EXPERIMENTAL STUDY | |
1. | The effect of carbondioxide pneumoperitoneum on the severity peritonitis Ali Uzunköy, İlyas Özardalı, Hakim Çelik, Mehmet Demirci PMID: 22792814 doi: 10.5505/tjtes.2012.53503 Pages 99 - 104 Background: There are still some suspects regarding the reliability of laparoscopic interventions in the presence of generalized peritonitis. The aim of the present experimental study was to investigate the effects of carbondioxyde pneumoperitoneum on inflammatory response and peritonitis severity score in experimental peritonitis. Methods: Twenty-one Wistar Albino rats were taken under the study. The rats were distributed into tree group; the control group (group 1, n=7), the bacterial peritonitis-induced group (group 2, n=7) and peritonitis + carbondioxide pneumoperitoneum-induced group (group 3, n=7). In group two and three, peritonitis was induced by intraperitoneally injected Escherishia coli. In group three, pneumoperitoneum was induced by giving CO2 insufflations. The rats were sacrificed after 24 hours. Five cc of blood was sampled and peritoneum tissue excised from the abdominal region of the rats. Peritonitis severity score, C-reactive protein level and white blood cell count were assessed in all groups. Results: Peritonitis severity score, C- reactive protein level and white blood cell count were significantly higher in group 2 and 3 than group 1 (both, p<0.05), while significantly lower in group 3 than group 2 (p<0.05). Conclusion: The results of this study shown that carbondioxyde pneumoperitoneum decreases the peritonitis severity and systemic inflammatory response in experiments with Escherishia coli peritonitis and sepsis. |
ORIGINAL ARTICLE | |
2. | Epidemiologic Evaluation of Patients with Major Burns and Recommendations for Fighting with Burns İlhan Çiftci, Kemal Arslan, Zeynep Altunbaş, Fatih Kara, Hüseyin Yılmaz PMID: 22792815 doi: 10.5505/tjtes.2012.45538 Pages 105 - 110 Objective: Burns are an important health problem in our country and in the world. In our study, we aimed to epidemiologically analyze the patients who were hospitalized in the burn unit serving 3 million individuals in Middle Anatolia. Material and Method: Records of 457 patients who had been hospitalized in burn unit between 2008-2010 were retrospectively analyzed. Patients were asseseed in terms of gender, age, burn area, burn depth, admission time to the health center, burn region, factors causing burns. Results: Majority (44.6%) of the patients was in 0-5 age group. Burn surface area was detected as 11.6±8.5%. Patients had reached health center in 252.8±892.5 minutes. While 82.7% of the patients had 2. degree of burns, 17.3% had 3. degree of burns. Most burns were on extremities (39.6%). The most common burn agent was scalds with hot liquids (54.1%). Conclusion: In our study, children in 0-5 age group was found to be the most commonly affected group from indoor burns. Basic factor for this is children’s spending more time in the house and being more active. Scalding burns may be prevented by taking care when using hot liquids that may lead to indoor burns. Informing parents is of first priority for this issue. |
3. | Clinical, radiological and bronchoscopic evaluation of inhalation injury cases treated at the burn center Sevda Şener Cömert, Hakan Acar, Coşkun Doğan, Benan Çağlayan, Ali Fidan PMID: 22792816 doi: 10.5505/tjtes.2012.99233 Pages 111 - 117 Aim: To introduce inhalation injury,pulmonary complications and mortality related factors on the basis of clinical,radiological and bronchoscopic findings at patients with inhalation burns.Material-method: Between January2009-January2010,patients hospitalized at intensive care unit of burn center,who were diagnosed as inhalation burn and bronchoscopy was performed were included.Demographic findings,burn type,burn percentage,clinical-laboratory features,chest x-ray findings on the first and fifth day,bronchoscopic lesions were obtained from files.Bronchoscopic findings were classified,bronchoscopic score for each patient was calculated.Clinical,laboratory,radiological findings,length of stay at intensive care unit,bronchoscopic score of patients who were discharged and were exitus were compared with each other and mortality related factors were investigated.Results: 29patients with mean age of 40.1±3.4were included.Radiological abnormalities were found at 41.3% and 65.5% of patients at first day and fifth day of hospitalization,respectively.There were no complications related to bronchoscopy. Percentage of burn and duration of stay in intensive care were higher at patients who were died than discharged patients;(%20.4-%48.5,p=0.003)(mean: 7.0-13.7days,p=0.037),respectively.Patients who were died showed 79.1% radiological abnormality and 50% ARDS on fifth day of hospitalization.There were no pathologic findings on chest x-ray and ARDS wasn’t observed on fifth day at patients who were discharegd(p<0.05).Conclusion: Inhalation burns existing in patients with cutaneous burns, causes high percentage of pulmonary complications and increases mortality.Bronchoscopy has to be performed early for diagnosis and close follow-up of these patients is necessary. |
