Ulus Travma Acil Cerrahi Derg: 20 (2)
Volume: 20  Issue: 2 - March 2014
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RESEARCH ARTICLE
1.The efficacy of a hemostatic agent in anticoagulant drug-induced rat bleeding model
Ertan Sönmez, Umut Yücel Çavuş, Cemil Civelek, Ali Dur, Eda Karayel, Bedia Gulen, Ömer Uysal, Göktürk İpek
PMID: 24740331  doi: 10.5505/tjtes.2014.54938  Pages 79 - 85
Background
Bleeding is the major problem in warfarin pretreated patients especially who need emergency surgerical procedures. APH is a hemostatic agent with ultra-hydrophilic and particulate properties. This study aimed to evaluate the in vivo hemostatic effect of APH in rats pretreated with warfarin.
Methods
Forty eight Wistar rats were divided into two main groups: one group was pretreated with warfarin and the other group was not. These two groups was further divided into 3 subgroups according to the administration of APH, wheat meal or saline, for a total of 6 subgroups. Standard full thickness tissue defects were performed on the back of the rats. Saline, wheat meal or APH were administered to the bleeding defect site in both main groups. Haemostasis time and amount of bleeding were calculated.
Results
The bleeding time in rats administered APH was significantly shorter than those administered wheat meal and saline and consequently amount of bleeding was significantly less than those of the control groups.
Conclusion
APH has an effective hemostatic property in rats pretreated or non-pretreated with anticoagulants. Hemostatic agents can be usefull for external bleedings which are growing because of anticoagulation.

CLINICAL ARTICLE
2.Evaluation of the Alvarado score in acute abdominal pain
Hamid Kariman, Majid Shojaee, Anita Sabzghabaei, Rosita Khatamian, Hojjat Derakhshanfar, Hamidreza Hatamabadi
PMID: 24740332  doi: 10.5505/tjtes.2014.69639  Pages 86 - 90
Background: Alvarado score is usually evaluated for patients who suffer from appendicitis. The goal of this study was to compare the Alvarado scores in patients who suffered from abdominal pain regardless of their causes.
Materials and methods: In a prospective study, 300 patients with acute abdominal pain who were referred to an Emergency Room were evaluated for Alvarado score regardless of the cause of the pain.

Results: From 300 patients, 257 patients (85.66%) had Alvarado scores 7 or less and 43 patients (14.33%) had Alvarado scores higher than 7. In this study, 66 patients from (25.7 %) with Alvarado scores 7 or less had Appendicitis, compared with 40 patients (93%) with Alvarado scores higher than 7, which showed statistically significant differences.This finding suggests that patients with abdominal pain and Alvarado score>7 are very likely suffered from Appendicitis. This scoring system seems to have 95% specificity for Appendicitis but a poor sensitivity (37%).
Conclusion: Alvarado scoring system in patients with acute abdominal pain could be used to predict Appendicitis. A positive test (Alvarado >7) would result in a 93% chance of appendicitis, whereas a negative test (Alvarado ≤ 7) would result in a 26% chance of appendicitis. So, this is a good rule-in test, but not an adequate rule-out test.

3.A comparison of case series comparing Non Operative Management vs Operative Management of splenic injury after blunt trauma.
Roberto Cirocchi, Alessia Corsi, Elisa Castellani, Francesco Barberini, Claudio Renzi, Lucio Cagini, Carlo Boselli, Giuseppe Noya
PMID: 24740333  doi: 10.5505/tjtes.2014.99442  Pages 91 - 96
Background
Spleen is the most easily injured organ in abdominal traumas. Several reports about successful non-operative management and modern diagnostic imaging have progressively allowed the diffusion of a conservative approach.
The aim of our retrospective study was to compare Non Operative Management with surgery.
Methods
We compared seven patients subjected to NOM, between 2007 and 2011, with six patients undergoing OM with similar preoperative characteristics.
Results
Average hospital stay was lower in NOM group than in patients with OM, although not statistically significant. NOM group required significantly fewer transfusions, and no patient in this group, necessitated a period of intensive care unit stay, while 83% of patients recovering from OM needed it. The failure rate of NOM was in our experience 14.3%.
Conclusions
In our experience, NOM was the treatment of choice, thanks to several advantages, in blunt splenic injuries grade I, II and III. NOM is slightly less than surgery, but this is an unadjusted comparison and the 95% confidence interval is extremely wide - from 0.04 to 16.99. Splenectomy was the chosen technique in patients with exclusion criteria for NOM, as well as in those with grade IV and V injury.

