|MANAGEMENT OF BRAIN EDEMA IN ACUTE HEAD INJURY
Dursun Aygün, Hakan Güven, Zahide Doğanay, Levent Altıntop, Fikret Bildik, Murat Yerliyurt, Havva Şahin
PMID: 12038024 Pages 65 - 73
BACKGROUND: We aim was to review the basic concepts and to analyze the current management of cerebral edema following acute head trauma (AHT).
METHOD: Cerebral edema should be recognized and treated early and aggressively to avoid disastrous results such as cerebral herniation. After clinical evaluation and early cardiorespiratory stabilization, the patients should be treated with the elevation of head, oxygen, mannitol, hyperventilation, and sedation-myorelaxation and may avoid from hypotension-hypoxia. If these treatments be unsuccessful, barbiturates may be used. There are also other possibilities such as hypothermia, ventriculostomy, hypertonic saline and neuroprotector agents.
CONCLUSIONS: All patients with AHT should be evaluated early and cerebral edema should be treated with correct therapy. Therefore, the mortality and morbidity rates may reduce.
|TISSUE AND SERUM SIALIC ACID LEVELS IN AN ANIMAL HEAD INJURY MODEL
Ezel Uslu, Feyza Karagöz Güzey, Deniz Güzey, Mine Kucur, Ahmet Belce
PMID: 12038025 Pages 74 - 77
BACKGROUND: Significant elevations of serum sialic acid level have been documented in various diseases including in a variety of central nervous system disorders. But, in head injury, there is no any study on the serum and brain tissue sialic acid levels. So, we planned an experimental study to evaluate serum and brain tissue sialic acid levels in head injury.
METHODS: Marmarou's impact-acceleration model was used in rats to produce diffuse brain injury. Rats were divided into equal three groups. In Group I, 450 g weight was fell from 1 m height to heads of subjects, and from 2 m in Group II. Group III was control group. Sialic acid levels were measured in both sera and brain tissue supernatants after trauma.
RESULTS: It was observed that serum sialic acid level was decreased according to the severity and period of trauma increased; and there was no change in brain tissue sialic acid levels.
CONCLUSION: Serum sialic acid level might be used as a marker to show the degree of diffuse brain injury.
|SKIN DEFECT COVERAGE WITH MICRO SKIN GRAFT
Nazım Gümüş, Yalçın Kaya, Sadık Karakaya, Cemalettin Camcı
PMID: 12038026 Pages 78 - 81
BACKGROUND: The aim of this study is to coverage of the large skin defect with microskin graft.
METHODS: The wound coverage of the large skin defect may be difficult with auto skin graft. In these patients, split thickness skin graft may be used in a bloc shape or expanded skin graft shape and a stamp skin graft shape or expanded stamp skin graft shape. On the other hand, split thickness skin graft may be used as a micrograft shape after the mincing process, which reduces of the graft size in a few milimimetre. In this study; 6 patients with skin defect was admitted in our clinic, and their skin defect was treated with micro skin graft. Expansion ratio was 1: 15.
RESULTS: Epitelization on the wound surface was complated in 4 to 6 weeks and cobblestone appearence was observed after the wound coverage.
CONCLUSION: Skin defect coverage with micrograft is an effective technique like the other skin graft coverage methods.
|THE ROLE OF cTnI, IN THE DEDTECTION OF ETIOLOGICAL FACTORS OF CARDIAC CONTUSION
Abdullah Sadık Sadık Girişgin, Başer Cander, Yavuz Turgut Gederet, Yunus Ağralı
PMID: 12038027 Pages 82 - 85
BACKGROUND: Cardiac contusion, asociated with on blunt chest trauma, was investigated according to changes of CPK, CKMB, ECG and especially cTnl levels.
METHODS: In this study, 88 cases with blunt traumas were evaluated prospectively. 61 cases with thoracic trauma and 27 cases without thoracic trauma as the control group were studied.
RESULTS: In 12 of61 cases with thoracic trauma cTnl was elevated. cTnl showed no increase in cases without thoracic trauma. CKMB level was high in both thoracic trauma and control groups. 11 of12 cases with elevated cTnl were traffic accidents. cTnl did not increase in 6 cases with sternum fractures.
CONCLUSIONS: We consider that decceleration wounds are the main cause of cardiac contusions. Altough thoracic trauma is essential in the pathogenesis of cardiac cortision, rib fracture is not a rule. Cardiac contusion is not related directly with degrees of body and thoracic trauma. However it is more related with the degree of cardiac trauma.
|THE TREATMENT OUTCOMES OF CHILDREN WITHGRADE II AND III OPEN FRACTURES OF THE LONG BONE
Hüseyin Arslan, Serdar Necmioğlu, Cumhur Kesemenli, Mehmet Subaşı, Hüseyin Ersuz
PMID: 12038028 Pages 86 - 89
BACKGROUND: We evaluated the treatment results in thirty-two children who had grade 2 and 3 open fractures according to
METHODS: There were 21 (%65) male and 11 female (OJ035) patient and the mean age was 9 years (range, 4-14 years). There were 18 (%56) grade-2, 7 (%22) grade-3A, 5 (% 15) grade-3B, and 2 (%6) grade-3C open fracture. All fractures were irrigated and debrided, and thenfixed with externalfixators. The average duration of follow-up was 11 months (range, 6-28 month).
