1. | THE STRATEGIES TO MAKE A SUITABLE ON-CALL SYSTEM IN THE EMERGENCY DEPARTMENT Arif Alper Çevik, C James Hollıman, Cüneyt Ayrık PMID: 11705165 Pages 1 - 7 Abstract | |
2. | Trauma and resuscitation course (TRC): evaluation of the first 2 years Korhan Taviloğlu, Cemalettin Ertekin, Recep Güloğlu, Rıfat Tokyay, Yılmaz Akgün PMID: 11705181 Pages 8 - 12 Eight Trauma and resuscitation Courses (TRC): two instructor and 6 student courses have been organized in Turkey between December 1998 and November 2000. Questionnaire results of 121 students and 63 instructors were reviewed. We strongly believe that these results will be supportive for the courses in the future. Fifty-five of the instructors were from university, and 8 were from teaching hospitals. 121 doctors attended six student courses, the average age of whom was 34. Average time period following university graduation was 10 years (3 months 43 years) for the participants. Among these, 94 % found the course content sufficient. The course book was determined as insufficient in terms of drawings and pictures by 15%. The main target population of the course was selected as emergency service doctors and practitioners. As a result we determined that the main criticisms were insufficient practical and video sessions and the lack of drawings in the course book our main goal is to accomplish the required changes, and make new courses more yielding and profitable, thus introduce standardization in terms of trauma care nationwide. |
3. | DO EMERGENCY DEPARTMENTS COMPLY WITH THE RULES OF PATIENT TRANSPORTATION? Erol Armağan, Şule Akköse, Hüseyin Çebişci, Zülfi Engindeniz, Rifat Tokyay PMID: 11705166 Pages 13 - 16 Emergency departments must comply with the rules of patient transportation. The aim of this study was to find out the compliance of the emergency departments in our region with patient transport the rules and regulations. 180 patients transported to our emergency department by an ambulance from another hospital, between 01.05.1999-01.07.1999 were analyzed. ACEP's (American College of Emergency Physicians) patient transportation rules were taken as a reference for comparison. Our findings have shown that the compliance to these rules is insufficient. Results of the study, will be presented to our colleagues working in the emergency departments in our region, in one of our monthly trauma meetings. State Department of health in the city, two state hospitals and Social Security hospitals in the region will also be informed about the results so that certain guidelines for better patient transportation can be established in the region. |
4. | TRAUMATIC SPLENIC INJURIES Erdoğan M Sözüer, Engin Ok, Oktay Banlı, Özhan İnce, Zeynep Kekeç PMID: 11705167 Pages 17 - 21 Splenectomy is the frequently used surgical method for the treatment of traumatic splenic injuries. In this study, the patients who had traumatic splenic injuries were investigated and the results of surgical treatments were evaluated. There were 225 patients with traumatic splenic injuries, which contains 55 (24%) female and 170 (76%) male. The mean age was 29 (range 16-71) years. Severity of splenic injury was classified according to Moore organ injury scaling and there were 23 (10%) patients in grade 1,96 (43%) in grade II, 75 (33%) in grade HI, 24 (11%) in grade IV and 7 (3%) in grade V. Splenectomy was performed in 203 (90%) patients, splenoraphy in 18 (8%) and partial Splenectomy in 4 (2%) patients. The overall mortality was 12%. A positive correlation was estimated between the combined trauma and the mortality (Fisher's Chi-Square test; X2-9,538, p<0.002). In conclusion, non-operative treatment methods may prevent unnecessary splenectomies, especially in grade I and II blunt or penetrating splenic injuries. Combined injuries are the major factor increasing the mortality. |
