BACKGROUND Apoptosis is a process of programmed cell death that plays a role in some normal and pathological conditions. In this study, we investigated the apoptosis during cerebral ischemic reperfusion injury in response to haemorrhagic shock in a rat model. METHODS Thirty-six adult Sprague-Dawley rats were divided into six groups: control, haemorrhagic shock (HS), ischemic reperfusion (IR), 1st hour IR, 3rd hour IR, 6th hour IR and 24th hour IR. Rats were sacrificed by taking blood from intracardiac area after finishing the experiment. The tissues were fixed using neutral buffered 10% formaldehyde solution for histopathological examination. Tissues were stained immunohistochemically with APO 2.7 and positive expression apoptotic cells were counted using a Clemex Vision Lite 3.5 vision analysis system. RESULTS There were 2-3 apoptotic cells in the control group (group 1) and this number increased to 8-11 in the haemorrhagic shock group (group 2) (p<0.05). Secondary or more serious injury occurs during ischemic reperfusion injury. The number of apoptotic cells increased to 11-14 at the 1st hour (group 3) and it was significant as compared to group 2 (p<0.05). The number of apoptotic cells significantly increased to 15-17 by the 3rd hour (group 4) as compared to group 3 (p<0.05). While there was no additional increase by the end of the 6th hour (group 5) as compared to group 4, the number of apoptotic cells significantly increased to 18-24 by the end of 24th hour (group 6) as compared to group 5 (p<0.05). CONCLUSION The majority of injuries to the brain following haemorrhagic shock occur during ischemic reperfusion. We observed that apoptosis increases step by step on the 1st, 3rd and 24th hours after ischemic reperfusion injury.

BACKGROUND: Bone regeneration is often needed for many aesthetic and reconstructive procedures. Tissue engineering provided a promising approach to supplement existing treatment strategies. In this study, we aimed to evaluate the effect of reconstructing mandibular defect by using bioceramics seeded with bone marrow derived osteoblasts. METHODS: Canine’s autologous marrow stromal cells were Culture-expanded and induced to osteoblastic phenotype, then were seeded into prepared porous beta-tricalcium phosphate, after being incubated in vitro. The cell/ scaffold complexes were implanted into the prepared defect in canines’ mandibula and fixed by internal rigid fixation. In control groups, beta-tricalcium phosphate alone and autologous iliums were implanted into the prepared defects. Twelve weeks after implantation, the specimens were examined macroscopically and histologically. RESULTS: In experimental group and autologous iliums group, new bone grafts were successfully developed at 12 weeks after implantation and repaired the continuity of the mandibula. Histologically, newly formed bone could be observed on the surface and in the pores of beta-tricalcium phosphate in the cell/scaffold group, whereas incomplete bone repair was found in pure beta-tricalcium phosphate group. CONCLUSION: The harvested bone marrow derived osteoblasts possess the ability to form new bone tissue when seeded onto porous beta-tricalcium phosphate, which shows the potential of using this method to repair large segmental mandibular defect clinically.

BACKGROUND: The objective of this prospective study is to validate the efficiency of Streptococcus pneumoniae and Haemophilus influenzae vaccines in splenectomized patients via the demonstration of seroconversion and uninterrupted ability for opsonization. METHODS: Thirty-two adult patients (18 males, 14 females; mean age 46.1 years; range 18 to 79 years) who underwent elective or urgent splenectomy for various benign and malignant hematological disorders, splenic trauma and splenic masses were reviewed. Pneumo-23 and Act-HIB were administered to all patients on routine basis. In order to demonstrate the ongoing opsonizing capacity of the immune system and the seroconversion of immunoglobulins after vaccination, antibody titers of IgG and IgM and plasma C3 and C4 levels were quantitatively measured. RESULTS: The operative morbidity was 9% and overall mortality was 16%, with no early postoperative death in this series. Five patients with various malignant disorders died due to dissemination of their primary tumor. None of the patients with benign hematological disorders or those with splenic trauma died during the mean follow-up of 427 days. Furthermore, death from overwhelming postsplenectomy infection was nil in our clinical survey. All of the patients including those with malignancy had normal IgG (mean: 1383.1 mg/dL) and IgM levels (mean: 80.9 mg/dL) during discharge and at the last follow-up. Among the patients with benign hematological disorders, splenic trauma and splenic masses necessitating splenectomy, C3 and C4 levels were entirely within normal limits with a mean of 108.8 mg/dL and 21.4 mg/dL, respectively. CONCLUSION: This preliminary study reveals adequate seroconversion of immunoglobulins in all patients and normal C3 and C4 levels in patients with benign hematological disorders and splenic trauma. Moreover, none of the patients in the latter group had S. pneumoniae or H. influenzae infection nor did they expire due to overwhelming sepsis during the follow-up period. Long-term follow-up is required to determine the continuation of this immunologic response and the necessity of repeated vaccination..

