BACKGROUND
The reason for acute renal failure (ARF) in abdominal compartment syndrome (ACS) is thought to be due to the increase in renal venous pressure. In this study, the changes in plasma and renal tissue cytokine levels and histopathologic changes in renal tubular and glomerular cells were evaluated and compared in a model of acute elevation in abdominal tension with different pressures.
METHODS
Eighteen Sprague-Dawley rats were randomly assigned into three groups: Sham-operated rats and rats in Groups 1 and 2, in which 20 and 30 mmHg of intra-abdominal pressure (IAP) was applied for 60 minutes, respectively. Left kidneys of the animals and intracardiac blood samples were taken at the end of the procedures. Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were investigated in plasma and renal tissue samples. Renal tissues were also evaluated for histopathologic changes.
RESULTS
Renal tissue and plasma TNF-α and IL-6 levels were found to be significantly increased when the sham-operated group was compared to the study groups (p<0.05). Renal tissue changes showed that the total histopathologic scores were significantly increased in study groups compared to the sham-operated group (p<0.05); tubular changes were more prominent than glomerular changes.
CONCLUSION
Abdominal tension linearly can cause renal tubular histopathologic changes. Cytokines may play a role in ARF due to ACS.

BACKGROUND
In this pilot study, we aimed to investigate the effect of dexmedetomidine on liver tissues during experimental sepsis by histopathological examination.
METHODS
The animals were allocated randomly to four groups, two of which received endotoxin. In the Sepsis Group (n: 10) and Dexmedetomidine/Sepsis Group (n: 10), endotoxemia was induced by E. coli lipopolysaccharide derived from E. coli 0111: B4. Animals in the Control Group (n: 10) received an infusion of 0.9% saline (1.0 mL•kg-1•hr-1) intravenously. The Dexmedetomidine Group (n: 10) and Dexmedetomidine/Sepsis Group received a bolus injection of 0.9% saline (1.0 mL/kg), followed by dexmedetomidine administration (infusion at 5 μg•kg-1•hr-1). All rats were euthanized at the 8th hour of endotoxin infusion. Histopathological examinations were performed on liver tissues.
RESULTS
In the liver, central venous congestion, congestion and dilation of the hepatic sinusoids and inflammation of the portal tracts were noted in the Sepsis Group. These parameters were seen slightly in the Sepsis/Dexmedetomidine group. There was a statistically significant difference between the Sepsis and Sepsis/Dexmedetomidine Groups (p<0.001).
CONCLUSION
Dexmedetomidine has a protective effect on liver tissues during experimental sepsis in the rat. We propose that dexmedetomidine sedation may be useful in the therapy of the liver dysfunction associated with sepsis and in other diseases related to local or systemic inflammation.

BACKGROUND
We determined the value of the inferior vena cava (IVC) diameter for predicting acute blood loss in control and blunt trauma patients and compared this with other parameters of hemorrhagic shock.
METHODS
Fifty volunteers and 28 consecutive hemorrhagic shock patients were recruited prospectively to participate in the study. Vital signs, blood lactate, and serum bicarbonate were measured, and shock index and base excess were calculated. Anteroposterior (AP) and mediolateral (ML) IVC diameters during inspiration and expiration were measured in the right subcostal region. IVC diameters in hemorrhagic shock patients were compared with those of controls and were also compared with other hemorrhagic shock parameters.
RESULTS
A significant relationship was determined between mean IVC AP and ML diameters during expiration and inspiration on admission in the study group and in the control group (p=0.000, p=0.000, p=0.000, p=0.000). Serum lactate levels correlated significantly with all IVC diameters (r=55), especially the IVC ML diameter during expiration.
CONCLUSION
IVC diameter, as measured by transabdominal ultrasound, was more accurate than the shock index and other commonly used non-invasive predictors of acute blood loss (blood pressure, heart rate per minute, serum lactate level, base deficit).

BACKGROUND
The aim of our study was to evaluate the results and effectiveness of early decompressive craniectomy in the treatment of severe traumatic brain injury.
METHODS
We conducted a prospective study to investigate the clinical and radiological results of early unilateral decompressive craniectomy in 33 patients with severe traumatic brain injury. The mean area of the craniectomy, potential expansion volume of the decompressed brain, and distance between the lower border of the craniectomy and the temporal cranial base were calculated from computed tomography scans. Clinical results were analyzed with modified Rankin Scale (mRS).
RESULTS
Time to surgery after trauma was 3.1±1.9 hours. There was a direct proportionality correlation between the area of the craniectomy and the calculated volume (p<0.0001). There was also a significant correlation between the state of the mesencephalic cisterns after craniectomy and the distance of the craniectomy to the base of the cranium (p<0.01). Assessment of overall one-year clinical outcome demonstrated favorable outcome (mRS 0-3) in 48.5% of patients.

