BACKGROUND
Acute pancreatitis with high mortality of severe onset is still a major problem in medicine. Early identification of the severity of the disease is critical for effective treatment. Many markers have been tried and are still being tested. The ideal marker should be able to identify the cases and distinguish between mild and severe.
METHODS
This prospective study included 34 cases (14 males, 20 females, mean age: 58 years) of acute pancreatitis and 33 cases (17 males, 16 females, mean age: 53 years) as a control group. Mild (n=29) and severe (n=5) cases were compared with respect to serum levels of amylase, C-reactive protein (CRP), alpha-1-protease inhibitor, and antichymotrypsin on admission and 24 and 48 hours (h) after admission.
RESULTS
Alpha-1 protease inhibitor and antichymotrypsin levels were significantly elevated in the first 24 h; however, CRP peaked after 48 h in the acute pancreatitis group. While CRP showed significantly higher concentrations in patients with severe pancreatitis, alpha-1-protease inhibitor and antichymotrypsin levels changed slightly, but without significance, in severe cases.
CONCLUSION
Alpha-1 protease inhibitor and antichymotrypsin are early events in acute pancreatitis, with high levels on admission. Activation of these variables declines after 24 h. These markers may have early diagnostic value in patients with acute pancreatitis. Because neither of them is good at discrimination of mild and severe cases in the disease, they should not be incorporated into routine clinical investigations.

BACKGROUND
Patients with maxillofacial fractures are at high risk of accompanying traumatic cranial injuries. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery.
METHODS
The records of 246 patients with maxillofacial fractures referred to the emergency department of our hospital between January 2006 and September 2009 were reviewed in this retrospective study. The patients’ age and gender, cause, type and location of the maxillofacial fracture, and the cranial injuries were analyzed.
RESULTS
The mean age of the patients was 23.61±16.75 years (83.3% males and 16.7% females). Cranial injury was observed in 38 patients with maxillofacial trauma. While the risk of head injury was found to be 3.44-fold lower among patients with single facial bone fracture (p<0.001), the risk of experiencing head injury significantly increased in patients with multiple facial bone fractures (p<0.001). The risk of head trauma significantly increased in patients with fractures of the nasal bone, maxillary bone, mandibular bone, and with frontal region fractures (p<0.05 in each group).
CONCLUSION
The patients with multiple facial bone fractures should be investigated with regard to head injury even if they do not have clinical findings.
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BACKGROUND
In reconstructive surgery, the ultimate goal in rebuilding a structure is to provide the most similar substitute from both the functional and structural points of view. At the same time, the reconstructive surgeon should focus on minimizing donor area complications.
METHODS
In this report, we present our experiences with the reconstruction of distal extremity defects using a free temporoparietal fascia flap in five patients. The flap was subsequently covered with a split-thickness skin graft harvested from the same region of the scalp as the flap donor site.
RESULTS
By procuring the skin graft from the scalp, the donor sites of both the flap and the skin graft were concealed by hair. The transferred flaps and skin grafts healed uneventfully in all patients without any complications at the donor or recipient site.
CONCLUSION
We conclude that this combination of harvesting a temporoparietal fascia flap, which has many advantages in reconstructing distal extremity defects, along with a skin graft from the same region as the flap, both hidden by hair, can limit donor site morbidity and achieve optimal reconstructive outcomes.

BACKGROUND
Head injury increases mortality in trauma patients. We aimed to study the epidemiological and clinical features of head injury in Al-Ain city, United Arab Emirates (UAE).

METHODS
Trauma patients with head injury who were admitted to Al-Ain Hospital for more than 24 hours and those who died in the hospital were included in the study. Data were prospectively collected from March 2003 - March 2006.
RESULTS
589 patients were studied, and 521 were males (88.3%). The median (range) age was 30 (1-89) years. The most common mechanism of injury was road traffic collision (67.1%) followed by fall from height (11.9%). Head injury was mild in 82.2% of patients, moderate in 5.7%, and severe in 12.1%. 20.9% of patients were admitted to the intensive care unit. 35 patients died (overall mortality 5.9%). Patients who died had significantly higher Injury Severity Score (p<0.0001), lower Glasgow Coma Scale (p<0.0001), and higher Abbreviated Injury Scale of the head (p<0.0001).
CONCLUSION
Motor vehicle collision was the main mechanism of head injury in the UAE followed by fall from height. Legislation for compulsory seatbelt usage and helmet usage by bicyclists and motorcyclists should be adopted. A safe work environment and preventive measures at work should be introduced.

