p-ISSN: 1306-696x | e-ISSN: 1307-7945
Volume : 19 Supp : 6 Year : 2021

Quick Search




Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 19 (6)
Volume: 19  Issue: 6 - November 2013
RESEARCH ARTICLE
1.The role of thoracic trauma in inflammatory responses, apoptosis and bacterial translocation following multipl trauma
Erhan Ayan, Oguz Koksel, Ayşe Polat, Lülüfer Tamer, Gülden Ersöz, Murat Demir, Hatice Yıldırım Yaroğlu, Alper Akdağ, Ali Özdülger, Sema Erden
PMID: 24347207  doi: 10.5505/tjtes.2013.29660  Pages 491 - 499
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.

2.Hypertonic, Normal Saline or Neither: Which One is better in Uncontrolled Hemorrhagic Shock? Experimental Study on Goat
Morteza Saeedi, houman hajseyedjavadi, samad shamsvahdati, vahid eslami, mohamad mokhtarpour, mahdi momeni, mohamad farnia, Nima Hafezi Nejad
PMID: 24347208  doi: 10.5505/tjtes.2013.31799  Pages 500 - 506
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.

3.Antioxidant and Anti-inflammatory Effects of Curcumin Against Hepatorenal Oxidative Injury in the Experimental Sepsis Model Created in Rats
Gülay Yılmaz Savcun, Erkan Özkan, Ender Dulundu, Ümit Topaloğlu, Ahmet Özer Şehirli, Olgu Enis Tok, Feriha Ercan, Göksel Şener
PMID: 24347209  doi: 10.5505/tjtes.2013.76390  Pages 507 - 515
AMAÇ: Deneysel sepsis modelinde antioksidan ve antiinflamatuvar bir ajan olan curcuminin serbest oksijen radikalleri, lipid peroksidasyonu üzerine olan etkileri ve sepsisin neden olduğu karaciğer ve böbrek doku hasarını önlemedeki rolü araştırıldı.
GEREÇ VE YÖNTEM: Ratlar rastgele 8’erli 3 gruba ayrıldı. Ratlarda sepsis çekum ligasyon perforasyon (ÇLP) yöntemiyle oluşturuldu. Gruplar, Kontrol grubu ( Grup 1), sepsis grubu ( Grup 2 ), sepsis + curcumin grubu ( Grup 3 ) şeklinde oluşturuldu. Curcumin intraperitoneal (i.p) yoldan (200mg/kg) iki eşit dozda çekum perforasyonundan sonra 0. ve 12.saatlerde verildi.
BULGULAR: Gruplar karşılaştırıldığında grup 2’de grup 1’e göre serum TNF-α, IL-1ß değerleri, doku MDA,MPO değerleri yüksek, doku GSH, Na⁺-K⁺ ATP az değerleri ise düşük bulunmuştur. Grup 3’te ise grup 2’ye göre bu değerler tersine değişmiştir. Grup 2’de grup 1’e göre histopatolojik değerlendirmede hasarlı hepatosit, glomerulus ve tubulus yapısı görülürken grup 3’te grup 2’ye göre bu hasarların belirgin şekilde azaldığı görüldü.
SONUÇ: Ratlarda deneysel sepsis modeli sonucu karaciğer ve böbrek dokusunda oluşabilecek doku hasarına karşı curcuminin güçlü antioksidan ve antiinflamatuvar etkisi gösterildi.
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.

