Background: Aged garlic extract (AGE) is a potent antioxidant agent with established neuroprotective effect in a cerebral ischemia. However, the potential protective effect of AGE in spinal cord injury (SCI) is still unknown.
Methods: Nineteen adult, male Wistar rats received spinal cord trauma using the clip compression method. Animals were divided into three groups. 250 mg/kg per day of AGE diluted in tap water for 15 days prior to trauma was administered to the animals in the AGE group orally by gavage. After spinal cord trauma malondialdehyde (MDA) and superoxide dismutase (SOD) levels of the AGE group were compared with the animals that control and SCI group. The animals were examined by inclined plane 24 h after the trauma. At the end of experiment, spinal cord tissue samples were harvested for pathological evaluation.
Results: Regarding tissue MDA and SOD levels after trauma, animals in AGE group demonstrated decreased MDA levels and increased SOD levels when compared with the SCI group. However, these results were no better than the control group. The AGE group demonstrated better pathological findings than the SCI group. In addition, the result regarding the functional finding was similar.
Conclusions: AGE demonstrated neuroprotective effects in SCI. Further studies with different experimental settings are required to achieve conclusive results.

Background: Because of the limitations of Glasgow Coma Scale (GCS), many scoring systems have emerged and compared with GCS. Herein, we investigated whether the Full Outline of Unresponsiveness (FOUR) score is better than GCS in predicting the morbidity and mortality of the children with head trauma.
Methods: Patients admitted to the emergency department with head trauma between 2-17 years of age who presented with altered level of consciousness were included in this study. In-hospital mortality, hospitalization more than three days, Glasgow Outcome Score (GOS) at discharge and after three months were used as the primary outcome measures.
Results: A total of 100 children were included in the study. The median age was 6 years, 69% of them were male. In-hospital mortality rate was 10%. The cut-off values for FOUR score in predicting in-hospital mortality was 9 and 7 for GCS. Area under curve (AUC) values in predicting in-hospital mortality, poor GOS (Score of 1-3) at discharge, poor GOS after 3-months are similar both for GCS and FOUR score.
Conclusion: FOUR score don’t provide a significant advantage to GCS in predicting morbidity and mortality for children with head trauma.

Objectives: - The objective of this study was to assess the value of total leukocyte count in patients presenting to the emergency department (ED) with sign and symptoms suggestive of acute appendicitis.
Methods: - Patient demographics, presenting sign, and symptoms, initials total leukocyte count and discharge diagnosis was documented retrospectively. Admitted patients were followed for surgical and clinical outcomes, and discharged patients followed up by telephonic interview.
Results: -Out of 116 eligible patients 48 patients was found to have acute appendicitis. Total Leukocyte count ≥10,000cell/mm3 yielded a sensitivity of 89.58% and a specificity of 64.71%.The positive predictive value (PPV) was 64.18%, and the negative predictive value( NPV ) was 89.80%.The positive likelihood ratio( +LR) was 2.54, and the negative likelihood ration( –LR ) was 0.16. The area under the curve (AUC) for the receiver operating characteristic( ROC) curve was 0.822, which was moderately accurate.

Conclusions: -The total leukocyte counts are helpful in the diagnosis and exclusion of acute appendicitis. The elevated leukocyte count ≥10,000cells/mm3was statistically associated with the presence of acute appendicitis. The ROC curve suggests there is value of total leukocyte counts and has sufficient sensitivity and specificity to be clinical value in the diagnosis of acute appendicitis

Objective: To evaluate the role of a normal elbow active range of movements (ROM) in predicting low fracture risk and avoiding elbow X-ray in patients with acute elbow injuries. Lack of any approved rules for this purpose led us to evaluate simple physical examination methods to predict fractures of elbow.
Methods: In this observational study, all patients with elbow injury presented to two emergency departments enrolled according to specific criteria. Patients were examined by emergency or orthopedics residents. Elbow radiographs were reviewed by a radiologist for fractures and soft tissue injuries. Results of clinical examination and radiographs were recorded for statistical analysis. Sensitivity, specificity, positive and negative predictive values were calculated.
Results: Elbow fractures were identified in 10 of 102 enrolled patients (9.8%), Nine out of 10 had limited ROM in all movements. Limited active elbow ROM in predicting elbow fracture were revealed a sensitivity of 90%, specificity of 92%, and a positive and negative predictive values of 56% and 98%, respectively. Individuals with limitation in one or two directions had no signs of fracture in the X-rays.
Conclusion: Patients with elbow injury and a limited ROM in all directions of flexion, extension, supination and pronation require further x-ray investigations.

