BACKGROUND
Ischemia is a troublesome problem that can cause intestinal emergencies and complicate the treatment. Identification of a chemical agent with beneficial effects on the healing process in risky colon anastomosis with the aim of reducing leakage rates is a popular topic in the era of surgical research. Data is lacking about the role of amelogenin, an extracellular matrix protein, during the healing process of gastrointestinal anastomosis. In this study, the effects of amelogenin treatment on ischemic colon anastomosis were evaluated.
METHODS
Adult male Wistar Albino rats weighing 200-250 g were divided into three weight-matched groups as normal colon anastomosis group (n=8), ischemic colon anastomosis group (n=8), and amelogenin-treated ischemic colon anastomosis group (n=8). Sufficient equal volume of amelogenin to cover the anastomosis area entirely was applied topically. All animals were sacrificed on postoperative day four. Bursting pressure levels were measured. Peri-anastomotic colon tissue hydroxyproline levels were also assessed.
RESULTS
Bursting pressure level of the ischemic colon anastomosis group was significantly lower than the normal colon anastomosis and the amelogenin-treated ischemic colon anastomosis groups, respectively (p=0.006, p=0.008).
CONCLUSION
Amelogenin treatment supports the physical strength of ischemic colon anastomosis.

BACKGROUND
The purpose of our study was to examine the role of cobalt-albumin binding assay (CABA) for the early diagnosis of abdominal compartment syndrome (ACS).
METHODS
Twenty-four anesthetized and ventilated rabbits were randomly assigned to four groups as 1 to 4, with each group comprised of six animals. Intraabdominal hypertension of 25 mmHg was induced for 15, 30, 45, and 60 minutes by insufflation in the four groups, respectively. Five ml of blood was drawn from each animal before the animals were sacrificed. A CABA test was performed on the samples and results were compared with pathologic diagnosis of intestinal samples shown as a score of damage severity values.
RESULTS
Ischemia-modified albumin (IMA) in Group 4 was significantly higher than in Group 1 and Group 2 (0.65±0.16, 0.60±0.25 and 0.61±0.14, respectively; p<0.05). However, there was no significant difference between the IMA of Group 3 and Group 4. Score of damage severity values reached statistically significant levels in Group 4 compared with Group 1 and Group 2 (p<0.004 and 0.006, respectively) and in Group 3 compared with Group 1 (p<0.004). There was also a statistically significant difference between Groups 1 and 2 (p<0.004).
CONCLUSION
CABA plays an important role in the early diagnosis of ACS at the beginning of intestinal ischemia.

BACKGROUND
The main objective of this study was to explore the patterns of road traffic crashes (RTCs) among drivers in Qatar and to examine the contributing factors involved.
METHODS
This study was a cross-sectional survey conducted from February to June 2009 at the Primary Health Care Centers in the State of Qatar. A random sample of 1675 Qatari drivers were approached, and 1228 of them responded and agreed to participate in this study, with a response rate of 74.6%. Face to face interview was conducted by well-trained research assistants based on a questionnaire covering sociodemographic information, driving history, type of vehicle, driver behavior, details of crashes, and accident pattern.
RESULTS
The study revealed that 26.6% of the studied Qatari drivers were involved in RTCs. 69.4% of the drivers with a history of RTCs were male. Drivers in the age group 25-34 years showed a higher risk of having a crash (31.2%). Drivers of cars (45.6%) and 4WD/SUVs (23.5%) were more frequently involved in RTCs. 23.5% of drivers who had RTC did not always wear their seat belt while driving. 37.9% of the drivers with RTC were engaged in eating and drinking and 41.9% were using their mobile phones while driving. More than half of the drivers with RTCs had traffic violations (57.2%), with 25.7% exceeding the speed limit. A highly significant difference was observed between the two groups (drivers with and without RTC) in terms of presence of traffic violation (<0.001) and exceeding the speed limit (<0.001). Most of the crashes happened during sunny days (84.7%) with fewer crashes on holidays (5.5%) and weekends (12.5%). Overturn skid (17.7%), angle collision (14.3%) and rear-end hit (10.7%) were the most frequently reported patterns of RTCs.
CONCLUSION
The study findings revealed the high risk of RTCs among drivers in the State of Qatar. Among the sociodemographic factors, male drivers and young drivers aged 25-34 years were found to have a higher accident involvement. Human behavior was identified as the main contributing factor of all RTCs, especially presence of traffic violations.

