BACKGROUND
We evaluated the applicability of urinary N-acetyl-beta-D glucosaminidase (NAG) levels in the diagnosis and follow-up in blunt kidney injury.
METHODS
Twenty Sprague-Dawley rats were studied. In the Sham group, left kidney exploration was made. In the Trauma group, after left kidney exploration, a 20 g weight was dropped onto the kidneys. Urine was collected for analysis with strip and determination of urinary NAG and creatinine (Cr) levels at baseline and 0-6, 12-24, 24-36 and 36-48 postoperative hours. Mann-Whitney U and Kruskal-Wallis tests were used.
RESULTS
Macroscopic examinations of traumatized kidneys revealed grade II and III injury, and histopathological examinations showed relevant changes. Macroscopic hematuria was observed in all traumatized rats. Urinary NAG/Cr levels in the Trauma group were found to be significantly higher than their base levels at 0-6, 12-24, 24-36, and 36-48 hours. In the Sham group, only the level of NAG/Cr at 0-6 hours was significantly higher. The increase in NAG/Cr levels at 0-6 hours was significantly higher in the Trauma group than in the Sham group.
CONCLUSION
After isolated blunt renal trauma, urinary NAG levels increase in the early stage. However, more detailed clinical studies are needed to develop NAG levels as a criterion in the follow-up of blunt renal trauma.

BACKGROUND
In the current study, we aimed to investigate the influences of pentoxifylline, which increases the flexibility, deformability and viscosity of the erythrocytes while reducing the aggregation abilities of the platelets, and vinpocetine, which has neuroprotective and antioxidant effects, on healing of colonic anastomoses.
METHODS
We used 30 Albino Wistar rats. Subjects were divided into three groups of 10 rats each. Colonic ischemia was established in all the groups. Following colonic transection, anastomosis was performed. Group A received intraperitoneal saline, whereas Group B and Group C received pentoxifylline and vinpocetine, respectively. The subjects were sacrificed on the postoperative 5th day by ether anesthesia, and their colonic bursting pressures were measured. The anastomotic area was excised for hydroxyproline assay and histopathologic examination.
RESULTS
According to intergroup comparisons, colonic bursting pressure was found to be higher in the treatment groups than in the control group; however, the difference was not statistically significant. Intergroup comparisons regarding tissue hydroxyproline levels showed statistically significant differences between Groups A and B, Groups A and C and Groups B and C.
CONCLUSION
Similar to pentoxifylline, vinpocetine was also shown to have a beneficial effect over ischemic colon anastomoses.

BACKGROUND
The concept of Focused Assessment with Ultrasound for Trauma (FAST), which was introduced by Rozycki et al. in 1996, has started a new era in the management of trauma patients. Today, Advanced Trauma Life Support (ATLS) suggests bedside ultrasonography (USG) evaluation of trauma patients. We aimed to investigate the usability and the reliability of handheld ultrasound (Vscan) in determining free fluid during the initial evaluation of trauma patients.
METHODS
This was a multi-center, prospective study involving multiple trauma patients who presented to three hospital emergency departments (EDs). FAST was completed using Vscan by an emergency physician and an abdominal USG was performed by a radiologist on all patients. Results of Vscan, abdominal USG and other radiological studies, if performed, were compared.
RESULTS
A total of 216 patients were included in the study. Of those, 203 had negative Vscan results, while 13 had positive results. When USG performed by a radiologist was considered as the gold standard, Vscan sensitivity for FAST was 88.9%, specificity was 97.6%, negative predictive value was 99.5%, and positive predictive value was 61.5% in our study.
CONCLUSION
Vscan, as the smallest portable imaging device, seems to have a promising future as an indispensable gadget, equal to stethoscopes, in evaluating trauma and other critical patients.

BACKGROUND
Traumatic abdominal wall hernia (TAWH) is uncommonly encountered despite the high prevalence of blunt abdominal trauma. The diagnosis is often difficult because of its varied presentation along with lack of awareness of this entity.
METHODS
The case files of all patients with TAWH who were operated at our hospital were retrospectively reviewed and analyzed.
RESULTS
A total of 11 patients with TAWH were analyzed (8 males, 3 females). The clinical presentation was varied, with a palpable defect and a reducible swelling (6 patients), localized area of irreducible swelling (3 patients), surgical emphysema (2 patients), and cellulitis/abscess formation (2 patients). All of these patients were operated within 24 hours of hospital admission. Except for the 3 patients who presented late, there was a favorable outcome in all the others. The cause of mortality was septicemia, possibly due to incarceration of bowel in the defect leading to strangulation and perforation.
CONCLUSION
TAWH, although uncommon, is associated with significant morbidity and mortality when there is a delay in diagnosis and intervention. Early intervention leads to a significantly better outcome.

