BACKGROUND: Intestinal ischemia is a serious and common clinical status. It develops as result of superior mesenteric artery (SMA) obstruction caused by many etiologic factors. Sepsis and multiple organ failure could develop following intestinal ischemia. The present study aimed to investigate the effects of ligustrazin, which has a vasodilator impact on intestinal ischemia.
METHODS: Forty male Wistar rats were divided into three groups randomly. Sham operation was performed on Group S (n=7); mesenteric ischemia and then 60 minutes reperfusion of the intestine process was performed on Group MI (n=7); mesenteric ischemia and then 60 minutes reperfusion of the intestine process was performed and 80 mg/kg ligustrazin was administrated intraperitoneally on Group MI+L (n=7). Intestinal tissue samples were taken for tissue MDA, SDO and nitric oxide (NO) levels, and ileum and jejunum samples were taken for histopathologic examination.
RESULTS: Tissue MDA levels and tissue NO levels of Group MI-L was determined to have significantly decreased. Tissue SOD levels were found similar to Group S. Chiu classification score of the jejunum and ileum was determined to have decreased in Group MI-L compared to Group MI.
DISCUSSION: As a result of this study, Ligustrazin was found to adjust lipid peroxidation in biochemical parameters during mesenteric I-R and decrease the severity of damage of I-R on the histopathological scores of the jejunum and ileum.

BACKGROUND: Abdominal compartment syndrome (ACS) is a clinical syndrome characterized by progressive intraabdominal organ dysfunction resulting from an acute increase in intra-abdominal pressure (IAP). In the absence of prompt treatment, ACS can
lead to lethal organ failure. Treatment of ACS is achieved by immediate decompression of the abdominal cavity. As to how and when decompression laparotomy should be performed depends on the clinical condition of the patients. There is limited data regarding outcomes of abdominal closure techiques. The present study aimed to investigate two different temporary closure methods, the vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who underwent decompressive laparotomy as part of the management of ACS.
METHODS: The study included 40 patients who developed ACS during follow-up or following trauma and abdominal surgery. As part of the treatment for ACS, these patients underwent decompressive laparotomy at the Cukurova University Medical Faculty, General Surgery Department and followed up in the Intensive Care Unit of the same hospital. VAC and Bogota bag procedures were performed as temporary closure methods for the treatment of ACS. Patients were randomly assigned to each of the two groups according to the temporary closure method performed. Clinical, laboratory, mortality and morbidity results of the patients in both groups were compared.
RESULTS: Demographic features of the patients (age, sex, body mass index, co-morbidities) were similar between the two groups. The most common reason of ACS was gastrointestinal perforation in 12 (30%) patients. Decrease in incision width was significantly faster in the VAC group than in the Bogota group. Primary closure of fascia was considered appropriate in 16.9 days in the VAC group and 20.5 days in the Bogota bag group. The decrease in abdominal pressure was similar between the two groups on days 1, 4 and 7 but appeared to be significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study. Among the deceased patients, 5 (12%) were in the VAC group, whereas, 7 (17.5%) belonged to the Bogota bag group.
CONCLUSION: Based on these results, it is suggested that VAC has advantages when compared to the Bogota bag as a temporary closure method in the management of abdominal compartment syndrome.

BACKGROUND: Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units.
METHODS: This cross-sectional study targeted all physicians working in the emergency units of Pamukkale University Hospital, County and City Hospitals, 112 Emergency Services, and Private Hospitals in Denizli. Data were obtained by means of a self-administered questionnaire that consisted of questions on the demographics of the participants, Turkish version of the Maslach Burnout Inventory, and of the perpetrators of violence. What was also documented on the questionnaire was whether participants had been subjected to or had witnessed any verbal or physical violence during the previous one month of emergency physicians’ certification program.
RESULTS: A total of one hundred and seventy-four physicians were included into the study (85% of the targeted group). Many of the participants were between 24 and 59 years of age, with a mean age of 36.8±5.8 years. Married male doctors working in the City Hospital made up the majority. There were significant associations between emotional exhaustion and total violence (p=0.012) and verbal violence (p=0.016); depersonalization and total violence (p=0.021) and verbal violence (p=0.012).
CONCLUSION: The results presented here indicated that there was a strong relation between burnout and violence experienced by physicians working in emergency units. Violence in the emergency department has a substantial effect on the physicians’ well-being.

BACKGROUND: Accurate measurement of surgical outcomes, proper evaluation of hospitals and surgeons regardless of case can be performed by mortality prediction models. The aim of this study was to analyze factors affecting mortality, present our clinical experience and patient profile and evaluate different scoring systems in use of these patients.
METHODS: A retrospective review of one hundred and twelve geriatric patients who underwent major abdominal emergency surgery between 2004 and 2008 was performed. APACHE II, ODIN, SAPS II expanded, P-POSSUM, Manheim peritonitis and Charlson comorbidity index, Goldman and ASA scores were calculated using patient data. Sensitivity, positive predictive value and Odd’s ratio were calculated to predict the mortality for these scoring systems.
RESULTS: The overall mortality rate for our patients was found 33.9%. The factors affecting mortality in this study were found to be the duration of initial complaint, requirement of intensive care unit, requirement of mechanical ventilation and its duration, the presence of coexisting disease and peritonitis.
CONCLUSION: According to our study, in this particular group of patients, APACHE II scoring system is more valid and accurate in estimating the mortality risk when compared to other scoring systems.