BACKGROUND
The Wenchuan earthquake was an enormous devastating disaster and caused mass casualties. The descriptive analysis presented here serves as a reference not only for present injury intervention but also for future earthquake disaster response.
METHODS
A total of 205 patients with a musculoskeletal injury were admitted in two teaching hospitals. We conducted a retrospective review of medical records to document the injury profile, chief complaints, damage locations and types, subsequent treatment, and prognosis.
RESULTS
Of the 205 patients, fracture was the major type of injury (78.0%). Forty patients were determined to have crush injuries and 19 patients had crush syndromes. Open fractures, multiple fractures and comminuted fractures were common. Fracture-associated neural injuries and trauma-associated infections were also common. Surgical treatments included debridement, bone traction, external fixation, open reduction and internal fixation, and spinal fixation. All the patients were effectively treated with few complications, a low deformity rate and no death.
CONCLUSION
For emergency conditions after a major earthquake, pre-hospital emergency care is highly important. After the patients are transported to the hospital, we should plan individualized treatment according to the patients’ respective clinical features, and at the same time, prevent and cure the related complications in a timely manner in order to reduce mortality and disability rates.

BACKGROUND
Tuberculous abdominal cocoon is a rare disease, and diagnosis is seldom made preoperatively. The bowel is encased in a membrane in a cocoon-like fashion. Histopathology is confirmatory.
METHODS
This prospective case note review was a study of patients diagnosed with tuberculous abdominal cocoon from April 2005 - April 2008. There were 8 females and 3 males.
RESULTS
All patients had features of small bowel obstruction. All had laparotomy and the characteristic finding of absence of the greater omentum from the involved area and the absence of any stigmata of gut tuberculosis. Peeling of membrane is all that is required, and patients received anti-tubercular therapy postoperatively. In each case, evidence of tuberculosis on histopathology of membrane was present.
CONCLUSION
Tuberculous abdominal cocoon is a rare entity. Females are commonly affected. Surgery is the preferred treatment.

BACKGROUND
We aimed to identify different methods of treating late perforation of the cervical esophagus.
METHODS
Ten late cervical esophageal perforations were caused by foreign bodies. The subjects were divided into three groups according to their diagnosis and treatment as follows: Group I: Cases with cervical abscess were drained by lateral cervical incision and primarily repaired, Group II: Cases with cervical abscess were drained by lateral cervical incision, and any foreign body granulomas found were removed, and Group III: Foreign bodies were removed. All cases were given broad-spectrum antibiotics and were prohibited from any oral food, except Case 5.
RESULTS
All patients recovered without mortality and retained normal swallow function. The time for treatment in each group was different.
CONCLUSION
The conservative management of removal of foreign body, prohibition of oral food and administration of broad-spectrum antibiotics is supported. Perforations with the presence of abscess can be surgically treated by debridement closure combined with strip muscle flap repair and irrigation drainage. Granuloma can be removed by lateral cervical incision and vacuum sealing drainage.

