Trauma continues to be a large source of poor outcomes for patients in the United States. While clinical guise is very important in the acute setting, objective physical data is becoming increasingly important in the diagnosis of many injuries sustained during trauma. Radiography has always been the primary diagnostic modality applied in trauma situations but it continues to be a time-consuming and unwieldy part of the acute resuscitation of the patient. The novel use of the Lodox® Statscan® (Lodox® Systems (Pty), Ltd., Benmore, South Africa), a type of digital radiography, as a means to help combat these problems was evaluated at Creighton University Medical Center, Omaha, Nebraska. This new machine uses a linear beam technology to scan the entire body in 13 seconds. Here, we describe this digital radiography system, its introductory use in the trauma bay, and discuss cases where it has proven valuable. Based upon our preliminary experience, the use of the device in large centers shows promise for improving morbidity and mortality outcomes in trauma patients.

BACKGROUND
We examined the role of programmed cell death (PCD) in the etiology of contralateral testis injury as well as the protective effect of carnitine.
METHODS
Thirty-six Wistar Albino rats were used in the study. Rats were divided into six groups as control, sham, torsion-detorsion with 6- and 24-hour intervals, and torsion-detorsion-carnitine administration with 6- and 24-hour intervals. The left testes of all rats were torsioned 720°. Intraperitoneal carnitine was administered to groups as 100 mg/kg one hour before detorsion. Orchiectomy was applied to the contralateral testis a week after detorsion. Testes were examined with respect to diameters of seminiferous tubules (DST), ratios of malonyl dialdehyde and Johnsen biopsy scores (JBS), and PCD ratios. Results were evaluated by ANOVA test.
RESULTS
Programmed cell death ratios were significantly higher in the torsion-detorsion with 6- and 24-hour intervals groups compared to the sham group. Those increases were more prominent in the torsion-detorsion with 24-hour interval group. DST and JBS of the control group were significantly higher than in the experimental groups (p<0.05). The protective effect of carnitine was significant in the 24-hour torsion group, while no significant difference were detected in the 6-hour torsion-detorsion-carnitine group.
CONCLUSION
Increased injury and PCD in the contralateral testis was observed with prolonged exposure time in this model. It was possible to decrease the injury with carnitine.

BACKGROUND
We aimed to compare conventional suture closure of arteriotomy with N-butyl-cyanoacrylate-assisted suture closure.
METHODS
Forty Wistar rats were randomly divided into two groups. Standard arteriotomy was performed to the abdominal aorta through a midline incision. In the first group, arteriotomy was closed by 3 stitches with 45° between each and in the second by two stitches with 0.1 ml (12-12.5 mg) cyanoacrylate. Amount of blood loss, operation time and severity of myointimal hyperplasia by immunohistochemistry on aorta segments were measured on postoperative days 7 and 30.
RESULTS
Mean anastomotic time was 13.5±1.64 in the first and 13.0±1.75 min in the second group (p=0.356). Operation time was 23.45±3.63 in the control and 21.0±3.09 min in the second group (p=0.027). Mean amount of bleeding was 473.75± 260.5 in the first and 327.5± 155.36 μl in the second group (p=0.037). Intimal thickness on the 7th day was 80.62±7.92 in the first and 83.24±3.42 μm in the second group, and on the 30th day was 81.64±5.11 in the first and 88.77±11.03 μm in the second group. The early and late intimal thicknesses were similar (p=0.35 and 0.87, respectively).
CONCLUSION
Reconstruction of arteriotomies with fewer sutures in combination with cyanoacrylate is a safe method associated with less blood loss and shorter operation time. It also does not lead to increased myointimal hyperplasia.

BACKGROUND
The influence of an omentectomy on peritoneal defense mechanisms and its clinical consequences have not been fully elucidated. In the present study, we aimed to investigate the influence of omentectomy on bacterial growth in blood and tissue specimen cultures in rats with experimental peritonitis.
METHODS
Fifty Wistar-Albino rats were included in the present study. Animals were assigned into five groups as follow: Group 1 (n=10), omentectomy alone; Group 2 (n=10), omentectomy + bacterial peritonitis; Group 3 (n=10), bacterial peritonitis alone; Group 4 (n=10), laparotomy alone; and Group 5 (n=10), sham group. Culture positivity rate and bacterial growth (colony forming units [CFU]/gram tissue) were assessed in mesenteric lymphoid tissue and venous blood of all animals.
RESULTS
Bacterial growth in lymphoid tissue was significantly higher in Groups 2 and 3 than others (both, p<0.05). CFU of Escherichia coli in lymphoid tissue was significantly higher in Group 2 than in Groups 1 and 3 (both, p<0.05/4). Blood culture positivity was significantly higher in Group 2 than the others (both, p<0.05).
CONCLUSION
The omentum has an important role in the host peritoneal defense system. Peritoneal infection may pursue a more severe course with increased bacterial entrance into the blood in the absence of the omentum.