5. | ESOPHAGEAL INJURIES Cemalettin Ertekin, Hakan T Yanar, Recep Güloğlu, Korhan Taviloğlu, Şükrü Dilege PMID: 11705168 Pages 22 - 27 Despite progress in the management of esophageal perforations by early diagnosis, antibiotics, monitoring, and respiratory and nutritional support, it still remains as a disasterous condition. The most common cause of esophageal perforation is iatrogenic disruption. The result in the management of esophageal perforation is influenced by several factors: localization and size of the rupture, length of delay in diagnosis, age, extent of mediastinal and pleural contamination, the presence of underlying esophageal diseases, and inflamation or tumor at the perforation localization. In this study, 7 cases of esophageal perforations in the last six years have been analysed retrospectively. In study group, there were 5 males and 2 females, and the mean age was 36 (12-75). The most common cause of perforation was gunshot injury (3 cases), and stab wound (1 case), foreign body (1 case), iatrogenic distruption (2 cases). Three patients died and four patients were discharged from hospital with recovery. Esophageal perforation is a life-threatening condition. Early diagnosis and repair reduces the morbidity and mortality. |
6. | THE ANALYSIS OF THE RESULTS OF ACTIVITIES FOR 6 MONTHS RELATING TO AN EMERGENCY MEDICINE CLINIC Başar Gander, Ali Çalıkuşu, Sadık Girişgin, Ayşegül Bayır PMID: 11705169 Pages 28 - 31 In our country emergency medicine expertise programmes have 6-year post yet. The second university emergency medicine department, S.U.T. F. Emergency Medicine Department and clinic, which was founded in 1995, has a long way in 5 years. 934 patient who has followed in observation and intensive care units had stayed in emergency medicine clinic for 45.53 hours on an average, after this time % 53 had dischanged from hospital, % 42.25 had send to other connecte clinics, % 4 died in S. U.T.F emergency medicine clinic in 6 months. The results of this article can be summarize as the emergency medicine clinic is successful as other clinics, reduced waiting on transport problems and prevented the complications because of unwilling behaviours to emergency patients. Becoming wides preaol of emergency medicine expertise programmes and emergency medicine clinics can be solution for reducing the delay in help, identification and treatment of patients. |
7. | Gallstone ileus: demographic and clinical criteria supporting preoperative diagnosis Günay Gürleyik, Emin Gürleyik PMID: 11705170 Pages 32 - 34 Gallstone ileus is an uncommon intestinal obstruction with unexpectedly high mortality. It is not easy to diagnose this uncommon disease preoperatively. The aim of our study is to establish some simple criteria supporting the suspicion of gallstone ileus patients with small intestine obstruction. We retrospectively analysed hospital records of 8 patients with gallstone ileus and 1230 cases of mechanical intestinal obstruction, excluding incarcerated external hernias. Gallstones were the cause of occlusion in 0.9% (8/886) of patients with small bowel obstruction. All our 8 patients were women with an average age of 74 years. Gallstone ileus was diagnosed 18% of elderly (+70 years) women with small intestine obstruction. This rate raised to 36% in this group of elderly women if previous abdominal operations that would produce adhesion were excluded. Previous ultrasonographic examinations had demonstrated gallstones in 5 (62%) patients. Only one patient (12.5%) was diagnosed preoperatively with plain X ray film demonstrating gas in the biliary tract. The obstruction was treated with enterolithotomy. Cholecystectomy was performed in two (25%) patients. The mortality was 25% in early postoperative period. Advanced age, female sex, and positive patient's history of known gallstone in the gallbladder have appeared as strong criteria. Gallstone ileus is a common cause of intestinal obstruction in elderly women with no previon abdominal operations and without incarcerated external hernia. Pneumobilia is more common radiological finding to establish the diagnosis of gallstone ileus in these patients. |
