p-ISSN: 1306-696x | e-ISSN: 1307-7945
Volume : 30 Issue : 4 Year : 2024

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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 30 (4)
Volume: 30  Issue: 4 - April 2024
NONE
1.Front Matters

Pages I - IX

EXPERIMENTAL STUDY
2.Changes in cytokines and chemokines in an acute pancreatitis model
Erdem Kınacı, Mert Mahsuni Sevinc, Anil Demir, Emre Erdogan, Fatih Alper Ahlatci, Ufuk Oguz Idiz
PMID: 38634842  PMCID: PMC11065975  doi: 10.14744/tjtes.2024.18049  Pages 229 - 235
AMAÇ: Akut pankreatitte gelişen inflamasyona sekonder immün yanıt, pankreatitin klinik seyrinde önemli rol oynamaktadır. Bu çalışmanın amacı pankreatit şiddetine göre çeşitli sitokin ve kemokinlerdeki değişiklikleri birlikte ortaya koymaktır.
GEREÇ VE YÖNTEM: Yirmi bir adet Wistar dişi albino sıçan üç eşit gruba ayrıldı. Kontrol grubuna herhangi bir müdahale yapılmadı. Hafif ve şiddetli pankreatit gruplarına sırasıyla 50 µg/kg ve 80 µg/kg dozlarında beş saat boyunca saatte bir kez intraperitoneal cerulein uygulandı. Pankreatit gelişip gelişmediği ve varsa şiddet düzeyi sakrifikasyon sonrası histolojik değerlendirme ile doğrulandı. Tüm sıçanlardan kan örnekleri alındı ve IL-10, IFN-y, CXCL-1, MCP-1, TNF-a, GM-CSF, IL-18, IL-12p70, IL-1β, IL-17A, IL-33, IL-1α, IL-6 düzeylerine bakıldı. Ayrıca pankreas dokularının Schoenberg inflamasyon skorları da değerlendirildi.
BULGULAR: Histopatolojik incelemeye göre çalışma gruplarının tüm vakalarında akut pankreatit modeli başarıyla sağlandı. Pankreatitli sıçanlarda CXCL-1, MCP-1 ve IL-6 parametrelerinin istatistiksel olarak anlamlı derecede yüksek olduğu, şiddetli pankreatitli sıçanlarda ise CXCL-1, MCP-1 ve IL-6 parametrelerinin istatistiksel olarak anlamlı derecede yüksek olduğu belirlendi. Korelasyon analizinde MCP-1 ve IL-6 pankreatit şiddeti ile orta düzeyde korelasyon göstermektedir.
SONUÇ: CXCL-1, MCP-1 ve IL-6, pankreatit gelişimi ve seyrinin nasıl olacağını göstermede anlamlı görülmüştür. Bu sitokinlerin üretim ve etki yolakları akut pankreatitin medikal tedavisi için potansiyel hedefler olarak değerlendirilebilir.
BACKGROUND: The immune response secondary to inflammation that develops in acute pancreatitis plays an important role in the clinical course of the disease. This study aims to evaluate the changes in various cytokines and chemokines according to the severity of pancreatitis.
METHODS: Twenty-one female Wistar albino rats were divided into three equal groups. The control group received no intervention. Intraperitoneal cerulein was administered to the other groups once per hour for five hours at doses of 50 µg/kg and 80 µg/kg for the mild and severe pancreatitis groups, respectively. The development of pancreatitis and its severity level were confirmed by histological evaluation after euthanization. Blood samples were taken from all rats to measure levels of Interleukin-10 (IL-10), Interferon gamma (IFN-γ), C-X-C Motif Chemokine Ligand 1 (CXCL-1), Monocyte Chemoattractant Protein-1 (MCP-1), Tumor Necrosis Factor alpha (TNF-α), Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF), IL-18, IL-12p70, IL-1β, IL-17A, IL-33, IL-1α, and IL-6. Additionally, the Schoenberg inflammation scores of pancreatic tissues were evaluated.
RESULTS: The acute pancreatitis model was successfully induced in all cases within the study groups, according to histopathological examination. It was found that the levels of CXCL-1, MCP-1, and IL-6 were statistically significantly higher in rats with pancreatitis, with these parameters being elevated in the group with severe pancreatitis. In correlation analyses, MCP-1 and IL-6 showed a moderate correlation with the severity of pancreatitis.
CONCLUSION: CXCL-1, MCP-1, and IL-6 exhibit predictive characteristics for the occurrence and clinical course of pancreatitis. Our results highlight the production and working pathways of these cytokines as potential targets for therapeutic intervention.

3.Effect of intra-abdominal boric acid in the experimental adhesion model
Rıdvan Barkın Kabalar, Semra Tutcu Şahin, Semin Ayhan
PMID: 38634852  PMCID: PMC11065977  doi: 10.14744/tjtes.2024.77767  Pages 236 - 241
AMAÇ: Bu çalışmada; batın cerrahilerinin giderek daha fazla sayıda yapılmasıyla sıklıkla karşılaşılan ve ciddi mortalite ile morbidite sebebi olan intraabdominal adezyonların azaltılabilmesi için; adezyon modeli oluşturulmuş ratlarda, %5 borik asit solüsyonu uygulamasının batın içi adezyon gelişimine etkisini araştırmak amaçlanmıştır. Borik asidin daha önce kanıtlanmış olan antiinflamatuvar, antioksidan ve antifibrotik etkileri ile intraabdominal adezyon gelişimini azaltacağı düşünülmüştür.
