Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES (ULUS TRAVMA ACIL CER)

Publications in this journal

• Article: The role of bedside ultrasonography for occult scaphoid fractures in emergency department

  Ahmet Yildirim, Erden Erol Unluer, Nergiz Vandenberk, Arif Karagoz
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  ABSTRACT: Objective: Our aim is to study the accuracy of emergency medicine (EM) physician-performed, bedside ultrasonography (BUS) in patients with clinical suspicion of scaphoid fracture and normal radiographs. Methods: From January to December 2011, an EM physician used BUS to prospectively evaluate patients presenting to the emergency department (ED) with clinical suspicion of scaphoid fracture and normal radiographs. BUS examination of the scaphoid prior to a wrist MRI scan, within 24 hours of wrist trauma. The outcome was determined by official radiology reports of the MRI. The results were statistically compared using the Chi-square test. Results: Of the 63 enrolled patients, 12 Patients were BUS-positive. Of these, MRI results agreed with the BUS findings in 12 patients, who had cortical damage of the scaphoid with hematoma. In 35 instances, hematoma with no cortical damage was detected with BUS, and corroborated by MRI. A scaphoid fracture was demonstrated by MRI in two patients from this group. The sensitivity, specificity, positive predictive value, negative predictive value, negative likelihood ratio for BUS were 85.7%, 100%, 100%, 100% and 0.14, respectively. Accuracy of BUS was not statistically different from MRI. Conclusion: The diagnosis of scaphoid fractures is another BUS application in the ED. EM physicians can diagnose scaphoid fractures using BUS in emergency department.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 04/2013; 19(3):241-245.
• Article: Epidemiology of pediatric burn injuries in Istanbul, Turkey.

  Hakan Arslan, Baran Kul, Handan Derebaşınlıoğlu, Oğuz Cetinkale
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  ABSTRACT: BACKGROUND: Many burns that occur in the first two decades of life are accidental and preventable. The aim of this study was to determine the demographic features, mortality, and other factors associated with pediatric burns in Istanbul, Turkey. METHODS: Our retrospective study included 375 hospitalized pediatric patients (225 male, 150 female; mean age 4.07±3.79; range 0.2 to 16 years) aged 16 years or less admitted between January 2005 and January 2009. Each child's medical record was reviewed and demographic features, mechanism of burn, place of residence, total body surface area (TBSA), surgical treatment, duration of hospital stay and mortality rates were analyzed. RESULTS: Scalding was the predominant cause among all pediatric age groups. There were no differences between the age groups with respect to mean TBSA. Length of hospital stay in infants and toddler age group was significantly lower than in other age groups (p<0.005). Sixteen (4.3%) patients died during the study period. Mortality rates associated with scalding, flame and electrical burns were 3.1%, 13.9% and 10%, respectively. Electrical burns and flame resulted in significantly higher mortality rates than scalding (p<0.05). CONCLUSION: Scalding was found to be the most important cause of burns and flame-related mechanisms resulted in the highest mortality rate among children. Only a specific preventive program for changing the traditional habits of Turkish parents would reduce burn injuries among children.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):123-126.
• Article: An analysis of 45 patients with pure nasal fractures.

  Yakup Cil, Erkan Kahraman
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  ABSTRACT: BACKGROUND: Nasal fracture is generally encountered alone or in combination with other serious injuries. The objective of this study was to analyze patients who had pure nasal fracture. METHODS: Forty-five records from patients with pure nasal fracture treated in the hospital between 7 October 2005 and 14 December 2011 were included. The following nasal fracture criteria were evaluated: age at the time of nasal trauma, gender, accident type, use of alcohol, findings of the physical examination, treatment time after the nasal fracture, and year and seasonal distribution. RESULTS: The age ranged from 6-32 years, with a mean age of 21 years. The most frequent reasons of the injury were violence 60% (27 cases) followed by falling 31% (14 cases), accidents 4.5% (2 cases) and sport injuries 4.5% (2 cases). The most frequent findings were tenderness in 71.1% (32 cases), followed by swelling in 51.1% (23 cases), nasal deviation in 42.2% (19 cases), and epistaxis in 15.6% (7 cases). Nasal bone fracture was diagnosed exactly by standard X-ray films in 91.1% (41 cases). CONCLUSION: In this study; pure nasal bone fractures occurred primarily among men under 25 years of age, and fights were found to be the main etiologic factor.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):152-156.
• Article: Posttraumatic intraocular pressure elevation and associated factors in patients with zone I open globe injuries.