BACKGROUND
A study was performed to determine the effects of blood albumin and total lymphocyte count on the postoperative one-year period in 74 elderly hip fracture patients.
METHODS
In 2006, 74 patients (52 female, 22 male) with hip fracture who were 65 years of age or older were included in the study. Admission albumin levels and total lymphocyte counts were recorded. The outcomes examined were mortality, length of hospital stay and ambulatory ability. Ambulatory ability was assessed according to Parkland and Palmer criteria.
RESULTS
There were 61 patients aged 65-84 years, and 13 patients aged 85-105 years. Forty-one patients (55.4%) had hypoalbuminemia and 23 patients (31.1%) had low total lymphocyte count. Low albumin and total lymphocyte counts were associated with higher mortality (p=0.011). Patients with low albumin levels had longer length of hospital stay (p=0.002). Patients with normal albumin and total lymphocyte counts had higher mobility score meaning better function (p=0.012). Multivariate analysis yielded that low total lymphocyte count, American Society of Anesthesiologists (ASA) 3-4 and female gender remained significant independent predictors of one-year mortality. No single blood parameter was found to be effective on ambulatory status.
CONCLUSION
Risk of mortality in elderly hip fracture patients increases with female gender, ASA 3-4 and low total lymphocyte counts. Hypoalbuminemia is associated with longer hospitalization. Identification of these risk factors can help in the case management for a more favorable outcome.

BACKGROUND
High velocity gunshot-related fracture is associated with massive soft tissue damage and severe comminution at the fracture site. This unique type of open fracture presents a serious challenge to the orthopedic traumatologist.
METHODS
The study was conducted prospectively involving patients who presented to the Accident and Emergency Department of the Bone and Joint Surgery Hospital Srinagar (India), from January 2005 to March 2007, with a history of high velocity gunshot wounds to the femur. Initial stabilization with external fixation was followed by delayed interlocking intramedullary nailing. The patients were followed for an average period of 26 months (range, 15-39 months).
RESULTS
All the patients were males, with an average age of 37 years (range, 22-52 years). Twenty-four (65%) were type IIIA, 11 (30%) were type IIIB and 2 (5%) were type IIIC. All the fractures united in good alignment in an average time of 24 weeks.
CONCLUSION
External fixation as a primary modality of treatment provides more than adequate stabilization to facilitate nursing, good wound care and physiotherapy. A staged protocol of primary temporary fixation by unilateral external fixation followed by delayed reamed intramedullary interlocking nail seems to be an effective method of treatment for high energy gunshot femoral fractures.

BACKGROUND
Prediction of mortality in trauma patients is an important part of trauma care. Trauma scoring systems are the current methods used for prediction of mortality. We aimed to evaluate and compare the performances of Injury Severity Score (ISS) and New Injury Severity Score (NISS) in firearm injuries.
METHODS
Records of 135 firearm-injured patients who applied to Uludag University Emergency Department between January 2001 and December 2005 were analyzed retrospectively. All patients’ data, including age, gender, cause of injury, initial vital signs, injury region, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), mortality, operation data, and final diagnosis, were collected, and ISS, NISS and Trauma and Injury Severity Score (TRISS) were calculated.
RESULTS
Mortality rate was 12.6%. The patients’ mean GCS, RTS, ISS, NISS, and TRISS scores were 13.41±0.31, 10.65±0.26, 17.04±1.20, 21.94±1.45, and 9.52±2.37, respectively. The patients were divided into two groups as ISS=NISS (53.3%) and ISSCONCLUSION
ISS and NISS both performed well in mortality prediction of firearm injuries. NISS demonstrated no superiority to ISS for prediction of mortality in these patients.

BACKGROUND
The trans-olecranon approach has been suggested to improve the visualization of complex intra-articular distal humerus fractures. Significant osteotomy complications have prompted a search for alternative approaches. The purpose of this series was to study the outcome of the olecranon osteotomy in terms of union and complications and the ultimate outcome of the fracture.
METHODS
Ninety-four patients with intra-articular fractures of the distal humerus (type C3) were treated by open reduction and internal fixation using the trans-olecranon approach. The patients were followed from 6 to 48 months, with an average follow-up of 24 months.
RESULTS
All osteotomies united in an average of 11 weeks (range, 8-20 weeks). There was no non-union, although union was delayed in four osteotomies, which all healed by 20 weeks without any intervention. The most frequent complication in this study was symptomatic osteotomy fixation in 19% of patients, all of whom underwent a secondary procedure for the removal of the implant after the osteotomy had united. Seventy-one percent of the unsatisfactory results were seen in those patients who had symptomatic olecranon fixation.
CONCLUSION
Despite a few manageable complications, the trans-olecranon approach is essential for the adequate visualization and fixation of the complex fracture of the distal humerus. Adequate fixation of the osteotomy is essential to prevent complications and achieve a satisfactory outcome.