BACKGROUND
We aimed to determine factors associated with mortality rates in patients with traumatic brain injury (TBI).
METHODS
Registered data of a national trauma project conducted in eight major cities in Iran during a five-year period were used. Patients with a TBI were identified and both univariate and multivariate analyses were performed.
RESULTS
2274 brain-injured patients including 1794 males (78.9%) were identified. The mean age of the patients was 30.1 ± 19.11 years. The age of 345 patients was less than 12, while 137 patients were older than 65. 383 patients (16.9%) died as a result of their injury. Univariate analysis showed a significant association between mortality and the following factors: age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), systolic, diastolic and mean arterial blood pressure (BP), and respiratory rate (RR) (p<0.05). The logistic regression analysis revealed a statistically significant association between death and age (odds ratio [OR]=1.04), GCS (OR=0.59), ISS (OR=1.03), mean arterial BP (OR=0.71), and RR (OR=0.82) one-half hour after hospital arrival.
CONCLUSION
Our results demonstrated that age, GCS, ISS, BP, and RR as prognostic factors in patients with TBI indicate those that need special care during the initial management in the emergency department.

BACKGROUND
We aimed to evaluate the role of Tc-99m labeled red blood cell (RBC) scintigraphy for determination of localization of gastrointestinal system (GIS) bleeding.
METHODS
Fifty-seven cases (27 females, 30 males; mean age 43.9±24; range 1 to 91 years) who referred to our clinic between 1995-2010 were evaluated for determination of localization of GIS bleeding with RBC scintigraphy. Prior to scintigraphy, gastroscopy in 51, colonoscopy in 45, and angiography in 9 patients were performed.
RESULTS
RBC scintigraphies were positive and negative in 31 and 26 patients, respectively. Positive scintigraphic findings were obtained within the 1st hour of dynamic imaging in 19 patients, within the 1st-4th hour static images in 7, and within the 4th-24th hour images in 5 patients. Fourteen patients underwent surgical exploration. In 13 patients, the surgery confirmed the diagnosis by RBC scintigraphy (accuracy: 92.8%). Of 43 patients without surgical exploration, 12 had anemia due to iron deficiency and their scintigraphic evaluation were negative. Four patients died and in 27 patients, GIS bleeding ceased spontaneously or with conservative measures.
CONCLUSION
Scintigraphy should be the primary tool for accurate diagnosis of patients with active GIS bleeding. Positive dynamic images obtained within the first hour of imaging may be more accurate for demonstrating bleeding localization and a good predictor of requirement of surgical exploration.

BACKGROUND
We investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS).
METHODS
The study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department.
RESULTS
The mean GCS score was 4.96±1.20 at admission and 4 preoperatively. Mean ICP in non-surviving patients after DS was higher (p<0.05). ICP decrease after DS was also higher in surviving patients than in non-surviving patients (p<0.05). The overall mortality rate was 61.02%. A GCS motor score >2 at admission was associated with lower mortality (p<0.05). Four of the surviving patients (14.28%) had a functional outcome (Glasgow Outcome Score: 4 and 5) at one year after hospital discharge.
CONCLUSION
Outcome in patients with BNDP after STBI may not always be fatal or poor. Rapid DS may increase the chance of functional survival, especially in patients with admission GCS score of 6 or 7.

BACKGROUND
We aimed to study the distribution and causes of trauma in women of child-bearing age.
METHODS
Data were collected from Al-Ain Hospital (United Arab Emirates-UAE) Trauma Registry. Females aged 16 to 45 years (child–bearing age) who were admitted with trauma between March 2003 and March 2006 were included in the study.
RESULTS
Females represented 9% (n=171) of all trauma patients (n=1809) of the same age group, of which 29% were UAE nationals. The mean age for females was 30.5 years. Road traffic collision (RTC) was the main mechanism of injury (n=78, 46%). Burns were significantly higher in females than males (p=0.001). Cervical fractures were significantly higher in females (p=0.04), while lumbar fractures were significantly higher in males (p=0.03). In females, pelvic fractures were diagnosed in 6.4%, spinal fractures in 7%, and both injuries in 1.2%. Three females died (1.7%), and all were due to RTC.
CONCLUSION
The majority of females involved in trauma were aged 20-34 years. RTC is the main mechanism of injury and fatality. Female trauma is associated with a high incidence of pelvic fractures. A higher rate of cervical injuries was observed in females in contrast to lumbar injuries in males.