BACKGROUND
Nitroglycerine (NTG) has analgesic properties. The aim of the present study was to assess the analgesic effect of three different doses of NTG (200 µg, 300 µg and 400 µg) when added to lidocaine in intravenous regional anesthesia (IVRA) in trauma patients.
METHODS
One hundred patients undergoing hand surgery were randomly allocated to four groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL in the control group (Group LS, n = 25) or 200, 300, 400 µg NTG plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL in the NTG group (Groups LN1, LN2, LN3 respectively; n = 25 in each group). Before and after the tourniquet application, hemodynamic variables, tourniquet pain, sedation, and analgesic use were recorded.
RESULTS
Sensory and motor block onset times were significantly shorter in the LN3 group compared with Groups LN1, LN2, and LS (p<0.05). Sensory and motor block recovery times were statistically prolonged in the LN3 group when compared with Groups LN1 and LS (p<0.05). Postoperative visual analogue scale (VAS) scores were significantly lower at 2, 4, 8, 12, and 24 hours after tourniquet release in Group LN3 compared with Group LS (p<0.05).
CONCLUSION
The addition of 400 µg NTG to lidocaine in IVRA shortens the onset of sensory and motor block in trauma patients and improves the quality of anesthesia and perioperative analgesia better than the addition of 200 µg or 300 µg NTG, without causing side effects.

BACKGROUND
We reviewed cases with Lisfranc injuries who presented to our center in order to study the adequacy of the treatment method and their final functional outcome.
METHODS
This is a retrospective review of 34 cases diagnosed with Lisfranc injuries treated at our center from 2000 to 2006. This review is aimed to determine the demography and functional outcome of all patients with Lisfranc injury treated during this period.
RESULTS
The injury was classified based on the "Hardcastle and Associates Classification". In our review, we found that the commonest Lisfranc injury was type B2 (41%). These injuries are mostly fixed with K-wires (76.5%). All patients assessed with Bristol Foot Score (BFS) had a good score in all categories, with a total score ranging from 16 to 25.
CONCLUSION
We concluded that all Lisfranc injuries, whether treated with closed or open fixation methods, demonstrated a good long-term functional outcome.

BACKGROUND
Traumatic brain injury is a major public health problem due to high mortality and morbidity among survivors.
METHODS
We performed a retrospective cohort study of patients with severe traumatic brain injury. We recorded the attending physician’s evaluation of the patient’s consciousness, the patient’s demographics, routine physical measurements, and medical interventions. We used Glasgow Coma Scale and Extended Glasgow Outcome Scale.
RESULTS
We included 60 patients (83.3% males, mean age: 49.5 years). The Glasgow Coma Scale score was 4.8±1.9 and the Extended Glasgow Outcome Scale score was 2.9±2.5 points. Linear regression for higher Extended Glasgow Outcome Scale score explained 59.8% of the variance and revealed the duration of hospital stay and the presence of epidural hematoma as significant predictors. The classification tree for the higher Extended Glasgow Outcome Scale score revealed the following variables to be important: the duration of hospital stay, Glasgow Coma Scale score, partial pressure of carbon dioxide, surgery, response time of out-of-hospital emergency team, systolic and diastolic blood pressure, fall, and basis fracture.
CONCLUSION
Standardized inpatient protocol on monitoring, intervention and outcome recording should be adopted to make future comparisons more useful and to promote benchmarking between trauma centers in order to improve care for patients with severe traumatic brain injury.

BACKGROUND
We present 11 cases with esophageal perforations who were treated in our department, with the intent of underlining the importance of surgical intervention.
METHODS
We retrospectively analyzed 11 cases of esophageal perforation who were treated from 2005 to 2010. The cases diagnosed within the first 24 hours were regarded as early diagnoses; those diagnosed later than this period were regarded as late diagnoses.
RESULTS
The mean age of the patients was 45.8 years. Following the perforation, 3 of the patients had early diagnoses and the others had late diagnoses. Of the 3 cases with early diagnosis, all had primary repair; of the late diagnosis cases, 4 had primary repair, 2 had colonic interposition, 1 had stent implantation, and 1 received medical treatment. All the cases with late diagnoses underwent drainage. The 3 cases who received early treatment recovered without complications. Of the other 8 cases, 1 had leakage from the anastomosis and 1 developed a fistula. Two (18.1%) of our patients died.
CONCLUSION
Treatments performed before the development of mediastinitis are lifesaving in esophageal perforation patients. We think that surgical treatment performed within the first 72 hours that includes primary repair would yield favorable results.