8. | OUR EXPERIENCE WITH THE ROLE OF INFERIOR VENA CAVA FILTER IN THE PREVENTION OF PULMONARY EMBOLISM RISK Mehmet Kurtoğlu, Erol Aydın, Ahmet Necefli, Recep Güloğlu, Arzu Poyanlı PMID: 11705171 Pages 35 - 39 The most serious and fatal complication of deep venous thrombosis (DVT) is still accepted as pulmonary embolism (PE). One of the methods used for PE prophylaxis is inferior vena cavafilter (VCF). Between 1999 and 2000, VCF is used in 12 patients (8 male, 4 female) who were hospitalized in Trauma and Surgical Emergency Service of Istanbul Medical Faculty. 10 of the VCF used were permanent and 2 of them were temporary filters. 8 permanent filter were applied to patients with life-long paraplegia or quadriplegia due to spinal cord injury. Two patients to whom permanent filters were applied had malignancy. Patient who had the diagnosis of late stage cervical carcinoma, had DVT. In this patient, because of the high bleading risk, we applied permanent filter. In the other patient, who had the diagnosis bladder carcinoma, had DVT despite the usage of low moleculer weight heparin. In two patients who needed short term PE prophylaxis, had temporary VCF. In one of these patients, primary diagnosis was subarachnoidal hemorrhage due to head trauma. In the 8. day of hospitalization, DVT occured. Because of high risk of intracranial bleedy, VCF was performed. The second patient had the diagnosis of subdural hematom and subarachnoidal hemorrhage due to head trauma and multiple lower extremity fractures. VCF were applied in Istanbul Medical Faculty, Department of Radiology. For canmdation line of permanent VCF (LGM Venatech - B.Braun) right femoral vein was used. For temporary filters (Proliser Cordis -Johnson and Johnson Company), right internal juguler vein was the preferred way. Two multitravma patients who had permanent filters died due to sepsis and multiorgan failure. In the follow up of other patients during the average period of 7,6 months, any problem due VCF application or by related complication and PE did not occur. Although larger patient groups with follow up period are necessary to evaluate better, we think that in PE prophylaxis, VCF is safe and effective modality. |
9. | TRAUMATIC INTRAABDOMINAL MAJOR VASCULAR INJURIES Ali Doğan Bozdağ, Yasin Peker, Yusuf Kumkumoğu, Hayrullah Derici, Okay Nazlı, Çağatay Gürkök PMID: 11705172 Pages 40 - 43 The records of 47 patients who underwent surgery with traumatic intraabdominal vascular injury at 2. and 3. Surgical Clinics of İzmir Atatürk Training and Research Hospital between January 1990 and December 1999 were studied. The aim of this study was to investigate the prognostic factors effecting the mortality. Hemoglobin (p<0.05), hematocrit (p<0.05), Glasgow Coma Score (p=0.01), blood pressure (p < 0.05), Revised Trauma Score (p=0.01), prehospital time (p=0.01) and associated organ injury (p< 0.05) were the significant factors effecting the mortality. Our overall mortality was 46.8 % and morbidity 41 %. |
10. | THROMBOEMBOLIC PROPHYLAXIS AFTER MAJOR ABDOMINAL SURGERY Fehmi Çelebi, Ahmet A Balık, M İlhan Yıldırgan, Mahmut Başoğlu, Hatip Adıgüzel, Durkaya Ören PMID: 11705173 Pages 44 - 48 Purpose: To investigate the efficacy of prophylaxis modalities after major abdominal surgery. Patients and methods: Patients who underwent major abdominal surgery between October 1998 and October 1999 were randomly divided into 3 grups. The patients in Group 1 received compression stockings, in Group 2 0.3 ml low-molecular weight heparin (nadroparine calcium 0,3 ml, 2850 IU AXa LMWH) subcutaneously and in Group 3 compression stockings and 0.3 ml LMWH. All symptomless patients evaluated with low extremity deep venous doppler ultrasonography (DUSG), and patients who had pulmonary embolus (PE) suspicion evaluated with pulmonary scintigraphy. Results: There were 91 patients in Group 1, 91 patents in Group 2 and 92 patients in Group 3. The mean age was 57.25±13.12, 54.53±13.54, and 53.65±13.28 respectively. Male /female ratio was 51/38, 56/35 and 62/30, in Grup 1, 2 and 3 respectively. Twenty-seven patients in Group 1, 26 patients in Group 2 and 37 patients in Group 3 had risk factors. DUSG showed deep venom trombosis (DVT) on the 7 th postoperative day in 10 patients in Group 1, in 8 patients in Group 2 and in 3 patients in Group 1 Pulmonary scintigraphy showed PE suspicion in 6 patients in Group 1, 1 patient in Group 2 and 1 patients in Group 3. Wound hematoma and hemorrhage from abdominal drains were developed in 1/0, 8/2 and 3/1 patients in Groups 1,2 and 3 respectevly. Four patients in Group 1 and 2 patients in Group 2 died during the treatment (2.2%). Statistical analysis showed significant differences in PE and wound hematoma between Grups 1 and 2, in DVT and PE between Groups 1 and 3, in risk factors between Groups 2 and 3 (p<0.05). The differences in DVT and PE and hematoma between group 2 and 3 were not significant. Conduction: All treatment modalities could not prevent all tromboembolic complications. In our study combinated treatment was the most effective one. |
