BACKGROUND
The aim was to investigate whether or not glutamine, an antioxidant effective amino acid, improves the reperfusion-induced oxidative injury of abdominal hypertension.
METHODS
Wistar Albino rats were used. Group 1: Abdominal compartment syndrome alone: With the rats under anesthesia, intraabdominal pressure was obtained. Three days later, the rats were sacrificed, and intestine, lung and liver samples were removed for determination of tissue malondialdehyde (MDA) and glutathione (GSH) levels as oxidative injury parameters and of myeloperoxidase (MPO) activity as an inflammatory parameter. Trunk blood was analyzed for the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Group 2: Abdominal compartment syndrome and glutamine: intragastric glutamine was given for seven days before and three days following establishment of the abdominal compartment syndrome model. The same examination procedure was then performed. Group 3: Glutamine administration alone. Group 4: Control group.
RESULTS
Intraabdominal pressure significantly increased the intestine, lung and liver MDA levels and MPO activities in comparison to the control group. Glutamine was associated with decreased MDA levels and MPO activities and increased GSH levels.
CONCLUSION
Glutamine appears to have protective effects against reperfusion-induced oxidative damage via its anti-inflammatory and antioxidant effect.

BACKGROUND
The purpose of the study was to compare classical primary suture repair and sutureless repair with fibrin glue or DuraSeal adhesion barrier for the closure of duodenal perforation in rats.
METHODS
Forty adult female Wistar Albino rats weighing between 250-300g were randomly divided into four equal groups. Primary repair, primary repair and omentoplasty, or application of fibrin glue or DuraSeal adhesion barrier was performed in each of the four groups, respectively. The bursting pressure, tissue hydroxyproline levels and histopathology were evaluated.
RESULTS
Bursting pressure values of the primary repair and primary repair and omentoplasty groups were significantly higher than in the fibrin glue and DuraSeal groups (p<0.001). There were no significant differences between the experimental groups regarding hydroxyproline levels and histological parameters.
CONCLUSION
The sutureless methods (Fibrin glue, DuraSeal) have no superior effects when compared with the conventional repair techniques. We observed similar results between the sutureless repair groups; thus, DuraSeal can be considered an alternative to fibrin glue for this purpose. This suggestion must be supported with new studies, however, which would be planned with other wound healing markers and different designs.

BACKGROUND
This experimental study was performed to investigate the benefit of curcumin via its antioxidant effect on spinal cord injury (SCI) in rats.
METHODS
Twenty-four adult Wistar albino rats were randomized into three groups. SCI was performed by the weight-drop model. Group 1 underwent laminectomy followed by SCI and received no medication. Group 2 underwent laminectomy followed by SCI and received curcumin (200 mg/kg/day orally). Group 3 underwent laminectomy followed by SCI and received methylprednisolone (30 mg/kg intraperitoneally). Twenty-four hours later, blood samples were obtained from all rats; serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels were determined, and the obtained results were compared.
RESULTS
SOD level in the curcumin group was higher than in the control group (p<0.000) and methylprednisolone group (p<0.012). MDA level in the curcumin group was lower than in the control group (p<0.042). Similarly, the MDA level in the methylprednisolone group was lower than in the control group (p<0.001).
CONCLUSION
The results of the present study show that curcumin effectively protects the spinal cord tissues against oxidative damage.

BACKGROUND
Abdominal ultrasonography (US) is the most commonly used diagnostic tool for diagnosing acute appendicitis, which is one of the most common causes of acute surgical abdomen. In this study, we examined the reliability of US for diagnosing acute appendicitis.
METHODS
In this prospective study, we performed abdominal US on 235 patients admitted to our surgical emergency department during 2007 and diagnosed as acute surgical abdomen according to the physical examination and laboratory findings. These patients were surgically treated by appendectomy, and the materials were pathologically examined.
RESULTS
Two hundred thirty-five patients were admitted to this study. One hundred ninety-three of these patients (82.1%) were diagnosed as acute appendicitis, and 42 (17.9%) were diagnosed differently. One hundred thirty-three (88.67%) of 150 patients diagnosed as acute appendicitis on US examinations were also reported as acute appendicitis on histopathological examination. Sixty of 85 patients diagnosed differently on US examination were reported as acute appendicitis on histopathological examination.
CONCLUSION
The sensitivity of abdominal US for diagnosing acute appendicitis was determined as 69%. The specificity was calculated as 60%, positive predictive value as 0.89, negative predictive value as 0.30, and accuracy as 0.67. Abdominal US is a helpful diagnostic tool for diagnosing acute appendicitis. However, it should not be seen as superior to anamnesis and physical examination findings.