BACKGROUND
Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Trauma Injury Severity Score (TRISS) are physiological and anatomical severity scores to predict trauma outcome. Nutritional Risk Screening (NRS-2002) is used for the screening of nutritional risk, which can affect outcome adversely. The objective of this study was to determine the reliability of these scales to predict disease severity, complications and mortality, and to compare the reliability of the NRS-2002 in predicting outcome with different scoring systems in trauma–intensive care unit (ICU) patients.
METHODS
The study enrolled 100 consecutive patients who were admitted to the ICU in a training hospital due to trauma in the six-month study period (1 July 2008 and 1 January 2009). Discrimination characteristics of the scoring systems were evaluated using receiver operating characteristic (ROC) curves.
RESULTS
Overall mortality was 14%, and the complication rate was 22%. Nutritional risk at admission was found to be increased in 58% of the patients. The NRS-2002 score was increased in patients with complication. ISS, TRISS and APACHE II at admission had a reliable power of discrimination (AUC>0.8) for mortality and complication prediction. The NRS-2002 score had moderate discrimination power for complication prediction (AUC=0.708) but showed high correlation with increased length of stay (LOS).
CONCLUSION
A significant percent of trauma patients are at nutritional risk. The NRS-2002 score can be useful in predicting complication and prolonged LOS in trauma patients.

BACKGROUND
This paper attempts to see if simple blood test results can predict the state of an emergency aneurysm as being non-ruptured, contained leak or free rupture.
METHODS
Ninety-three patients who presented to our emergency room and were operated for abdominal aortic aneurysm (AAA) between January 1999 and March 2009 were evaluated retrospectively. Cases were classified as: chronic contained rupture (Group I), impending rupture (Group II), dissecting rupture (Group III), and free rupture (Group IV).
RESULTS
Chronic contained rupture was determined in 15 (16.1%), impending rupture in 31 (33.3%), dissecting rupture in 14 (15.1%), and true (free) rupture in 27 (29%) cases. Aortocaval fistula was present in 3 (3.2%) patients, aortoenteric fistula in 2 (2.2%) and aorto biliary fistula in 1 (1.1%). Group IV was significantly different from Groups I, II and III with regard to hematocrit levels, white blood cell counts, neutrophils and lymphocyte rates, bicarbonate levels, and mortality rates.
CONCLUSION
To avoid a delay in diagnosis, it is important to know the different presentations of emergency AAA. In the emergency room, simple laboratory parameters may be highly directive in suspicion of ruptured AAA.

BACKGROUND
We aimed to present the demographic and epidemiologic data on spinal cord injury (SCI) patients who were rehabilitated at our hospital, to identify high-risk groups and etiological factors, and to evaluate the factors that affect the duration of hospitalization (DOH).
METHODS
Data on 905 SCI patients treated on an inpatient basis between December 2000 and June 2007 at our hospital were retrospectively evaluated. Patient age, sex, etiology of injury, DOH, neurologic level, and functional grouping were analyzed. Additionally, the effects of age and sex on DOH were evaluated.
RESULTS
In total, 661 (73%) of the patients were male and 244 (27%) were female. The mean age of the patients was 33.4±15.0 years; 51.27% of the patients were 20-33 years of age. The mean DOH was 73.6±49.8 days. In all, 304 (33.5%) of the patients were tetraplegic and 601 (66.5%) were paraplegic. Motor vehicle collisions were the most common cause of injury (n=318, 35.1%), followed by falls from an elevated height (n=170, 18.8%). DOH was significantly higher among the tetraplegia American Spinal Injury Association (ASIA) A-B patients than among the other patients (p<0.01).
CONCLUSION
It is clear that most of the SCIs we observed were preventable. Comprehensive identification of the epidemiologic, demographic and pathologic features of SCIs contributes to identifying high-risk groups, thereby making it possible to pay personal and communal attention to precautions for SCIs.

