p-ISSN: 1306-696x | e-ISSN: 1307-7945
Volume : 9 Issue : 2 Year : 2023

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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 9 (2)
Volume: 9  Issue: 2 - April 2003
1.EMERGENCY PHYSICIANS AND "BURN OUT" SYNDROME
Arif Alper Çevik, C. James Holliman, Sedat Yanturalı
PMID: 12836100  Pages 85 - 89
Emergency physicians are continuously under stress because of overcrowded departments, severity of cases, and their work schedules. In addition to this work stress, unregular social and familiy life are the main components of ongoing burn
out process in these professionals. Burn out is the end point of the process which is complicated by the loss of professional enthusiasm and satisfaction, and negative behavioral approach to the patients. This review includes detailed statements on specific headlines, such as residency period, shift system, sleep management, risk of physical and psychological diseases, and stress management for emergency physicians.

2.THE EFFECTS OF L-TRYPTOPHAN AND PENTOXIPHYLLINE ON STRESS ULCER
Nurullah Bülbüller, M. Ali Akkuş, Y. Selim İlhan, Feridun Baysal, İbrahim Özercan, Erhan Aygen, Cüneyt Kırkıl
PMID: 12836101  Pages 90 - 95
Background: It is well known that stress leads to the formation of gastric mucosal lesions. Free oxygen radicals play an important role in the pathogenesis of inflammation and tissue damage. It was observed that L-tryptophan has a positive effect on gastric mucosal damage in ischemia-reperfusion injury by inhibition of free oxygen radicals. The protective effect of pentoxifylline was shown in gastric mucosal damage induced by ischemia - reperfusion or the application of some topical agents.We performed an experimental study to determine whether intragastric L-tryprophan and intramuscular
pentoxifylline protect gastric mucosal damage that is induced by immobility stress.
Methods: Forty rats were immobilized and divided into four groups. No treatment was made in the first group; in group 2,3 and 4, L-tryptophan, pentoxifylline and L-tryptophan + pentoxifylline were administered, respectively. The gastric lesions were assesed macroscopically and microscopically two hours following treatment.
Results: In the second and fourth groups, the lesion surface area and average mucosal damage were fewer in comparison to the control group (p<0,03). Moreover, an histopatologically improvement in the surface epithelium was observed in these groups. The average lesion score also reduced significantly (p<0,03) only in the L-tryptophan group. On the other hand, no statistically significant improvement was observed in the pentoxifylline group.
Conclusion: As a result, it was concluded that L-tryptophan could play a protective role in the gastric mucosal damage associated with stress.

3.THE EFFECT OF THERMAL INJURY AND MELATONIN ON INCISIONAL WOUND HEALING
Pınar Y. Başak, Fatih Ağalar, Fatih Gültekin, Erol Eroğlu, İrfan Altuntaş, Canan Ağalar
PMID: 12836102  Pages 96 - 101
Background: Oxygen - free radicals are generated during inflammatory reactions and cause tissue damage when overproduced. The wounds, especially burn injuries which comprise several events, result in generation of reactive oxygen species and impairment of cellular functions as in wound healing process. This experimental study was done in order to investigate whether 20% body surface area, third degree burn injury creates systemic impairment in wound healing. Additionally, our aim was to evaluate the effects of melatonin on incisional cutaneous wound healing.
Methods: Fifty adult Wistar-Albino rats were included in the study. A group of animals were subjected to dorsal burn injury followed by full-thickness midline skin incision, 2 cm in length on the abdominal region which was primarily sutured.
Melatonin was administered on incisional wounds and breaking strength, hydroxyproline, thiobarbituric acid reactive substance values and antioxidant enzyme activities in the wounded tissue were determined at day 7; to examine firstly the
influence of thermal injury on systemic wound healing and secondly, whether melatonin possesses improving effects.
Results: No detrimental effect of 20% burn injury on unburned cutaneous incisional wound healing was determined.
There was not any difference in breaking strength, hydroxyproline, thiobarbituric acid reactive substance and glutathione peroxidase values, except for significantly elevated catalase and superoxide dismutase activities in melatonin-treated animals comparing to the control group.
Conclusion: This preliminary study disclosed that exogenous melatonin, at a dose of 10mg/kg for two days, exerted few variation in antioxidant status during wound repair. Nevertheless, half-life of melatonin is short and further studies are required, to investigate longer duration or higher dosage of administration which may be beneficial for cutaneous wound healing.

