BACKGROUND: Acute pancreatitis is an inflammatory disease accompanied by pancreatic inflammation characterized by acinar cell damage and leukocyte infiltration in the tissue. At present, mortality and morbidity rates are high despite the current treatment of pancreatitis; therefore, new studies and treatment studies are needed. In this study, the effects of alpha-tocopherol on different doses of L-arginine-induced experimental acute pancreatitis model were investigated.
METHODS: Thirty adult male Sprague–Dawley albino rats were randomly divided into four groups; control (sham) group (n=6), acute pancreatitis group (n=8), low-dose alpha-tocopherol (200 mg/kg once intraperitoneal [IP]) group (n=8), and high dose alpha-tocopherol (400 mg/kg once ip) group (n=8). Experimental acute pancreatitis model was created by a single IP dose of 5 g/kg of L-arginine. Alpha-tocopherol was administered in a single dose intraperitoneally, 30 min before the creation of the experimental model of acute pancreatitis induced by L-arginine induction in Groups 3 and 4. Tissue and blood samples were taken under anesthesia 72 h after L-arginine injection; then the rats were sacrificed by decapitation. Serum amylase, lipase, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP) levels were examined. Pancreatic tissue samples were examined under a light microscope for histopathological examination.
RESULTS: When the acute pancreatitis group (Group 2) was compared to the control group (Group 1), serum amylase, lipase, IL-1β, IL-6, TNF-alpha, and CRP levels were all significantly increased (p<0.05 for all). Histopathological examination showed significant difference in edema (p<0.001) and inflammation (p=0.007) scores. When the low (Group 3) and high (Group 4) dose alpha-tocopherol groups were compared to Group 2, amylase, lipase, IL-1β, IL-6, TNF-alpha, and CRP parameters were statistically significantly lower (p<0.05 for all). In the histopathological comparison of Groups 2, 3, and 4, edema and inflammation scores were decreased in Groups 3 and 4 compared to Group 2. Comparing Group 4 to Group 3, lipase (p<0.01), IL-6 (p=0.038), and TNF-alpha (p=0.002) levels were significantly decreased; no significant difference was observed in the histopathological evaluation.
CONCLUSION: Alpha-tocopherol was found to reduce inflammation and pancreatic damage in acute pancreatitis and was more effective in high doses.

BACKGROUND: Inadequate intestinal perfusion resulting from hemorrhagic shock negatively affects wound healing. In this experimental study, we aimed to evaluate the effects of resuscitation with hypertonic saline on colonic anastomosis in rats with controlled hemorrhagic shock.
METHODS: A total of 24 male Wistar albino rats weighing between 200 and 250 g were used in this study. The rats were divided into four groups as: Control, hypotonic, isotonic, and hypertonic. Median laparotomy, colon resection, and colocolonic anastomosis were performed to the rats in the control group. After creating controlled hemorrhagic shock to rats in other three groups, resuscitation was achieved with hypotonic, isotonic, and hypertonic saline. After resuscitation, median laparotomy, colon resection, and colocolonic anastomosis were performed on rats in these three groups. On the 5th post-operative day, a median laparotomy was applied to the rats in all groups and anastomosis lines were evaluated. Anastomotic bursting pressure, tissue hydroxyproline level, and tissue fibrosis degree were compared between the groups.
RESULTS: There was no statistically significant difference between the groups in terms of anastomotic bursting pressure, tissue hydroxyproline level, and tissue fibrosis degree (respectively; p=0.320, p=0.537, p>0.05).
CONCLUSION: In rats with controlled hemorrhagic shock, resuscitation with hypertonic saline does not differ significantly from isotonic or hypotonic saline in terms of healing of colonic anastomosis.

