Background: Blunt chest trauma and its complications are common clinical problems in emergency medicine. We used a rat model for to investigate the evolution thoracic trauma role of inflammation, apoptosis and bacterial translocation in multiple traumas.
Materials and Methods: 90 Wistar rats were divided nine groups. Rats were performed a standardized blunt thoracic and/or head trauma and sacrified 24, 48 hours after the trauma. Multiple specimens from different organs and blood samples were collected and quantitatively cultured for aerobic organisms. Interleukins, TNF-α, MCP-1 levels were assessed in sera and apoptosis in lungs.
Results: Levels of interleukins, TNF-α and MCP-1 in all trauma groups significantly increased compared to control groups (p=0,001). Levels of apoptotic cell in head and thoracic trauma (HTT) groups significantly increased compared to respective Control group (p=0,009). Light microscopic evaluating of all groups, damage significantly increased in HTT groups compared to C group. The incidence of bacterial translocation was significantly higher in HTT group (p=0,003).
Conclusions: Multitude of inflammatory mediators is activated in multiple traumas including blunt thoracic trauma and bacterial translocation and apoptotic process to be formed. We believe plays major role of thoracic truma in post traumatic bacterial tranlocation inflammation and apoptozis after the multipl trauma.

Objective
To evaluate the effect of various fluids on uncontrolled hemorrhagic shock (UHS).
BACKGROUND
There is controversy over appropriate dose and types of fluids in UHS. This study evaluated the effects of hypertonic saline (HTS), normal saline (NS) and no fluid resuscitation (NFR) during UHS.
METHODS
Thirty goats were underwent right leg ablation and randomized to NFR, HTS and NS. The selected features of the UHS, including Hemoglobin (HR), Heart Rate (HR), Blood Loss (BL), Mean Arterial Pressure (MAP), Bleeding Time (BT) and pH were analyzed.
RESULTS
All the goats receiving HTS died within 60 minutes; 4 in NS and 1 in NFR died in 120 minutes. The NFR group had a higher HG than NS and HTS groups at the end of trial. BL in HTS was more than the other two groups (p<0.05). MAP in NFR and NS groups was higher than HTS (p<0.05). PH was higher in the NFR group compared with the other two groups (p<0.05).
CONCLUSION:
Study showed that HTS is not suitable for UHS when compared with NFR and NS. NFR is superior to HTS and NS in all features of UHS. NS or HTS fluids may worsen the condition in the pre-hospital field until surgical repair can be accomplished.

BACKGROUND: To investigate the effects of curcumin, an antioxidant and anti-inflammatory agent, on free oxygen radicals and lipid peroxidation in the experimental sepsis model, as well as the role of curcumin in preventing hepatorenal tissue damage caused by sepsis.
METHODS: The rats were randomly divided into three groups (n=8) as follows: control group (group 1); sepsis group (group 2); and sepsis + curcumin group (group 3). Sepsis was created using the cecal ligation and perforation (CLP) method. Curcumin was administered via the intraperitoneal route (200 mg/kg) in 2 equal doses just after the perforation and at the post-perforation 12th hour
RESULTS: Serum TNF-α and IL-1β, and tissue MDA and MPO values were higher, whereas tissue GSH and Na+/K+-ATPase values were lower in group 2 as compared to group 1. These values in group 3 were the inverse of those in group 2. As compared to group 1, histopathological evaluation of group 2 showed damaged hepatocytes, glomeruli and tubules, whereas the damage was significantly reduced in group 3 as compared to group 2.
CONCLUSION: The strong antioxidant and anti-inflammatory effects of curcumin against potential hepatorenal damage was shown using an experimental sepsis model in rats.

