BACKGROUND: The aim of this study was to analyze the potential protective effect of Carvedilol against liver ischemia-reperfusion (I/R) injury in rats.
METHODS: A total of 40 Wistar albino rats were randomly divided into four groups (n=10 each). Group I (Sham/Control group) underwent only laparotomy, Group II (Carvedilol group) was administered carvedilol and then underwent laparotomy, Group III (I/R group) underwent laparotomy and hepatic ischemia/reperfusion, and Group IV (I/R + Carvedilol group) was administered carvedilol and then underwent laparotomy and hepatic ischemia/reperfusion. Blood samples were collected for malondialdehyde, glutathione (GSH), and myeloperoxidase (MPO) analysis. Liver sections were obtained for histopathological analysis and stained with hematoxy-lin-eosin. Tumor necrosis factor-α (TNF-α) and Caspase-3 primary antibodies were used for the immunohistochemical analysis.
RESULTS: Serum GSH levels increased in the I/R + Carvedilol group. MPO activity was increased significantly in the IR group. In I/R + Carvedilol group, serum MPO levels were similar to the control group. Histopathological findings showed reduced dilatation and congestion in vena centralis, regenerative changes in hepatocyte cells with the protected nucleus structure in the I/R + Carvedilol group. Hepatocyte nuclei with increased pycnosis and apoptosis and the dilated vena centralis were observed in I/R group. In the control group, TNF-α showed a positive reaction in macrophage cells around vena centralis. An increase in TNF-α expression was observed in hepatocyte cells of I/R group. Positive expression of caspase-3 in hepatocyte cells and a small number of endothelial and Kupffer cells were seen in I/R group. However, negative caspase-3 expression was seen in hepatocyte, endothelial, and Kupffer cells in I/R + Carvedilol group.
CONCLUSION: Carvedilol may prevent initiation of oxidative stress process, inflammation induction and apoptotic progression.

BACKGROUND: This study aims to compare medical treatment and appendectomy in patients diagnosed with uncomplicated acute appendicitis during the COVID-19 pandemic.
METHODS: Retrospectively analyzed were the data of 80 patients who received medical or surgical treatment for uncomplicated acute appendicitis between March 15, 2020, and August 31, 2020. The demographic characteristics of the patients, length of hospital stay, physical examination and radiology findings, laboratory results, and any complications were recorded. Patients were divided into two groups depending on the mode of treatment, as surgical and non-surgical.
RESULTS: Forty patients were given medical treatment and 40 patients were directly operated on for appendicitis. Of the 40 patients who received medical treatment, 8 (20%) ended up requiring an operation due to recurrence. The mean duration of hospitalization was 2 days (range: 1–3), and the mean follow-up duration was 285.35±65.66 days (range: 101–379). The white blood cell count was significantly higher in the surgical group (p=0.004), and the length of hospital stay was longer in the non-surgical group (p<0.001). The prevalence of post-operative complications was similar for patients who underwent appendectomy directly on admission or after recurrence (p=1.000). Among the patients who received medical treatment, the most important predictors of requiring surgery were the red cell distribution width and increased appendix diameter in computed tomography (p<0.05).
CONCLUSION: Medical treatment is an effective alternative in patients with uncomplicated appendicitis. Even in the case of a recurrence in follow-up, surgery due to a potential recurrence is not associated with an increased rate of complication compared to direct surgery.