BACKGROUND: Chest trauma constitutes 10% of admissions due to trauma and causes 25–50% of trauma-related deaths. It is important to evaluate the level of thoracic trauma in patients accurately and early, start the correct treatment, predict the need for intensive care and mortality, and prevent complications that may develop. In this study, the predictive efficiency of the serum lactate level, shock index, and scoring systems regarding the prognosis in patients with major thoracic trauma were compared.
METHODS: The files of the 683 patients who applied to the emergency department of our hospital due to trauma, between 2014 and 2020, were analyzed retrospectively. Patients with isolated thoracic trauma were included in the study.
RESULTS: A total of 683 patients were included in the study. Of the patients, 34 (5%) were in the non-survivor group and 649 (95%) were in the survivor group. There was no statistically significant difference between the systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, or shock index in either group (p>0.05). The Glasgow Come Scale (GCS) score in the non-survivor group was significantly lower than that in the survivor group (p=0.000). The lactate level, revised trauma score (RTS), injury severity score (ISS), and New ISS (NISS) in the non-survivor group were significantly higher than those in the survivor group. A significant difference was found in terms of age, lactate level, and the GCS, RTS, ISS, and NISS (p<0.05). In logistic regression analysis, it was found that a 1 unit increase in the lactate value increased the mortality rate by 1.19 times in terms of the effect of the trauma scores and numerical change in the lactate level on mortality.
CONCLUSION: In patients with thoracic trauma, the NISS may be a useful factor that can be used in emergency rooms when a quick decision is required. However, increases in blood lactate levels during patient follow-up may also be a blood parameter that the clinician should pay attention to. In addition, further studies should be conducted on scoring in patients with thoracic trauma.

BACKGROUND: To investigate the efficacy of new foams with boric acid particles combined with a negative pressure wound treatment (NPWT) system in open fractures with tissue defects secondary to trauma.
METHODS: Forty-nine patients with open fractures secondary to trauma with soft tissue defects who were admitted between 2016 and 2018 were included in the study. Patients were examined in two groups. In Group 1, boric acid-impregnated foams combined with the NPWT system were used in 27 patients, and in Group 2, silver nitrate-impregnated foams combined with NPWT systems were used in 22 patients. In addition to evaluating the broad-spectrum antibacterial feature of silver nitrate, the antimicrobial, angiogenetic, and epithelializing effects of boric acid were investigated macroscopically and histopathologically.
RESULTS: A reduction in wound size and granulation was observed in each group. Macroscopically, the reduction in wound size, epithelialization and granulation were pronounced in Group 1 and in Group 2. Microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1 compared with Group 2.
CONCLUSION: In this clinical trial, both the broad spectrum antimicrobial feature of boric acid and its positive effect on the cells responsible for wound healing were found to be an alternative compared with silver nitrate. The use of new foams with boric acid particles combined with the NPWT system may be a good alternative method in the treatment of open wounds due to trauma.

BACKGROUND: Various scoring systems have been developed to determine the trauma severity and prognosis of patients following multiple blunt trauma (MBT). However, these scoring systems do not provide exactly the desired severity assessment. In recent years, serum concentration of many specific microRNAs (miRNAs), especially for head trauma, has been shown to play an important role in determining the diagnosis, severity, and prognosis of injury. To date, however, no studies have investigated serum miRNAs in patients with MBT. Thus, this study measured the expression of miRNA-93 and -191 in the serum of adults with MBT and examined the correlations of Injury Severity Score (ISS) and Revised Trauma Score values with serum miRNA-93 and -191 levels in these patients with the aim of predicting trauma severity based on the miRNA levels.
METHODS: This prospective case–control study enrolled 50 consecutive adults with MBT and age- and sex-matched 60 healthy controls. The patients were divided into ISS >16 (Group 1, major or severe trauma) and ISS ≤16 (Group 2, minor or mild-moderate trauma) groups. Serum miRNA-93 and -191 levels were assessed using quantitative real-time reverse transcription-PCR. We evaluated whether the miRNAs were differentially expressed in major and minor MBT patients and determined their utility for assessing the severity of injury.
RESULTS: The mean serum miRNA-93 and -191 levels were significantly elevated in the patients compared to the controls and were higher in patients with ISS >16 compared to those with ISS ≤16, although the difference was not significant. In the patients with multitrauma, ISS was significantly, negative and weak correlated with serum miRNA-191 level (rho=−0.320, p=0.023) but not with the serum miRNA-93 level. No optimal cutoff for the serum miRNA-93 level was found with respect to trauma severity (AUC 0.617, [0.455–0.779]). However, an optimal cutoff value for serum miRNA-191 was identified, with values <1.94 indicating severe trauma (AUC 0.668 [0.511–0.826]; 65.6% sensitivity, 77.8% specificity).
CONCLUSION: miRNA-191 and -93 levels were significantly upregulated in multitrauma patients compared to controls. The level of miRNA-191 in conjunction with ISS, but not that of miRNA-93, may be a useful biomarker for determining injury severity in patients with multitrauma.