BACKGROUND
Doctors working in emergency services often fulfill the task of preparing judicial reports. For a number of reasons, these reports have undesirable mistakes that become problematic in subsequent judicial processes. This study aimed to evaluate the judicial reports that were prepared over a certain period at a university hospital with regard to any mistakes or deficiencies.
METHODS
The distribution of the judicial reports prepared between 01 June 2005 and 30 June 2009 in the emergency service of a University Research and Training Hospital was determined with respect to the types of cases, and their contents were studied for mistakes, deficiencies and legibility. Out of 3499 visits to the emergency service during the specified period, 3219 judicial reports that were accessible were considered in the evaluation.
RESULTS
It was determined that the most frequent types of cases were traffic accidents and injuries by sharp and penetrating instruments. Furthermore, many mistakes were made frequently regarding the presence of life-threatening conditions, and personal identification information and times of the event and examination were often incomplete.
CONCLUSION
The fact that the doctors largely failed to prepare precise reports and tended to write unsatisfactory reports even for cases with adequate information and findings was attributed to their insufficient training in this area. At the same time, mistakes in life-threatening situations and in treatment by using simple medical interventions stem from lack of training and sensibility. Pre- and post-graduate forensic medicine education must be considered highly important, and periodic on-the-job training must be organized, creating a better awareness among doctors regarding their legal responsibilities.

BACKGROUND
Necrotizing fasciitis is a rare but life-threatening soft-tissue infection primarily involving the superficial fascia and subcutaneous tissue.
METHODS
We conducted a retrospective study of 44 patients with necrotizing fasciitis between 2004 and 2008 in Akdeniz University Hospital, Department of Infectious Diseases and Clinical Microbiology and other departments. The aim of this study was to determine the causative agents of the necrotizing fasciitis, and the localization, predisposing factors, and comorbid conditions.
RESULTS
We found that diabetes mellitus, trauma and surgery were the most important predisposing factors. Moreover, the lower extremity and perianal region were the most frequently involved sites. Polymicrobial agents were the most frequent and the mortality was found as 25%.
CONCLUSION
In conclusion, necrotizing fasciitis cases followed in our hospital were evaluated in this study.

BACKGROUND
The number of patients applying to the emergency Plastic and Reconstructive Surgery outpatient clinic varies considerably depending on the sociocultural profiles of societies. Due to the abundance of anatomic regions comprising the targets of this field of specialization, plastic surgery is continuously gaining in importance in emergency traumatology.
METHODS
In this study, 10,732 patients admitted to the outpatient clinic of Emergency Plastic Surgery in Þiþli Etfal Training and Research Hospital were evaluated retrospectively regarding etiology, sex, age distribution, injury characteristics, and treatment.
RESULTS
While 64% of all patients had forearm and hand injuries, 28% had maxillofacial injuries, and 8% had tissue defects. There was a male: female ratio of 4: 1, and the mean age of all patients was 22.9 years. The mean age of patients (males 81%) admitted with upper extremity injuries was 22.3 years. Most of the upper extremity injuries were due to glassware cuts (33%). The mean age of patients admitted with maxillofacial trauma was 23.2 years. Among the patients with head-and-neck injuries, the most frequent cause of trauma was traffic accidents (38%).
CONCLUSION
Regarding the frequency and characteristics of the patients treated, we suggest that plastic surgery shows a progressively increasing significance and widening field of practice in emergency traumatology and, as no similar study currently exists, ours will contribute significantly to the literature.

BACKGROUND
We aimed in this study to investigate and compare the diagnostic and therapeutic methods in tracheobronchial injuries.
METHODS
Nine cases (7 male, 2 female) operated between 2003 and 2008 because of tracheobronchial injury were included in the study. The cause of tracheobronchial injury was trauma in 7 cases and postintubation laceration in 2 cases. The cases were evaluated in terms of age, sex, type of trauma, clinical findings, localization of injury, performed diagnostic and therapeutic methods, and results.
RESULTS
The causes of tracheobronchial laceration were blunt trauma in 6 cases, penetrating trauma in 1 case and iatrogenic (postintubation) in 2 cases. Lacerations were in the trachea in 5 cases and at the bronchial level in 4 cases. Operations included right upper bilobectomy in 1 case, tracheal resection and end to end anastomosis in 1 case, end to end anastomosis in 3 cases, and primary repair in 4 cases. One case died during the operation and 1 case died postoperatively.
CONCLUSION
In tracheobronchial injuries, early diagnosis and treatment are very important. The most useful method is bronchoscopy for determining the type and localization of the injury. In treatment, primary repair should be preferred over anatomical resections whenever possible.