GEREÇ VE YÖNTEM: Çalışma her biri 16 adet rat içeren 2 grupta (adezyon modeli oluşturulmuş kontrol grubu ve %5’lik borik asit solüsyonu uygulanmış deney grubu) yapıldı. Operasyon sonrası 14. günde ratlar sakrifiye edilip tekrar eksplore edildi ve gelişen adezyonlar makroskopik ve mikroskopik olarak değerlendirildi. Makroskopik ve mikroskobik skorlamalar sonucunda elde edilen veriler IBM SPSS Statistics 24 programında Mann-Whitney U testi ile değerlendirildi. İstatistiksel anlamlılık düzeyi “p<0.05” olarak belirlendi.
BULGULAR: İstatistiksel veriler incelendiğinde borik asit uygulanan grupta adezyon gelişiminde makroskopik ve mikroskopik olarak anlamlı bir azalma olduğu görüldü (p<0.05).
SONUÇ: Bu çalışmanın sonucunda; deneysel adezyon modelinde intraabdominal %5’ lik borik asit solüsyonu uygulamasının, postoperatif intraabdominal adezyonları azaltmada anlamlı etkiye sahip olabileceği gösterilmiştir. Bu etkinin borik asidin antiinflamatuvar, antioksidan ve antifibrotik etkilerinden kaynaklandığı öngörülmektedir. Bu çalışma, borik asidin intraabdominal adezyonları azaltma mekanizmasının ve ideal dozun araştırılması için öncü olacaktır.
BACKGROUND: The continuous advancement in medical and surgical techniques has led to a rise in the frequency of abdominal operations, subsequently increasing the incidence of intra-abdominal adhesions. Over 90% of laparotomies result in postoperative intra-abdominal adhesions. This study investigates the effect of a 5% boric acid solution on the development of intra-abdominal adhesions in rats, using an adhesion model.
METHODS: This study was conducted with two groups: a control group, in which the adhesion model was applied without any treatment, and a boric acid group, which was treated with a 5% boric acid solution. Each group comprised 16 rats. On the 14th postoperative day, the rats were sacrificed, re-explored, and the developed adhesions were evaluated both macroscopically and microscopically. The data from macroscopic and microscopic scoring were analyzed using the Mann-Whitney U test in the IBM Statistical Package for the Social Sciences (SPSS) Statistics 24 program. A p-value of less than 0.05 was considered statistically significant. This research was supported by the Manisa Celal Bayar University Scientific Research Projects Commission.
RESULTS: A statistically significant difference was observed between the boric acid-treated group and the control group, with the boric acid group showing a significant decrease in adhesion development both macroscopically and microscopically (p<0.05).
CONCLUSION: In the future, boron could play a significant role in reducing and preventing intra-abdominal adhesions after surgery. This investigation could pave the way for further research into the mechanism by which boric acid prevents the development of intra-abdominal adhesions. Moreover, it is imperative to explore the potential side effects of intra-abdominal boron application at the optimum concentration of the solution.

ORIGINAL ARTICLE
4.The role of ischemia-modified albumin, presepsin, delta neutrophil index, and inflammatory markers in diagnosing acute cholecystitis
Muhammed Semih Gedik, Ali Ihsan Kilci, Hakan Hakkoymaz, Muhammed Seyithanoğlu, Muhammed Alperen Orakçı, Nuri Mehmet Basan, Arif Aksu, Ömer Faruk Küçük
PMID: 38634849  PMCID: PMC11065968  doi: 10.14744/tjtes.2024.67520  Pages 242 - 247
AMAÇ: Erişkinlerde akut kolesistit tanısında C-reaktif protein, prokalsitonin, tam kan sayımı parametreleri, delta nötrofil indeksi, iskemik modifiye albümin, presepsin, oksidatif stres göstergeleri gibi inflamasyon, oksidatif stres ve iskemi ile ilişkili belirteçlerin patolojideki yerini belirlemektir.
GEREÇ VE YÖNTEM: Çalışmaya acil serviste akut kolesistit tanısı alan hastalar ve sağlıklı kontrol grubu dahil edildi. Çalışmaya alınan hastalara rutin kan sayımı ve biyokimya tetkikleri yapıldı. İskemik modifiye albümin, presepsin ve oksidatif stres göstergelerini ölçmek için kan serumu kullanıldı.
BULGULAR: Lökosit sayısı, nötrofil/lenfosit oranı, trombosit/lenfosit oranı, delta nötrofil indeksi, C-reaktif protein, prokalsitonin, iskemik modifiye albümin, iskemik modifiye albümin/albümin oranı, presepsin ve oksidatif stres göstergeleri değerleri akut kolesistit tanılı hastalar da kontrol grubu ile karşılaştırıldığında anlamlı olarak yüksek saptandı.
SONUÇ: Nötrofil/lenfosit oranı, delta nötrofil indeksi, iskemik modifiye albümin, iskemik modifiye albümin/albümin oranı ve presepsin değerlerinin yüksek duyarlılık, özgüllük ve düşük negatiflik olasılığı oranları nedeniyle akut kolesistit tanısında yeni belirteçler olarak kullanılabileceğine inanıyoruz.
