In major liver surgery especially in liver trauma and liver tumor, per-operative blood loss is important in patient's mortality and morbidity. A bloodless field is achieved by Pringle maneuver. Pringle maneuver causes potentially dangerous hepatic parenchymal ischemia. Although harmful effect of ischemia occurs during ischemia, it has been shown that much more harm occurs during reperfusion. In this study, ischemia reperfusion injury was examined by liver function tests, free oxygen radicals and with histologic examination in rest of liver tissue during liver resection and also PGE., was investigated if it is useful to prevent the liver ischemia reperfusion injury or not. This study was carried out at Haydarpaþa Teaching Hospital Experimental Animal Laboratory. 24 Albino Wistar male rats weighing 300-350 grs. were used f or the study. Following 30 minutes ischemic period 70 % hepatectomy was done and during liver resection the effect of PGE2 was investigated by doing ischemia and reperfusion. The levels of ALT and AST were rapidly elevated on the first day of post operative period. In IR + PGE2group this elevation was remarkably less if compared to IR group. ALT and AST levels rapidly turned to normal levels on the seventh day of post operative period. Alkaline Phosphatase was also elevated in IR group more and reached to maximum level on the seventh day. The significant difference between groups was disappeared and on the twenty first days declined. Serum bilirubin levels were elevated but there was no significant difference between two groups, gamma GT levels were elevated in both groups but the decrease observed in IR group was slower. Also LDH levels were higher in IR group and inclined to decrease on 7th and 21 st days. In conclusion, PGE2 is assessed to be useful to prevent ischemia reperfusion injury in liver resection. Liver function tests are bad in early period but rapidly become normal. It is seen that liver masses come to normal in three weeks.

Recent studies have demonstrated that free oxygen radicals were involved in many pathologic processes and significant improvements were gained by using radical scavengers in numerous human diseases. The authors surveyed the pathogenic role of free oxygen radicals in gastric stress ulceration and evaluated the therapeutic potency of Tocopherol (Vitamin E) as a radical scavenger in the management of this disease. Forty female Wistar albino rats were randomized into four equal groups (n= 10). Nothing was done to group LTlie other three groups were stressed. Group 2 was not treated, group 3 was given ranitidine alone and group 4 was administered a combination of ranitidine and tocopherol (vitamin E). Twenty four hours later, all the animals were sacrificed and samples were taken for biochemical analysis, pathologic-anatomic examination and chemiluminescence measurements. No significant differences were found among the four groups in terms of the results of biochemical analysis except the glucose levels. Significantly lower ulcer indexes and chemiluminescence values were found in both Group 3 and 4 in regard to Group 2, but the difference between Group 2 and 3 was not significant in terms of the same values. Our study has demonsrated the ulcerogenic effects of free oxygen radicals but more detailed data are required for evaluation of the ameliorating potency of tocopherol as a radical scavenger in gastric stress ulceration.

From May 1995 to November 1995, in our clinic 20 consecutive patients hospitalized with acute abdomen disease and undergone an emergent operation due to peritonitis symptoms and 20 consecutive patients undergone elective cholecystectotmy operations due to cholelithiasis are included in this study. Leucocyte, amylase, plasma and peritoneal lactic acid levels an determined. Peritoneal lactate and peritoneal minus plasma lactate difference are found to be meaningful for all cases when studied with discriminant analysis for their values in assessing acute abdomen disease. We concluded that in order to get 10 percent sensitivity and specificity, periton and plasma lactate difference must be equal to or more than 1,5 mMol/L. Our findings show that when acute abdomen disease cannot be cleared by other means, the difference between periton and plasma lactates is a useful diagnostic index.

In this study, we evaluated the results of surgical treatment of urinary injury due to penetrating abdominal high velocity missile (HVM) and the probability of performing organ preserving surgery. 42 military conscripts who were operated for penetrating abdominal injury with HVM were evaluated for age, trauma and operation interval, trauma score, associated organ injury, mean blood transfusion, morbidity and mortality rates. 3 (7.1 %) patients were lost because of hypovolemic shock Unilateral renal injury was observed in 9 (21.2%) patients while ureteral injuries in 2 (4.7%) and bladder injuries in 1 (2.3 %) patients. Nephrectomy was performed on 6 (66.6%) of 9 renal units while primary repair and reconstruction were performed on 3 (33.3 %) and all (100%) ureteral and bladder trauma patients. It was concluded that although the chance for organ preservation and vascular reconstructive surgery is lower in penetrating renal injuries, but it is higher for ureter, bladder and minor renal injuries due to blast effect of high velocity missile.