4.Nonoperative management of blunt hepatic trauma: 80 cases
Bünyami Özoğul, Abdullah Kısaoğlu, Bülent Aydınlı, Gurkan Öztürk, Atıf Bayramoğlu, Murat Sarıtemur, Ayhan Aköz, Özgür Hakan Bulut, Sabri Selçuk Atamanalp
PMID: 24740334  doi: 10.5505/tjtes.2014.20737  Pages 97 - 100
Amaç: Karaciğer karın travmalı hastalarda en sık yaralanan solid bir organdır. Biz bu çalışmada tedavisinde ve takibinde herhangi bir invaziv tanısal girişim yada cerrahi müdahale yapılmayan bir grup künt karaciğer travmalı hastayı sunmayı amaçladık.
Gereç ve yöntem: Genel cerrahi kliniğine yatırılan ve bunun yanısıra ek yaralanmaları sebebiyle diğer kliniklere yatırılıp genel cerrahi tarafında bu kliniklerde takibi yapılan toplam künt karaciğer yaralanması olan 80 hasta nonoperatif olarak izlendi. Normal dağılım gösteren veriler student’s t-testi veya tek yönlü varyans analizi ile değerlendirildi. Anormal dağılım gösteren veriler ise Mann-Whitney U testi veya Kruskal-Wallis varyans analizi ile incelendi. Kategorik veriler Chi–square testi ile analiz edildi ve p < 0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Takip edilen hastaların hemoglobin düzeyleri, karaciğer yaralanma derecesi ve taburcu olması ile yaralanma mekanizması arasında istatistiki olarak anlamlı bir ilişki bulunamadı. Aynı zamanda karaciğer yaralanması derecesi, taburcu olması ve yaralanma mekanizması ile ALT ve AST değerleri arasında da istatistiki olarak anlamlı bir ilişki yoktu. Hastalarımızın hiçbirinde ölüm vakası olmadı.
Sonuç: Karaciğer yaralanmasının tanı ve tedavisinde son yirmi beş yıl boyunca hayatta kalma süresini uzatan değişiklikler olmuştur. Nonoperatif management of liver injury (NOM) hemodinamik olarak stabil olan karaciğer travmalı hastaların takip ve tedavisinde altın standart olarak görülmektedir.
Anahtar sözcükler: Karaciğer, Travma, nonoperatif yaklaşım
Background: Liver is the most frequently injured organ during abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention.
Methods: A total of 80 patients with blunt liver injury who hospitalized to the general surgery clinic, as well as to other clinics because of the concomitant injuries were followed non-operatively. The normally distributed numeric variables were evaluated by Student’s t-test or one way analysis of variance, while non-normally distributed variables were analyzed by Mann-Whitney U test or Kruskal-Wallis variance analysis. Chi–square test was employed for the comparison of categorical variables. Statistical significance was assumed for p < 0.05.
Results: There was no significant relationship between patients’ Hgb level and liver injury grade, outcome and mechanism of injury. Also there was no relationship between liver injury grade, outcome and mechanism of injury and ALT levels as well as AST level. There was no mortality in any of the patients.
Conclusion: Changes during the last quarter of century in the diagnosis and treatment of liver injury are associated with increased survival. Nonoperatif management of liver injury (NOM) in hemodynamically stable patients with hepatic trauma seems to be the gold standard.
Keywords: Liver, Trauma, nonoperatif management

5.Comparison of Diagnostic Peritoneal Lavage and Focused Assessment by Sonography in Trauma as an adjunct to Primary Survey in Torso Trauma: A prospective randomized clinical trial
Sunil Kumar, Abhay Kumar, Mohit Kumar Joshi, Vinita Rathi
PMID: 24740335  doi: 10.5505/tjtes.2014.37336  Pages 101 - 106
Background: Lately, FAST is preferred over DPL as adjunct to primary survey. However, this is not evidence based as there has been no randomized trial.
Methods: 200 consecutive torso trauma patients meeting inclusion criteria were randomized to undergo either DPL or FAST. The results were then compared with either contrast enhanced computerized tomography (CECT) (in patients managed non-operatively) or laparotomy findings (in patients undergoing operative treatment). Outcome parameters were: result of the test, therapeutic usefulness, role in diagnosing bowel injury and time taken to perform the procedure.
Results: 200 patients with mean age of 28.3 years were studied, 98 in FAST and 102 in DPL group. 104 sustained blunt trauma and 76 sustained penetrating trauma due to stabs. 38 (38.7%) were FAST positive and 48 (47%) were DPL positive (p=0.237, not significant). As a guide to therapeutically beneficial laparotomy, negative DPL was better than negative FAST. For non-operative decisions, positive FAST was significantly better than positive DPL. DPL was significantly better than FAST in detecting as well as not missing the bowel injuries. DPL took significantly more time than FAST to perform.
Conclusions: This study shows that DPL is better than FAST.