BACKGROUND
In patients aged 1-34 years, injury is the leading cause of mortality, disability and health care costs. Two to 3% of Level I trauma patients have peripheral nerve injury (PNI).
METHODS
Data were collected from the Iran National Trauma Registry database, compiled according to the International Classification of Diseases, 9th revision (ICD9) codes, from August 1999 to February 2004. The information included demography, mechanism, levels and regions of PNI, associated injuries, Abbreviated Injury Scale, duration of hospital stay, and costs.
RESULTS
Of 16,753 patients, 219 (1.3%) had PNI; 182 (83.1%) were male. The mean age of the patients with PNI was lower than of those without nerve injury (28.6±14.45 vs. 33±21.08 years; p<0.001). The most common cause of PNI was direct laceration from a sharp object (61%) followed by road traffic crashes (22%). Penetrating trauma was more common than non-penetrating injuries (5.6% vs. 0.4%, p<0.001). The most frequent PNI location was from the elbow to the hand (10%). The ulnar nerve was the most commonly injured nerve. The most common area of ulnar nerve injury was at the forearm (15.3%).
CONCLUSION
Sharp laceration and road traffic crash have the highest rates of PNI, which are more common in young males. Open wounds from the elbow to the hand should raise suspicion of PNI in triage. Although injuries leading to PNI are rare, their outcomes and disabilities require further research.

BACKGROUND
A common consent regarding repair indications, timing of repair and choice of reconstruction materials for isolated orbital base fractures does not yet exist.
METHODS
We retrospectively reviewed our patients (41 male, 13 female) who were operated due to a diagnosis of isolated orbital floor fracture between 2002 and 2010.
RESULTS
Fifty-four patients diagnosed with isolated orbital base fracture were found; 49 of 54 patients required surgery. The indications for surgery were restricted ocular motility and marked enophthalmos in 20.4% of the patients, whereas in 79.6%, surgical intervention was decided largely based on the coronal computed tomography images. 36.7% of the cases were operated earliest, in the first 16 hours, and 10.2% were operated the latest, in 72-96 hours. Ultra-thin porous polyethylene was used in the orbital base repair. Twelve patients contacted for this study were evaluated. Enophthalmia and exophthalmia were in normal limits in patients, and none of the patients displayed ectropion or scleral show findings or reported any complaints related to scar formation.
CONCLUSION
When not treated in a timely manner and with appropriate materials, orbital base fractures might result in enophthalmia and diplopia. We believe that a good prognosis of orbital base fractures relies on the right decision for surgical indication, early surgical intervention, and repair with appropriate material.

Torsion of the omentum is a rare pathology that was described 100 years ago. The characteristic appearance of omental torsion and a review of the literature are presented with respect to a case of primary omental torsion that was causing acute abdomen. Excision of the ischemic omentum is the proper treatment for omental torsion.

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.

Liquefied petroleum gas (LPG) is an odorless and colorless gas that is a mixture of hydrocarbons (propane and butane). It is now more commonly preferred among drivers as an autogas throughout the world because it is cheaper than petrol or diesel and produces the same amount of energy. Because of its rapid vaporization and consequent lowering of temperature, it may cause severe cold injuries. A 33-year-old male who suffered from hand burn due to LPG is presented in this article. In LPG-converted cars, if the conversion has not been done properly, LPG may leak. Thus, the public must be informed of this potential danger while undertaking repairs of their vehicles.

Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases.

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, and in the majority of cases it remains asymptomatic. The total lifetime rate of complications is 4%. It is an uncommon cause of intestinal obstruction in adults. Loop formation of Meckel’s diverticulum leading to small bowel obstruction is an extremely rare event. We report two such cases in which the bowel became obstructed and strangulated in a loop formed by adhesion of the distal end of the Meckel’s diverticulum to the proximal ileum and mesentery.

A 30-year-old male presented with sudden diminution of vision, orbital pain, diplopia, and swelling of the eyelid of the right eye after blowing his nose within three days after a blunt ocular trauma. His best-corrected visual acuities were 6/10 in the right eye and 10/10 in the left eye. Anterior segment and fundus examination were normal bilaterally. Limitation of upward ocular motility was noticed in the right eye. Diplopia was detected in both upward and downward motilities. Intraocular pressures were 21 mmHg in OD and 16 mmHg in OS. Hertel exophthalmometry measurements were 21 mm for the right eye and 19 mm for the left eye. The direct computerized tomography image displayed the inferior orbital wall fracture and orbital emphysema in the right orbit. Prophylactic antibiotherapy was applied. The patient was advised not to blow his nose. He had no complaints on the third day after the trauma. Follow-up examinations showed no ophthalmological complications.