BACKGROUND: The purpose of this study is to determine the significance of markers such as C-reactive protein, procalcitonin, complete blood count parameters, delta neutrophil index, ischemia-modified albumin, presepsin, and oxidative stress indicators, which are associated with inflammation, oxidative stress, and ischemia in the pathology and diagnosis of acute cholecystitis in adults.
METHODS: Patients diagnosed with acute cholecystitis in the emergency department and healthy individuals in the control group were included in the study. Routine blood count and biochemistry analyses were performed on the participants. Blood serum was used to measure ischemia-modified albumin, presepsin, and oxidative stress indicators.
RESULTS: White blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, delta neutrophil index, C-reactive protein, procalcitonin, ischemia-modified albumin, ischemia-modified albumin to albumin ratio, presepsin, and oxidative stress indicators were significantly higher in patients with cholecystitis compared to the control group. Measurements of white blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and delta neutrophil index can be included as part of the complete blood count. The complete blood count parameters are readily available and do not incur additional costs to the healthcare system.
CONCLUSION: The authors believe that the neutrophil-to-lymphocyte ratio, delta neutrophil index, ischemia-modified albumin, ischemia-modified albumin to albumin ratio, and presepsin values can be used as new markers in the diagnosis of acute cholecystitis due to their high sensitivity, specificity, and low negative likelihood ratio.

5.The impact of ankle kinesio taping on pain management in patients with acute ankle sprain
Ömer Faruk Karakoyun, Zeynep Nisa Karakoyun, Elif Aylin Yüce Yörük, Mustafa Buğra Coşkun, Yalçın Gölcük
PMID: 38634848  PMCID: PMC11065976  doi: 10.14744/tjtes.2024.55494  Pages 248 - 253
AMAÇ: Bu çalışmanın amacı, Acil Servis (AS) ortamında Akut Ayak Bileği Burkulması (AABB) olan hastalarda Kinezyotape (KT) uygulamasının destekleyici tedavi olarak etkinliğini değerlendirmektir.
GEREÇ VE YÖNTEM: Üçüncü basamak bir AS'te prospektif yarı-rasgele kontrollü bir çalışma yapılmıştır. İzole stabil Grade 1 ve Grade 2 AABB tanısı konmuş erişkin hastalar dahil edildi. Hastalar, iki gruba ayrıldı: KT grubu, geleneksel tedaviye ek olarak KT uygulanan grup; kontrol grubu ise sadece geleneksel tedavi alan grup. Ağrı şiddeti, analjezik kullanımı ve hasta memnuniyeti değerlendirildi.
BULGULAR: Her iki grup arasında başlangıçta ve 30. dakikada benzer ağrı düzeyleri bildirilirken, kontrol grubu 60. dakikada anlamlı ölçüde daha düşük ağrı düzeyleri bildirdi (sırasıyla p=.575, p=.437 ve p=.042). KT grubu, analjezik ilaç tüketiminde azalma ve daha yüksek hasta memnuniyet düzeyleri sergiledi (sırasıyla p<.001 ve p=.003). Lojistik regresyon analizi, 60. dakikada ağrı şiddetindeki farkın anlamını yitirdiğini, ancak analjezik kullanımı ve hasta memnuniyetinin anlamlı olduğunu ortaya koydu (sırasıyla p=.631, p=.003 ve p=.026).
SONUÇ: KT uygulaması, destekleyici bir tedavi olarak, AS'teki AABB hastalarında analjezik ihtiyacını azaltabilir ve hasta memnuniyetini artırabilir. Uygulamanın etkinliğini doğrulamak ve standart AABB tedavi protokollerindeki yerini belirlemek için daha fazla araştırmaya ihtiyaç vardır.
BACKGROUND: The objective of this study was to assess the efficacy of Kinesio Tape (KT) application as a complementary treatment for patients with acute ankle sprain (AAS) in an Emergency Department (ED) setting.
METHODS: A prospective, quasi-randomized controlled trial was conducted in a tertiary care ED. Adult patients diagnosed with isolated, stable Grade 1 and Grade 2 AAS were included. Patients were divided into two groups: the KT group, where KT was applied in addition to conventional treatment, and the control group, receiving only conventional treatment. Pain intensity, analgesic usage, and patient satisfaction were assessed.
RESULTS: While pain levels were similar between both groups at baseline and the 30th minute, the control group reported significantly lower pain levels at the 60th minute (p=0.575, p=0.437, and p=0.042, respectively). The KT group exhibited reduced analgesic drug consumption and higher patient satisfaction levels (p<0.001 and p=0.003, respectively). Logistic regression analysis revealed that the difference in pain intensity at the 60th minute lost significance, while analgesic usage and patient satisfaction remained significant (p=0.631, p=0.003, and p=0.026, respectively).
CONCLUSION: KT application, as a complementary treatment, may reduce the need for analgesics and enhance patient satisfaction in patients with AAS in the ED. Further research is needed to refine its application and confirm its effectiveness in standard AAS treatment protocols.