  Uğur Acar, Elvin H Yıldız, Damla Ergintürk Acar, Uğur Emrah Altıparmak, Züleyha Yalnız Akkaya, Ayşe Burcu, Nurten Unlü
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  ABSTRACT: BACKGROUND: The object of this study was to determine factors that might be associated with intraocular pressure (IOP) elevation after anterior segment open globe injuries (zone I). METHODS: Data were obtained from the records of 68 patients who experienced zone I open globe injury between January 2008 and October 2010. Group I was composed of patients with chronically elevated IOP of at least 21 mmHg within a 1-year follow-up period. The rate of posttraumatic IOP elevation and associated structural and functional risk factors were evaluated. RESULTS: Of the 68 patients, 17 (25%) developed posttraumatic IOP elevation (Group 1). The mean age in group I was significantly older compared to group II (36.8±24.4 and 15.7±15.3 years, respectively [p=0.003]). Iris damage, postoperative inflammation, and use of long-term corticosteroids were significantly greater in group I (p<0.001, p<0.001, p=0.005 respectively). In group I, 13 of 17 patients (76.5%) had a wound size larger than 6 mm compared to only one patient (1/51, 2%) in group II, and the result was statistically significant (p<0.001). The size of wound larger than 6 mm also retained its statistical significance in multivariate analysis (p<0.001, odds ratio: 162.5). CONCLUSION: This study shows a significant relationship between larger wound size (>6 mm) and elevation of IOP after trauma in zone I open globe injuries.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):115-118.
• Article: Thermoelastic stress analysis to validate tibial fixation technique in total ankle prostheses - a pilot study.

  Andreas Ficklscherer, Bernd Wegener, Thomas Niethammer, Matthias F Pietschmann, Peter E Müller, Volkmar Jansson, Hans-Heinrich Trouillier
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  ABSTRACT: BACKGROUND: Recent literature has shown a persistently high rate of aseptic loosening of the tibial component in total ankle prostheses. METHODS: We analyzed the interface between the tibial bone and tibial component with a thermoelastic stress analysis to demonstrate load transmission onto the distal tibia. In this regard, we used two established ankle prostheses, which were implanted in two human cadaveric and in two third-generation composite tibia bones (Sawbones®, Sweden). Subsequently, the bones were attached to a hydropulser and a sinusoidal load of 700 N was applied. RESULTS: Both prostheses had an inhomogeneous load transmission onto the distal tibia. Instead of distributing load equally to the subarticular bone, forces were focused around the bolting stem, accumulating as stress maxima with forces up to 90 MPa. Furthermore, we were able to demonstrate load transmission into the metaphysis of the bone. CONCLUSION: As demonstrated in this study, anchoring systems with stems used in all established total ankle prostheses lead to an inhomogeneous load transmission onto the distal tibia, and furthermore, to a distribution of load into the weaker metaphyseal bone. For these reasons, we favor a prosthetic design with minimal bone resection and without any stem or stem-like anchoring system, which facilitates a homogeneous load transmission onto the distal tibia. Thermoelastic stress analysis proved to be a fast and easy-to-perform method to visualize load transmission.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):98-102.
• Article: Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature.

