BACKGROUND
The aim of this study was to investigate whether intraabdominal Ankaferd Blood Stopper (ABS) causes increased intraabdominal adhesion formation and to determine any side effects of ABS in vivo.
METHODS
The present experimental study was designed to examine the effects of Ankaferd solution on peritoneal adhesion formation in a rat model of cecal abrasion. Intraperitoneal adhesions were assessed macroscopically and histopathologically on the 10th postoperative day. The possible adverse affects of ABS on liver and lung tissues were analyzed histopathologically, and blood chemistry was also evaluated.
RESULTS
Our study revealed that ABS reduced intraperitoneal adhesion formation in an experimental rat model. The blood chemistry was not disturbed due to ABS administration. Intraperitoneal administration of ABS led to some minor changes in the lungs and serosal surfaces of the intestines, with minor architectural changes in the liver that were not considered as toxic. Further studies with various application doses and routes with more detailed cellular analysis are thus warranted to clarify the possible pleiotropic and adverse effects of this new agent away from hemostasis.
CONCLUSION
There was less intraperitoneal adhesion formation in the ABS group than in the control group and saline group. Intraperitoneal administration of ABS has no toxic effects on blood chemistry or the lungs, kidneys and the liver, but it has some minor adverse effects.

BACKGROUND
Aquaporin-4 (AQP4) is the major water channel in the central nervous system. Brain edema emerges from increased AQP4 expression in traumatic brain injury (TBI). Cell line studies have shown that the protein kinase activator phorbol ester exerts a suppressive effect on AQP4 and water permeability. The aim of this study was to investigate the effects of a phorbol ester, phorbol dibutyrate (PDBu), on increased TBI AQP4 expression and accompanying brain edema.
METHODS
Fifty-six male Wistar rats were first divided into two groups: the edema group, in which the percentage of water in brain tissue would be evaluated, and the immunohistochemical group, allowing AQP4 expression to be determined. Both groups were further sub-divided into four groups consisting of 7 subjects. These four groups were as follows: sham-operated control group, severe diffuse TBI group, 0.9% saline-treated diffuse TBI group, and the PDBu-treated diffuse TBI group (2300 µg/kg, iv). The results were evaluated statistically.
RESULTS
PDBu treatment significantly reduced brain water concentration (p<0.001). Furthermore, PDBu was found to reduce trauma-induced AQP4 upregulation (p<0.05).
CONCLUSION
This study showed that traumatic brain edema was prevented by intravenous PDBu administration via AQP4 downregulation, supporting the idea emphasizing the importance of AQP4 expression control in TBI.

BACKGROUND
The increase in terrorist attacks has brought a profound and new knowledge of blast injuries. In order to improve our knowledge regarding the mechanisms of blast injuries, we analyzed the effects of shock waves.
METHODS
100 g TNT and 1000 g C4 were detonated and recorded by high-speed camera. Blast wind, shock wave and shrapnel speeds were calculated, and final condition of the target was examined.
RESULTS
A flash ball appeared first followed by the shock wave. Finally, blast wind occurred and shrapnel was distributed. The macroscopic structure of targets was not affected by the shock wave but was affected by shrapnel and blast wind. Shock waves created a transparent ballistic gel inside the target mat by changing its microscopic structure. The speed of the shock wave was 6482-7194 m/sn and shrapnel speed was 1420-1752 m/sn.
CONCLUSION
Shock waves especially affect the air-filled organs and cause lung injury, acute respiratory distress syndrome, and intestinal and eardrum perforation. Blast wind destroys targets due to its high speed and high density. The main cause of mortality is shrapnel injury. The high temperature created by the explosion causes thermal injuries. Being informed of the mechanisms of blast injuries will assist in providing better treatment. Additionally, consideration of all mechanisms of blast injuries will facilitate lower mortality and morbidity rates.

BACKGROUND
Post-burn contractures severely deteriorate life quality. We aimed to present our treatment protocols for post-burn sequelae and the contractures that cause functional limitations.
METHODS
Seventy-seven cases with post-burn contracture were treated in our clinic. Post-burn contractures occurring after a burn injury affected the upper extremity, face and neck in 60, 17 and 6 cases, respectively. Skin grafts, local flaps such as advancement flaps, Z-plasties, K-plasties, regional flaps such as posterior interosseous flap, tissue expanded flaps, and free flaps were used according to the severity of the contractures.
RESULTS
In one patient with type II axillary contraction, recurrence was seen. Full range of motion was achieved in the 3.6-year follow-up period in elbow contractures. Eight of 71 phalangeal joint contractures recurred. Two patients underwent reoperation for neck contracture recurrences.
CONCLUSION
Excellent results were seen with prefabricated flaps, which were used for the facial reconstruction.