4.A PRACTICAL VOLUME CONTROLLED BLEEDING METHOD IN ANIMAL HEMORHAGIC SHOCK MODEL
Hakan Güven, Murat Hökelek
PMID: 12836103  Pages 102 - 103
The bleeding method is the most widely used technique in volume controlled hemorrhagic shock model that was described as withdrawing blood by an heparinized syringe from veins of laboratory animals. However the difficulty in establishing a constant bleeding rate and volume at a desired time is the major disadvantage of this technique. This disadvantage may also lead to the mortality during the exsanguinating phase due to inconstant bleeding rate. Reversely connected infusion pump that was described in this report is a useful and practical method to withdraw blood with predetermined bleeding volume and rate. The described method can easily be applied to various pathophysiological and metabolic studies on acute blood loss.

5.A NEW BALLISTIC SIMULANT "TRANSPARENT GEL CANDLE" (EXPERIMENTAL STUDY)
Ali İhsan Uzar, Mehmet Dakak, Tahir Özer, Gökhan Öğünç, Taner Yiğit, Cengiz Kayahan, Köksal Öner, Derviş Şen
PMID: 12836104  Pages 104 - 106
Background: Inanimate tissue simulants have been used to show the bullet effects in ballistic studies. Gelatin has been being used as a ballistic simulant for the last 20 years. It was considered that transparent gel candle (kraton in white paraffin oil) might be used as a soft tissue simulant that can be an alternative for gelatin.
Methods: For calibration of transplant gel candle, firstly it was shot at the 10% ordnance gelatin at 4 o C, and several concentrations of the transparent gel candle at 4 o C, by later on, by using a competition air gun. It was seen that 15% kraton in 85% white paraffin oil is the most suitable concentration. This kind of transparent gel candle blocks tested by using 9 mm parabellum and 7.62 mm x 51 (NATO 7.62) infantry rifle bullets and high-speed camera.
Results: Because of its transparency and elasticity, the penetration, permanent and temporary cavities of bullets were observed clearly in transparent gel candle.
Conclusions: As a result, transparent gel candle is a good soft tissue simulant that it can be used in wound ballistic studies.

6.THE ROLE OF PERITONEAL ASPIRATION CYTOLOGY DIAGNOSIS OF ACUTE APPENDICITIS
Erol Kisli, Ersin Özgören, Hasan Arslantürk, Metin Aydın, Osman Güler, İrfan Bayram
PMID: 12836105  Pages 107 - 110
Background: The purpose of this study is to search the role of peritoneal aspiration cytology in acute appendicitis.
Methods: Peritoneal aspiration cytology was (PAC) conducted for fifty suspected acute appendicitis patients before their operations. PAC findings was compared with histopathologic results.
Results: Negative appendicectomy rate according to clinical diagnosis was 20%. PAC was positive in 32 and negative in 18 patients. 93.75% PAC (+) patients had acute appendicitis, 44.4% PAC (-) patients had normal appendices. The false positive rate was 6.2% and the false negative rate was 55.6%. The sensitivity, the specificity, the positive predictive value, the negative predictive value of PAC for the diagnosis of acute appendicitis were 75%, 80%, 93.8%, 44.4%, respectively and the accuracy was 76%.
Conclusion: PAC positive results support the diagnosis of acute appendicitis strongly. However, PAC (-) results don’t exclude the diagnosis of acute appendicitis.

7.DOES THE LEUKOCYTE COUNT CORRELATE WITH THE SEVERITY OF INJURY?
Şule Akköse, Mehtap Bulut, Erol Armağan, Veysel Balcı, Atıf Yolgösteren, Halil Özgüç
PMID: 12836106  Pages 111 - 113
Background: Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients.
Methods: 713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at
presentation.
Results: Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS.
Conclusions: The leukocyte count at presentation can be used as an adjunct in the evaluation of the severity of injury in blunt trauma patients.

