Volume: 19 Issue: 1 - January 2013 | |
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EXPERIMENTAL STUDY | |
1. | The histopathological investigation of the effect on regional and systemic tissues of the application of Medicinal Plant Extract Ankaferd Blood Stopper in deep tissue injuries in Rats Mehmet Okumuş, Kasım Zafer Yüksel, Davut Özbağ, Harun Çıralık, Zeki Yılmaz, Yakup Gümüşalan, Vedat Bakan, Ali Murat Kalender PMID: 23588971 doi: 10.5505/tjtes.2013.65642 Pages 1 - 7 Purpose: This study was planned to evaluate the hystopathological changes under light microscope when the ABS (mixture of five plant extracts) was applied in deep tissue hemorrhage and the systemic organ effects as animal study model. Materials and Methods: A total of 50 Wistar Albino rats were divided into 5 groups each consisting 10 rats. The rats underwent femoral vein puncture and treated with ABS tampon, ABS spray, Surgicel and one group left untreated. After 2 weeks, each group underwent partial tissue excision in the same femoral region and as well as from brain, heart, kidney and liver. Results: The specimens from all group was obtained from femoral region after two weeks and evaluated under light microscope. The light microscope revealed any histopathological changes on neurovascular structures or in deep connective tissues in all groups. Conclusions: Ankaferd Blood Stopper provided hemostasis and was observed to stop bleeding. There were any hystopathological changes in tissue level and no pathological effects in other organs tissues under light microscope, the remote organ tissue remain clear. |
2. | Glucosamine-Sulfate On Fracture Healing Akın Uğraş, Elif Güzel, Petek Korkusuz, İbrahim Kaya, Fatih Dikici, Emrah Demirbaş, Ercan Çetinus PMID: 23588972 doi: 10.5505/tjtes.2013.03256 Pages 8 - 12 Amaç: Bu çalışmanın amacı kıkırdak glukozaminin kırık iyileşmesi üzerinde etkisi olup olmadığının araştırılmasıdır. Yöntemler: 61 dişi şıçan tibiasında tek taraflı kırık oluşturuldu. Sıçanlara ya 230mg/kg glukozamin sülfat verildi ya da ilaç verilmedi. Kırıklar birinci, ikinci ve dördüncü haftalarda incelendi. Yeni kemik oluşum miktarı ve osteoblast sayısı histolojik olarak ölçüldü. Histomorfometrik analiz için kırık iyileşmesi semikantitatif olarak skorlandı. Radyografik olarak kemik köprü oluşumu değerlendirildi. Sonuçlar: Glukozamin verilen grupta yeni kemik oluşumu ve osteoblast sayısı 1. haftada anlamlı derecede yüksekti. 1. ve 4. haftalarda kontrol grubuna göre, glukozamin verilen grupta çevre bağ dokusu hücre sayısı bakımından zengin, daha vasküler ve yeni oluşan kemik trabekülleri daha fazla sayıdaydı. Fakat radyolojik olarak 4. haftada kontrol grubu, glukozamin verilen gruptan daha iyi skorlar aldı. Tartışma: Bu veriler günlük glukozamin verilmesinin sıçan tibiasında kırık iyileşmesinin erken fazını, artmış yeni kemik oluşumu ve osteoblast sayısı ile histolojik olarak hızlandırdığı, fakat radyolojik olarak aynı etkinin görülmediğini göstermektedir. Background: The aim of this study is to determine whether glucosamine-sulfate has any effects on bone-healing. Methods: An unilateral fracture was created in the tibia of sixty-one female rats. Rats were given no drug or 230mg/kg glucosamine-sulfate daily. Fractures were analyzed at first, second and fourth weeks after creation of fracture. Quantitative measurement for new bone formation and osteoblast lining were determined histologically. Semiquantitative score for fracture healing was used for histomorphometric analyses. Bridging bone formation was assessed radiographically. Results: New bone formation and osteoblast lining were significantly higher in glucosamine-treated group at week 1. Surrounding connective tissue was more cellular, vascular, and the newly formed bone trabecules were in bigger amount in glucosamine-treated group, comparing to control group at week 1 and 4. But radiologically, the control group had better scores than that of the glucosamine-treated group at week 4. Conclusion: These data demonstrate that daily glucosamine sulfate administration accelerate early phase of fracture repair in the rat tibia, with increased new bone formation and osteoblast lining histologically, but radiologic bone union is not favoured on radiographs |
ORIGINAL ARTICLE | |
