BACKGROUND
Platelet-rich plasma (PRP) has been applied to promote bone healing and developed as a novel material for bone regeneration. This study aimed to investigate the feasibility of PRP carrier to deliver bone marrow derived stromal cells (BMSCs) and regenerate bone tissues to reconstruct critical bone defects in rabbits.
METHODS
Critical sized defect were made on eighteen rabbits’ crania and treated by different composites: BMSCs/PRP (n=6); Autogenous particulate cancellous bone group (n=6) and PRP alone group (n=6). The defects were evaluated by gross observation, radiographic examination, histological examination, and mechanical examination at 12 weeks postoperatively.
RESULTS
The results showed that repair of bone defect was the least in PRP alone group, and significant new bone formation could be observed in BMSCs/PRP group and particulate cancellous bone group, radiopacity area in BMSCs/PRP group attained 76.5%, which was in the same range of that in autogenous particulate cancellous bone group (82.4% in radiopacity area), compressive strength of engineered bone in BMSCs/PRP group attained 71% of that in autogenous particulate cancellous bone group (p<0.05).
CONCLUSION
These data implicated that BMSCs delivered from PRP gel can repair bony defect in immunocompetent animals, and the tissue engineered bone in BMSCs/PRP group is comparable to autogenous particulate cancellous bone group for the repair of critical-sized bone defect.

BACKGROUND
The aim of this study was to investigate the effect of low circulating thyroid hormone levels on the development of acute stress gastritis in rats.
METHODS
Sixty adult Sprague-Dawley rats were divided into six groups: Control group, surgically thyroidectomized group, stressed group, surgically thyroidectomized + stressed group, surgically thyroidectomized + T4 + stressed group, and surgically thyroidectomized + T3 + stressed group. Damage to the gastric mucosa was studied using millimetric acetate papers on photographs enlarged 3.5 times and the number and the size of the lesions was recorded.
RESULTS
Acute stress gastritis was significantly increased in stress + surgically thyroidectomized rats as compared to rats that were only put under stress (group III) (stress gastritis scores; group IV: 44, group III: 16, p<0.001). The stress gastritis score in group VI was significantly decreased compared to rats in group IV (stress gastritis scores; group VI: 10, group IV: 44, p<0.001).
CONCLUSION
Low circulating thyroid hormone levels in rats increased the development of stress gastritis. This effect could be prevented by thyroid hormone replacement therapy.

BACKGROUND
Air exposure is a factor that inhibits in vitro cellular proliferation and matrix synthesis in tendons. Aim of this experimental study was to evaluate effect of dehydration and irrigation on healing of Achilles tendon.
METHODS
Achilles tenotomy was done in forty-five Sprague-Dawley rats. In control group, tendon was sutured immediately. In the remaining two groups, the Achilles tendons were allowed to direct exposure of air. Irrigation of Achilles tendon was performed in one of exposed groups, while irrigation was not done in other group. After 60 minutes, tendons of both groups were sutured same as control group. Rats were sacrificed at postoperative day 28. Achilles tendons were dissected and histological and biomechanical evaluations were performed.
RESULTS
Histological evaluation revealed intense fibrosis formation with adhesion of tendon to surrounding tissues in the air exposed groups. The quantity of angiogenesis and inflammatory reaction were also higher in experimental groups regardless of irrigation. Air exposed tendons had higher tensile strength however lower stiffness than control group in biomechanical evaluation.
CONCLUSION
Air exposure decreases quality of healing by increasing fibrosis and adherence formation. These negative effects of exposure to air were not counteracted by irrigation. However, air exposure didn’t affect tensile strength of the healing.

BACKGROUND
This study validates the accuracy of the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) systems for prediction of need intubatin (NI), need mechanical ventilation (NMV), and duration of mechanical ventilation (DMV) in intensive care unit (ICU) trauma patient admissions.
METHODS
One-hundred ten trauma patients were included in this prospective cohort study. The predictive accuracies of the ISS and the NISS were compared using Receiver Operator Characteristic (ROC) curves and Hosmer-Lemeshow (H-L) statistics for the logistic regression model of ICU admission.
RESULTS
For prediction of NI, the best cut-off points were 22 for ISS and 27 for NISS. The positive prediction value was 91.6% in NISS and 87.8% in ISS. The Youden index had best cut-off points at 0.47 for NISS and 0.57 for ISS. The area under Receiver Operating Characteristic (ROC) curve was 0.79 in the ISS and 0.86 in the ISS. There were statistical differences among NISS with ISS in terms of Youden index and the area under the ROC curve (p<0.05). For the prediction of NMV, NISS yielded significantly better results in the area under the ROC curve and Youden index than those of ISS (p<0.05).
CONCLUSION
For prediction of NI or NMV, the NISS has better accuracy than ISS.