BACKGROUND
The surgical treatment of fractures of the tibia includes reamed and unreamed options. Reamed nails have mechanical advantages but they significantly harm the endosteal circulation. Unreamed nails spare the endosteal circulation, but provide a less stable fixation. In both systems, immediate full weight-bearing is not possible due to instability related to distal interlocking (DI). Further, DI is responsible for the majority of the fluoroscopy requirement and a significant loss of surgical time.
In our study, we present the clinical results of a new intramedullary (IM) nail and system, which allows stable fixation with an unreamed technique that permits immediate full weight-bearing, with a minimum fluoroscopy requirement for DI.
METHODS
Fifty tibia fractures (49 patients) operated using our new IM system between 2008 and 2010 were evaluated retrospectively. They were allowed full weight-bearing the day after surgery. The patients were followed at least 10 months postoperatively.
RESULTS
Mean fluoroscopy time was 18 seconds (min: 10, max: 30) for DI. Mean union time was 9 weeks (min: 6, max: 12). There was no neurovascular injury, deep infection, malunion, delayed union, or nonunion.
CONCLUSION
We demonstrated that our newly developed IM nail and new DI system may be an option to solve the stability problems sourced from the DI screw. It also significantly decreases the requirement of fluoroscopy.

BACKGROUND
We evaluated the data of our patients who experienced rectal injury during radical prostatectomy (RP).

METHODS
We analyzed the data for the 7 patients (6 perineal, 1 retropubic) with iatrogenic rectal injury who were selected from 451 patients with RP (218 retropubic, 233 perineal) operated in our clinic between 2003 and 2011.
RESULTS
The mean age of the 7 patients was 64.4 years. Rectal injury occurred during prostatic apical dissection in 4 patients, during dissection of Denonvilliers fascia in 1 patient, during transection of the rectourethral muscles in 1 patient, and during dissection of the rectal region proximal to the anal sphincter in 1 patient. The mean size of the lesions was 2 (1-4) cm. All of the rectal injuries were recognized during the operation, and double-layered sutures were used for the primary repair. None of the cases required colostomy procedure. No postoperative complications were encountered in 6 of the patients; however, 1 patient underwent a second operation on the following day due to detachment at the injury site. None of the patients displayed urethrorectal fistula, urinary incontinence or urethral stricture.
CONCLUSION
Primary repair with double-layered suturing is sufficient for the treatment of rectal injuries that occur during RP if they are recognized intraoperatively.

BACKGROUND
Pellet gunfire injuries inflicted while controlling agitated mobs has been studied.
METHODS
A total of 198 patients admitted to the Accident and Emergency Department with pellet gun injuries were studied in terms of anatomic site, severity and type of injury, treatment, and outcomes.
RESULTS
72.7% of patients were aged 16-25 years. The most common sites of injury were the extremities (47.9%), abdomen (36.3%) and chest (31.3%). 59.5% of patients were found to have minor injuries. Of the 80 patients admitted to the hospital for their injuries, 43 (53.7%) required an operative procedure. Six deaths (3.03%) were observed.
CONCLUSION
While the pellet wound itself may seem trivial, if not appreciated for the potential for tissue disruption and injuries to the head, chest, and abdomen, there can be catastrophic results. Patients should be evaluated and managed in the same way as those sustaining bullet injuries.

BACKGROUND
On 23 October 2011, an earthquake occurred in the city of Van, Turkey. This earthquake was an enormous devastating disaster and caused mass casualties. The descriptive analysis presented here serves as a reference not only for the present injury profile but also for future disaster response.

