Background: To review the current developments in staged abdominal re-operation for abdominal trauma.
Methods: To overview the steps of damage control laparotomy.
Results: The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized.
Conclusions: General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

Background: The aim of this study was to investigate the effects of antioxidant and resuscitation fluids which were used during haemorrhagic shock on tissue ischemia.
Methods: Forty New Zealand type rabbits were divided into four groups as C (control), I (hypertonic saline), H (HAES) and D (Dymethylsulphdxide-DMSO). Haemorrhagic shock was induced by bleeding from carotid artery. Thirty minutes after shock, Group C was not resuscitated while Group I was resuscitated with Hypertonic saline 7.2, Group H with 10 % HAES and Group D with HAES 10 % and DMSO. Thiobarbituric acid reactive substances (TBARS) and lactate levels in blood, liver and small bowel samples were measured.
Results: There were no significant differences among the groups tissue and plasma TBARS and lactate levels.
Conclusion: Resuscitation fluids and addition of antioxidants to the resuscitation fluids do not have any superiorities over each other to prevent tissue ischemic insult in haemorrhagic shock.

Background: To investigate the appropriate surgical method that should be selected in the localized fecal peritonitis due to colonic injuries with 24 hours delay.
Methods: Colonic injuries were performed in 35 rats and the repairs were carried out after 24 hours. Seven rats (%20) died of generalized peritonitis in this period. The remaining 28 rats in which fecal peritonitis were localized by surrounding organs, were randomized in two groups: colostomy (n=14) and primary anastomosis (n=14). Intraabdominal complications and 15 days mortality were assessed.
Results: The groups had similar results according to intraabdominal complications. The 15 days survival was 71.4 % for the colostomy group and 78.5 % for the anastomosis group (p=0.31)
Conclusion: If the injured or perforated colon is surrounded by the organs and so the generalized peritonitis is avoided, primary anastomosis would have similar results with colostomy despite fecal contamination and prolonged intervention time.

Background: Whether nitric oxide (NO) protects or impairs the liver function and structure during the early phase of sepsis is still controversial. The aim of this study is to evaluate the effect of NO on lipopolysaccharide (LPS) or lipoteichoic acid (LTA) induced liver injury in rats.
Methods: One hundred twenty-six Wistar rats were assigned randomly and equally to LTA and LPS groups. Each group was divided into three subgroups which received saline, L-Arginine (L-Arg) or NG-nitro-L-arginine methylester (L-NAME) consecutively, one hour prior to either 5 mg/kg LPS or 3 mg/kg LTA injection. Plasma nitrite plus nitrate [NOx] were measured.
Liver injury was assessed by measuring the rises in circulating liver enzymes and by scoring the extent of liver necrosis.
Results: Administration of L-NAME+LPS not only reduced [NOx] production but also enhanced liver damage. LNAME+ LTA caused an increase in the plasma levels of [NOx] (p=0.0006), and produced sinusoidal enlargement in liver.
L-Arg protected the hepatocytes against LPS injury, whereas, enhanced the liver damage in the LTA group.
Conclusion: Our data indicated that overproduction of NO exerts detrimental effect on LTA-treated rats while providing a protective function in LPS group.

Background: To determine the role of nitric oxide (NO) which is vasodilator agent and inflammatory cytokine, in burn injury.
Methods: Rats were divided into 5 groups, and a 30 % burn was inflicted. In addition to sham control and burn control groups, other 3 groups were given L-Arginin, and L-nitro-L-Arginine methylester (L-NAME), and both. Neutrophil and hematocrit percentage in blood, NO, TNF-alfa and malondialdehyde (MDA) levels in plasma and neutrophil
infiltration in the lung were evaluated at 24 hours after thermal injury.
Results: The inhibition of NO production with L-NAME treatment significantly decreased these parameters when compared to burned control group. MDA was decreased significantly in all groups which were given drugs.
Conclusion: The induction and inhibition of NO production both reduced lipid peroxidation but induction increased the mortality, plasma TNF-alfa and neutrophil in the blood. Inhibition of NO production is found more useful after thermal injury in rats.