BACKGROUND: The number of people actively participating in society has decreased following the coronavirus disease 2019 (COVID-19) pandemic as a result of the measures taken to reduce the risk of transmission, such as interruption to education, social isolation, and curfews. Accordingly, change in the etiology of emergency surgery and characteristics of patients may be expected. The current study aimed to compare emergency surgery between the COVID-19 pre-pandemic and pandemic periods and to present the data and emergency anesthesia management of patients with suspected COVID-19.
METHODS: Patients who underwent emergency surgery in our hospital between January 22 and April 29, 2020, were examined retrospectively. The patients were divided into two groups: Those operated before March 11, 2020 (Group 1) and those operated from this date April 29, 2020 (Group 2). The data of the two groups were compared. Routine emergency anesthesia and surgical approach were applied to all patients in Group 1 and those without suspected COVID-19 in Group 2. Patients with suspected COVID-19 in Group 2 were treated with an algorithm created in accordance with the guidelines of official institutions and scientific associations.
RESULTS: Age, gender, chronic medical diseases, ASA classification, Mallampati score, surgical department, surgical procedures, surgical etiology, duration of surgery, and length of hospital stay were similar in both groups. The number of patients undergoing general anesthesia and spinal anesthesia was 198 (82.5%) and 42 (17.5%) for Group 1 while it was 161 (73.9%) and 57 (26.1%), respectively, for Group 2 (p=0.025).
CONCLUSION: The clinical data and surgical features of emergency patients during the pandemic were similar to those before the pandemic; however, the rate of spinal anesthesia was higher in the former. Personal protective equipment standards should be followed to prevent cross-infection among the anesthesiology team during anesthesia procedures for emergency operations. We consider that necessary emergency interventions can be safely performed and COVID-19 nosocomial infection can be prevented in the operating room by following the Ministry of Health recommendations and guidelines that are updated regularly.

BACKGROUND: Acute appendicitis (AA) is one of the most common diseases requiring emergency surgery. Today, diagnosis of AA is made through anamnesis, physical examination along with advanced imaging methods. Thermal imaging confers advantages over conventional techniques for being portable, non-invasive, easily conducted, ionization radiation-free, and inexpensive. Digital infrared thermal imaging (DITI) has been the subject of research in various clinical scenarios. In this prospective randomized controlled study, diagnostic potential of DITI in AA was investigated.
METHODS: Totally, 224 volunteers (112 healthy volunteers and 112 patient volunteers) were enrolled and divided into two groups; control group and patient group. All subjects were assessed by DITI. Steady-state images of both lower quadrants and sternum were taken. Thermal images were transferred to computer software and analyzed. Potential of thermal imaging as a diagnostic method was evaluated.
RESULTS: Regarding temperature differences between the quadrants, statistical analysis delivered significant difference between the both groups (p<0.001). As a result of the analysis, the cutoff value for the diagnosis of AA was found to be 0.4°C difference between the average lower quadrant temperatures.
CONCLUSION: This study has enlarged the application of DITI to abdominal pain, especially within context of AA. Thermal evaluation of patients with abdominal pain seems promising.