6.Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier’s gangrene severity index for predicting the number of debridements in Fourner’s gangrene?
Şahin Kahramanca, Oskay Kaya, Gülay Özgehan, Burak İrem, İbrahim Dural, Tevfik Küçükpınar, Hülagü Kargıcı
PMID: 24740336  doi: 10.5505/tjtes.2014.62829  Pages 107 - 112
AMAÇ: Fournier gangreni (FG) ciltaltı ve fasial dokuların hızlı seyirli, nekrotizan ve ölümcül enfeksiyöz bir hastalığıdır. Bu çalışmada, tersiyer bir referans hastanesinde 68 hastaya ait prognostik faktörleri ve tedavi sonuçlarını irdelemeyi amaçladık.
GEREÇ VE YÖNTEM: Ocak 2006 ve Ocak 2013 tarihleri arasında acil servise başvuran hastalar iki gruba ayrıldı ve geriye dönük olarak incelendi. Grup I’deki (G1) hastalar bir debridman gereksimi duyanlar ve Grup II’deki (G2) hastalar birden fazla debridman gereksinimi olanlardı. Demografik ve klinik özellikler kaydedildi. Fournier gangreni şiddet indeksi (FGSI) puanları, nötrofil-lenfosit oranları (NLO) ve trombosit-lenfosit oranları (TLO) hesaplandı. Prognostik faktörler gruplar arasında karşılaştırıldı.
BULGULAR: Gruplar arasında yaş ortalaması, kadın-erkek oranı, başvuru anındaki belirti süresi yönünden fark yoktu ama enfeksiyon kaynağı, predispozan faktör, pozitif kültür sonuçları G2’de yüksekti. Hastanede kalış süresi, toplam maliyet ve mortalite oranı da G2’de yüksekti. G2’de NLO ve TLO yönünden istatistiksel olarak anlamlı yükseklik vardı ama FGSI skorları yönünden gruplar arasında fark saptanmadı.
TARTIŞMA: Bulgularımıza göre FGSI puanlama sisteminin prognoz belirlemede değeri yoktu. Buna karşılık daha önce İngilizce literatürde bu amaçla kullanımına rastlayamadığımız NLO ve TLO değerli bulundu.
BACKGROUND: Fournier’s gangrene (FG) is a rapidly progressive and necrotizing infection of the subcutaneous and fascial tissues with a high mortality rate. In the present study, we aimed to investigate prognostic factors and analyze the outcomes of 68 patients in a tertiary reference hospital.
METHODS: Patients admitted to the emergency department were investigated retrospectively between January 2006 and January 2013 and divided into two groups. The patients in Group I (G1) required one debridement, and Group II (G2) patients required more than one. Patient demographic and clinical characteristics were encoded. Fournier’s Gangrene Severity Index (FGSI) scores, neutrophil-lymphocyte ratios (NLR), and platelet-lymphocyte ratios (PLR) were calculated. Prognostic factors were compared between the groups.
RESULTS: There were no statistically significant differences between the groups in terms of mean age, female-male ratio, or duration of symptoms on admission; however, there were more infection sources, predisposal factors, and positive culture results in G2. Additionally, hospital stay, total cost, and mortality rate values were high in G2. We found statistically higher NLR and PLR ratios in G2, but there was no significant difference in FGSI scores between the groups.
CONCLUSION: The FGSI scoring system was not found to be valuable in determining prognosis. However, NLR and PLR were valuable, and previous use of NLR and PLR for determining Fournier’s gangrene prognosis could not be found in the English literature.

