BACKGROUND: In developing countries, esophageal burns are quite common. They are caused by the ingestion of corrosive substances that may lead to esophageal perforation in the short-term and stricture formation in the long-term. Prevention of stricture progression in the esophagus is the main aim of the treatment for corrosive esophageal burns. We aimed to investigate the protective and anti-inflammatory effects of methylene blue (MB) treatment on corrosive esophageal burns.
METHODS: Twenty-eight rats were used in the study and randomly divided into four equal groups; group 1 (Sham), group 2 (control), group 3 (topical treatment), and group 4 (topical plus systemic treatment). Except for group 1 (Sham group), all three groups received sodium hydroxide (NaOH) in order to generate esophageal burns. In addition, group 2 was given normal saline, group 3 topical MB, and group 4 topical and systemic MB.
RESULTS: Hydroxyproline levels were found to be lower in each of the treatment groups as compared to the control group (p=0.005 for group 3 and p=0.009 for group 4). There were no differences in the tumor necrosis factor-α (TNF-α) levels between the groups. The stenosis index (SI) in the treatment groups was also lower than the control group (p=0.016 for group 3 and p=0.015 group 4). The histopathologic damage score (HDS) was prominently lower in group 4 as compared to the control group (p=0.05).
CONCLUSION: MB is effective in treating tissue damage caused by corrosive esophageal burns and in preventing esophageal stenosis. Complication rates of corrosive esophageal burns may be decreased by using MB in the initial treatment stage.

BACKGROUND: Oils from marine organisms have a different fatty acid composition. Fish oil (FO) has a high content of eicosapentaenoic and docosahexaenoic acids esterified to triacylglycerols; while in krill oil (KO), fatty acids are primarily esterified to phospholipids. This study aimed to compare the efficacy of two different, marine-derived omega-3 fatty acid sources in the wound healing of colon anastomoses rat model.
METHODS: For the study, we used 42 male Wistar albino rats. The rats were divided into six groups with seven rats in each group—CO3: left colonic anastomosis (control group), sacrificed on the third day; KO3: left colonic anastomosis + oral KO, sacrificed on the third day; FO3: left colonic anastomosis + oral FO, sacrificed on the third day; CO7: left colonic anastomosis (control group), sacrificed on the seventh day; KO7: left colonic anastomosis + oral KO, sacrificed on the seventh day; FO7: left colonic anastomosis + oral FO, sacrificed on the seventh day. Peritoneal adhesions, anastomotic bursting pressures, hydroxyproline levels, and histological examination of the anastomotic tissue were evaluated.
RESULTS: On day 7, bursting pressure and hydroxyproline measurements of the KO group was significantly higher than the FO group (p=0.012; p=0.002, respectively). Also, on day 7, a statistically significant difference was observed between the groups according to inflammatory cell infiltration, fibroblast activity, neoangiogenesis, and collagen deposition in favor of the KO group (p=0.023; p=0.028; p=0.016; p=0.012, respectively).
CONCLUSION: Both KO and FO supplementation in patients before colorectal surgery may reduce some risk of anastomotic leakage; and KO might be a better alternative and excellent omega-3 source.

BACKGROUND: Although there are studies demonstrating hyperoxia may be an independent risk factor for increased mortality and morbidity, this issue remains unclear. Our research then aimed to examine the relationship between arterial oxygen tension, arterial carbon dioxide tension, and in-hospital mortality of critically ill patients in intensive care unit (ICU).
METHODS: After obtaining ethics committee approval, we analyzed a retrospective data of patients over the age of 18 who survived at least 24 hours in the ICU on mechanical ventilatory support between year 2008 and 2012. The demographic properties, mechanical ventilation, and blood gas parameters were studied. We defined hyperoxia group as PaO2 value of ≥120 mmHg and normoxemia group as PaO2 of 60–120 mmHg. Patients with PaCO2 value <30 mmHg were determined to have hypocapnia, those with 30–50 mmHg normocapnia, and those with >50 mmHg hypercapnia.
RESULTS: Between 2008 and 2012, a total of 7689 patients were admitted to the ICU. Of 450 patients meeting the inclusion criteria of the study, 263 (58.4%) were male and 187 (41.6%) were female. Normoxia was observed in 232 (51.5%) patients and hyperoxia in 218 (48.5%) patients. The mean PaO2 was 16.2 kPa (121.50 mmHg), and FiO2 was 60%. 254 (56%) of the patients had died during the five-year period. There was no statistically significant difference in mortality between PaO2 levels and PCO2 levels (p>0.05). According to the classification of PaO2 and FiO2, there was no statistically significant difference in mortality (p>0.05) among patients. In addition, no statistically significant difference was found between the survival rates according to PCO2 classification (p=0.602, p>0.05).
CONCLUSION: There was no significant association between mortality and oxygen and carbon dioxide of patients in ICU on mechanical ventilatory support.