RESULTS: All fractures healed. Inadequate recovering was detected in four patients who had nerve injury, in addition the joint limiting contracture occured on six patients.
CONCLUSION: Fracture union without segmental bone loss is not a significant problem in open fractures in children, and that joint contractu res, compartment sydrome and nerve injuries negatively affect the late outcomes.
|PANCREATICODUODENECTOMY IN THE MANAGEMENT OF PA.NCREATIC AND DUODENAL INJURIES
Gökhan İçöz, Pars Tunçyürek, Murat Kılıç, Özer İlkgül, Mustafa Tercan, Mustafa Yılmaz
PMID: 12038029 Pages 90 - 93
BACKGROUND: Patients who have undergone pancreaticoduodenectomy because of duodenopancreatic injury are retrospectively evaluated.
METHODS: Eight patients have undergone pancreaticoduodenectomy because of trauma in Ege University School of Medicine Department of Surgery. Six of the injuries were penetrating, and two of them were blunt. Six patients were male and two of them were female with a mean age of 29,2 (between 17 and 63).
RESULTS: All patients had complicated duodenopancreatic, and associated grade I and grade 11 liver injuries. Major vessels were injured in three patients. There were also two colonic, one gastric, and one jejunal injury as a coexisting pathology. Two patients were died because of sepsis. One patient had pancreatic, and one had biliary fistula, both healed spontaneously.
CONCLUSION: Pancreaticoduodenectomy should be practiced as a life-saving procedure in the management of severe duodenopancreatic trauma. Qualified centers with adequate experience have a higher success rate.
|DIAPHRAGMATIC RUPTURE: ANALYSIS OF 48 CASES
Hasan Fehmi Küçük, Recep Demirhan, Necmi Kurt, Yaman Özyurt, İshak Topaloğlu, Mustafa Gülmen
PMID: 12038030 Pages 94 - 97
BACKGROUND: Our aim is to investigate treatment modalities and the results of traumatic diaphragmatic rupture in our trauma patients.
METHODS: In this retrospective study, 48 patients admitted to our hospital between 1997-2000 with diaphragmatic injury were evaluated according to the type of injury; diagnostic methods, associated organ injury; treatment modality; morbidity and mortality. Injury severity score (ISS) was used in patients with associated organ injury to assess the effect on mortality.
RESULTS: There was penetrating injury in 69 % and blunt injury in 31% of patients. Physical examination and X-ray films were enough in the diagnosis of 66.6 % of patients. There was associated organ injury in 83.3% and isolated diaphragm injury in 16.6 % of patients. The morbidity and mortality ratio were 8.3 % and 10.4 % respectively. There was no difference between mortality ratio of penetrating and blunt trauma statistically (p > 0.05). On the other hand, in regard with morbidity and mortality; the injury severity score was higher in patients with associated organ injury (p < 0.000 1).
CONCLUSION: Traumatic diaphragmatic rupture is usually seen with associated organ injury and mortality and morbidity are higher in this case.
|ACUTE APPENDICITIS IN PREGNANCY
Koray Atila, Deniz A. Uçar, Tarkan Ünek, Ali Sevinç, A. Alper Çevik, Selman Sökmen
PMID: 12038031 Pages 98 - 101
BACKGROUND: Review of our cases of appendicitis with pregnancy.
METHODS: Betweenjune 1990 and may 2001, eighteen cases were investigated, retrospectively.
RESULTS: Six patients were infirst trimestet; 10 in second trimester and 2 in third trimester: Mean age was 25. Sixteen cases (88.9%) were acute appendicitis and 2 cases (11.1%) were perforated appendicitis. The time interval between the onset of complaints and operation was 1.6 days. There were no fetal or maternal mortality. One of perforated appendicitis developed wound infection and two developed athelectasia.
CONCLUSION: Early laparotomy in appendicitis with pregnancy will reduce the fetal and maternal morbiditiy and mortality.
|OUR CURRENT APPROACH IN THE TREATMENT OF SIGMOID COLON VOLVULUS
Korhan Taviloğlu, Erol Aydın, Cemalettin Ertekin, Recep Güloğlu, Mehmet Kurtoğlu
PMID: 12038017 Pages 102 - 107
BACKGROUND: Our aim was to emphasize the role of endoscopic detorsion in the treatment of sigmoid colon volvulus, which we currently apply in the majority of our cases.
METHODS: The data of37 patieots were analyzed in a retrospective mannel; during a 86-: month period, betwen May 1994 andJuly 2001. The patients were classified into three groups. The first group consisted of9 patients with resection and anastomosis, the second group consisted of20 patients with Hartmann's procedure, and the third group consisted of8 patients with endoscopic detorsion.
RESULTS: Complications were encountered in 7 patients (19 %), and 3 patients (8 %) diedfollowing treatment.