CONCLUSION
The high overall morbidity and mortality rates demonstrated in our group despite the performance of early decompressive procedures reflect the severity of the underlying injuries.

BACKGROUND
The aim of the study was to investigate the role and importance of the urine trypsinogen-2 dipstick test in the differential diagnosis of acute pancreatitis in the Emergency Department and to compare results with those of conventional tests.
METHODS
The study was performed prospectively in the patients admitting to the Emergency Department due to upper abdominal pain. Thirty-two of the 87 patients included in the study had acute pancreatitis diagnosis. Serum amylase, lipase, C-reactive protein (CRP) and urine trypsinogen-2 using Actim pancreatitis dipstick were studied in all patients. The statistical analysis was performed using SPSS 11.5 package program.

RESULTS
Urine trypsinogen-2 was found positive in 21 (65.6%) of 32 patients. The sensitivity of the test for pancreatitis was identified as 64%, specificity as 85%, positive predictive value as 72%, and negative predictive value as 81%. These values were statistically significant compared to the control group (p<0.01).

CONCLUSION
Although it has lower sensitivity and specificity compared to amylase and lipase, we suggest that urine trypsinogen-2 test may be an important diagnostic tool in excluding the diagnosis of acute pancreatitis, since it provides results within 5 minutes in the Emergency Department, is cheaper, has a higher negative predictive value, and is easy to use.

BACKGROUND
We aimed to evaluate the efficacy and safety of low molecular weight heparin (LMWH) compared to elastic stockings in combination with intermittent pneumatic compression (ES+IPC) in venous thromboembolism (VTE) prophylaxis in the intensive care unit (ICU) of trauma and emergency surgery.
METHODS
From June 2005 to June 2007, 259 patients who were on mechanic ventilation in the ICU were assigned to two groups as either LMWH (152 patients) or ES+IPC (94 patients). Color flow Doppler sonography was performed on the 3rd and 7th days.
RESULTS
Deep venous thrombosis was determined in 3 (2%) of the LMWH group and in 1 (1%) in the ES+IPC group. Minor bleeding was seen in 15 patients. The frequency of VTE was 1.5%. Two patients suffered from fatal pulmonary embolism (PE) among a total of 4 patients with PE.

CONCLUSION
We believe that the protocol applied for VTE prophylaxis in the Emergency Surgery Department of Istanbul Medical Faculty is effective and safe in this group with such high mortality and morbidity.

BACKGROUND
Missile vascular injuries have reached an epidemic proportion in Kashmir valley since the eruption of militancy. The present study was undertaken to analyze the mode, pattern, presentation, and management of missile vascular injuries.
METHODS
A retrospective study of patients with missile vascular injury from January 1990 to October 2008 was undertaken. Five hundred eighty patients with missile vascular injury were studied. All patients with vascular injury due to causes other than missiles were excluded from the study.
RESULTS
Most of the patients were treated by interpositional saphenous vein graft or end-to-end anastomosis. The most common complication was wound infection (22.7%) followed by graft occlusion (3.8%). The amputation rate was 3.3% and was higher in patients with a delay of >6 hours to revascularization and associated fractures.
CONCLUSION
Missile vascular injury requires prompt resuscitation and revascularization. Preoperative angiography is seldom necessary. Doppler study may sometimes be needed to aid in the diagnosis.

BACKGROUND
We describe herein the characteristics of lethal injuries caused by low-voltage electrical current (electrocution), the most frequent injury caused by electrical current.
METHODS
Nine hundred forty-five cases over a period of 41 years (1965-2006) were reviewed, of which, 351 electrocution cases were identified. The descriptive statistical analyses were carried out with the application of SPSS 11.0 software.
RESULTS
Electrocution accounted for 37.14% of all studied electricity-caused injuries. The average age of the victims was 35.25 years. The average age of male victims was 36.19 years and of female victims was 32.55 years. The distribution by gender showed a significant prevalence of the male sex (74.07%). Among the circumstances leading to electrocution, household accidents (78.06%) prevailed over occupational accidents (13.39%). Suicides were significantly rarer (7.41%). 66.10% of all electrocution cases occurred during the summer period from June through September.
CONCLUSION
Household accidents prevail among the circumstances under which electrocution occurs, with an insignificant difference in the male/female proportion in this group. The majority of electrocutions occurred during the summer period (June-September). The results obtained in this research can help in the development of a differentiated strategy for the prevention of electrocution, while taking into consideration gender, age and season of the year.