BACKGROUND
Many approaches to the release of burn contracture have been described. Each offers some advantages for the treatment of contractures, but they have some limitations affecting their indications and outcomes. In this study, we attempt to describe clearly the difficulties with running V-Y plasty after our experience with this technique.
METHODS
This study included 21 patients with scar contracture. Preoperatively, for marking the flaps, a zigzag line, the angles of which were kept in the range of 60-90°, was drawn over the contracture line. The incision was firstly made into the skin to avoid retraction of the flaps, and then deep through the fascia, making advancement of the V flap easy by sliding. The V flap was advanced along the long limb of the Y on the base of a subcutaneous pedicle. After meticulous hemostasis, all incisions were sutured.
RESULTS
In most of the patients, successful release of the contracture was achieved without any complication. However, in a few cases, some challenging problems developed, suggesting possible limitations of the running V-Y plasty procedure.
CONCLUSION
When considering running V-Y plasty for the release of contracture, awareness of the related difficulties will be helpful and will facilitate selection of the cases suitable for the procedure to achieve successful results and avoid possible complications.

BACKGROUND
We evaluated the results of intertrochanteric hip fractures treated with closed reduction and external fixation (minimally invasive and biological osteosynthesis) in patients with high surgical risk.
METHODS
Twenty-three patients (14 females, 9 males; mean age 74 [65-88]) with intertrochanteric hip fracture classified as group III and IV according to American Society of Anesthesiologists (ASA) criteria were treated with closed reduction and unilateral external fixation under short-term anesthesia. Fourteen fractures were stable (60.8%) and nine were unstable (39.2%). The mean follow-up was 23.8 months (4-58). We evaluated the operation time, hospitalization time, union time, mobilization capacity, complications, and mortality rates.
RESULTS
The mean duration of operation was 25 minutes (15-40), mean duration of hospital stay 4 days (2-9) and average union time 13 weeks. Five patients (21.7%) died due to additional health problems in the first six months after surgery. Superficial pin tract infection occurred in 11 cases (47.8%). There was no implant failure. In the last follow up, an average 5° varus (range: 0-8°) and 1 cm shortening (range: 0-3) in stable fractures and an average 15° varus (range: 8-20º) and 3 cm shortening (range: 2-5) in unstable fractures were determined.
CONCLUSION
The treatment of intertrochanteric hip fractures with closed reduction and external fixation is an easy, effective and safe biological fixation method with minimal damage to surrounding tissues, especially in patients with high surgical risk.

BACKGROUND
In the rescue and management of patients with multiple traumas, identifying and eliminating risk factors can guarantee a promising outcome.
METHODS
This was a prospective randomized cohort study in trauma patients in the Department of Surgery, Jundishapour University of Medical Sciences, covering 17 months. Based on the cause of mortality, complications and discharge, the patients were divided into groups as non-survivor and complicated and non-complicated groups. The results were compared for the risk factor extraction.
RESULTS
From 125 studied patients, 27 died, 19 cases were complicated and 79 injured patients were successfully treated and discharged. Three extracted classifications as main (real), moderate and predictive risk factors were determined. Referral delay, delay in diagnosis and treatment, decreased blood pressure on arrival, multiple intra-abdominal visceral injuries, and severe acidosis were identified as the main risk factors. Age, multiple surgery and pitfalls, intensive care unit admittance, electrolyte imbalance, and mismanagement during transfer were identified as moderate risk factors. Low hemoglobin, hypoxemia, observation in multiple services, and distance of more than 100 kilometers were identified as predictive factors.
CONCLUSION
Elimination of the main risk factors is a substantial issue to decrease inevitable mortalities. Thus, attempt to shorten the lethal chain of the risk factors can lengthen a patient’s life and improve the prognosis.