BACKGROUND
The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments. But they do not display a linear relation to mortality. The mortality rates are significantly different between pairs of Abbreviated Injury Scale (AIS) triplets that generate the same ISS/NISS total.
METHODS
The LISS is defined as the sum of 1.7987 multiply by that 5.53 to the power of the natural logarithm by the three most severe AIS injuries regardless of body region in which then occur. LISS values were calculated for every patient in a large data set: 3,784 patients treated during a six-year period at the three Level of first-class comprehensive hospital in Affiliated Hospital of Hangzhou Normal University, China. The power of LISS to predict morality was then compared with previously calculated NISS values for the same patients in each of the data set.
RESULTS
We find that LISS is more predictive of survival as well (Receiver operating characteristic (ROC): NISS = 0.931, LISS = 0.949, P = 0.006). Moreover, LISS provides a better fit throughout its entire range of predicting (Hosmer Lemeshow statistic: NISS = 15.76, P = 0.027; LISS = 13.79, P = 0.055).
CONCLUSION
LISS should as the standard summary measure of human trauma.

75% of all trauma-related deaths are related to Thoracic Trauma. Very few penetrating cardiac trauma patients arrive at the hospital alive. Due to the high prevalence an understanding of the pathogenesis, manifestations, and management of cardiac trauma is becoming increasingly important to medical personnel.
We retrospectively reviewed the files of 169 patients with a preoperative diagnosis of vascular injury that underwent management at the Aga Khan University Hospital (AKUH) during 2001 to 2006. Out of these patients 13 had cardiovascular and cardiac injuries.
There were 23% (n=3) Cardiac injuries, two right ventricle injuries and in one both the ventricles were injured. Great vessel injuries included; Pulmonary artery (n=2), Inferior Vena cava (n=1), Left Carotid Artery (n=1), Left Subclavian Artery (n=2) and Right Subclavian Artery (n=3). 53.8% of the patients suffered from post-operative complications. The overall mortality of patients was 15.4%.
We believe that in comparison to the past the inevitable delay in the diagnosis lead to unsuccessful thoracotomies, late transfers to the operating room and physiological deterioration of the patients. As the incidence of trauma is increasing worldwide it is essential for surgeons to be prepared to handle cardiovascular and cardiac trauma injuries immediately, as delay can adversely affect the outcome in terms of both morbidity and mortality.

Background: In this study, we evaluated the clinical and radiological results of the distal tibial epiphyseal fractures in children treated with surgery.
Methods: We evaluated 59 patients (33 boys and 26 girls) retrospectively. Physeal fractures were classified according to the Salter-Harris classification; 4 fractures were in type I, 22 were in type II, 29 were in type III and remaining 4 fractures were in type IV. Closed reduction and internal fixation was performed in 29 patients while open reduction and internal fixation were performed in 30 patients. Mean age at the time of trauma was 10.9 years (6-14). Patients were evaluated by AOFAS score.
Results: Patients were operated in mean 3.8 hours time (3-72). Fixation was performed with K-wire in 50 patients, with screw in 6 patients, and with both K-wire and screw in 3 patients. Mean follow-up time was 71.7 months (12-149). Complications like premature physeal arrest, limb length inequality, angular deformity, infection, nonunion, and osteonecroses were not observed in any patients. Mean AOFAS score was 86.6 (65-100) at last follow-up.
Conclusion: Successful results with fewer complications could be obtained in ankle ephyseal fractures by early management through adequate reduction and stabilized fixation using maximum two reduction maneuvers.

Objective: To determine risk factors and the impact on treatment cost of infection, for patients with isolated head injury.
Materials and Methods: Data acquired from 299 patients with isolated head trauma hospitalized for more than 72 hours at Trakya University Medical Faculty Hospital between years 2001-2007, were evaluated retrospectively. Data including age, gender, initial neurological examination, radiological findings, duration of hospitalization, need for surgery, cost of infection treatment, total cost of care and outcome scores were determined. Two groups divided according to the development of infection are compared for risk factors and the impact of infection on the cost of treatment.
Results: On the group of patients with infection the mean Glasgow Coma Scale value at delivery was lower; anisocoria, light reflex loss, lateralized deficit, skull base fracture, subdural hematoma, cerebral edema findings were more frequent; a four times longer hospital stay, a ten times higher total cost and a significantly increased mortality rate have been found. For the patients with light head injury, on the group of patients with infection the mean age has found to be higher.
Conclusion: For patients with isolated head injury, there are some risk factors for the development of infection which increases the hospitalization time, the total cost of care and the mortality rates.