BACKGROUND
It is not clear why complex regional pain syndrome (CRPS) develops in some patients but not in others, despite similar initiating events. The aim of this study was to investigate risk factors for CRPS in cases who had suffered traumatic upper extremity injury.
METHODS
One hundred sixty-five patients who had suffered a mechanical traumatic injury isolated to their hand or forearm were included in this study. Age, gender, body mass index, tissue types injured, and side of affected forearm/hand were investigated as possible risk factors for CRPS.
RESULTS
CRPS was diagnosed in 84 patients. Female/male ratio was higher in patients with CRPS versus those without. The mean age was higher in patients with CRPS. The affected forearm/hand was the dominant side in 62.9% of patients without CRPS and in 64.2% of patients with CRPS. CRPS incidence was higher in patients with motor nerve injury and in patients with sensory nerve injury. A logistic regression showed that risk for CRPS was higher in patients with motor nerve injury and in females.

CONCLUSION
This study indicates that motor nerve injury and female gender are risk factors for CRPS. The prevention measures should be focused mainly on females and patients with motor nerve injury in order to reduce the risk of CRPS.

BACKGROUND
Intensive care of Traumatic Brain Injury (TBI) is associated with substantial morbidity, mortality and cost; however, there is very little published work on this topic. The purpose of this study was to examine direct costs and survival outcomes of patients with TBI admitted to an intensive care unit (ICU).
METHODS
A retrospective review of the records of Trakya University Hospital’s ICU from 2002-2006 was undertaken. Patients with TBI were determined and assessed regarding costs and survival.

RESULTS
The study group consisted of 126 patients, and 27.8% of them had been operated. Male gender (80.2%) was dominant, mean length of stay was 9.8±8.7 days, and motor vehicle injury (59.5%) was the major reason for ICU admission. Mortality rate was 50% and the Glasgow Coma Score (GCS) of the patients was 6.1±1.9. The average cost per ICU stay was US$ 4846±5084. Cost per life saved and per life-year saved were US$ 9533 and US$ 313.60, respectively. Survival rates were significantly different among injury types (p=0.010). GCS appeared to be a prognostic parameter in patient survival (Hazard Ratio: 0.643; 95%CI: 0.529-0.781; p<0.001).


CONCLUSION
Intensive care of TBI cases is characterized by high mortality and high cost.

BACKGROUND
The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma.
METHODS
We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid.
RESULTS
A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88±3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%.

CONCLUSION
In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.

BACKGROUND
Pregnancy-associated acute biliary pancreatitis is a rare but challenging clinical entity in terms of diagnosis and management. We report our institutional medical data of pregnancy-associated acute biliary pancreatitis.
METHODS
Medical records of 27 patients admitted to our clinics for pregnancy-associated acute biliary pancreatitis between January 2005 and January 2010 were reviewed.
RESULTS
Of the 27 patients, 25 (93%) were in the post-partum period, and 2 (7%) were pregnant. Seventeen patients (63%) were managed with conservative treatment, and were scheduled for interval cholecystectomy, while 10 patients (37%) had early cholecystectomy prior to discharge. The mortality rate was 3% (n=1).

CONCLUSION
Pregnancy-associated acute biliary pancreatitis usually has a mild-to-moderate clinical course with a favorable outcome, and can be managed successfully with conservative treatment. Early cholecystectomy done prior to discharge in the initial admission should be considered in mild-to-moderate pregnancy-associated acute biliary pancreatitis, except in patients within the first trimester.

BACKGROUND
Spontaneous intramural hematoma of the small intestine is a rare clinical condition that may result in potentially serious complications. The purpose of this study was to present our experience with the diagnosis and management of spontaneous intramural hematoma of the small intestine.
METHODS
The medical records of the patients with spontaneous intramural hematoma of the small intestine were retrospectively reviewed. Six patients were included in this study.
RESULTS
Anticoagulation therapy and factor VIII deficiency were found to be responsible for the intramural hemorrhage in five patients (83%) and one patient, respectively. Acute abdominal pain followed by nausea and vomiting were the most common presenting symptoms. Abdominal computed tomography scan was diagnostic in five of the six patients. Four patients were followed up with conservative therapy. Surgical intervention was required in two patients due to acute abdomen. All patients were discharged from the hospital uneventfully.
CONCLUSION
The patient’s medical history, physical examination and radiological evaluation proved adequate for the diagnosis. Conservative therapy provides regression of the hematoma in most patients. Surgery should be reserved only for the complicated cases.