BACKGROUND
The aim of the present study was to evaluate the clinicopathological features in patients with perforated gastric cancer, to point out the surgical approaches, and to analyze the factors that affect morbidity and mortality.
METHODS
The data of 24 patients with perforated gastric cancer who underwent emergency intervention between 1996 and 2006 were retrospectively analyzed. The overall age was 60.6 years, and 62.5% of the patients were male.
RESULTS
The tumor was localized at the antrum most frequently (66.7%), and stage IV disease was present in 66.7% of the patients (n=16). Concomitant disease was present in 58.3% of the patients (n=14). In 54.2% of patients (n=13) primary repair and omentopexy, in 20.8% (n=5) D0 or D1 total gastrectomy, in 8.3% (n=2) D0 subtotal gastrectomy, in 8.3% (n=2) D0 wedge resection, and in 8.3% (n=2) staged D2 total gastrectomy were performed. The morbidity rate was 29.2% (n=7) and the mortality rate was 25% (n=6). Multivariant analysis showed that diffuse peritonitis and the period between perforation and operation (longer than 24 hours) were effective on prognosis, either on morbidity (p=0.002 and p=0.002, respectively) or on mortality (p=0.009 and p=0.000, respectively).
CONCLUSION
Postoperative morbidity and mortality rates are high in patients with perforated gastric cancer. In resectable cases, one-stage radical gastrectomy should be encouraged if conditions allow. In patients with diffuse peritonitis and poor general condition, palliative surgery or staged radical gastrectomy should be considered. High rates of mortality and morbidity can be reduced with early diagnosis and with the surgical control of gastric perforation before peritonitis.

BACKGROUND
Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment.
METHODS
In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p<0.05 was considered significant.
RESULTS
A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology.
CONCLUSION
Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.

BACKGROUND
The aim of this study was to evaluate the first “Turkish Ambulance Rally”, which provides training and motivation for the rally teams and introduces the prehospital emergency medical services of Turkey via international participation.
METHODS
Data in this descriptive study were collected using quantitative and qualitative research methods. Quantitative data were summarized in distribution and averages, whereas qualitative data were summarized in shared views and comments. There were totally 10 teams, with 96 participants; only two competitors were female.
RESULTS
Mean scores of driving techniques, locating address /patient transferral, advanced life support, and patient-carrying techniques were 93.1, 74.8, 70.4, and 67.6, respectively. The question regarding the organization’s effect on the teams in the deployed city and expansion of motivation to the city was scored lowest (2.5%), while desire for re-competition was scored highest (95.8%) in feedback results. According to the qualitative data, it was determined that the scientific content of the stage scenario was adequate, evaluations were made objectively, and participants and officials obtained professional benefits. However, it was also determined that these benefits did not project to all emergency medical services.
CONCLUSION
The rally was both beneficial and motivational for participants. It is considered that the more extensive contribution of the rally is the increased motivation of the workers and of the consciousness of the community.

BACKGROUND
The reconstruction of soft tissue defects of the elbow area (including antecubital fossa and peri-olecranon area) should be performed with the most appropriate soft tissue and functional rehabilitation immediately.
METHODS
Ten patients were included in this study. One had a brachial artery defect, another had postburn axillary contracture deformity, and a third had an ulnar bone body fracture in addition to their soft tissue defects, while the remaining seven had only soft tissue defect. Patients underwent surgical closure either by local arm fasciocutaneous flap (1), radial forearm flap (1), multiple Z-plasty (1), pedicled latissimus dorsi muscle flap (3), or with the antecubital fasciocutaneous island flap (4).
RESULTS
The follow-up was 9 months to 4 years (mean: 19 months). All the flaps achieved wound closure without losing the range of motion at the elbow joint.
CONCLUSION
Surgical closure of the antecubital fossa and peri-olecranon areas can be a challenge for plastic surgeons since this area includes numerous neuro-vascular bundles and a functional joint. Therefore, we describe herein an algorithm for the treatment of defects in these areas from the inspiration in our clinical experience and a literature review. Our algorithm will help to decide the most appropriate choice among all of the surgical options available.