BACKGROUND
The purpose of this article is to describe and highlight our experience of end-to-side anastomosis technique in such cases for limbs salvage in the single artery of a traumatized extremity with free-flap transfer.
METHODS
Thirty-two traumatized patients in need of free-flap transfer for their extremity reconstruction were referred to our hospital from March 2006 to November 2008. Angiography was performed in all patients. A single artery was confirmed in 11 cases (Gustilo IIIC). End-to-side anastomosis was applied for limb salvage in single-artery extremity reconstruction, such as preserving recipient’s flow and preserving donor’s flow in 11 patients.
RESULTS
The anastomosis arteries included the popliteal artery (n=3), posterior tibial artery (n=2), peroneal artery (n=5) and radial artery (n=1). The mean time from the injury to the flap reconstruction was 34 days. All patients had severe fracture or bone deficit plus soft tissue defect. Postoperative hospital stay was 12-18 days. Time interval between the injury and referral was 27-45 days. Split thickness skin graft was performed in eight patients.
CONCLUSION
Free-flap transfer by end-to-side anastomosis for limb salvage with a single artery is a safe procedure, so a vein graft and T and Y shape anastomosis are not necessary.

BACKGROUND
We aimed to compare the effects of nursing-implemented sedation protocol and daily interruption of sedative infusion on the duration of mechanical ventilation.
METHODS
Fifty patients receiving mechanical ventilation and requiring sedation in the intensive care unit (ICU) were randomly selected to receive either daily interruption of sedative infusion (Group P, n=25) or nursing-implemented sedation protocol (Group N, n=25). In Group P, daily interruption of sedative infusions without any sedation protocol was performed by physicians. In Group N, nursing-implemented sedation protocol prepared by physicians was applied. In this group, if the ideal level of sedation was not achieved, information was given by nurses to physicians. Patients in each group were compared according to demographic variables, duration of mechanical ventilation and sedation, length of stay in the ICU, and mortality.
RESULTS
Demographic variables, length of stay in the ICU and mortality were similar between the two groups. In Group P, duration of sedation and mechanical ventilation were significantly shorter than in Group N. Light sedation was seen more frequently in Group P and deep sedation in Group N.
CONCLUSION
Daily interruption of sedative infusions provided shorter duration of sedation and mechanical ventilation than nursing-implemented sedation with protocol. Although nurse-implemented sedation protocol has been found acceptable, if the number of nurses is lacking, we believe the nurse-implemented sedation protocol should not be applied.

BACKGROUND
Although vascular trauma of the upper extremity is increasingly more common, mortality and morbidity rates remain low, at between 0-8%. Self-mutilation has become evident in recent years. We planned this study to compare the results of self-mutilation with other penetrating trauma in upper extremity vascular injuries and also to emphasize the dangers of self-mutilation for society.
METHODS
Data of 249 patients with penetrating vascular injury of the upper extremity were retrospectively analyzed. There were 214 male (86%) and 35 female (14%) patients, with a mean age of 24.76 ± 11.28 years (range: 2-69 years). Of these, 129 (52%) were self-mutilators.
RESULTS
The ulnar artery was the most frequently affected (n=140, 56%). There was no mortality or limb loss. However, eight (3.21%) patients, who had penetrating trauma, had restriction in finger motions. Male predominance, substance abuse and associated nerve injury were significantly more common among self-mutilators (p values <0.001, <0.001 and 0.005, respectively), whereas brachial artery injury, vein graft interposition and fasciotomy rates were higher among the penetrating trauma group (p<0.001 for all).
CONCLUSION
The form of and reason for injuries and presence of substance abuse in case of self-mutilation must be investigated cautiously, and the immediate commencement of psychiatric treatment must be provided to the self-mutilators.

BACKGROUND
Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.
METHODS
This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).
RESULTS
All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.
CONCLUSION
Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

