Volume: 18 Issue: 6 - November 2012 | |
Hide Abstracts | << Back | |
EXPERIMENTAL STUDY | |
1. | Effects of the aged garlic extract in spinal cord injury in the rat Berker Cemil, Emre Cemal Gokce, Husamettin Erdamar, Ayca Karabork, Ozlem Onur, Aylin Heper Okcu, Ramazan Yigitoglu, Bulent Erdogan PMID: 23588902 doi: 10.5505/tjtes.2012.84829 Pages 463 - 468 Amaç: Aged garlic extract (AGE) serebral iskemide nöroprotectif etkileri gösterilmiş güçlü bir antioksidan ajandır. Ancak garlic extract’ın omurilik yaralanmasında potansiyel koruyucu etkileri halen bilinmemektedir. Gereç ve yöntem: Wistar cinsi 19 yetişkin erkek sıçana klip kompresyon metodu ile omurilik travması uygulandı. Hayvanlar üç gruba ayrıldı. Travmadan 15 gün once sıçanlara gavajla oral yolla 250 mg/kg’a AGE suda çözülerek verildi. Omurilik yaralanması sonrası AGE verilen gruptaki sıçanların malondialdehyde (MDA) ve superoxide dismutase (SOD) seviyeleri, kontrol grubundaki ve sadece omurilik travması uygulanan gruptaki sıçanlarla karşılaştırıldı. Hayvanlar travma sonrası 24.saatte eğik düzlemde değerlendirildi. Deney sonrası omurilik doku örnekleri patolojik incelemeye gönderildi. Bulgular: Dokulardaki MDA ve SOD seviyeleri incelendiğinde, AGE verilmiş ve omurilik travması uygulanmış gruptaki sıçanlarda, sadece omurilik travması uygulanmış sıçanlara göre azalmış MDA ve artmış SOD seviyeleri saptandı. Bununla birlikte sonuçlar kontrol grubundakilere göre daha iyi değildi. AGE grubun patolojik bulguları omurilik yaralanması grubuna göre daha iyiydi. Aynı zamanda fonksiyonel değerlendirme bulguları benzer sonuçlar gösteriyordu. Sonuç: AGE, omurilik yaralanmasında koruyucu etkiler göstermiştir. AGE’ın etkinliği ile ilgili daha ileri ve farklı deneysel çalışmalara ihtiyaç duyulmaktadır. Background: Aged garlic extract (AGE) is a potent antioxidant agent with established neuroprotective effect in a cerebral ischemia. However, the potential protective effect of AGE in spinal cord injury (SCI) is still unknown. Methods: Nineteen adult, male Wistar rats received spinal cord trauma using the clip compression method. Animals were divided into three groups. 250 mg/kg per day of AGE diluted in tap water for 15 days prior to trauma was administered to the animals in the AGE group orally by gavage. After spinal cord trauma malondialdehyde (MDA) and superoxide dismutase (SOD) levels of the AGE group were compared with the animals that control and SCI group. The animals were examined by inclined plane 24 h after the trauma. At the end of experiment, spinal cord tissue samples were harvested for pathological evaluation. Results: Regarding tissue MDA and SOD levels after trauma, animals in AGE group demonstrated decreased MDA levels and increased SOD levels when compared with the SCI group. However, these results were no better than the control group. The AGE group demonstrated better pathological findings than the SCI group. In addition, the result regarding the functional finding was similar. Conclusions: AGE demonstrated neuroprotective effects in SCI. Further studies with different experimental settings are required to achieve conclusive results. |
ORIGINAL ARTICLE | |
2. | Predicting the outcome of children with head trauma: Comparison of FOUR score and GCS Fatih Büyükcam, Ural Kaya, Muhamed Evvah Karakılıç, Umut Yücel Çavuş, Feruza Turan Sönmez, Öner Odabaş PMID: 23588903 doi: 10.5505/tjtes.2012.23169 Pages 469 - 473 Amaç: Glasgow Koma Skalası'nın (GKS) özellikle sözel değerlendirmede kısıtlılıkları bulunduğundan birçok değişik skorlama sistemleri ortaya çıkmış ve bunlar GKS ile karşılaştırılmıştır. Bu çalışmada acil servise kafa travması ile getirilen çocuk hastalarda Full Outline of Unresponsiveness (FOUR) skorunun GKS skorundan daha iyi morbidite ve mortalite öngörüsünün olup olmadığı araştırıldı. Gereç ve Yöntem: 2-17 yaş arasında bilinç değişikliği ile acil servise getirilen kafa travmalı çocuk hastalar çalışmaya alındı. Hastane içi mortalite, üç günden fazla hastanede yatış, taburculukta ve üç ay sonraki Glasgow Sonuç Skoru (GOS) değerleri primer sonuç ölçümleri olarak alındı. Bulgular: Toplamda 100 hasta çalışmaya dahil edildi. Hastaların ortanca yaşı 6 ve %69'u erkekti. Hastane içi mortalite oranı %10'du. Hastane içi mortalite öngörüsünde FOUR skoru için eşik değer 9, GKS için 7 idi. GKS ve FOUR skoru; hastane içi mortalite, taburculukta ve üç ay sonraki kötü GOS öngörüsünde benzer değerlere sahipti. Sonuç: FOUR skorunun kafa travmalı çocuk hastalarda, morbidite ve mortalite öngörüsünde GKS''ye göre belirgin bir avantaj sağlamadığı gözlemlendi. Background: Because of the limitations of Glasgow Coma Scale (GCS), many scoring systems have emerged and compared with GCS. Herein, we investigated whether the Full Outline of