BACKGROUND: Currently, all progress in diagnostic techniques, surgical techniques, antibiotherapy, and intensive care units is accompanied by a decrease in the mortality due to severe secondary peritonitis; however, the rate is still unacceptably high. To remove the source of peritonitis, a surgeon has several options, such as closure, exclusion, and resection, depending on the preference of the surgeon and the condition of the patient. The aim of this study is to determine the rates of bacterial translocation by comparing the dry cleaning method (gauze squeezed with saline) and peritoneal lavage method (cleaning with saline), which are among the peritoneal cleaning methods.
METHODS: A total of 64 rats were studied as sham, control, dry cleaning, and saline cleaning groups. Only laparotomy was performed in the sham group, and cecal ligation puncture was performed in the control group. After ligation puncture operations in the other two groups, one of them was subjected to dry cleaning and the other to isotonic cleaning. The samples obtained from the liver, spleen, and mesothelium were sacrificed and cultured under aerobic and anaerobic environments.
RESULTS: There was no significant difference in the anaerobic bacterial counts, although there was a significant difference in the results of the aerobic bacterial counts in liver, spleen, and mesothelium samples on comparing the dry cleaning and saline cleaning groups.
CONCLUSION: According to our study, the cleaning of intraabdominal infections with dry gauze is more effective than the cleaning with physiological saline for the elimination of aerobic bacteria. There is no difference observed with respect to the anaerobic bacterial counts.

BACKGROUND: Trauma is associated with a profound immunological dysfunction. This predisposes patients to infections and adverse outcomes. β-glucan has been implicated in the initiation of anti-microbial immune response. The present study aimed to evaluate the effects of an enteral diet containing β-glucan on serum levels of IL-12 and highly-sensitive C-reactive protein (hs-CRP), occurrence of infection, and clinical outcomes in critically ill multiple-trauma patients.
METHODS: Forty multiple-trauma patients requiring enteral nutrition for at least 10 days were randomly assigned to the intervention group (n=20) or the placebo group (n=20). The intervention group received a high-protein enteral diet providing 3 g β-glucan, and the control group received a similar diet, except for 3 g of maltodextrin as a placebo. Serum levels of IL-12 and hs-CRP were measured on days 0, 10, and 21.
RESULTS: The β-glucan group showed significantly higher serum levels of IL-12 on day 21 compared to the control group. Infection frequency and duration of mechanical ventilation were significantly lower in the β-glucan group. A significant difference was found in the Sequential Organ Failure Assessment (SOFA) score in favor of the β-glucan group. No difference was found in the serum levels of hs-CRP, length of ICU stay, occurrence of infection, and mortality rates between the two groups.
CONCLUSION: β-glucan may increase serum levels of IL-12, shorten the duration of mechanical ventilation, and reduce organ failure in critically ill multiple-trauma patients.

BACKGROUND: In this bibliometric study, we aimed to conduct multi-dimensional citation analysis of the top 100 cited articles in traumatology.
METHODS: We analyzed the top 100 cited articles among 56.980 trauma articles published between 1975 and 2017, which we obtained from databases in Web of Science and PubMed based on their citation rates and publication years, countries of origin, institutions or organizations, the most common subjects, funding status, article types, and levels of evidence.
RESULTS: In the top 100 cited articles, the number of total authors was 649 and average authorship was 6.49±5.46 (1–32); group author or study group number was eight, and the number of total collaborators was 1241. USA was the top country in terms of country of origin and institutions or organizations and also the number of proceedings papers in scientific activities. We found that 70 of the top 100 cited articles were supported by funding agencies in developed countries. In the present study, the three most common subjects were central nervous system trauma (21 articles), major trauma–hemorrhage–bleeding control–transfusion–early coagulopathy (18 articles), and trauma care and systems (eight articles), respectively. The average level of evidence of the top 100 cited articles was 2.45±1.05 (range: 1–4). We also found that 66 of the 100 most frequently cited articles in traumatology were published in scientific journals that had an impact factor of ≥2.6 (range: 2.648–72.406). We found that the most commonly preferred article type by authors is clinical research (92 articles) and sub-type is prospective comparative studies (27 articles). Evidence groups of classical papers in traumatology were B (54 articles), A (26 articles), and C (20 articles), respectively.
CONCLUSION: Despite some flaws in determining the scientific values of articles, citation analysis of classical papers in traumatology can provide important scientific contributions.

