood pressure, presence of hypoxia, multiple trauma, admission GCS score and multiple intracranial lesions (p<0.05). Admission WBC counts and serum glucose levels were not correlated with GOS. CONCLUSION: This study describes clinicoradiologic findings and prognostic factors regarding severe head injury in pediatric patients. The goals of managements of pediatric patients with severe traumatic head injury include normalizing intracranial pressure, optimizing arterial blood gases and systemic blood pressure, and prevention of factors that exacerbate secondary brain injury.

11.Can a pin-tract infection cause an acute generalized soft tissue infection and a compartment syndrome?
Haldun Orhun, Gürsel Saka, Meriç Enercan
PMID: 16341974  Pages 344 - 347
A patient who developed soft tissue infection and osteomyelitis secondary to pin tract infection after skeletal traction was evaluated. Tibial traction was performed on a patient who had exposed to a femoral pertrochanteric fracture after falling from a tree in a rural public hospital. On the first postoperative day shortly after development of soft tissue swelling, redness, and tenderness in the affected leg, compartment syndrome was noted with subsequent removal of the pin at the same health center. After arrival of the case in our center surgical decompression with an open faciatomy and proper antibiotherapy were instituted. Simultaneously hyperbaric oxygen was administered. After eradication of soft tissue infection we treated the fracture with a Richards compression screw-plate device. The patient was discharged with complete cure. This case presented how seriously a simple pin-tract infection can cause a grave clinical entity resulting in potential loss of an extremity.

12.Intestinal perforation in Wegener’s granulomatosis: a case report
Tamer Akça, Tahsin Çolak, Mehmet Çağlıkülekçi, Koray Öcal, Suha Aydın
PMID: 16341975  Pages 348 - 351
Wegener's granulomatosis is a disease characterized by a necrotizing vasculitis and granulomatous inflammation. The localized form involves the upper and/or lower respiratory tracts while in the common generalized form there is a widespread necrotizing vasculitis and renal involvement. Although gastrointestinal involvement which has been detected at necropsy in 24% of the cases is an uncommon finding, it might cause severe complications. We report a patient with clinical Wegener’s granulomatosis who subsequently developed gastrointestinal perforation. Gastrointestinal perforation was treated with surgical resection and the patient survived under the treatment of cyclophosphamide and prednisolone with no further gastrointestinal complications. The present case indicates that the gastrointestinal complications might be considered in natural history of Wegener’s granulomatosis.

13.Penetrating injury of cranium: a case report
Cüneyt Temiz, Ahmet Şükrü Umur, Celal Bağdatoğlu, Cumhur Tosun, Mehmet Selçuki
PMID: 16341976  Pages 352 - 355
A 38 year-old male patient treated for paranoid schizophrenia for five years was found on a chain saw table at his workplace with a great parasagittal, linear active bleeding wound from left occiput to medial portion of left orbita. He was unconscious with a Glascow coma score of 5 points as 1-3-1. Cranial radiographies revealed a bone defect from left occipital region to left medial border of orbita. CT scan showed also a great linear tissue damage involving left lateral ventricle, and an intracerebral hematoma located mainly at left frontoparietal region. An emergent left frontoparietal craniotomy was performed. Four centimetres laterally midline, there was a linear, vertical tissue wound. Hemostasis was achieved at first and intracerebral haematoma evacuated. At one week postoperatively, his eyes started to react to verbal commands. At 7 months postoperatively he was attempting to cooperate with eye movements and writing. He was right hemiplegic, aphasic and on the right side deep tendon reflexes were hyperactive. His Karnofsky score was almost 40 points. Cranial injuries due to chain saw accidents are very rare. Early surgical procedures (incl. decompression) combined with aggressive antibiotherapy seem to have a great survival benefits. However best long- term results show that this type of injuries have a great rate of mortality and morbidity despite all surgical and medical treatment procedures.

14.Gallbladder torsion as a rare cause of acute abdomen; a case report and review of literature
Servet Rüştü Karahan, Ersin Kayalıbağ, Yaşar Özdenkaya, Oğuzhan Karatepe
PMID: 16341977  Pages 356 - 359
Torsion of the gallbladder is a rare cause of acute surgical abdomen. Less than 300 patients have been reported so far. On the other hand incidence seems to be higher than expected especially in elderly patients. This condition must be suspected in an elderly patient who represents signs and symptoms of toxemia and cholecystitis . Diagnosis is usually established during laparotomy. Torsion occurs at the base of the gallbladder around cystic duct and artery. Treatment is emergent cholecystectomy.