6.Evaluation of pediatric trauma score and pediatric age-adjusted shock index in pediatric patients admitted to the hospital after an earthquake
Merve Misirlioglu, Mehmet Alakaya, Ali Ertug Arslankoylu, Gulcin Bozlu, Fatma Durak, Ali Delibas, Serra Surmeli Doven, Ozlem Tezol, Edanur Yesil, Feryal Karahan, Isa Killi, Mehtap Akca
PMID: 38634847  PMCID: PMC11065969  doi: 10.14744/tjtes.2024.47835  Pages 254 - 262
BACKGROUND: In our earthquake-prone country, it is crucial to gather data from regional hospitals following earthquakes. This information is essential for preparing for future disasters and enhancing healthcare services for those affected by earthquakes. This study aimed to evaluate the Pediatric Trauma Score (PTS) and the Shock Index, Pediatric Age-Adjusted (SIPA), in children affected by earthquakes, to provide clinicians with insights into the severity of trauma and hemodynamic stability.
METHODS: The study included patients admitted to our hospital's pediatric emergency service within the three weeks following the earthquake. We evaluated their age, sex, admission vital signs, mechanical ventilation requirements, development of crush syndrome, length of hospital stay, PTS, and SIPA.
RESULTS: Our study included 176 children (89 females and 87 males) with trauma. Fifty-eight (32.95%) children had crush syndrome, and 87 (49.43%) were hospitalized. The median PTS was 10 (ranging from -3 to 12), and the median SIPA was 1.00 (ranging from 0.57 to 2.10). We observed a negative correlation between the time spent under debris and PTS (r=-0.228, p=0.002) and a positive correlation with the SIPA score (r=0.268, p<0.001). The time spent under debris (p<0.001) and SIPA score (p<0.001) were significantly higher in hospitalized children. PTS was significantly lower in hospitalized children than in others. A PTS cutoff point of 7.5, and a SIPA cutoff point of 1.05, predicted hospitalization in all children. Time spent under debris and SIPA were significantly higher in children with crush syndrome than in others (p<0.001). PTS at a cutoff point of 8.5 and SIPA at a cutoff point of 1.05 predicted crush syndrome in all children.
CONCLUSION: PTS and SIPA are important practical scoring systems that can be used to predict the severity of trauma, hospitalization, crush syndrome, and the clinical course in pediatric patients admitted to the hospital due to earthquake trauma.
BACKGROUND: In our earthquake-prone country, it is crucial to gather data from regional hospitals following earthquakes. This information is essential for preparing for future disasters and enhancing healthcare services for those affected by earthquakes. This study aimed to evaluate the Pediatric Trauma Score (PTS) and the Shock Index, Pediatric Age-Adjusted (SIPA), in children affected by earthquakes, to provide clinicians with insights into the severity of trauma and hemodynamic stability.
METHODS: The study included patients admitted to our hospital's pediatric emergency service within the three weeks following the earthquake. We evaluated their age, sex, admission vital signs, mechanical ventilation requirements, development of crush syndrome, length of hospital stay, PTS, and SIPA.
RESULTS: Our study included 176 children (89 females and 87 males) with trauma. Fifty-eight (32.95%) children had crush syndrome, and 87 (49.43%) were hospitalized. The median PTS was 10 (ranging from -3 to 12), and the median SIPA was 1.00 (ranging from 0.57 to 2.10). We observed a negative correlation between the time spent under debris and PTS (r=-0.228, p=0.002) and a positive correlation with the SIPA score (r=0.268, p<0.001). The time spent under debris (p<0.001) and SIPA score (p<0.001) were significantly higher in hospitalized children. PTS was significantly lower in hospitalized children than in others. A PTS cutoff point of 7.5, and a SIPA cutoff point of 1.05, predicted hospitalization in all children. Time spent under debris and SIPA were significantly higher in children with crush syndrome than in others (p<0.001). PTS at a cutoff point of 8.5 and SIPA at a cutoff point of 1.05 predicted crush syndrome in all children.
CONCLUSION: PTS and SIPA are important practical scoring systems that can be used to predict the severity of trauma, hospitalization, crush syndrome, and the clinical course in pediatric patients admitted to the hospital due to earthquake trauma.

7.Pancreatic injury due to blunt trauma on CT: does retropancreatic fat tissue reduce the severity of pancreatic injury?
Vefa Cakmak, Duygu Herek, Alten Oskay, Gülay Gungör, Pinar Cakmak, Mert Özen
PMID: 38634850  PMCID: PMC11065974  doi: 10.14744/tjtes.2024.60622  Pages 263 - 270
AMAÇ: Künt karın travmasına bağlı pankreas yaralanmaları eşlik eden yaralanmalarla birlikte yüksek mortalite oranına sahiptir. Bu çalışmanın amacı, pankreas travmalı hastalarda retropankreatik yağ dokusu büyüklüğü ile pankreas ve komşu organ yaralanmalarının şiddeti arasındaki ilişkiyi araştırmaktır.
GEREÇ VE YÖNTEM: Künt karın travması olan 34 hastanın (25 erkek, 9 kadın, 13-69 yaş) ve 34 kontrolün (28 erkek, 6 kadın, 15-66 yaş) bilgisayarlı tomografi görüntüleri (BT) retrospektif olarak tarandı. Pankreas gövdesinin arka tarafında yer alan retropankreatik yağ dokusunun alanı tüm hastalar için aksiyel düzlemde ölçüldü. Pankreas yaralanmasının derecesi yaralanma yeri, retropankreatik yağ dokusu alanı ve diğer organ yaralanma dereceleri açısından değerlendirildi.