3. | The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain Cüneyt Kırkıl, Koray Karabulut, Erhan Aygen, Yavuz Selim İlhan, Mesut Yur, Kenan Binnetoğlu, Nurullah Bülbüller PMID: 23588973 doi: 10.5505/tjtes.2013.88714 Pages 13 - 19 Amaç: Sağ alt kadran (SAK) ağrısı olan hastaların gereksiz hastane yatışları ve bnegatif apendektomiler tedavi giderlerini artırır. Bu çalışmada, apandisit skorlama sistemlerinin tedavi maliyetine etkisini değerlendirmeyi amaçlandı. Gereç ve Yöntem: Bir yıl içinde SAK ile hastanemiz genel cerrahi kliniğine kabul edilen hastaların kayıtları incelendi. Alvarado ve Lintula skorları hesaplandı. Ameliyat kararı vermede skorlama önerileri kullanılmış olsaydı tedavi giderlerini saptamak için bir benzetim çalışması düzenlendi. Bulgular: 114 hastanın 64’üne (%56) apendektomi yapıldı. Negatif apendektomi oranı %17.2 idi. Alvarado ve Lintula skorlarının “yatış” ve “tedavi” kararı vermedeki genel doğruluk oranları sırasıyla %82.7 ve %91.9 idi (p=0.102). Hastaların tümü için toplam tedavi maliyeti 39,655 $ idi. Alvarado ve Lintula skorları kullanılmış olsaydı toplam tedavi giderleri sırasıyla 34,087 $ ve 25,772 $ (p=0.015 ve p=0.000); negatif apendektomi oranları %18.5 ve %3.6 olacaktı. Sonuç: Alvarado ve Lintula skorlarının hastaneye kabul ve apendektomi kararı için kullanılması akut SAK ağrısı için tedavi giderlerini düşürecektir. Background: Unnecessary hospital admissions and negative appendectomies increase healthcare costs of patients with right lower quadrant (RLQ) pain. This study aimed to evaluate the impact on the cost of treatment in appendicitis scoring systems. Methods: Charts were reviewed of patients admitted to the general surgery ward of our hospital with RLQ pain within a year. Alvarado and Lintula scores were calculated and a simulation was performed to determine the treatment charges which would have been generated had the scoring recommendations been used for admission and surgical decision-making. Results: Of the 114 admitted patients, 64 patients (56%) underwent appendectomy. The rate of negative appendectomy was 17.2 per cent. The overall accuracy rates of the Alvarado and Lintula scores for both ‘admit’ and ‘operate’ decision-making were 82.7 and 91.9%, respectively (p=0.102). Total charges for the 114 patients were $39,655. If the Alvarado or Lintula scores had been used, the total treatment charges would have been $34,087 and $25,772 (p=0.015 and p=0.000), with negative appendectomy rates of 18.5% and 3.6%, respectively. Conclusion: The implementation of Alvarado and Lintula scores for the decision of hospital admission and appendectomy would have reduced overall treatment charges for acute RLQ pain. |
4. | Management of Acute Appendicitis in Pregnancy Selin Kapan, Mehmet Abdussamet Bozkurt, Ahmet Nuray Turhan, Murat Gönenç, Halil Alış PMID: 23588974 doi: 10.5505/tjtes.2013.81889 Pages 20 - 24 Background: Acute appendicitis is the most common surgical nonobstetric pathology during pregnancy. In this report pregnant patients operated with diagnosis of acute appendicitis in the last 3 years are evaluated retrospectively. Methods: Between January 2009 and January 2011, 20 pregnant patients were operated for acute appendicitis. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay, mean operative time and outcome. Results: In 17 of 20 patients acute appendicitis was confirmed and appendectomy was performed. Ten of patients were operated with laparoscopic technique and remaining ten had open appendectomy. There was no fetal or maternal morbidity and mortality in any patient. All 20 patients delivered healthy babies on the postoperative course. Conclusion: Acute appendicitis is a challenging diagnosis in pregnant patient, however early surgical intervention should be performed with any suspect. Type of surgery depends on the surgeon’s choice and experience. |
5. | The missed extremity fractures in emergency department Erhan Er, Pınar H Kara, Orhan Oyar, Erden E Ünlüer PMID: 23588975 doi: 10.5505/tjtes.2013.08555 Pages 25 - 28 AMAÇ: Bu çalışmanın amacı izole ekstremite travmalarında, acil servis doktorlarının yorumlarının resmi radyoloji raporlarıyla karşılaştırılmasıyla en zor yorumlama alanını belirlemek ve acil doktorlarının yorumlarının doğruluğunu analiz etmektir. GEREÇ VE YÖNTEM: Radyolog raporları ve acil servis doktorlarının yorumları izole ekstremite travmalı hastalarda retrospektif olarak 01.05.2011’den 31.05.2011 tarihine kadar karşılaştırıldı. Toplam 608 vakada 181 kırık saptandı. BULGULAR: Yanlış yorumlanan kırıkların yerleri sırasıyla ayak bileği ve ayak (%51.4), bilek ve el (%32.4), dirsek ve önkol (%5.4), omuz ve üst kol (%5.4), kalça ve uyluk (%2.7), diz ve bacak (%2.7) olarak belirlenmiştir. Acil servis doktorlarının ve radyologların tanısal doğrulukları arasında anlamlı bir fark saptanmadı (kapa=0.856, p=0.001). SONUÇ: En sık atlanan kırık tiplerinin bilinmesi, bu konuda eğitimin yoğunlaştırılmasıyla acil servislerde kaçırılan vakaların minimuma indirilmesini sağlayabilir. BACKGROUND: The purpose of the study was to analyse the accuracy of emergency physicians’ (EP) interpretation of extremity traumas to determine the most difficult area for interpretation compared with official radiology reports for direct X-ray. METHODS: The radiologist reports and the EP reports of the direct X-rays from isolated extremity trauma patients were retrospectively compared from 01.05.2011 to 31.05.2011. A total of 181 fractures in 608 cases were confirmed. RESULTS: The locations of the misinterpreted fractures were ankle and foot (51.4%), wrist and hand (32.4%), elbow and forearm (5.4%), shoulder and upper arm (5.4%), hip and thigh (2.7%), and knee and leg (2.7%). The diagnostic accuracy of the EPs and radiologists were not significantly different (kappa = 0.856, p=0.001). CONCLUSION: Knowledge about the types of fractures that are most commonly missed facilitates a specifically directed educational benefit. |
6. | Prophylactic injection therapy is necessary for Forrest type 2b duodenal ulcers. Osman Zekai Oner, Murat Gonenc, Mustafa Uygar Kalayci, Mehmet Abdussamet Bozkurt, Selin Kapan, Halil Alis PMID: 23588976 doi: 10.5505/tjtes.2013.88220 Pages 29 - 32 Objective: To assess the effect of prophylactic injection therapy during the index gastroscopy on upper gastrointestinal bleeding due to Forrest type 2b duodenal ulcer. Methods: The patients who were admitted with upper gastrointestinal bleeding and who had emergency gastroscopy between January 2004 and January 2011 were retrospectively recruited to the study. Among those, the patients with Forrest type 2b duodenal ulcer were selected and divided into two groups. The patients in Group 1 had only diagnostic gastroscopy, whereas those in Group 2 had prophylactic injection therapy during the index gastroscopy. Results: Eighty seven patients were included to the study. There were 41 patients in Group 1 and 46 patients in Group 2. There was a significant difference in the incidence of rebleeding (26.8% versus 6.5%, p=0.017). The mortality rate was similar in both groups (9.7% versus 2.1%, p=0.184). Conclusion: We recommend prophylactic injection therapy in patients with upper gastrointestinal bleeding who have Forrest type 2b duodenal ulcer. |
7. | The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation. Mehtap Ilgar, Muzaffer Elmali, Mehmet Selim Nural PMID: 23588977 doi: 10.5505/tjtes.2013.44538 Pages 33 - 40 Amaç: Bu çalışmada gastrointestinal kanal perforasyonlu hastalarda batın bilgisayarlı tomografinin perforasyon bulgularını ve perforasyon yerini belirlemedeki rolünü araştırdık. Gereç ve Yöntem: Temmuz 2007 ve temmuz 2010 tarihleri arasında, gastrointestinal kanal perforasyonu olduğu cerrahi olarak kanıtlanmış 47 hastanın ameliyat öncesi batın BT görüntüleri retrospektif olarak yeniden değerlendirildi. Her bir hasta için BT de serbest hava, kontrast madde kaçağı, duvar kalınlaşması, duvar devamsızlığı, apse, flegmon ve serbest sıvı varlığı araştırıldı. Belirlenen bu bulgular ışığında perforasyon yeri tahmin edildi ve cerrahi sonuçlar ile karşılaştırıldı. Bulgular: Batın BT bulgularına göre; gastroduodenal perforasyonu olan hastaların %85,7’sinde, ince barsak perforasyonu olanların %85,7’sinde, kalın barsak perforasyonu olanların %69,2’sinde, rektum perforasyonu olanların %100’ünde, apendiks perforasyonu olanların %90,9’unda, tüm hastaların ise %82,9’unda perforasyon yeri doğru olarak belirlendi. Gastrointestinal kanal perforasyonunda BT’ de en sık rastlanan bulgu % 89.4 oranı ile batında serbest sıvı idi. Diğer bulguların rastlanma oranları ise sırasıyla şöyleydi; serbest hava: %76.6, segmental duvar kalınlaşması: %48.9, duvar devamsızlığı: %25.5, apse: %12.8, flegmon: %10.6. Oral kontrast kullanılan 30 hastanın 7 sinde (%23.3) ekstraluminal kontrast kaçağı saptandı. Sonuç: BT gastrointestinal kanal perforasyon bulgularını ve perforasyon yerini belirlemede oldukça etkilidir. Background: In this study, we investigated the role of abdominal CT in determining perforation findings and site in patients with gastrointestinal tract perforation. Methods: Preoperative abdominal CT scans of 47 patients who had surgically proven gastrointestinal tract perforation between July 2007 and July 2010 were reviewed, retrospectively. The presence of free air, leakage of contrast material, wall thickness, wall discontinuity, abscess, free fluid and phlegm on were investigated for