  Ioannis Maroulis, Charalambos Spyropoulos, Christina Kalogeropoulou, Dimitrios Karavias
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  ABSTRACT: Active liver hemorrhage with hemodynamic instability is a serious situation often requiring surgical intervention. The most common causes of hepatic bleeding are trauma and tumors of the liver parenchyma: mainly hepatocellular carcinoma and adenoma. Liver hemorrhage from blunt trauma or spontaneous tumor rupture is sometimes difficult to control with traditional methods and postoperative complications are frequent. Recently, the radiofrequency ablation system (RF) has been used for obtaining haemostasis of ruptured hepatic tumors or for controlling hemorrhage due to liver trauma in experimental models. We report two cases where the radiofrequency ablation system (RF) has been efficiently used during emergency laparotomy in humans in order to control massive hemorrhage from spontaneous rupture of a liver metastatic testicular germ cell tumor and from a Grade IV blunt liver trauma. RF ablation system combined with traditional techniques was effective in controlling liver bleeding during laparotomy in both cases. No recurrence of the hemorrhage or any side effects associated with the RF system were recorded postoperatively. RF system is an effective strategy for achieving hemostasis in patients with active liver hemorrhage. In cases of bleeding liver tumors, RFA could also be helpful in synchronous tumor elimination, maximizing the chances of longer term survival.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):167-172.
• Article: Distribution of occult fractures detected in emergency orthopedic patient trauma with computerized tomography.

  Ahmet Imerci, Umut Canbek, Ahmet Kaya, Levent Sürer, Ahmet Savran
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  ABSTRACT: BACKGROUND: Computerized tomography (CT) is a very useful diagnostic method in orthopedic emergency cases where fractures are suspected but cannot be detected through direct radiography, or when the fracture is detected in direct radiography but better evaluation of the anatomical structure is necessary. In this study, we analyzed occurrences of missed fractures in radiographs that were subsequently diagnosed in CT scans. METHODS: This was a retrospective study. We examined the medical records of all orthopedic trauma patients who visited our hospital's emergency room due to orthopedic trauma between January 2010 and January 2011 and whose spine, pelvis and extremity CTs were taken. RESULTS: Occult fractures were detected using CT in 12 (6.6%) of the children and 102 (6.8%) of the adults. We detected cervical vertebra fractures in 23 patients, femoral neck fractures in 6 patients, and tibia plato fractures in 5 patients, which can cause complications unless immediately acted upon in the emergency room. CONCLUSION: CT revealed most missed diagnoses and proved that direct radiography is less capable of detecting fractures of some critical regions. Where there is clinical suspicion, we recommend that before conservative treatment of patients, especially in cases of possible cervical spine and pelvic region fractures, CT should be requested, even if the radiography is normal.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):157-163.
• Article: Bilateral isolated cut of sensory branch of radial nerve.

  Nuray Akkaya, Hakan Ramazan Ozcan, Inci Gökalan Kara, Füsun Sahin
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  ABSTRACT: Bilateral injuries of the sensory branch of the radial nerve (SBRN) usually occur as a result of tight-handcuff neuropathy. In this case we aimed to present bilateral isolated cut of SBRN resulting an injury mechanism that has not been reported in the literature previously. A male twenty-four years old, a worker in a glass factory, presented to our clinic. The dorsolateral skin of his wrists were cut by breaking of the glass as a result of occupational accident and was primarily sutured in a healthcare center. The patient sought additional care after a month because of lingering numbness and pain, and surgery was planned. During surgery, scar tissue and neuroma at the cut ends of SBRN were excised, and bilateral SBRN cuts were repaired. Four weeks after operation, mild sensory deficit on the dorsal side of bilateral thumbs, and left first web space and flexion limitation on the right wrist were detected. At the 3rd month postoperative, right wrist joint range of motion was full, and sensory deficits, and hyperesthesia were decreased. The SBRN elicits the sensory innervation of the thumb dorsum and its injury does not cause important functional deficit. However because of susceptibility of SBRN to develop painful neuroma, diagnosis, treatment and follow up of isolated SBRN injury would be worthwhile for prevention of possible painful neuropathy disturbing quality of life.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):186-188.
• Article: Isolated unilateral vagus nerve palsy secondary to trauma.