8.THE LATE OUTCOMES OF VENA CAVA FILTERS IN THE PREVENTION OF PULMONARY EMBOLISM
Mehmet Kurtoğlu, Orhan Alimoğlu, Ahmet Necefli, Arzu Poyanlı
PMID: 12836107  Pages 114 - 119
Background: Pulmonary embolism (PE) is the most serious complication of deep venous thrombosis (DVT) resulting in high morbidity and mortality rate. The purpose of this study is to evaluate the long-term results of vena cava filters (VCFs) placement for prevention of PE in high- risk patients.
Methods: Between June 1999 and March 2002, at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty, 15 high-risk patients who underwent placement of filters were evaluated.
Results: There were eleven males (73%) and four females (27%) with mean age of 50 years (range 14 to 76). Eleven of VCFs were placed for prophylactic and four for therapeutic purposes. The indications of VCFs placement are as follows: Spinal
cord injury with life-long paraplegia in eight and quadriplegia in two patients, venous thromboembolism while on anticoagulation in two patients, contraindications to anticoagulation in three patients. The mean duration of follow-up was 17 months (range 3-32 months). No patients developed DVT and recurrent DVT. No patients clinically had signs or symptoms of PE. There was one insertion site thrombosis that related to VCF complications, which resolved with medical therapy. Four patients died during the study period. Medical records revealed no evidence of PE.
Conclusion: Although VCF placement seems to prevent PE in high- risk patients, prospective randomized trials with larger patient groups and longer-term follow up period are necessary to evaluate efficacy and safety of VCF in prevention of PE before making definitive conclusion.

9.THE COMPARISON OF INCISION AND DRAINAGE WITH SKIN EXCISION AND CURETTAGE IN THE TREATMENT OF ACUTE PILONIDAL ABSCESS
Ramazan Eryılmaz, Mustafa Şahin, Orhan Alimoğlu, Bülent Kaya
PMID: 12836108  Pages 120 - 123
Background: To compare therapeutic values of incision and drainage, with skin excision and curettage in surgical treatment of the patients with acute pilonidal abscess.
Methods: In this prospective study, patients with acute pilonidal abscess were divided into two groups. The first group of patients were treated with incision and drainage and the second with skin excision and curettage. Two treatment modalities were compared in terms of healing time, time of returning to active work and development of chronic pilonidal sinus rates with chi-square and student-t test.
Results: Development of chronic pilonidal sinus rate was 76% in incision and drainage group and 24% in skin excision and curettage group (p<0.001). Healing time and time of returning to active work were 27 and 35 days in skin excision and curettage group, 19 and 26 days in incision and drainage group, respectively (p<0.001).
Conclusion: Skin excision and curettage, which is associated with lower rates of development of chronic pilonidal sinus, may be the treatment of choice in acute pilonidal abscess,.

10.RETROSPECTIVE ANALYSIS OF THE PATIENTS WITH PENETRATING CARDIAC TRAUMA
Soykan Arıkan, Ahmet Fikret Yücel, Ahmet Kocakuşak, Yıldıray Dadük, Gökhan Adaş, Mehmet Ali Önal
PMID: 12836109  Pages 124 - 128
Background: Penetrating cardiac stab wounds are among rarely seen traumas, associated with high mortality. We aimed to present and investigate our experience in such cases.
Methods: Eighteen cases with penetrating cardiac stab wounds, between 1993-2001, were investigated retrospectively.
Gender, age, conditions at application, injured areas, extent of cardiac damage, accompanying organ damages and outcomes of these patients were studied.
Results: All patients were male with a mean age of 25.38 years (between 16-42 years). Heart was the only affected organ in nine 9 patients, whereas there were additional organ injuries in the remaining patients. The injuries were at left ventricle in 11, right ventricle in 4 and right atrium in three patients. Only two patients survived among 14 patients who developed cardiac arrest. There was additional organ damage in three of the six survivors.
Conclusion: The overall mortality was 66%. Suspect of cardiac injury should be considered in patients who are injured close around cardiac area and one should intervene quickly both in diagnosis and treatment.

11.THE INCIDENCE OF PATHOLOGIC FINDINS OF THE CRANIAL COMPUTED TOMOGRAPHY IN PATIENTS WITH MINOR HEAM TRAUMA AND ITS CORRELATION WITH AGE AND CLINICAL FEATURES
Dursun Aygün, Hakan Güven, Lütfi İncesu, Havva Şahin, Zahide Doğanay, Levent Altıntop
PMID: 12836110  Pages 129 - 133
Background: Our objective was to determine the incidence of diagnosing lesions by cranial computed tomography (CT) and to evaluate prospectively whether this incidence correlated with clinical fetaures and age in patients with minor head trauma (MHT).
Methods: This prospective study included 78 patients with MHT. All of the cases underwent CT following their clinical assessment.
Results: In the 34.61% of cases, there was a pathologic finding in the CT however the incidence of intracranial injury was 15.38%. There were no significant differences between children (n:22) and adults (n:56), the patients with and without a history of the loss of consciousness/amnesia and the patients with and without clinical symptoms (p>0.05).
Conclusion: Our results support the studies which have reported that there is no non-focal clinical factor as a predictor for pathologic CT findings.

