p-ISSN: 1306-696x | e-ISSN: 1307-7945
Volume : 18 Issue : 4 Year : 2025

Quick Search




SCImago Journal & Country Rank
Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 18 (4)
Volume: 18  Issue: 4 - July 2012
EXPERIMENTAL STUDY
1. Effects of hemoperitoneum on wound healing and fibrinolytic activity in colonic anastomosis
Neşet Köksal, Mehmet Ali Uzun, Ömer Faruk Özkan, Münire Kayahan, Osman Metin İpçioğlu, Yusuf Günerhan, Ersin Ergün, Pembegül Güneş
PMID: 23138992  doi: 10.5505/tjtes.2012.65289  Pages 283 - 288
AMAÇ
Kolon anastomozlarında iyileşme ve fibrinolitik aktivite üzerine hemoperitoneumun etkisi araştırıldı.
GEREÇ VE YÖNTEM
Wistar Albino cinsi 20 sıçanda, kolon kesilip anastomoz yapıldıktan sonra 10 sıçana (Grup 1) karın içine verici sıçanlardan alınan kan (25 ml/kg), 10 sıçana (Grup 2) ise serum fizyolojik verildi. Sıçanlar beşinci gün sakrifiye edilerek anastomoz patlama baçınçları ölçüldü. Anastomoz hattının histopatolojik değerlendirilmesi yapılarak, omentum, akciğer ve anastomoz hattında hidroksiprolin, doku plazminojen aktivatörü (tPA), plazminojen aktivatör inhibitörü-1 (PAI 1) ve tPA/PAI 1 kompleksi düzeyleri saptandı.
BULGULAR
Anastomoz patlama basıncı Grup 1’de 224,5 mmHg, Grup 2’de 254,4 mmHg idi (p=0,121). Hidroksiprolin değerleri Grup 1 ve Grup 2’de sırasıyla 45,89 ve 65,959 mg/gr protein olarak bulundu (p=0,257). Histopatolojik incelemede anlamlı farklılık saptanmadı. Omentum tPA değeri Grup 1’de 0,962 ng/ml, Grup 2’de 0,27 ng/ml olup, fark anlamlı idi (p=0,041). Omentum PAI 1 ve tPA/PAI 1 kompleksi değerleri, anastomoz ve akciğer dokuları tPA, PAI 1 ve tPA/PAI 1 kompleksi değerleri açısından gruplar arasındaki fark anlamlı değildi. Grup 2’de anastomoz hattı tPA değeri ile anastomoz patlama basıncı arasındaki ilişki yüksek düzeyde anlamlı idi (r=0,778; p=0,008).
SONUÇ
Kolon anastomozlarında hemoperitoneumun etkisini araştıran bu ilk çalışmada, anastomoz iyileşmesinde ve omentum haricinde fibrinolitik aktivitede anlamlı fark gözlenmedi. Farklı kan volümleri ve farklı değerlendirme zamanları ile yapılacak yeni çalışmalara ihtiyaç vardır.

ORIGINAL ARTICLE
2. The relationship of trauma severity and mortality with cardiac enzymes and cytokines at multiple trauma patients
Ali Karakuş, Zeynep Kekeç, Ramazan Akçan, Gülşah Seydaoğlu
PMID: 23138993  doi: 10.5505/tjtes.2012.81488  Pages 289 - 295
BACKGROUND
In this study, we aimed to determine the effects of trauma severity on cardiac involvement through evaluating the trauma severity score together with diagnostic tests in multiple trauma patients. A trauma score was determined using various trauma severity scales.
METHODS
After obtaining the approval of the ethics committee of the faculty, this prospective study was performed through evaluating 100 multiple trauma patients, aged over 15 years, who applied to our Emergency Department (ED). After determining the trauma severity score using instruments such as the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS), the cardiac condition was evaluated using biochemical and radiological diagnostic tests.
RESULTS
During the study period, 100 patients were evaluated (78 male, 22 female; mean age: 33.2±15.4; range 15 to 70 years). It was determined that 92 (92%) were blunt trauma cases, and 77 (77%) of them were due to traffic accidents. The majority of cases showed electrocardiogram (ECG) abnormalities (63%) and sinus tachycardia (36%). Abnormal echocardiogram (ECHO) findings, mostly accompanied by ventricular defects (n=24), were determined in 31 of the cases. Nineteen cases with high trauma severity score resulted in death, and 14 of all deaths were secondary to traffic accidents. Trauma scores were found to show a significant difference between the two groups.
CONCLUSION
The ISS trauma scale was determined to be the most effective in terms of indicating heart involvement in patients with multiple traumas. Close follow-up and cardiac monitoring should be applied to patients with high trauma severity scores considering possible cardiac rhythm changes and hemodynamic disturbances due to cardiac involvement.