Background: To determine the beneficial effects of adjuvant hyperbaric oxygen therapy (HBO) in an experimental compartment syndrome model.
Methods: Twenty Wistar albino male rats, weighing between 270-325 g. were divided into four groups as: Control, Fasciotomy, HBO and HBO-Fasciotomy. Rear legs of all animals were strangulated with a tourniquet for 4 hours. Fasciotomy was performed by double incisions. HBO protocol was set as: 6 sessions/day in the first two days, 4 sessions/ day in the 3rd and 4th days. The intra-compartmental pressure and leg volume in all groups were measured daily. The legs of the sacrificed animals underwent histopathological examination.
Results: Fasciotomy was more effective than HBO to decrease leg volume and intra-compartmental pressure. The combination of HBO and fasciotomy was more effective than the single application of HBO and fasciotomy. The findings of inflammation and necrosis were less in the HBO group when compared with the fasciotomy and HBO-fasciotomy groups. This result was attributed to the higher risk of infection and mechanical damage in the groups with fasciotomy.
Conclusion: Adjuvant HBO is beneficial in the treatment of compartment syndrome.

Purpose: The aim of this study is to analyze the relationship between the changes in blood and peritoneal fluid and the duration of mechanical intestinal obstruction.
Methods: A mechanical intestinal obstruction was surgically carried out in 52 Wistar albino rats. The blood and peritoneal fluid were sampled immediately (Group 1, n=13), and at 6 hours (Group 2, n=13), at 24 hours (Group 3, n=13), and at 48 hours (Group 4, n=13) following the procedure.
Results: Blood and peritoneal fluid ammonia concentrations, as well as blood aldolase activity have risen progressively over time (p<0.05), although not all pair-wise comparisons were statistically significant (P>0.05).
Conclusions: Our data suggest that peritoneal fluid and blood ammonia levels and blood aldolase levels rise according to duration of the intestinal obstruction. Since the results were not available to determine cut-off levels, future research is required to confirm these results and determine whether ammonia or aldolase can be used in clinical practice to predict the presence and duration of a mechanical intestinal obstruction.

Background: Ninety-six percent of Turkey's land is in the earthquake zone. Consequently the results of every earthquake should be presented and discussed. The aim of this study was to evaluate the results of Afyon Sultandaðý Earthquake.
Methods. The records from Governorship of Afyon, local hospitals and Public Work Directorate have been evaluated retrospectively and compared with current literature.
Results: An earthquake was detected with the magnitude of 6.0 at 9:11 A.M. at February 3rd , 2002, in the Sultandagi town, which is localized in Afyon city of Turkey. Bolvadin and Çay towns were also affected from the disaster. This earthquake,
caused 39 deaths (23 of them were older than 65 year-old; 15 male and 24 female), 325 injured persons; 315 cows and water buffalos and 3,176 sheep, 14,328 poultry were dead, and 15,032 buildings were damaged. The causes of deaths in human beings were: myocardial infarction in three patients and traumatic cerebral hematoma in one; the others expired from respiratory insufficiency due to dust inhalation because of the traditional architecture of the rural area. Health professionals reached the victims in about four hours, 35 of the injured patients were treated with hospital care and the remaining did not require health support.

Background: Objective of this study is to analyze the treatment outcomes of patients undergoing surgery for complex pancreatic injuries in our center over a 20-year period.
Methods: Between January 1980 and December 2001, medical records of 11 patients who underwent surgical intervention for complex pancreatic trauma were investigated retrospectively.
Results: The study group consisted of nine males and two female patients with a mean age of 36 years. Six patients had stab wounds, three had motor vehicle accidents and two had gunshot wounds. The mean value of Injury Severity Score (ISS) was 32.
Among six patients with Grade III injury, five were managed by distal pancreatectomy and one by external drainage. In three patients with Grade IV injury each underwent distal pancreatectomy, subtotal pancreatectomy and pancreaticoduodenectomy.
The remaining two patients with Grade V injury were managed by pancreaticoduodenectomy. In the postoperative course, pancreatic fistula was observed in two patients and peripancreatic abscess and pancreatitis in one patient each.
Endocrine insufficiency occurred in one patient who underwent subtotal pancreatectomy. Operative mortality was 18.2%.
Conclusion: Owing to the retroperitoneal location of the pancreas and its proximity to major vascular structures, associated organ injuries play a significant role in morbidity and mortality.