BULGULAR: Pankreas yaralanması 16 hastada (%23.5) baş kesiminde, dört hastada (%5.9) gövde kesiminde, 14 hastada (%20.6) kuyruk kesimi yerleşimliydi. Retropankreatik yağ alanı pankreas travmalı hastalarda, kontrollere göre anlamlı derecede düşük bulundu (<0.0001). Retropankreatik yağ alanının vertebral korpus alanının oranı, pankreas yaralanması olan ve olmayan hastalar arasında anlamlı farklılık gösterdi (p=0.014). SONUÇ: Retropankreatik yağ dokusu pankreas gövdesinin künt karın travmasından daha az etkilenmesini sağlar ve retropankreatik yağ dokusu miktarındaki artış daha düşük pankreas hasarı oranları ile ilişkilidir.
BACKGROUND: Pancreatic injuries from blunt abdominal trauma have a high mortality rate, often accompanied by injuries to adjacent organs. This study aims to investigate the relationship between the size of retropancreatic adipose tissue and the severity of pancreatic and adjacent organ injuries in patients with pancreatic trauma.
METHODS: We retrospectively screened computed tomography (CT) images of 34 patients (25 males, nine females, aged 13-69 years) and 34 controls (28 males, six females, aged 15-66 years) who suffered blunt abdominal trauma. The area of adipose tissue located posterior to the pancreatic body was measured in the axial plane for all subjects. The severity of pancreatic injury was assessed in terms of the injury site, the retropancreatic adipose tissue area, and the degree of other organ injuries.
RESULTS: Pancreatic injuries were located in the head for 16 patients (23.5%), in the body for four patients (5.9%), and in the tail for 14 patients (20.6%). The retropancreatic fat area was found to be significantly smaller in patients with pancreatic trauma compared to controls (p<0.0001). Furthermore, the ratio of the retropancreatic fat area to the vertebral corpus area differed significantly between patients with and without pancreatic injuries (p=0.014).
CONCLUSION: Retropancreatic adipose tissue protects the pancreatic body from the impacts of blunt abdominal trauma. An increased amount of retropancreatic adipose tissue is associated with a reduced rate of pancreatic injury.

8.The role of Ottawa ankle rules in geriatric emergency department visits
Avni Uygar Seyhan, Rohat Ak, Faruk Şimşek, Senem Ayvacı, Oğuzhan Açıkgöz
PMID: 38634845  PMCID: PMC11065971  doi: 10.14744/tjtes.2024.39240  Pages 271 - 275
AMAÇ: Acil servis (AS) başvurularında ayak bileği yaralanmaları önemli bir yer tutmaktadır. Etkin bir tanı ve tedavi süreci, hastaların hızla iyileşmesi ve acil servislerdeki tıkanıklığın azaltılması için hayati öneme sahiptir. Bu çalışmanın amacı, acil servise başvuran geriatrik hastalarda Ottawa ayak bileği kurallarının (OAR) yeterliliğini ve etkinliğini değerlendirmektir.
GEREÇ VE YÖNTEM: Şubat 2022-Kasım 2022 tarihleri arasında, izole ayak bileği yaralanması şikayetiyle acil servise başvuran 65 yaş ve üzeri 160 hasta (118 kadın, 42 erkek) çalışmaya dahil edilmiştir. OAR'nin sensitivitesi, spesifitesi, pozitif prediktif değeri ve negatif prediktif değeri hesaplandı.
BULGULAR: Çalışmada, hastaların %37.5'inde fraktür tespit edilmiştir. OAR'nin sensitivitesi %98.33, spesifitesi %86, negatif prediktif değeri %98.85 ve pozitif prediktif değeri %80.82 olarak bulunmuştur.
SONUÇ: Çalışma, OAR'nin geriatrik popülasyonda yüksek sensitiviteye sahip olduğunu, ancak spesifite ve pozitif prediktif değer açısından bazı sınırlılıklar gösterdiğini ortaya koymaktadır. Bu sonuçlar, geriatrik popülasyonda ayak bileği yaralanmalarının değerlendirilmesinde OAR'nin kullanımının etkinliğini desteklemekte, ancak aynı zamanda yanlış pozitif sonuçlar açısından dikkatli kullanılması gerektiğini göstermektedir.
BACKGROUND: Ankle injuries are a common reason for visits to the emergency department (ED). An effective diagnosis and treatment process is crucial for the swift recovery of patients and for alleviating congestion in EDs. This study aims to evaluate the adequacy and effectiveness of the Ottawa Ankle Rules (OAR) in geriatric patients presenting to the emergency department (ED).
METHODS: Between February 2022 and November 2022, 160 patients aged 65 and older (118 women, 42 men) who presented to the ED with isolated ankle injuries were included in the study. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the OAR.
RESULTS: The study found fractures in 37.5% of patients. The sensitivity of the OAR was 98.33%, the specificity was 86%, the negative predictive value was 98.85%, and the positive predictive value was 80.82%.
CONCLUSION: This study demonstrates that the OAR is highly sensitive in the geriatric population but shows some limitations in terms of specificity and positive predictive value. These results support the effectiveness of using the OAR in evaluating ankle injuries in the geriatric population but also highlight the need for cautious application due to the potential for false-positive outcomes.