BACKGROUND The aim of our study is to compare the safety and efficiency of the use of the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) with the use of endotracheal tube (ETT) for maintain patent airway during percutaneous tracheostomy (PCT). METHODS The patients were randomly assigned to LMA group (n=35, M/F; 28/7, age; 52 [18-79]), COPA group (n=31, M/F; 23/8, age; 57 [18-80]) and ETT group (n=30, M/F; 22/8, age; 49 [18-80]) with respect to use of LMA, COPA and ETT in order to maintain patent airway during PCT procedure. PT was performed as described by Griggs et al. Complications occurred during and after PCT procedure and airway manipulations required to maintain a patent airway were recorded. RESULTS Duration of PT was longer in the ETT group comparing with the other groups (for both groups; p<0.01). The LMA failed to maintain patent airway in 1 of 35 patients (2.9%) and the COPA failed to maintain patent airway in 3 of 31 patients (9.7%). The airway intervention required to maintain patent airway was found to be higher in the COPA group (45.2%) than in the LMA group (11.4%) (p<0.01). There was no significant difference with respect to the complications between the groups. CONCLUSION In our study, LMA and COPA were inserted easily during PCT with high success rates, but airway manipulations were higher in the COPA group. In our opinion, supra/infraglottic airway devices to maintain patent airway during PCT should be chosen according to patient's status and physician's experience.

BACKGROUND: The research was performed to determine the effect of adding a service unit planned to be carried out by nurses into the current emergency work flow on the patient satisfaction. METHODS: The research was carried out on 300 patients who were discharged from an University Hospital Emergency Department in Turkey between 21 January 2002 and 22 March 2002. The data of the research were collected by using Patient Identification Form, Nurse Activity Form, The Evaluation Form for Service of Giving Information and Patient Follow-up Form. The patients were informed by the information booklet developed by the researcher, their questions were answered and a copy of the information booklet was given to the patients and/or their families. The patients were called from their homes or offices one week after their discharge from the hospital and their satisfaction levels of the information given by the researcher were questioned. The data collected from the research were analyzed in computer by using percentage, chi-square and the significance test for universe rate. RESULTS: It was determined that the level of patient satisfaction was increased when the information was given together with the booklet about their diseases, treatments and the cares and it was also understood that calling the patients to be followed was essential. CONCLUSION: It is suggested that the informations should be given to the patients and their relatives on discharge by the nurses and new information booklets should be developed.

BACKGROUND: We planned this study to evaluate trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers, and the importance of helmet usage. METHODS: Data in this study were obtained by retrospective review of the files of trauma cases admitted to the Pediatric Emergency Unit of Trakya University Medical Faculty between January 2003 and August 2005. Patients’ age, gender, clinical signs, type of injury, season of the event and percentage of hospitalization were obtained from hospital records. RESULTS: Fifteen (24.6%) of 61 cases who were admitted to our emergency unit were females and 46 (75.4%) were males. The types of trauma of all patients who suffered from bicycle accidents were as following: 42 (68.9%) head trauma, 29 (47.5%) extremity trauma, 49 (80.3%) soft tissue trauma, 2 (3.3%) abdominal trauma, and one case of urogenital trauma. Also multiple traumas were present in most of these cases. Thirteen patients had extremity fractures and three had cranial fractures. None of the bicycle drivers were using helmets at the time of the trauma. CONCLUSION: Bicycle drivers should have specific education, helmet use must become widespread and special traffic regulations have to be settled.