each patient. The results were compared with the surgical outcomes. Results: Perforation sites were determined correctly in 85.7% of the patients with gastro duodenal perforation, 85.7% of the patients with small bowel perforation, 69.2% of the patients with large bowel perforation, 100% of the patients with rectum perforation, 90.9% of the patients with appendix perforation, and 82.9% of all the patients according to the abdominal CT findings. The most common CT finding in gastrointestinal tract perforation was free fluid with a rate of 89.4%. The rate of other findings were as follows respectively: free air 76.6 %, segmental wall thickening 48.9%, wall discontinuity 25.5%, abcess 12.8%, phlegmon 10.6%. Of 30 patients who received oral contrast, 7(23.3%) had extraluminal contrast leakage. Conclusion: CT is very effective in determining gastrointestinal tract perforation findings and site of perforation. |
8. | Inferior glenohumeral dislocation (luxatio erecta humeri): Report of six cases and review of the literature Ahmet İmerci, Yalçın Gölcük, Sabri Gökhan Uğur, Hüseyin Tamer Ursavaş, Ahmet Savran, Levent Sürer PMID: 23588978 doi: 10.5505/tjtes.2013.35305 Pages 41 - 44 Amaç: İnferior omuz çıkığı, ayrıca luxatio erecta olarak adlandırıp omuz çıkığının nadir görülen bir tipidir. Görülme sıklığı tüm omuz çıkık arasındaki yaklaşık 200 (% 0.5) de 1 'dir. Bu çalışmanın amacı, inferior omuz çıkığının klinik ve radyolojik olarak sunumu, tedavisi ve nihai sonucun 6 olgu ile gözden geçirilmesidir. Hastalar: Dört erkek ve iki kadın, toplam 6 hasta aşağı omuz çıkığı tanısı ile 2007 ve 2010 yılları arasında tedavi edilmiştir. Tedavi ettiğimiz bu hastalar nedeniyle, bizim amacımız kaynaklar paralelinde deneyimimizi paylaşmaktır. Bulgular: Hastaların omuz fonksiyonlarını değerlendirmek için Constant omuz skorlaması kullanılarak ağrı, pozisyon, günlük yaşam aktiviteleri, eklem hareket açıklıkları ve güçü kaydedildi. Hastaların tamamında kapalı redüksiyon ve rehabilitasyon ile tedavi sonrası 2 yıl içinde tam fonksiyonel iyileşme sağlanarak mükemmel yada iyi sonuç alındı. Sonuçlar: Doktorlar bu nadir durumun oluşumuna aşina olmalı ve doğru redüksiyon teknikleri dışında yapılan erken redüksiyonlar neticesinde oluşabilecek muhtemel komplikasyonları önlemeleri gerekir. Objectives: Inferior shoulder dislocation, also named as luxatio erecta, is a rare type of shoulder dislocation. Its incidence is about 1 in 200 (0.5%) among all shoulder dislocations. The objective of this study was to review six cases of inferior shoulder dislocation, their clinical and radiological presentation, management and final outcome. Patients: Four male and two female, a total of 6 patients with the diagnosis of inferior shoulder dislocation have been treated between the years 2007 and 2010. Because of these patients that we have treated, our purpose is to present our experience with parallel research of the bibliography. Results: Constant score was used to evaluate shoulder function. Pain, position, daily activities, range of motion and strength scores were noted. All patients had good to excellent results with full functional recovery within 2 years after closed reduction and shoulder rehabilitation. Conclusions: Doctors should be familiar with the occurrence of this infrequent condition and should prevent possible complications that might result from early reductions with correct maneuvers except ordinary reduction techniques. |
9. | Does a penetrating diaphragm injury have an effect on morbidity and mortality? Bünyami Özoğul, Abdullah Kisaoglu, Gurkan Ozturk, Sabri Selçuk Atamanalp, Yener Aydin, Bülent Aydinli, Mehmet İlhan Yildirgan PMID: 23588979 doi: 10.5505/tjtes.2013.14194 Pages 45 - 48 Amaç: Bu çalışmada penetran abdominal hasar ile birlikte olan diafragma rüptürlerini inceledik. Gereç ve yöntem: Bu çalışmaya Ocak 1996- Aralık 2010 tarihleri arasında Genel Cerrahi Kliniği’nde penetran abdominal travmalı 237 hastanın kayıtları retrospektif olarak incelendi. Diafragmatik rüptüre sahip olmayan hastalar Grup 1 ve diafragmatik rüptüre sahip olan hastalar Grup 2 olarak ayrıldı. Bulgular: 177 hastada diafragmatik hasar yoktu ve 60 hastada ise diafragmatik hasar vardı. Diafragmatik hasar hastaların 12’sinde sağda, 7’sinde bilateral ve 41’inde sol tarafta idi. 11 vakada toraksa herniasyon vardı ve en fazla kolon, mide, omentum, ince barsaklar ve dalak torakal kaviteye herniye idi. Postoperatif komplikasyon oranımız Grup 1’de %50 (n=89) ve Grup 2’de %47 (n=28) idi. Her iki grup arasında istatistiksel olarak anlamlı bir fark yoktu (p˃0.05). Hastanede kalış süresi Grup 2’de az miktar fazla olmasına rağmen anlamlı bir fark yoktu (p˃0.05). Grup 1 ‘de 17 hasta (%9.6) ve Grup 2’de 4 hasta (%6.6) eksitus oldu. Mortalite hızları iki grup arasında anlamlı değil idi (p˃0.05). Sonuç: Penetran abdominal travmalı hastalarda diafragmatik rüptür yaygın değildir. Penetran yaralanmalarda diafragma yaralanması olan hastalarla olmayan hastalar arasında fark bulunamamıştır. Aim: In this study, we investigated the diaphragmatic ruptures that accompanied penetrating abdominal injury. Material and Methods: Retrospectively 237 patients records with penetrating abdominal trauma in General Surgery Clinics between January 1996 and December 2010 were investigated. Patients with diaphragmatic rupture were designated to Group 1 and those without were designated to Group 2. Results: There was no diaphragmatic injury in 177 patients, and there was diaphragmatic injury in 60 patients. Diaphragmatic injury was on the right side in 12, on the left side in 41, and bilateral in 7. Eleven had thoracic herniation and the most common hernia contents were colon, stomach, greater omentum, the small bowel and the spleen. The postoperative complication rate was 50% in Group 1 (n=89) and 47% in Group 2 (n=28). There was no significant difference between the two groups (p˃0.05). The length of hospital stay was slightly increased, but not significant in Group 2 (p˃0.05). Seventeen patients (9.6%) in Group 1 and four patients (6.6%) in Group 2 died. The mortality rates between the two groups were not significant (p˃0.05). Conclusion: Diaphragmatic rupture is not common among patients with penetrating abdominal trauma. There was no difference between patients that had penetrating injuries with or without diaphragmatic injuries in terms of mortality and morbidity. |
10. | Local Differences in Epidemiology of Traumatic Spinal Injuries Mehmet Özgür Erdoğan, Sibel Anlaş Demir, Mehmet Koşargelir, Şahin Çolak, Engin Öztürk PMID: 23588980 doi: 10.5505/tjtes.2013.74501 Pages 49 - 52 Giriş: Spinal kord yaralanması ömür boyu süren etkiye sahiptir. Hastalar ve toplum için ağır sosyal ve ekonomik etkileri vardır. Bu çalışmanın amacı şehir yaşamının TSCI üzerinde yarattığı epidemiyolojik farklılıkları tanımlamaktır. Materyal Metot: Haydarpaşa Numune Eğitim ve Araştırma Hastanesi acil servisine Ocak 2007-Aralık 2011 arasında başvuran 409 TSCI hastası değerlendirildi. Kategorik değişkenler için Fischer Exact testi; parametrik veriler için Independent Samples T testi kullanıldı. Sonuçlar: En sık yaralanma şekli yüksekten düşmelerdi. 85(%20.8)hasta basit düşme sonucu yaralanmıştı. En sık ikinci yaralanma şekli basit düşmelerdi. 196(%48) hasta lomber spinal yaralanma geçirmişti. En sık lomber spinal yaralanmalar gözlenmişti. Torakal bölge en sık ikinci yaralanan bölgeydi. Lomber spinal yaralanmalar yüksekten düşmelerde daha sıktı (p=0.00011). Basit düşmelerde torakal bölge yaralanmaları daha sıktı (p=0.003). Otomobil kazalarında belirgin şekilde servikal (p=0.00001) ve lomber (p=0.004) yaralanmalar daha sıktı. Karar: Servikal yaralanmalar otomobil kazalarında daha sık olmaktadır. Şehir merkezinde otomobil kazasına bağlı TSCI oranı diğer çalışmalara göre daha azdı. Servikal yaralanma oranıda otomobil kazası ilişkili TSCI oranının azalması ile azalmıştır. Objectives: Spinal cord injury has a lifetime serious impact. It has obvious social and economic effects for patients and society. The aim of this study was to collect recent information and analyze changes in the epidemiology of traumatic spinal injuries. Patients and Methods: Data included TSCI patients admitted to ED of Haydarpasa Numune Training and Research Hospital between January 2007 and December 2011. 409 TSCI patients were included to the study. Categorical variables were analyzed with Fischer’s Exact Test and parametric variables were analyzed with Independent Samples T Test. Results: Most common injury mechanism was fall from heights. 85(%20.8) patients were injured in low falls. Second most common injury mechanism was low falls. Most common injury was lumbar spine injury. 196(%48) patients suffered isolated lumbar spine injury. Thoracal spine injuries were the second most common injuries. Lumbar spinal injuries (p=0.00011) were higher in high falls. Low fall was a significant mechanism for thoracal spine injuries (p=0.003). Automobile accidents had a significant relation with cervical (p=0.00001) and lumbar spinal injuries(p=0.004). Conclusion: Although cervical injuries were higher in automobile accidents, ratio of automobile accident related TSCI was less than other studies. Cervical injury ratio of population has decreased due to decrease in number of automobile accident related TSCI. |
