Background
Peritoneal lavage with saline at room temperature causes peritoneal hypothermia, vasoconstriction, hypoxia, and acidosis. These effects are known to reduce fibrinolysis. Decreased fibrinolysis causes permanent adhesions. Normothermic lavage may prevent this deleterious process and reduces peritoneal adhesions.

Methods
A rat model of cecal abrasion was used. Control animals received no medication, while hypothermic or normothermic saline lavage were administered intraperitoneally to the experimental groups (n = 24 for each group). Cardinal parameters of peritoneal fibrinolysis (tissue plasminogen activator [tPA] and plasminogen activator inhibitor type 1 [PAI-1]) were determined in peritoneal tissue samples at the postoperative day 1, 3, and 10. At postoperative day 10 adhesions were graded. In the sham group (n=8), following laparotomy peritoneal samples were taken to determine basal values of tPA and PAI-1 in healthy peritoneum.

Results
Cecal abrasion increased PAI-1 levels about tenfold at postoperative day 1 and caused adhesions. Normothermic saline lavage prevented this traumatic PAI-1 increase and stabilized it to baseline values throughout the experiment and reduced peritoneal adhesion formation. Hypothermic lavage also caused an inhibition of PAI-1 rise but adhesion, prevention was not significant.

Conclusion
Our results suggest that normothermic saline lavage reduces adhesions by improving peritoneal fibrinolysis.

Objectives: There are many studies in the literature combining vein grafts with cell cultures, muscle, tendon, nerve tissues but none of them could replaced isolated nerve grafts for nerve repair in clinical settings. There are studies in the literature indicating that adipose tissue derived stromal vascular fraction(SVF) enhances peripheral nerve healing. Considering these facts we performed an experimental study in rats based on combining SVF with vein grafts for peripheral nerve defect repairs.
Methods: We studied with 30 rats and produced 3 groups. In the first stage 8 mm nerve defect was created in tibial nerve of each rat. In group 1 defect was reconstructed with nerve graft, in group 2 defect was reconstructed with vein graft and in group 3 defect was reconstructed with vein graft filled with SVF solution. After 3 months, second surgical stage was performed and nerve biopsies were take. Tissue samples were observed histopathologically.
Results: Statistically there were no meaningful differance between nerve grafts, vein grafts and adipose tissue derived SVF- vein grafts combination groups considering myelin diameter, axonal diameter. Axon count was superior statisticcly in nerve graft and study group when compared empty vein groups.
Conclusion: Ýn conclusion, our results support usage of stromal vascular fraction-vein graft combination for peripheral nerve defect repairs.

Introduction: The Chinese people in Fuyang city, a northwest city of Anhui Province, are accustomed to burning incense at home for blessing during the Spring Festival. Their children, especially toddlers like playing around the burning incense and are at risk to burn by hot incense ashes. The purpose of this study is to describe the unique cause and clinical characteristics of pediatric deep burns caused by hot incense ashes during 2014 Spring Festival.
Methods: Twelve consecutive children admitted to our Burn Center and Fuyang People’s Hospital during 2014 Spring Festival, with burn injuries caused by the hot incense ashes were epidemiologically studied retrospectively. Data on age, gender, size, depth and site of burn, incidence by day, number of operation, hospital stay, and causes of burns, were collected.
Results: All patients came from Fuyang city. Of the 12 patients, the average age was 2.17 years with a range of 1-6. The boy-to-girl ratio was 2: 1. The mean total burn surface area (TBSA) was 5.83% and 91.67% of children sustained full-thickness burn. Hands were the most common parts of body to be injured. Dry necrosis developed in 14 fingers of 3 patients. January 31, 2014, the first day of the Chinese New Year, was the time of highest incidence. Six patients (50 percent) required surgical intervention while the number of operations including escharectomy, excision, skin grafting, or amputation of necrotic fingers, per patient was 2. A total of 14 fingers were amputated of the necrotic parts. All children survived and the mean time in hospital of the patients was 20 days.
Conclusion: Hot incense ashes cause serious injuries to children in Fuyang city during the Spring Festival. Preventive programs should be directed towards high risk groups to reduce the incidence of this burn.