Unresponsiveness (FOUR) score is better than GCS in predicting the morbidity and mortality of the children with head trauma. Methods: Patients admitted to the emergency department with head trauma between 2-17 years of age who presented with altered level of consciousness were included in this study. In-hospital mortality, hospitalization more than three days, Glasgow Outcome Score (GOS) at discharge and after three months were used as the primary outcome measures. Results: A total of 100 children were included in the study. The median age was 6 years, 69% of them were male. In-hospital mortality rate was 10%. The cut-off values for FOUR score in predicting in-hospital mortality was 9 and 7 for GCS. Area under curve (AUC) values in predicting in-hospital mortality, poor GOS (Score of 1-3) at discharge, poor GOS after 3-months are similar both for GCS and FOUR score. Conclusion: FOUR score don’t provide a significant advantage to GCS in predicting morbidity and mortality for children with head trauma. |
3. | Clinical value of Leukocyte counts in evaluation of patients with suspected appendicitis in emergency department Mohammad Zikrullah Tamanna, Uzma Eram, Turki Mohsen Al Harbi, Saleh Awad Alrashdi, Shafkat Ullah Khateeb, Saleem Ahmed Aladhrain, Abdul Muthalib Hussain PMID: 23588904 doi: 10.5505/tjtes.2012.83652 Pages 474 - 478 Objectives: - The objective of this study was to assess the value of total leukocyte count in patients presenting to the emergency department (ED) with sign and symptoms suggestive of acute appendicitis. Methods: - Patient demographics, presenting sign, and symptoms, initials total leukocyte count and discharge diagnosis was documented retrospectively. Admitted patients were followed for surgical and clinical outcomes, and discharged patients followed up by telephonic interview. Results: -Out of 116 eligible patients 48 patients was found to have acute appendicitis. Total Leukocyte count ≥10,000cell/mm3 yielded a sensitivity of 89.58% and a specificity of 64.71%.The positive predictive value (PPV) was 64.18%, and the negative predictive value( NPV ) was 89.80%.The positive likelihood ratio( +LR) was 2.54, and the negative likelihood ration( –LR ) was 0.16. The area under the curve (AUC) for the receiver operating characteristic( ROC) curve was 0.822, which was moderately accurate. Conclusions: -The total leukocyte counts are helpful in the diagnosis and exclusion of acute appendicitis. The elevated leukocyte count ≥10,000cells/mm3was statistically associated with the presence of acute appendicitis. The ROC curve suggests there is value of total leukocyte counts and has sufficient sensitivity and specificity to be clinical value in the diagnosis of acute appendicitis |
4. | Does preservation of active range of motion after acute elbow injury rule out the need for the radiography? Hassan Amiri, Samad Shams Vahdati, Sanaz Fekri, Shayan Abdollah Zadegan, Hamid Shokoohi, Vafa Rahimi-movaghar PMID: 23588905 doi: 10.5505/tjtes.2012.26790 Pages 479 - 482 Objective: To evaluate the role of a normal elbow active range of movements (ROM) in predicting low fracture risk and avoiding elbow X-ray in patients with acute elbow injuries. Lack of any approved rules for this purpose led us to evaluate simple physical examination methods to predict fractures of elbow. Methods: In this observational study, all patients with elbow injury presented to two emergency departments enrolled according to specific criteria. Patients were examined by emergency or orthopedics residents. Elbow radiographs were reviewed by a radiologist for fractures and soft tissue injuries. Results of clinical examination and radiographs were recorded for statistical analysis. Sensitivity, specificity, positive and negative predictive values were calculated. Results: Elbow fractures were identified in 10 of 102 enrolled patients (9.8%), Nine out of 10 had limited ROM in all movements. Limited active elbow ROM in predicting elbow fracture were revealed a sensitivity of 90%, specificity of 92%, and a positive and negative predictive values of 56% and 98%, respectively. Individuals with limitation in one or two directions had no signs of fracture in the X-rays. Conclusion: Patients with elbow injury and a limited ROM in all directions of flexion, extension, supination and pronation require further x-ray investigations. |