Background
A “degloving injury” is referred to as seperation of cutaneous tissue from the deeper structures of the body. Although many methods have been defined to reform the tissue integrity; defatting and readaptation of the avulsed flap still comprises one of the most effective methods.
Methods
In the time interval between 2000-2012, we have treated a total of 9 patients with avulsed extremities with defatting and readaptation of the same flap. The fat compartment of the flaps were removed and the skin was meshed. The patients have been followed for 12 months in average (range: 8-18 months).
Results
Total closure of the defect and healing could be achieved in 7 patients. Although 30% of the total surface area of the graft was lost in 1 patient, and 10% in another, total epithelialization could be achieved later with secondary grafting.
Conclusion
Defatting, meshing and readaptation of the same flap to its original site is still a valuable option for avulsion injuries. The main reason is relatively the ease of the procedure, shorter operative times, and usability of the procedure by general surgeons. This might be particularly important in places where a reconstructive plastic surgeon is not available.

Introduction:
The aim of this study is to evaluate functional outcome and quality of life using statistically validated tools.
Methods:
Patients were called and asked questions from the Short Form 36 (SF-36), the Disability of the Arm, Shoulder and Hand questionnaire (DASH), a pain scale and an additional question on their satisfaction with the surgery.
Results:
A total of 33 patients were operated by a single surgeon (MI) between 1997 and 2010 at Neurosurgery Department of Istanbul School of Medicine. Three of these patients refused to participate and the other three patients were excluded, leaving 27 patients, with an average follow-up of 79,6 months, for review. Most common cause of TBPI was motor vehicle accidents. 14 patients had isolated supraclavicular and three patients had infraclavicular injuries. Remaining 10 patients’ injuries were both supra- and infraclavicular. Avulsion was encountered in three patients. The patients who were operated in the first six months after trauma represented significantly better scores in DASH, SF-36 and pain scale.
Conclusions:
Statistically validated tests like DASH, SF-36 questionnaires are valuable tools for evaluating the TBPI patients. Specialised centers dealing with TBPI surgery may use these tests pre- and postoperatively which lead to objective personalised evaluation of patients’ subjective symptoms.

Objective: Falls from height are placed on the top of trauma cases presenting to emergency departments and are causes of important mortality and morbidity. We aimed to investigate in the present study the factors effective on mortality in falls from height.
Methods: Data belonging to 2252 trauma patients who presented to Dicle University Emergency Service due to falling from height in Southeastern Anatolia region, between January 2005 and December 2008, were retrospectively analyzed. We analyzed parameters which were considered effective on mortality including; month of fall, age, gender, etiology, place of fall, ground of fall, height of fall, intubation, hypotension, tachycardia, neck, head, thoracal, abdominal, pelvic, extremity injuries, Glasgow Coma Score(GCS), Injury Severity Score(ISS), and Revised Trauma Score(RTS).
Results: The numbers of males and females were 1435(63.7%) and 817(36.3%), respectively. Two thousand thirty-one(94.6%) patients survived whereas 121(5.4%) died. The mean age of surviving patients was 15,55±18,60 years, and the mean height was 3.09 meters while patients who died had a mean age of 29,59±28,93 years and a mean height of fall of 6,61±5,73 meters(P<0.001).
Conclusion: The mean fatal height of fall in falls from height is 6.61 m. Age, suicide, height of fall, ground of fall, place of fall; head, thoracic, and abdominal trauma are factors affecting mortality.

Firearm injuries (FI) are the most common cause of death among military personnel. In this study, postmortem examination and autopsy records of deaths that resulting from firearm injuries were examined retrospectively in the Department of Forensic Medicine of Gulhane Military Medical Academy between 1993-2010. We determined the characteristics of these 153 firearm deaths which comprised (%36.6) of all medicolegal autopsies. There were 152 men (99.3 %) and 1 female (0.7 %). The mean age of the cases was 23.1 years (4.7; range, 20-43 years). Cases were examined according to the manner of death and it is determined that 41.8% of cases were suicide, 39.9% was homicide.
The most common sites for the firearm entrance wounds were in head and neck region of 109 (71.2%) of victims, in chest of 26 (17%), in abdomen of 14 (9.2%). Type of firearm was not clear in most cases. As a conclusion, We think that keeping the forensic and medical records complete and properly lead to conclude in rapid and accurate of the legal process and to reflect more accurate and objective results in retrospective research that will be made in the future.