4. | Eye injuries at a tertiary health centre in West Black Sea region, Turkey Atilla Alpay, Özlem Özcan, Sılay Cantürk Uğurbaş, Suat Hayri Uğurbaş PMID: 22792817 doi: 10.5505/tjtes.2012.94803 Pages 118 - 124 Background: To investigate clinical aspects, the visual prognosis in eye injury and to constitute datum to national statistics, in the West Black Sea Region, in Turkey Methods: A retrospective analysis of 281 eye trauma cases admitted to the emergency department of Zonguldak Karaelmas University Hospital between 2001 and 2010 was performed. Results: A majority of eye injuries (42.7%) affected individuals between the ages of 30 and 50 years. The most frequent cause of injury was wooden objects in rural areas. The most frequent cause of injury was work site injuries in males between the ages of 30 and 50 years. Corneal-scleral lacerations were found to be the most serious injuries with regard to initial and final visual acuities. Conclusion: Eye injuries are still the most common and preventable cause of blindness. Simple precautions and public education might prevent this health problem which causes loss of labor force, economic loss and psychological problems. One of the basic precautions would be raising public awareness on wearing seat belt inside the car and protective eyeglasses at the work site and while working in rural areas. |
5. | Effecting Factors of Outcome in Head Injury Serkan Akyel, Osman Şimşek, Necdet Süt PMID: 22792818 doi: 10.5505/tjtes.2012.37928 Pages 125 - 132 BACKGROUND In this study, the data that can be obtained from our patient record system is investigated to effect on the outcome in the adult head injured patients. METHODS The records of 356 adult head injured patients hospitalized in Trakya University Hospital, Department of Neurosurgery and Intensive Care Unit have been examined. Result of the obtained data has been analyzed by statistically. RESULTS Age (p=0.012), using airway tube (p<0.001), values of GCS was detected on injury side and Emergency Unit (p<0.001), clustered systolic and diastolic TA values (p<0.001, accompanied by chest (p=0.001) and abdominal (p=0.041), injury, anisocoria (p=0.001), pupillary ligth responce (p<0.001), intracranial radiologic findings such as; SDH (p<0.001), brain contusion (p=0.006), traumatic SAH (p<0.001), traumatic ICH (p=0.005) and brain edema (p<0.001), doing surgical procedure (p<0.001) and presence of nosocomial infection (p<0.001) make significant differences on the outcome were found. CONCLUSION Main aim must be reducing the formation of an accident at reducing of death due to head injuries; additionally, emergency and hospital care facilities should be developed injury cases. |
6. | Evaluation of urogenital injuries in patients with trauma at the emergency department Fatih Büyükcam, Jale Şen, Şenay Akpınar, Yılmaz Zengin, Mustafa Çalık, Öner Odabaş PMID: 22792819 doi: 10.5505/tjtes.2012.48403 Pages 133 - 140 Background: The aim of this study is to investigate the characteristics of the patients admitted to the emergency department with the urogenital system trauma and the factors effecting mortality and mortality. Methods: In this prospective, cross-sectional descriptive study, the demographic characteristics, trauma types, laboratory and radiologic results, hospitalization states and the outcome of the patients with urogenital trauma were investigated. Results: A total of 153 patients with major trauma were included in this study. 108 (%70.6) of them were male. 23 (%15.03) of them were penetrating trauma and 130 (%84.96) of them were blunt trauma. 79 of them were presented with motor vehicle accidents, 42 of them were falls, 10 of them were gunshot wounds, 10 of them were stab wounds. There were pelvic fractures at 60 patients, renal injuries at 35 patients, bladder injuries at 4 patients. 21 of the patients underwent surgery for any reason and 17 patients dead. There was a significant relationship between hematuria and renal injury. Conclusion: The urogenital injuries are frequently seen with other system injuries and deaths generally occur due to other system injuries. The timely identification and management of genitourinary injuries with a deep clinical evaluation is important for preventing deaths due to urogenital region trauma. |