3. Burn unit: colonization of burn wounds and local environment
Touria Essayagh, Alban Zohoun, Khalid Tourabi, Mohamed Amine Ennouhi, Abdellatif Boumaarouf, Hsain Ihrai, Sakina Elhamzaoui
PMID: 23138994  doi: 10.5505/tjtes.2012.26928  Pages 296 - 300
BACKGROUND
We present the results of a comparative prospective study of the resistance profile of strains isolated from pathological material of patients hospitalized in the burn unit of the military hospital in Rabat and from their environment over a period of one and a half years (July 2009-February 2011).
METHODS
The study concerned 125 pathological products from patients (40 men, 20 women; mean age 38±14.8 years; range 2 to 80 years) hospitalized with burns. This allowed the isolation of 86 non-redundant bacterial strains during the first period and 50 during the second.
RESULTS
The dominant species were Acinetobacter baumannii (15.6%), followed by Pseudomonas aeruginosa (13.8%) and Staphylococcus aureus (11%). During the second period, we noted the abundance of A. baumannii (15.5%), followed by P. aeruginosa (11.3%) and Klebsiella pneumoniae (8.5%). Of the 104 environmental samples of burn patients, 139 microorganisms were isolated. Coagulase-negative staphylococcus was the most abundant strain in the two study periods (69.2% and 64.6%).
CONCLUSION
All species showed an almost identical sensitivity to the various antibiotics tested.

4. Cardiac monitoring in patients with electrocution injury
Meltem Akkaş, Hilal Hocagil, Ay Didem, Erbil Bülent, Kunt Mehmet Mahir, Özmen Mehmet Mahir
PMID: 23138995  doi: 10.5505/tjtes.2012.69158  Pages 301 - 305
BACKGROUND
The necessity of admitting patients exposed to electrocution injuries for monitoring and observation in the emergency department (ED) remains controversial.
METHODS
We evaluated the medical records of 102 patients (86 male, 16 female; median age 29.5; range 18 to 68 years) admitted to the adult ED with electrocution injuries over the past 20 years.
RESULTS
Only 9 deaths were reported: 3 as a result of contact with low-voltage electricity and 6 after contact with high-voltage electricity. With the exception of a case of sepsis, all deaths were related to early rhythm abnormalities immediately following the incident. The ECG findings of surviving patients in the study group were as follows: 70 normal, 8 sinus tachycardia, 3 sinus bradycardia, 4 ST-T wave changes, and 1 ventricular extrasystole. ECG recordings of 7 patients could not be found. 72 cases had been followed up with repeat ECG recordings. There were no observed ECG changes requiring any medical or electrical therapies in the surviving patients.
CONCLUSION
Cardiac rhythm abnormalities related to electrocution injuries are usually observed at the time of the incident. If the patient’s overall clinical condition is good and they have a normal ECG at the time of admission to the ED, the probability of observing any delayed serious dysrhythmia is unlikely.

5. A life-saving approach after thoracic trauma: Emergency room thoracotomy
Tevfik İlker Akçam, Kutsal Turhan, Ayşe Gül Ergönül, Emrah Oğuz, Alpaslan Çakan, Ufuk Çağırıcı
PMID: 23138996  doi: 10.5505/tjtes.2012.70194  Pages 306 - 310
BACKGROUND
In this article, the outcomes, indications and methods of emergency department service resuscitative thoracotomy in cardiac and/or respiratory arrest patients after thoracic trauma are discussed.
METHODS
Between January 2004 and December 2010, nine resuscitative thoracotomies were performed after thoracic trauma in the emergency department of our hospital. The records of the patients were evaluated retrospectively.
RESULTS
A total of nine patients underwent resuscitative thoracotomy: five stab wounds, two traffic accidents, one fall from height, and one gunshot wound. Anterolateral thoracotomy in supine position was performed in all. Three patients had lung parenchymal laceration, three patients had cardiac laceration, two patients had intercostal vessel injury, and one patient had descending aorta injury. None of the four patients with blunt trauma recovered. Three of five patients with penetrating trauma were discharged after an average of eight days of follow-up, whereas two of them were lost perioperatively.
CONCLUSION
Emergency room thoracotomy can be performed in thoracic trauma cases who are in shock and have unresponsive hypotension despite large volume fluid and blood replacement and no time for transportation to the operating room. The results are better in penetrating trauma patients than in blunt trauma.