METHODS
This is a retrospective study based on the medical records of earthquake victims admitted to Van Training and Research Hospital. The results were compared with the current literature.
RESULTS
1582 earthquake victims (806 male, 776 female, mean age 36.9 years) were admitted to emergency service. 301 of the patients were treated with hospital care in different departments: 84 (27.9%) in orthopedics surgery, 40 (13.2%) in general and pediatric surgery, 26 (9%) in thorax surgery, 34 (11%) in neurosurgery, 56 (19%) in internal medicine, 39 (13%) in the intensive care unit, and 22 (7%) in other departments. The total number of deceased was 60.
CONCLUSION
To minimize mortality and morbidity after earthquake disaster, immediate and effective triage should be done, and after the patients are transported to the hospital, individualized treatment should be planned according to the patients’ respective clinical features. Coherent collaboration between many departments is vital.

We present a rare case of self-inflicted penetrating head trauma by a 34-year-old male who hammered four nails into his own head; he had been diagnosed with schizophrenia seven years before.
On the physical examination, four nails were observed in the hairy scalp that had been driven into the cranium in the right temporal and parietal areas of the head. No cerebrospinal fluid fistulas were present. On the neurological examination, no motor or sensory deficits were present. The Glasgow Coma Scale was 15. On direct skull X-ray and cranial computerized tomography (CT), the nails were seen to be approximately 10 cm long and extending in various directions. No injury was observed in the main vasculature on CT angiography. Under general anesthesia, two nails in the right temporal area were removed by extraction, and the other two nails in the right parietal area were removed through a mini craniotomy. In areas such as the temporal area where the bone is thin, nails can be removed by extraction. However, in areas like the parietal bone where the bone is thick, removal of the nails using this method may not always be possible.

Major fractures and dislocation of the talus and peritalar joint are uncommon. We present here a very rare case of injury with delayed presentation of closed total talus dislocation with fractured medial malleolus and posterior talar tubercle fracture. This report analyzes previous reports in the literature and the proposed treatment.

The coexistence of pyloric atresia (PA) and epidermolysis bullosa (EB) is a rare but well-known surgical emergency in neonates. PA/EB is described by the association of atresia of the pylorus and bullous lesions on the skin. Ninety-one cases have been reported in the literature to date. We present two new cases and evaluate the association of PA/EB, its etiopathogenesis and the clinical properties.
Case 1:
A three-day-old female presented with nonbilious vomiting and bullous lesions 2-3 cm in diameter on the extremities. Abdominal X-ray showed a single air-fluid level in the left upper quadrant. At laparotomy, we found PA and performed a pyloro-pylorostomy. The patient died due to sepsis complication of EB two months after surgery.
Case 2:
A two-day-old male presented with severe dermal bullous lesions on the trunk, neck and extremities. His stomach was dilated and there was no gas distally. We found PA and performed gastroduodenostomy. Initially, he tolerated the feeding well, but he died due to severe sepsis on the postoperative 23rd day.
Almost all neonates born with the PA/EB result in a fatal outcome in the first few years. The complications related to EB are usually the cause of death. Even after successful repair of PA, skin lesions lead to death due to infection.

Operating room fires occur very rarely. Nevertheless, a disaster can complicate almost any kind of surgery. The majority of operating room fires result from the use of alcohol-based surgical preparation solutions, electro-surgical equipment, or flammable drapes in an oxygen-rich environment. We report a patient with an ovarian cyst and uterine myomas who suffered a flame burn while undergoing gynecological surgery.

The authors present an unusual case of isolated hemorrhagic contusion of an incidental meningioma showing radiological findings similar to those of a hemorrhagic cerebral contusion on computed tomography (CT) in a female patient who presented to our hospital for head trauma. This case has two characteristics. First, although the meningioma had a hemorrhagic contusion due to head trauma, most of the brain tissue was intact. Second, there was a possibility that the hemorrhagic contusion of the incidental meningioma on CT was misdiagnosed as a cerebral hemorrhagic contusion. In this case, we propose a possible mechanism to explain this rare phenomenon.

Intestinal malrotation is a developmental anomaly of the midgut in which the normal fetal rotation of intestines around the superior mesenteric artery and their fixation in the peritoneal cavity fail. Rotational anomalies of the midgut are rare in adults. Operative intervention is required generally when they are symptomatic. While difficult to diagnose, prompt recognition and surgical treatment usually lead to a successful outcome. Intestinal malrotation is rarely asymptomatic and generally diagnosed incidentally in adults. In the present report, a case of incidental intestinal malrotation with clinical findings of small bowel obstruction is discussed with a literature review.