9.Is it possible to predict mortality in patients with high-grade blunt liver injury? A single trauma center study
Muhammed Kadir Yıldırak, Hanife Seyda Ulgur, Mert Gedik, Enes Sertkaya, Emre Furkan Kırkan, Fikret Ezberci, Hüseyin Kerem Tolan, Adnan Özpek
PMID: 38634851  PMCID: PMC11065970  doi: 10.14744/tjtes.2024.60646  Pages 276 - 284
AMAÇ: Künt karın travmaları tüm travma vakalarının önemli bir bölümünü oluşturur ve sıklıkla karaciğer yaralanmaları ile ilişkilidir. Yüksek dereceli künt karaciğer yaralanmaları ise günümüzde dahi hayatı tehdit eden klinik tablolara sebebiyet verebilmektedir. Bu nedenle daha yakın takip ve tedavi gerekecek kritik hastaların tanınması önem arz etmektedir. Bu minvalde mortaliteyi arttıran faktörlerin tespiti için bu hastalardaki deneyimimizi paylaşmayı amaçladık.
GEREÇ VE YÖNTEM: 2008 ve 2023 yılları arasında acil kliniğinde künt travma sonrası grade 3 ve üzeri karaciğer yaralanması tanısı almış 38 hasta çalışmaya dahil edildi. Vefat eden 11 hasta 1. gruba alınırken, sağ kalan 27 hasta 2. gruba dahil edildi. Gruplar yaralanma mekanizması, görüntüleme sonuçları, glasgow koma skorları, travma şiddeti skorları, başvuru esnasındaki baz açığı, laktat ve pH değerleri yönünden karşılaştırıldı. Anlamlı fark olan parametrelerde eşik değeri bulmak için ROC analizi kullanıldı.
BULGULAR: Karaciğer yaralanma derecesi ve ek abdominal organ yaralanma oranları 1. grupta anlamlı daha yüksekti (p<0.05). Ekstraabdominal organ yaralanması yönünden gruplar arasında fark yoktu (p>0.05). Eritrosit suspansiyonu ihtiyacı 1. grupta anlamlı daha yüksekti (p<0.05). Ortalama laktat ve baz açığı değerleri 1. grupta anlamlı daha yüksekti (p<0.05). Lökosit değerleri 1. grupta anlamlı daha düşük bulundu (p<0.05).
SONUÇ: Baz açığı, hemoglobin, laktat, travma şiddeti skoru, karaciğer yaralanma derecesi, eşlik eden abdominal yaralanmalar ve eritrosit suspansiyon ihtiyacı artmış mortalite ile ilişkili bulunmuştur. Yukarıda belirtilen parametreler ile alakalı net eşik değerlerinin belirlenebilmesi için daha fazla veriye ve yayına ihtiyaç vardır.
BACKGROUND: Blunt abdominal trauma constitutes a significant portion of trauma cases and is often associated with liver injury. Given that high-grade liver injuries remain life-threatening, identifying patients who will likely require more vigilant attention and care is crucial. This study aims to determine the parameters that increase mortality in patients with high-grade liver trauma.
METHODS: This study enrolled 38 patients with Grade III or higher liver injuries, treated by the general surgery department between 2008 and 2023. Eleven patients who died were categorized into Group 1, and 27 survivors were placed in Group 2. We evaluated their respective mechanisms of injury, imaging results, Glasgow Coma Scale scores, Base Excess, Lactate levels, pH, and Injury Severity Score findings. Receiver Operating Characteristics (ROC) analysis was performed for parameters with significant differences, and certain cutoff values were determined.
RESULTS: The grade of liver injury and additional abdominal organ injuries were significantly higher in Group 1 (p<0.05). The difference in extra-abdominal injury sites was statistically insignificant between the groups (p>0.05). Erythrocyte suspension requirements were significantly higher in Group 1 (p<0.05). Average lactate and base deficit values were also significantly higher in Group 1 (p<0.05), while leukocyte counts were significantly lower in Group 1 (p<0.05).
CONCLUSION: Base deficit, hemoglobin (Hb), lactate levels, injury severity, liver injury grade, accompanying abdominal injuries at admission, and erythrocyte suspension demands were found to be associated with increased mortality rates. Certain cutoff values for the aforementioned parameters could be established. However, further data are required to confirm these findings.

10.A dangerous tradition: retrospective analysis of celebratory gunfire-related injuries in three tertiary hospitals
Mustafa Ferudun Celikmen, Mustafa Cicek, Melih Imamoglu, Verda Tunaligil
PMID: 38634853  PMCID: PMC11065979  doi: 10.14744/tjtes.2024.98200  Pages 285 - 289
AMAÇ: Kutlamalarda silahların havaya ateşlenmesi, kamu güvenliği için önemli riskler oluşturan bir gelenektir. Yorgun mermi yaralanması olarak isimlendirilen bu olay sonrası düşen bu mermiler yüksek hızlara ulaşabilir ve bir kişiye, hayvana veya eşyaya çarpması durumunda ciddi yaralanma veya ölüme neden olma potansiyeline sahip olabilir.
GEREÇ VE YÖNTEM: Bu çalışmanın amacı, 2014-2023 yılları arasındaki 10 yıllık dönemde Türkiye'nin iki farklı kentindeki 3 farklı hastaneye başvuran kutlama amaçlı silah ateşine bağlı yaralanmaların (CGRI) retrospektif olarak tespit edilmesi ve sonuçlarının araştırılmasıdır.