CONCLUSION: We favor colonic resection following endoscopic treatment Resection should be preferred, if endoscopic detorsion is not succesful or in the presence of a complication.
|EARTHQUAKE AND TRIAGE
Ömer Keskin, Murat Kalemoğlu
PMID: 12038018 Pages 108 - 111
BACKGROUND: In this article we aimed to report the difficulties at the Emergency Services (ES) after the Marmara earthquake end to identify the preventive measures especially the triage procedure.
METHODS: In this trial, after August 17. "Marmara Earthquake" the clinic results of the patients brought to the hospital and documentedfrom the ES and the hopital records.
RESULTS: At the ES the mortalityrate was highest (%4.5) in 48 hours. During this period, the major difficulty was to determine the priority of the patients needing emergency treatment.
CONCLUSIONS: To minimize the mortality and morbidity after the disastet; first aid and triage should be done at the disaster area and the patient collection sites.
|THE CORRELATION BETWEEN THE TRISS TRAUMA SCORE ANDPLASMA LEVELS OF NO AND TBARS IN MULTIPLY TRAUMATIZEDPATIENTS FOLLOWING TRAFFIC ACCIDENT
Zeynep Kekeç, Erdoğan M Sözüer, Cuma Yıldırım, İbrahim İkizceli, Sebahattin Muhtaroğlu
PMID: 12038019 Pages 112 - 117
BACKGROUND: There are controversies on determination of trauma severity and on predicting effects of trauma severity on organism in patients with multiple trauma. It is of great importance to rule out these controversies in Turkey where incidence of multiple trauma due to traffic accidents is considerably high. The aim of our study was to investigate whether a correlation exists between trauma severity and plasma levels of nitric oxide and thiobarbituric acid reactive substance in patients with multiple trauma.
METHODS: The patients with multiple trauma were divided into two groups as the study group (TRISS score 30 or above) and the control group (TRISS score below 30) and the relationship between plasma NO and TBARS levels was evaluated. In our study; we used the TRISS trauma score (Revised Trauma Score, Injury Severity Score and Age Combination Index) to evaluate trauma severity.
RESULTS: There was no effect of trauma severity on plasma NO levels (p>0.05). There was a positive correlation between TRISS scores and plasma TBARS levels (p < 0.05).
CONCLUSIONS: It can be suggested that measurement of plasma NO levels is not useful to indicate trauma severity because change in TRISS is not associated with a correlated change in plasma NO levels. On the other hand, there is a significant correlation between plasma TBARS levels and increase in trauma severity.
|CLOSED DEGLOVING INJURY CMPLİCATED WITH PARAPLEGIA
Kaya Yorgancı, Mesut Atlı, Aycan Kayıkçı, Volkan Kaynaroğlu
PMID: 12038020 Pages 118 - 119
Degloving injuries are frequently seen in emergency departments. However, closed degloving injuries are quite rare and easily missed. A case of closed degloving injury complicated with traumatic paraplegia in a 47-year old man is presented. A different type of mechanism of injury, presence of associated injuries, and initial surgery to the spinal fracture with conservative surgery to the degloved skin made his management quite complicated. Surgeons who deal with trauma patients should keep in their mind the closed degloving injury, and its possible difficult management.
|ENDOVASCULAR APPROACH IN THE TREATMENT OF TRAUMATICPERIPHERAL ARTERIAL LESIONS: THE REPORT OF TWO CASES
Serdar Ener, Cüneyt Erdoğan, Abdulkadir Ercan, Arzu Gündoğdu, Yurtkuran Sadıkoğlu
PMID: 12038021 Pages 120 - 122
Arterial injuries associated with pseudoaneurysms or arteriovenousfistulas are usually due to penetrating trauma. Endovascular treatment modalities are emerging as an alternative and less invasive method compared to the conventional surgical repair methods. Herein we report our recent experience on with two cases of traumatic arterial injury who were successfully managed by using stent-grafts with endovascular approach. Endovascular treatment options should be remembered as an alternative to the surgical repair for management of penetrating arterial injuries.
|MIGRATION OF TWO STEINMANN PINS FROM THE HIP TO THORAX AND THE PELVIC ABDOMEN
Levent Çanakkalelioğlu, Hedef Özgün, Abdulkadir Akbaş
PMID: 12038022 Pages 123 - 125
Pins and wires are frequantly reported for their migration. Close follow-up and prompt recognition may reduce mortality and morbidity. We report a case of intrathoracic and pelvic migration of two Steinmann pins used for managing an infective complication of hip prosthesis following the treatment of femoral neck fracture.
|RAPID SPONTANEOUS RESOLUTION OF AN ACUTE EPIDURAL HEMATOMA
Erhan Çelikoğlu, Hikmet Süslü, Mevlüde Delatioğlu, Ayçiçek Çeçen, Tayfun Hakan, Mustafa Bozbuğa
PMID: 12038023 Pages 126 - 128
The rapid spontaneous resolution of an acute epidural hematoma within a one hour is reported in a 8 year-old boy. The literature is reviewed and the potential communication between intracranial and epicranial spaces through a fracture is emphasized in very rapid spontaneous resolution of epidural hematomas.