Aim: Only one diagnostic parameter is not available for acute appendicitis. For the establishment of diagnosis, combination of medical history, clinical, laboratory tests, radiological imaging modalities are used so as to decrease the rates of negative laparotomy and morbidity secondary to delay in diagnosis. In the present study, we aimed to determine haematological and inflammatory markers which will be used in the discrimination of acute appendicitis (AA) and renal colic which are the most frequent and indistinguishable causes of abdominal pain in patients who applied to the emergency service
Methods: A total of 215 patients who presented with abdominal pain and histopathologically diagnosed as AA, and 200 patients who presented with abdominal pain and diagnosed as renal colic were included. Control group consisted of 65 patients without any complaints who came to the outpatient clinics of internal medicine only for blood counts. Analyzed blood samples were WBC, RDW, Hb, MCV, MPV, neutrophil, lymphocyte, NLR and PLR. All differences associated with a chance probability of.05 or less were considered statistically significant.
Results: Statistically significant intergroup difference was seen between AA and renal colic groups as for age, WBC, Hb, MCV, neutrophil, lymphocyte, NLR and PLR. Statistically significant intergroup difference was seen between AA and control groups regarding age, WBC, Hb, RDW, MPV, neutrophil, lymphocyte, NLR and PLR. Statistically significant intergroup difference was seen between renal colic and control groups as for age, WBC, RDW, MPV, neutrophil and NLR. In ROC curve analysis, the area under AUCs for WBC, neutrophil, NLR and PLR were 0.896, 0.916, 0.888 and 0.725, respectively (p≤0.05).
Conclusion: In the discrimination between patients with renal colic and those without any illness, WBC, RDW, MPV, neutrophil and NLR; in the differentiation between the patients with AA and healthy individuals, WBC, RDW, MPV, neutrophil, lymphocyte, NLR and PLR; and more importantly in the discrimination between patients with AA and those with renal colic who presented to emergency services with abdominal pain WBC, neutrophil, lymphocyte, PLR and NLR can be useful parameters.

BACKGROUND: Self-immolation is one of the most violent methods of suicide in the developing countries. present study is to investigate survival rate and factors affecting survival of self-immolation patients.
METHODS: All people either died or hospitalized of Intentional burns were assessed in Kermanshah province during 2010 to 2013. Required information gathered from two sources of Kermanshah province legal medicine and burning center of Imam Khomeini hospital. we estimate the survival function through Cox regression. The data analyzed with Stata 12 software.
RESULTS: During 2010 to 2013 (three years), 446 person attempted self-immolation of which 370 were female (83%). In general, 276 people (61.8%) died due to severity of burns. The median of survival time was 47±5 day. The survival rate after one day, one week, and 21 day after accident was 86%, 52%, and 38%, respectively. Multivariate analysis demonstrates that burns is the most powerful risk factor, so that the risk in those with over 70% burns is 17 times more than those with burns less than 30%.
CONCLUSION: Burns percentage is the strongest risk factor, those with high burns percentage should be hospitalized quickly and without waste of time.

Introduction: The trauma and injury severity score (TRISS) and Acute Physiology And Chronic Health Evaluation IV (APACHE IV) are accurate but complex.
Aim of the work: To compare venous glucose, levels of serum lactate and base deficit in polytraumatized patients as simple parameters to predict the mortality in these patients versus (TRISS) and (APACHE IV).
Patient and Method: a comparative cross-sectional study of 282 patients with polytrauma attended to the Emergency Department (ED).

Results: The best cut off value of TRISS probability of survival score for prediction of mortality among poly-traumatized patients is ≤ 90. APACHE IV demonstrated 67% sensitivity and 95% specificity at 95% CI at cut off point 99. The best cutoff value of Random Blood Sugar was>140 mg/dl, with 89%, sensitivity, 49% specificity; base deficit was less than -5.6 with 64% sensitivity, 93% specificity; lactate for was > 2.6 mmol/L with 92%, sensitivity, 42% specificity.

Conclusion: Venous glucose, serum lactate and base deficit are easy and rapid biochemical predictors of mortality in patients with polytrauma. These predictors could be used as TRISS and APACHE IV in predicting the mortality.

Introduction: Burns are one of the most important causes of traumatic death in children worldwide.