BACKGROUND: The COVID-19 pandemic has affected the health-care system unpredictably. Restrictions and precautions have had a significant impact on the volume and nature of admissions in emergency services. In this study, we hypothesized that the pandemic would result in a change in the number of emergencies admitted to the general surgery inpatient service and a worse patient outcome compared to the previous year.
METHODS: A retrospective analysis of emergency general surgical admissions during the first 6 months of the pandemic and the same period in 2019 was conducted. Demographics, laboratory assessments, diagnosis, treatment strategies, and postoperative out-comes were analyzed.
RESULTS: 761 patients were admitted to the general surgery service during two 6-month periods (392 vs. 369, respectively). This represented a 5.9% reduction in admissions. However, in the first 2 months of the pandemic, the number of emergency general surgical admissions decreased by 37.1% and 43.7%, respectively. Comparison of periods demonstrated no significant differences in demograph-ics, laboratory values, incidence of emergencies, treatment strategies, and hospital stay. Acute appendicitis, cholecystitis, and bowel obstruction were the three most common surgical emergencies in the pandemic. However, there was no significant difference in outcomes between the periods when each surgical emergency was evaluated separately.
CONCLUSION: Pandemic appears to affect general surgical admissions with a fluctuating pattern, an increasing trend following a sig-nificant 2-month decrease. These findings suggest that patients presented with a delayed presentation; however, contrary to concerns, there was no difference in patient outcomes between the two periods. This study provides a perspective in management strategies for surgical emergencies in such unusual conditions.

BACKGROUND: The aim of the study was to evaluate etiologies of hand injuries in emergency department (ED), to compare the etiologies of hand injuries at the time of this study with the previous year, to assess whether novel coronavirus-2019 (COVID-19) pandemic affected the treatment decisions, and to investigate the COVID-19 infection rate within the first 14 days after admission.
METHODS: A total of 229 patients admitted to ED with hand injury between March 15 and April 30, 2020, were included in the study. The control group consisted of 439 ED admissions with hand injury in the previous year (March 15–April 30, 2019). Data including age, sex, cause of trauma, treatment, and COVID-19 infection status within 14 days after ED admission were compared between groups.
RESULTS: The mean age was 32.30±15.63 years in the study group and 30.85±18.54 years in the control group. The number of patients consulted to the surgery department decreased by 52.6% and the number of patients admitted to ED with hand injuries de-creased by 47.6% during the pandemic, compared to the previous year (p=0.0001). The incidence of home accidents increased and the glass cuts and penetrating/perforating injuries were the most common causes during the pandemic most of which occurred at home.
CONCLUSION: The COVID-19 pandemic-mandated social restrictions led to a significant decrease in the number of ED admissions with hand injuries and the type of injuries. The incidence of home accidents increased with more time spent indoors. This study may be a useful guide for ED admissions of hand injury cases and management planning in the current and future pandemics.

BACKGROUND: The COVID-19 pandemic started to affect Turkey in March 2020. In this study, we retrospectively investigated spontaneous rectus sheath hematoma (S-RSH) in patients with COVID-19 presenting with acute abdominal pain during the ongoing pandemic.
METHODS: The demographic characteristics, laboratory findings, length of hospital stay, and treatment processes of COVID-19 cases with S-RSH detected between March and December 2020 were recorded. The rectus sheath hematoma diagnosis of the patients was made using abdominal computed tomography, and the patients were followed up. Low-molecular-weight heparin treatment, which was initiated upon admission, was continued during the follow-up.
RESULTS: S-RSH was detected in 13 out of 220 patients with COVID-19 who were referred to general surgery for consultation due to acute abdominal pain. The mean age of these patients was 78±13 years, and the female-to-male ratio was 1.6. Mechanical ven-tilation support was applied to three patients, all of whom were followed up in the intensive care unit. Two patients died for reasons independent of rectus sheath hematoma during their treatment. Among the laboratory findings, the activated partial thromboplastin time (aPTT) values did not deviate from the normal range. While there was no correlation between the international normalized ratio (INR) and aPTT (p>0.01), a significant correlation was found between INR and interleukin-6 (IL-6) (p<0.002). None of the patients required surgical or endovascular interventional radiology procedures.
CONCLUSION: In the literature, the incidence of S-RSH in patients presenting with acute abdominal pain is 1.8%. However, in our series, this rate was approximately 3 times higher. Our patients’ normal INR and aPTT values suggest that coagulopathy was mostly secondary to endothelial damage. In addition, the significantly higher IL-6 values (p<0.002) indicate the development of vasculitis along with the acute inflammatory process. S-RSH can be more commonly explained the high severity of vasculitis and endothelial damage due to viral infection.