Posttraumatic Cerebrospinal Fistulas (PBF) are serious complications of head trauma which may cause to morbidity and mortality. Usually, they present with rhinorrhea or otorrhea, and they occur acutely in the first week after the trauma, rarely months and years later. In this retrospective study, from 2850 patients suffered head trauma, 48 (% 0.16) of them had PBF. The most frequent etiology was traffic accident in 34 (% 70) cases. Fifteen (%31.5) of all cases had temporal bone fracture; 8 of them had also petrous bone fracture, 31 (% 64.5) cases had parietal bone fracture; 12 of them had also ethmoid bone fracture, 2 (% 4.1) cases had fronto-parietal open depression fracture, also with fracture in the anterior fossa and the ethmoid bone. Rhinorrhea was encountered in 35 (% 73) cases, and otorrhea in 13 (% 27) cases. All patients, except four of them, admitted in 48 hours after the trauma (acute). Ten patients were treated surgically who were unresponded to the conservative treatment. Bifrontal craniotomy with extradural and/or intradural anterior fossa eksploration was performed. Primer repair could be achieved only in one case, eight cases were treated with galea greft, one case with fascia lata greft. Additionally, 8 cases needed the use of fibrin glue, and one case siyanoacrilate. The success of surgical treatment was 100%, and no postoperative fistul formation was observed. Two cases had meningitis on admission. During hospital stay, any case in this series developed meningitis. All patients were treated with prophylactic two combinations antibiotic therapy. For the precise evaluation of PBF, the efficacy of the conservative treatment and prophylactic antibiotic therapy, surgical indications of resistant cases, and appropriate surgical treatment was discussed with literature review.

Trauma is the leading cause of increased morbidity and mortality of the recent decades. Head trauma and its complications are the major contributors for this high morbidity and mortality. We retrospectively studied 1680 patients who were hospitalized and treated for head trauma and its complications. Their ages, sexes, causes for trauma, initial clinical status, hospitalization times were analysed. As a result it was seen that most frequent cause for head trauma was traffic accidents followed by falls. In the pediatric age group falls was the primary cause of head trauma. The most prolonged hospitalization time was seen in the adult male group. Gunshot wounds of the head were generally mortal. As a result we think that the head traumas are a kind of public health problem and its not possible to manage it just by medical or surgical precautions, but preventive public health precautions are also necessary.

Fifteen patients with fracture of the penis were treated conservatively or surgically between June 1991-October 1998 at our clinic. Average age of the patients was 29.8 years, with range from 21 to 49 years. Ten of patients were treated surgically, immediately after the diagnosis was established, whereas 5 were treated conservatively. Postoperative complications were 10% in surgical group such as wound infection and 40 % in conservative group such as penil curvature and fibrous plaque. The duration of hospital stay in surgically treated patients ranged from 2 to 5 days (average: 4.1 days), in conservatively treated patients ranged from 5 to 14 days (average: 8.6 days). In conclusion, we think that early surgical treatment is useful, effective, short hospitalisation duration and has low complication ratio in penil fracture management.

Motion restriction and functional loss are frequently encountered after flexor tendon operations. Permanent functional loss can be minimized by application of early rehabilitation program. This study includes 16 male and 5 female patients which were operated for flexor tendon injuries in Trakya University School of Medicine between February 1996 and November 1998. Early mobilization with Kleinert technique was begun on the 4th post operative day. After 3 weeks the Kleinert splint was removed and rehabilitation program was continued until the post operative 8th week. Effectiveness of postoperative early mobilization was investigated retrospectively. Overall results by Strickland's criteria 17 cases were excellent, 2 cases were good, 1 case was fair and case was poor.

The effect of delayed therapy in abdominal stab wound injuries and morbidity and mortality rates were evaluated retrospectively in the patients who were followed diagnostic peritoneal lavage (DPL) and if necessary who were operated on with a minimum delay of 8 hours. There were 66 cases with stab wound injuries in our series. In 37 patients (%55.6) conservative treatment was done after DPL. But the others had hollow organ injuries. 29 patients (% 44.4) were assessed after DPL and performed operation immediately. But 7 of these patients (%24.2), the treatment was performed at least 8 hours delay and 2 of them (%28.8) had ileum ruptures. There were colonic and jejunal ruptures in 2 patients (%28.8), in 2 patients (%28.8) colonic ruptures and duodenum rupture in one patient (% 14.4). All of these injuries were managed with primary sutures. Duodenostomy was added in the duodenal injury. Wound infection was presented in only one patient. There was no complication in the other patients. As a result, it has been observed that conservative therapy can cause delay in diagnosis and treatment of patients with hollow viscus injuries in abdominal stab wound injuries. But there will be no effect on mortality and morbidity rates in these patients if the patients are observed by peritoneal lavage closely.