5. | The Natural Logarithm Transforms the Abbreviated Injury Scale That Improves Accuracy Scoring Xu Wang, Xiaoming Gu, Zhiliang Zhang, Fang Qiu, Keming Zhang PMID: 23588906 doi: 10.5505/tjtes.2012.08522 Pages 483 - 489 BACKGROUND The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments. But they do not display a linear relation to mortality. The mortality rates are significantly different between pairs of Abbreviated Injury Scale (AIS) triplets that generate the same ISS/NISS total. METHODS The LISS is defined as the sum of 1.7987 multiply by that 5.53 to the power of the natural logarithm by the three most severe AIS injuries regardless of body region in which then occur. LISS values were calculated for every patient in a large data set: 3,784 patients treated during a six-year period at the three Level of first-class comprehensive hospital in Affiliated Hospital of Hangzhou Normal University, China. The power of LISS to predict morality was then compared with previously calculated NISS values for the same patients in each of the data set. RESULTS We find that LISS is more predictive of survival as well (Receiver operating characteristic (ROC): NISS = 0.931, LISS = 0.949, P = 0.006). Moreover, LISS provides a better fit throughout its entire range of predicting (Hosmer Lemeshow statistic: NISS = 15.76, P = 0.027; LISS = 13.79, P = 0.055). CONCLUSION LISS should as the standard summary measure of human trauma. |
6. | Major Thoracic Vessels and Cardiac Trauma: Case Series from a centre in a developing country Saulat H Fatimi, Hashim M Hanif, Anum Awais, Ghina Shamsi, Marium Muzaffar PMID: 23588907 doi: 10.5505/tjtes.2012.39225 Pages 490 - 494 75% of all trauma-related deaths are related to Thoracic Trauma. Very few penetrating cardiac trauma patients arrive at the hospital alive. Due to the high prevalence an understanding of the pathogenesis, manifestations, and management of cardiac trauma is becoming increasingly important to medical personnel. We retrospectively reviewed the files of 169 patients with a preoperative diagnosis of vascular injury that underwent management at the Aga Khan University Hospital (AKUH) during 2001 to 2006. Out of these patients 13 had cardiovascular and cardiac injuries. There were 23% (n=3) Cardiac injuries, two right ventricle injuries and in one both the ventricles were injured. Great vessel injuries included; Pulmonary artery (n=2), Inferior Vena cava (n=1), Left Carotid Artery (n=1), Left Subclavian Artery (n=2) and Right Subclavian Artery (n=3). 53.8% of the patients suffered from post-operative complications. The overall mortality of patients was 15.4%. We believe that in comparison to the past the inevitable delay in the diagnosis lead to unsuccessful thoracotomies, late transfers to the operating room and physiological deterioration of the patients. As the incidence of trauma is increasing worldwide it is essential for surgeons to be prepared to handle cardiovascular and cardiac trauma injuries immediately, as delay can adversely affect the outcome in terms of both morbidity and mortality. |
7. | Clinical and radiological results in distal tibial physeal injuries Mustafa Can Taşkıran, Ali Turgut, Önder Kalenderer, Haluk Ağuş PMID: 23588908 doi: 10.5505/tjtes.2012.46548 Pages 495 - 500 Amaç: Bu çalışmada tibia alt uç büyüme plağı yaralanması sebebiyle cerrahi tedavi edilen çocuklarda yaralanmanın dağılımı incelenerek klinik ve radyolojik sonuçlar değerlendirilmiştir. Gereç ve yöntem: 26’sı kız, 33’ü erkek olan toplam 59 olgu retrospektif olarak değerlendirildi. Büyüme plağı kırıkları Salter-Harris’ sınıflamasına göre sınıflandırıldı; kırıkların 4’ü tip I, 22’si tip II, 29’u tip III ve 4’ü tip IV idi. 29 hastaya kapalı, 30 hastaya açık redüksiyon ve internal tespit uygulandı. Kırık anında ortalama hasta yaşı 10,9 (6-14) idi. Hastalar AOFAS sistemine göre değerlendirildi. Bulgular: Hastalar ortalama 3,8 saat (3-72) içinde ameliyata alındı. Tespitte 50 hastada yalnızca K teli, 6 hastada sadece vida, 3 hastada da K teli ve vida birlikte kullanıldı. İzlem süresi ortalama 71,7 ay (12-149) idi. Hiçbir hastada erken fizis kapanması, ekstremite kısalığı, açısal deformite oluşumu, enfeksiyon, kaynamama, osteonekroz gibi komplikasyonlar ile karşılaşılmadı. Son kontrollerinde AOFAS skoru ortalama 86,6 (65-100) olarak saptandı. Sonuç: Ayak bileği epifiz kırıklarında, erken müdahale ile en fazla iki kez redüksiyon manevrası kullanılarak yeterli redüksiyon ve stabil tespit sağlanması halinde başarılı sonuçlar elde edilebilir ve komplikasyonlar en aza indirilebilir. Background: In this study, we evaluated the clinical and radiological results of the distal tibial epiphyseal fractures in children treated with surgery. Methods: We evaluated 59 patients (33 boys and 26 girls) retrospectively. Physeal fractures were classified according to the Salter-Harris classification; 4 fractures were in type I, 22 were in type II, 29 were in type III and remaining 4 fractures were in type IV. Closed reduction and internal fixation was performed in 29 patients while open reduction and internal fixation were performed in 30 patients. Mean age at the time of trauma