7.Pelvic bone fractures associated with intra-abdominal solid organ injury
Hyo-min Kwon, Sun-hyu Kim, Jung-seok Hong, Wook-jin Choi, Ryeok Ahn, Eun-seog Hong
PMID: 24740337  doi: 10.5505/tjtes.2014.72698  Pages 113 - 119
Background: This study analyzed the clinical characteristics and prognosis of pelvic bone fractures, the occurrence of accompanying intra-abdominal solid organ injury and the risk factors for intra-abdominal solid organ injury.
Methods: Medical records were retrospectively collected. The subjects were divided into the solid organ and the non-solid organ injury group, with respect to intra-abdominal solid organ injury, to compare demographics, outcomes and prognosis. Risk factors for the occurrence of intra-abdominal solid organ injury in patients with pelvic bone fractures were evaluated.
Results: The solid organ injury group comprised 69 (17.4%) patients. Fall height was greater in the solid organ injury group than the non-solid organ injury group. Initial blood pressure and Revised Trauma Scores were lower in the solid organ injury group. Shock immediately after emergency department arrival was a risk factor for intra-abdominal solid organ injury in trauma patients with pelvic bone fractures. The prognosis of the solid organ injury group was poor and more invasive treatment was performed in this group.
Conclusions: Patient prognosis needs to be improved through early diagnosis and aggressive treatment according to the early prediction of intra-abdominal solid organ injury in trauma patients who present at the emergency department with shock and suspicion of pelvic bone fracture.

8.Investigation of Relationship Between Severity of Injury, Return to Work, Impairment and Activity Participation in Hand and Forearm Injuries
Negihan Çakır, Ramazan Hakan Özcan, Ali Kitiş, Nihal Büker
PMID: 24740338  doi: 10.5505/tjtes.2014.04741  Pages 120 - 126
Amaç: Önkol, el yaralanmaları işle ilişkili özrün temel nedenidir. Çalışma el ve önkol yaralanmaları sonrası yaralanma ciddiyetleri ile işe geri dönüş süresi, aktivite ve katılım düzeyleri arasındaki ilişkiyi incelemek amacıyla planlanmıştır.
Gereç-Yöntem: Çalışmaya yaş ortalamaları 31±11,13 yıl (18-63 yıl) olan el ve önkol yaralanmalı toplam 130 hasta dahil edilmiştir. Modifiye El ve Önkol Yaralanması Ciddiyet Skorlaması (MEYCS) ile yaralanma ciddiyeti belirlenmiştir. Yaralanmadan sonra 8.haftada Jebsen El Fonksiyon Testi (JEFT), Buck-Gramko skorlaması uygulanmıştır. Bozukluk/semptom skorunun değerlendirilmesi için 12. haftada Kol, Omuz ve El Sorunları Anketi’nin Türkçe versiyonu (DASH-T) kullanılmış, kavrama kuvveti ölçümü yapılmıştır. Hastaların işe geri dönüş süreleri kaydedilmiştir.
Bulgular: Çalışmanın sonunda MEYCS ile hastaların eski işlerine geri dönüş süresi, kavrama kuvveti değerleri, DASH-T skorları ve Buck Gramko skorları arasında istatistiksel olarak anlamlı ilişki olduğu gözlenmiştir (p< 0,05). MEYCS ile JEFT arasında istatistiksel olarak anlamlı ilişkiye rastlanmamıştır (p>0,05). Hastalar UFÖSS sistemine göre değerlendirildiğinde; vücut işlevleri bölümünde vücut yapı ve fonksiyonları (1,86±1,47), aktivite bölümünde yazı yazmada (2,06±1,50) en yüksek bozukluk düzeyine sahip oldukları bulunmuştur.
Sonuç: Sonuç olarak yaralanma ciddiyet düzeyinin yüksekliği aktiviteye geri dönüşü, katılımı, işe geri dönüşü geciktirmiştir. DASH-T skorlarının işe geri dönüşe en fazla etki eden faktör olduğu sonucuna varılmıştır. Ayrıca el, önkol yaralanmalı hastalarda, aktiviteye geri dönüş ve katılım ile işe geri dönüş zamanı arasında pozitif ilişki vardır.
Background: Forearm, hand injuries are the main cause of work-related disability. This study was planned to investigate the relationship between severity of injury, return to work, impairment, activity participation in patients with hand, forearm injuries.
Methods: Thirty patients have had forearm, hand injuries with mean age of 31±11,13 years were participated. Injury severity was evaluated with Modified Hand and Forearm Injury Severity Scoring (MHISS) after surgery. Patients were evaluated with Jebsen Hand Function Test (JHFT), Buck-Gramko scoring at 8th week. Also grip strength was evaluated with dynamometer, disability/symptom score was evaluated with Turkish version of Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire at 12th week of injury.
Results: It was found a statistically significant relation between MHISS, hand strength, time of return to work, DASH-T ve Buck-Gramko scores in patients with forearm, hand injuries (p≤ 0,05). It was found higher impairment level at body structure and body functions (1,86±1,47) in body functions level, writing (2,06±1,50) in activity regarding ICF framework.
Conclusion: It was concluded that return to work and activity and participation is delayed in the higher score of MHISS. DASH-T scores was the most important factor in returning to work. Also there is a positive relation between return to work, activity and participation in patients.