6. Is total-subtotal colectomy and primary anastomosis a good treatment alternative in malignant obstructive lesions of the left colon?
Kemal Arslan, Mehmet Ali Eryılmaz, Ahmet Okuş, Osman Doğru, Ömer Karahan, Hande Köksal
PMID: 23138997  doi: 10.5505/tjtes.2012.36418  Pages 311 - 316
BACKGROUND
This study was designed in order to compare the effectiveness of subtotal-total colectomy with other surgical methods in the treatment of malignant obstructive lesions of the left colon.
METHODS
Patients admitting with symptoms of colonic obstruction and treated by emergency surgery in Konya Education and Research Hospital between 2004 and 2007 were enrolled. Patients were divided into three groups according to the surgical procedures (Group I: Hartmann procedure; Group II: resection + diverting ileostomy; Group III: total-subtotal colectomy). Related patient data were evaluated retrospectively.
RESULTS
The mean age of 62 patients was 64 (38-89) years. There were no significant differences between the groups with respect to gender, age, American Society of Anesthesiology scores, and tumor stages. There were no significant differences between the study groups in terms of operative duration, postoperative mortality, and five-year survival; however, the length of hospital stay and hospitalization costs were lower in Group III compared to the other groups.
CONCLUSION
We suggest that subtotal-total colectomy performed by experienced surgeons may be a good alternative to the other procedures.

7. The factors affecting the development of phthisis bulbi after penetrating eye injuries
Mesut Coşkun, Mustafa Ataş, Ali Akal, Özgür İlhan, Uğurcan Keskin, Esra Ayhan Tuzcu
PMID: 23138998  doi: 10.5505/tjtes.2012.02223  Pages 317 - 320
BACKGROUND
We aimed to investigate the factors affecting the development of phthisis bulbi after penetrating eye injuries.
METHODS
The medical records of 132 patients admitted to our clinic between 2000-2006 with the diagnosis of penetrating eye injury were collected. The records of the eight patients who developed phthisis bulbi were evaluated retrospectively. The aspects of anatomic localization, type of trauma, associated events, and development of phthisis bulbi were also investigated.
RESULTS
The mean age of the eight patients (5 males, 3 females) was 7.12±4.70 years (range: 2-16 years) and the mean follow-up time was 2.06±1.47 years (range: 6 months–5 years). Three of eight patients developed post-perforation endophthalmitis. Three patients had zone 2-3 scleral perforation and associated retinal detachment and the remaining two patients had proliferative vitreoretinopathy according to the trauma; all eight patients eventually developed phthisis bulbi. The mean time for the development of phthisis bulbi was 5.5±2.13 months (range: 3-10 months).
CONCLUSION
After penetrating eye injuries, visual prognosis and development of phthisis bulbi were affected significantly by the factors including anatomic localization, size of the injury, associated anterior or posterior segment pathologies, and endophthalmitis secondary to the trauma.

8. Ocular trauma score in transferred fireworks-related ocular injuries: a case series
Yong Liu, Yi-fei Huang, Jing-jing Jiang, Ji-feng Yu, Yu-bo Gong, Xi-bin Zhou, Gai-ping Du, Qian-qian Xu
PMID: 23138999  doi: 10.5505/tjtes.2012.39000  Pages 321 - 327
BACKGROUND
Our aim was to review the characteristics of transferred fireworks-related ocular damage and to evaluate the prognostic value of the ocular trauma score (OTS) for these injuries.
METHODS
This study included 22 transferred patients (19 male, 3 female; mean age 22.6±14.9 years) (25 eyes). The data were retrospectively reviewed, including the characteristics of the geography, types of fireworks, status of injuries, therapeutic procedures, and the best-corrected visual acuity (BCVA). All the injured eyes were classified using the OTS at the time of the initial examination.
RESULTS
Twenty eyes (80%) were in OTS category 1, three eyes (12%) were in OTS category 2, and two eyes (8%) were in OTS category 3. All cases received surgical therapy. Six eyes (24%) were enucleated, four (16%) of which achieved an improvement in their final BCVA. There was a statistically significant improvement in final BCVA between OTS category 1 and the other two OTS categories (p=0.016).
CONCLUSION
The aforementioned transferred fireworks-related ocular injury cases occurred mainly in young adults, men and active participants, all of which incurred serious vision loss and blindness. The OTS is quite effective for classifying the status and estimating the prognosis of transferred fireworks-related ocular injuries.