Aim: A pediatric burn center was established in our hospital in August 2009. The aim of this study was to compare the patient profiles and data before and after the burn treatment center was established.
Material and Method: Burn patients were admitted to the pediatric surgery department between January 2005 and August 2009 and there was no intensive care service in this department. Intensive care service has been provided since August 2009 with the burn center established at our hospital. The 316 cases that were followed-up at the pediatric surgery department in the first period were identified as Group I and the 442 cases that were admitted to the burn center in the second period were identified as Group II. The data of the groups were then compared.
Results: The mean age of the cases was 5.1 years in Group I and 7.7 years in Group II. The total mean body burn percentage was 16.12% in Group I and 17.54% in Group II. Although scalding burns were the most subtype in both groups, flame burns were 2.13 times, electrical burns 3.44 times, flame+inhalation burns 8.33 times, and burns with an over 40% total burn surface area 2.41 times more common in Group II than in Group I. The mortality rates were 0% in Group I and 2.26% in Group II.
Conclusion: Converting a normal department admitting burn patients in a burn unit format to an actual burn center means more severe cases will be admitted. This requires a patient and attentive process while the burn team struggles with the new patient profile on one hand and has to learn how to overcome with less personal trauma the loss of patients, a feeling it is unfamiliar with, on the other hand. This is also an actual training process for the entire burn team.

BACKGROUND: Although the fractures of the mandibular condylar region are very common, the controversies about the treatment of this area is still ongoing. In recent years, general agreement has emerged that open treatment is more effective than closed approaches for extracapsular condylar fractures. However, the method of surgical approach has become controversial at this time. The aim of this study was to evaluate the effectiveness of the retromandibular transparotid approach for fixation of subcondylar/high ramus mandible fractures.
METHODS: Subcondylar/high ramus mandible fractures were operated via the retromandibular transparotid approach with a two-point fixation in 24 patients. The patients were evaluated for bleeding during the operation and for hematoma, infection, Frey's syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site, hypoesthesia of the ear, and temporomandibular (TME) joint movements in the postoperative period.
RESULTS: Only one major complication was encountered in one (4.1%) patient, which was damage to the temporal branch of the facial nerve.
CONCLUSION: The retromandibular transparotid approach appears to be a safe and effective method for the internal fixation of extracapsular condylar fractures.

High voltage electrical injuries can cause devastating results especially in distal extremities. Althought the free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF). This flap can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury.
In this study, we evaluate long term results of 11 patients who had reconstruction to the lower extremity due to a high voltage electrical burn injury between the years of 2003-2013.
The cross-leg DBSF has good tissue compliance, provides tissue of adequate quantity and quality for leg and foot defects, and has low complication rates in the long term.

Introduction
Treatment of the distal tibial fractures are challenging due to the limited soft tissue, the

subcutaneous location and poor vascularity. In this control-matched study, we aim to compare

the traditional open reduction and internal fixation with minimal invasive plating(MIPO). We

hypothesized that superior results may be achieved with MIPO technique.

Materials and Methods
22 patients treated with traditional open reduction and internal fixation were matched

with 22 patients treated with closed reduction and MIPO on the basis of age (±3), gender, and

fracture pattern (AO classification). Evaluation was assed according to the wound problems,

the American Orthopaedic Foot and Ankle surgery (AOFAS) scoring [14], radiological

union, malunion, delayed union, hospitalisation time, time from injury to surgery, and

operation time.

Results

There was no significant difference in the distribution of AO/OTA classification, age,

gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed

union, malunion and infection (p>0.05). The operation time was significantly longer in the

open group than in the MIPO group. 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the

MIPO group (p< 0.01).The hospitalisation time was significantly longer in the open group

than in the MIPO group. 7.64±4.71 days for the MIPO, and 10.18±4.32 days for the ORIF

group (p< 0.05).

Conclusions

In conclusion, MIPO technique can be beneficial for the treatment of distal tibia AO/OTA

A and B type fractures with reduced hospital stay, cost-effectiveness, infection rate.

Key words: MIPO, Distal tibia, malunion, fracture.