  Dursun Aygün, Ethem Acar
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  ABSTRACT: A 41-year-old man presented to emergency service with loss of consciousness lasting 20 minutes after a piece of wood struck the right side of his face. Shortly after admission, he developed difficulty swallowing. On admission, he was alert and had normal vital findings. There was no motor, sensorial, or cerebellar deficit. Deviation of the uvula to the left side and pharyngeal reflex loss on the right side was obvious. The right vocal cord was paralyzed. Other cranial nerves were intact on examination. The patient's cranial computed tomography (CT), CT-angiogram, cranial and neck magnetic resonance (MR) imaging, MR-angiogram, and cervical and lung X-ray were normal. We evaluated this case with isolated unilateral vagus nerve palsy (VNP) secondary to trauma at the emergency department. Our case illustrated that trauma can cause isolated VNP with the absence of abnormal findings on imaging modalities.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):180-182.
• Article: Multiple magnet ingestion resulting in small bowel perforation: a case report.

  Feryal Gün, Tansel Günendi, Başak Kılıç, Alaaddin Celik
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  ABSTRACT: Foreign body ingestion is a common clinical situation that is primarily diagnosed by emergency clinicians. Most foreign bodies can be evacuated without difficulty. Although rare, magnets that reach the lower intestinal tract may cause complications such as intestinal fistula formation, perforation, volvulus or appendicitis. We report herein a two-year-old girl who was admitted to our department 3 days ago with abdominal pain and non-bilious vomiting. Upon admission direct abdominal roentgenogram revealed a foreign body consisting of multiple spheric parts bound together forming a circle in the lower quadrants of the abdomen. Her family, unaware of this ingestion, stated that a magnetic toy matching the object present on the plain radiograph was lost several days ago. Surgical intervention showed a magnetic toy in the proximal part of the ileum causing multiple perforations in the intestinal wall and the neighboring mesentery. The ileal portion containing the magnet toy was seen folded over itself forming a blind loop. The patient was discharged uneventfully in the 7th postoperative day. Our case highlights a well known fact that foreign body ingestion in children may not have eye witnesses and should be taken into consideration when evaluating children with abdominal pain.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):177-179.
• Article: The functional results of acute nerve grafting in traumatic sciatic nerve injuries.

  Haluk Vayvada, Cenk Demirdöver, Adnan Menderes, Mustafa Yılmaz, Can Karaca
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  ABSTRACT: BACKGROUND: The sciatic and peroneal nerves are the most frequently injured in lower extremities, followed by tibial and femoral nerves. The aim of this study is to evaluate the functional results of acute nerve grafting in traumatic sciatic nerve injuries. METHODS: A total of 9 patients with sciatic nerve defect were treated with primary nerve grafting. The mean age was 31.7 years. The etiologic factors were gunshot wounds, traffic accident, and penetrating trauma. RESULTS: All of the patients had sciatic nerve defects ranging from 3.4 to 13.6 cm. The follow-up period ranged between 25 and 84 months. The tibial nerve motor function was "good" or "very good" (M3-M4) in 5 patients (55.6%). The plantar flexion was not sufficient for the rest of the patients. The peroneal nerve motor function was also "good" and "very good" in 3 patients (33.3%). CONCLUSION: The functional results of the acute nerve grafting of the sciatic nerve within the first week after the injury are poorer than reported in the related literature. This protocol should only be applied to select patients who have adequate soft tissue coverage and healthy nerve endings.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):109-114.
• Article: Mid-term results of calcaneal plating for displaced intraarticular calcaneus fractures.