was 10.9 years (6-14). Patients were evaluated by AOFAS score. Results: Patients were operated in mean 3.8 hours time (3-72). Fixation was performed with K-wire in 50 patients, with screw in 6 patients, and with both K-wire and screw in 3 patients. Mean follow-up time was 71.7 months (12-149). Complications like premature physeal arrest, limb length inequality, angular deformity, infection, nonunion, and osteonecroses were not observed in any patients. Mean AOFAS score was 86.6 (65-100) at last follow-up. Conclusion: Successful results with fewer complications could be obtained in ankle ephyseal fractures by early management through adequate reduction and stabilized fixation using maximum two reduction maneuvers. |
8. | Infection in the patients with isolated head injury: risk factors and the impact on treatment cost Alp Arslan, Barış Birgili, Ahmet Tolgay Akıncı, Osman Şimşek, Cumhur Kılınçer PMID: 23588909 doi: 10.5505/tjtes.2012.06791 Pages 501 - 506 Amaç: İzole kafa travmalı hastalarda enfeksiyonun risk etkenlerini ve tedavi maliyeti üzerine etkisini saptamak. Gereç ve Yöntem: Trakya Üniversitesi Tıp Fakültesi Hastanesi’nde 2001–2007 yılları arasında 72 saatten uzun süre hastanede yatan izole kafa travmalı 299 olgunun verileri geriye yönelik olarak incelendi. Olgulara ait yaş, cinsiyet, ilk nörolojik muayene, radyolojik bulgular, yatış süresi, ameliyat gereksinimi, enfeksiyonun maliyeti, toplam maliyet ve çıkış skoru değerleri belirlendi. Olgular enfeksiyon gelişimine göre iki gruba ayrılarak, risk etkenleri ve enfeksiyonun tedavi maliyeti üzerine etkisi açılarından karşılaştırıldı. Bulgular: Enfeksiyon gelişen grupta giriş Glasgow Koma Ölçeği değerleri ortalamasının daha düşük; anizokori, ışık refleksi kaybı, taraf bulgusu, kaide kırığı, subdural hematom ve serebral ödem bulgularının daha sık; hastanede yatış süresinin yaklaşık dört kat, toplam tedavi maliyetinin yaklaşık on kat ve ölüm oranının anlamlı derecede daha yüksek olduğu saptandı. Hafif kafa travmalı hastalarda, enfeksiyon gelişen grupta gelişmeyen gruba kıyasla yaş ortalamasının daha yüksek olduğu saptandı. Sonuç: İzole kafa travmalı hastalarda enfeksiyon gelişmesi için bazı risk etkenleri vardır ve enfeksiyon gelişmesi ile hastanede yatış süresi, toplam tedavi maliyeti ve ölüm oranı artmaktadır. Objective: To determine risk factors and the impact on treatment cost of infection, for patients with isolated head injury. Materials and Methods: Data acquired from 299 patients with isolated head trauma hospitalized for more than 72 hours at Trakya University Medical Faculty Hospital between years 2001-2007, were evaluated retrospectively. Data including age, gender, initial neurological examination, radiological findings, duration of hospitalization, need for surgery, cost of infection treatment, total cost of care and outcome scores were determined. Two groups divided according to the development of infection are compared for risk factors and the impact of infection on the cost of treatment. Results: On the group of patients with infection the mean Glasgow Coma Scale value at delivery was lower; anisocoria, light reflex loss, lateralized deficit, skull base fracture, subdural hematoma, cerebral edema findings were more frequent; a four times longer hospital stay, a ten times higher total cost and a significantly increased mortality rate have been found. For the patients with light head injury, on the group of patients with infection the mean age has found to be higher. Conclusion: For patients with isolated head injury, there are some risk factors for the development of infection which increases the hospitalization time, the total cost of care and the mortality rates. |
9. | Necrotizing fasciitis: Diagnosis Treatment and Review of the Literature Haluk Vayvada, Cenk Demirdöver, Adnan Menderes, Can Karaca PMID: 23588910 doi: 10.5505/tjtes.2012.97523 Pages 507 - 513 Giriş: Nekrotizan fasiit (NF) yumuşak doku ve fasyaların hızla yayılan nekrozuyla karakterize, uygun tedavi edilmezse fulminan seyirli olabilen bir hastalıktır. Diyabet, lokal travma, parafimozis, perirektal-perianal enfeksiyonlar, cerrahi girişimler predispozan faktörlerdendir. Amaç: Bu çalışmanın amacı, NF olgularında erken tanı yöntemlerinin saptanması, tedavi ve rekonstrüksiyon seçeneklerinin gözden geçirilmesi ve morbidite-mortalitenin tartışılmasıdır. Hastalar-Yöntem: 2000-2010 yılları arasında NF tanısı ile tedavi edilen 68 hasta yaş, cinsiyet, lokalizasyon, tanı konma süresi, predispozan faktörler, doku defekti özellikleri, izole edilen ajanlar, yapılan cerrahi girişim, komplikasyonlar ve mortalite oranı açısından geriye dönük olarak incelendi. 