BACKGROUND: The diagnosis and severity of acute appendicitis (AA) are still challenging despite all the improvements in diagnosis and treatment. This study aimed to evaluate the efficacy of complete blood count (CBC) parameters in diagnosing AA and measuring severity.
METHODS: Data of 521 patients were reviewed retrospectively. Fifty-three patients with CBC results influenced by various reasons were excluded from the study. Age, gender, length of stay, CBC parameters, and histopathological results were examined.
RESULTS: The study included 468 patients: 90 patients with a preliminary diagnosis of AA, not undergoing surgery but receiving medical treatment (Group I), 227 patients with uncomplicated appendicitis (Group II), and 151 patients with complicated appendicitis (Group III). Of the patients, 279 were male (59.6%) and 189 were female (40.4%). The mean age was 33.37±13.05 years. Groups I and III had the lowest and highest white blood cell (WBC), neutrophil, and neutrophil-to-lymphocyte ratio (NLR), respectively. There was a statistically significant difference between the groups (p<0.05). The highest and lowest mean platelet volume (MPV) values were in Groups II and III, respectively. There was no statistically significant difference between the groups (p>0.05).
CONCLUSION: AA is the most common cause of abdominal surgery. The CBC is a cost-effective and easily-accessible test with acceptable diagnostic accuracy. It provides fast results and can be used in the diagnosis of appendicitis. Neutrophil, WBC, and NLR are helpful and useful parameters for physical examination and other diagnostic methods in diagnosing AA and measuring severity. However, the use of MPV is not recommended as it has a low diagnostic rate and contradictory results.

BACKGROUND: The aim of this study is to evaluate the patients with intestinal perforation secondary to necrotizing enterocolitis (NEC) following cardiac surgery in the terms of risk factors and diagnosis/treatment process.
METHODS: A series of cases operated for intestinal perforation secondary to NEC were retrospectively reviewed in two groups. Group I involved patients who had cardiac surgery for congenital heart disease previous to intestinal perforation secondary to NEC. Group II consisted patients who had intestinal perforation secondary to NEC without any previous cardiac surgery. Demographic characteristics, prenatal and postnatal features, and pre- and post-operative course of groups were statistically compared to define differences.
RESULTS: Thirty-two patients underwent laparotomy secondary to intestinal perforation in this period. The gestational age and birth weight were smaller in Group II (p=0.001, p=0.001). Intrauterine growth retardation was more frequent in Group II (p=0.05). More Group I patients had hypotensive periods (p=0.018) before the diagnosis of NEC. Prostaglandin treatment and requirement of renal replacement therapy were more frequent in Group I (p=0.022, p=0.03). The mortality rate was higher in Group I (p=0.018). All patients in Group I were late stage NEC at the time of diagnosis.
CONCLUSION: NEC developing after cardiac surgery is different from NEC seen in the neonatal period in the terms of etiology, facilitating factors, and clinical course. Mortality rate is higher in NEC after cardiac surgery. The diagnosis of intestinal perforation might be difficult in NEC after cardiac surgery due to insignificant physical examination findings and characteristic radiological signs of NEC. The history of prostaglandin usage and requirement of renal replacement were thought as alarming signs in terms of possible intestinal complications after cardiac surgery.

BACKGROUND: In this study, it was tried to determine the factors affecting the clinical process in patients who were followed up in hospital for coronavirus disease-2019 (COVID-19).
METHODS: The study, which was designed as a single-center and retrospective cohort, included 658 patients admitted to the service due to COVID-19. The patients were grouped and compared as the patients followed up in the wards (Group 1) and those admitted to ICU (Group 2), between those who were intubated (Group I) in the ICU and those who were not (Group NI), and between patient groups who died (Group M) and survived (Group NM) among those who were intubated.
RESULTS: Of the 658 patients hospitalized in the wards, 566 (86%) were discharged and 99 (14%) were later admitted to the ICU. The mortality rate for the 658 patients that were followed up was found to be 7.75%. When Groups 1 and 2 were compared, it was observed that the patients in Group 2 had more comorbidity and higher KDIGO stages (p<0.001). In addition, patients in Group 2 had older age, higher APACHE II and SOFA scores, high WBC counts, neutrophil counts, lymphocyte counts, N/L ratio, CRP, LDH, CK, PTZ, D-dimer, procalcitonin, and ferritin values (all values p<0.001, for CK p=0.034). When the patients in Group I and Group NI were compared, it was observed that the patients in Group I had more comorbidities and higher mortality rate (p<0.001). In addition, patients in Group I had older age, high D-dimer, and ferritin levels (p=0.008; 0.011, and 0.043, respectively). When the patients in Group M and Group NM were compared, it was observed that the patients in Group M were mostly males (p=0.017) and were mostly in KDIGO Stages 1 and 2 (p=0.005). In addition, it was found that the CRP and LDH levels of patients in Group M were significantly higher than those in Group NM (p=0.018 and 0.023, respectively).
CONCLUSION: Comorbidity, clinical features, and laboratory findings are parameters that can help in predicting the clinical course of hospitalized patients due to COVID-19.