BACKGROUND
Head traumas are among the most common causes of mortality and morbidity among young adults in urban areas. We aimed to contribute to the epidemiological database of our country with regard to head traumas.
METHODS
We retrospectively analyzed 954 patients older than 15 years with head trauma who were treated in the Neurosurgery Department of Samsun Mehmet Aydýn Education and Research Hospital between January 2003 and June 2008. Seven hundred twenty-one (75.5%) patients were male and 233 (24.5%) were female. Five hundred twenty-one (52.5%) were between 15-40 years old.
RESULTS
Traffic accident (75%) was the most common cause of head trauma. According to Glasgow Coma Score (GCS), 48% of the patients had mild (13-15), 31% moderate (9-12) and 21% severe (3-8) head injury. One hundred seventy-seven (18.5%) patients were operated. The commonest operations were performed for subdural and epidural hematomas. Mortality was 19.4% (185). Common causes of mortality were traffic accidents (77%) and gunshot injuries.
CONCLUSION
It is important to have local epidemiological studies and data about head traumas in order to prevent these traumas. In this study, the predominance of young men and the causes of trauma and mortality were similar to that reported in the related literature.

BACKGROUND
In this article, we aimed to discuss treatment strategies in fracture of the femoral head, which is a very rare injury.
METHODS
We reviewed five patients (six fractures) who admitted to our emergency department due to femoral head fracture between March 2006 and December 2007. Functional outcomes of the patients who were treated operatively and nonoperatively were compared.
RESULTS
Half of the fractures were treated nonoperatively and half of them surgically. We observed a rate of 50% excellent to good results. Avascular necrosis developed in a patient with bilateral injury. The functional results were poor for this patient. Early posttraumatic arthritis was observed in a patient who was treated surgically; this patient had moderate results.
CONCLUSION
We should aim at anatomic reduction of the fragments with minimum soft tissue injury. The best approach should be chosen for excellent view of the fragments. We should not forget that half of these patients will have a poor outcome despite all treatment strategies.

BACKGROUND
The aim of this study was to retrospectively evaluate our approach to the diagnosis and treatment of penile fracture.
METHODS
We retrospectively evaluated the results of 107 patients with penile fracture treated in our clinic between January 1990 and January 2009. Patient age, etiology of each fracture, history, physical examination results, radiologic findings, type of treatment, and postoperative complications were recorded. In 5 cases cavernosography was performed and in 8 cases retrograde urethrography.
RESULTS
The most common etiologies of penile fracture were coitus and manually bending the penis for detumescence. Diagnoses were made based on history and physical examination in 102 patients and cavernosography in 5 patients. In order to evaluate urethral injury in 8 cases, retrograde urethrography was performed. Rupture was repaired surgically in 101 patients, but 6 patients were treated conservatively. Among the 6 conservatively treated patients, 3 developed penile curvature 6 months post-treatment; no complications occurred in the surgically treated patients.
CONCLUSION
Cavernosography should be performed only when history and physical examination are insufficient for diagnosis, and retrograde urethrography should be performed when urethral injury is suspected. In order to prevent the development of penile curvature and to ensure rapid recovery, early surgical repair is advised.

BACKGROUND
The mortality rate following burn is an important outcome parameter. This study aimed to identify factors associated with mortality in adult hospitalized burn patients in Tehran, Iran.
METHODS
This cross-sectional study was performed during a one-year period in two referral burn centers in Tehran. During the study period, 1321 adult (>15 years) hospitalized burn patients were enrolled. Univariate and multivariate (logistic regression) analyses were performed to identify factors associated with mortality.
RESULTS
The mean age of the patients was 33.1±14.9 years. By far, the majority of burns were accidental (n=1076, 81.5%). Regarding the mechanism of burn, burn with petroleum products was the most frequent. Mean percent burned total body surface area (TBSA) was 39.9%±25.8%. The mortality rate was 33%. Sepsis was the most common cause of mortality. The results of the present study indicated that non work-related burns, burned TBSA and body surface area affected by second- or third-degree burns were independent determinants of mortality among adult hospitalized burn patients.
CONCLUSION
The present study showed a high mortality rate in the studied burn centers. Patients with identified risk factors should be categorized as high risk at the time of admission and need special attention and care during hospitalization.