BULGULAR: Trabzon Kanuni Eğitim ve Araştırma Hastanesi, Karadeniz Teknik Üniversitesi Tıp Fakültesi Farabi Hastanesi ve Yeditepe Üniversitesi Kozyatağı Hastanesi'nden elde edilen veriler, 48 yorgun mermi yaralanması vakasını ortaya koydu; bu yaralıların %64.6'sını erkekler oluşturdu. 0-17 yaş arası çocuklar en çok etkilenen grup, baş-boyun-yüz bölgesi en sık yaralanan bölge iken, vakaların çoğunluğunun kırsal alanlarda gerçekleştiği belirlendi. Sekiz vaka (%16.7) ölümle sonuçlandı. Silahların ateşlenme nedenleri vakaların %43.8'inde belirlenemedi.
SONUÇ: Sosyolojik olarak, bazı toplumlarda silah sahipliği prestij anlamına gelir ve genellikle düğünlerde kutlamalara yönelik silah kullanımını tetikler. Ancak bu gelenek, dünya çapında trajedilere yol açabilmektedir. Ruhsatsız silah kullanımını önlemek için daha sıkı düzenlemeler ve yasal altyapılara ihtiyaç vardır. Kutlamalarda ateşlenen silahların toplum olarak normal görülmesine karşı etkili bir mücadele için işbirlikçi çabalar hayati öneme sahiptir. Gelecekte yapılabilecek prospektif çalışmalar, CGRI insidansını kapsamlı bir şekilde değerlendirebilir ve kamu sağlığını korumak için önleyici stratejilerin belirlenmesinde rol alabililir.
BACKGROUND: Firing guns into the air during celebrations is a tradition that poses significant risks to public safety. These falling bullets, often referred to as tired bullets, can attain high velocities during their descent and have the potential to cause serious injury or death to people and animals, or significant damage to property upon impact.
METHODS: This study aimed to retrospectively detect and analyze incidents of celebratory gunfire-related injuries (CGRI) that were admitted to three different hospitals in two cities in Turkey over a 10-year period from 2014 to 2023.
RESULTS: Data collected from Trabzon Kanuni Training and Research Hospital, Karadeniz Technical University Faculty of Medicine Farabi Hospital, and Yeditepe University Kozyatağı Hospital revealed 48 cases of injuries attributed to celebratory gunfire. Of these cases, 64.6% involved male victims. Children aged 0-17 years were the most affected demographic, with the head, neck, and face being the most frequently injured areas. The majority of incidents occurred in rural areas. Eight cases (16.7%) resulted in fatalities. The reasons for gunfire in 43.8% of the cases could not be determined.
CONCLUSION: Sociologically, gun ownership is often associated with prestige and can trigger the use of firearms in celebrations, such as weddings, in some societies. However, this tradition can result in tragic consequences worldwide. Stricter regulations and legal frameworks are necessary to prevent the use of unlicensed weapons. Collaborative efforts are crucial for effectively addressing the societal normalization of celebratory gunfire. Future prospective studies can comprehensively evaluate the incidence of CGRI and identify effective preventive strategies to safeguard public health.

11.Non-malignant left colon emergency surgery: evaluation of factors affecting clinical outcomes and complications
Mehmet Sabri Çiftçi, Burak Uçaner, Mehmet Zeki Buldanlı
PMID: 38634846  PMCID: PMC11065972  doi: 10.14744/tjtes.2024.40009  Pages 290 - 296
AMAÇ: Acil kolorektal rezeksiyonlar genel cerrahi pratiğinde önemli yer tutmakta ve sol kolon yerleşimli patolojiler azımsanmayacak ölçüde görülmektedir. Çalışmamızda, benign etiyolojili izole sol kolon cerrahisi sonuçlarını klinikopatolojik ve biyokimyasal veriler üzerinden değerlendirmeyi amaçladık.
GEREÇ VE YÖNTEM: Üçüncü basamak bir hastane genel cerrahi kliniğinde, Ocak 2017-Ocak 2022 tarihleri arasında malignite acilleri haricinde sol kolon cerrahisi yapılan hastaların, demografik, klinik ve laboratuvar verileri retrospektif olarak taranarak istatistiksel analizi yapıldı.
BULGULAR: Çalışmaya dahil edilen 48 hastanın yaş ortalaması 56.9±16.4 yıl idi. En sık acil cerrahi endikasyonu komplike akut divertikülit idi (n=19, %39.6). En sık yapılan cerrahi teknik hartmann prosedürüydü (n=30, %62.5). Postoperatif morbidite ve mortalite (30 gün içinde) oranımız sırasıyla %27.1 ve %8.3 idi. İleri yaş (ortalama 65.4±15.8’e karşın 53.8±15.7, p=0.028), preoperatif vazopressör ajan kullanımı, daha düşük trombosit düzeyleri, hipoalbuminemi (<3 mg/dl) ve azotemi (üre>20 mg/dl) artmış postoperarif morbiditeyle ilişkiliydi. Komorbidite, American Society of Anesthesiologists (ASA) skoru, cerrahi teknik ve diğer klinik veriler ile postoperatif sonuçlar arasında istatistiksel anlamlılık bulunamadı.
SONUÇ: Sol kolon patolojileri nedeniyle yapılan acil kolorektal cerrahide; yaşlı, böbrek fonksiyon anormalliği olan ve vazopressör kullanımı gerektiren hipotansif hastaların perioperatif süreçte kapsamlı değerlendirilmeleri gerekmektedir.
