This study was planned for evaluating the effect of collagenase which is one of the popular enzyme used in wound healing recently. Two groups of rats which consist 15 animals each were used by this aim. On collagenase applied group Novuxol-as ointment- consist of the enzymes as protease and clostrodiopepsidase-A that is obtained from the culture filtrates of clostridium hystoliticum. In the control group serum physiologic was used. At second and seventh days samples were taken from the wound for microbiological and histopathological examinations. Histopathological examinations revealed that wound healing was better in the collagenase group than the control group (p<0.005). There were no significant difference about neovascularisation and cellular infiltration among the groups. It was seen that infection reduced the activation of fibroblasts and density of collagen's in control group (p<0.001) and impaired the regulation of collagen in collagenase treated group (p<0.001). As a result, we saw that treatment with collagenase accelerates healing in open wounds, supports a significantly clean and viable granulation tissue, increases activation of fibroblast and myofibroblast and results in a regular and dens increase in collagen fibrin's.

We created a study group from 20 patients who were performed colocolic anastomosis between October 1992 and September 1995'at Kartal training and research hospital. At the same time, control group was created from 20 patients who underwent abdominal operations without colonic anastomosis. Colonic sigmoid catheter was inserted to all patients transanally and observed their intramural PH posoperatif five days. While in control mean PH was 7.26±0.022 in the fifth day, in study group mean PH was 7.06±0.113. In study group, patients who were performed double row or stapler anastomosis technics or who were urgent cases or multisystem injuries were observed that intramural PH was lower in fifth day than the others. In two patients whose PH were 6.9 or lower, clinical leakage were seen and relaparatomies were performed. Significant differences between control and study groups were seen and relaparatomies were performed. Significant differences between control and study groups were found in statistically (p<0.01). As a result, we consider that intramural PH monitoring by using colonic sigmoid catheter and following clinical and laboratory observation can be useful for clinician in early subclinic anastomotic leakage.

88649 patients, admitted to Kartal Eðitim ve Araþtýrma Hastanesi (KEAH) Surgical Emergency Policlinics from 1.4.1993 to 31.3.1997 analysed retrospectively by dividing four one-year periods. According to their reasons of apply, patients are classified as traumatic (Traffic accident, penetrating wounds, gunshot wounds and patients have fallen or got thrashings) and non-traumatic. During this period there was a significant increase in trauma patients and a male dominance was visible. In winter season, there was not a significant difference in the number of patients admitted because of traffic accidents. But in other seasons the number of patients without trauma increased so a relative dominance was seen in the number of patients admitted because of traffic accidents when compared with whole policlinic patients.

The aim of this study is to evaluate the causes and rates of postcholecystectomy syndrome after acute and elective laparoscopic cholecystectomy. A prospective analysis was carried out on 110 patients with chronic cholecystitis (Group I) and 73 with acute cholecystitis (Group II) undergoing laparoscopic cholecystectomy at Pamukkale University Hospital between January 1995 and May 1996. The mean follow-up period was 12 months. Postcholecystectomy syndrome rates were 18.1 % in Group I and 5.4 % in Group II. The most common cause in postcholecystectomy syndrome was found to be gastroduodenitis. The other causes were peptic ulcus, peritonitis carcinomatosa, pancreatic carcinoma and choledocholithiasis. In group I, the rate of postcholecystectomy syndrome was significantly higher than in group II (p<0.05). We conclude that, physical examination and ultrasonography is sufficient in diagnosis of acute cholecystitis, and after elimination of the pathology causing the symptoms, rate of postcholecystectomy syndrome will be low. On the other hand, one should not be contented only with ultrasonography for elective cases and further upper gastrointestinal examinations should be carried out, especially for patients with dyspeptic symptoms and the patients must be informed that their symptoms may not subside despite the operation.