7. | Skeletal injuries following unintentional fall from height Divesh Gulati, Aditya Nath Aggarwal, Sudhir Kumar, Anil Agarwal PMID: 22792820 doi: 10.5505/tjtes.2012.12058 Pages 141 - 146 Background: Falls from height are one of the leading causes of death from unintentional injuries. Materials and methods: We reviewed cases of musculoskeletal trauma due to fall from height, over one year, at a tertiary care hospital in Delhi for demographic data, site of accident, circumstances and location of fall, approximate height of fall, season, landing surface, details of skeletal and other injuries and duration of hospital stay. Results: Of 1451 admissions during the period, 138 were injured due to fall from height. Thirty seven cases were excluded. Mean age of patients was 31.3 years. The mean height of fall was 4.54 meters (range 0.6-12 meters). A total of 126 fractures occurred in 101 patients, 55 in the upper limbs, 50 in lower limbs, 14 in spine and seven in pelvis. Associated injuries included head (n=17), chest (n=9) and abdominal injuries (n=6). Ninety patients (89%) needed surgical intervention for fracture management. Eleven of these 101 (10.8%) injuries were fatal. Conclusion: Fall from height is a potentially preventable cause of skeletal injuries as most of the injuries sustained due to fall from height were domestic injuries and occurred due to poor dwelling units. |
8. | Long term outcome of unreamed intramedullary nails in femur diaphyseal fractures Bülent Özdemir, Burak Akesen, Burak Demirağ, Muhammed Sadık Bilgen, Kemal Durak PMID: 22792821 doi: 10.5505/tjtes.2012.19970 Pages 147 - 152 Objectives: We evaluated the results of patients with traumatic femur diaphyseal fracture who had undergone biologic fixation with unreamed intramedullary nailing. Methods: 25 adults with 29 traumatic femur diaphyseal fracture who had undergone unreamed intramedullary nailing at Uludag University School of Medicine Department of Orthopedics and Traumatology were included in the study. Gender, age, cause of injury, fracture type, operation length, time lapse till surgery, blood loss, fluoroscopy duration, early and late complications, time till union and functional results were noted. Founctional results are evaluated with Klemm-Börner, Thoresen and SF-36 health survey questions. Results: mean follow-up of the patients was 65,1±31,6 months (26-138). There was no statistically significant difference between operation length, blood loss and time till union of simple and complex fractures (p>0,05). Also, SF-36 questionnaire revealed no statistically significant difference between pain scores (p>0,05). Conclusion: We state that sparing of the endosteal and periosteal circulation, low infection and high union rates and good functional outcomes of unreamed intramedullary nailing fixation make it the treatment of choice for simple and comminuted fractures of the femur shaft, especially for multi-trauma patients and patients with cardiopulmonary co-morbidities. Key words: Femur shaft fractures, biologic fixation, unreamed intramedullary nail. |
9. | Anterior cruciate ligament injuries: do affect surgical treatment with otograft and allograft options, clinical results ? Ahmet Aslan, Özgür Özer, Metin Lütfi Baydar, Hüseyin Yorgancıgil, Remzi Arif Özerdemoğlu, Nevres Hürriyet Aydoğan PMID: 22792822 doi: 10.5505/tjtes.2012.90767 Pages 153 - 161 Objectives: We investigated clinical outcome that allograft or autograft with anterior cruciate ligament (ACL) reconstructions. Methods: We retrospectively evaluated 82 patients who underwent arthroscopic ACL reconstruction with anterior tibial tendon (ATT) allograft (n=52) or quadrupled hamstring tendon (DHT) otograft (n=30). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores,functional(one leg hop) and laxity (pivt-shift,lahman,anterior drawer) tests. Results: The two groups were similar with respect to age and sex distribution, operated side, preop preiod and associated injuries (p>0.05). Results were satisfactory in both groups, but there is no statistically significant difference between groups that respect to IKDC, lysholm score,functıonality and ligament laxity. However, were found in effusions DHT group than in the ATT group. Conclusion: Our results suggest that differences graft options of the ACL reconstructions tunnel fixation have no effect clinical outcome. Allografts with to be developed solutions to immune response may be a good alternative in ACL reconstruction. |
10. | Volar plate fixation of distal radius fractures Emrah Rıza Demirbaş, Ali Akın Uğraş, İbrahim Kaya, İbrahim Sungur, Cemal Kural, Ercan Çetinus PMID: 22792823 doi: 10.5505/tjtes.2012.64022 Pages 162 - 166 Objective: To evaluate results of volar locking and unlocking plate fixation of adult distal radius fractures. Methods: 34 patients (14 female and 20 male, the mean age was 48.5±17.9) who were treated for distal radius fractures,retrospectively investigated. The fractures were distirubuted as follows; 17.6% AO type B3, 11.8% AO type C2 and 70.6% AO type C3. The patients were evaluated clinically (Gartland and Werley scale, Visual analog score (VAS), Disabilites of the arm shoulder and hand score (DASH)) and radiographically (Stewart score). Results: The mean follow-up of patients were 24±16.3 months. According to Gartland-Werley scale, the results were excellent in 24.9% of patients, good in 55.9% of patients, moderate in 11.8% of patients and poor in 2.9% of patients. The mean VAS score was 0.5±1.1, and the mean DASH score was 26.1. According to Stewart criteria, 44.1% of patients rated as excellent, 52.9% of patients rated as good and 2.9% of patients rated as moderate. 