9. Normal çalışma saatleri dışında ortopedik travma cerrahisi için hazır mıyız? Retrospektif bir analiz
Dr Mansour A Al-saflan, Dr Mohammed Q Azam, Prof Mir Sadat-ali
PMID: 23139000  doi: 10.5505/tjtes.2012.82084  Pages 328 - 332
BACKGROUND
This retrospective analysis was done to determine whether there is a change in outcomes of trauma patients undergoing intramedullary nailing (IMN) for femur and tibia fracture as an emergency versus elective procedure.
METHODS
Data were collected for all patients admitted to male orthopedic wards between 1 January 2004 and 30 June 2009 with femur and tibia fractures that required IMN. The data collected included surgery undertaken on as emergency or elective procedure, duration of surgery, complications encountered, and union status of fracture.
RESULTS
There were 431 fractures of the tibia, fibula and femur. Operating time for femur fracture as an emergency procedure was significantly greater than for elective surgery (191±79 versus 155±65 minutes; p≤0.001, confidence interval [CI] -19.54). For tibia fracture, operating times were 167.1±62 versus 69.2±35 minutes (p<0.001, CI <-85.4). Complications of infection, secondary surgery and of union were more common in emergency procedures than elective surgeries.
CONCLUSION
This study shows that complications are higher in emergency surgery than elective surgery due to the increase in the duration of surgery. This is attributed to the non-availability of dedicated trained orthopedic nursing staff and theater during emergency procedures. We believe that it is time to develop dedicated orthopedic trauma theaters in hospitals that treat emergency fracture fixations.

10. Management of inhalation injury and respiratory complications in Burns Intensive Care Unit
Afife Ayla Kabalak, Ahmet Çınar Yastı
PMID: 23139001  doi: 10.5505/tjtes.2012.09735  Pages 333 - 338
BACKGROUND
Inhalation injury has high mortality and carries a significant risk of permanent pulmonary dysfunction. Inhalation injury and its consequences impose difficulties for the respiratory therapists, nurses and doctors who play a central role in its clinical management. In this study, we aimed to report our clinical experience and the role of non-invasive mechanic ventilatory (NIMV) support in a series of inhalation-injured patients.
METHODS
Patients hospitalized at Ankara Numune Training and Research Hospital’s Burns Intensive Care Unit between March 2009 and March 2011 was reviewed, and patients with required respiratory support due to inhalation injury were included in the study.
RESULTS
Among the patients, 37 had inhalation injury, and their mortality was 13.5%. Of the 37 patients, 16 had mandatory intubation (6 in the first 6 hours and 10 in the clinical course); however, others (67.8%) had only NIMV support.
CONCLUSION
Application of NIMV support with proper modes decreases the need for invasive procedures in inhalation-injured patients. Based on our results, we propose the application of NIMV support in inhalation-injured burn patients.

11. The impact of Ramadan on peptic ulcer perforation
Ali Kağan Gökakın, Atilla Kurt, Mustafa Atabey, Ayhan Koyuncu, Ömer Topçu, Cengiz Aydın, Metin Şen, Gündüz Akgöl
PMID: 23139002  doi: 10.5505/tjtes.2012.61257  Pages 339 - 343
BACKGROUND
Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP.
METHODS
A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting.
RESULTS
The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation.
CONCLUSION
The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

CASE REPORTS
12. Surgical treatment of a case with rapidly growing mass lesion after trauma: on the left forearm arteriovenous malformation
Süreyya Talay, Bilgehan Erkut, Mehmet Esref Kabalar
PMID: 23139003  doi: 10.5505/tjtes.2012.87059  Pages 344 - 346
In this case, we report a vascular malformation with high flow pattern complicated with trauma. A postoperative histopathology examination confirmed an arterio-venous malformation in specimens of surgical excision material. In our opinion, posttraumatic progression of a vascular malformation is an emergency and requires an urgent evaluation with surgery at any localization of the body.