  Deniz Gülabi, Ferdi Sarı, Cengiz Sen, Cem Coşkun Avcı, Fevzi Sağlam, Mehmet Erdem, Güven Bulut
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  ABSTRACT: BACKGROUND: The radiological and functional results of surgical treatment in intraarticular calcaneal fractures are presented in this study. METHODS: 27 feet of 26 patients with displaced intraarticular fractures were treated surgically in our clinic between November 2003 and May 2009. Twenty-one patients were male (81%), and 5 were female (19%). The average age was 29.2 (range, 18-61 years) at the time of the surgical treatment. Open reduction internal fixation was performed by using a calcaneal plate. RESULTS: The results were evaluated according to the Maryland foot scores and Creighton-Nebraska scores. The mean follow-up period was 34.4 months (range, 19-85 months). The radiological evaluation was made according to the mean value changes of Böhler and Gissane angles after injury and at the last follow-up. Except for 3 patients with Sanders type 4 fractures, good results were obtained with surgical treatment. CONCLUSION: We conclude that open reduction and internal fixation methods yield a reasonable outcome, even in patients with Sanders type 4 intraarticular fractures of the calcaneus.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):145-151.
• Article: [Evaluation of treatment results among patients with acute gastrointestinal bleeding due to Dieulafoy's lesion admitted to the emergency department.]

  Yavuz Beyazit, Selçuk Dişibeyaz, Burak Suvak, Tugrul Purnak, Serkan Torun, Erkan Parlak
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  ABSTRACT: BACKGROUND: Dieulafoy lesions (DL) are a rare cause of gastrointestinal bleeding (GIB), characterized by exteriorization of a large pulsatile arterial vessel through a minimal mucosal tear surrounded by normal mucosa. In the present study, we aimed to review the clinical experience with DL in our center, primarily focusing on clinical features and endoscopic therapeutic preferences according to clinical outcomes. METHODS: Data from patients with upper GIB were admitted to the Turkiye Yuksek Ihtisas Training and Research Hospital gastrointestinal endoscopy unit between 2007 and 2011 and were reviewed for DL. Detailed clinical and endoscopic data were abstracted and collected. RESULTS: Twenty-seven patients were identified with DL. Their ages ranged from 24 to 85 years (median age 70). Fifteen patients were male and twelve were female. Most of the DL occurred in the stomach and were most commonly localized in fundus (59.2%), followed by corpus (29.6%) and antrum (11.2%). The most common initial endoscopic therapeutic approaches were the application of hemoclips with (33.3%) or without adrenalin (40%) injection. CONCLUSION: Our study revealed that DL occurred in relatively older patients with a male dominance. Primary hemostasis with endoscopic intervention is safe, successful and cost-effective.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):133-139.
• Article: Management of acute myocardial infarction after a blunt chest trauma.

  Oner Ozdoğan, Mustafa Karaçelik, Cenk Ekmekçi, Cengiz Ozbek
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  ABSTRACT: Coronary artery dissection is a rare complication after blunt chest trauma. Patients usually present with sudden death and the diagnosis is frequently missed. In this report, we present a case of a 46-year-old with a hyperacute anterior wall myocardial infarction after blunt chest trauma. Diagnostic coronary angiography showed total occlusion of the left anterior descending coronary artery (LAD) starting at the takeoff of the vessel from the left main coronary artery (LMCA). A bare-metal stent was immediately deployed at the proximal LAD and TIMI 3 flow was achieved; however post-procedural images revealed no satisfactory results. A proximal dissection and intraluminal thrombus extending to the LMCA was observed. Because of the proximity of the lesion to the LMCA, re-intervention was considered to be risky and urgent coronary artery bypass grafting (CABG) was planned. Coronary artery stenting is the advised treatment modality for coronary occlusion after blunt chest trauma. However, post-traumatic percutaneous coronary intervention was sometimes considered to be risky because of the anatomic features of the lesion. Timing is cardinal in achieving early reperfusion in the course of myocardial infarction after blunt chest trauma and CABG should be the preferred procedure for initial reperfusion treatment especially in proximal LAD dissections with subsequent thrombus formation leading to total occlusion of the artery.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):173-176.
• Article: A rare complication of aortobifemoral bypass operation: internal herniation.