12.A LOOP FORMATION OF MECKEL'S DIVERTICULUM: A CASE WITH OBSTRUCTION OF THE ILEUM
Morimasa Tomikawa, Junya Taomoto, Motonori Saku, Morishige Takeshita, Koji Yoshida
PMID: 12836111  Pages 134 - 136
An adult case of obstruction of the ileum caused by a loop formation of Meckel’s diverticulum is described. The patient, having severe abdominal pain and vomiting, was diagnosed as having ileus. A roentgenogram with a contrast medium showed severe obstruction at the mid part of the ileum. From findings of elective laparotomy, adhesion between the inflammatory end of Meckel’s diverticulum and the corresponding mesenterium had formed a loop, which had clasped the distal part of ileum. We here warn that Meckel’s diverticulum forming a loop is a cause of obstruction of the ileum in
adults.

13.A CASE OF ACUTE ABDOMEN DUE TO VENTRICULO-PERITONEAL SHUNT INFECTION
Ramazan Çiçek, Serdar Türkyılmaz, Akif Cinel, Uzel Küçüktülü, Sezgin Mumcu, Ertuğrul Çakır
PMID: 12836112  Pages 137 - 139
Peritonitis is a rare complication of ventriculoperitoneal shunt. Shunt infection may be the cause in patients with ventriculoperitoneal
shunt, who have acute abdomen. Spesific clues taken from patient’s history, physical examination and
some further investigations may clarify the diagnosis. This case is a 25-years-old male with a ventriculoperitoneal shunt who presented symptoms of acute abdomen. The patient was admitted with complaints of abdominal pain. There were
no neurologic signs or symptoms. Physical examination on admission revealed a mass in the right lower abdomen and abdominal muscular guarding with rebound tenderness. Laboratory studies showed leukocytosis of the peripheral blood.
Abdominal ultrasound demonstrated a mass and the preoperative diagnosis was appendicitis. On abdominal exploration, appendix was found to be normal but a catheter infection related omental necrosis was present. Surgical therapy was carried out by withdrawal of the catheter and segmental resection of the omentum. The patient was discharged on seventh day postoperatively.

14.DIEULAFOY'S DISEASE AS A CAUSE OF MASSIVE UPPER GASTROINTESTINAL HEMORRHAGE
Adil Koyuncu, Hasan Lice, Soykan Arıkan, Orçun Oral Şentürk, Ahmet Fikret Yücel, Ahmet Kocakuşak
PMID: 12836113  Pages 140 - 142
Dieulafoy's disease is a rare cause of gastrointestinal hemorrhage. The cause of this disorder is not known exactly but it is generally characterized with massive hemorrhage from the abnormal submucosal vessels. Although abnormal submucosal
vessels are mostly seen in stomach, they can also be seen in duedonum, jejunum or colon. In this report we presented a patient who developed massive gastrointestinal hemorrhage due to Dieulafoy disease.

15.LAPAROSCOPIC EVALUATION IN INCARCERATED GROIN HERNIA FOLLOWING SPONTANEOUS REDUCTION
Haluk B. Güvenç
PMID: 12836114  Pages 143 - 144
The authors report their initial experience of diagnostic laparoscopy in a baby presenting with small bowel obstruction secondary to strangulated groin hernia. Laparoscopy was accomplished through ipsilateral hernia sac to determine the
viability of the incarcerated bowel segment under general anesthesia, following spontaneous reduction under general anesthesia. Diagnostic laparoscopy showed edematous intestinal segments but no sign of necrotic bowel or indirect
findings of intestinal perforation. Diagnostic laparotomies may be useful in selected cases preventing an unnecessary laparotomies.

16.MANAGEMENT OF LISFRANC’S FRACTURE-DISLOCATION
Özcan Pehlivan
PMID: 12836115  Pages 145 - 148
Lisfranc's joint injuries are rare and complex. A car driver who sustained a traffic accident, was admitted because of partial dorsolateral fracture-dislocation of the Lisfranc's joint. The diagnosis was made by physical examination and radiographs. Reduction and pin fixation were performed under general anesthesia. At the end of the ninth month, range of motion of the foot and ankle was full, with no pain on daily activities.