BACKGROUND: Significant portion of trauma-related deaths occur in the 1st h; therefore, rapid diagnosis and adequate resuscita-tion in trauma patients are essential preventing mortality. In this study, we aimed to evaluate the role of lactate-to-hematocrite ratio (LHR) score for predicting mortality in patients with severe thoracoabdominal trauma.
METHODS: In this retrospective, cross-sectional study, we evaluated patients who applied to the emergency room between January 1, 2016, and December 31, 2019, due to multiple trauma. We measured the blood gas analysis values and LHR score of patients with severe thoracoabdominal trauma included in the study and investigated the effectiveness of the LHR score in predicting mortality.
RESULTS: 106 patients with severe thoracoabdominal trauma were included in the study. The 30-day mortality rate of the patients was 42.5% (n=45). Considering the 30-day mortality rates, the initial hematocrit, lactate, base deficit, and LHR score were statistically different between patients who died and survived. When the cutoff value for the LHR score was taken as 0.187 on the ROC curve to distinguish mortality, the sensitivity was found to be 77.8%, specificity to be 90.2%.
CONCLUSION: LHR score is an effective parameter with high sensitivity and specificity in predicting mortality in patients with severe thoracoabdominal trauma.

BACKGROUND: Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI.
METHODS: The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded.
RESULTS: The median age of the 136 children was 9 (IQR: 5–14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2–8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively).
CONCLUSION: Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.

BACKGROUND: The aims of this study were to investigate the clinical significance of systemic inflammatory response index (SIRI), systemic inflammation index (SII), prognostic nutritional index (PNI), and Glasgow prognostic score (GPS) in deciding whether to perform cholecystostomy when determining if cholecystostomy is the right choice for acute cholecystitis (AC) patients.
METHODS: Between January 2018 and December 2020, 126 consecutive patients with AC with and without cholecystostomy were retrospectively recruited from the Trakya University in Edirne, Turkey. Group I included AC patients with cholecystostomy and Group II included AC patients without cholecystostomy. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) were calculated. The PNI and SII were calculated
RESULTS: There is significant difference between the two groups by the comparison of SIRI, SII, PNI, and GPS values (p<0.001). In Group I, SIRI, SII, and GPS values are higher than the Group II and PNI value in Group I is lower than the Group II. Furthermore, the NLR and PLR ratios in Group I are significantly higher than Group II, and the LMR ratio in Group I is significantly lower than Group II.
CONCLUSION: According to our study, we can say that NLR, PLR, SII, SIRI, and GPS are positive predictors and LMR and PNI are negative predictors for the severity of AC. Therefore, when we decide to treat AC medically, we may prefer the application of chole-cystostomy tube at the beginning of hospitalization by the help of evaluating NLR, PLR, LMR, SIRI, SII, GPS, and PNI values.