CLINICAL ARTICLE
4.Management of the soft tissue extremity degloving injuries with the full-thickness grafts obtained from the avulsed flap
Özgür Pilancı, Funda Aköz Saydam, Karaca Basaran, Aslı Datlı, Erdem Güven
PMID: 24347210  doi: 10.5505/tjtes.2013.64928  Pages 516 - 520
Amaç
Deri ve subkutan dokunun muskulofasyal tabaka sağlam kalacak şekilde derindeki yapılardan ayrılmasına avülzyon (degloving) yaralanması denir. Doku bütünlüğünün yeniden sağlanması için birçok yöntem tanımlanmış olsa da, avülze flebin yağ dokudan arındırılarak yeniden yerine adaptasyonu hala en etkili yöntemlerden birisidir.
Gereç ve yöntem
Kliniğimizde 2000-2012 yilları arasında ekstremite avülzyon yaralanması mevcut 9 hastada avülze flebi yağ dokudan arındırdık. Grefte meshler açarak yeniden yerine adapte ettik. Hastalar ortalama 12 ay takip edildi. (Dağılım: 8-18 ay)
Bulgular
7 hastada tamama yakın iyileşme elde ettik.Bir hastada greftin %30’unda, diğerinde ise %10’a yakın kayıp gözlemledik. Fakat bu hastalar sekonder greftlemelerle epitelizasyon sağlanarak sorunsuz tedavi edildi.
Sonuç
Avülzyon yaralanmalarında yağ doku uzaklaştırılarak, greftin meshlenip eski yerine adaptasyonu hala değerini korumaktadır. Bunun başlıca sebebi, yöntemin genel cerrahlar tarafından da kısa sürede kolaylıkla uygulanabilir olmasıdır. Bu da plastik cerrahlara ulaşmanın zor olduğu durumlarda önem arz edebilir.
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.

5.Functional Outcomes after Treatment of Traumatic Brachial Plexus Injuries: Clinical Study
Yavuz Aras, Aydın Aydoseli, Pulat Akın Sabancı, Mehmet Osman Akçakaya, Görkem Alkır, Murat İmer
PMID: 24347211  doi: 10.5505/tjtes.2013.48107  Pages 521 - 528
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.

6.Factors Affecting Mortality In Falls From Height
Mustafa İçer, Cahfer Güloğlu, Murat Orak, Mehmet Üstündağ
PMID: 24347212  doi: 10.5505/tjtes.2013.77535  Pages 529 - 535
ABSTRACT
Amaç: Acil servislere başvuran travma hastaları içinde yüksekten düşmeler ilk sırada yer alır ve önemli oranlarda morbidite ve mortaliteye neden olur. Çalışmamızda yüksekten düşmelerde mortalite üzerine etkili faktörleri araştırmayı amaçladık.
Methods: Bu çalışmada Ocak 2005 ile Aralık 2008 tarihleri arasında Güneydoğu Anadolu bölgesinde yüksekten düşme ile gelen ve Dicle Üniversitesi Hastanesi Acil Servisinde tedavi edilen 2252 travmalı hastaya ait veriler geriye dönük olarak analiz edildi. Mortalite üzerinde etkili olabileceğini düşündüğümüz; düşmenin olduğu ay, yaş, cinsiyet, düşme nedeni, düşme yeri, düşme zemini, düşme yüksekliği, entübasyon, hipotansiyon, taşikardi, baş boyun, göğüs, karın, pelvis, ekstremite yaralanması, Glasgow Koma Skalası (GKS), Injury Severity Score (ISS) ve Revize Travma Skoru (RTS)’nu içeren parametreleri inceledik.
Bulgular: Çalışmaya alınan hastaların 1435 (%63,7)’i erkek, 817 (%36,3)’i kadındı. Hastaların 2131 (%94,6)’i yaşadı, 121 (%5,4)’i öldü. Yaşayan hastaların yaş ortalaması 15,55±18,60 yıl, düşme yüksekliği ortalaması 3,09 metre iken, ölen hastaların yaş ortalaması 29,59±28,93 yıl, düşme yüksekliği ortalaması 6,61±5,73 metre idi (P<0,001).
Sonuç: Yüksekten düşmelerde ölümcül düşme yüksekliği ortalaması 6,61 m. dir. Yaş, intihar, düşme yüksekliği, düşme zemini, düşme yeri, kafa travması, göğüs travması ve batın travması mortaliteyi etkileyen faktörlerdir.
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.

7.An Analysis of Firearms-Related Deaths Between 1993-2010: A Retrospective Study
Mehmet Toygar, Türker Türker, Murat Eroğlu, Ümit Kaldırım, Yavuz Poyrazoğlu, Yusuf Emrah Eyi, Murat Durusu, Mehmet Eryılmaz
PMID: 24347213  doi: 10.5505/tjtes.2013.70120  Pages 536 - 542
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.