BACKGROUND
The aims of this study were to determine the diagnostic value of elements of the disease history, the clinical findings and basic laboratory examinations in differential diagnosis of the patients with nonspecific abdominal pain and to analyze the long-term survey of these patients.
METHODS
A prospective observational study was performed at the Department of General Surgery Medicine Faculty of Uludag University between November 2001 to November 2002. Based on the diagnosis reasons for abdominal pain, 610 patients were classified as being of specific abdominal pain (n=501) versus nonspecific abdominal pain (n=109). Patients with nonspecific abdominal pain were invited to a follow-up examination 24 hours later and 4 follow-up interviews were conducted on days 8, 15, 30 and at the end of 1 year. Statistical analyses were performed between findings of two groups.
RESULTS
In logistic regression analysis, presence of a history of similar pain (odds ratio 1.88; p=0.009), nausea (odds ratio 0.46; p=0.001), rigidity (odds ratio 0.24; p=0.024), fever ≤36.6°C (odds ratio 1.66; p=0.037), leukocyte count ≤8700 (odds ratio 1.85; p=0.011), age ≤39 years (odds ratio 1.85; p=0.018), respiratory rate ≤15 (odds ratio 3.19; p=0.00..) were significantly independent diagnostic factors. There was no malignancy during one-year follow-up period.
CONCLUSION
The possibility of a specific cause is higher in patients with history of a similar pain, nausea, rigidity, fever >36.6°C, leukocyte count >8700, age >39 years, respiratory rate >15 in admission and persistent pain 24 hours after discharge.

OBJECTIVES
Identification and assessment of predictive factors of in-hospital mortality of trauma patients injured in vehicle accidents.
METHODS
We reviewed the Trauma Registry data of Herakleion University Hospital, a level I trauma center in Crete, Greece. All 730 consecutive, adult motor-vehicle trauma patients admitted to our hospital from 1997 to 2000 were included in the study. Variables included in the analysis were: sex, age, mechanism of injury, injuries per anatomic region, initial vital signs, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and the final outcome. In order to better describe continuous variables, two categories were created: age ≥60 and <60; ISS ≥18 and <18.
RESULTS
Mortality rate was 4.8% (n=35). Multivariate survival analysis showed that age greater than or equal to 60 years (p=0.0002), ISS greater than or equal to 18 (p=0.003), being a pedestrian (p=0.007), craniocerebral injuries (p=0.01), thoracic (p=0.01), and abdominal injuries (p=0.01) are independent predictors of the in-hospital mortality of the patients.
CONCLUSION
Trauma patients after vehicle accidents aged ≥60, pedestrians, those with an ISS ≥18 and craniocerebral, thoracic or abdominal injuries are at higher risk of an in-hospital fatal outcome.

BACKGROUND
Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality.
METHODS
The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality.
RESULTS
The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury.
CONCLUSION
The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.

BACKGROUND
To establish the characteristics of patients in pediatric age who have been referred to hand rehabilitation center since 1998.
METHODS
The patients were screened retrospectively and those within 0-16 age range were included into the study (178 patients; 126 males [70.8%], 52 females [29.2]; mean age 10.33±4.45; range 0 to 16 years). Demographic data, causes and locations of injury and follow-up period (week) were recorded.
RESULTS
Mean duration of application for rehabilitation was 5.4±0.7 weeks. Only 99 (55.6%) patients could be followed-up for a period more than 4 weeks (20.8±22.2 weeks). Types of injuries were categorized as accidental (n=133; 74.7%), intentional (n=29; 16.3%) and congenital (n=15; 8.4%). Accidents were related to domestic (n=109; 61.2%) and environmental causes (n=53; 29.8%). The most frequent domestic accident was glass injury and fall accident. The regions in order of decreasing frequency were wrists, metacarpal bones, proximal phalanges, forearms, elbows, plexus, mid-phalanges, total hands, shoulders, total arm and bilateral hands. Fourth digit was the most frequently injured digit. The most common types of injuries were as followings: flexor tendon cut (44.5%), nerve cut and arterial injuries, fractures and burn contractures.
CONCLUSION
Hand injuries occurred mostly in male children, the most frequent type injury was accidental domestic injury of the wrist flexor tendon caused by broken glass fragments and the most frequently injured digit was the 4th and adherence of the patients to the follow-up protocol was unsatisfactory since majority of referrals were out-of-towners.