9.An Easy, Safe and Effective Method for the Treatment of Intussusception: Ultrasound-Guided Hydrostatic Reduction
Fatma Esra Bahadır Ülger, Aykut Ülger, Ali Erdal Karakaya, Fatih Tüten, Ömer Katı, Mustafa Çolak
PMID: 24740339  doi: 10.5505/tjtes.2014.37898  Pages 127 - 131
AMAÇ: İnvajinasyon pediatrik yaş grubunda önemli bir intestinal obstruksiyon nedenidir. Ultrason eşliğinde hidrostatik redüksiyon invajinasyon tedavisinde popüler bir yöntemdir. Bu çalışmada ultrason ile invajinasyon tanısı konan hastaların demografik özellikleri, tedavi yaklaşımlarını paylaşmayı amaçladık.
GEREÇ VE YÖNTEM
Ağustos 2011-Mayıs 2013 tarihleri arasında ultrason ile invajinasyon tanısı konan 41 olgu retrospektif olarak incelendi. Bu vakalardan klinik kontrendikasyonu bulunmayan 24’üne ultrason eşliğinde hidrostatik redüksiyon ile tedavi uygulandı.
BULGULAR
Olguların 24’ü erkek, 17’si kız olup erkek kız oranı 1.4: 1 olarak bulundu. Olguların çoğunluğu 6-24 ay ve 2-5 yaş aralığında saptandı. Yaş ortalaması 31,12±26,32 (3-125) ay idi. Olgular en sık nisan ve mayıs aylarında saptandı. Klinik kontrendikasyonu bulunan 17 olgu doğrudan cerrahiye alındı. Ultrason eşliğinde hidrostatik redüksiyon yapılan 24 olgudan 20’sinde redüksiyon sağlandı. Bu olguların 3’ünde rekürrens saptandı. 3 olgudan 2 sine tekrar hidrostatik redüksiyon yapılıp başarı sağlandı. Diğer olgu cerrahiye alındı. Toplamda 24 olguya 26 kez hidrostatik redüksiyon denenmiş olup 22’sinde başarı sağlandı (%84.6). Olgularda işleme bağlı komplikasyon görülmedi.
SONUÇ
Ultrason eşliğinde hidrostatik redüksiyon, yüksek başarı oranları ve radyasyon riskinin bulunmaması nedeniyle invajinasyon tanısı alan çocuklara tedavi yaklaşımında ilk seçenek olmalıdır.
BACKGROUND: Intussusception is one of the important cause of intestinal obstruction in children.Hydrostatic reduction under ultrasound guidance is a popular treatment method of intussusception.We aimed to explain the demographic characteristics, treatment approaches in patients diagnosed with intussusception by ultrasound.
METHODS: Forty one patients diagnosed with intussusception by ultrasound between August 2011-May 2013 were retrospectively analyzed.Twenty-four of these patients which didn’t have any contraindication had ultrasound guided hydrostatic reduction as a treatment.
RESULTS: Twenty-four of the patients were male,17 of the patients were female where there was a 1.4: 1 ratio of male to female.The majority of the patients were between the ages of 6-24 months and 2-5 years.Mean age was 31,12±26,32(3-125) months.Patients were more frequently diagnosed in april and may.Seventeen patients which had clinical contraindication enrolled directly to surgery.In 20 of 24 patients who had ultrasound guided hydrostatic reduction, reduction was achieved.Three of them there was recurrence.In 2 of these patients successful reduction was achieved with second attempt.The remaining patient was enrolled to surgery.For these 24 patients hydrostatic reduction was performed for 26 times and in 22 of them success was achieved(84,6%).There was no procedure-related complications in patients.
CONCLUSİON: Ultrasound guided hydrostatic reduction with high success rates and having no radiation risk,should be the first choice for therapeutic approach in children diagnosed with intussusception.

