BACKGROUND: In this experimental study we evaluated the pH and potassium changes of the peritoneal irrigation fluid in the early phase of mesenteric ischemia. METHODS: The Wistar albino rats were assigned randomly to 5 equal groups of 10 rats: sham operation, 30, 60, 120 and 180 minutes ischemia by arterial occlusion. We enregistred the ranges of pH and potassium in peritoneal irrigation fluid and serum pH. RESULTS: Lower pH and increased potassium levels in peritoneal irrigation fluid were observed in 30 and 60 min ischemia groups. In 120 and 180 ischemia groups the level of pH continued to be lower and potassium level increased gradually, the serum pH were markedly lower in these groups. Histological analysis showed a positive correlation between the intestinal injury and ischemia time. CONCLUSION: In contrast to sham group, increase in potassium and decrease in in pH levels in peritoneal irrigation fluid were seen in 30 and 60 min ischemia groups. The decrease of serum pH was enregistred after 120 min of ischemia. In early phase the measurement of potassium and pH in peritoneal irrigation fluid may be an early diagnostic tool for mesenteric ischemia.

BACKGROUND: To investigate the protective effects of sildenafil citrate (SC) on indomethacin-induced gastric ulcer in a rat model. METHODS: Gastric ulcers were induced by oral ingestion of indomethacin. Thirty rats were used in the study. The rats were divided into 3 groups, and given either SC (n=10) at a dose of 50 mg/kg or omeprazole (n=10), or no treatment (n=10, the control group). In addition to the measurements of ulceration areas, the sum of gastric tissue nitrite (NO2-) and nitrate (NO3-) were evaluated as an indicator of gastric tissue NO level. All the measurements were done at 6th hour of oral administration of indomethacin. RESULTS: The mean values of ulceration areas were 4.0±2.31, 3.0±2.00, and 21.4±8.43 in the SC, omeprazole and control groups, respectively. The mean values of ulceration areas in the SC-treated group was lower than that of the control group. The contents of NO were 32.2±3.05, 24.8±3.23 and 21.0±0.82 (µmol/g protein) in gastric tissue in indomethacin, SC, omeprazole and control groups, respectively, The content of NO in the SC-treated groups was significantly higher than control group (p<0.001). CONCLUSION: Sildenafil citrate may have a role in protecting gastric mucosa from the damage caused by indomethacin. This effect may be associated with the increased level of NO in gastric tissue.

BACKGROUND: Resveratrol, a polyphenol found in grape and red wine, was previously shown to have free radical scavenging and antioxidant properties in various tissues. In this study, the effects of resveratrol were investigated in muscle tissue concerning the ischemia reperfusion (I/R) injury of rat hindlimb. METHODS: Arterial circulation of right hindlimbs of 24 Sprague-Dawley rats was ceased by a tourniquet applied for four hours (h). The tourniquet was released at the end of 4th hours and rats were divided into four groups of six rats. Then, extremity was reperfused for 4h in group I and for 8h in group II. Resveratrol in 0.5% ethyl alcohol was administered with a dose of 10 mg/kg in the treatment groups (group I and group II) intraperitoneally. Only 0.5% ethyl alcohol were administered in the control groups (group III and group IV) intraperitoneally. Gastrocnemius muscle was used for histological assessments and the anterior tibial muscle was used for measurement of malondialdehyde (MDA) levels. RESULTS: MN infiltration, edema, changes in diameters of muscle fibers and segmental necrosis were less prominent in rats treated with resveratrol compared with control groups (p<0.05). The MDA levels was significantly lower in treatment groups (p<0.05). CONCLUSION: The results suggest that resveratrol may protect the skeletal muscles against I/R injury with its potent antioxidant properties.

BACKGROUND: The aim of this study is to present time course of insulin like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in both cerebrospinal fluid (CSF) and serum of patients after severe head injury (SHI) and to compare with controls. METHODS: Our trauma and control groups included 11 consecutive patients with isolated SHI and 9 patients with hydrocephalus (one with normotensive and eight with hydrocephalus due to aqueduct stenosis), respectively. Both serum and cerebrospinal fluid levels of IGF-1 and IGFBP-3 were measured during post-traumatic days and we compared the levels with controls. RESULTS: Patients and controls showed undetectable levels of both IGF-1 and IGFBP-3 in their CSF. When considering serum levels, patients with SHI had always lower levels of both molecules than that of controls. CONCLUSION: Administration of IGF-1 during acute, as well as chronic phase of severe head trauma may provide beneficial effects and may decrease both mortality and morbidity in humans with SHI.

BACKGROUND: Reduction of intussusception under ultrasound guidance by saline has become popular in recent years. However, methods, duration of the procedure and causes of failure are not defined. In this study, we reviewed the patients who underwent ultrasound (US) guided saline reduction and compared them with those who were previously managed by operative intervention. METHODS: Patients with severe peritonitis or perforation, those over 3 years or younger than 1 month were excluded. Saline was applied by anus. Entry of saline into the ileum was the main indicator for successful reduction. Dramatic improvement in the clinical findings was considered as an additional sign of successful reduction. No limit was imposed on duration of the procedure.
RESULTS: Hydrostatic reduction was successful in 41 out of 51 patients with intussusception. In three patients with partial resolution, hydrostatic reduction was attempted later and total reduction was achieved. No perforation or other complications were seen. In ten cases withreduction failure, one had an ileal lymphoma and another one had a duplication cyst as lead points. CONCLUSION: US guided hydrostatic reduction for childhood ileocolic intussusception is safe and, painless, has a high success rate and avoids radiation exposure risk. Presence of ultrasonographic and clinical changes is the best indicator of a successful reduction. In some cases, a second attempt may be necessary for reduction.