BACKGROUND: The present study was designed to compare the effectiveness of topical silver sulfadiazine (SSD) and Ankaferd Blood Stopper® (ABS) usage in experimental partial-thickness burns in rats.
METHODS: Twenty-one male Wistar albino rats weighing 250–290 (range: 270±19) g were used in the present study. A round brass probe that was specifically designed (3×3 cm diameter) was used to induce the burns in rats. After the presence of partial-thickness burns was confirmed, the rats were divided into three groups: Group 1 (ABS group) Ankaferd Blood Stopper® pad, Group 2 (SSD group) silver sulfadiazine (Silverdin®), and Group 3 (Control group) 1% isotonic saline solution-impregnated pad. The healing period was followed up clinically and histopathologically. The day on which 50% and 80% of re-epithelization at first were detected for each rat was also recorded.
RESULTS: The mean times of 50% and 80% of re-epithelization at first were 10.8 days, 13.8 days, and 16.8 days in Groups 1, 2, and 3, respectively (p<0.001), and 16.4 days, 19.7 days, and 25.2 days, respectively (p<0.001). The mean inflammatory scores were also found to be better in the ABS group than in other groups (p<0.05).
CONCLUSION: Our study showed that ABS has better results for the healing of the burn wound than SSD in experimental partial-thickness burns in rats.

BACKGROUND: The present study investigated the therapeutic effect of resveratrol on cardiac injury resulting from blunt chest trauma and the utility of endocan as a biomarker of the inflammation process using rats.
METHODS: The rats were randomly divided into the following four groups (n=7 in each group): a control group (no treatment or trauma); trauma-induced group (trauma group); resveratrol group (resveratrol 0.3 mg/kg administered via the intraperitoneal [i.p.] route group); and resveratrol + trauma group (resveratrol 0.3 mg/kg administered via the i.p. route 1 hour prior to the induction of trauma).
RESULTS: The immunoreactivity of tumor necrosis factor-α and inducible nitric oxide synthase in the trauma group was increased, whereas the reaction intensity in resveratrol + trauma group was deceased. The mean endocan values of the differed between the groups (p<0.001). The mean endocan value in the resveratrol + trauma group was higher than that of the other groups.
CONCLUSION: Resveratrol exhibited anti-inflammatory and antioxidant effects in lung injury after blunt chest trauma and contributed favorably to the treatment process. We believe that there is a need for further studies on the clinical use of endocan as a biomarker of inflammation in cardiac injury after blunt chest trauma.

BACKGROUND: Chest injuries, accounting for 25% of all trauma-related deaths, are one of the main causes of death in young
adults. Our priority is the early identification of life-threatening injuries both immediate and delayed. The role of various biomarkers,
such as Clara cell protein 16, von Willebrand factor, interleukin-6, tumor necrosis factor, and angiopoietin, has been studied in
trauma-related acute respiratory distress syndrome (ARDS). Serum angiotensin-converting enzyme (ACE) levels have been studied
in non-trauma-related ARDS. The aim of this prospective observational study was to evaluate the role of ACE levels as a prognostic
marker in thoracic trauma.
METHODS: A prospective observational study was conducted to evaluate serum ACE levels in thoracic trauma patients and to
explore its prognostic potential with regard to clinical outcome. A total of 48 thoracic trauma patients were included in the study.
RESULTS: The mean ACE level in the study population was 66.54±11.18. A strong positive correlation was found among serum ACE
levels and Thoracic Trauma Severity Score (TTSS).
CONCLUSION: Our study demonstrates that serum ACE levels are increased in thoracic trauma patients with higher levels, indicating
the severe nature of trauma in concordance with increased TTSS scores.

BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method—computed tomography (CT) scan.
METHODS: A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted.
RESULTS: The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland–Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p<0.001. The VAS scores for the palpation and US difficulty were 5.13±1.1 and 3.32±0.9 (p<0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US.
CONCLUSION: Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.