BACKGROUND: Prolonged stays and multiple operations in burn management increase the risk of transmission. We would like to discuss our experience in hospitalized burn patients with Coronavirus disease (covid-19) infection.
METHODS: In-patient burns with confirmed COVID-19 infection were studied. Age, gender, burned total body surface area (TBSA), number and sort of operations and dressing changes, intensive care unit stay, ward stay, total length of stay, and morbidity and mortality were analyzed. Medical staff observed for infection.
RESULTS: The mean age of the 11 positive patients was 51 (±19.37) years and burned TBSA was 34.36% (±21.97%). Six (54.5%) patients presented with negative polymerase chain reaction (PCR) tests; however, symptoms and findings revealed the illness. Patients underwent 85 operations including hydrosurgery. Totally, 475 dressing changes were done. Respiratory failure caused three mortalities without sepsis. Age, TBSA, and deep dermal burn percent of the mortalities showed no difference. None of the staff and hospitalized other patients had hospital acquired COVID-19 infection.
CONCLUSION: Healthcare must continue during pandemics. Awareness, proper usage of personal protective equipment, keeping social distance, and strengthened access control to the clinic are important priorities to avoid viral transmission. The difficulty in PCR negative patients was the confusing effect of burns as most of the laboratory and radiologic findings overlaps with the major burns’ consequences. Findings, cannot be explained by the clinical course of burn, should indicate COVID infection. Regarding our results, burn patient treatment routines can be applied safely by competence to focused and re-adopted precautions as there were no hospital acquired COVID-19. Patients must trained for cross-contamination. Healthcare’s must prioritize their own health under all situations including pandemics. Updating, the preventive cautions and rigid compliance are a must.

BACKGROUND: In this study, we aimed to compare the radiological, clinical and functional results of volar radius locking plate, and K-wire augmented bridging external fixator (BEF) treatments that applied in intra-articular distal radius fractures.
METHODS: Between May 2016 and January 2019, 162 patients who met the inclusion criteria of 23–C2 and 23–C3 according to the AO/OTA classification who operated in our clinic were evaluated retrospectively. 78 patients (37 males, 41 females, mean age 49.92) were fixated with K wire augmented BEF and 84 patients (41 males, 43 females, mean age 46.81) were fixated with volar locking plate (VLP). Demographic (age, gender, type of trauma, and follow-up time), radiological (radial inclination, radial height, volar tilt, and fracture healing time), and clinical and functional (range of motion [ROM], grip strength, Quick Dash, Green O’Brien and Mayo scores) data of the patient groups were recorded and compared statistically.
RESULTS: There was no significant difference between the patient groups in terms of functional scoring systems. Radiologically, radial inclination, and radial length were significantly better in the volar plate group. In terms of joint ROM, flexion, extension, pronation, and supination movements were significantly better in the VLP group. Sudek atrophy incidence and loss of grip strength were higher in BEF group. Mean time of union was significantly shorter in the BEF group.
CONCLUSION: Successful results can be obtained in both treatment methods. However, VLP treatment provides better joint ROM and lower complication rates compared to BEF treatment.

