Critical illness such as sepsis, trauma and shock is associated with both immunosupression and glutathione (GSH) deficiency. Liver is a target organ during sepsis because of this. Hepatic GSH levels decrease due to sepsis. We have investigated the level of hepatic GSH during sepsis by Tc 99m GSH scanning. Sepsis was induced in rats by cecal ligation and puncture following 24 hours of sepsis, Tc 99m GSH was administered by cardiac puncture and hepatic GSH uptake scanning was performed. As a result no significant changes of hepatic GSH uptakes was determined by Tc 99m GSH in sepsis.

In this study which was done to determine the value of prophylactic ceftriaxone in thorax surgery, 19 patients have been evaluated. 17 of the patients were operated for lung ca, 1 for cyst hidatic in lung, and 1 was operated for the carsinoid the of lung. Preop I gr IV ceftriaxone was given to the patients. During the operation serum and lung tissue samples were collected from the patients. The antibiotic level in those samples were evaluated by agar well diffusion method using Bacillus subtilis ATCC 6633 as the test organism. The antibiotic level in the tissue was measured as 12-53.6 µg/g and in serum was measured as 50.1-114.9 µg/g. This values were higher than the MIC of ceftriaxone for most of the bacteria. During postop clinical follow-up period none of the patients had wound infection or amphiema. These findings brought the conclusion that prophylactic ceftriaxone is successful and can be suggested in thorax surgery.

Gliconeogenesis, catabolism and basal energy expenditure increase after burn injury In this study; ten burned pediatric patients were started early enteral tube feeding within 24 hours after burn injury. Mean value of 745 kcal was administered within 24 hours after burn injury. Commercial feeding solution was used. Serum albumin levels and change in weight were investigated. Nutritional support was administered continuously infusion by using a feeding pomp. Albumin level of one case felt to 2.4gr/dl once. Albumin replacement was made in this patient. Non of the other patients required albumin replacement. Of ten patients, 20% lost weight of 1250gr; 80% gained weight of 450 gr in average. No important complication was observed. In burned pediatric patients, early sufficient enteral feeding is effective, safe and physiologic method to support of calorie protein, vitamin and other nutritional requirements.

Head trauma is one of the leading causes of morbidity and mortality in neurosergery practice. Epidural hematoma, subdural hematoma, intracerebral hematoma and depression fractures are surgically treatable complications of the head trauma. Early diagnosis and initial management of the head trauma complications, is of vital importance. Recently some reports discuss indications and timing of surgery. We retrospectively evaluated 348 patients admitted to our clinic with the diagnosis of head trauma and operated on. They were studied in the two groups. One is the patients who were referred from another clinic after initial handling posttravmatically, the second group was the ones, directly admitted to our clinic posttravmatically. Change in the surgical pathology during the initial handling and transport period preoperatively was evaluated. Results showed us that in referred patients group, during the time from trauma to surgery surgical pathology either increased in size or an additional pathology was added to the scene. So trauma patients must not be kept waiting in primary handling centers, because pathology may change in size or in nature during the transfer period.

Twenty-three patients with sternum fracture were diagnosed among the trauma patients that were admitted to the Emergency Service of Ege University Medical School Hospital in 1995. In 21 of these, car accident was the main reason and 15 of these patients with sternum fracture were caused by seat belt. There were neither additional life threatened injuries nor related complications and the mean hospital stay was two days. Using seat belt is life saving. Contrary, it was observed that it rarely gives way to life threatening injuries.

Pancreas injuries cannot be easily noticed because of its anatomic location, clinical presentation and its usually being accompanied with other organ injuries and so attract not enough attention In fact, pancreas injuries in cases of blunt and penetran abdomen traumas are relatively fewer, but not rare. In these injuries, surgery involves a wide spectrum of the treatment and in 2-3% of them Whipple procedure is needed to be done. In this paper, we present 3 cases, treated by Whipple procedure for grade 5 pancreas rupture and examine patients for other injuries, postoperative complications and survival.

34 cases, with penetrating wounds to the heart, who were operated in the general surgery clinics of our hospital during 1989 - 1996 were reevaluated. The cause of injury was stab wounds in 32 cases and gunshot wounds in 2 cases, immediate resusitation together with emergency thoracotomy was done to the eleven of the patients in group 1 and 11. In all cases (Except two cases who died) there were only one penetrating wound the heart. Right ventricular injury was the most frequent type. All cases were mended with suturing and pericards were left open. Our morbidity ratio was %22, mortality ratio was %6. We believe that our mortality is low because most of the injuries are caused by stab wounds, complicated injury ratio is low and that patients are taken the emergency services in shorter time in relation with our country's conditions.