BACKGROUND
The aim of this study is to outline the sociodemographic and traumatic characteristics of children who were referred to the Burn Unit of Emergency Service with burn injuries, to discuss the doctors’ approach to these cases, and to compare the prognosis of patient groups with and without life-threat.
METHODS
This epidemiological study was carried out between 14 October 2004 and 31 December 2006 and included a total of 134 pediatric patients aged between 0-18 years. A semi-structured questionnaire form was designed to obtain the information from the study population. The obtained data were statistically evaluated.
RESULTS
66.2% (n=90) of the cases were male and 33.8% (n=46) were female. The mean age of the study population was 3.9±4.1 years and the mean percentage of burned body area was 22.47±17.37. The main cause of burn was scalding with hot water, with a frequency of 77.2% (n=105). When the percentage of burn area of the body was lower than 20%, the mortality was 6.3% (n=6), whereas it was 61% (n=25) when the burn area exceeded 20% of the body (p=0.0001). While the mortality was 21.0% (n=25) among the cases with first-degree burns, it was 35.3% (n=6) among those with second- and third-degree burns (p=0.189). Mortality ratio among the cases with life-threat was higher than those without life-threat, and this difference was statistically significant (p=0.033).

CONCLUSION
Extent of burn is a determinative factor for prognosis in children. Evaluation of all burn cases in children should be approached as cases of neglect/abuse; protection of these children in this manner will serve as an important practice of preventive medicine.

The association between necrotizing fasciitis and tuberculosis is extremely rare. We report two cases in which the initial clinical presentation of tuberculosis was that of necrotizing fasciitis proven by histopathology. Repeated adequate surgical debridement was performed in both. In one patient, acid-fast bacillus was cultured from a discharging sinus one year postoperatively. The other patient was diagnosed to have pulmonary tuberculosis two months postoperatively. The diagnosis of tuberculosis should be suspected in patients with necrotizing fasciitis with recurrence or unexpected slow response to surgery.

A 77-year-old male patient was admitted to the hospital with a worsening acute ischemia of the left lower extremity. The patient, who had a coxarthrosis and was being followed by the orthopedic clinic, had undergone a total hip prosthesis, with a revision performed at the sixth month of its placement. The physical examination revealed the absence of the femoral, popliteal and distal pulses of the left lower extremity. The left hip movements were painful and limited in external rotation posture. Doppler ultrasonography showed an acute occlusion of the left common femoral artery due to the dislocated hip prosthesis, and right-to-left femorofemoral expanded polytetrafluoroethylene graft bypass was carried out. After successful surgery and an uneventful postoperative period with palpable femoral and popliteal pulses, the patient was put on low molecular weight heparin and referred to orthopedics once the ischemia had subsided with the intervention. Case reports regarding occlusions due to migration of total hip prosthesis are rare in the literature. The emphasis of this case report is to describe one such case.

Although airbags reduce the overall risk of injury and death from motor vehicle accidents, the airbag may cause injuries during deployment. We present a case of apparently isolated sternal fracture caused by airbag deployment during a motor vehicle crash and we discuss the ultrasonographic diagnosis. We also examine the mechanism of injury caused by the airbag.

A rare case of an Ascaris worm emerging through an intercostal chest tube is reported here because of its unusual presentation. A five-year-old male child had a liver abscess, which had ruptured into the right pleural cavity. An intercostal chest tube was inserted for right pleural effusion. On the 5th postoperative day, a 7 cm long worm was noticed emerging through the chest tube. Ascaris lumbricoides infestation can lead to serious complications because of the mobility of the worms. Though complications such as intestinal obstruction, volvulus, gangrene, pancreatitis, biliary obstruction, cholangiohepatitis, and liver abscess have been reported to occur, intrapleural ascariasis is an extremely rare situation. This report describes a clinical situation of intrapleural ascariasis and emphasizes the importance of remaining aware of this rare complication of ascariasis.

Correct identification of lesions in examined patients is as important in forensic medicine application as it is in the medical profession. However, general practitioners and clinicians often fail to give proper attention to the definition and recording of the lesions and clinical findings in patients. Additionally, the identification of the lesion is sometimes deficient or incorrect. This has hindered, particularly in traumatic events that are of a forensic nature, reaching accurate conclusions during the interpretative and legal phases. In this study, we describe the case of a nine-year-old boy admitted to the hospital following a traffic accident. During his evaluation, an ecchymosis “resembling a rail” on his chest was noted. Consequently, legal/judicial authorities suspected the child may have been exposed to violence or child abuse and he was referred to our department. Practitioners may contribute to inaccurate decisions/conclusions if they fail to give the necessary detailed attention during the forensic interpretation (detailed examination and recording of lesions) and judicial process or if they have insufficient knowledge on this subject. This case is submitted as an interesting example since it included the possibility of inaccurate conclusion and judgment.

Massive intra-abdominal hemorrhage represents a challenging operative emergency. Temporary control of the aorta and inferior vena cava (IVC) using intra-luminal balloon occlusion, preemptive trans-thoracic clamping or infra-diaphragmatic clamping has been achieved with variable success. We report the use of wooden spoons with convex arches cut from their bases as a cheap and effective alternative. They can be used to compress the aorta or IVC against the vertebrae, giving vascular control while leaving good surgical access (Fig. 1). This equipment requires minimal financial investment and only basic woodworking skills.