BACKGROUND: This study aimed to evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy.
METHODS: Forty patients with intra-articular distal humerus fractures were retrospectively analyzed. TRAP approach was used in 22 patients (12 males, 10 females; mean age 37.8 years, range 17-70), and olecranon osteotomy in 18 patients (11 males, 7 females; mean age 35.4 years, range 18–62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score.
RESULTS: The overall mean arc of elbow motion was 108° (range 70°–140°) in the TRAP group, whereas that of the olecranon osteotomy group was 98° (range 70°–115°). A significant difference was observed between the two groups in terms of overall mean arc of elbow motion (p=0.038). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.412, p=201, respectively). The overall complication rate was 27.2% in the TRAP group and 55% in the olecranon osteotomy group.
CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates.

Introduction and Aim: In this study, it is aimed to analyze the cases of traffic accident related deaths, that were buried without performing autopsy, in order to increase awareness of the physicians about declaration liability of forensic cases and also emphasize the decleration of the forensic case and autopsy importance.
Material and Method: In the First Specialization Board of Council of Forensic Medicine, 542 death cases that was reported between the years 2004-2008, who were exposed to traffic accidents, and buried without an autopsy being performed, were evaluated retrospectively.
Results: It was found that 69.37% of the cases (n: 376) were male, whereas %30.63 (n: 166) were female; the average age was 58.50±20.91 (between 3-98 years). The age 61 and above was the most frequent age group with 301 cases (55.5%). Of the cases, 336 (61.99%) had died in hospital, 241 (44.46%) had died in 1-12 months following the accident and medico-legal corpse examination was performed only in 123 (22.88%) cases. Three hundred fourty four (63.5%) of the cases were not reported as forensic cases and death certificate was signed by any physician other than medical examiner without declerated as a legal case. According to the decisions of Board; since an autopsy was not duly performed, the cause of death could not be determined for 95 cases (17.5%) and for 57 cases (10.5%) it was not possible to determine whether there was a causality between the accident and death.
Conclusion: Our findingsemphasizes the importance of decleration of the forensic cases and performing autopsy in time in traffic accident victims.

Background: Present study aimed to investigate predictive importance of cut-off levels of preoperative WBC, neutrophil and CRP concentrations in operated appendicitis patients.
Methods: Patients operated for acute appendicitis between January 2008-November 2010. retrospectively screened.Patients were divided three groups accordingly postoperative histopathology. Group I: normal appendix, Group II: Uncomplicated appendicitis, Group III: complicated appendicitis. ROC curves are intended for positive distinguishing pathological laboratory measurements. Cut-off values determinated and distinguishing performances are assessed.
Results: 175 of 320 patients were male (%54.7), 145 were female (%45.3). Average age was 35.95±14.75. Cutoff values for WBC=12,080 and significant distinguishing total appandisitis (group II+ group III) from normal appendixes and distinguishing group II from group I (p<0,001), however was'nt significant distinguishing group II from group III (p=0,768). Cut-off values for neutrophil=73% significant distinguishing group II+group III from group I and distinguishing group II from group I (p<0,001), however was'nt significant distinguishing group II from group III (p=0,681). Cut-off values for CRP=45.98 and was'nt significant distinguishing group II+group III from group I and distinguishing group II from group I, however was significant distinguishing group II from group III (p<0,001). When all measurements are evaluated together it is detected that the increase of only neutrophil percentage increases the non complicated acute appendisitis (OR: 1,082; p < 0,001) and increase of both neutrophiles and CRP increase the risk of complication (OR: nötrofil =1,066; p=0,009- CRP= 1,005; p=0,013).
Conclusion: The cut-off value of labaratuary tests may help the determination of diagnosis and treatment. Especially cut-off value of CRP may be helpful to determine the method of incision during the operation as conventional appendectomy or laparoscopic appendectomy.

BACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures.
MATERIAL AND METHOD: 42 pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluations included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications.
RESULTS: In 27 patients radial pulse was palpated following the reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture and the other two were managed with saphenous vein graft and primary repair.
CONCLUSION: It is vital to re-evaluate the patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