  Bülent Citgez, Gürkan Yetkin, Mehmet Uludağ, Ismail Akgün, Uğur Ekici, Abdulcabbar Kartal
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  ABSTRACT: Intestinal brids are most common cause of postoperative ileus although there are various cause of ileus after abdominal operation. On the other hand internal herniation is a rare cause of ileus after abdominal operations. Diagnosis of this hernias are important because of strangulation and necrosis of its content due to circulatory disturbance. In this case report, we publish a patient with ileus due to a greft which has been used in a previous abdominal surgery for abdominal aort aneurysm.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):164-166.
• Article: [Analysis of the pediatric trauma score in patients wounded with shrapnel; the effect of explosives with high kinetic energy: results of the first intervention center.]

  Hüseyin Taş, Ayhan Mesci, Suzi Demirbağ, Mehmet Eryılmaz, Taner Yiğit, Yusuf Peker
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  ABSTRACT: BACKGROUND: We aimed to assess the pediatric trauma score analysis in pediatric trauma cases due to shrapnel effect of explosives material with high kinetic energy. METHODS: The data of 17 pediatric injuries were reviewed retrospectively between February 2002 and August 2005. The information about age, gender, trauma-hospital interval, trauma mechanism, the injured organs, pediatric Glasgow coma score (PGCS), pediatric trauma score (PTS), hemodynamic parameters, blood transfusion, interventions and length of hospital stay (LHS) were investigated. RESULTS: While all patients suffered from trauma to the extremities, only four patients had traumatic lower-limb amputation. Transportation time was <=1 hour in 35% of cases, and >1 hour in 65% of cases. While PTS was found as <=8 in 35.3% of cases (n=6), the score was found to be higher than 8 in 64.7% of them (n=11). Median heart rate in patients with PTS <=8 was 94 beats/min. This value was 70 beats/min in those with PTS >8 (p=0.007). Morbidity rates of PTS <=8 cases and PTS >8 cases were 29.4% and 5.9%, respectively (p=0.026). While LHS was 22.8 days in PTS <=8 cases, LHS was found to be only 4 days in PTS >8 cases. This difference was found to be statistically significant (p=0.001). CONCLUSION: PTS is very efficient and a time-saving procedure to assess the severity of trauma caused by the shrapnel effect. The median heart rate, morbidity, and LHS increased significantly in patients with PTS <=8.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):140-144.
• Article: [Effects of anti-edema drugs on diffuse cerebral edema in rats: Experimental study.]

  Fevzullah Akyüz, Merih Iş, Hikmet Aytekin, Murat Anlar, Osman Akgül
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  ABSTRACT: BACKGROUND: Traumatic brain edema is one of the most common problems encountered in neurosurgical practice and it leads to morbidity and mortality via increased intracranial pressure. The aim of this study was to examine the effect of hypertonic saline on traumatic brain edema in comparison to mannitol. METHODS: Eighty adult male Sprauge-Dawley rats weighting 300-350 g were used in this experimental study. Rats were randomly divided into control (C); trauma (T); mannitol only trauma+mannitol; NaCl 3% only; Trauma+NaCl 3%; NaCl 7.5% only; trauma+NaCl 7.5%; NaCl 23.4% only and trauma+NaCl 23.4% groups. All medications were given intraperitoneally. Rats were sacrificed and decapitated 24 hours after trauma with or without medications and the brains were examined histopatologically. RESULTS: Although no difference was observed with regard to hemorrhage between trauma only and trauma+NaCl 23.4% groups, there was a statistically significant difference in brain edema within these two groups (p=0.003). There were no statistically significant differences within groups with respect to plasma osmolarity and serum sodium levels. CONCLUSION: This study demonstrates that 23.4% NaCl is more effective than other concentrations of hypertonic saline or mannitol in the prevention of posttraumatic brain edema. Further clinical studies with different dosages and concentrations of hypertonic saline are required.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):89-97.
• Article: Assessment of the severity of acute pancreatitis by contrast-enhanced computerized tomography in 350 patients.

