Background. To investigate the healing properties of open and percutaneous techniques in a rabbit model and to compare histological, electron microscopical and biomechanical findings of the healed tendon between the groups.

Methods. 26 rabbits were randomly assigned to 2 groups of 13 rabbits in each. Percutaneous tenotomy of the AT was applied through a stab incision on the right side 1.5 cm above the calcaneal insertion in all animals. Using the same Bunnel suture, first group was repaired with open and second group was repaired with the percutaneous method. ATs were harvested at the end of eight weeks for biomechanical and histological evaluation.

Results. When the sections were evaluated for fibrillar density under electron microscopy it was noted that fibrils were more abundant in percutaneous repair group. The
tendon scores in the percutaneous group was less than the open group indicating closer
histological morphology to normal. The difference was not significant(p=0.065). The mean force to rupture the tendon was 143.7± 9.5 N in percutaneous group and 139.2±8.2 N in the open group. The difference was not significant (p=0.33).

Conclusion. Percutaneous techniques provide as good clinical results as the open techniques. The healing tendon shows better findings in histological and electron microscopical level with percutaneous technique.

Severe burn induces systemic inflammation and reactive oxygen species that leads to lipid peroxidation which may play a role in remote organs injury. Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil reduces oxidative stress and inflammation in distant organs. The aim of present study was to evaluate the effects of different dosages of sildenafil in remote organs injury. A total of 32 rats were randomly divided into four equal groups. The groups were designated as follows: Sham, Control, 10, and T20 mg/kg sildenafil treatment groups. Levels of malondialdehyde (MDA), vascular endothelial growth factor (VEGF), VEGF receptor (Flt-1), activities of glutathione peroxidase (Gpx), levels of total antioxidative capacity (TAC), and total oxidant status (TOS) were measured in both tissues and serum, a semi-quantitative scoring system was used for the evaluation of histopathological findings. Sildenafil increased levels of Gpx, and Flt-1, and decreased MDA and VEGF levels in tissues. Sildenafil also increased serum levels of TAC and Flt-1 and decreased TOS, OSI, and VEGF. Sildenafil decreased inflammation scores in remote organs in histopathological evaluation. Sildenafil has protective effects in severe burn-related remote organ injuries by decreasing oxidative stress and inflammation.

Background: Spinal cord injury (SCI) is one of the most devastating conditions, leading to neurological impairment and disabilities. The aim of the study was to investigate the potential neuroprotective effect of thymoquinone (TQ) histopathologically in an experimental model of traumatic spinal cord injury (SCI). Methods: Twenty-four male Wistar albino rats were randomly divided into 4 groups: control group; SCI group; SCI-induced and 10 mg/kg/day TQ administered group; SCI-induced and 30 mg/kg/day TQ administered group. TQ was given as intraperitoneal for 3 days prior to injury and 4 days following injury. Spinal cord segment between T8 and T10 were taken for histopathologic examination. Hemorrhage, spongiosis and liquefactive necrosis were analyzed semiquantatively for histopathological changes. Results: Administration of TQ at dose of 10 mg/kg did not cause any significant change on histological features of neuronal degeneration as compared to the SCI group (p=0.269); but, 30 mg/kg TQ significantly decreased the histological features of spinal cord damage below that of SCI group (p=0.011). Conclusions: Data from this study suggest that TQ supplementation attenuates trauma induced spinal cord damage. Thus, TQ needs to be taken into consideration, for it may have a neuroprotective effect in trauma induced spinal cord damage.

Introduction: Fournier's gangrene (FG) is a devastating and potentially fatal disease that requires prompt and aggressive debridement. In this study, we aimed to assess the predictors of mortality in a large cohort.
Methods: Prospectively maintained data of patients with FG were analyzed. Demographic data, duration of symptoms, Uludag Fournier’s Gangrene Severity Index (UFGSI) scores, co-morbidities [particularly diabetes mellitus (DM)], etiologies, number of debridement, stoma requirements, length of intensive care unit and hospital stay, morbidity and mortality rates were reviewed. Multivariate analysis was performed in order to determine factors affecting mortality.
Results: 120 patients (81 male) were included in the study. Median age was 58(22-85) years. UFGSI score was median 9(1-30). DM was present in 69(57.5%) patients. Etiology of FG was perianal in 59, urogenital in 52, and skin in 9 patients. Median debridement count was 3(1-12). Thirty-one patients required stoma. Forty-eight patients were admitted to intensive care unit and 25 patients required mechanical ventilation. Overall mortality rate was 20.8%. Multivariate analysis revealed UFGSI as the only predictor of mortality (p=0.001). Mortality rate was 13.64 times higher for patients with a UFGSI score of 9 or higher.
Conclusions: FG is a mortal disease requiring emergency surgery. UFGSI is an efficient predictor of mortality for patients with FG.