BACKGROUND: Although many precautions have been introduced into early burn management, post burn contractures are still significant problems in burn patients. In this study, a form of Z-plasty in combination with relaxing incision was used for the correction of contractures.
METHODS: Preoperatively, a Z-advancement rotation flap combined with a relaxing incision was drawn on the contracture line. Relaxing incision created a skin defect like a rhomboid. Afterwards, both limbs of the Z flap were incised. After preparation of the flaps, advancement and rotation were made in order to cover the rhomboid defect. Besides subcutaneous tissue, skin edges were closely approximated with sutures.
RESULTS: This study included sixteen patients treated successfully with this flap. It was used without encountering any major complications such as infection, hematoma, flap loss, suture dehiscence or flap necrosis. All rotated and advanced flaps healed uneventfully.
In all but one patient, effective contracture release was achieved by means of using one or two Z-plasty. In one patient suffering severe left upper extremity contracture, a little residual contracture remained due to inadequate release.
CONCLUSION: When dealing with this type of Z-plasty for mild contractures, it offers a new option for the correction of post burn contractures, which is safe, simple and effective.

BACKGROUND: Conduction disturbances including type 2 second-degree atrioventricular block (Mobitz II) and third-degree atrioventricular block following blunt chest trauma are probably rare. Moreover, the pathophysiological mechanisms responsible for this rare dysrhythmia following trauma are not well understood yet. In this study, it was aimed to identify the frequency of this dysrhythmia associated with trauma.
METHODS: Two hundred and fifty-three consecutive Mobitz II block and third-degree atrioventricular block patients admitted to the Emergency Department of Internal Medicine between January 2012 and March 2013 were evaluated. Only four patients with Mobitz II block and third-degree atrioventricular block associated with trauma were enrolled into the present study. The level of atrioventricular block was defined according to electrocardiographic characteristics.
RESULTS: Only four (mean age: 40.2±19.7 years, two male) of 253 patients were associated with trauma. All patients had normal coronary arteries in coronary angiography or multislice computed tomography. Permanent pacemaker was performed in two patients with third-degree atrioventricular block. None of the patients had coronary artery disease or hypertension.
CONCLUSION: Rare clinical cases in the literature confirm that blunt chest trauma can cause conduction defects, which are usually transient. However, patients with blunt chest trauma must need an electrocardiographic evaluation for atrioventricular block upon admission and in the follow-up period.

BACKGROUND: Most of healed lower femoral fractures resulted in various degree of loss of the knee motion. Flexion deficit is a serious problem for the Eastern persons that are where squatting and sitting on the ground are necessary for daily activities. The aims of this study were to compare outcomes of using condylar buttress plate and dynamic condylar screw (DCS) in treatment of distal femoral fractures. Secondly, we present our clinical experience for optimizing the technical application of the studied implants.
METHODS: Two groups (plate and DCS) of 57 patients were treated for 59 lower femoral fractures with condylar buttress plate or DCS and followed prospectively for 24 months.
RESULTS: Plate group reported adequate reduction in 67% and varus angulation in 13.3% of the fractures. DCS group reported adequate reduction in 72.4% and posterior angulations in 17% of the fractures. Other reasons for inadequacy of reduction were reported in both groups. Full knee motion range was achieved in 50% of plate group and in 55% of DCS group. 75% and 90 % satisfactory functional outcomes were reported in the plate and DCS groups respectively.
CONCLUSION: Both implants nearly achieved equal results concerning restoration of knee motion range. The condylar buttress plate and DCS are liable for technical optimization.

BACKGROUND: Malpractice is an occasion that occurs due to defective treatment in the course of providing health services. Neither all of the errors within the medical practices are medical malpractices, nor all of the medical malpractices result in harm and judicial process. Injuries occurring at the time of treatment process may result from a complication or medical malpractice. This study aims to evaluate the reports of the controversial cases brought to trial with the claim of medical malpractice, compiled by The Council of Forensic Medicine.
METHODS: Our study includes all of the cases brought to the Ministry of Justice, Council of Forensic Medicine General Assembly with the claim of medical malpractice within a period of 11 years between 2000 and 2011(n=330).
RESULTS: In our study, we saw that 33.3% of the 330 cases were detected as “medical malpractice” by the General assembly. Within this 33.3% segment cases, 14.2% of them resulted from treatment errors such as wrong or incomplete treatment and surgery, use of wrong medication, running late for a true diagnosis after necessary examination, inappropriate medical processes as well as applied treatment having causality with an emergent injury to the patient. 9.7% of them emerged from diagnosis errors like failure to diagnose, wrong diagnosis, lack of consultation request, lack of transfer to a top centre, lack of intervention resulting from not recognizing the postoperative complication on time. 8.8% of them occurred because of careless intervention such as lack of necessary care and attention, lack of post operation follow-ups, lack of essential informing, absenteeism when called for a patient, intervention under suboptimal conditions. Whereas 0.3% of them developed from errors due to inexperience, 0.3% of them were detected to have occurred because of the administrative mistakes following malfunction of healthcare system.
CONCLUSION: It is very important to analyze the errors properly in order to get the medical malpractice under control. Going through the errors, on which process of health service they occur and their owners; keeping the record of all examinations and treatments in the course of health service regularly and properly will be a cornerstone for both occupational and forensic medicine practices to be standardized.