BACKGROUND: The prediction of posttraumatic potential organ donors is a complex process. The aim of this study is to evaluate the organ procurement process in trauma-related injuries and determine the medical markers in organ donors and posttraumatic mortal patients at the first level emergency, in emergency surgical service, and surgical intensive care departments.
METHODS: In this retrospective study, after the approval of the ethics committee, the records of the patients in the emergency surgery unit, the operating room, and the organ donors in surgical intensive care unit between the years 2000 January–2011 December were examined. Patient demographics, distribution of donated organs, intubation area, transfer to the hospital, patient’s service, trauma type, injury mechanism, and severity of the injury were examined. Continuous variables were evaluated with independent samples by the Student’s t-test or Mann-Whitney U test and binary variables with the Pearson Chi-Square test. The patients who lost their lives and survived in the emergency department (ED) were compared with an age ratio of 1: 3. Final results were evaluated by multiple logistic regression.
RESULTS: The patients with ≤90 mmHg systolic blood pressure (SBP) or penetrant serious injuries were more likely to be candidates for organ donation in ED, respectively; 68.2% vs. 15.2% [AOR: 4.59 (1.14, 18.40), p<0.031] and 63.6% vs. 37.9% (AOR: 6.25 [1.27–30.49] [p<0.024]). Patients with AIS head ≥3 and in-hospital blood replacement of 1500 cc or more, were more likely to be organ donors after ED: 54.5% vs. 97% (AOR: 0.074 [0.014 kan0.548], [p<0.01]) and 10% vs. 58.1% (AOR: 0.098 [0.016–0.591], p<0.01]).
CONCLUSION: In terms of predictive traits for organ procurement, a SBP of ≤90 mmHg and presence of serious penetrant injuries were found to be more predictive for organ transplantation than other factors such as AIS Head ≥3 or 1500 cc or more replacement of blood and blood products.

BACKGROUND: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations.
METHODS: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods.
RESULTS: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001).
CONCLUSION: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

BACKGROUND: Head trauma is a health problem that may be observed in all age groups, and it may cause significant losses in terms of health and economy. The purpose of our study is to evaluate the abnormal computerized brain tomography (CBT) prevalence and the rate of admission to brain surgery clinics in patients who applied to the Emergency Service Department for CBT due to minor head trauma.
METHODS: In the present study, the patients who were admitted to Afyonkarahisar Health Sciences University, Faculty of Medicine Hospital, Emergency Service Department between January 1st, 2017, and December 31st, 2017, due to head trauma and in who CBT was performed were examined retrospectively. The electronic files, CBTs, and consultation notes of these patients were accessed in the information system of the hospital.
RESULTS: A total of 43,389 patients who applied to the Emergency Service Department in 1 years’ time (2017) were examined retrospectively. As a result of the examination, it was determined that a total of 2,515 (5.7%) patients received CBT. The reason for a total of 1,152 (45%) of these patients was traumatic injury. It was determined that 618 (53.6%) of the patients in who CBT was performed due to trauma were aged <18 years; 280 (24.3%) patients were aged <2 years; 179 (15.5%) patients had to consult with the Brain Surgery Clinic; and 94 (8.1%) were hospitalized. It was also determined that there were abnormal computed tomography (CT) findings in only 68 (5.9%) of the patients in who CBT was performed.
CONCLUSION: The use of CBT indication criteria, which have been previously established and which reliability has been proven, in emergency trauma cases applying to the Emergency Service Department with minor head traumas may reduce the complication risk that may appear as a result of an unnecessary CBT and avoid complications that may occur in the long run due to CBT.

BACKGROUND: The impact of decompressive craniectomy (DC) on the overall outcome of pediatric acute subdural hematoma patients has not been fully determined to date. In this paper, we aimed to investigate the role of decompressive craniectomy performed to treat traumatic subdural hematoma in patients from the pediatric age group.
METHODS: We described our experience with DC in pediatric acute subdural hematoma patients and analyzed the outcomes.
RESULTS: Eleven (7 unilateral and 4 bilateral) DCs were performed. The patients’ ages ranged from 8 months to 15 years. The mean GCS score at admission was 7.8. All patients underwent DC with duraplasty within 2 hours of injury. All the patients were admitted to the intensive care unit for 10 days postoperatively. The mean hospital stay was 22 days and the mean follow-up period was 3.7 years.
CONCLUSION: Early DC for pediatric subdural hematoma patients, independent of their initial GCS, was recommended. Larger studies are needed to define the indications, surgical techniques, and timing of DC in the pediatric population.

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention.
METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72).
RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84±1.84 h in the TVS group and 5.95±1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant.
CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.