2 patients had complex regional pain syndrome, one patient had carpal tunnel syndrome and one patient had tenosynovitis. Conclusions: Volar plate fixation is a good and an effective treatment for distal radius fractures. Plate should be inserted properly and physiotherapy should not be ignored. |
11. | Outcomes of four distinctive fixation methods in the conservative treatment of fifth metacarpal neck fractures Ayhan Kılıç, Sami Sökücü, Seçkin Basılgan, Sedat Yeniocak, Engin Çetinkaya, Atilla Sancar Parmaksızoğlu, Yavuz Selim Kabukcuoğlu PMID: 22792824 doi: 10.5505/tjtes.2012.23090 Pages 167 - 170 Aim: We evaluated four distinctive fixation methods for conservative treatment of neck fractures of fifth metacarp. Patients and Methods: Patients who have been treated with non-surgical methods following closed reduction in our clinics between 2008 and 2009 were evaluated prospectively.In study that consists of 60 male patients, the following were the fixation methods applied for 4 weeks; circular cast extending from the wrist to the distal interphalangeal joint (Group A), circular cast covering semiflexed metacarpophalangeal and DIP from the wrist to the distal interphalangeal joint (Group B), circular self-adherent wrap (Coban™) covering metacarpal bones II–V, from wrist to DIP joint (Group C) and ulnar gutter splint covering semiflexed 4-5.MP, proximal and distal IP joints (Group D). In patients who were followed up with AP and oblique radiography, angulations and metacarpal lengths of patients were measured before and after reduction Results: 52 patients with an average age of 30(SD: 9) completed the studyFractures with radiographical angulation of 17˚ (SD: 11) and 46˚(SD: 11.7) before treatment, union achieved with an angulation of 5˚(SD: 5.9) and 27̊ (SD: 10. 5) after 4 weeks (p0.05). Conclusion: No statistically significant difference was found between the applied non-surgical treatment methods of fifth metacarpal fracture. |
CASE REPORTS | |
12. | Adrenal injuries following blunt abdominal trauma in children: Report of two cases Stylianos Roupakias, Marinos Papoutsakis, George Tsikopoulos PMID: 22792825 doi: 10.5505/tjtes.2012.65390 Pages 171 - 174 Adrenal injuries following blunt abdominal trauma are uncommon. Adrenal hemorrhage in children associated with multiple organ injury, has received little attention in the past, and is an increasingly recognized phenomenon in modern trauma centers with the wide-spread use of abdominal computed tomography (CT). Adrenal trauma occurs in the setting of multisystem organ injury. Isolated adrenal injury is exceedingly rare. We report two children with blunt adrenal trauma (one with isolated and one with associated injuries), who were admitted to our pediatric surgery department after abdominal trauma during the last two years. We determined the prevalence, management and general prognosis of blunt adrenal injury in pediatric population. Traumatic adrenal hemorrhage appears to be an incidental and unsuspected finding that resolves on follow up imaging. |
13. | Delayed diagnosis of traumatic diaphragmatic rupture with herniation of liver- A case report. Anand Kuppusamy, Gayathri Ramanathan, Jayakar Gurusamy, Balaji Ramamoorthy, Karunanithi Parasakthi PMID: 22792826 doi: 10.5505/tjtes.2012.79477 Pages 175 - 177 Diaphragmatic rupture is a potential life threatening clinical situation. It occurs as a result of high velocity blunt or penetrating injury to abdomen and thorax. Acute traumatic rupture of diaphragm may go undetected and there is often delay between the injury and diagnosis. Right sided rupture is less common due to hepatic protection and increased strength of right hemidiaphragm. A systematic review of literature by Rashid F et al has revealed 13 cases of right sided diaphragmatic rupture, while herniation of liver occurred only in six cases. We report a case of 28 year old man who was admitted with breathlessness to our hospital 72 hours after trauma. Since clinical signs and symptoms were non-specific, helical computed tomography was done which revealed diaphragmatic rupture with hepatothorax. Emergency thoracotomy was done to repair diaphragmatic rent. Postoperative period was uneventful and patient was discharged from hospital after three weeks. |