Background: Necrotizing fasciitis (NF) is characterized by rapidly spreading necrosis of soft tissue and fascia which can be fatal if it'is not managed properly.
Objective: The aim was discussing morbidity-mortality in NF patients to evaluate early diagnosis and reconstructive options.
Patients and Methods: 68 NF patients who were treated between 2000-2010 were assessed retrospectively for age, sex, localization, time elapsed between onset of symptoms, diagnosis, predisposing factors, characteristics of tissue defects, isolated microbiological agents, surgery, complications,and mortality rate. The mean age of 59 male, 9 female patients was 55.9 years.
Results: Of the 52 patients (76.4%) comorbidities such as diabetes, obesity, smoking, and corticosteroid use were present. The most common localization was perineum-inguinal region (70.5%). Time elapsed between onset of symptoms and diagnosis was 6.2 days. The mean size of tissue defect after debridement was 54.2cm2. The most common isolated microbiological agents were Escherichia coli, Enterococci,and Ps.aeruginosa. The most common reconstructive procedures were fasciocutaneous flap+STSG (57.3%). No major complication was observed except wound dehiscence and partial graft loss. The mortality rate was 13.2%.
Conclusion: The early diagnosis of NF may be lifesaving. When NF is suspected, early debridement should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.

Objective: Burn injuries are a huge public health issue for children. The aim of this study was to determine demographic, etiologic, burn wound infections and clinical trends of 2346 pediatric burns patients during fifteen years in the southeast provinces of Turkey, and create criteria for a pediatric burn prevention program.
Patients and method: Age, gender, degree of burn, demographics, etiology of burn, burn wound infections, and length of hospital stay, the total body surface area percentage and outcome data of 2346 children who admitted to the Burn Center of Dicle University between January 1994 and December 2008 were recorde.
Results: The average age of 2346 pediatric burn patients were 4.42±3.56 years. There were 1,064 (45.3%) males and 1,282 (54.7%) females. The highest incidence appeared in the 0–4 years group as 68.5%. Burn type of cases was 1828 (77.9 %) scalding burns, 332 (14.2%) flame burns and 186 (7.9%) electrical burns. The mean of total body surface area burn was 21.5±12.6 %. The mean of Length of hospitalization was 12.87±10.02 days.
Conclusion: In our study, the epidemiological features of pediatric burns are different from the other region. Burn prevention education should train the for pediatric burn prevention.

Background: The aim of this study was to retrospectively evaluate sexual injury treated in our clinic.
Methods: We evaluated results of 31 patients with sexual injury during consensual sexual activity, referred to emergency department between January 2004-December 2010. Patients age, etiology of injury, time passed after trauma, physical/operative examination results, type of treatment, duration of hospitalization, and postoperative complications were investigated.
Results: Of 31 patients, 14 were women and 17 men. The mean age of the patients was 31.97±11.64years. Sexual injury was occurred in women as vaginal laceration, in man penile fracture. All of the cases were treated with early surgical repair. Such vaginal injuries were formed in virginal girls during first sexual intercourse. Cases were usually complained with vaginal pain and then bleeding during sexual activity. The commonest site of injury is posterior vaginal fornix. Etiology of penile fracture was sexual intercourse and masturbation. Sudden pain in penis, edema, color change, sudden detumescence were main complaints. Of patients 11 had right, 5 had left and one had both tunical ruptures, with defects of 0.5-3cm in length. Patient with bilateral injury had accompanying incomplete urethral rupture.
Conclusion: Consequently, sexual injury can effectively be diagnosed based on history and physical examination, and may be treated with successfully by early surgical procedure.

Acute epidural hematomas remain among the most common causes of mortality and disability resulting from traumatic brain injury. In the literature, there are cases about the resolution and recurrence of spinal epidural hematomas. This case is characterized by the rapid disappearance and re-formation of an acute cranial epidural hematoma (EDH) associated with no any overlying skull fracture. Various authors have reported resolution of EDH s managed conservatively, but rapid resolution and recurrence of cranial EDH was not reported before.