Introduction: In this study, the results of AO 42A and 42B type tibia fractures treated with intramedullary nail(IMN) and percutaneus locking plate(PLP) were evaluated. It was questioned whether the type of fixation affect union time, functional results, complications or not.
Material-methods: Forty-two patients with extraarticular distal tibial fractures were enrolled in this retrospective study. Eighteen patients were treated with closed IMN (Group I) and 24 patients were treated with PLP fixation (Group II). The mean age was 41 (range: 16-70) years; thirty-two of the patients were men. Fractures were classified according to the AO classification system. The union time, functional results and complications(malunion, malalignment, infection) were compared. The American Orthopaedic Foot and Ankle surgery(AOFAS) scoring was used to compare the functional results.
Results: The average follow-up period was 20(12-32) months for group I, 23(13-36) months for group II. The average union time was 16(12-24) weeks in Group I and 19(range: 16-24) weeks in Group II ( p=0.002 ). The AOFAS scoring was 85 (range: 69-100) point in group I, 81 (range: 60-95) point in group II. The difference in AOFAS scoring was not significant (p=0.06). Two patients had nonunion in Group II. Two patients in group I and three patients in group II had a malalignment.
Conclusion: We suggest that IMN can provide early healing time. Although it is not statistically significant, complication rate was lower and functional results was better in patients treated with ÝMÇ.
Key words: intramedullary nail, percutaneus locking plate, distal tibia, fractures

A 20-year old man presented with complaints of inability to see the outer half of objects and blurred near vision when reading. His complaints began one year ago after a motor vehicle accident that caused cranio-orbital fractures. Ocular examination revealed complete bitemporal hemianopsia and slight exotropia. Central visual acuity was 20/20 in both eyes. Radiologic studies demonstrated fractures in the fronto-ethmoid and sphenoid bones and thinning of the optic chiasm. No hypothalamic-pituitary abnormality was detected. Clinical findings remained unchanged during follow-up. Although rare, blunt head trauma may cause an isolated damage to the chiasmal crossing nerve fibers, resulting in a complete, bitemporal hemianopsia associated with normal visual acuity. Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.

Patients admitted to emergency departments with a loss of consciousness following trauma often have cervical vertebrae fractures and spinal cord injuries with a ratio of 5–10%. Computed tomography (CT) and radiography have important role for diagnosis. We aimed to describe the interesting CT and radiography findings of a patient who had C3-4 dislocation, distraction that was called shearing injury. C3 and C4 seperated but there was no fracture and major vascular injury. Images were interesting. We also mentioned NEXUS and Canadian Rules for clinical evolution. Imaging modalities espacially reformatted CT images make easier to diagnose where and what the problem is.

Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gall stone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.

Background: Splenic artery aneurysms are very rare causes of acute abdomen but are important to recognize since they carry high rate of mortality when rupture.
Case report: We present a middle aged man with sudden onset of abdominal pain. Previously on steroid treatment due to sarcoidosis the gentleman developed hypovolemic shock during work-up in diagnostic imaging and went on emergency laparatomy. The source was identified as a ruptured splenic artery aneurysm. Splenectomy en bloc with the aneurysmatic distal splenic artery was performed and he was discharged uneventfully.
Conclusion: Although rare it is important to recognize splenic artery aneurysm in the emergency department and immediate intervention is required to save the patient.

Aim: To analyse patients those admitted to our clinic due to perforation in duodenum. Patients and Method: Fourteen patients those have been admitted to our center with perforation in duodenum between 1990 – 2014 analysed retrospectively. Results: Ten patients (8M, 6F) those have been admitted to our clinic between 1990 – 2014 have a mean age of 6.2 years (25 days – 16 years). Two of cases admitted directly to our clinic and the rest refered from another hospitals. Mean time for appliance to our clinic was 3.2 days ( 1day – 1 week). Ulcer in duodenum was the cause of perforation in 10 cases while in 3 the cause was trauma and in 1 case was surgical complication of infantyl persistant hyperinsulinism (IPHH). The case with hyperbilluribinemia after near total pancreatectomy due to IPHH had been explored and perforation in deuedenum diagnosed. Resection in first two parts of duodenum and pylor, choledochojejunostomy, gastrojejunostomy and jejunojejunostomy was performed. Primary repair was performed in the remaining patients. In one case with primary repair gastrostomy was performed, while in 9 cases omentoplasty were performed. In the follow-up 12 cases has no problems and doing well. Two patients died.
Conclusion: Perforation in duedenum is a rare entity that pediatric surgeons should encounter and keep in mind. Primary repair(duodenoraphy ± omentoplasty) is safe and reliable surgical treatment modality.