Anal canal - perineal injuries (ACPI) may pose challenging diagnostic and therapeutic dilemmas. These massive soft - tissue injuries overlie fractures of the pelvis and femur, and may involve pelvic floor, rectum and genitourinary tract. Over the last 10 years, 21 patients with complex ACPI managed at Department of General Surgery, University of Çukurova, School of Medicine was reviewed retrospectively. The effects of age, sex, mechanism of the injury, additional injuries, missing time from injury to therapy, the surgical procedures on the development of morbidity were statistically evaluated by using chi-square and Fischer exact tests. Delayed surgical therapy more than 24 hours and the presence of pelvic fractures were the significant factors on morbidity (p<0.05). Total complication rate was 80 %. Sphincter failure was detected in 9 cases, primary repair was performed only in 2. We conclude that total diversion of fecal stream, radical initial debridement of necrotic soft - tissue, exhaustive irrigation of the perineal wounds, parenteral antibiotic therapy, nutritional support, and appropriate management of bone injuries and skin grafts optimize recovery this devastating injury.

Delayed traumatic intracerebral hematomas (DTICH) is a rare condition and ethiopatogenesis is still controversial. CT has been helpful to increase the diagnosed patients population. From January 1, 1990 to December 31, 1996, 840 patients, 10 patients developed DTICH were presented. There were 9 males (90%) and 1 females (10%). The ages of the patients ranged from 6 to 73 years (mean 43 years). The most common ethiological factor was traffic accident. Glasgow Coma Scale scores were 10 in all patients on admission. Of 10 patients 8 were treated conservatively. The mortality rate was 50% (n=5). The study indicated that the patients who sustained severe head trauma (GKS 10) the patients with intracerebral hematomas, contusion or extracerebral hematoma on the initial CT, older age (>50 age), one at greatest risk of developing DTICH. Additionally, the presence of a skull fracture and the findings of coagulopathy one the another risk factor. These patients should be followed up by the repetetive CT scans.

Epidural hematomas not causing mass effect and neurological deficit can be managed conservatively. In this retrospective study, 86 patients treated conservatively and 268 patients treated surgically were analyzed. The results demonstrated that age of the patient and the neurological status were important clinically, and location, thickness, volume and mass effect of the hematoma were important radiologically. Conservative treatment is more common in infants and old patients. The temporal and posterior fossa epidural hematomas could be managed conservatively in a higher rate. Not only thickness and volume of the hematoma but also the parameters revealing mass effect were taken into account. Most oftenly a period of the first 24 hours was critical in decision making. All patients treated conservatively did well, and resorption of the hematoma was shown. Conservative management in patients sustaining certain clinical and radiological features is suggested and discussed in detail.

Twelve head injured patients with cerebrospinal fistula and/or pneumocephalus due to deep and extensive cranial base dura-brain lacerations were operated upon in order to be repaired of their defects intradurally using extended (basal) frontal approach or combined extended (basal) frontal approach and fronto-orbital approach. Six patients demonstrating frontobasal fracture and presenting with loss of vision, five patients with superior orbital fissure syndrome caused by a comminuted and extensive sphenoid ridge fractures, and three patients with orbital apex syndrome and sphenoid bone fracture were explored using fronto-orbital approach, and the traumatic region was explored and the involved cranial nerves were decompress. All of the patients whose frontobasal dural defects had been repaired did well, and no complications or recurrences the fistula or pneumocephalus occurred. Out of the patients with cranial nerve syndromes, postoperatively, three improved in vision significantly, one had a partial improvement in vision, and two superior orbital fissure patients improved minimally. The other eight cases did not change their neurological findings. The most striking factors in prognosis of the patients with traumatic cranial nerve compression are thought to be time of the surgical intervention and the type of the cranial nerve injury. These cranial base approaches provided a wide exposure and minimised the need of brain retraction.

The accessory ulnar styloid process is an uncommon variation in the wrist. This ossicle is generally believed to be asymptomatic but when traumatized, it can be responsible for the pain in the ulnar border of the wrist. Identification of this variation is of importance because the injury may occur as a result of chronic repetitious trauma and the ossicle may easily be mistaken for a fracture. In our study; the incidence, the types and female/male percentages for the accessory ulnar styloid process were investigated by means of radiograps from volunteers and clinic cases. This ossicle was encountered in 10 cases as; incidence 2.5%, male/female persentage 7/3 and one of them is symptomatic. Clinical importance of this variation was discussed by the knowledge of literature.

