BACKGROUND: Losartan, a drug with antiinflammatory properties, has been shown to prevent ischemic injury in various organs. The purpose of the present study was to investigate the effects of losartan on ischemic skin flaps and on flap survival.
METHODS: A 3x9 cm dorsal flap was elevated in 24 Sprague-Dawley rats. Rats received the following treatment for seven days: Group I (n=8): 10 mg/kg losartan; Group II (n=8): 40 mg/kg losartan; and Group III (n=8): nonionized water. At the end of the seventh day, the viable flap areas were calculated, and histological analysis was conducted to count cells and capillaries in microscopic fields.
RESULTS: Mean flap survival was 61%, 56% and 60% in Groups I, II and III, respectively. Comparison of flap survival between groups did not yield any significant difference (p>0.05). Ischemic zones of the flaps in all groups demonstrated an increase in number of neutrophils, fibroblasts and capillaries (p<0.05), whereas no difference was seen in mast cells. The cell counts in the viable areas of the flaps showed a significant
decrease in fibroblasts in the group treated with 40 mg/kg losartan (p<0.05). The number of neutrophils, mast cells and capillaries was not influenced by treatment.
CONCLUSION: Losartan does not improve skin flap survival but it has a significant
antiproliferative effect on fibroblasts.

BACKGROUND: We aimed to investigate the effects of spinal immobilization devices on pulmonary functions.
METHODS: This study was a cross-over trial in healthy volunteer subjects; 60 volunteers were included. We performed a full spirometry in the supine position, and forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC were recorded in all subjects. Then, Philadelphia type cervical collar (Philly) and Kendrick extrication device (KED) were applied to all subjects. We measured FVC, FEV1, FEV1/FVC in all subjects in the supine position at the 5th and 30th minutes after application of cervical collar and KED. After a one-hour relaxation period, Philly
and long spinal backboard with straps were applied to all subjects. FVC, FEV1, FEV1/FVC were measured again in all subjects at the 5th and 30th minutes after application of
cervical collar and long spinal backboard.
RESULTS: After application of KED, baseline levels were compared with levels at the 5th and 30th minutes. Statistically significant decreases were determined in FEV1 (p=0.000) and FVC levels (p=0.000) after application of KED, but there were no significant differences in FEV1/FVC levels. After application of the long spinal backboard, a comparison of baseline levels and levels at the 5th and 30th minutes demonstrated statistically significant decreases in FEV1 (p=0.000) and FVC levels (p=0.000), but no significant difference in FEV1/FVC levels.
CONCLUSION: We determined that both KED and long spinal backboard cause a decrease in pulmonary functions.

BACKGROUND: Peritoneal adhesions cause significant long-term postoperative morbidity. This study evaluates the efficacy of agar plates as the physical barrier in reducing adhesion formation after abdominal surgery in an animal model.
METHODS: Adhesions were induced, by cecum abrasion, in 20 C57/BL6 mice during a laparotomy procedure. Agar plates were used in 10 mice as the experimental group. At a second operation, 28 days later, the adhesions were graded, in two groups. Data were analyzed by using Student t test.
RESULTS: There was no significant difference in weight gain of the two groups during the study period. A comparison of the morphological appearances of the adhesions demonstrated that there was no evident difference between the two groups. There was also no significant difference in the incidence ratio of adhesions or postoperative adhesion scores between the two groups (p value >0.05).
CONCLUSION: Despite the hydrogel properties of agar, it was not successful in practice in the reduction of adhesion formation after peritoneal surgery. Since agar is a biological product, it may cause a hyperreactivity induced by the innate immune system
in peritoneum. Therefore, agar does not appear to be useful in clinical practice for the reduction of adhesion formation after peritoneal surgery.

BACKGROUND: Our objective was to evaluate the accuracy of paramedicperformed
Focused Assessment with Sonography in Trauma (PFAST) for detection of free fluid in patients admitted to the Emergency Department (ED) following trauma.
METHODS: After four hours of didactic and four hours of hands-on training, four paramedics prospectively evaluated trauma patients. Our gold standard was the official radiologist reports of ultrasonography and computerized abdominal tomography (CAT). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were calculated and analyzed using SPSS 15.0 with χ2 testing.
RESULTS: One hundred and twenty-seven patients were evaluated by the paramedics. Fourteen patients had positive free fluid in the abdomen. Of these, 11 were corroborated by radiology reports and CAT (true positives), and three were found to be negative (false positives). In 113 cases, PFAST was negative for free fluid. Of these, 111 were determined not to have free fluid (true negatives), whereas free fluid was detected by CAT in 2 (false negatives). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were 84.62, 97.37, 32.15, 0.16, and 203.50, respectively.
CONCLUSION: Our study shows that paramedics can perform FAST in hospital EDs with a high degree of accuracy.