BACKGROUND: This study aimed to conduct a clinical and radiological analysis of treatment results in Schatzker type I and type II tibial plateau fractures and investigate the effect of Body Mass Index on these results.
METHODS: A total of 64 patients (44 male [68.8%], 20 female [31.3%]; mean age 21-80; range 45.05±13.47 years) undergoing surgery for Schatzker type I and type II tibial plateau fractures were included into the study. Clinical and radiological results were evaluated according to Rasmussen scores. During evaluation, BMI of the patients was reported. The effects of obesity on these clinical and radiological results were further evaluated.
RESULTS: In Schatzker type II cases, there was an indirect 48.4% statistically significant relation (p<0.01) between Rasmussen Clinical scores and age.
DISCUSSION: In Type II fractures, the results of obese patients were found to be worse when compared to patients with normal weight. While obesity is not a problem which can be overcome in a short time interval, close follow-up and careful rehabilitation are essential to achieve good results in this group of patients.

BACKGROUND: The aim of the present study was to investigate the demographic and clinical characteristics of electrical injuries, type of electrical current and the importance of electrocardiography in clinical course.
METHODS: Fifty-three patients (50 males [94.3%], 3 females [5.7%]; mean age 34.5±9.6; range 19 to 61 years) with electrical injuries treated in the burn center between 2011 and 2012 were retrospectively analyzed. The patients were evaluated for demographic and clinical characteristics, electrocardiographic findings and clinical outcomes.
RESULTS: The electrocardiography findings of the patients were as follows: twenty-seven normal, twelve sinus tachycardia, three atrial fibrillation, seven right bundle brunch block, and four ventricular extra-systole. There was no mortality among patients with electrocardiographic findings of normal, right bundle brunch block, and ventricular extra-systole. Four patients with sinus tachycardia and one patient with atrial fibrillation died. Electrocardiographic findings of the patients wounded by high-voltage electricity were: two normal, two sinus tachycardia, and one atrial fibrillation.
DISCUSSION: Mortality was higher in patients with sinus tachycardia and atrial fibrillation in the electrocardiography at the time of admission. These ECG findings were more often in patients wounded by high-voltage electricity. Therefore, electrocardiographic findings and type of the electrical current may provide prognostic value in the clinical course of patients.

The objective of this study was to report an unusual case of unilateral adrenal hematoma in; a 19-year-old young man who did not have a history of any specific systemic disease. The patient was admitted to hospital with chest pain that lasted for one day. Preoperative contrast-enhanced computerized tomography evaluated an adrenal mass (sized, 10.5x12.7 cm) adjacent to the anterior of the left kidney, and findings were indicative of adrenal hematoma. The final pathological diagnosis was adrenal adenoma.

One-stage reconstruction of complex penile defects with functional and cosmetic results is a challenging procedure. The selection of proper technique and materials for reconstruction depends on the type of the deficient tissue components, the size of the wound surface, and the donor site. This article presented a case of a partial penile and urethral defect due to an infection in the previous surgical site. The patient was treated with a perforator based pedicled composite anterolateral thigh flap combined with vascularized fascia lata. The urethral defect was reconstructed with the vascularized fascia lata. The remaining part of the flap was used for the resurfacing of the right cavernous body and penile skin defect. There was no fistula and the urinary caliber was accepted as good. The pedicled composite anterolateral thigh flap contains various tissue components suitable for a functional and cosmetic reconstruction of complex penile defects using the one-stage technique.

Cardiac injuries may rarely be observed due to blunt thoracic traumas. Cardiac injury often creates a life-threatening condition requiring urgent surgical intervention, and follow-up of these patients should be carefully carried out in the perioperative period. These injuries depend on various factors including clinical presentation, type of injury, the time that passes until the patient reaches the hospital, bleeding, cardiac tamponade, or additional injuries. This article aimed to report a case who suffered penetrating cardiac injury in blunt thoracic trauma. Evaluated in the emergency department due to a motor vehicle accident, the 61-year-old male patient’s chest x-ray revealed pulmonary contusion, rib fractures and cardiac tamponade. The patient was operated emergently. Right atrial injury was observed in the operation. The cardiac injury was repaired with primary suture technique. Cardiac injury in patients with blunt thoracic trauma is likely to be observed. In these patients, careful physical examination, early diagnosis, and treatment are very important.

In parallel with technological developments, small size but strong magnets are commonly used in modern devices. In terms of foreign body injuries, magnet injuries are quite rare. However, due to their unique characteristics, there are some difficulties in their management. The magnetic field generated by the magnet affects the surgical instruments and make treatment difficult. In this case report, a nasal injury due to neodymium magnet and our alternative approach for its management was reported.