Background: The purpose of this study is to introduce a hinge-fixator technique for the treatment of open tibial fractures, which has advantages in application and also in the follow up period.
Method: The technique was used in 14 open tibia fractures of 14 adult patients. Using this method, the anatomic reduction achieved initially and temporary stability were obtained on the hinge-fixator, and after fixator applications were completed. Patients’ radiological and clinical results were evaluated according to the Paley’s criteria at the time of last follow-up.
Results: Patients were followed up 5.4 years. According to Paley, two patients had good and 12 patients had excellent radiological results and 13 patients had excellent and one patient had good functional results.
Conclusion: The hinge-fixator technique is a fast and easy method with a shorter operation time, lesser radiation exposure, shorter hospital stay, longer follow up visit intervals, and makes the treatment period more comfortable.
Key words: tibia fracture, circular fixator, hinge technique

Background: Unstable intertrochanteric fractures remain a challenging problem in elderly individuals due to high failure rates associated with internal fixation. Hemiarthroplasty is one of the treatment choice for intertrochanteric femur fractures in elderly patients. The aim of the present study was to compare the reliability of cementless and cemented hemiarthroplasty for unstable intertrochanteric femur fractures in elderly patients.
Methods: Elderly patients with an AO type 31-A2 intertrochanteric femur fracture were treated with cemented (n= 40) or cementless (n=46) hemiarthroplasty. Duration of surgery, amount of blood loss and blood transfusion, Harris hip scores, rate of loosening of the femoral component, duration of hospital stay after surgery and mortality rates were recorded.
Results: There were no significant differences between the groups regarding the hospital stay, Harris hip scores and blood transfusion, implant loosening and follow-up mortality rates. Walking ability was better in the cemented group in the early follow-up period. Duration of surgery, amount of blood loss and perioperative mortality rates were significantly lower in the cementless group than that of the cemented group.
Conclusion: Cementless hemiarthroplasty is a reliable treatment choice for unstable intertrochanteric femur fractures in elderly with early mobilization, acceptable functional results, low implant loosening rates, shorter surgery time, lesser blood loss and lower perioperative mortality rate.

Purpose: Appendicitis is the most common form of surgical abdominal pain in children. This study investigates the effects of age, sex, seasonal, and familialfactors on the histopathology of appendectomies.
Method: 588 patients who have been operated between September 2009 and 2011 for acute appendicitis were included in this study. The patients were classified under three groupsbased on their histopathological results: acute, perforated and negative appendectomy. This study investigates the effectiveness of age, sex, seasonal, and familial factors on these groups.
Results: The patients’ mean age was 11.8±3.26 years (1-16 years). Results from the patient analysis revealed that appendicitis was 2.41 times more common after 10 years old. Appendicitis was found to be 4.63 times more common among men than women. Negative appendectomy was encountered more commonly after 10 years of age. The proportional effect of appendicitis on family history and seasons was established, but it was found to be statistically insignificant (p>0.05).
Conclusion: Age and sex should be considered when planning appendicitis surgeries because an accurate diagnosis is correlated with age and sex. Besides, the histopathology of appendicitis is affected by familial and environmental factors.

Background: Increased intraabdominal pressure (IAP) can cause progressive multi-organ failure. Trauma, mechanical bowel obstruction (MBO), abdominal wall defects (AWD) and fluid resuscitation in septic shock are high risk diseases for increasing IAP in children. Can we treat these diseases under IAP measurement more safely?

Methods: A prospective study was performed between December 2009 and October 2010. Intravesical pressure (IVP) measurement was used to determine IAP. Intra abdominal hypertension (IAP>12 mmHg) and abdominal compartment syndrome (IAP>15 mmHg + a new organ dysfunction) were used as thresholds in decision making.

Results: IVP monitoring was used in patients with abdominal trauma (14), AWD (8), fluid resuscitation in septic shock (7) and MBO (6). ACS was determined in 14% of trauma patients and required surgery. IAH/ACS was seen in 38% of AWD and closure strategy was arranged. IAH was seen in 43% of patients during the fluid resuscitationin septic shock and decompressive interventions were performed. IAH/ACS was seen in 50 % of MBO patients and only these patients underwent surgery.