8.A new application technique of circular fixator for the treatment of open tibial fractures: Circular fixator-hinge technique
Bilal Demir, Sami Sökücü, Erdem Özden, Umut Yavuz, Serda Duman, Yavuz Selim Kabukçuoğlu
PMID: 24347214  doi: 10.5505/tjtes.2013.47936  Pages 543 - 547
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

9.Cemented calcar replacement versus cementless hemiarthroplasty for unstable intertrochanteric femur fractures in elderly.
Deniz Cankaya, Bülent Ozkurt, Abdullah Yalcin Tabak
PMID: 24347215  doi: 10.5505/tjtes.2013.57615  Pages 548 - 553
AMAÇ: Anstabil intertrokanterik femur kırıklarının yaşlılardaki tedavisi, içten tespitteki yüksek başarısızlık oranları nedeniyle halen üzerinde görüş birliği olmayan bir sorundur. Hemiartroplasti, yaşlı hastalarda tercih edilen tedavi seçeneklerinden biridir. Bu çalışmanın amacı; yaşlı hastalarda görülen anstabil intertrokanterik femur kırıkları için, çimentosuz ve çimentolu parsiyel artroplastilerin güvenilirliklerini karşılaştırmaktır.
GEREÇ VE YÖNTEM: 2008 ile 2010 yılları arasında; AO sınıflamasına göre 31-A2 tipi intertrokanterik femur kırığı olan 86 yaşlı hastaya, çimentosuz (n=40) ve çimentolu (n=46) parsiyel artroplasti uygulandı. Hastaların; cerrahi süreleri, kan kayıpları, kan transfüzyonları, Harris kalça skorları, femoral komponentlerin gevşemeleri, hastanede kalma süreleri ve ölüm oranları kaydedildi.
BULGULAR: Gruplar arasında, kan transfüzyonu, hastanede kalış süresi, implant gevşeme oranları, harris kalça skorları ve takiplerdeki ölüm oranları açısından fark yoktu. Yürüme yeterliliği erken dönemde çimentolu grupta daha iyiydi. Cerrahi zamanı, kan kaybı ve perioperatif ölüm oranları çimentosuz grupta anlamlı derecede düşüktü.
SONUÇ: Çimentosuz hemiartroplasti; ileri yaş grubundaki hastalarda görülen anstabil intertrokanterik femur kırıklarının tedavisinde; erken mobilizasyona olanak tanımasıyla, kabul edilebilir fonksiyonel sonuçlarıyla, düşük implant gevşeme oranlarıyla, daha kısa cerrahi süresiyle, daha az kanamayla ve daha düşük perioperatif ölüm oranıyla güvenilir bir tedavi seçeneğidir.
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.

10.Analsis of the risk factors for child appendicitis
Turan Yıldız, Zehra Bozdağ, Ünal Erkorkmaz, Arif Emre, Taner Turgut, Zekeriya İlçe
PMID: 24347216  doi: 10.5505/tjtes.2013.52059  Pages 554 - 558
Amaç: Apandisit çocuklardaki en sık cerrahi karın ağrısı nedenidir. Biz bu çalışmada apandektomilerin histopatolojileri üzerine yaş, cinsiyet, mevsim ve ailesel faktörlerin etkisini araştırdık.
Metod-Metod: Akut apandisit nedeni ile Eylül 2009-2011 yılları arasında opere edilen 588 hasta çalışmaya alındı. Hastalar histopatolojik bulgularına göre akut, perfore ve negatif apandektomi olarak üç gruba ayrıldı. Bu gruplar üzerine yaş, cinsiyet, mevsim ve ailesel faktörlerin etkinliği araştırıldı.
Bulgular: Hastaların ortalama yaşı 11.8±3.26 yıl ( 1-16 yıl) idi. Hastaların analizinde 10 yaşından sonra apandisit 2.41 kez sık görüldü. Erkeklerde apandisit kızlara göre 4.63 kez daha sık bulundu. Negatif apandektomi ile 10 yaşından sonra daha sık karşılaşıldı. Aile hikayesi ve mevsimlerin apandisit üzerine etkisi oransal olarak saptandı fakat bu etki istatistiki olarak anlamlı değildi(p> 0.05).
Sonuç: Apandisit cerrahisi planlarken yaş ve cinsiyet dikkate alınmalıdır. Çünkü doğru tanı yaş ve cinsiyet ile ilişkilidir. Ayrıca apandisit histopatolojisi ailesel ve çevresel faktörlerden etkilenir.
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.