BACKGROUND
The aim of the study was to investigate the indicators of corrosive esophageal injury (EI) severity in children.
METHODS
We retrospectively reviewed data from children who accidentally ingested corrosive substance and underwent endoscopic evaluation over a one-year period. A total of 134 consecutive children with corrosive agent ingestion who underwent diagnostic endoscopy (74 boys, 60 girls) were included in this study. Patients were divided into two groups as low-grade and high-grade EI. Statistical differences and predictive values of common signs and symptoms and white blood cell (WBC) count of patients with low- and high-grade EI were analyzed.
RESULTS
The majority of patients (70%) were asymptomatic at the initial examination. We found that drooling saliva and oral lesions were significantly more frequent in high-grade injury (p<0.05). Mean WBC count in the high-grade EI group was significantly higher than in the low-grade EI group (p=0.000). Sensitivity, specificity and predictive values of clinical findings in children were analyzed; none of them was shown to be valuable for estimating EI severity. WBC count was sensitive, but it is not a good predictor.
CONCLUSION
Our study demonstrated the relationship between clinical findings and corrosive EI severity in children with accidental corrosive ingestion, but direct visualization of the esophagus is required for definitive diagnosis.

BACKGROUND
Minimally invasive approaches to severe panfacial fractures are being used increasingly to reduce surgical trauma and the related complications. In this study, it was aimed to determine the ideal surgical approaches in severe panfacial fractures.
METHODS
Sixteen patients with severe panfacial fractures were included in this study. Minimally invasive approaches were used for Le Fort III fracture in six patients, for Le Fort II fracture in four patients, and for bilateral maxillary and orbital floor fractures in six patients. We used subciliary, intraoral vestibular, lateral eyebrow incisions to reach orbital, maxillary, zygomaticomaxillary buttress, and nasoethmoidal fractures, respectively.
RESULTS
All fractures were repaired with miniplates and screws. No hematoma, wound infections or other complications were observed.
CONCLUSION
Minimally invasive approaches in severe panfacial fractures are considered suitable and effective in terms of aesthetic results.

BACKGROUND
The frequency of violent incidents is increasing. This increase has made the role of Emergency Department (ED) staff more important in the collection, recording, protection, and storage of the evidence until the arrival of the responsible people concerned with the issue. Therefore, this study was designed to analyze the knowledge and practices of the nursing staff working in the EDs with respect to the protection and preservation of the evidence in forensic cases.
METHODS
This research, which was designed to be descriptive, was conducted with 44 health care workers in the hospitals with Emergency Departments in the center of Bolu province between October 2008 and January 2009.
RESULTS
It was observed that 90.9% of the health care workers encountered forensic cases, 65.9% of them had not attended any training on forensic cases, and 22.7% of them did not use care when removing and storing the clothes of the patient. It was considered that 90.9% of the health care workers duly carry out their duties and responsibilities in forensic cases; however, 18.2% of them do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.
CONCLUSION
It was observed that most health care workers do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.

BACKGROUND
Research was carried out to train families with children between the ages of 0-6 years regarding home accidents and how to make their homes safer.
METHODS
Five hundred and sixty-three people who exhibited potential trainer qualities and who dealt directly children aged 0-6 years and their families were trained. Trainers applied a home accident safety test to 5117 mothers. Each trainer interviewed 10 mothers with children aged 0-6 years, and a short training was provided and brochures were delivered. Home accident safety products were distributed to 500 homes with low home accident safety scores, and these homes were evaluated regarding the usage of the products.
RESULTS
A significant difference was found between pretest-posttest average scores of trainers. The average score on the home accident safety test was 75.50±8.22 before the distribution of home accident safety products, and this increased to 90.50±7.77 after the distribution of those products, and the difference was statistically significant (p<0.05).
CONCLUSION
Training the families on risk factors and ways of making their homes safer could be recommended to protect children aged 0-6 years from home accidents.

Primary epiploic appendagitis is a rare, self-limiting inflammatory disease of epiploic appendices of the colon. Although treatment options do not include surgery, it sometimes mimics acute abdominal diseases for which surgery is required for treatment. We present the computed tomography findings of this rare disease in our case report. A 21-year-old male patient admitted to the emergency ward with a three-day history of left lumbar pain. Physical examination revealed low-grade fever and tenderness and defense with left lumbar localization; laboratory findings revealed leukocytosis. Abdominal computed tomography workup showed a mass lesion with fat density in the anterior neighborhood of the descending colon, with a hyperdense rim. Antibiotic treatment was started after radiological assessment as primary epiploic appendagitis. Clinical healing was seen on the ninth day from the onset of symptoms.