BACKGROUND
Our aim was to evaluate the effective factors on mortality in flame and scald burns in the Diyarbakýr region.
METHODS
The data of 816 patients who applied to the Dicle University Emergency Department between January 2001 and May 2005 with flame and scald burns were investigated retrospectively. The patients were separated into two groups as alive or deceased. Gender, age, burns shapes, burn degrees and rates, burn regions, admission periods, hospitalization times, complications, and the treatments were analyzed.
RESULTS
43.5% of the patients were female and 57.5% were male. Six hundred fifty-eight patients were under 6 years old. 70.5% of burns occurred as a result of negligence; 76.5% occurred due to scald and 23.5% due to flame. In cases of death, 39 patients were under 10 years old. The mean age was 9.32 years. The average hospitalization period was 10.37 days. The most common complication was wound infection. The mortality rate was 6.1%.
CONCLUSION
The mortality rate was higher among patients who were hospitalized longer than 15 days (p=0.030); whose burns were due to suicide attempt (p=0.002); who used shoe paint on the burn wounds instead of treatment (p=0.000); who had more than 40% second-degree burns (p=0.000) or more than 20% third-degree burns (p=0.000); and among those with acute respiratory failure, compartment syndrome, hypoalbuminemia, and sepsis (p=0.000).

BACKGROUND
In this study, scald burns in a Turkish population (0-16 years of age) were studied with reference to their occurrence and common causes.
METHODS
Of the burn victims hospitalized at the Burns Unit of Ankara Numune Education and Research Hospital between April 2001 and December 2003, 354 patients were aged 3 months to 16 years and 228 (64.4%) were male.
RESULTS
When burn causes were examined, scald burns were the primary type, reported in 77.7% (275) of the patients (p<0.001). Scalds were the most frequent burn agents in the pediatric population. Tea is a traditional beverage in Turkey. It is consumed especially at breakfast and throughout the day until late at night. Tea in Turkey is steeped and brewed for consumption. As brewing and steeping is a time-consuming process and the tea is served hot, the appropriate level of care regarding the hot tea is neglected. Consequently, tea carries a serious potential to cause burns in this country. Of the scalded children, 93 scald burns (33.8%) were due to the tea itself or to the boiling water used in steeping tea, and 87.1% of these children were preschoolers. The mortality rate was 7.1% in the hospitalized children group.
CONCLUSION
Traditional behaviors may sometimes have some serious unexpected consequences. In households where family members tend to ignore an ongoing problem, governmental and non-governmental organizations should consider taking preventive measures to protect the children from the devastating consequences of such negligence.

Hemangiopericytoma (HP) is a vascular tumor that mostly develops in soft tissues. The greater omentum is a very rare site for its occurrence. We present herein the clinical evaluation and outcome of a very rare case of HP that caused acute abdomen. We evaluated a case of acute abdomen due to rupture of a HP of the greater omentum. The clinical and laboratory findings and treatment modality are reported. A 70-year-old patient with severe abdominal pain was operated with the diagnosis of acute abdomen. A semi-solid mass (12x10x6 cm) originating from the greater omentum was detected during surgery. There was active bleeding from the tumor. Pathologic evaluation of this lesion was reported as benign HP. HP of the greater omentum can be the cause of intraabdominal bleeding leading to acute abdomen. Surgical resection is the treatment of choice, especially in benign hemangiopericytomas.

Subarachnoid pleural fistula (SPF) following injury to the vertebral column is an extremely rare complication and is usually described after blunt trauma. We report the first case of SPF with pneumocephalus due to a gunshot wound to the spine.

The nature of a tube thoracostomy -a blind maneuver- renders it subject to complications. Nevertheless, it is very uncommon to create a diaphragmatic hernia with this procedure. Herein, we present the occurrence of this complication after six months under emergency conditions that was treated by thoracotomy.

Arterial occlusive diseases are highly prevalent and constitute the leading overall cause of death. Adverse events are due to the effects of impaired circulation on critical end organs, namely the brain, heart, abdominal viscera or extremities. Acute thromboembolism remains a major surgical challenge. Even with optimal surgical management, acute lower extremity ischemia resulting from thromboembolic ds continues to cause significant morbidity and mortality. We report a case of thromboembolism of the left popliteal artery by an Ascaris worm in a patient with oriental cholangiohepatitis.

Trauma is the leading cause of death under the age of 35 years worldwide. Traumatic aortic rupture is responsible for 18% of all road accident mortality. Eighty percent of these patients die at the scene of the accident. Of the survivors, 50% die within 24 hours if left untreated. Rapid transport and resuscitation, awareness of the injury, availability of multi-slice computed tomography (MSCT), and timely intervention can significantly improve survival in aortic injury.

Intracranial foreign bodies are usually secondary to penetrating injuries. Nails, knives, screwdrivers, sewing needles, bullets, and shrapnel have been described related to penetrating brain injury. In this report, we present a 34-year-old prisoner with an intracranial screw located in the right parietal lobe. The screw was used by prisoner in an attempted suicide. A right parietal craniectomy was performed, and the screw was removed successfully. It is important to know the type of penetrating brain injury preoperatively in order to determine the best surgical approach to remove the foreign body settled in the brain. A long-term radiological assessment should be performed to detect any future complications, such as a cerebral abscess.