BACKGROUND: Despite the magnitude of occupational hand injuries, there are no authoritative guidelines for hand injury prevention, and little research has been done to investigate the epidemiology of acute occupational hand injuries in South China or other developing areas. In this study, the epidemiology of acute occupational hand injuries treated in emergency departments (EDs) in Foshan City, South China, was examined and data were supplied to assist with preventive strategies in similar developing regions.
METHODS: A multicenter study was prospectively designed and conducted in 5 large hospital EDs in Foshan City from July 2010 to June 2011. An anonymous questionnaire was designed specifically to collect the data for this study.
RESULTS: A total of 2142 patients with acute occupational hand injury completed the questionnaire within the 1-year study period. Results indicated that most occupational hand injuries were caused by machinery. Hand injury type and site of the injury did not correspond to age, but were related to gender and job category. July and August 2010 were the peak periods of admission to EDs, while January and February 2010 were the trough periods.
CONCLUSION: Epidemiological data enhance our knowledge of acute occupational hand injuries and could play a role in the prevention and treatment of future occupational hand injuries.

BACKGROUND: Technological developments support using ultrasonography (US) in all patients, if available, and advanced diagnostic methods such as abdominal computed tomography (CT) in case of clinical suspicion during diagnostic process of acute appendicitis. We aimed to investigate whether CT was appropriately and efficiently used in the diagnosis of acute appendicitis.
METHODS: Between May 2013 and February 2016, 811 patients who underwent appendectomy were retrospectively reviewed from an IRB-approved database, and those who underwent a preoperative CT were enrolled into the study. Results of Alvarado scores and US were recorded in addition to which clinic requested the CT (general surgery or emergency department).
RESULTS: The frequency of CT use in the diagnostic process was 25% (n=208/811). Ultrasound was negative for appendicitis in 53% of these patients. The mean Alvarado score was 5±1.5 (range: 3–8). General surgeons requested 57% of CTs. Alvarado scores were significantly higher in patients whose CT was requested by general surgery than in those whose CT was requested by the emergency clinic (5.6 vs. 4.7, p=0.013). Regarding histopathological results, age and Alvarado scores were significantly lower (p=0.015 and 0.037, respectively), whereas the frequency of negative CT was significantly higher (p=0.042) in those with negative appendectomy (n=29, 14%).
CONCLUSION: Most patients who underwent CT in the diagnostic process had an Alvarado score between 5 and 8 and negative ultrasound for appendicitis preoperatively. These findings may provide efficient use of CT in the diagnosis of appendicitis with an acceptable rate of 25% compared with the findings in current literature. However, further research is needed to ensure more efficient use of CT because negative appendectomy has been a concern in our series despite promising results of this study.

BACKGROUND: Currently, the measurement of optic nerve sheath diameter (ONSD) has been offered as a possible indicator of
intracranial pressure (ICP). Increased ICP is observed during intracranial injury. The objective of this study was to evaluate the relationship
between increased ONSD and positive intracranial findings from multislice computed tomography (CT) of the brain.
METHODS: In total, CT scans of 161 patients were retrospectively reviewed. The image that showed the largest ONSD was magnified
five times.
RESULTS: The CT scan revealed intracranial lesions in 54 patients and no intracranial lesions in 107 patients. A significant relationship
was observed between positive CT findings and increased ONSD: 5.60±0.75 mm vs. 5.35±0.75 mm (p=0.038). The area under the
receiver operating characteristic curve was 0.600 (95% confidence interval, 0.508–0.692; p<0.039). A cut-off value of ≥5.0 mm had a
sensitivity and specificity of 80% and 36%, respectively.
CONCLUSION: This study demonstrated a significant yet poor relationship between intracranial injury and increased ONSD from
the multislice CT scan. Severe structural changes in the brain and trauma that causes bleeding have only limited effects on the extension
of the optic nerve.

BACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum- Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated.
METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013–2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared.
RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05).
CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality
rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

BACKGROUND: Acute pancreatitis (AP) is a common abdominal disorder, which requires early diagnosis and treatment. Several prognostic scoring systems introduced to clinical practice are not suitable in emergency department (ED) because these require much time and complex parameters. Recently, the harmless acute pancreatitis score (HAPS) has been introduced to identify AP with a nonsevere course. The aim of this study was to determine the utility of HAPS in predicting the severity of AP.
METHODS: All patients aged >16 years who were diagnosed as AP in ED were enrolled in this retrospective study. The study included 144 patients with a mean age of 58.7±15.4 years, and 69 (47.9%) of them were males and 75 (52.1%) were females. Patient data were collected from hospital database. The utility of HAPS was analyzed and compared using the Ranson’s score.
RESULTS: HAPS was statistically significant for predicting mild disease (p=0.008) and has demonstrated a specificity of 81%, a positive predictive value (PPV) of 96%, and an odds ratio of 5.57 (1.51–20.50). The predictability of Ranson’s scores was not significant. The measure of agreement (κ) between the two scores was 0.15, indicating a low agreement.
CONCLUSION: HAPS is a simple and useful scoring algorithm to predict the non-severe course of AP in ED. HAPS-0 patients did not require early aggressive treatments and advanced radiological screening tools during the early stages of the disease.