Combination of lumbosacral junction injury with closed vertical shear sacral fracture and disruption of the symphysis pubis is a very rare pattern of injury, particularly with a late presentation. To our knowledge, the complexity of such a lumbosacral injury with pelvic fractures, which was presented with a chronic condition, has never been addressed or identified in the previous literature. We aimed to demonstrate a case with a late presentation of a complex lumbosacral fracture-dislocation, pelvic ring disruption and a vertical shear sacral fracture with neurological deficits and to emphasize the difficulties in the management in this case and the operative technique used for the definitive treatment. The initial event had occurred three months earlier. Closed reduction by skeletal traction had failed; therefore, surgical correction was performed by means of indirect reduction via pedicle screws, iliac screws and rods system. Definitive stabilization with posterior lumbo-pelvic segmental fixation and posterolateral fusion were performed using a posterior approach. At one year after surgery, the clinical result was satisfactory with almost complete correction of a deformity and solid posterolateral fusion. The patient had partial recovery from the preoperative neurological deficit. We report herein a patient with a very unusual complex spondylo-pelvic injury pattern with late presentation, which required meticulous planning of management, imaging, and surgical technique before definitive treatment.

In the present paper, we report a female patient with multiple cystic lesions of bone arising from the primary hyperparathyroidism and pathological femur and contralateral tibia fractures at the level of these cystic lesions (osteitis fibrosa cystica). The patient’s history revealed that she was admitted to a medical center with vague symptoms such as sudden onset of dyspepsia, loss of appetite, myalgia, arthralgia, fatigue, and weight loss six years ago but no disease was diagnosed. Loss of appetite and loss of weight continued. She had been walking only by assisted ambulation for the last year. However, primary hyperparathyroidism was overlooked until our examination. The fractures were managed by interlocking nailing and grafting after confirming with biopsy that the fractures were due to osteitis fibrosa cystica. The fractures healed uneventfully. In conclusion, it is essential to evaluate patients with these vague symptoms with full biochemical screening and radiological examination for the early detection of the disease.

This article reports a case of high-energy type traumatic abdominal wall hernia (TAWH) associated with multiple organ injuries including pelvic fractures, liver laceration and ascending colon perforation. The cause of the trauma was falling to the ground from a height of approximately 8 meters. Since the forces affecting the abdomen are unique when falling on a flat surface, the mechanism of defect may be different between a low-energy type handlebar hernia and high-energy type TAWH. Only a few cases of high-energy type TAWH exist in the literature, all reporting falling on or hitting an angled or curved material. To our knowledge, this is the only report of TAWH resulting from falling onto a flat surface. The diagnosis and management are summarized, the literature data are reviewed, and the mechanism of action is discussed.

Endovascular stent-grafting of the aorta, as an alternative to open surgical techniques, is gaining in popularity everyday, especially in high-risk patients. Acute or chronic traumatic lesions of the descending aorta, especially after motor vehicle accidents, constitute such a group with a high-risk of morbidity and mortality. Here, we report the successful endovascular repair of acute and chronic traumatic thoracic aortic aneurysms after motor vehicle accidents in five patients.

The benign solitary cecal ulcer is a rare clinical entity that is not usually included in the differential diagnosis of the cecal diseases. The etiology is unknown, and there are no pathognomonic lesions or symptoms. Pre-operative and intra-operative diagnosis is difficult. Definitive diagnosis is generally obtained by histologic evaluation of the surgical specimen after a right hemicolectomy performed for a suspected neoplasm of the cecum. We herein describe a 70-year-old woman with solitary cecal ulcer presenting with abdominal pain, palpable mass on the right lower quadrant and leukocytosis, mimicking plastron appendicitis on initial evaluation.