BACKGROUND: The aim of this study was to retrospectively evaluate patients who underwent surgery in our department for radial nerve lesions in terms of surgical outcomes.
METHODS: Thirty-eight patients were admitted to our department with radial nerve lesion. Twenty-seven of the patients had entrapment neuropathy and 11 had radial nerve injury secondary to other traumas. Various factors such as surgical results, time to surgical intervention, injury mechanism, and reconstruction technique were analyzed.
RESULTS: In all of 27 patients who were operated for radial nerve entrapment neuropathy, a complete improvement in wrist dorsal flexion was detected at postoperative 3rd month. Seven of the 11 patients who were operated for radial nerve lesion had different degrees of improvement in wrist dorsal flexion at the postoperative 3rd month. Two of the seven patients underwent anastomosis using a sural nerve graft. The recovery rate in our series was 89%. Three of the 4 patients who did not recover after the radial nerve injury were the patients who were operated within the 1st month after the trauma.
CONCLUSION: Better functional results were obtained in the postoperative period in patients who were operated after the 1st month, underwent internal neurolysis and used a short nerve graft for anastomosis in the radial nerve lesions. In patients with entrapment neuropathy, the earliest surgery revealed satisfactory results in the postoperative period.

Background: Bilateral vertebral artery occlusion is an uncommon and mortal injury that could be seen after high-energy traumas. We illustrate an extreme case of bilateral vertebral artery occlusion following traumatic cervical disruption with complete spinal cord injury in a patient with ankylosing spondylitis. A 49-year-old male was admitted to our emergency department after a motor vehicle accident. The American Spinal Injury Association Impairment Scale was a complete A grade. Computed tomography (CT) scan of the cervical region revealed complete disruption between C2 and C3 levels. Magnetic resonance imaging showed apparent compression and narrow calibration of the spinal cord. CT angiography demonstrated occlusion of the bilateral vertebral arteries. Because of the neurological status of the patient, extensive hematoma, and edema at the region, no surgical intervention could be planned. The patient died on the second day of his hospitalization. Only fourteen cases of bilateral vertebral artery occlusion following blunt cervical spine traumas have been reported to date. They have a possibility to cause vertebrobasilar ischemic events with a poor prognosis of morbidity and mortality. The gold standard of diagnosis is the catheter angiography, but also CT angiography has close sensitivity and specificity. The treatment strategies of vertebral artery occlusion are still unclear.

Emergency physicians may overlook spinal cord injury in patients when the direct impact of a gunshot on the spine is lacking. A 30-year-old man who was shot on his right chest wall was brought to the emergency department. He arrived in a state of shock and underwent emergent thoracotomy for massive hemothorax. After surgery, he was found to be paraplegic. Magnetic resonance imaging of the spine showed T4 spinal cord contusion. The penetrating bullet dissipates energy to the surrounding tissue and contuses the spinal cord. Another assumption of the spinal cord injury is the impairment of blood supply to the cord. No effective treatment exists for gunshot-related indirect injury to the spinal cord. These reported cases reminded emergency physicians that after stabilization of the patient with a gunshot wound, a complete neurologic examination should be performed to discover occult spinal cord injury.

Primary omental torsion (POT) is a rarely encountered clinical condition as an acute abdominal pathology. POT is more prevalent in males than females. The diagnosis of POT is challenging, and pregnancy initiates the diagnosis more difficult and essential. The fact that radiological methods such as computed tomography cannot be used during pregnancy constitutes the biggest problem in diagnosis. At this point, diagnostic laparoscopy plays a significant role in the diagnosis and treatment of acute abdominal pathologies in pregnant patients. The diagnosis of a 28-week pregnant woman who was admitted to our emergency department with the aggravation of abdominal pain was not clarified by abdominal ultrasound so the patient was diagnosed with POT by diagnostic laparoscopy. Conservative follow-up plays an important role in pregnant patients, and the poor progress of the patient in both laboratory and physical examination leads diagnostic laparoscopy to an important point when the limitation of imaging methods is added.