BACKGROUND: Normal physiologic changes during pregnancy result in similar laboratory and symptomatology changes as those during acute appendicitis (AA), making the diagnosis extremely difficult. The aim of the present study was to analyze the efficacy of conventional laboratory and radiologic tests in the diagnosis of AA according to different stages of pregnancy.
METHODS: Twenty-five pregnant patients with pathologically confirmed AA operated at our department between 2012 and 2017 were retrospectively analyzed in terms of changes in conventional laboratory parameters as well as neutrophil-to lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios to aid the diagnosis of AA according to different stages of pregnancy.
RESULTS: There were no significant changes in C-reactive protein levels, leukocyte and neutrophil counts, and accuracy of ultrasonography between patients in the first (group 1) and second + third trimesters (group 2) (p>0.05). Lymphocyte count was significantly lower (p>0.05), whereas NLR and PLR were significantly higher in group 2 (p<0.05).
CONCLUSION: Laboratory values change significantly during pregnancy, and NLR and PLR seems to be valuable tools for evaluating AA in a stage-specific manner in pregnant patients.

BACKGROUND: The occurrence of a serious infection called overwhelming post-splenectomy infection (OPSI) increases more than 50 times in patients who have hyposplenia. The aim of this study was to investigate the adherence to vaccination recommendations after traumatic splenic injury.
METHODS: We identified patients who underwent total splenectomy due to abdominal trauma between May 2012 and March 2016. We recorded the clinical, laboratory, and pathological features of the patients. We calculated the vaccination proportions before discharge, after discharge, and final.
RESULTS: Twenty-seven patients underwent total splenectomy. For the vaccination status before discharge, after discharge, and final, the number of patients who received all the three vaccinations were 0 (0%), 0 (0%), and 8 (18.5%) and those who received none were 13 (48.2%), 11 (40.8%), and 9 (33.4%), respectively. The data of 17 patients were available for developing OPSI. The median follow-up time was 17.8 (4.4–41.2) months, and no OPSI cases were observed.
CONCLUSION: Adherence to vaccination recommendations remains still low. Establishing a vaccination tracking system and following vaccination recommendations will be helpful to prevent serious infections, such as OPSI, after traumatic splenectomy.

BACKGROUND: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases.
METHODS: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. χ2 test was used for statistical analysis.
RESULTS: Bite and sting cases comprised 0.5% of all the patients reporting to the hospital’s emergency department, with scorpion sting cases comprising almost half (54.2%) of these hospital presentations, followed by Hymenoptera (bee and wasp) sting (30.8%) and snake bite (5.5%) cases. Unnecessary antihistamine administration was found to be significantly high in asymptomatic patients (p=0.00006). Furthermore, antivenom use was found to be significantly high in patients with scorpion sting and snake bite despite the absence of systemic or local indications (p<0.0001, χ2=80.595).
CONCLUSION: The study results showed that antivenom was used in scorpion sting and snake bite cases even when it was not indicated. Therefore, primary practitioners should be provided training for management of envenomation cases and should be made aware of the updated guidelines and references to raise their knowledge levels.

BACKGROUND: Ultrasonography (US) is noninvasive, readily available, and cheap. The diameter of inferior vena cava (dIVC) and its respiratory variation were proposed as a good surrogate of the hemodynamic state. However, recent studies have shown conflicting results, and the value of IVC-derived parameters in the estimation of fluid status and hemorrhage remains unclear.
METHODS: This was an observational study of trauma patients who presented to emergency department. dIVC and aorta diameter (dAorta) were measured at the initial US and CT in all patients. The correlation of these measurements and all parameters derived from those measurements along with the initial vital signs and laboratory values of hemorrhage (hemoglobin, hematocrit) and shock (lactate, base excess) were assessed. US and CT values were also compared for accuracy using Bland–Altman analysis.
RESULTS: The final study population was 140, with a mean age of 38 years and 79.3% were male. dIVC and dAorta did not have any clinically significant correlation with any of the vital signs or laboratory values of hemorrhage or shock when measured by US or CT. A good and significant correlation was observed between dIVC and dAorta measured by US and CT.
CONCLUSION: The value of an initial and single measurement of IVC and aorta parameters in the evaluation of trauma patients should be questioned. However, the change in the measured parameters may be of value and should be investigated in further studies.