14. | Endovascular repair in acute traumatic aortic transection: a case report Soner Sanioğlu, Sinan Şahin, Hakkı Aydoğan, Hakan Barutça, Ergin Eren PMID: 22792827 doi: 10.5505/tjtes.2012.45389 Pages 178 - 180 A thirty-eight year old, male patient who suffered from 10th and 11th thoracal vertebrae fractures, paraplegia and acute traumatic aortic transection because of accidental fall was referred to our hospital. Open surgical repair had a very high risk due to severe coexisting injuries. Transection was treated with 30x100 mm Vailant thoracic endograft which was deployed just distal to the ostium of the left carotid artery. Patient was transfered to neurosurgery clinic for treatment of paraplegia after uneventful recovery. Endovascular repair of acute transection confers substantial advantages in mortality and morbidity according to surgical repair. But the long-term durability of thoracic endografts is still unknown. If the long-term results are satisfactory just like promising mid-term results, this technique may become a gold standart approach for treatment of acute transection. |
15. | An Unusual Penetrating Craniocerebral Injury Due To Landmine Explosion: A Case Report Cem Atabey, Turgay Ersoy PMID: 22792828 doi: 10.5505/tjtes.2012.76753 Pages 181 - 184 Penetrating landmine injuries are the unavoidable consequences of military conflicts. They are potentially life-threatening conditions. The mortality rates in the literature range from 23% to 92% and are considerably higher in patients that admitted with poor neurologic state. Penetrating craniocerebral injuries require early surgical management designated to prevent infection and remove foreign objects, necrotic tissue, and complicating blood clots, as well as to minimalize post-traumatic sequelae. We reported an interesting case of penetrating intracerebral injury with shrapnel due to landmine in a 20-year-old young man. |
16. | Ventricular septal defect, developed due to the coronary artery injury after blunt chest trauma in childhood Zehra Karataş, Fatih Şap, Hakan Altın, Hayrullah Alp, Tamer Baysal, Sevim Karaaslan PMID: 22792829 doi: 10.5505/tjtes.2012.15045 Pages 185 - 188 Cardiac response associated with blunt chest trauma in children was generally reported as case reports in the literature and interventricular septum rupture due to trauma is quite rare. Interventricular septum rupture can be developed even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present report; a 7 year-old boy with interventricular septum rupture at mid-muscular region and left ventricle pseudo aneurysm developed due to the injury of the left anterior descending coronary artery after a traffic accident was reported. The patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury and in those detected the signs of ischemia on electrocardiography, it should not be forgotten that coronary artery may be affected. |
17. | Contact With Wet Cement: An Unrecognised Cause For Chemical Burn Nevra Seyhan, Mustafa Keskin, Nedim Savacı PMID: 22792830 doi: 10.5505/tjtes.2012.56254 Pages 189 - 191 Chemical burns account for a small percentage of admissions to burn units. Wet cement is a poorly recognized cause for a chemical burn. As the construction industry is growing, it becomes more likely to get in contact with this material and be more prone to its harmful effects. Wet cement can cause severe full-thickness burns with prolonged contact but this property is not well-known among professional users. Lack of information about its potential hazards makes it an important problem which must be taken into consideration more seriously as a risk factor for a chemical burn. Increasing public knowledge about taking necessary preventive measures is crucial for avoiding this type of chemical burn injuries. |
18. | Intestinal Perforation Due To Multiple Magnet Ingestion: A Case Report Mehmet Nuri Cevizci, Çetin Ali Karadağ, Mesut Demir, Ali İhsan Dokucu PMID: 22792831 doi: 10.5505/tjtes.2012.22457 Pages 192 - 194 Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets might stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. Case report: An eight years old girl was presented with abdominal pain and vomiting. She had abdominal tenderness and defense at examination. Abdominal x-ray showed air and fluid levels. Metallic images were not considered firstly as important in diagnosis. Abdominal ultrasonography was reported as acute appendicitis. At abdominal exploration, appendix was normal, but there were dense adherences around ileum and cecum. After adhesiolysis, intestinal perforations were seen in cecum and 15 and 45 cm proximal to cecum. Magnet and metal pieces were present in perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications and she was discharged on postoperative 5th day. Conclusion: Pediatric surgeons should be aware of the complications of multiple magnet ingestions. If the patient has the complaint of multiple magnet ingestions, follow-up with daily abdominal x-rays should be done and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered. |