BACKGROUND
We aimed to investigate the use of drainage in surgery for perforated appendicitis and to determine its effect(s) on complications.
METHODS
Two-hundred and eight patients diagnosed with perforated appendicitis between May 1999 and January 2009 were retrospectively evaluated in terms of using drainage with respect to surgical infections and other complications and duration of hospital stay.
RESULTS
A total of 208 patients diagnosed with perforated appendicitis underwent surgery. The mean age of the patients was 41.05 ± 16.30 years. Of the 208 patients, 128 (61.5%) were male. The median duration of complaints was 2 days (1-15 days). Drainage was applied in 83 patients (39.9%). The median duration of drainage was 3 days (1-7 days). Surgical infections, wound dehiscence, other complications, and re-hospitalization rates were significantly higher in patients with drainage. The mean time from appearance of complaints to surgery, the duration of hospitalization and antibiotic treatment were also longer in the drainage group (p=0.001 for all). A higher rate of the patients with an accompanying disease (39.8%-19.2%) and midline incision (20.5%-3.2%) and of the elderly patients had drainage. Multivariate analyses showed that using a drain independently affected surgical infections (p<0.001).
CONCLUSION
It can be concluded that using a drain after surgery for perforated appendicitis increases surgical infections and in turn the duration of hospital stay.

BACKGROUND
The refrigerant liquids and gases used widely in industry, farming and medicine for their cooling properties may cause severe frostbite. Despite their widespread use, only a few reports on frostbite of the hand involving these liquids and gases have been published. In this study, the circumstances accompanying these injuries, several adjunctive therapies and preventive measures are discussed.
METHODS
A retrospective analysis of hand frostbite injuries was conducted between June 2005 to June 2009 in a burn care center in Istanbul, Turkey. Seventeen patients (13 men, 4 women) were treated for hand frostbite injuries due to contact with refrigerant liquids and gases.
RESULTS
There was a preponderance of male patients (76.5%). Ages ranged from 22 to 52 years (mean age, 30.82 years). Eleven patients were treated conservatively. The hospital stay for treatment of their burns ranged from 16 to 52 days, with a mean stay of 30 days.
CONCLUSION
Frostbite injuries of the hand are uncommon and their etiologies vary. Thus, the low incidence of these injuries and limited experience in handling rare cases of this nature may lead to misjudgments in treatment that can have grave consequences. Decreasing the exposure time is an important first step in the treatment approach. After exposure to gas, quick delivery of the patient to a burn center is essential.

BACKGROUND
The purpose of the present study was to determine the factors affecting morbidity and mortality in geriatric patients undergoing abdominal surgery.
METHODS
Ninety-two patients who had undergone acute abdominal surgery at >65 years of age were evaluated in terms of surgical indications, morbidity and mortality rates and the factors affecting morbidity and mortality. Forty-eight patients (52.2%) were males and 44 (47.8%) were females. The mean age was 73.32±6.37 (65-92) years.
RESULTS
The most common surgical indication was acute cholecystitis (26.09%). Morbidity was established as 21 (22.82%) and mortality as 14 (15.21%), and the most common cause of mortality was mesenteric vascular occlusion. American Society of Anesthesiology (ASA) IV was noted in 90.05% of the patients admitted to intensive care, and 92.85% of the patients had mortal progression. The mean hospitalization duration was 7.94±7.13 days (median, 7 days). While older age and high ASA scores were significantly correlated with morbidity, mortality and duration of hospitalization, gender was not (p>0.05).
CONCLUSION
In order to decrease the postoperative mortality rate in geriatric patients, precaution should be taken beforehand to avoid surgical complications. By carrying out elective surgery in geriatric patients, the likelihood of common causes of acute abdomen, such as acute cholecystitis and incarcerated hernia, can be reduced.

BACKGROUND
We aimed to identify the role of computerized tomography (CT) in the differential diagnosis of acute appendicitis in patients with a low Alvarado score and negative ultrasonography findings.
METHODS
Fifty-two cases who underwent appendectomy (December 2004-September 2008) were included. All patients had an Alvarado score of 4-6 together with negative ultrasonography findings; preoperative abdominal CT examination results were available in all patients. CT results were compared with intraoperative and pathological findings.
RESULTS
The mean age of the cases was 31±4 years (range 11 to 71 years). The mean Alvarado score was 4.9. CT results were in favor of acute appendicitis in 34 of 52 cases. Of these 34 patients, acute appendicitis was confirmed by pathological findings in 31, whereas acute appendicitis could not be confirmed in the remaining three cases (8.2%). In 15 of 18 cases without CT findings of appendicitis, intraoperative and pathological findings were also in agreement; however, the remaining three cases had acute appendicitis. Based on the results of the recent studies, sensitivity and specificity of CT in the diagnosis of acute appendicitis were 91.2% and 83.3%, respectively.
CONCLUSION
To avoid unnecessary appendectomies in suspected acute appendicitis cases with a low Alvarado score and negative ultrasonography findings, CT may be used as a complementary diagnostic tool.