BACKGROUND
The incidence of abdominal tuberculosis (TB) is increasing in western and developed countries. This pathology has several complications, including free intestinal perforation. The aim of this study was to analytically summarize all the pertinent literature discussing the various treatments for TB-related perforations.
METHODS
We reviewed the patient database of the Emergency Surgery Department of the Bologna University Hospital, checking the last 13 years. A retrospective review was conducted of all reported cases of intestinal perforation due to intestinal TB published through 3 March 2009.
RESULTS
119 cases of abdominal TB presenting with intestinal perforation were published. There are no standardized guidelines regarding the surgical treatment. Of the 119 reported cases, 40 (33.6%) were treated with resection and anastomosis, 17 (14.2%) with direct sutures, 4 (3.3%) with a simple drain, and in 57, the treatment was not reported.
CONCLUSION
No clinical evidence has been available for analysis to discern the optimal surgical strategy for treating intestinal perforations induced by TB. The direct closure of the perforation typically correlates with poor morbidity and mortality results. The better treatment seems to be the surgical resection of the perforated part with anastomosis. However, pharmacological therapy remains the essential pillar of treatment.

We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

Penetrating head and neck trauma with construction nails are uncommon life-threatening injuries and an important problem in developing countries. Assessment of the neurovascular and systemic physical status is a first requirement, and the decision concerning which surgical approach to perform for the removal of the nail is of critical importance. A 10-year-old girl was presented one hour after a fall injury with complaint of a swelling and foreign body lodgment on the left forehead. Neurological and systemic physical examinations were normal except for weak direct pupillary light reflex on the left side and the patient’s state of uneasiness. Radiological investigations showed that the head of the nail had entered from the left infra-orbital region and become lodged through the orbital roof, below the frontal bone. Surgical extraction of the nail in the operating room was performed successfully using left pterional craniotomy and lateral orbitotomy technique, and there was no complication after surgery. Here, we report a case with a rare craniocerebral penetrating wound and type, with the head of the nail lodged in the anterior fossa through the orbital roof, which may be defined as ‘reverse penetration of the nail’.

We present herein a case with a four-day history of fresh rectal bleeding due to leech bite. The cause was found to be a leech in the rectum by anoscope. This pathological condition is extremely rare in urban areas. Leech endoparasitism, although rare, may cause serious, even lethal, complications. Suspicion of leech infestation should be kept in mind when faced with intermittent or severe rectal bleeding in humans, and should be investigated surgically as with all other foreign bodies. In the current study, we present a patient who admitted with rectal bleeding due to leech bite. The leech was removed by hand examination (by forceps) without requiring any surgical attempt.

Our case is a male student which was dead because of traffic accident as passenger in October, 01, 2007. His heart was found to be lacerated and ruptured horizontally from atrio-ventricular region through all layer of the wall at autopsy. There were not any changes of skeletal system. Our case is considered as a rare and interesting case because there was no lesion on the bones, though the case was exposed to so massive trauma that cause rupture of heart from all layers.

Strongyloidiasis is a parasitosis caused by the female nematode of the Strongyloides stercoralis. S. stercoralis causes a chronic infection that is asymptomatic in 50% of chronically infected patients, and it can also affect the stomach. Gastric involvement causes symptoms mostly mimicking gastritis. We report herein a case of gastric perforation in a 37-year-old woman, which was thought to be caused by S. stercoralis.

Pneumomediastinum and subcutaneous emphysema are very rare reported signs of colonic perforation most often associated with diverticulitis, toxic megacolon and colonoscopy. We report a case of a 60-year-old man with subcutaneous emphysema and pneumomediastinum, which developed three days after a car accident without pneumothorax. A computed tomography scan demonstrated perforation of a sigmoid diverticulum in conjunction with air. A laparotomy was performed and revealed a perforated sigmoid diverticulum, fistulized into the retroperitoneal cavity. We suspect that this diverticular perforation was caused by the deterioration of the sigmoid mesocolon secondary to the blunt abdominal trauma. To our knowledge, this is the first report in the literature about pneumomediastinum and subcutaneous emphysema caused by sigmoid diverticular rupture following mesosigmoid trauma.