BACKGROUND: In this study, patients with hemothorax due to blunt or penetrating
thorax trauma and treated by tube thoracostomy were compared with the patients treated by videothoracoscopic surgery (VATS) in order to determine whether VATS
can be the first choice in treatment.
METHODS: Sixty patients with hemothorax due to trauma were examined prospectively. Thirty patients with isolated hemothorax and treated by tube thoracostomy were classified as Group I (50%), and 30 patients treated by VATS were classified as Group II (50%). Patients were compared according to healing duration, tube thoracostomy duration, hospitalization duration, success rate of treatment, morbidity, and mortality.
RESULTS: When Group I and II were compared according to the duration of tube thoracostomy and hospitalization, Group I was found to have longer duration statistically (p=0.001). When the two groups were compared according to morbidity, statistical morbidity was found higher in Group I (p=0.030).
CONCLUSION: VATS seems to be better in the treatment of hemothorax when compared with traditional drainage method because of its advantage of direct diagnosis and hemostasis by diagnostic thoracoscopy. If clotted blood is evacuated, empyema
and fibrothorax are preventable. In these cases, chest tube duration and hospital length of stay are shorter. Therefore, these patients can be discharged early.

BACKGROUND: The aim of this study was to evaluate the clinical results of a temporary fecal containment device (Flexi-Seal® FMS) in our burn center.
METHODS: All patients in whom temporary fecal containment devices were applied for perineal burns between August 2008 and August 2009 in our institution were reviewed. Demographics, etiology of burns, total body surface area (TBSA) burned, intensive care unit (ICU) need, early mortality, and post-application data were obtained from a prospectively designed database. In addition, some variables were investigated as potential risks factors for fecal leakage.
RESULTS: The mean age of patients (n=15) was 43.1±22.1 years, and 66.7% of the patients were male. The mean %TBSA burned was 40.7±16.6. Fecal leakage was seen in 6 patients. Local infection in the perineum was observed in 6 patients, including 4 of the 6 patients with fecal leakage. The mortality rate was 33% (5 deaths). All exitus patients had 50% or more TBSA burned. Electrical burn injury was found as a significant risk factor for fecal leakage in surviving patients (p<0.05). Autologous split-thickness grafting was performed in 8 patients without complication. The mean duration of catheterization was 22.5±5.7 days. Except for superficial mucosal erosion in the distal rectum in 2 cases, no complication was observed. The mean hospitalization time was 46.7±12.7 days.
CONCLUSION: If the safety of these devices is proven in further prospective, high-volume studies, they may reduce the necessity of diverting stoma operation in burn patients.

BACKGROUND: Mortality and morbidity in burn cases can be reduced with early diagnosis. Many markers are used for early diagnosis of burn complications like sepsis. In this current study, the relationship between numerical/morphologic granulocyte abnormalities and complications was investigated in pediatric burns. It was aimed to introduce histopathologic marker(s) for burn-related complications.
METHODS: Thirty-two pediatric burn cases hospitalized between December 2006 and December 2009 were included in the study. A total of 192 complete blood count and peripheral blood smear results were analyzed comparatively. Findings were used to identify any correlation among white blood cell count and peripheral blood smear changes (the appearance of immature granular cells, toxic granulation, purple granules
and Döhle bodies) and complications such as bacteriemia, sepsis, wound infections, severe anemia, and graft failure.
RESULTS: White blood cell count changes and the appearance of immature granular cells were not suitable for use as a diagnostic marker for complications. Nevertheless, there was a statistically significant correlation between the appearance of toxic granulation, purple granules and Döhle bodies and subsequent complications (p: <0.0001, 0.041, 0.001, respectively).
CONCLUSION: Toxic granulation, purple granules and Döhle bodies appear to be helpful in predicting burn-related complications. Therefore, peripheral blood smear is a suitable test for predicting future complications.

BACKGROUND: In this study, it was aimed to evaluate the demographic, medical and forensic aspects of patients who were bitten by cats or dogs and admitted to the Eskiþehir Osmangazi University, Education, Training and Research Hospital.
METHODS: All the medical records of the last five years inside the automation system of the hospital were investigated. One hundred sixty-seven cases were included according to their ICD-10 diagnostic codes. On statistical evaluation, frequency and chi-square analyses were conducted and SPSS 13.0 program was used.
RESULTS: One hundred sixteen patients were bitten by dogs, whereas 46 patients were bitten by cats. Most of the victims were children. 51.9% of the bites were on an upper extremity, and 29.1% were on a lower extremity. Although cat and dog bites demonstrate seasonal changes, summer months were found important, when children were on holidays. Hyperemia, scratch and laceration were the most frequent diagnoses after injury. The length of hospital stay was between 1-22 days and calculated as a mean 7.3±5.8 days.
CONCLUSION: Dog and cat bites are very well known public health issues in our country. To know animals and their needs and to respect them should be the priority of families to avoid unexpected injury. Families should teach their children to treat dogs and cats with respect, to avoid direct eye contact with the animals and not to annoy them.