BACKGROUND
The epidemiology of trauma to genitourinary (GU) organs following Road Traffic Collisions (RTC) is not well-studied, especially in the Middle East.
METHODS
The data of the RTC Injury Registry in Al-Ain City were collected prospectively from April 2006-October 2007.
RESULTS
Of the 1,008 patients in the registry, there were 23 GU injuries. Renal injuries accounted for 74% of injuries. Of these, 35% were severe (grade IV-V). There were two extraperitoneal bladder injuries and two membranous urethral injuries, all of which were associated with pelvic fractures. In addition, there were two asymptomatic adrenal injuries. The mean Injury Severity Score, mean total hospital stay and percentage of patients who required intensive care unit (ICU) admission were higher in patients with GU injuries compared to non-GU patients (24.9 vs. 9.0 (p<0.0001), 24.1 vs. 8.9 days (p<0.0001) and 67% vs. 17% (p<0.0001), respectively). Side-angle collision was the primary crash mechanism in 39% of GU patients vs. 16% in non-GU patients (p=0.015).
CONCLUSION
This is the first population-based study of GU injuries following RTC from the Middle East. Patients with GU organ injury tend to have more severe trauma compared to other patients. The incidence of GU injuries following RTC in the current study appears to be higher than that reported in the West.

BACKGROUND
“Fractures of the body” is a new definition in which the punishment for “aggravated injury in the end” is delineated in the new Turkish Penal Code (Article 87, Section 3). In the current study, we intended to evaluate the fact-evaluation reports of injuries with broken bones in the framework of the new Turkish Penal Code, which went into effect on 1 June 2005.
METHODS
Of the 842 forensic reports of our Eskisehir Osmangazi University, Department of Forensic Medicine, 306 cases with bone fractures were determined between 1 June 2005 and 31 December 2008.
RESULTS
Traffic accidents were determined as the most common cause of all broken bone cases (n=183, 59.8%). One hundred and eight of the cases (35.3%) were determined to have fracture in the head area, with life endangered in 61.1% (n=187) of all cases.
CONCLUSION
All traumatic phenomena are considered judicial cases. Forensic experts need to report on institutions to ensure they are complying with the regulations, and their work in this area is widely considered to be useful. However, in current circumstances, the doctor responsible for all forensic reports required to edit the case should be applied to broken bones to not fall into the legal procedures and practices need-to-know basis.

BACKGROUND
Phytobezoars are a rare cause of acute small bowel obstruction. The aim of this work was to identify the diagnostic difficulties and treatment of this rare entity.
METHODS
Data of 14 patients operated between January 1999 - January 2009 with small bowel phytobezoar were retrospectively studied. The patients (n=432) were treated in our clinic for small bowel obstructions. Of these, 14 (3.2%) phytobezoar-induced small bowel obstructions were included in this series. Median patient age was 57.25 years; nine (64%) of the patients were male, and five (36%) were female.
RESULTS
The predisposing factor was previous gastric surgery in 12 (87.5%) patients and previous abdominal surgery and total absence of the teeth in two (14.3%) patients. A completely obstructing terminal ileal phytobezoar was found in nine (64%) patients and jejunal phytobezoar in five (36%) patients during exploration. There was no mortality.
CONCLUSION
Phytobezoar-induced small bowel obstruction remains an uncommon diagnosis that poses a diagnostic and management challenge. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, poor dentition or a history suggestive of increased fiber intake.