BACKGROUND: Laparoscopic cholecystectomy (LC) is being performed frequently in general surgery practice. Estimation of difficult cholecystectomy is very important to take precautions against complications. Cholecystokinin (CCK) is an important enzyme for gall-bladder motility. CCK receptor is the target for CCK. Fibrosis and emptying problems of gallbladder are related with difficult cholecys-tectomies. We aimed to evaluate the association between plasma CCK and difficult cholecystectomy and try to explain the mechanism.
METHODS: Prospective cross-sectional study was conducted on a group of patients with cholelithiasis Patients who underwent elective cholecystectomy were classified into easy, difficult and very difficult preoperatively using LC difficulty scores. Pre-operative gallbladder empting ratios were measured by ultrasonography. Serum C-reactive protein, and postprandial serum CCK and pancreas polypeptide levels were measured before the operation. Operation data including operation times, adhesion scores, and complications were collected. Tissue CCK receptor levels and tissue fibrosis scores were obtained.
RESULTS: Easy, difficult, and very difficult LC (DLC) groups were consisted of 34, 28, and 8 patients, respectively. Gallbladder emp-tying was 60% in easy LC group, but 15% in very DLC group. Plasma CCK levels in easy group (37.4 pg/ml) were significantly lower than plasma CCK levels of difficult (58.6 pg/ml), and very difficult groups (66.23 pg/ml). Tissue CCK receptor levels of easy, difficult, and very difficult were 372.4, 178.3, and 144.1 ng/100 mg, respectively. Adhesion scores and fibrosis scores of very difficult group were significantly higher than other groups. Operation times were significantly longer in very difficult group. There were two conversions to open in very DLC group (25%).
CONCLUSION: CCK is a reliable parameter for determining the difficulty of LC. Decreased CCK receptor levels with fibrosis of gallbladder are the probably responsible mechanism.

BACKGROUND: In more than 60 countries worldwide, laboratory testing plays a challenging and expensive role in trauma resus-citation. In 1995, the literature already suggested that routine laboratory testing may not be useful for most trauma patients. Our study hypothesized that still the need for some laboratory tests perhaps should be reconsidered. Therefore, the aim of this study was to create more insight in the distribution between normal and abnormal parameters for routine laboratory testing in trauma patient management.
METHODS: This retrospective analysis was performed at Amsterdam UMC, location AMC, an academic level 1 trauma center. Data concerning age, gender, American Society of Anesthesiologists (ASA) physical state classification system (ASA), Injury Severity Scores, Glasgow Coma Scales, mechanism of injury, presence of high-energy trauma, and type of injury (blunt or penetrating) were obtained. Laboratory parameters included comprehensive hematology, coagulation, arterial blood gas, kidney, and liver blood panels. Analytical focus was paid to the patient’s vital status, the indication for an emergency intervention, and the risk of in-hospital mortality.
RESULTS: A total of 1287 patients were included in the study. Patients with unstable vital signs or who required emergency inter-vention were most often dealing with abnormalities in pO2, glucose, D-dimer, creatinine, and alcohol values. Mean corpuscular volume (MCV), international normalized ratio (INR), fibrinogen, and amylase were obtained in more than 80% of the patients, but in specific patient groups only abnormal in less than 9%.
CONCLUSION: Trauma patients suffer mainly from abnormal values of D-dimer, pO2, glucose, creatinine, and alcohol. By contrast, MCV, INR, amylase, fibrinogen, and thrombocytes are regularly obtained as well, but only abnormal in a small amount of trauma patients. These findings suggest reconsiderations and more accuracy in the performance of laboratory testing, especially for trauma patients with stable vital signs.

BACKGROUND: In this study, we aimed to evaluate the laboratory markers used in the diagnosis of acute appendicitis (AA) and present the parameters that can be used to predict acute perforated appendicitis.
METHODS: The cases who underwent an appendectomy in our clinic between September 2018 and March 2020 were evaluated retrospectively. A total of 530 patients who met the study criteria were included in the study. Patients were divided into two groups according to the presence of an intraoperative perforation. Non-complicated appendicitis patients formed Group-1, and perforated appendicitis patients formed Group-2. The demographic, clinical, and laboratory characteristics of the patients were compared.
RESULTS: The number of non-complicated patients in Group 1 was 443, while there were 87 (16.4%) patients in Group 2 who had perforated appendicitis. The mean age of the patients in the normal appendicitis group was 29.90±10.51 years, and the mean age of the patients in the perforated appendicitis group was 36.32±14.58 years. In the normal appendicitis group, 257 (58%) of the patients were male, 186 (42%) were female, while in the perforated appendicitis group, 38 (43.7%) were male, 49 (56.3%) were female. In the perfo-rated appendicitis group, white blood cell (WBC) value was 16.19±4.71 (p<0.001), C-reactive protein (CRP) value was 146.28±113.59 (p<0.001), total bilirubin value was 0.71±0.36 (p<0.001), and neutrophil-lymphocyte ratio (NLR) was 10.85±6.25 (p<0.001).
CONCLUSION: We believe that the WBC, total bilirubin, CRP, and NLR values obtained within this study, which is tested in the rapid and easily accessible blood tests in routine examinations that can contribute to the prediction of perforation.