The increased use of central venous catheters in the modern medical practice has brought a proportional increase in the number of cases of iatrogenic vascular injuries. Concerning the subclavian artery, the site of the lesion associated with the vessel size demand urgent and effective treatment in order to obtain favorable prognosis. It has been a common practice for a long time to consider this type of lesion as a surgical emergency. Nevertheless, emerging endovascular interventional procedures appear to offer an alternative that is effective and safe as well.
We hereby report 3 cases of suclavian artery injury, which were repaired by endovascular approach with the placement of a cover stent. Hypovolemic shock (demonstrated in two patients) as well as brachial plexus palsy due to pseudoaneurysm of the subclavian artery (presented in another patient) were successfully managed by percutaneous brachial (in two patients) or right femoral (in the patient with the pseudoaneurysm) approach and placement of balloon expandable covered stents (4-9 mm x 38 mm). No procedure-related complications were observed. Short-term follow up results in two of three patients are quite satisfactory concerning patency.

Background: Explosives create and energize particles that act as projectiles prone to further fragmentation, creating secondary missiles in the body, and may result in secondary injuries. We report this process for abdominal injuries after fascial penetration in the military setting.
Patients and Methods: Observational case series study. Local wound exploration was performed in conscious patients who sustained abdominal wall injuries. An intraperitoneal injury was assumed in those with a full thickness fascial defect, and laparotomy was performed.
Results: Twenty patients met the study eligibility criteria. Out of those 20 patients, 12 had negative wound exploration and were excluded from the study, while abdominal organ injuries were found in eight (40%) patients. During laparotomy, projectile-induced injuries in a sprayed distribution were found in three (38%) of these patients. Injuries were far from the predictable trajectory. The overall mean number of peritoneal defects was 1.7, and a mean of 6.8 intra-abdominal injuries for each peritoneal defect were found when through and through injuries were excluded.
Conclusions: Despite a single peritoneal defect, there may be multiple intraperitoneal injuries due to further fragmentation of the projectile. Under mass casualties, wound exploration with a full thickness fascial defect could serve as an indicator of possible intra-abdominal injuries, indicating exploratory laparotomy.

Introduction: Traumatic pulmonary pseudocysts are cavitary lesions that rarely seen after blunt thoracic traumas.
Case reports: Two male patients who diagnosed with cystic lesions in left lung after trauma were followed-up in our clinic with diagnosis of traumatic pulmonary pseudocyst. Due to increase in cyst dimensions and wall tension which seen control thorax tomography, surgical intervention decision was taken for both cases. The first case was underwent cystotomy and capitonage via thoracotomy, and discharged without any complication. However, the second case was lost due to cardiac arrest during the operative preparations.
Conclusion: The thorax tomography is an important method in diagnosis and radiological follow-up of traumatic pulmonary pseudocysts. The surgery option should always be remembered for the ones that show progression during follow-up.

Isolated cricoid fracture is rarely encountered at clinic follow-up. A 71 years old female patient was referred to emergency service with complaints of fall from height and the urgent tracheotomy was performed due to her dyspnea. At examination, isolated fractures of the cricoid cartilage were identified. With the conservative approach, the patient remained symptom-free and was discharged after decannulation.

Carotico-jugular fistulae are known complications of gunshot injuries and stab wounds, but they can be iatrogenic. Untreated, these lesions may lead to heart failure, endocarditis, cerebral embolization. We present the CT-angiographic view and its value for treatment strategy in carotico-jugular fistula. 35 year old man was referred in the second hour of a ballistic injury on the right side of the neck. Physical examination revealed hematoma, exit hole and thrill on the right sternocleidomatoid muscle. Diagnosis was confirmed with doppler ultrasound and CT-angiography. Surgical interposition with 6 mm PTFE for carotid artery and with 12 mm dacron for internal jugular vein was performed. Fistulous tract was ligated. In the postoperative 6th month doppler ultrasound was normal and the patient was on antiaggregant therapy and healthy.

The intermaxillary fixation (IMF) is an essential guide to optimize the reduction and fixation of most facial fractures associated with occlusal alterations. To allow IMF, the nasotracheal intubation is used in most cases. When the nasotracheal intubation is not possible, a tracheotomy may be indicated, but this carries significant morbitidy. The submental endotracheal intubation allows IMF to be used without resorting to nasal intubation or tracheostomy, and it does not interfere on reduction and fixation of fractures in most cases. The purpose of this article is to describe indications, counter indications and the technique of the submental endotracheal intubation as performed in our service.