59 erkek ve 9 kadın hastanın ortalama yaşı 55,9'di. Bulgular: Hastaların 52’sinde (%76,4) diyabet, obezite, sigara, kortikosteroid kullanımı gibi risk faktörleri mevcuttu. En sık lokalizasyon perine ve inguinal bölgeydi (%70,5). Tanı koyma süresi ortalama 6,2 gündü. İlk debridman sonrası ortaya çıkan doku defekti ortalama 54,2 cm2 idi. En sık izole edilen mikrobiyal ajanlar sırasıyla Escherichia coli, Enterococci, Pseudomonas aeruginosa'ydı. Hastaların 54’ünde (%79,4) polimikrobiyal bir tablo söz konusuydu. Hastalara en sık uygulanan rekonstrüktif cerrahi girişim fasyokutanöz flep + kısmi kalınlıkta deri grefti ile onarımdı (%57,3). Yara yeri ayrılması, kısmi greft kaybı gibi minör komplikasyonlar dışında hiçbir majör komplikasyon izlenmedi. Mortalite oranı %13,2'yi. Sonuç: NF olgularında erken tanı hayat kurtarıcıdır. NF’ten şüphelenildiği durumlarda erken debridman uygulanmalıdır. Enfeksiyon tablosu ve nekrozun yayılımı kontrol edildikten sonra rekonstrüksiyon planlanmalıdır. Background: Necrotizing fasciitis (NF) is characterized by rapidly spreading necrosis of soft tissue and fascia which can be fatal if it'is not managed properly. Objective: The aim was discussing morbidity-mortality in NF patients to evaluate early diagnosis and reconstructive options. Patients and Methods: 68 NF patients who were treated between 2000-2010 were assessed retrospectively for age, sex, localization, time elapsed between onset of symptoms, diagnosis, predisposing factors, characteristics of tissue defects, isolated microbiological agents, surgery, complications,and mortality rate. The mean age of 59 male, 9 female patients was 55.9 years. Results: Of the 52 patients (76.4%) comorbidities such as diabetes, obesity, smoking, and corticosteroid use were present. The most common localization was perineum-inguinal region (70.5%). Time elapsed between onset of symptoms and diagnosis was 6.2 days. The mean size of tissue defect after debridement was 54.2cm2. The most common isolated microbiological agents were Escherichia coli, Enterococci,and Ps.aeruginosa. The most common reconstructive procedures were fasciocutaneous flap+STSG (57.3%). No major complication was observed except wound dehiscence and partial graft loss. The mortality rate was 13.2%. Conclusion: The early diagnosis of NF may be lifesaving. When NF is suspected, early debridement should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered. |
10. | An Evaluation Of Pediatric Burn Patieints a Fifteen-Years Period Recep Tekin, İlyas Yolbaş, Cafferi Tayyar Selçuk, Ali Güneş, Ayhan Özhasanekler, Mustafa Aldemir PMID: 23588911 doi: 10.5505/tjtes.2012.75031 Pages 514 - 518 Amaç: Yanık yaralanmaları çocuklar için büyük bir halk sağlığı problem olup, bu çalışmada amacımız Güneydoğu Anadolu bölgesinde 15 yıl boyunca takip edilen 2346 çocuk yanık hastasıın demografik, etyolojik, yanık yara enfeksiyonu ve klinik gidişlerini değerlendirmek ve çocuk hastalar için bir yanık önleme programı geliştirmekti. Material metod: Dicle Üniversitesi yanık ünitesinde Ocak 1994 - Aralık 2008 tarihleri arasında yatırılarak takip edilen 2346 çocuk hastanın yaş, cinsiyet, yanık derecesi, dermografik özellikleri, yanık etyolojisi, yanık yara enfeksiyonu, hastanede kalma süresi, yanık yüzeyi yüzdesi ve hasta sonlanımı verileri retrospektif olarak değerlendirildi. Bulgular: Çalışmaya 2346 çocuk yanık olgularının yaş ortalaması 4.42±3.56 yıl idi. Hastaların 1282 (54.7%) kız ve 1064 (45.3%) erkek idi. En yüksek insidans 68.5%. ile 0-4 yaş aralığında görüldü. Yanık tipleri 1828 (77.9 %) haşlama yanığı, 332 (14.2%) alev yanığı ve 186 (7.9%) elektrik yanıklarından oluşuyordu. Yanık dereceleri açısından 19 (0.8 %) birinci derece, 2172 (92.6 %) ikinci derece ve 155 (6.6 %) üçüncü derece yanıklardan oluşuyordu. Ortama total vücut yanık yüzdesi ortalaması %21.5±12.6 idi. Ortalama hastanede kalış süresi 12.87±10.02 gün idi. En sık izole edilen yanık yara enfeksiyonları 52% (368) Pseudomonas aeruginosa, 12% (83) Acinetobacter spp., ve 9% (66) Escherichia coli idi. Sonuç: Çalışmamızda yanık hastalarının özellikleri diğer bölgelerden farklı idi. Çocuk yanık önleme programı için bölge halkı eğiltilmelidir. Objective: Burn injuries are a huge public health issue for children. The aim of this study was to determine demographic, etiologic, burn wound infections and clinical trends of 2346 pediatric burns patients during fifteen years in the southeast provinces of Turkey, and create criteria for a pediatric burn prevention program. Patients and method: Age, gender, degree of burn, demographics, etiology of burn, burn wound infections, and length of hospital stay, the total body surface area percentage and outcome data of 2346 children who admitted to the Burn Center of Dicle University between January 1994 and December 2008 were recorde. Results: The average age of 2346 pediatric burn patients were 4.42±3.56 years. There were 1,064 (45.3%) males and 1,282 (54.7%) females. The highest incidence appeared in the 0–4 years group as 68.5%. Burn type of cases was 1828 (77.9 %) scalding burns, 332 (14.2%) flame burns and 186 (7.9%) electrical burns. The mean of total body surface area burn was 21.5±12.6 %. The mean of Length of hospitalization was 12.87±10.02 days. Conclusion: In our study, the epidemiological features of pediatric burns are different from the other region. Burn prevention education should train the for pediatric burn prevention. |