The aim of this study is to discuss the data consisting of the causes, diagnostic methods and outcomes of the patients that we have hospitalized and treated. Through a 45 months of period the data of 82 cases with vascular injury were assessed retrospectively. Ten cases of these 82 cases had venous injuries only. The rest of the cases had arterial and/or venous injury of vascular system. The most frequent type of damages were cutting/penetrating machines(47,5%). Diagnostic conventional angiography was applied in only (12%).Treatment was autogenous vein interpositioning in 28 (34%) cases, reanastomosis in 21 cases (27%). The mortality and amputation rates were (8,5%). Immediate diagnosis and proper treatment were important in vascular injuries in order to protect the patient life and the related extremity functions. In conclusion, in some centers that haw limited facilities, proper diagnosis and treatment may be available, without a detailed assesment.

Foreign body aspirations are required emergent treatment. It needs to be treated in every regional hospital because of this reason. Although there are some general principals in the management of foreign body aspirations, every case varies to some extent. Broncoscopy was performed in 61 cases with foreign body aspiration in our clinic. Besides the general principals of the management of foreign body aspiration, some special problems were also discussed.

In this study 29 patients were retrospectively evaluated who were operated for abdominal vascular injuries in our clink between 1986 and 1998 in order to detect the factors affecting morbidity and mortality in patients undergoing surgery due to the abdominal vascular injury. Out of 29 patients 21 were male and 8 female and the average age was 32 years. The cause of the injury was blunt in 6 patients and penetrating in 23 patients. The average time from field notification to patients arrival in the emergency department was 65 minutes, from emergency department to arrival to operating room was 34 minutes. Mean trauma severity score was 19.7. The mean blood requirements in these patients was 5500 ml in the preoperative period. The inferior vena cava, abdominal aorta and iliac veins were injured most frequently. While more than one abdominal vascular injury was determined in 8 patients, 34 associated intraabdominal organ injuries including mostly small intestine and colon were found in 21 patients. Treatment including simple suture (n =31), ligation (n =5), and dacron grafts (n=3). The mortality rate was higher in abdominal aorta and vena cava injuries compared to other vascular injuries. The overall mortality rate was 41%. In conclusion, despite the increasing experience in vascular repair methods and surgical explorations carried out without delay major abdominal vascular injuries threatening the life still result in high operative mortality.

20% of all spine injuries are cervical spine injuries. Surgical treatment of these injuries must take into account the great mobility of this part of the spinal column. Therefore, biomechanical aspects must be considered, especially in the upper cervical spine, C1 and C2 (1). In this paper, a case of a fresh type II fracture, according to Anderson & D'Alonzo classification, of the odontoid process treated firstly with posterior approach and secondly with direct screw fixation is reported. A 52-year-old man complained of severe neck pain and limitations of neck motions following a hit on his forehead incurred in a falling accident in moving vehicle. Neurological examination was normal. Cervical spine x-ray films and axial and tree D-CT and MR scans revealed a fracture at the base of the dens. Five days after the injury, the patient operated with posterior approach, wiring of atlanto-axial bone and grafting with autologue iliac wing bone was performed. 5 month after operative procedures, no fusion was seen and with a second operation, this odontoid fracture was directly fixed with a K screw by an anterior cervical approach. Immediately after the operation, his neck pain disappeared. He returned to his previous job 1 months after second surgery without any limitation of his neck movement. For proper assembly of this method, the following two points are particularly recommended: a screw insertion perpendicular to the fracture plane and the use of an optimal screw with both the desired total and thread lengths.

Several methods are present for treatment of frontal sinus fractures and those are still controversial. In this article, eight cases with frontal sinus fracture and our treatment modalities were presented. Our treatment methods were compared with the methods which were recommended in the literature are discussed.

Peutz - Jeghers Syndrome is a rare, inherited autozomal dominant disease characterized by gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. In this paper we report two cases of Peutz -Jeghers syndrome who were admitted and operated with intussusception. Screening their family members revealed intestinal and extraintestinal manifestations of the disease and no malignancy was detected.

The effective management of acute bleeding in the lower part of the gastrointestinal (GI) tract requires a flexible approach of sequential investigations to prevent diagnostic and therapeutic errors. The specific sequence of diagnostic studies is determined primarily by the clinical status of the patient and by the rate and pattern of the bleeding. Isolated right-sided diverticular disease (IRSDD) as a source of massive lower GI bleeding is relatively infrequent. In comparison with left-sided (LS), IRSDD tended to present more often with profuse bleeding than with diverticulitis and fistulation. Surgery for bleeding was also required more often for RS than for LS disease. The need for urgent and accurate diagnosis is essential f or proper management. The aim of this case report is to characterize the clinical entity of IRSDD presenting with recurrent self-limited bleeding and to discuss the evaluative steps and surgical treatment.