11. | EVALUATION OF THE EARTHQUAKE VICTIMS: AUGUST THE 17TH, 1999 OUR EXPERIENCE IN THE MARMARA EARTHQUAKE Necmi Kurt, Hasan Fehmi Küçük, Gürhan Çelik, Recep Demirhan, Özden Gül, Gülüm Altaca PMID: 11705174 Pages 49 - 51 This study describes the experience of Kartal Research and Training Hospital in the Marmara Earthquake. We reviewed medical records of 698 patients admitted to our hospital in a 30 days' period after the earthquake and analysed the types of injuries, treatment, morbidity and mortality rates. The hospitalized 273 patients were grouped according to the major injury; patients with crash syndrome were analysed separately. The most frequent injuries were crush injury (23.1 %), extremity fractures (16.8 %) and pelvis and spine injuries (16.1%). More than two system injuries were seen most frequently in the abdominal injury (45.5%), crush injury (24.4%), and pelvis and spine injury (27.3%) groups (p < 0.05). Overall mortality rate was 7.3 %. The highest mortality rates were seen in the abdominal injury (27.3%) and crush injury (20%) groups (p<0.05). 61.9% of the patients with crush syndrome underwent fasciotomy due to the compartment syndrome; hemodialysis was performed in 31 patients. The most serious problem with earthquake is organization in the earthquake area, between hospitals and in hospitals. Crush injury is the major injury seen earthquakes. Early diagnosis and proper treatment should be done to improve survival, |
12. | THE RESULTS IN ACUTE GRADE III ACROMIOCLAVICULAR DISLOCATIONS TREATED WITH NEVIASER'S METHOD Davut Keskin, Naci Ezirmik, Recep Çelik PMID: 11705175 Pages 52 - 55 There are the different opinions on the methods used in the treatment of acute grade III acromioclavicular dislocations and their results. In this study, the results of 10 patients treated with Neviaser's method and followed in The Department Orthopaedics and Traumatology of Atatürk University Medical School were evaluated. All patients were males and the average age was 36.5 (25 to 45) years. The causes of dislocations were falls on the shoulder in 5 cases (50%), traffic accidents in 4 cases (40%) and direct trauma to the shoulder in 1 case (10%). The mean interval between injury and operation time was 10.2 (5 to 20) days. The cases were followed up with an average period of 13.1 months (6 months 2 years). The excellent and good results were obtained in 9 cases (90%) and the complication was observed in not one of the patients. We consider that Neviaser's method is a good alternative in the treatment of acute grade III acromioclavicular dislocations that operation is indicated. |
13. | RESULTS OF SURGICAL TREATMENT IN PATELLAR FRACTURES Hakan Özdemir, Merter Özenci, Kürşat Dabak, Ahmet Turan Aydın PMID: 11705176 Pages 56 - 59 Twenty patients were treated surgically between March 1996 and March 2000. The mean age was 39.5 (18-68) and whom 13 were male and 7 were female. Surgical treatment methods as follows; modified tension band wiring in 10 of the patients with transverse fractures, mini cancellous screw and lag-screw fixation in 7 with vertical fractures and in 2 with distal pol fractures, combination of K wire and circumferential cerclage wire fixation in 5 with comminuted fractures. The average follow-up time was 24 months (6-54 months) and findings were evaluated radiologically and according to scale of Levack. Results were rated as good in 55%, moderate in 35% and poor in 10% of the patients. It was found that modified tension band wiring technique gave the best results. We concluded that majority of the trauma, type of the fracture, surgical technique and post operative rehabilitation were affected the results of patellar fractures treated surgically. In addition to this, patellectomy may be performed in severely comminuted fractures where no major fragments containing of articular surface of the patella exist. |