In this study; 28 patients underwent surgery secondary to penetrating injury of the bladder due to gunshot wounds between 1990 and 1996 were evaluated retrospectively according to the diagnosis and treatment methods, associated organ injury, morbidity and mortality rates. The bladder rupture was diagnosed with retrograde cystography in 16 patients and with laparotomy in 12 patients. Bladder rupture was intraperitoneal in 26 patients and extraperitoneal in 2 patients. Bladder ruptures were repaired with primary suture in all of patients. No patient had isolated bladder injury, while there were intraabdominal injury in 27 patients, fractures in 12 patients and other organ injuries in 5 patients as associated injuries. There were no mortally directly related with the bladder injury, 2 patients died secondary to associated organ injury. As a result; the bladder ruptures due to gunshot wounds can be repaired primarily with safety. But, associated injuries can cause severe complications.

Duodenum was seldom influenced in blunt or penetrating abdominal injuries. Retroperitoneal localization of duodenum and its anatomical relation with the pancreas are factors that increase potential of injury in blunt abdominal traumas particularly. Between January 1993-December 1996 eight patients with duodenal injury were analysed in terms of tip of injury, grade of injury, Injury Severity Score, The mean Penetrating Abdominal Trauma Index. Four patients with Grade II or III injury underwent primary repair after debridement of the duodenal wound, pancreatoduodenectomy was performed in three patients with Grade IV or V injury and primary repair + tube duodenostomy in one patient with Grade II injury. The mean duration from trauma to surgery was 8.3 hours, mean transfusion requirements were 6 units of blood and mean hospital stay was 27.5 days. The complications developed after surgery were abdominal sepsis in two patients, severe pancreatitis in one patient, duodenal fistula in one patient. The overall mortality rate for the study was 12.5 per cent. We concluded that primary repair is sufficient treatment in simple isolated duodenal injuries. However in cases complicated with excessive peripancreatic homorrhage Whipple procedure should be preferred.

Injury to the gastrointestinal tract from blunt trauma which was first reported by Aristotle is a rare event. There are no charecteristic laboratory findings, and diagnostic methods. We there fore reviewed our experience with gastroenteric injuries from blunt trauma to evaluate the etiology, diagnosis, management, and prognostic factors of these unusual injuries. We prospectively and retrospectively reviewed the charts of all patients who sustained gastrointestinal injury from blunt trauma and were treated at the Department of General Surgery in Cumhuriyet University. Injury severity Score (ISS), concomitant extraabdominal organ injury, and shock index were determined for each patient. Small bowell perforations were the most frequent injuries, followed by colorectal injuries. Five prognose predictive factors were determined. These factors were age, initial hematocrit value, shock index, injury severity score and number of concomitant extraabdominal injury.

Hartmann's procedure is suitable operation and its indications are extended for different kinds of pathologies of rectum and sigmoid colon when primary restorative resection cannot be safely performed. During the June 1992 to 1997 time period, we analyze our experience in the 31 patients who underwent Hartmann's procedure at the Department of Surgery, Dokuz Eylül Universty Hospital. There were 16 men and 15 women, with a median age of 65 (range 32-88) years. Twenty seven (87,1%) patients were operated for emergent diseases, four (12,9%) patients for elective conditions. The pathologic process encountered was benign in 19 (61,3%) and malign in 12 (38,7%). The median time interval for Hartmann's procedure to reversal was 86 (range 54-300) days in only 17 (62,99%) of these patients. The mortality rate of primary procedure was 12,9% and important morbidity was 29,3%. No anastomotic leak and mortality was found following ostomy closure. Morbidity due to another reasons occurred in 3 patients (17,6%). There has been a notable but progressive decline in the seemingly high incidence of morbidity and in the technical difficulty frequently associated with Hartmann's procedure and its reversal. So, Hartmann's procedure can be selected as "a first choice" or "a hist resort" operation in high risk patients.

A women who sustained injury to a breast because of falling down is presented. Except isolated seat belt traumas, isolated breast traumas are very rare events. Trauma to the breast can produce lesions which cannot be distinguished from malignant lesions by clinical examination or radiological imaging. If we have any suspicion all such lesions should be biopsied to minimize the risk of missing a carcinoma.

Injuries of iliac veins are uncommon but, frequently fatal. They are usually occurred after penetrating injuries. Two patients who have iliac vein injury were treated by the ligation of veins. Of these two patients, first one had no complication but, severe edema developed in the second one after the operation and adjunctive fasciotomy was used. Both of the patients did not have permanent edema. Although venos repair is often recommended, ligation in extensive injures may be necessary, and is usually well tolerated in young, previously healthy individuals.