BACKGROUND: The radial head is essential for the rotational stability of the forearm and resistance to valgus stress. Radial head fractures are the most common elbow fracture in adults. Various treatment options are available, depending on the fracture severity. However, the treatment of Type-III fractures is controversial. The aim of this study was to evaluate functional results in patients with irreparable Mason Type-III radial head fractures treated with radial head resection or prosthesis.
METHODS: Fourteen irreparable Mason Type-III radial head fracture patients treated with radial head resection (n=7) or radial head prosthesis (n=7) were evaluated in this multicenter, retrospective study. Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow and Wrist scores were used to determine clinical outcomes. A hydraulic hand dynamometer was used to measure grip strength on the operated and unoperated sides to avoid potential bias. Measurements were made three times for each extremity, and the mean value was recorded. Grip strength was calculated as a percentage of the strength of the unoperated side.
RESULTS: Functional outcomes for resection and prosthesis patients were the following: mean DASH scores, 25.8 and 17.2; mean Mayo Elbow scores, 74 and 84.1; mean Mayo Wrist scores, 84 and 92.5; and maximum grip strengths, 48.8% and 77.8%, respectively. The range of motion of the respective resection and prosthesis groups were as follows: flexion, 112.14° and 104.29°; extension, −10.00° and −25.00°; pronation, 70.00° and 47.86°; and supination, 70.00° and 52.14°.
CONCLUSION: Although range of motion was restricted in the radial head resection group, functional results and grip strength were superior in patients treated with a radial head prosthesis. These results support the radial head prosthesis as a superior treatment modality for patients with irreparable Mason Type-III radial head fractures with respect to patient satisfaction and functional outcomes.

BACKGROUND: Extensive scalp defects caused by various etiologies often require free-tissue transfer. We aimed to review our experience in the reconstruction of extensive scalp defects with free anterolateral flaps.
METHODS: A retrospective analysis was performed on all patients with extensive scalp defects that were reconstructed with free anterolateral thigh flaps from November 2007 to April 2015. Eleven patients with a mean age of 44 years were included in this study.
RESULTS: Eleven free-tissue transfers were used to reconstruct the extensive scalp defects. The flaps were 7–14 cm in width and 10–34 cm in length.
CONCLUSION: Microvascular free-tissue transfer is the mainstay for the treatment of extensive scalp defects. We recommend anterolateral thigh free flap use for challenging and complex cases, given the method’s numerous advantages, including reliability and safety.

BACKGROUND: It is often difficult to achieve satisfactory reduction and fixation of both-column acetabular fractures owing to the complexity of the regional anatomy of the pelvis and the fracture configuration, which is commonly associated with a high degree of comminution. Herein, we describe the use of a three-dimensional (3D) patient-specific printed model of the pelvis to facilitate preoperative planning, simulate the fracture reduction procedure, and pre-contour the fixation plates for treating both-column acetabular fractures.
METHODS: The 3D-printed model was constructed using a fused deposition modeling method with computed tomography images as inputs. Operative and clinical outcomes were evaluated for 5 patients with both-column acetabular fractures (mean age: 41.4 years). The status of fracture reduction was classified using the Matta criteria, and the functional outcome was assessed using the modified Merle d’Aubigne score.
RESULTS: Reduction was classified as excellent in 4 patients and good in 1 patient, and good functional outcomes were achieved in all patients at the final follow-up. The average incision length was 6.9 cm with an average operative time of 124 min.
CONCLUSION: We successfully applied 3D printing for the surgical management of both-column acetabular fractures, thereby improving surgical outcomes while achieving good-to-excellent reduction and good medium-term functional outcomes.

Morgagni hernia (MH) is a very rare congenital defect found in the anterior aspect of the diaphragm between the costal and sternal portions of the muscle. The most common defect is congenital diaphragmatic hernia, 90% of which are Bochdalek type. MHs account for approximately 3% of all diaphragmatic hernias. Most MHs are found and repaired in children, but 5% are found in adults. Here, we present the case of an incarcerated and strangulated MH with synchronous prolapse of the liver and transverse colon in a 77-year-old man who was admitted to our hospital for abdominal pain and symptoms of intestinal obstruction.