BACKGROUND
A considerable number of deaths due to firearm injuries is occurred during wars in all over the world. In this study we aim to evaluate demographic characteristics and injury properties of cases died during civil war in Syria.
METHODS
The postmortem examination and autopsy reports of total of 321 forensic deaths occurred between January and December 2012 were analyzed retrospectively. Of these 186 cases of death due to injuries occurred in civil war in Syria were included in the scope of the study. Four cases who died by natural causes or traffic accidents were excluded from the scope of the study.
RESULTS
Cases were most commonly (n=73, 39.2%) aged between 21 and 30 years, and 21.5 % (n=40) of cases aged less than 20 years. Of females, 68.8% (n=11) were children and young adults less than 20 years of age. Overwhelming majority of deaths (n=125, 67.2%) caused by explosive and shrapnel injuries, followed by (n=49, 26.3%) gunshot injuries related deaths.
CONCLUSION
This study indicated that a significant proportion of those who died after injuring in the Syrian war were children, women and elderly people. The nature and localization of the observed injuries indicated open attacks by military forces regardless of target being civilians and human rights violations.

BACKGROUND: Infections and sepsis remain the leading cause of morbidity and mortality in secondary peritonitis. Clinicians are still challenged with the task of finding an early and reliable diagnosis of septic complications. We evaluated the role of inflammatory markers (Procalcitonin (PCT), C-reactive protein (CRP) and thyroid hormones in determining the severity of secondary peritonitis.

METHODS: Pre and postoperative days 1-3-5-7-14 PCT, CRP and thyroid hormone concentrations were measured in serum from 84 consecutive patients who were operated on for secondary peritonitis between January 2008 and January 2010. All data was entered and analyzed using the Statistical Package for Social Sciences, version 15.0 and clinical parameters compared using the student’s t test.

RESULTS: For the groups diagnosed with perforated viscus, PCT concentrations were significantly low in contrast to high thyroid hormone levels in patients who developed postoperative complications or died when compared to patients whose postoperative course were uneventful or discharged. The PCT concentration significantly correlated with the CRP concentration and WBC count.

CONCLUSION: In the absence of postoperative complications, PCT is a better predictor of outcome than CRP in secondary peritonitis. Our study showed that a low thyroid hormone level can serve as an important prognostic parameter of disease severity in secondary peritonitis.

BACKGROUND
In this study, it was aimed to analyze the traffic accidents with postmortem examinations and autopsies.

METHODS
From the 1815 forensic autopsies reports of 334 traffic accidents were searched. Features like, scene of accident, type of accident, type of vehicles involved in the accident, year, season, day and hour of the accident, location of the victims in the traffic, concomitant orthopedic injuries, whether autopsy was performed or not, and cause of death were investigated.
RESULTS
Among 1815 forensic death cases observed cause of death was determined to be traffic accidents in 334 (18.4%) cases. Male cases accounted 84.1%, and male/female ratio was 5.3/1. From reports 32.6% of the accidents happened in summer and most commonly during holidays (33%). The accident rate happened in the city center was 35.3% and 32.9% of te cases died because of the pedestrian collision and it was determined that the most injured person was the driver. As the cause of the traffic accidents, automobiles were the lead.

CONCLUSÝON

It is realized that traffic-accident related deaths have a substantial place among forensic deaths and continues to be an important public health problem. It is conspicuous that enhancing public education on traffic safety, increasing traffic management and control measures.

Key words: traffic accidents, forensic medicine, autopsy.

Purpose: Liver is the most frequently injured intraabdominal organ following abdominal trauma. Liver injury in polytraumatized patients can vary from minor contusions to major lacerations, and has an associated with morbidity and mortality. The objective of this study is to evaluate the outcome of liver injury in polytraumatized patients.
Methods: Only surgically treated 82 patients with liver injury over 8-years period (2005-2013) were included in this study and retrospectively analyzed. Data collected included demographics, laboratory findings, intraoperative findings, operative management and outcome. The patients were divided two groups: mortality and survivor and the data were compared.
Results: The overall mortality rate was %18.3 (15 of 82 patients). 34 (%41.5) patients had blunt, 48 (%48.5) had penetrating trauma. There were multiple traumas in 47 (%57) patients. 47 (%57) patients had total of seventy one coexisting intraabdominal injuries. 46 (%56.1) patients had stable, 36 (%43.9) patients had unstable hemodynamics on admission. In mortality group AST, ALT, LDH, APTT, PT, INR, creatinine levels were high, fibrinogen levels and platelet counts were low on admission.
Conclusions: Hemodynamic instability, coexisting musculoskeletal and chest injury, and high APTT, PT, INR, AST, ALT, LDH levels and low fibrinogen levels and low platelet counts on admission should be considered as predictive factors for mortality.