BACKGROUND: We evaluated thoracic trauma cases with respect to etiologic causes, other system injuries accompanying to the thoracic trauma, treatment methods and outcomes and the prognostic factors affecting the need for thoracotomy, length of hospital stay, morbidity and mortality in the light of relevant literature data. METHODS: A retrospective evaluation was performed on 141 patients (102 males (72.3%), 39 females (27.7%); mean age 40; range 8 to 89 years) who were treated for thoracic trauma in our center between July 2003 and December 2005. RESULTS: 117 patients (83%) had blunt and 24 (17%) penetrating thoracic trauma. Isolated thoracic trauma and multisystem trauma were found in 48 (34%) and 93 (66%) patients, respectively. Mean white blood cell count was 12.560±5.7 (5-25x103 /uL) at admission. The number of patients who met lung injury scale criteria for grade I, grade II, grade III and grade IV were 19 (13.5%), 12 (8.5%), 25 (17.7%) and 13 (9.2%), respectively. Hypotension was determined in 16 patients (11.3%) during admission. With regard to treatment, while symptomatic conservative management was satisfactory in 76 patients (53.9%), tube thoracoscopy and thoracotomy were performed in 59 (41.8%) and 11 (7.8%) patients respectively. The morbidity was seen in 30 patients (21.3%). The mortality rate was 7.8% (n=11). CONCLUSION: The high white blood cell count, high lung injury scale grade, 3 and more rib fractures and accompanying head injury were determined as the prognostic factors affecting the morbidity and mortality.

Conservative management of solid abdominal organ injuries has been increasing and challenging trauma surgeons. This case report describes a successful non-operative management of a grade V renal lesion associated to a grade III hepatic lesion. Such lesions have not been described in conjunction in the revised literature.

A 47-year-old male patient had undergone endoscopic baloon dilatation six times due to pyloric stenosis however the result was not satisfying. Surgical treatment was considered. Chest X-ray revealed free sub-diaphragmatic air but there were no acute abdomen signs clinically. In abdominal computerized tomography, there were small intestinal loops anterior to the liver and there was gas collection, which can not be differentiated exactly between an extraluminal free air and the one in the bowel wall of adjacent small bowel segments. In the emergency surgery cysts filled with gas in the wall of distal ileal segments were seen. Pneumatosis intestinalis should be kept in mind in the differential diagnosis of free intraabdominal air.

Traumatic aneursym of superficial temporal artery is an uncommon lesion. Blunt traumas of war, firearm, motorized vehicle and sport injuries are common causes. In this case, traumatic aneursym of superficial temporal artery that occurs after scalp trauma in 74 years old male patient, was reported. Patient who suffers from a mass in his forehead ten days after trauma was admitted to our clinic. Selective angiography of the right temporal arttery was performed as traumatic aneurysm was suspected upon the findings of physical examination and cranial computerized tomography studies. The aneursym was detected. The proximal and distal part of the aneurysm was ligated and it was totally removed under general anesthesia. The histopathological investigation confirmed the presence of the traumatic aneurysm. Especially in hairy skin injuries, traumatic lesions should be considered as an aneurysm. Diagnosis, treatment, and surgical strategy must be planned by the help of these informations.

Fractures of the clivus are often associated with severe head trauma and have high mortality rates due to coexisting injury of the adjacent vessels, brain stem and lower cranial nerves. An early diagnosis is often not possible because of adherent problems, high mortality rate and inadequacy of emergency imaging. Diagnosis has recently become easier with high resolution bone window computed tomography studies. In this study, radiological and clinical findings of three patients with longitudinal clival fractures and severe head trauma have been presented and associated injuries and prognostic issues are discussed with reference to the limited number of similar cases in the English literature.

We present the management and survival of an eight-year-old boy with a severe high-tension electrical burn injury of 68% of total body surface area in a surgical intensive care unit, as a result of a well-planned and applied treatment strategy. Subsequent to escharotomy and fasciotomy operations under general anesthesia, the patient was taken into the surgical intensive care unit. In addition, patient underwent nine more operations including right femur disarticulation and split-thickness skin graftings with homografts from his brother and autografts. The patient was connected to mechanical ventilator for 59 days. By the time the patient was transferred to plastic and reconstructive surgery ward, he was fully conscious, cooperated and hemodynamically stable.