BACKGROUND: Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP.
METHODS: We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves.
RESULTS: mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]).
CONCLUSION: mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.

BACKGROUND: The aim of this study is to determine the effects of local anesthetics administered intraperitoneally in laparoscopic appendectomy.
METHODS: Patients who underwent laparoscopic appendectomy due to acute appendicitis were enrolled in the study. The children were divided into two groups. Intraperitoneal bupivacaine injection to appendectomy site and subdiaphragmatic area was performed after resection of appendix and aspirastion of intraperitoneal reactive fluid in Group 1 while Group 2 did not receive this therapy. The children were questioned by a nurse at postoperative 1st, 6th, 12th, and 24th h. Pain scores (PS) (abdominal), abdominal wall incisional pain (IP), shoulder pain (SP), and first need for analgesics were recorded.
RESULTS: One hundred and twenty children were enrolled to the study. There was no significant difference in PS values and IP values between the two groups (p>0.05). SP values at 12th and 24th h were significantly lower in Group 1 (p<0.05). There was a statistically significant reduce in analgesic need in Group 1 (p=0.007).
CONCLUSION: Intraperitoneal bupivacaine instillation to surgery site and subdiaphragmatic area seems to reduce the SP post-opera-tive and also reduce post-operative analgesic need. More meaningful results can be obtained with an increase in the number of patients.

BACKGROUND: Although appendectomy is still a curative therapy for acute appendicitis, medical treatment has come to the fore in uncomplicated cases. This study aimed to determine the importance of immature granulocyte (IG) count and percentage for the role of medical treatment success in uncomplicated acute appendicitis.
METHODS: Acute appendicitis cases were prospectively registered between July 2019 and April 2020. Using ball drawing, patients were divided into two groups as medical treatment (Group M) and undergo appendectomy (Group A). Group M was divided into two subgroups as those who responded to medical treatment medically responded (MR) and failed medical treatment (MF) within 24 h of follow-up. Changes in IG count and percentage, C-reactive protein levels, neutrophil-lymphocyte ratio, and white blood cell count between initial administration and 24th h of follow-up were examined.
RESULTS: Sixty-four patients who met the inclusion criteria were followed as 31 patients in Group A and 33 in Group M. At Sub-group MF 11 patients and Subgroup MR 22 patients were followed up. At the 24th h of the follow-up, the IG count and percentage were higher in the Group MF (for IG count: Between Group A and MF, p=0.002; between Group A and Group MR, p=0.111; and between Group MR and MF, p<0.001) (for IG percentage: Between Group A and MF, p=0.001; between Group A and MR, p=0.809; and between Group MF and MR, p=0.001). This decrease in the IG count and percentage suggests that the response to medical treatment was effective [for IG count: F (148.862) = 61, p≤0.001, η2=0.707] [for IG percentage: F (10.157) = 0.252, p≤0.001, η2=0.504].
CONCLUSION: IG count and percentage are effective for evaluating the success of medical treatment of uncomplicated acute ap-pendicitis and they guide in the decision to continue medical treatment of uncomplicated acute appendicitis.