11. | The management of penetrating abdominal trauma by diagnostic laparoscopy: A Prospective non-randomized study Faruk Karateke, Mehmet Özdoğan, Sefa Özyazıcı, Koray Daş, Ebru Menekşe, Yusuf Can Gülnerman, İlhan Bali, Safa Önel, Cihan Gökler PMID: 23588981 doi: 10.5505/tjtes.2013.40799 Pages 53 - 57 INTRODUCTION: Penetrating abdominal trauma (PAT) has been traditionally treated by exploratory laparotomy (EL). The aim of our study was to examine the use of diagnostic laparoscopy (DL) in the management of hemodynamically stable patients with PAT. MATERIALS and METHODS: A prospective study was performed to compare the outcomes of hemodynamically stable patients with suspected intra-abdominal injuries due to abdominal stab wounds who underwent either EL or DL. Data extracted for analysis included demographic information, operative findings, length of hospital stay, mortality, and postoperative complications. RESULTS: 52 hemodynamically stable patients were admitted to the trauma service. There were 45 male (86.5 %) and 7 female (13.5 %); average age was 34, 5 years-old (18 – 60). 26 (50 %) patients underwent EL, and 26 (50 %) patients underwent DL. Re-exploration by laparotomy was required in 9 of the 26 cases (34, 6 %). Patients who underwent DL had significantly shorter hospital stay (1,82±0,63 days versus 5,4 ±2,1 days; P<0.05) and shorter operation time (17,9±6,38 versus 68,4±33,2 minutes; P <0.05) than patients who underwent EL. CONCLUSION: Selective use of DL in the hemodinamically stable patients with PAT effectively decreased the rate of negative laparotomies, minimized morbidity, and decreased hospital stay. Key words: Diagnostic laparoscopy, penetrating abdominal trauma |
12. | Foreign Body Penetrations of Hand and Wrist; a Retrospective Study Emre Hocaoğlu, Samet Vasfi Kuvat, Burhan Özalp, Anvar Akhmedov, Yunus Doğan, Erol Kozanoğlu, Fethi Sarper Mete, Metin Erer PMID: 23588982 doi: 10.5505/tjtes.2013.04453 Pages 58 - 64 Amaç: Konuyla ilgili ileri seviyedeki pratik bilgi birikimimize rağmen, el ve elbileğinin yabancı cisim penetrasyon yaralanmaları, halen eksik tedaviler ve komplikasyonlarla gündeme gelebilmektedir. Konunun sosyal, etiolojik ve hukuki boyutu günlük yoğun pratik içinde atlanabilmektedir. Bu çalışmada, konunun sosyal, klinik ve terapötik özelliklerini ele almak amaçlanmıştır. Yöntem: Bir el cerrahisi kliniğince tedavisi yapılmış 86 hastanın retrospektif analizi yapılmıştır. Bulgular: Ortalama yaşı 32 olan popülasyonun %25,6’sı endüstriyel işçilerden ( en kalabalık mesleki grup) oluşmaktaydı. Başvuruların %26,7’si elektif idi. Yaralanma döneminde ek hastalığı olanlar popülasyonun %15,1’ini, psikiyatrik tanısı olanlar %5,8’ini oluşturuyordu. İşaret parmağı en sık yaralanan bölge (%33,7) idi. Operasyonların %94,2’si lokal anestezi altında yapılmıştı. %30 hastada nöral, tendinöz ve/veya kemiksel hasar mevcuttu. Hastaların %30’u postoperatif el fizyoterapi programına dahil edilmişlerdi. Sonuç: El ve elbileğinin yabancı cisim penetrasyon yaralanmaları genel yönleri ve pratikte gözden kaçabilen özellikleri ile ele alınmıştır. Background: Despite significant practical knowledge and experience on foreign body penetration injuries of the hand and/or wrist; deficient managements and complications can still be encountered and ignorance of its causative and eventual social aspects unfortunately is a substantial fact. This study aims to cover the clinical and social properties and the management of this kind of injuries. Methods: A retrospective analysis of 86 patients that needed evaluation and treatment in a Hand Surgery Division of a university hospital is made. Results: The median age was 32 (min: 4, max: 63). Industrial workers constituted the most crowded occupational group (n: 22, 25.6%). Twenty-three (26.7%) of the cases were elective admissions. Thirteen (15.1%) patients had various comorbidities and five (5.8%) had psychiatric diagnoses at the time of the injury. Index finger was the most frequent site of injury (n: 29, %33.7). General anesthesia was not necessary for the management of 94.2% of the cases. In 26 (30%) of the patients neural, tendinous or osseous damage was observed. Twenty-four (30%) patients were included in a postoperative hand physiotherapy program. Conclusion: The practically well known general features of the issue and its aspects that could still be overlooked currently are reevaluated in the light of our observational data. |