  Mohd Altaf Mir, Biant Singh Bali, Riyaz Ahmad Mir, Hamza Wani
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  ABSTRACT: BACKGROUND: This prospective study has been conducted with the aim to assess the severity of acute pancreatitis. METHODS: The study included 350 consecutive patients with acute pancreatitis admitted over a period of five years. All these patients were subjected to detailed history and clinical examination and investigations to ascertain the diagnosis. The severity was assessed by contrast - enhanced computed tomography (CT). Data collected were tabulated and subjected to appropriate statistical analysis. RESULTS: On the basis of the CT Severity Index (CTSI), the severity of acute pancreatic was classified into Group A (mild), Group B (moderate), or Group C (severe). Group C patients had the most complications (in 77 [91.67%] patients), and Group A patients had the least (in 7 [6.25%] patients). Mortality was found to be highest among Group C (14 [16.67%] patients), indicating the severe nature of disease in these patients, while no mortality was noted in Group A patients. The mean duration of hospital stay of patients in Group A was 9.25 days, Group B 12.0 days and Group C 24.58 days. CONCLUSION: The use of contrast-enhanced computed tomography as a routine investigation in patients to predict a severe attack of acute pancreatitis early in the course of the disease decreases overall mortality and burden of disease.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):103-108.
• Article: Intestinal stenosis from mesenteric injury after blunt abdominal trauma in children: case reports.

  Mustafa Imamoğlu, Haluk Sarıhan
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  ABSTRACT: The incidence of mesenteric injury after blunt abdominal trauma (BAT) has increased in recent years; however, relatively little attention has been paid to instances of its sequelae, especially in childhood. We present three children who had post-traumatic intestinal stenosis (PIS). A history of BAT was obtained in all. They had abdominal pain, bilious vomiting and peritoneal signs. The time intervals, the duration from the initial trauma to the onset of symptoms, ranged from 23 to 62 days. Stenotic segments were parallel to the location of the previously recognized mesenteric hematoma (MH), and resection with primary anastomosis was performed. Pathological examinations of specimens confirmed mucosal and mural ischemia and full-thickness fibrosis of the intestinal wall. In our opinion, large MH may pose an increasing risk of narrowing in the adjacent intestine at different time points. Therefore, if there is a large MH at laparotomy after BAT, it should be evacuated and the bleeding halted. For the differential diagnosis, typical BAT should be investigated carefully in cases presenting with intermittent colic abdominal pain and/or partial intestinal obstruction findings.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):183-185.
• Article: Hepatic hydatid disease requiring urgent treatment during pregnancy.

  Candaş Erçetin, Ilgin Ozden, Cem Iyibozkurt, Koray Güven, Kürşat Serin, Orhan Bilge, Yaman Tekant, Aydın Alper, Ali Emre
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  ABSTRACT: BACKGROUND: Pregnant women may experience an acute presentation of hepatic hydatid disease. The available literature is limited to case reports. METHODS: The charts of 7 patients who underwent urgent treatment for hepatic hydatid disease during pregnancy between 1992 and 2010 were reviewed. RESULTS: The median patient age was 27 (range 23-39) years and median gestational age was 18 (range 13-24) weeks. The symptoms were severe abdominal pain (4), vomiting (2), jaundice (2), pruritus (2) and severe dyspepsia (1); in the asymptomatic patient, a closed intraperitoneal rupture had been detected during gynecologic ultrasonography. Surgical drainage of the cysts was performed in all cases. The two patients with frank biliary rupture underwent choledochoduodenostomy or Roux-Y hepaticojejunostomy. Four patients required postoperative tocolysis. Albendazole was not used. All mothers gave birth to healthy babies at term. The patients were followed for a median of 9 (range 4-19) years. Two patients developed recurrences at 2 and 7 years; these were treated with surgical drainage and albendazole. CONCLUSION: This entity entails the responsibility of two human beings. Although it imposes limitations on the routine diagnostic and therapeutic options due to risk of premature labor or teratogenicity, acceptable results can be obtained in collaboration with the department of obstetrics and gynecology.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2013; 19(2):119-122.