Conclusion: IVP measurement may be a useful adjunct to identify and determine the candidates for surgical treatment in trauma and MBO. Similarly, closure of abdominal wall defects and fluid resuscitation in septic shock may be performed and adjusted with regular IVP monitoring.

We describe a 62 year old patient who presented with acute anterior ischemia and afterwords developed iliopsoas hematoma. The patient was treated surgically due to rapid progresion and femoral neuropathy, and iliopsoas muscle rupture was diagnosed intraoperatively. The rupture was related to the external electrical defibrillation the patient had on admission. This is a rare case, and we hope the report would help to raise the physicians awarenes regarding this complication and treatment.

Pelvic fractures are traumas with high mortality. The management of major pelvic injuries is still one of the most important problems in modern trauma care. A 39-year-old male patient was brought to the emergency department after a 500-kg load fell on him. His general condition was average and vital findings were unstable. Pelvic tomography revealed fractures in the bone structures, thickening secondary to hematoma in both iliopsoas muscles and hemorrhage-related active extravasation in the left internal iliac trace.The patient’s hemodynamics worsened despite fluid and blood replacement, and angiographic embolization was scheduled and bilateral embolization of the iliac artery was performed. Control angiography revealed that full embolization had been established. The patient was sent for monitoring in intensive care, but was lost on the third day of monitoring due to acute kidney failure, disseminated intravascular coagulation and multi-organ failure. Angiographic embolization is a technique that yields successful results in term of hemorrhage control in pelvic trauma, but that can also involve complications such as ischemia and necrosis.

Background: Various kinds of foreign bodies causing appendicitis have been reported. However, a needle located in the appendix is very rare, especially in adults.
Case presentation: We report an unusual case of a twenty years old man who had ingested a needle ten days before and presented with signs and symptoms of acute abdomen. Abdominal CT scan revealed acute appandisitis so the patient was successfully treated with laparoscopic surgical intervention.
Conclusion: In cases of foreign body in the gastrointestinal tract which can not be removed endoscopically, and followed up with conservative treatment, the emergence of non-specific symptoms may be the early symptoms of acute abdomen.

Background: Paraduodenal hernia, as the most common type of internal herniation, is a rare etiology for acute intestinal obstruction. Any delay in diagnosis and surgical intervention may be important for high morbidity and mortality.
Methods: This report presents a case of left paraduodenal hernia causing an acute intestinal obstruction.
Results: A 43-year old male patient admitted with a diagnosis of acute intestinal obstruction. Left paraduodenal hernia was diagnosed by computed tomography findings of an encapsulated cluster of dilated small bowel loops occupying mainly left upper quadrant between stomach and pancreas, and engorged and displaced vascular pedicle at orifice of hernia. On exploration, dilated proximal jejunal segments were found in left paraduodenal fossa which was enclosed in a hernia sac. After reducing intestinal segments to abdominal cavity, orifice of hernia sac was closed by suturing to retroperitoneum.
Conclusion: Paraduodenal hernia should be thought as a possible etiology for acute intestinal obstruction because of its unremarkable presentation. Physicians should be familiar to demonstrative imaging findings of paraduodenal hernia taken by computed tomography. Early surgical intervention is very important to avoid morbidity and mortality associated with this condition.

Posttraumatic pulmonary arteriovenous fistulea is a rare complication of generally penetrating type of injuries. It can be assymptomatic for years and can be subsequently diagnosed. We present a case of pulmonary arteriovenous fistulea related to penetrating thorax trauma before 6 years which was occluded with septal occluder device. Regular use of CT or conventional catheter pulmonary angiography following penetrating thorax trauma cases is essential for diagnose of pulmonary arteriovenous fistulea which can became symptomatic in the future. New generation occluder devices make transcatheter approach an alternative to surgery in selected cases for closure of high pressure and large defects.

Injury and death ratio is high in patients with chest gunshot wounds. But it is so rare to meet at literature that the subject of outcomes for foreign bodies which are left in thorax without any pathology. At this study, we present a case of removal of steel shot with mediastinoscopy which migration was determined through the mediastinum and the risk that may cause tracheal fistula.