BACKGROUND: Spinal canal remodeling results according to Magerl classification
and fracture localization after short- and long-segment posterior instrumentation treatment were evaluated in patients with thoracolumbar junction burst fracture.
METHODS: Eighty patients were divided into two groups: Group 1: short-segment posterior instrumentation was applied in 36 patients [9F, 27M; Median age: 42.1 (range: 19-65)] and Group 2: long-segment posterior instrumentation was applied in 44 patients [18F, 26M; Median age: 46.3 (range: 18-78)]. Twenty patients had T12, 41 patients had L1 and 19 patients had L2 fracture. According to Magerl classification, 44 patients were A3.1, 19 were A3.2 and 17 were A3.3. In both groups, spinal canal remodeling effectiveness was evaluated postoperatively with respect to all parameters.
RESULTS: Median follow-up time was 35.7 months for Group 1 (12-58) and 33.1 months for Group 2 (12-58). In both groups, spinal canal remodeling was statistically significant, but a higher recovery ratio was obtained in Group 2 in comparison to Group 1. According to Magerl classification, in type A3.3 fractures, a more significant remodeling was obtained in Group 2 patients (p=0.005). A significant difference was determined in Group
2 at the T12 level according to fracture localization (p=0.018).
CONCLUSION: An adequate spinal canal remodeling is obtained by posterior instrumentation, but in comminuted fractures like Magerl type A3.3, a better remodeling can be obtained by long-segment posterior instrumentation.

BACKGROUND: We characterize in this report the mechanism and type of skull fracture in urban populations of Iran.
METHODS: Data including the general characteristics, mechanism of trauma, abbreviated injury scale, Glasgow coma scale, duration of hospitalization, and outcome of trauma patients registered from 1999 to 2004 were extracted from the Iranian National Trauma Registry database.
RESULTS: Of 16,321 registered trauma patients, 1704 cases with skull fracture were found. The most common mechanism of trauma was motor-vehicle crash (MVC) (62.5%) followed by fall (23.8%). The majority of traffic victims were pedestrians (41.6%). Skull fracture was more likely to be seen in men (78.6%), with a mean age of 27.2 ± 17.7 years. In MVCs, skull base fracture was observed in 51.2% and vault fracture in 48.8% of patients. A significant difference was found in sex distribution between skull base and vault fracture (p=0.002). MVC was the mechanism of injury in 67.4% of skull base fracture cases compared to 58.1% of vault fracture cases (p<0.001).
CONCLUSION: Safety legislations and risk-specific intervention programs should be improved considerably in Iran.

BACKGROUND: Shotgun injuries of the extremities create challenging problems for vascular surgeons. In this study, we retrospectively analyzed surgical results without preoperative angiography.
METHODS: Forty-nine patients with shotgun wounds who underwent vascular reconstruction in the extremities from 1999 to 2004 were retrospectively reviewed.
RESULTS: Vascular reconstruction of the extremities after shotgun injury differs from that following injuries caused by other firearms because of extensive tissue damage. In 19 patients, function of the extremity was unsatisfactory after one year; in 12 of them functional deficit was extreme, which was thought to be the result of nerve injury. After several interventions, 25 of 49 patients are well after one year under a rehabilitation program.
CONCLUSION: Based on these results, we favor immediate operative exploration of the extremities in patients with hard signs of vascular trauma, thereby minimizing the ischemic interval, and we recommend angiography only for elective operations. Early fasciotomy should be done without hesitation in patients with long ischemic periods and in those with combined arterial/venous injury.

BACKGROUND: We aimed to compare two (plate-screws and locked intramedullary
nail) biological internal fixation techniques in the treatment of adult femur shaft fractures.
METHODS: Group I included 28 patients operated with biological internal fixation with plate and screws. Group II consisted of 31 patients operated with locked intramedullary nailing technique. During the follow-up period in Group I, 1 patient died and 3 patients dropped out of the study, so the results of 24 patients were evaluated. During the follow-up period in Group II, 2 patients died and 3 patients dropped out of the study, so the results of 26 patients were evaluated in this group.
RESULTS: Age, sex, injury mechanism, fracture type, time to operation, duration of operation, amount of bleeding, fluoroscopy usage time, early and late complications, duration of hospitalization, fracture union time, and functional results of all patients were comparatively evaluated.
CONCLUSION: According to our results, no superiority of either technique was demonstrated with respect to fracture union time, complication rate and functional results. Biological internal fixation with plate and screws is an alternative technique to
locked intramedullary nailing in patients with multi-trauma or compromised pulmonary or cardiac function, or in complex comminuted or segmented diaphyseal or metaphyseal
fractures.