11. | Sexual injuries during consensual sexual activity Aysun Savaş, Ozan Efesoy, Filiz Çayan, Selahittin Çayan PMID: 23588912 doi: 10.5505/tjtes.2012.47347 Pages 519 - 523 Amaç: Bu çalışmada kliniğimizde tedavi edilen seksüel yaralanmaların retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2004-Aralık 2010 tarihleri arasında hastanemiz acil servisine istemli seksüel aktivite sırasında oluşan seksüel yaralanma nedeniyle müracaat eden 31 olgu değerlendirildi. Olguların yaşı, yaralanmaya sebep olan travma şekli, yaralanmadan sonra hastaneye müracaata kadar geçen süre, fiziki/operatif muayene sonuçları, uygulanan tedavi yöntemleri, hastanede kalış süreleri ve görülen komplikasyonlar incelendi. Bulgular: Olguların yaş ortalamaları 31,97±11,64 (dağılım 18-60) yıl, 14’ü (%45) kadın, 17’si (%55) ise erkektir. Seksüel yaralanmalar kadınlarda vajina laserasyonu, erkeklerde ise penis fraktürü şeklinde görülmüştür. Olguların tamamına erken dönemde cerrahi tedavi uygulanmıştır. Vajina yaralanmalarının çoğu (%64) bakirelerde, ilk cinsel ilişki esnasında oluşmuştur. Cinsel ilişki sırasında vajinal ağrı ve akabinde kanama en sık rastlanan başvuru şikayeti idi. Yaralanmaların çoğu (%43) arka fornikste lokalize idi. Penis fraktürü olguların %76’sında cinsel ilişki, %24’ünde ise mastürbasyon sırasında oluşmuştur. Olguların tamamında sertleşmiş peniste ağrı, sertleşmenin hızlı bir şekilde kaybolması ve sonrasında penisin şişerek morarması şikayeti mevcut idi. Olguların 11’inde sağ, 5’inde sol ve birinde bilateral korpus kavernozum tunika albugineasında 0,5-3 cm arasında değişen uzunluklarda yırtık saptandı. Bilateral yırtılma olan olguda aynı zamanda inkomplet üretra rüptürü de vardı. Sonuç: Genellikle detaylı bir anamnez ve fizik muayene ile tanı konulabilen seksüel yaralanmalarda erken dönemde cerrahi tedavi ile yüz güldürücü sonuçlar elde edilmektedir. Background: The aim of this study was to retrospectively evaluate sexual injury treated in our clinic. Methods: We evaluated results of 31 patients with sexual injury during consensual sexual activity, referred to emergency department between January 2004-December 2010. Patients age, etiology of injury, time passed after trauma, physical/operative examination results, type of treatment, duration of hospitalization, and postoperative complications were investigated. Results: Of 31 patients, 14 were women and 17 men. The mean age of the patients was 31.97±11.64years. Sexual injury was occurred in women as vaginal laceration, in man penile fracture. All of the cases were treated with early surgical repair. Such vaginal injuries were formed in virginal girls during first sexual intercourse. Cases were usually complained with vaginal pain and then bleeding during sexual activity. The commonest site of injury is posterior vaginal fornix. Etiology of penile fracture was sexual intercourse and masturbation. Sudden pain in penis, edema, color change, sudden detumescence were main complaints. Of patients 11 had right, 5 had left and one had both tunical ruptures, with defects of 0.5-3cm in length. Patient with bilateral injury had accompanying incomplete urethral rupture. Conclusion: Consequently, sexual injury can effectively be diagnosed based on history and physical examination, and may be treated with successfully by early surgical procedure. |
CASE REPORTS | |
12. | Re-Formation of Acute Parietal Epidural Hematoma Fallowing Rapid Spontaneous Resolution in a Multitraumatic Child: A Case Report Mehmet Bülent Önal, Erdinç Civelek, Atilla Kırcelli, Hakan Yakupoğlu, Tuna Albayrak PMID: 23588913 doi: 10.5505/tjtes.2012.91129 Pages 524 - 526 Travmaya bağlı beyin yaralanması sonrası gelişen akut epidural hematom ölüme ve ciddi sakatlığa sebep olabilen nedenlerden biridir. Literatürde, rezolüsyon sonrası rekürrens görülen spinal epidural hematom vakaları bildirilmiştir. Bu vaka, kafatası kırığı olmaksızın spontan hızlı rezolüsyona uğrayıp sonrasında tekrar oluşan akut kranyal epidural hematom ile karakterizedir. Çeşitli yazarlar spontan hızlı rezolüsyona uğrayıp konservatif takip edilen akut epidural hematoma vakaları bildirmişlerse de, spontan hızlı rezolüsyona uğrayıp aynı yerde tekrar oluşan kranyal epidural hematom vakası daha önce bildirilmemiştir. Acute epidural hematomas remain among the most common causes of mortality and disability resulting from traumatic brain injury. In the literature, there are cases about the resolution and recurrence of spinal epidural hematomas. This case is characterized by the rapid disappearance and re-formation of an acute cranial epidural hematoma (EDH) associated with no any overlying skull fracture. Various authors have reported resolution of EDH s managed conservatively, but rapid resolution and recurrence of cranial EDH was not reported before. |
13. | Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases. Polytimi Leonardou, Paris Pappas PMID: 23588914 doi: 10.5505/tjtes.2012.50374 Pages 527 - 530 The increased use of central venous catheters in the modern medical practice has brought a proportional increase in the number of cases of iatrogenic vascular injuries. Concerning the subclavian artery, the site of the lesion associated with the vessel size demand urgent and effective treatment in order to obtain favorable prognosis. It has been a common practice for a long time to consider this type of lesion as a surgical emergency. Nevertheless, emerging endovascular interventional procedures appear to offer an alternative that is effective and safe as well. We hereby report 3 cases of suclavian artery injury, which were repaired by endovascular approach with the placement of a cover stent. Hypovolemic shock (demonstrated in two patients) as well as brachial plexus palsy due to pseudoaneurysm of the subclavian artery (presented in another patient) were successfully managed by percutaneous brachial (in two patients) or right femoral (in the patient with the pseudoaneurysm) approach and placement of balloon expandable covered stents (4-9 mm x 38 mm). No procedure-related complications were observed. Short-term follow up results in two of three patients are quite satisfactory concerning patency. |
14. | Unexpected multiple intra-abdominal injuries after projectile fragmentation: report of three cases Aytekin Ünlü, Aytekin Ünlü, Patrizio Petrone, Tamer Karsidag, Juan A. Asensio PMID: 23588915 doi: 10.5505/tjtes.2012.48569 Pages 531 - 534 Background: Explosives create and energize particles that act as projectiles prone to further fragmentation, creating secondary missiles in the body, and may result in secondary injuries. We report this process for abdominal injuries after fascial penetration in the military setting. Patients and Methods: Observational case series study. Local wound exploration was performed in conscious patients who sustained abdominal wall injuries. An intraperitoneal injury was assumed in those with a full thickness fascial defect, and laparotomy was performed. Results: Twenty patients met the study eligibility criteria. Out of those 20 patients, 12 had negative wound exploration and were excluded from the study, while abdominal organ injuries were found in eight (40%) patients. During laparotomy, projectile-induced injuries in a sprayed distribution were found in three (38%) of these patients. Injuries were far from the predictable trajectory. The overall mean number of peritoneal defects was 1.7, and a mean of 6.8 intra-abdominal injuries for each peritoneal defect were found when through and through injuries were excluded. Conclusions: Despite a single peritoneal defect, there may be multiple intraperitoneal injuries due to further fragmentation of the projectile. Under mass casualties, wound exploration with a full thickness fascial defect could serve as an indicator of possible intra-abdominal injuries, indicating exploratory laparotomy. |
15. | Traumatic pulmonary pseudocyst: 2 case report Mesut Erbaş, Sami Karapolat, Suat Gezer, Gülbin Sezen, Hakan Ateş PMID: 23588916 doi: 10.5505/tjtes.2012.10734 Pages 535 - 538 Giriş: Travmatik pulmoner psödokistler künt toraks travmaları sonrasında nadiren gelişebilen akciğerin kaviter lezyonlarındandır. Olgu sunumları: Travma sonrası sol akciğer yerleşimli kistik lezyonları tespit edilen 2 erkek olgu travmatik pulmoner psödokist tanıları ile kliniğimizde takip edilmiştir. Kontrol toraks tomografilerinde kistik lezyonların boyutlarında ve duvar gerginliklerinde artma görülmesi üzerine cerrahi kararı alınmıştır. İlk olguya torakotomi ile kistotomi ve kapitonaj uygulanmış ve sorunsuz olarak taburcu edilmiştir. Ancak 2. olgu operasyon hazırlıkları esnasında oluşan kardiyak arrest nedeniyle kaybedilmiştir. Sonuç: Travmatik pulmoner psödokistlerin tanı ve radyolojik takiplerinde toraks tomografisi önemli bir yöntemdir. İzlemde progresyon gösteren psödokistlerin tedavisinde cerrahi seçenek daima hatırlanmalıdır. Introduction: Traumatic pulmonary pseudocysts are cavitary lesions that rarely