14. | TRAUMATIC KNEE: MRI FINDINGS Gürkan Ege, Haluk Akman, Kısmet Kuzucu, Ekrem Ertem, Şafak Şahlan PMID: 11705177 Pages 60 - 65 Purpose: The knee is the most frequently injured joint that physical examination and plain radiographies are limited to diagnose precisely the knee injuries. Magnetic resonance imaging (MRI) has been contributed great benefits to the accurate diagnosis by determining the injuries of menisci and ligaments in addition to bone structures. We evaluated MRI findings in traumatic knees and compare them to literature. Materials and methods: The patients with the knee injury who were admitted to orthopedic surgery service were reviewed. Of them, 49 patients (50 knees) correlated operatively, arthroscopicly and clinically were included in our study population. If the diagnosis was not sufficient by using plain films and clinical evaluation, the patients underwent MRI examination. Results: Bone contusions were the most common finding in the injuries (n: 33). The other findings were respectively, the anterior cruciate ligament injuries in 17 patients, meniscal tears in 12 patients, osteochondral fractures in 9 patients, collateral ligament injuries in 7 patients and bone fractures in 5 patients. Conclusion: MR imaging plays a major role in decisions 0,7 evaluation and management of traumatic knees, improves clinician diagnostic certainty and reduces the need for arthroscopy. |
15. | PIPKIN TYPE IV FRACTURE DISLOCATION OF THE HIP ASSOCIATED WITH A TRAUMATIC AORTIC VALVE RUPTURE Abdullah Göğüş, Sercan Akpınar, Mehmet Ünal, Bingür Sönmez, Azmi Hamzaoğlu PMID: 11705178 Pages 66 - 69 Traumatic aortic valve rupture with resultant aortic insufficiency is a rare complication of blunt trauma. Here reported is a case with a posterior fracture-dislocation of the hip (Pipkin type-IV) and an undisplaced sternum fracture who developed hemodynamic instability in the clinical follow-up and was diagnosed having a traumatic aortic valve rupture using echocardiography. He first was treated with a biological valve replacement. Two weeks later a total hip arthroplasty combined with the osteosynthesis of the posterior wall of the asetabulum was performed. Sternum fracture healed conservatively. In multiply injured patients especially with a blunt thorax trauma hemodyanamic instability despite appropriate fluid replacement should rise the suspicion of cardiac injuries, especially traumatic aortic valve rupture. Echocardiography is a simple but reliable method for the diagnosis. |
16. | Use of a modified occlusal bite guard to treat self-induced traumatic macroglossia (two case reports) Serhat Yalçın, Buket Aybar, Cemalettin Ertekin, Recep Güloğlu PMID: 11705179 Pages 70 - 73 Objective: To describe the use of a bite guard to avoid continued tongue trauma and edema Design: Two case reports. Interventions: bite raiser. Conclusion: Muscle relaxation and a bite guard were used in a 16 years old male and 22 years old female with traumatic macroglossia, which allowed for rapid resolution of edema and prevented additional trauma to the tongue. |
17. | A CASE OF SMALL BOWEL PERFORATION DUE TO PRIMARY INTESTINAL LYMPHOMA İbrahim Aydın, Ahmet Başkent, Gürhan Çelik, Acar Aren, M Zeki Eren, Erdal Ayar, Mete Demir PMID: 11705180 Pages 74 - 76 A 17 years old male with symptoms of acute abdomen was operated. The preoperative diagnosis was peptic ulcus perforation but at the operation there were multipl perforations throughout the small bowels, multiple lymphadenopaties in the mesentery of the jejenum. 60 cm small bowel resection- end to end anastomosis, raphe omentoplasty, primary repair with suture were performed. The patient got well after the operation and discharged postoperative 14th day. The pathological diagnosis was diffuse grand cell lymphoma. We conclude that, this rare condition which we could be able to find only one case in the literature must be thought among the reasons of acute abdomen. |