BACKGROUND: The aim of this study was to contribute to the epidemiological database of our country about pediatric head injuries.
METHODS: We retrospectively analyzed 851 patients younger than 14 years old with head injury, treated in the Neurosurgery Department of Samsun Mehmet Aydýn Education and Research Hospital between January 2003 and June 2008.
RESULTS: Five hundred and fifty (65%) patients were male and 301 (35%) were female. Falls (70%) were the most common cause of head injury. According to Glasgow Coma Score (GCS), 74% of patients had mild (13-15), 22% moderate (9-12) and 4% severe (3-8) head injury. Eighty-seven (10.5%) patients were operated. The commonest operations were performed for depressed fractures and epidural hematomas. The mortality rate was 3.8% (33). Common causes of mortality were traffic accidents and falls from heights.
CONCLUSION: Other reported studies and this study show that the majority of pediatric head injuries occur as a result of preventable causes. It is important to have local epidemiological studies and data about head injuries in order to prevent these traumas before their occurrence.

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed
two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

With the development of microsurgery, successfully replanted cases of scalp avulsions have been reported. In spite of previous publications of replantations based on a single artery and vein, it is now accepted that multiple anastomoses increase the success rate. We present herein the case of a successfully replanted avulsion in a child who caught her hair in a go-kart motor belt, and we discuss the mechanism of injury and number of anastomoses.

Soccer (football) is a popular sport worldwide and can result in severe abdominal injuries. Nevertheless, the necessity of surgical intervention for abdominal organ injuries has been reported rarely. We report a case who was injured during a soccer game who underwent abdominal surgery. Distal subtotal pancreatectomy, splenectomy, cholecystectomy, and choledochotomy + T-tube drainage were performed. He was discharged on the postoperative seventh day without any complication.

Delayed acute abdominal compartment syndrome (ACS) due to retroperitoneal bleeding is rare. Herein, we report the clinical management of such a rare case. A 46-year-old male who fell from a height of 12 meters was admitted to Al-Ain Hospital. He was hemodynamically stable. His abdomen was soft and not distended. Abdominal computed tomography (CT) was normal on admission. On day 7, the patient tolerated enteral feeding. On day 15, he became suddenly hypotensive. CT of the abdomen showed a large retroperitoneal hematoma compressing the inferior vena cava (IVC) associated
with contrast blush indicating active bleeding. The abdomen became distended and tense. The patient developed respiratory failure and severe acidosis, increased airway
pressure and reduced urine output. A clinical diagnosis of ACS was made. There was dramatic improvement in the hemodynamic and respiratory function directly after laparotomy. Exploration of the retroperitoneal hematoma showed an actively bleeding ligated ileocolic vessel. The abdomen was temporarily closed using saline IV bags sandwiched between two layers of Steri-Drape. The abdomen was closed primarily on day 6. The patient was discharged home on day 50. Life-threatening delayed retroperitoneal bleeding may occur suddenly two weeks after trauma causing ACS.

Because the cases of post-traumatic cerebral infarction in children are uncommon, little research has been done on this subject. The case of a 14-month-old child who had cerebral infarction after mild head injury is discussed. He fell from a height of approximately 70 cm 12 hours before. He did not use his left arm after the injury. His parents took him to the public hospital, where he was investigated in terms of mechanical complication and was observed for six hours, but no computed tomography (CT) scan was performed at that time. The patient was then presented to our department by his parents. He was not able to walk and was sitting. His neurological examination revealed right hemihypoesthesia, hemiparesis and mild left facial paresis. CT showed a hypodense region in the right basal ganglia location. The right lateral ventricle seemed mildly compressed due to edematous changes. The magnetic resonance imaging revealed hyperintense signal changes that affected the right lentiform nucleus and the head of the caudate nucleus. The aim of the case is to remind emergency physicians that post-traumatic ischemic stroke is uncommon but may be
the cause of disability in pediatric patients, and a systematic physical examination must be performed in all ages even if the patients appear quite well.

Pseudomeningocele is cerebrospinal fluid collection in an extradural area after meningeal tear. The size of the defect in the dura-arachnoid, the pressure of spinal fluid, and the
resistance of the soft tissue presumably determine the size of the pseudocyst. The main symptoms are often: headache, neck pain and myelopathic and radicular signs. Pseudomeningocele is diagnosed by myelography, sonography, computed tomography, and magnetic resonance imaging. We present a case of intraoperative identification nerve root
entrapment by pseudomeningocele cyst and postoperative recovery of a patient’s neurologic deficit.