BACKGROUND: Approximately 10%–25% of patients with colon diverticular disease experience colonic diverticulitis during their lives. Right-sided diverticulosis is a rare condition in Western countries, but it is common among Asian countries. The aim of this study was to evaluate the clinical and treatment outcomes in our patients with right colon diverticulitis.
METHODS: Demographic and clinical data of 22 patients with a diagnosis of cecum and right-sided colon diverticulitis between 2014 and 2017 were analyzed. The Hinchey staging was applied according to the radiological evaluation and clinical findings. Then, the proportions of demographic and clinical features of the patients according to the Hinchey staging and its statistical significance were evaluated.
RESULTS: Our study included 22 patients who suffered from right colon diverticulitis. The female-to-male ratio was 0.69. A total of 68.1% of the patients were the Hinchey Stage I, and 31.8% were the Hinchey Stage II, all of which were evaluated by tomography. The Hinchey Stage I diverticulitis was mostly found in the right colon (66.7%) and the Hinchey Stage II diverticulitis in the cecum (57.1%). The mean age of the Hinchey Stage II patients was higher (63.6 years) and statistically significant (p<0.05). Two patients had appendectomy, and one had right hemicolectomy. Conservative treatment was applied to other 19 patients. The mean hospitalization time was 3.4 days. Four patients who received conservative treatment at the 2-year follow-up had recurrence. No recurrence was observed in patients receiving surgical treatment.
CONCLUSION: Right colon diverticulitis is usually seen in solitary men aged <50 years from Eastern societies. As a treatment option, conservative methods should be preferred, especially in uncomplicated cases. Surgical treatment is usually used in the treatment of recurrent and complicated cases.

BACKGROUND: The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures.
METHODS: The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed.
RESULTS: It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42–78), anxiety score 64 (55–77), state anger score 20 (16–30), and Group 2 barrat impulsivity score 61 (55–69), anxiety score 66 (58–72), and anger score 19 (14–26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2.
CONCLUSION: Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

BACKGROUND: The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures.
METHODS: A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck–shaft angle, and loss of the abductor muscle strength. Data were compared between the groups.
RESULTS: The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck–shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar.
CONCLUSION: Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.

Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old male construction worker presented to our emergency department due to falling onto a concrete reinforcing steel rod that penetrated through his perineum to the L4 vertebra. Examination revealed paralysis and sensory loss of the left foot. The rod was removed in the operating room (closed removal) under general anesthesia, followed by laparotomy. Rectal laceration was primarily repaired, and colostomy was performed. In a separate session, laminectomy was performed. At 3 months post-discharge, the patient was ambulatory with armrest based on the same motor examination performed on presentation This case is a good example of careful preoperative planning, multidisciplinary involvement, and appropriately sequenced interventions resulting in an acceptable outcome for an injury with high morbidity and mortality and demonstrates the feasibility and potential benefits of closed removal of the rod in an operating room just before laparotomy. The presence of an intestinal perforation increases the infection risk, but infections can still be prevented in this setting. Shorter time intervals between the incidence and surgery may reduce the infection rate.

Transvaginal small bowel evisceration is a rare, life-threatening condition, requiring urgent surgical intervention. In our case, ischemia developed in the intestinal segment with evisceration, with a laceration in the small intestine of the mesentery, and finally, a small bowel resection was required. An 89-year-old woman was brought to the hospital with a sudden onset of abdominal pain, which lasted for 4 hours. Upon the examination, it was found that approximately 50 cm of the small intestine was eviscerated from the vagina, with its mesentery. The intestines were edematous, and also there were signs of ischemia on the mesentery. The patient was urgently transferred to surgery. Functional end-to-end anastomosis was performed, following a 70 cm small bowel resection. The vaginal defect was repaired transvaginally. Transvaginal small bowel evisceration is rarely described in the literature. It is most commonly seen in postmenopausal, elderly women who underwent vaginal surgery before and who have enterocele. The treatment is an emergent surgical approach. Surgical treatment should be based on individual patient. Various surgical techniques have been described for the repair of transvaginal small bowel evisceration, such as vaginal, abdominal, laparoscopic, and combined approaches. Transvaginal small bowel evisceration should be considered in the differential diagnosis of patients with a sudden onset abdominal pain. Patients with an increased risk for transvaginal small bowel evisceration are postmenopausal women and patients who underwent vaginal surgery before. After the accurate diagnosis, patients should be operated as soon as possible, and necessary surgery should be done.