11.Can high risk diseases for increasing intraabdominal pressure be treated more efficiently under intravesical pressure measurement?
Emre Divarcı, Orkan Ergün, Bülent Karapınar, Mehmet Yalaz, Ahmet Çelik
PMID: 24347217  doi: 10.5505/tjtes.2013.35478  Pages 559 - 563
Amaç: Karın içi basınç artışına bağlı ilerleyici organ yetmezliği gelişebilmektedir. Travma, adheziv ileus, karın ön duvarı defektleri ve septik şokta sıvı resüssitasyonu çocukluk çağında karın içi basınç artışına neden olabilen hastalıklardan bazılarıdır. Bu hastalıkların tedavisi intraabdominal basınç (İAB) ölçümü kontrolü altında daha güvenle yapılabilir mi?

Gereç ve Yöntem: Aralık 2009- Ekim 2010 tarihleri arasında prospektif bir çalışma uygulanmıştır. İAB saptanmasında intravezikal basınç (İVB) ölçümü kullanılmıştır. Tedavi stratejilerinin belirlenmesinde intraabdominal hipertansiyon (İAB >12 mm Hg) ve abdominal kompartman sendromu (İAB> 15 mm Hg+ yeni gelişen organ disfonksiyonu) eşik değerler olarak kullanılmıştır.

Bulgular: Abdominal travma (14), karın ön duvarı defektleri (8), septik şokta sıvı resüssitasyonu (7) ve adheziv ileuslu (6) 35 hasta çalışmaya dahil edilmiştir. Travmalı hastaların % 14’ ünde AKS saptanmıştır ve cerrahi gerekli olmuştur. İAH/ AKS karın ön duvarı defektli hastaların % 38’ inde defektin kapatılması sonrasında saptanmıştır ve kapatma stratejileri değiştirilmiştir. Septik şokta sıvı resüssitasyonu sırasında hastaların % 43’ ünde İAH gözlenmiştir ve dekompresif girişimler uygulanmıştır. İAH/ AKS saptanan adheziv ileuslu üç hastada (% 50) cerrahi girişim kararında basınç yüksekliklerinin katkısı olmuştur.

Sonuç: İVB ölçümü, izlem ve tedavileri sırasında İAB artışına yol açabilen hastalıkların tedavilerinin yönlendirilmesi ve girişim gerekliliğinin karar verilmesinde önemli katkılar sağlayabilmektedir. Riskli hastalık gruplarında İVB ölçümü, kolay ve güvenle uygulanabilecek yardımcı bir yöntemdir.
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.

CASE REPORTS
12.Iliopsoas hematoma due to muscular rupture following defibrillation.
Artan Jahollari, Raif Cavolli, Murat Tavlasoglu, Ferhat Sallahu, Shkelzen Muriqi
PMID: 24347218  doi: 10.5505/tjtes.2013.74152  Pages 564 - 566
Biz burada, akut anterior iskemi ile müracaat eden ve ardında iliopsoas hematomu gelişen 62 yaşında bir hastayı sunuyoruz. Çabuk ilerleme ve femoral nöropati gelişmesi nedeniyle hasta cerrahi olarak tedavi edildi ve intraoperatif olarak iliopsoas kas rüptürü tespit edildi. Rüptür, kabul esnasında uygulanan eksternal elektrik defibrilasyonla ilişkilendirildi. Bu nadir olgu sunumunun bu komplikasyon ve tedavisinin hakkında hekimlerin farkındalığını artıracağını ummuyoruz.
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.

13.Trauma-associated bleeding from the bilateral internal iliac arteries resolved with angiographic embolization
Ali Aygün, Yunus Karaca, Emin Ayan, Türkmen Suha, Hasan Dinç
PMID: 24347219  doi: 10.5505/tjtes.2013.00836  Pages 567 - 569
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.

14.A Rare Cause Of Acute Appendicitis: An Ingested Foreign Body
Batuhan Hazer, Özgür Dandin, Dursun Özgür Karakaş
PMID: 24347220  doi: 10.5505/tjtes.2013.60329  Pages 570 - 572
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.