CASE REPORTS | |
13. | Unexpected Colonic Perforation in a Renal Recipient. A Case Report Kürşat Rahmi Serin, Metin Keskin, Hüseyin Bakkaloğlu, Fatih Tunca, Ali Emin Aydın, Cumhur Uluğ Eldegez PMID: 23588983 doi: 10.5505/tjtes.2013.53496 Pages 65 - 68 Background: Gastrointestinal complications such as gastrointestinal bleeding and perforation due to immunosuppressant use are seen more frequently after solid organ transplantation. Case: A 52 year-old male is admitted on the 7th day of a living donor renal transplantation with serous drainage at incision site. He didn’t have any abdominal complaints. He was on triple immunosuppressant therapy. Abdominal plain X-ray and US were found normally, but diffuse extraluminal air was detected at CT scan. There weren’t any pathological laboratory findings regarding to the function of the renal allograft. We began the operation laparoscopically and then converted to laparotomy. Sigmoid colonic perforation was detected on the antimesenteric side. Neither diverticulitis nor ischemia was observed, no evidence about iatrogenic injury was seen. And there was no transrectal instrumentation history. Omentoplasty and sigmoid loop colostomy was performed. He was discharged on the 9th day of the operation. His colostomy was closed on the first year of the operation. Conclusion: Gastrointestinal complications can be fatal, but don’t seem to influence the long term survival or renal allograft function. Most of them are seen after using high doses of immunosuppressants to manage early postoperative period or episodes of acute rejection. Early diagnosis and aggressive treatment play an important role on survival. |
14. | Post-traumatic Sagittal Sinus Thrombosis –case report Nayil Khursheed, Ramzan Altaf, Nizami Furqan, Abrar Wani, Ashish Jain, Yawar Ali PMID: 23588984 doi: 10.5505/tjtes.2013.79745 Pages 69 - 72 Background Post-traumatic superior sagittal sinus thrombosis is rare. The usual presentation is raised intracranial pressure symptoms. Case report A case of post-traumatic superior sagittal sinus thrombosis is presented where CT scan revealed depressed fracture of vertex with parasagittal contusions. Despite surgical elevation of fracture and repair of superior sagittal sinus, patient developed thrombosis of anterior half of superior sagittal sinus with bilateral hemorrhagic infarcts in motor strip. Discussion This case is reported for its rarity and to highlight the importance of post-operative vigil on such patients even after surgery. In such settings timely diagnosis and anticoagulant therapy is rewarding. |
15. | Diffuse Idiopathic Sceletal Hyperosteosis and Central Cord Syndrome After Minor Trauma: A Case Report Olcay Eser, Ergün Karavelioğlu, Mehmet Gazi Boyacı, Abdullah Ayçicek PMID: 23588985 doi: 10.5505/tjtes.2013.81593 Pages 73 - 76 Diffuse idiopathic sceletal hyperosteosis is characterised with anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in patient with DISH after minor trauma. The patient was treated surgically. We also discussed symptamotology and common mechanisim of cord injury in DISH. |
16. | Rotational head trauma with callosal contusion and C6 fracture: a high-speed motorcycle accident Gentian Vyshka, Blerti Troshani, Dorjan Bozaxhiu, Arben Mitrushi PMID: 23588986 doi: 10.5505/tjtes.2013.40374 Pages 77 - 79 We present the case of a 34 years old Albanian male, who fell from the motorcycle during a high-speed accident, after performing a triple pivotal-round circle in air at the site of the impact, before falling on the ground. The clinical picture thereafter was one of a deep coma, treated in the intensive care unit for nine days, till the patient regained conscience and long-term rehabilitation procedures were put in place. The magnetic resonance and computed tomography images were very illustrative of a rotational head trauma mechanism, since apart from multiple callosal hemorrhages and the lack of cranial fractures, a linear complex fracture of the C6 was seen as well, justifying orthopedic treatment through immobilization of the cervical spine. Rotational angular acceleration seems to be an important causative factor toward provoking diffuse brain and/or axonal injury; the etiological importance on the direct skull impact is controversial, but anyhow not negligible. |