Purpose: To compare the effectiveness and success of early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing with the surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy) in pilonidal sinus abscess cases.
Material and Method: Data of patients who had been treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were retrospectively analyzed. Those who had early surgery were determined as group S, and those who had elective surgery following drainage-antibiotic therapy were determined as Group K. Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time. Patients were followed for an average of 14 months.
Results: Of the 53 patients included in the study, 28 were in Group S and 25 were in Group K. The mean age and gender distribution of both groups were similar and a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02).
Conclusion: In treatment of acute pilonidal abscesses, the Karydakis method, following drainage-antibiotic therapy, is a preferable method due to its shorter treatment duration and higher patient comfort.

Purpose: To report our recent experience of bladder injuries due to gunshot in the Syrian conflict and the review literature regarding diagnosis and treatment.
Materials and Methods: We report 22 cases with abdominal and inguinal firearm wounds and bladder rupture sustained in the Syrian conflict.Age,mechanism/location of damage, associated injuries,Revised Trauma Score (RTS),Injury Severity Score (ISS),Trauma Injury Severity Score(TRISS),and complications were analyzed. Severity of bladder injuries is classified according to the American Association for the Surgery of Trauma Organ Injury Scaling(AAST-OIS grade ≥II database).Type of the bladder rupture is defined according to the classification System for Bladder Injury Based on Findings at CT Cystography.
Results and Conclusions: Mean age was 26 years(range 18 to 36)).The mean ISS was 22 (10-57),mean TRISS was 0.64(0.004-0.95),and mean RTS was 6.97(3.30-7.84).In the mortality group, the mean ISS,TRISS,and RTS were 48(36-57),0.016(0.004-0.090),and 4.10(3.30-4.92),respectively,whereas the mean ISS, TRISS, and RTS were found as 21 (10-26),0.64(0.49-0.95), and 7.24(5.65-7.84),respectively in the survival group (P=0.06).CT-cystography showed 17 type 2, 3 type 4,and 2 type 5 bladder injuries. According to AAST-OIS there were 9 grade IV,6 grade III, 5 grade II,and 2 grade V injuries. In war settings when injuries are often severe and multiple,surgical exploration and closure is mandatory.Mortality risk was associated with high ISS,low TRISS and low RTS values.

Background: There is no specific laboratory method for the diagnosis of acute mesenteric ischemia (AMI). In this study, we aimed to determine the efficacy of the D-dimer test in selected cases prior to multi-detector angio-CT, which is expensive and has side effects.
Methods: Patients with abdominal pain over the age of 65 years were included to our study. The D-dimer test was applied to 230 (34%) of 676 abdominal pain patients who were admitted to our emergency service. The D-dimer levels of the patients diagnosed with AMI by angio-CT were compared.
Results: In AMI patients sensitivity of the D-dimer test was 84,6% and the specificity was 47,9%. Elevated D-dimer levels and AF were observed in 90,9% of the patients who were diagnosed with AMI by CT.
Conclusions: D-dimer levels were elevated in the AMI patients. Patients suspected of having AMI patients with unclear clinical results, D-dimer levels above 1000 ng/ml and AF should undergo further evaluation.

Background: Owing to the diversity in cause and damage, there is no standard surgical treatment method for a complicated penetrating craniofacial injury. We report the treatment of a complicated penetrating head injury caused by a steel bar.
Case report: A 66-year-old woman fell onto a steel bar at a construction site, and it penetrated the mandible, entered the sinus and orbital cavities, and reached the base of the frontal bone.
Results: A multi-disciplinary team including a neurosurgeon, otolaryngologist, and plastic surgeon was involved in removing the steel bar. The patient survived without sequelae except for blindness in the right eye.
Conclusions: Despite the lack of standardized surgical treatment for a complicated penetrating craniofacial injury, aggressive treatment by a multidisciplinary team can result in good outcomes.

Fournier’s gangrene is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic and immune compromised patients. Here, we report an unusual case of Fournier’s gangrene with isolated glans penis necrosis in a diabetic 77years old male who presented to the emergency department complaining of 5 days of pain, black color on glans penis. Examination of the patient’s glans penis was consistent with Fournier’s gangrene and included significant erythema, and infectious discharge. He was given intravenous antibiotics and emergency debridement was done. On following days the necrotic area spread to distal parts of both cavernosal areas. We performed partial penectomy. Isolated penile involvement in FG is very rare. Performing partial penectomy in appropriate cases can save penile length, stop the progression of disease and increase the quality of life.

Phytobezoars are a rare cause of intestinal obstruction. They are usually present in patients who had predisposing factors like previosly gastric surgery, diabetes, edentulousness. In this case report we report an uncommon cause of intestinal obstruction due to migration of gastric phytobezoar in a patient who had no known predisposing factor.

Foreign body ingestion is a common problem in children, but it is also seen among adults. Perforation of the gut by a foreign body, followed by migration of the foreign body to the liver is quite rare. Most of the fish bone ingestions have uneventful outcome. But occasionally it can cause serious complications if the gastrointestinal tract is perforated. Herein we report a case of liver abscess caused by a fish bone. The best of our knowledge it is the first case in our country.