13. Cerebral infarction caused by traumatic carotid artery dissection
Ayşegül Bayır, Demet Aydoğdu Kıreşi, Ali Söylemez, Osman Demirci
PMID: 23139004  doi: 10.5505/tjtes.2012.66900  Pages 347 - 350
Traumatic carotid artery dissection, if not diagnosed and treated early, is a serious problem with permanent neurological deficit and a high mortality rate of up to 40%. We present a case with delayed diagnosis of traumatic carotid artery dissection in a 21-year-old female. While there were no ischemic infarct findings on the admission cerebral computerized tomography (CT), such findings were observed on two cerebral CTs taken because of the left hemiplegia noticed seven days later when the patient regained consciousness. The patient was referred to our emergency service, and definitive diagnosis was achieved with arterial Doppler ultrasonography, cerebral magnetic resonance imaging (MRI), diffusion MRI, and MR angiography. We did not consider invasive treatment since the neurological damage was permanent and dissection grade was IV according to angiography findings. The case was discharged within a week and physiotherapy was advised. Despite the advances in diagnostic methods, diagnosis of traumatic carotid artery dissection is still missed or delayed, as in the case presented here. Early diagnosis can ameliorate permanent neurological damage or even prevent it. However, the vital factors for early diagnosis are the obtained anamnesis leading to appropriate radiological examinations, detailed physical examination and high clinical suspicion.

14. Ileus due to Meckel’s diverticulum: case reports
Selim Sözen, Ömer Topuz, Mustafa Tükenmez, Ömer Fazıl Bilgin, Yunus Dönder
PMID: 23139005  doi: 10.5505/tjtes.2012.06887  Pages 351 - 354
Meckel’s diverticulum is the most common congenital anomaly of the small intestine, with an estimated incidence of approximately 1-3% in the general population. Intestinal obstruction is the most common complication in adult patients. Since accurate diagnosis before the operation is difficult, decision for surgery is delayed, and serious problems may be encountered. Here in, we present the diagnosis and management of our patients with intestinal obstruction due to Meckel’s diverticulum.

15. Bilateral asymmetric traumatic hip dislocation with bilateral acetabular fracture: case report
Ercan Olcay, Oktay Adanır, Erdem Özden, Alican Barış
PMID: 23139006  doi: 10.5505/tjtes.2012.04317  Pages 355 - 357
Bilateral traumatic hip dislocation is a very rare condition. Simultaneous anterior and posterior traumatic dislocation of both hips is even more unusual. A case report of a bilateral asymmetrical hip joint dislocation with bilateral acetabular fracture in a 28-year-old man is presented.

16. Perforation of Meckel’s diverticulum by a button battery: Report of two cases
Bülent Hayri Özokutan, Haluk Ceylan, Sefa Yapıcı, Sedat Sımsık
PMID: 23139007  doi: 10.5505/tjtes.2012.48742  Pages 358 - 360
Ingested button battery perforation of Meckel’s diverticulum is extremely rare, with only two reported cases in the recent literature. Two additional preschool children who accidentally swallowed an alkaline button battery and developed a perforated Meckel’s diverticulum are reported. Surgeons should be aware of this rare complication. Careful clinical, radiologic and laboratory monitoring of children who ingest a button battery is advisable.

17. Subcutaneous emphysema and pneumomediastinum complicating a dental procedure
İsa Döngel, Mehmet Bayram, İsmail Önder Uysal, Güven Sadi Sunam
PMID: 23139008  doi: 10.5505/tjtes.2012.26817  Pages 361 - 363
Cervicofacial emphysema and pneumomediastinum are rarely observed complications of dental interventions. The complications are associated with the use of a high-speed air-turbine dental drill. It is a potentially life-threatening condition, but the majority of cases are self-limiting and benign. We describe a patient with remarkable subcutaneous emphysema, pneumomediastinum, and partial pneumothorax after right second mandibular molar extraction. Dentists and physicians more often attribute the rapid onset of dyspnea in patients after a dental procedure to an allergic reaction to the anesthesia used during the procedure. Dentists and physicians should be aware that soft tissue emphysema can cause acute swelling of the cervicofacial region after dental procedures, which may mimic an allergic reaction.

18. Late-onset spinal accessory nerve palsy after traffic accident: case report
Tamer Tekin, Tolga Ege
PMID: 23139009  doi: 10.5505/tjtes.2012.67674  Pages 364 - 366
An injury to the spinal accessory nerve is mostly reported after surgical procedures performed in the posterior triangle of the neck. In addition, it may be caused by fractures in the jugular foramina, traumas or skull base tumors. Clinically, paralysis of the trapezius muscle leads to weakness, downward rotation of the scapulae and falling down of the shoulder girdle. A 38- year-old male with left shoulder pain, scapular deviation and weakness in the left upper extremity, whose symptoms developed over a two-year period following a traffic accident, is presented herein. In the electromyography (EMG) study, partial spinal accessory nerve palsy was detected. The patient was treated conservatively for the nerve palsy since the time elapsed rendered surgical intervention inappropriate. We report a case in which spinal accessory nerve palsy developed two years after a traffic accident. Accessory nerve injury following a traffic accident is very uncommon.