17. | Unusual manifestation of acute retrocecal appendicitis: Pericholecystic fluid Oktay Algin, Evrim Ozmen, Aysenur Şirin Ozcan, Şehnaz Durmuz, Mustafa Karaoglanoglu PMID: 23588987 doi: 10.5505/tjtes.2013.74508 Pages 80 - 82 Subhepatic-retrocaecal appendicitis is a rare entity in which the diagnosis is challenging. In patients presented with right abdominal pain with atypical clinical, laboratory and ultrasound (US) findings, acute appendicitis should be eliminated with computed tomography (CT). Multi detector CT (MDCT) can be used effectively for the diagnosis of retrocaecal appendicitis without additional preparation or focused examination. Here we present a patient of acute subhepatic-retrocaecal appendicitis in whom clinical and US findings mimicked acute cholecystitis. To the best of our knowledge, there is no previous report related to acute appendicitis presented with only pericholecystic fluid and could be diagnosed with MDCT. In conclusion; retrocaecal-subhepatic appendicitis is a rare condition which might be presented with atypical clinical, laboratory and radiological signs. US is usually insufficient for the definitive diagnosis. In this situation MDCT could be a rapid and efficient tool for localizing the appendix and for differential diagnosis. |
18. | Double acute appendicitis in appendical duplication Semra Tutcu Şahin, Yamaç Erhan, Hasan Aydede PMID: 23588988 doi: 10.5505/tjtes.2013.80557 Pages 83 - 85 Appendiks vemiformis duplikasyonu nadir bir konjenital anomalidir ve genellikle laparotomi esnasında tesadüfen saptanır. Apendikslerin birinin diğerine ve çekuma göre lokalizasyonunu tanımlamada ve aynı zamanda duplikasyonun boyutunu göstermede modifiye Cave ve Wallbridge sınıflaması kullanılır. Bizler, akut karın ağrısı nedeniyle laparotomi uygulanan 45 yaşında bir hastayı bildirdik. Operasyon bulguları, apendiks duplikasyonu ile birlikte çift akut apandisit şeklinde idi. Tip B duplikasyon olması nedeniyle apendiksler ayrı ayrı alındı. Apendektomi en sık uygulanan abdominal cerrahi olması nedeniyle tüm cerrahlar bu nadir klinik antiteyi akılda tutmalıdırlar. Duplication of the vermiform appendix is a rare congenital abnormality and usually found incidentally during laparotomy. Modified Cave and Wallbridge classification is used to describe the locations of both appendixes according to each other and the cecum and also indicates the extent of the duplication. We report a 45-year-old patient who underwent laparotomy for acute abdominal pain. The operative finding was double acute appendicitis in appendical duplication. The appendixes were separately removed as it was Type B duplication. Since appendectomy is the most common abdominal operation, all surgeons should keep this rare clinical entity in mind. |
19. | Barolith, a rare cause of acute appendicitis: a case report Volkan İnce, Burak Işık, Cemalettin Koç, Adil Başkıran, Asım Onur PMID: 23588989 doi: 10.5505/tjtes.2013.39327 Pages 86 - 88 Baryum taşı, yoğunlaşmış baryum ile feçesten oluşur ve gastrointestinal sistem (GİS) görüntüleme çalışmalarından sonra nadiren görülür. Bu tür görüntüleme yöntemlerinde kullanılan baryum apendiks lümenine girebilir ve lümeni daraltarak yada tıkayarak nadiren akut apandisite sebep olabilir. Baryum yutularak ya da lavmanla yapılan bu görüntüleme tetkiklerinde, baryum %80-90 apendiks lümenini doldurur ve apendiks görüntülenir, ve bu sağlıklı apendiks bulgusu olarak kabul edilir. Tetkik sonrası %90-95 oranında baryum apendikste kalır ve bu kalma süresi hastaların %10 unda 72 saatten uzundur. Baryumun apendikste kalışı 2 aydan uzun sürerse komplike apendisitle sonuçlanabilir. Baryumlu çift kontrast kolon grafisinden 3 ay sonra, baryum taşına bağlı akut apandisit tanısı alan ve apendektomi yapılan 46 yaşında erkek hasta sunulmaktadır. Baryumlu görüntülemelerden sonra baryumun apendikste kalarak akut apandisite sebep olabileceği yönünden hastalar bilgilendirilmeli ki eğer karın ağrısı gelişirse, hızlı bir şekilde uygun tedavi için bir sağlık merkezine yönlendirilebilir ve erken müdahale ile akut apandisitin komplikasyonları önlenebilir. A barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, can cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualised in 80~90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90~95%) and 10% of the patients retain barium in the appendix beyond 72 h. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double contrast barium enema study. After barium studies, patients should be informed for retention of barium in the appendix and can cause acute appendicitis, so if abdominal pain develops, the patient can be referred to a medical centre for the appropriate treatment quickly and the complications of acute appendicitis can be prevented by early intervention. |