BACKGROUND
Fall from height is one of the important causes of musculoskeletal injuries. Fall from walnut trees constitutes an important entity that leads to a significant mortality and morbidity amongst those engaged in fruit collection. The present study aimed to determine the prevalence of different musculoskeletal injuries in these victims and to highlight the importance of recognizing this incident as an occupational injury.
METHODS
A retrospective study of all patients admitted to the Orthopedic Department of the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Medical College from January 2003 to December 2007 was conducted. The medical records were studied for the different types of bony injuries, associated injuries and delay in the referral of patients.
RESULTS
94% of falls occurred from August to October. Of the 115 patients, 63 (54.7%) had associated non-orthopedic injuries. Head injury was the most common associated injury, presenting in 34 patients (29.5%). Thoracolumbar (16.5%), calcaneum (10.5%) and distal radius (8.7%) fractures constituted the common fractures encountered in the victims.
CONCLUSION
Walnut tree injuries mostly involve young males who form the productive group of the population. Being a seasonal injury, it puts a considerable load on the health resources of the region over a small period of time.

We herein report a case of ileal invagination secondary to metastasis of a cutaneous melanoma. A 45-year-old female was admitted with intermittent abdominal pain and nausea. The patient’s medical history was remarkable for cutaneous malignant melanoma. Imaging studies showed a solid mass in the right lower quadrant and the possibility of invagination. We made a preoperative diagnosis of partial intestinal obstruction, and laparotomy was performed. Intraoperative findings revealed ileal invagination. Segmental ileum resection with wide mesenteric lymph node dissection was performed. A polypoid metastasis of melanoma into the lumen of the ileum was confirmed with pathological examination. The diagnosis and management of intestinal metastasis of cutaneous malignant melanoma are discussed together with a literature review.

Air guns (AGs) are arms that use air or another compressed gas to propel a projectile. Generally, brain injury may occur in children due to their incomplete skull development; however, the less-resistant and thin region of the skull in adults may also be penetrated by an AG shot. In this paper, we present three adult cases treated in our clinic for brain injury caused by an AG. The first case had brain and skull damage related to the high pressure of the compressed gas, and the others additionally had foreign bodies in their brain. All of the patients were operated. Two were discharged without neurological deficit; the third case had a permanent slight hemiparesis. Average follow-up was 11 months and no abscess formation was observed in this period. AGs are known as low-velocity arms; however, they have the potential to cause brain injury, and brain penetration may occur especially in the relatively less resistant and thin sites of the skull such as the orbit and temporal and occipital bones. As cerebrospinal fluid leakage is one of the expected conditions, urgent surgery is usually required.

Pneumopericardium is defined as the presence of air within the pericardial space. It is an uncommon complication of blunt or penetrating chest trauma and may also occur iatrogenically. ‘Simple’ pneumopericardium produces no discernible circulatory compromise; however, simple pneumopericardium may progress rapidly to produce cardiovascular compromise or circulatory collapse, when it is termed ‘tension’ pneumopericardium. Tension pneumopericardium requires emergent drainage of the pericardial sac. Failure to achieve rapid effective drainage may result in cardiac arrest. Drainage of the pericardial sac may be achieved by either percutaneous or open drainage technique. Formation of a sub-xiphoid pericardial window has been advocated as a rapid and effective means of achieving open drainage. This may be carried out at the bedside with minimal equipment, and the authors advocate this technique as the preferred option for achieving drainage. This case demonstrates the rapid and dramatic deterioration to cardiac arrest of a multiply injured trauma patient with radiologically confirmed pneumopericardium. The effectiveness of open drainage via a sub-xiphoid pericardial window at the bedside with resultant return of spontaneous circulation is also shown. In addition, the pathogenesis and natural history of this uncommon condition are reviewed and the options for management are discussed.

Despite advances in imaging techniques, the detection of retained wooden foreign bodies remains a difficult and challenging task. The detection of wood is especially important because it may serve as a nidus for superimposed infection. The initial examination may mimic malignancy. We report a rare case of retained wooden foreign body in the lung parenchyma that was found on chest X-ray and computerized tomography as a thick wall cavity. Surgical resection was performed and a wooden particle was revealed. Review of the literature shows that presence of wooden foreign bodies in the lung parenchyma is quite rare and may present with a wide variety of densities. We conclude that foreign body should be considered in the differential diagnosis of unusual lung opacity, and it must be resected on an urgent basis due to the risk of recurrent infection.

Subclavian artery stenosis represents a relatively lower rate for upper extremity emboli source. Subclavian artery stenosis with thrombus localized distal to the stenosis was diagnosed on the arteriography of a patient who had a history of three previous brachial artery embolectomies. In this report, a case with subclavian artery stenosis causing recurrent brachial artery embolism who was successfully treated using subclavian-carotid transposition is presented.