seen after blunt thoracic traumas. Case reports: Two male patients who diagnosed with cystic lesions in left lung after trauma were followed-up in our clinic with diagnosis of traumatic pulmonary pseudocyst. Due to increase in cyst dimensions and wall tension which seen control thorax tomography, surgical intervention decision was taken for both cases. The first case was underwent cystotomy and capitonage via thoracotomy, and discharged without any complication. However, the second case was lost due to cardiac arrest during the operative preparations. Conclusion: The thorax tomography is an important method in diagnosis and radiological follow-up of traumatic pulmonary pseudocysts. The surgery option should always be remembered for the ones that show progression during follow-up. |
16. | Conservative approach to the isolated cricoid cartilage fracture Fikret Çınar, Cenk Evren, Mehmet Birol Uğur, Serkan Çorakçı, Cemile Zuhal Erdem PMID: 23588917 doi: 10.5505/tjtes.2012.40326 Pages 539 - 541 İzole krikoid fraktürüne klinikte ender olarak rastlanmaktadır. Yüksekten düşme yakınması ile acil servisimize yönlendirilen 71 yaşındaki bayan hastaya solunum sıkıntısı nedeniyle acil trakeotomi açıldı. Yapılan tetkiklerde krikoid kartilajda izole fraktür tespit edildi. Tedavisinde konservatif yaklaşımın seçildiği hasta yakınmalarının geçmesi üzerine dakanülasyon yapıldıktan sonra taburcu edildi. Isolated cricoid fracture is rarely encountered at clinic follow-up. A 71 years old female patient was referred to emergency service with complaints of fall from height and the urgent tracheotomy was performed due to her dyspnea. At examination, isolated fractures of the cricoid cartilage were identified. With the conservative approach, the patient remained symptom-free and was discharged after decannulation. |
17. | Carotico-jugular fistula following a ballistic injury Recep Oktay Peker, Mustafa Etli, Ulaş Sağlam, Zafer Erk, Tülay Tunçer Peker, Mehmet Özaydın, Ahmet Yeşildağ PMID: 23588918 doi: 10.5505/tjtes.2012.02603 Pages 542 - 544 Karotiko-juguler fistüller ateşli silah, kesici alet yaralanması sonucu veya iatrojenik olabilir. Geç dönemde kalp yetmezliği, endokardit, serebral embolizasyon gibi komplikasyonlarla ortaya çıkabilir.Bu yazıda nadir görülen karotiko-juguler fistülde BT-anjionun tedaviyi planlamaya katkısı ve görüntüleme bulgusu sunuldu. 35 yaşında erkek hasta sağ servikal bölgeden ateşli silah yaralanmasıyla merkezimize 2.saatte sevk edildi. Fiziksel incelemede sağ sternokleidomastoid adalesi yakınında hematom ve çıkış deliği, şiddetli üfürüm ve trill tespit edildi. Doppler ultrason ve BT-anjio ile tanı konuldu. Cerrahi yaklaşım ile 6mm PTFE kullanılarak karotis artere, 12mm dacron greft ile de juguler vene interpozisyon yapıldı.Fistül traktı kapatıldı. Postoperatif 6.ayda USG yapılan hasta antiagregan tedavi ile sorunsuz izlenmektedir. Carotico-jugular fistulae are known complications of gunshot injuries and stab wounds, but they can be iatrogenic. Untreated, these lesions may lead to heart failure, endocarditis, cerebral embolization. We present the CT-angiographic view and its value for treatment strategy in carotico-jugular fistula. 35 year old man was referred in the second hour of a ballistic injury on the right side of the neck. Physical examination revealed hematoma, exit hole and thrill on the right sternocleidomatoid muscle. Diagnosis was confirmed with doppler ultrasound and CT-angiography. Surgical interposition with 6 mm PTFE for carotid artery and with 12 mm dacron for internal jugular vein was performed. Fistulous tract was ligated. In the postoperative 6th month doppler ultrasound was normal and the patient was on antiaggregant therapy and healthy. |
SHORT REPORT | |
18. | The submental endotracheal intubation as an alternative to tracheostomy in selected cases of the facial fracture: literature review and technique report. Joel Motta Junior, Leando Eduardo Klüppel, Cecilia Luiz Pereira Stabile, Glaykon Alex Vitti Stabile PMID: 23588919 doi: 10.5505/tjtes.2012.43403 Pages 545 - 548 The intermaxillary fixation (IMF) is an essential guide to optimize the reduction and fixation of most facial fractures associated with occlusal alterations. To allow IMF, the nasotracheal intubation is used in most cases. When the nasotracheal intubation is not possible, a tracheotomy may be indicated, but this carries significant morbitidy. The submental endotracheal intubation allows IMF to be used without resorting to nasal intubation or tracheostomy, and it does not interfere on reduction and fixation of fractures in most cases. The purpose of this article is to describe indications, counter indications and the technique of the submental endotracheal intubation as performed in our service. |