BACKGROUND: Emergency colorectal resections hold a significant position in general surgical practice, and pathologies of the left colon are relatively common. This study was conducted to assess the outcomes of isolated left colon surgeries with benign etiologies, drawing on clinicopathological and biochemical data.
METHODS: We carried out a retrospective review and statistical analysis of demographic, clinical, and laboratory data of patients who underwent left colon surgery at the general surgery clinic of a tertiary care hospital, excluding those with malignancy-related emergencies, from January 2017 to January 2022.
RESULTS: The average age of the 48 patients in the study was 56.9±16.4 years. Complicated acute diverticulitis was the most frequent indication for emergency surgery (n=19, 39.6%). The Hartmann procedure was the surgical technique most often employed (n=30, 62.5%). The rates of postoperative morbidity and mortality within 30 days were 27.1% and 8.3%, respectively. Increased postoperative morbidity was linked to advanced age (mean 65.4±15.8 vs. 53.8±15.7, p=0.028), the preoperative administration of vasopressors, lower platelet counts, hypoalbuminemia (<3 mg/dl), and azotemia (blood urea nitrogen >20 mg/dl). There was no statistically significant correlation between comorbidities, American Society of Anesthesiologists (ASA) scores, surgical methods, or other clinical data and postoperative outcomes.
CONCLUSION: For emergency colorectal surgery pertaining to left colon pathologies, it is critical to conduct a comprehensive evaluation in the perioperative period, especially for elderly and hypotensive patients with renal function abnormalities and for those requiring vasopressors.

12.Clinical properties and rehabilitation needs of earthquake survivors in a subacute rehabilitation setting
Emine Esra Bilir, Pinar Borman, Ayşe Merve Ata, Ebru Alemdaroğlu, Hatice Bodur, Burcu Yanık, Fatma Yurdakul, bilge kesikburun, Tuba Güler, Bedriye Başkan, Selami Akkuş, Oznur Uzun, Evren Yaşar
PMID: 38634844  PMCID: PMC11065973  doi: 10.14744/tjtes.2024.27553  Pages 297 - 304
BACKGROUND: This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaraş and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach.
METHODS: The study included patients injured in the Kahramanmaraş-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data.
RESULTS: A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support.
CONCLUSION: This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.
BACKGROUND: This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaraş and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach.
METHODS: The study included patients injured in the Kahramanmaraş-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data.
RESULTS: A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support.
CONCLUSION: This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.

CASE REPORTS
13.Firearm injury and the Deloyers procedure: case report and literature review
Cengiz Ceylan
PMID: 38634843  PMCID: PMC11065978  doi: 10.14744/tjtes.2024.20813  Pages 305 - 308
Geniş kolon rezeksiyonları sonrasında kolorektal anastomoz yapmak mümkün olmayabilir. Bu nedenle, sağ kolon transpozisyonu ile yapılan Deloyers prosedürü tanımlanmıştır. 2010-2023 yılları arasında yapılan Deloyers prosedürlerini inceleyerek, prosedürün hangi durumlarda uygulandığını ve erken ile geç dönem sonuçlarını tartışmayı amaçladık. Ateşli silah yaralanması sonucu sigmoid kolon, inen kolon, transvers kolon ve mezenterde büyük organ ve doku kaybı yaşayan 22 yaşındaki bir kadın hastada, hasar kontrol cerrahisini takiben restoratif cerrahide Deloyers prosedürü uygulandı. Çekum ve sağ kolonun mobilizasyonu sonrasında, ileokolik arter pedikülü üzerinde kraniokaudal yönde rotasyon yapıldı, ardından appendektomi gerçekleştirildi. Kolorektal anastomoz ise sirküler stapler ile oluşturuldu. Postoperatif takiplerde herhangi bir komplikasyon gelişmedi. Postoperatif 14. günde hasta taburcu edilen hastanın barsak hareketleri 2.5 mg difenoksilat hidroklorür ve 0.025 mg atropin sülfat tedavisi ile günde 4 kezdi. 6 aylık izlemde, medikal tedaviye ihtiyaç duymaksızın barsak hareketleri günde 2'ye düştü. Geniş sol kolektomileri takiben hastaların fonksiyonel sonuçlarını düşünerek, düşük morbiditesi olan Deloyers prosedürü güvenle uygulanabilir.
Following extended colon resections, it may not always be possible to perform colorectal anastomosis. The Deloyers procedure, which involves the transposition of the right colon, has been identified as a viable solution. This report aims to discuss the circumstances under which the Deloyers procedure was performed, as well as to evaluate the early and late postoperative outcomes, by reviewing cases conducted between 2010 and 2023. In a 22-year-old female patient who suffered major organ and tissue loss (with injuries to the sigmoid colon, descending colon, transverse colon, and mesentery) due to a firearm injury, the Deloyers procedure was applied during restorative surgery following initial damage control surgery. The procedure involved mobilizing the cecum and right colon, performing a cranio-caudal rotation over the ileocolic artery pedicle, followed by an appendectomy, and creating a colorectal anastomosis using circular staplers. There were no complications during the postoperative follow-ups. By the 14th postoperative day, the patient was discharged and experienced bowel movements four times a day, managed with 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulfate. At the 6-month follow-up, the frequency of bowel movements had decreased to twice daily without the need for medical treatment. Given the functional outcomes in patients after extended left colectomies, the Deloyers procedure, with its low associated morbidity, stands out as a viable option.