15.Acute intestinal obstruction secondary to left paraduodenal hernia: a case report
Merve Busra Cengiz, Mustafa Hasbahceci, Gokhan Cipe, Oguzhan Karatepe, Mahmut Muslumanoglu
PMID: 24347221  doi: 10.5505/tjtes.2013.30776  Pages 573 - 575
Amaç: Paraduodenal herni, internal herninin en sık görülen tipi olarak akut intestinal obstruksiyonun nadir bir sebebidir. Tanı ve cerrahi tedavideki gecikmeler yüksek morbidite ve mortalite için önemli olabilir.
Gereç ve Yöntem: Bu yazıda akut intestinal obstruksiyona sebep olan bir sol paraduodenal herni olgusu sunulmaktadır.
Bulgular: Kırk üç yaşındaki bir erkek hasta akut intestinal obstruksiyon ön tanısı ile başvurdu. Bilgisayarlı tomografide saptanan, mide ile pankreas arasında özellikle sol üst kadranı dolduran enkapsüle dilate ince barsak segmentleri kümesi ve herni açıklığında bulunan genişlemiş ve yer değiştirmiş ince barsak vasküler pedikülü bulguları ile sol paraduodenal herni tanısı kondu. Eksplorasyonda, sol paraduodenal fossa yerleşimli bir herni kesesi içerisinde sınırlanmış dilate proksimal ince barsak segmentlerinin olduğu görüldü. Barsak segmentleri karın içi boşluğa redükte edildikten sonra, herni açıklığı retroperitona dikilerek kapatıldı.
Sonuç: Paraduodenal herni, belirgin olmayan başvuru şekli nedeniyle akut intestinal obstruksiyonun olası bir sebebi olarak düşünülmelidir. Hekimler bilgisayarlı tomografi ile elde edilebilen tanısal görüntüleme bulgularına aşina olmalıdır. Erken cerrahi girişim, bu hastalık ile ilişkili morbidite ve mortalitenin azaltılması için önemlidir.
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.

16.Late Presented Posttraumatic Pulmonary Arteriovenous Fistulea Occlusion With Septal Occluder Device
Bülent Güçyetmez, Ece Salihoğlu, Aykut Ayyıldız, Levent Saltık, Lütfi Telci
PMID: 24347222  doi: 10.5505/tjtes.2013.06432  Pages 576 - 580
Travmatik pulmoner arteriyovenöz fistül (PAVF) genelde penetran yaralanmalardan sonra gelişen nadir bir komplikasyondur. Yıllarca asemptomatik kalarak geç dönemde tespit edilebilir. Bu yazıda altı yıl önce geçirilmiş penetran toraks travması sonrası gelişen ve septal tıkayıcı cihaz ile kapatılan PAVF vakası sunulmuştur. Penetran toraks travmalarında bilgisayarlı tomografik anjiyografi(BT-Anjiyografi) ve pulmoner arteriyografinin rutin olarak kullanılması geç dönemde oluşabilecek semptomatik PAVF tespitinde önemlidir. Yeni nesil tıkayıcı cihazlar sayesinde daha geniş ve yüksek basınçlı defektlerin kapatılmasında transkateter yaklaşım uygun vakalarda cerrahi tedaviye alternatif olabilir.
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.

17.Case Report: Removal of mediastinal foreign body (steel shot) with mediastinoscopy
Bayram Metin, Halil Tözüm, Serkan Kaya
PMID: 24347223  doi: 10.5505/tjtes.2013.85453  Pages 581 - 584
Toraksa yönelik ateşli silah yaralanmalarında sakatlık ve ölüm oranı yüksektir. Ancak “toraks içinde kalıp herhangi bir patolojiye neden olmayan yabancı cisimlerin akıbeti” konusu literatürde az rastlanır bir durumdur. Bu çalışmada, boyun bölgesinden ateşli silah yaralanması sonucu acil servise getirilen ve erken dönemde komplikasyon gelişmeyen fakat takip sürecinde boyun bölgesindeki saçma çekirdeğinin mediastene doğru migrasyon gösterdiği tespit edilen ve trakeal fistül yaratma riski nedeni ile de mediastinoskopi ile saçma çekirdeiğinin çıkarıldığı bir olguyu sunuyoruz.
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.

LETTER
18.Torsion of an epiploic appendage of vermiform appendix
Yuri N Shiryajev, Anna V Glebova
doi: 10.5505/tjtes.2013.82574  Page 593
Abstract | Full Text PDF