Background: To evaluate the results of the conservative treatment without a reduction maneuver in patients with anterior sternoclavicular joint (SCJ) dislocation.
Methods: Four cases with anterior dislocation of the SCJ were evaluated retrospectively. Three cases were unconscious and were followed in the intensive care unit. All of the cases were treated conservatively without any reduction maneuver, as they are either unconscious or refused the reduction in one case.Average follow-up period was 16 months (10-21 months).
Results: Good clinical results were achieved in three cases with only mild cosmetic problems, except one case with marked deformity.
Conclusion: Good functional results may be achieved with conservative treatment of the anterior dislocation of the SCJ even without a reduction maneuver.

Background: In our retrospective study, we evaluated pediatric femoral shaft fractures sustained by children of five to fifteen years of age, all of whom were treated with elastic intramedullary nailing.
Methods: Between 1990 and 2000, 32 femoral fractures of 30 children, 14 (47%) polytraumatized, with an average age of 9.9 (6-14), were treated with elastic intramedullary nailing.
Results: Average follow-up was 105.3 (25-145) months. Three cases (9.3%) were re-operated due to developed angulations related to weight bearing in the early postoperative period. In three (9,3%) of our cases we diagnosed more than five degrees valgus deformity, in one (3.1%) anterior angulation and in 1 (3.1%) internal rotation. The average of absolute value of length discrepancies was determined as 9 mm (-15mm - +15mm).
Conclusion: Elastic intramedullary fixation is a recommended method, especially for polytraumatized patients, because of facilitates of patient care, recovers social activity quickly, and causes minimal soft tissue damage. However angular or rotational deformations are also possible. Selection criteria and follow up period is important and treatment of the complications must be on time.

Two patients were admitted to the emergency service of Haseki Education and Research Hospital due to ingestion of narcotic filled bags. Incomplete mechanical bowel obstruction developed in one of them. Both patients were treated conservatively with cleansing enema and were discharged from the hospital without any complication . We present clinical follow-up of these patients with literature review.

Secondary peritoneal echinococcosis is one of the important complications of cyst hydatid disease. Although many ruptured hydatid cysts of a primary organ have been reported, there is only one case of peritoneal hydatid cyst rupture in the literature. In this case report we present a 25 year-old male patient, who had been operated for hydatid cyst of the liver four years ago and had pelvic hydatid cyst rupture due to blunt abdominal trauma.

The old unreduced traumatic patellar dislocation is very rare and the results of the treatment are not always satisfactory. We report a 11 year-old boy with an unreduced patellar dislocation and a healed ipsilateral femoral fracture. The dislocation was reduced by an operative procedure. A long leg cast was applied for 6 weeks then the knee exercises were started. One year after surgery, he still has satisfactory results. This case suggests that if the dislocation is not of long duration and degenerative changes are absent in the patella and the knee joint, open reduction may be helpful in the treatment of old unreduced traumatic patellar dislocations.

Neglected elbow dislocations, rarely seen in the developed countries, are very attractive due to the difficulties of treatment and diversity of prognosis. A 32 year-old woman was admitted with chronic elbow dislocation and defective forearm pseudoarthrosis due to an accident four months prior to admission. Open reduction and distraction arthroplasty using hinged external fixator for the elbow, open reduction and internal fixation with plate-screws with fibula allograft for the forearm was performed. The elbow was stable and had 110º and -15º of active flexion and extension respectively on the ninth month of follow-up. Both radius and ulna were united.

We describe a case of a 55-year-old man with hypovolemic shock who developed a symmetrical peripheral gangrene (SPG) on hands and feet. The SPG syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and rarely, the nose, upper lip, ear lobes or genitals without large vessel obstruction or vasculitis. Vasopressors have been implicated directly or as a contributory cause in many cases. In this case, dopamine was used with high dose (> 20 µg/kg/min) which is inappropriate in hypovolemic shock states. SPG might be a severe and rare complication of dopamine. Care should be taken with the use of dopamine in patients with shock.