BACKGROUND: Violence in healthcare in public health is a problem about socio-economic and personal development that is un-fortunately seen in every service but more frequently in emergency departments. In our study, we aimed to determine the violence experiences of general surgeons in the emergency room and their perceptions about it.
METHODS: The study is designed in a cross-sectional type. We sent a survey containing 11 questions to the e-mails of 941 general surgeons registered in the National Trauma and Emergency Surgery Association in August–September 2019. The rate of participation to the online survey was 9.98%.
RESULTS: The participants who have been subjected to violence in anyway and who have never encountered violence were 64.9% and 16.0%, respectively. Female surgeons composed 10.6% of the participants and their rate of exposure to violence was 90.0%. When the number of patients accepted by the surgeon increased, the rate of being exposed to violence rose (p=0.014). Those who’re ex-posed to verbal violence applied to courts less frequently (p=0.046). The surgeons whose had to applied to courts could not receive remarkable support from their institutions. The participants stated that who’re source of violence should get effective punishments and victims should be strongly supported.
CONCLUSION: The specialists exposed to violence in the emergency room include general surgeons. Increase of the risk of ex-posure to violence for surgeons correlates workload. Verbal violence moved to the court stage has observed less frequently than the physical. It would be appropriate to take serious sanctions strengthened by legal regulations as the first step toward a solution.

BACKGROUND: The aim of this study is to contribute to the literature by determining the morphometric reference values of the bony structures in the craniovertebral junction (CVJ) from computer tomography (CT) images of the pediatric age group.
METHODS: In this study, CT’s of 151 simple trauma patients aged between 3 and 15 years between 2016 and 2020 were evaluated. All CT examinations were performed using a 32-slice CT and included images of the skull base and C1-C2 junction. A total of 10 measurements were obtained from these images, including Wachenheim clivus canal angle (WCA), Welcher basal angle (WBA), Cran-iocervical tilt angle (CCT), power ratio (PR), Atlantodens interval, McRae Line (MRL), McRae - Dens distance, basion-dens interval (BDI), basion-axis interval (BAI), and atlantooccipital measurement (AOM).
RESULTS: In comparison between gender groups, MRL (p=0.011) and AOM (p<0.001) measurements were found to be significantly higher in males. McRae-Dens distance, BDI, and AOM were significantly higher in patients aged 3–9 years (respectively, p=0005, p=0.003, p<0.001), and BAI (p=0.001) was significantly higher in patients aged 10–15 years. The McRae - Dens distance (p=0.119) was similar between patients with and without terminal ossicle in odontoid apex. But BDI of patients without terminal ossicle was significantly higher (p=0.048). All parameters, except the WCA, WBA, CCT, and PR, were statistically significantly correlated with the patient age (respectively, p=0.21, p=0.13, p=0.70, p=0.99).
CONCLUSION: In this study, the morphometric reference values of the bone structures at the CVJ were determined from the CT images of the pediatric age group.

BACKGROUND: In proximal humerus fractures, loss of reduction can occur following surgical fixation. The factors that affect loss of reduction in cases treated with locking plates as well as their relationship with the degree of loss of reduction were investigated in this study.
METHODS: The study included 48 patients who underwent surgical treatment with a locking plate for a displaced proximal humerus fracture and experienced loss of reduction during follow-up. According to the degree of reduction loss, patients were divided into two groups as low grade and severe loss of reduction. The following parameters were investigated: Head-neck angle, loss of head height, degree of medial support displacement, screw penetration, implant-to-screw ratio, graft use, calcar screw application for medial sup-port, delayed union/nonunion, arthrosis, and avascular necrosis findings.
RESULTS: In the early period, in Group I (n=27) and Group II (n=21) patients, the mean head-neck angle was 133°±9.9° (118°–141°) and 131°±11.2° (114°–143°), the distance between the head-plate end points was 8.08±2.8 mm and 11.5±3.1 mm, and the displace-ment between the medial support fracture fragment was 1.19±0.9 mm and 1.69±1.8 mm, respectively. Furthermore, in the late period, the mean head-neck angle was 120°±11.8° (106°–136°) and 112°±13.1° (98°–120°), the distance between the head-plate end points was 5.6±3.2 mm and 6.3±3.3 mm, and the displacement between the medial support fracture fragment was 2.79±1.9 mm and was 6.79±1.9 mm in Group I and Group II patients, respectively. While there was a significant relationship between the amount of medial displacement and changes in neck-shaft angle (p=0.0313) and humeral head height (p=0.0272), there was no significant relationship between the groups in terms of screw ratios, fracture type, and age.
CONCLUSION: Many factors influence loss of reduction in proximal humerus fractures after surgical treatment with a locking plate. Supporting the medial region is particularly critical for maintaining reduction in the post-operative period. Furthermore, a relationship was revealed between the amount of medial displacement and the values of head-neck angle and head height.