During last 5 years, 60 children were consecutively admitted to our emergency department with blunt chest trauma. The most common mechanisms of injury were motor vehicle crashes (%30), pedestrian injury (%55) and falling from a high level (% 13). The most common intrathoracic injuries were pulmonary contusion (%50), multiple injuries (%20), pneumothorax (%7) haemothorax (7%), main bronchus rupture (%5), diaphragmatic rupture (%5) and isolated rib fractures (%5). The mean pediatric trauma score (PTS) of the children who had additional system injuries were significantly worse than the children who had isolated blunt chest trauma. Associated system injuries resulted in increase in length of hospital stay, compared to children with isolated chest injuries. Ten percent of the children were entubated and admitted to the intensive care unit, where they stayed an average of 5.8 days. The overall mortality rate for children with thoracic injury is 3%.

Between January 1980 May 1997 23 cases with tracheobronchial injuries were treated in our clinic. In 7 (30.4%) of theses there were combined tracheal and esophageal injuries. The cause was gunshot wound injury in all patients. Diagnosis of esophageal injury has been made by esophagography in 5, and by surgical exploration in two cases. The duration of time between the injury and surgical management was 30 hours frange, 648 hours). Surgical approach was made by anterior sternocleidomastoid incision in all cases. Operative techniques included drainage(3), two-layer dosure(3), and cervical tube esophagostomy + near total esophageal exclusion (1) for esophageal injuries. Tracheal repair was done with a single layer interrupted polypropylene or polyglycolic acid sutures. Associated injuries were pneumothorax (3), hemothorax(2), hemopneumothorax(2), larynx(1), and n.Laryngens inferior(1). Permanent tracheostomy was performed in one patient with severe laryngeal injury. Complications were cervical esophageal leak(1), tracheoesophageal fistula EF(1), esophageal stenosis(1), andpneumonia(1). The morbidity rate in our series was 42.8%. The cause of mortality in these 3 cases was sepsis. The mean length of hospital stay was 36.8 days (frange, 5 99 days). The number of complications can be lowered by prompt recognition of the injuries and repair of the trachea and esophagus. In order to protect the tracheal repair and prevent TEF formation a viable tissue, Sternocleidomastiod muscle being the first choice should be placed between the repairs regardless of the time between the injury and surgery.

Using the Dimon - Hughston technique, open reduction and internal fixation were applied to 22 patients, Harran University, Faculty of Medicine, Orthopaedic and Traumatology Clinic, between 1995 - 1997, with unstable femur trochanteric fractures. The average age of our cases was 67.6. The mean follow-up period was 12.6 months. The evaluation of the patients was made according to anatomic, radiological and clinical parameters applied in our clinic. To this evaluation, the results were defined as follows, 18 cases (%81.8 ) were good, 2 cases (%9) were modarete, and 2 cases (% 9) were poor. Coxa Vara and refractures were observed in 3 patients (13.6). Aseptic necrosis and the perforated head were observed in no cases.

Quantitative and objective characterisation of injury was essential for evaluation of accomplishment of management of trauma in this study, injury severity of 312 trauma patients admitted to Emergency Aid and Traumatology Hospital from October 1995 to October 1996 were estimated and probability of survival (Ps) was defined based on TRISS methodology. Conclusions were compared with Major Trauma Outcome Study (MTOS) results by Z and M statistics. Mathematically unexpected deaths and unexpected survivors were denoted on pre - charts. 31 cases of 312 patients died and 7 of them were unexpected (Ps>%50) deaths. There were no differences between study and MTOS results by Z and M statistics.

The patient is male who was 18 years old. Approximately 1 month ago he was taken laparotomy at another hospital because of the penetrating abdominal trauma. It was found a perforation on the surface of the stomach in 1 cm diameter and injury of mesentery of the small intestine. Perforation had repaired primarily and nothing had done anything to the retroperitoneal space and mesentery of the small intestine. He was discharged in the fifteenth day after operation without any problem. He was referred to our center because of an acute abdominal pain, restlessness, and hypotension. We found an aneurysm and hematoma of SMA with doppler ultrasonography and spiral abdominal computerized tomography. We excised pseudoaneurysm of SMA with laparotomy and SMA was repaired primarily. After operation we performed angiography of SMA. We couldn't find any patology on the SMA. After that the patient was discharged in the postoperative thirteenth day without any complication and problem. We concluded that, in the patients which has penetrating abdominal injury, mesenteric pseudoaneurysm must be keep in mind and in such case the surgeon must be explore the abdominal vascular tree.

Acute appendagitis is a rare cause of acute abdomen. There is still only one case report in the Turkish medical literature. We described 2 new cases and examined the properties of diagnosis and treatment. Although the differantial diagnosis is not important from acute appendicitis, good exploration of the abdomen is needed for accurate diagnosis. In the cases of "white appendicitis" acute appendagitis must also be examined like meckel diverticulitis.

Penile tourniquet injury probably is not a rare entity and has been reported following the application of numerous foreign objects, including rings, rubber bands, bottles, pipes and threads. Penile strangulation caused by a coil of hair frequently is an unrecognized clinical entity with severe potential complications, such as urethrocittaneous fistulas, necrosis of the glands and partial or complete amputation of the glands. We report an interesting case of penile strangulation secondary to a strand of human hair and discuss important anatomical considerations, mechanism of injury and methods or treatment.