BACKGROUND: To evaluate the factors affecting visual acuity in cases subjected to surgical repair due to open globe injury. METHODS: The records of the patients who have been subjected to emergency surgical repair due to open globe injury were examined retrospectively. From a total of 195 cases, 119 eyes of 119 cases who fulfilled the inclusion criteria were included into the study. Cases were examined in terms of age, gender, trauma type, localization, preoperative examination findings, the presence of additional surgical interventions and the findings in the last examination. Chi-square test and logistic regression analysis were used in statistical analysis. RESULTS: Original visual acuity (p=0.042), zone (p=0.001), trauma type (p=0.003), preoperative anterior chamber loss (p=0.005), existence of hyphema (p=0.001), vitreous prolapse (p=0.000) and posterior segment pathology development (p=0.000) influenced the visual outcome. In cases with grade 4 or grade 5 resulting visual acuity, statistically significant factors were determined as “existence of pathology in the posterior segment” (p=0.000, Odds ratio=12.397) and “total anterior chamber loss” (p=0.015, Odds ratio=4.661).
CONCLUSION: Changes occurring at the posterior segment pathology and anterior chamber loss are determinant in terms of resulting visual acuity. For this reason, opthalmoscopy and ultrasonography that should not be omitted in the follow-up period for cases with a transparent media and with media opacity, respectively.

BACKGROUND: We aimed to present the rates and causes of morbidity and mortality of the patients who were operated due to pancreatic trauma. METHODS: We studied retrospectively 13 patients (13 males; mean age 35.3; range 20 to 60 years) with pancreatic trauma who were to our emergency unit between 1996-2004. RESULTS: Ten patients had penetrating and three had blunt trauma. The avarage time between the admission to the emergency unit and the operation was 5.8 hours (1-48 hours). Mortality was 23% (three patients; two of them had major vascular injuries). The most prominent postoperative complication was pleural effusion which was seen in two patients (15%). CONCLUSION: It was recorded that mortality and morbidity were related in great part to the associated organ injury.

BACKGROUND: Snake envenomation, its treatment and outcomes are presented in this study. METHODS: Twenty-one snake bite cases (10 males, 11 females; mean age 36.4; range 10 to 70 years) were followed up at our clinic during the summers of 2004 and 2005. Four of these patients were “dry bite”. The remaining 17 cases were envenomated.
RESULTS: Local and hematological disorders were detected in envenomated cases. Local skin necrosis developed in a case. Thrombocytopenia was seen in five of the cases. Seven units of whole blood were transfused in three patients. When the Zagreb antiserum which was produced against European snakes was used, better results achieved. The serum which was imported from Egypt was given to the patient in case of lacking of Zagreb serum was lacking. Clinical conditions were improved later with the “Egypt serum” although higher doses had been administered. CONCLUSION: Hematological disorders and local wound problems were more prominent with poisonous snake bite cases in our region. We conclude that these problems can be prevented by using antiserum treatment as early as possible.

Primary spleen angiosarcoma is an infrequent disease and the diagnosis is usually difficult. In this report we discussed a case who presented with abdominal pain. In clinical follow symptoms of shock were observed. Laparotomy was performed and spleen rupture was detected. Spleen angiosarcoma must be considered in the differential diagnosis of patients with unexplained anemia, splenic mass and splenomegaly. It has rapid course and poor prognosis. Splenectomy must be performed because of threat of rupture.

We report a case with a late diagnosis of posttraumatic lateral abdominal wall hematoma. The patient was admitted with a giant hematoma presenting with pleural effusion, anemia and weight loss on postoperative 30th day after a blunt trauma. Computerized tomography analysis revealed a hematoma extending from axilla to the gluteus. Fine-needle aspiration revealed an exudative fluid and five liters of fluid collection was drained. Misdiagnosed lateral abdominal wall hematomas can be diagnosed with nonspecific findings as in this case.

Air embolism is known to be a complicating factor in several clinical settings, including thoracic, cardiovascular and neurosurgical operations, central line placement, penetrating thoracic and cranial trauma and haemodialysis. Computed tomography (CT) is useful for showing cerebral air embolism. However, CT demonstration of massive air in all of the major cerebral arteries is extremely rare. In this report, we present a 45-year-old woman with cerebrovascular pneumoangiogram on postmortem CT examination after an unsuccessful posttraumatic cardiopulmonary resuscitation and discuss the possible mechanisms of pneumoangiogram.

A 14-year-old was admitted with right groin pain which has started after kicking ball in a football game one week before. He had limited active and passive hip extension. A plain AP radiograph of the pelvis revealed a bone fragment displaced inferiorly about 1 cm from the right anterior inferior iliac spine. The patient was treated conservatively with analgesics and limited weight bearing. Four weeks later, range of motion was normal without pain and at eighth week the hip flexors regained full strength.