BACKGROUND
Burn traumas resulting from industrial accidents may generate a death risk. In such cases a forensic report should be filled up. In forensic findings, the death risk which is associated with the degree of trauma, of the victim is as important as the treatment of the subject. The aim of our research was to investigate what degree of burns causes fatality and which type of industrial accidents cause them.
METHODS
This research was done between the dates October 2004 and December 2006 with the descriptive epidemiology method by the evaluation of all data entered emergency surgical room- burn unit. The results of the study were analyzed with respect to its socio-demographic characteristics clinical findings of the type of burn and the type of the event which caused the burn. Categorical variables were assessed using Chi-square test, continuous variables were tested by Pearson’s correlation.
RESULTS
For the total 128 incidents, 69.5% (n=89) were males and 30.5% (n=39) females. 28.9% (n=37) of the incidents were industrial accidents. 48.6% (n=18) of the burns were caused by boiling water, 32.4% (n=12) due to contact by flame, 10.8% (n=4) electrocution and %8.2 (n=3) due to burns by contact with chemicals. The 19.50% (n=25) of the incidents had ended up by loss of life, 80.5% (n=103) were cured and discharged. The incidents which had resulted under 20%, the mortality rate was 1.3% (n=1), the incidents which had above 20%, the mortality rate was 49.0% (n=24) (p=0.0001).
CONCLUSION
The degree of burn was found to be valuable in determining the death risk but the extent of the burned area was found to be more deterministic in assessing this particular risk.

BACKGROUND
The aim of this study was to determine the habit of handwashing among health care workers in the intensive care unit of hospitals’ general surgery department.
METHODS
Potential handwashing opportunities were detected and observations were recorded. Handwashing habit of health care workers was monitored for over 1710 min., during 30 min. observation periods.
RESULTS
In this study which had 1710 minutes of observation period, the overall habit of handwashing of the medical staff was 23%. Compliance among physicians, nurses and other health care workers were 12%, 34% and 19% respectively (p<0.05).
CONCLUSION
The handwashing habit of healthcare workers in our unit is unacceptably low. We believe that introduction of social pressure models will help to improve handwashing awareness of the health care worker.

We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.

Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for less than 1% of cases in Western countries. In the literature, it has been described as a complication following numerous common surgeries as well as a number of minimally invasive procedures. Presumably, it is more likely to occur following any surgical procedure which might require some degree of medial visceral rotation or disruption of the fusion plane between the cecum or ascending colon with the lateral peritoneum, providing sufficient mobility to allow for cecal volvulization to occur. In addition, cadaver and autopsy studies have also suggested that 10-20% of the population may have sufficient mobility of the colon to allow for volvulization. We present a review of the literature pertaining to the diagnosis and management of cecal volvulus as well as the case of J.R., a 78-year-old male with cecal volvulus six days following a right radical nephrectomy for renal cell carcinoma.

Diaphragmatic and urinary bladder ruptures are rare entities after blunt abdominal trauma and they are usually the results of high energy injuries. They seldom occur in isolation. For the diaphragmatic rupture, the accurate diagnosis depends on high index of suspicion and careful scrutiny of the chest X-ray, while gross hematuria is the hallmark finding in patients with bladder rupture. Suprapubic pain, tenderness, and inability to void are the main symptoms and signs of bladder rupture. In this report, we describe our successful experience with a case of combined diaphragmatic and urinary bladder rupture occurred in isolation as a result of low energy trauma, with special emphasis on diagnosis and surgical treatment.

Adenocarcinoids are rare and aggressive tumors with histological features of both carcinoid tumor and adenocarcinoma. We report a case of a 32-year-old man with diffuse infiltration of the appendix wall and mesoappendix by an adenocarcinoid. Due to the involvement, a hemicolectomy was performed at a later date. We suggest that patients with diffuse appendiceal involvement require an aggressive surgical therapy and follow-up.