Infectious aortitis has various causes, presents mainly with an aneurysm, and is fatal without surgical intervention. This case report describes an 89-year-old woman who developed fever and back pain which initially diagnosed infectious aortitis confirmed through contrast-enhanced computed tomography (CT). Pyogenic spondylitis and psoas abscess, which were not visible through CT at admis-sion, were identified as the cause of infectious aortitis confirmed through positron emission tomography (PET). After percutaneous drainage and intravenous antibiotics, the patient was discharged in good condition and without surgical intervention. This case report emphasizes the critical role of PET in identifying the cause of infectious aortitis and demonstrates the effectiveness of successive treat-ment with antibiotics and timely radiologic intervention.

Gluteal compartment syndrome (CS) secondary to the superior gluteal artery (SGA) injury and pseudoaneurysm formation is a very rare condition. When it does occur, it usually manifests with acute and life-threatening hemorrhage resulting in early hypov-olemic changes. Delayed presentation of the gluteal CS (GCS) after trauma has been described in the literature seldom and these cases were demonstrated with sciatic nerve palsy, hemodynamic instability, decreased hemoglobin levels, increasing buttock pain, and a large gluteal hematoma. In this report, we present a case of GCS presenting with the palsy of the peroneal division of the sciatic nerve secondary to SGA pseudoaneurysm following ballistic injury, with a delay of nearly 20 days in diagnosis and treatment with normal hemodynamic findings. The patient required emergent angiographic embolization and then fasciotomy which were approx-imately 13 days after the onset of the symptoms. The patient made a positive recovery with no further neurologic deterioration and none local wound or systemic complications. This case emphasizes the importance of early diagnosis and treatment of this rare condition.

Tracheostomy has become a common procedure in today’s intensive care units. On the other hand, tracheostomy has some life-threat-ening complications. In here, we presented that an interesting case of a tracheaesophageal fistula, rare complication of surgical trache-ostomy, caused by posterior tracheal membrane laceration than has progressed to form a single passage. This passage progressively led both air trapping in gastrointestinal tract due to required mechanical ventilatory support and reflux of gastrointestinal content into tracheobronchial tree. Conventional measures were not beneficial, nor immediate surgical repair was feasible due to unstable condition of the patient. Then, a Sengstaken–Blackmore tube was introduced and overwhelmed the condition.

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-spe-cific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.

Gastric perforation secondary to accidental esophageal intubation is a very rare mortal complication with only a few cases reported in the literature. In the management of this fatal complication, the early diagnosis and rapid surgical intervention are critical. In this case report, we present our experience with an unusual case, who required intubation in the intensive care unit due to acute hypoxemia and subsequently developed gastric perforation.

Wohlfahrtiimonas chitiniclastica is a rare pathogen that was first isolated from Wohlfahrtia magnifica, a parasitic fly. It is an uncommon, but an emerging human pathogen reported only in Europe and South America. Until today, it has been reported to be a zoonotic pathogen originating from different geographic locations. The present case, a patient suffering from osteomyelitis in Turkey, represents the first report of this pathogen in this country and so far no reports of related osteomyelitis associated with W. chitiniclastica is available. Clin-ical awareness of these emerging human pathogens is crucial for controlling infectious diseases.