10.Blunt renal trauma in children: a retrospective analysis of 41 cases
Mehmet Emin Balcıoğlu, Mehmet Emin Boleken, Muazez Çevik, Murat Savaş, Fatıma Nurefşan Boyacı
PMID: 24740340  doi: 10.5505/tjtes.2014.65392  Pages 132 - 135
AMAÇ
Çocukluk çağında, sıklıkla künt travma sonrası gelişen böbrek yaralanmaları nonoperatif olarak başarıyla tedavi edilebilmektedir. Bu çalışmada, çocuklarda künt travma sonucu gelişen böbrek hasarı olan hastalar değerlendirildi.

GEREÇ VE YÖNTEMLER
Bu çalışmada Ocak 2000 ile Mart 2012 yılları arasında künt karın travması sonrası böbrek hasarı nedeniyle çocuk cerrahi servisine başvuran 41 çocuk hastanın bilgilerine ulaşıldı. Hasta verileri geriye dönük olarak, demografik karakteristik özellikleri, hastanede kalış süresi, travma etkeni, tedavi, ve sonuçları açısında değerlendirildi.

BULGULAR
Olguların yaş ortalaması 10±4,85 idi. Böbrek hasarı; Grade 1 (n=13), Grade 2 (n=13), Grade 3 (n=6), Grade 4 (n=6), ve Grade 5 (n=3) mevcut idi. Bütün olgular başlangıçta konservatif olarak takip edildi. Bütün olgulardan 7 olguya cerrahi tedavi uygulandı. Cerrahi tedavi olarak olgulara nefrektomi(n=3), mesane onarımı(n=1), piyeloplasti(n=1), ileum onarımı(n=1), ve üretra onarımı(n=1), yapıldı. Hiçbir olguya geç dönem cerrahi tedavi gerekmedi. Olgulardan hayatını kaybeden olmadı.

SONUÇ
Çocuklarda böbrek yaralanmalarında, konservatif tedavi etkili ve güvenilirdir. Çoğu böbrek hasarı cerrahi gerektirmemesine rağmen, hasarın derecesine bakılmaksızın hayatı tehdit eden kanamalara cerrahi müdahale yapılmadır.
BACKGROUND
Renal injuries often related blunt trauma are successfully treated with nonoperatively in childhood. In the present study, patients with renal damage were evaluated to caused by blunt trauma in children.

MATERİALS AND METHODS
In the present study, between January 2000 and March 2012, medical record of 41 cases were admitted to pediatric surgery related renal injury after blunt abdominal trauma. Cases’ demographic characteristics, duration hospitalization, cause of trauma, treatment, and outcomes were analyzed retrospectively.
RESULTS
The mean age was 10 ± 4,85. Renal damage; Grade 1 (n = 13), grade 2 (n = 13), Grade 3 (n = 6), Grade 4 (n = 6), and Grade 5 (n = 3) were present. All patients were initially treated conservatively. Seven patients were underwent surgical treatment. Surgical treatment was nephrectomy (n = 3), pyeloplasty (n = 1), bladder (n = 1), ileum (n = 1), and urethra repair (n = 1). Surgical treatment was not required in long term in all cases. There was no death.

CONCLUSİONS
The conservative treatment of pediatric renal injuries is safe and effective. Although the vast majority of renal injuries do not require surgical intervention, life-threatening renal bleeding, regardless of the grade of injury, should be treated with immediate surgery.

CASE REPORTS
11.Acute liver failure secondary to hepatic compartment syndrome: case report and literature review
Bei Ye, Yang De Miao
PMID: 24740341  doi: 10.5505/tjtes.2014.95825  Pages 136 - 138
We reported a patient of delayed huge intrahepatic hematoma and transient decline in hemoglobin to 62 g/L 18 days after liver injury. Abdominal computed tomography revealed seriously flattening of inferior vena cava, which was consistent with compression by the enlarging hematoma. Although traditionally there was no indication for surgical intervention, the patient developed acute liver failure with a progressive increase in liver enzymes and bilirubin. We postulated the ever-expanding hematoma may have led to dramatically elevated intrahepatic pressures that in turn restricted hepatic vein reflux and subsequently acute liver failure. Therefore, she underwent percutaneous drainage and the decompression instantly reversed the liver injury. This phenomenon is similar with the well-described abdominal compartment syndrome, which is defined as new onset organ dysfunction or failure secondary to sustained intraabdominal hypertension and decompression is the standard treatment.

12.Endoscopic Endonasal Removal of A Sphenoidal Sinus Foreign Body Extending into Intracranial Space
Ali Erdem Yıldırım, Denizhan Divanlioglu, Nuri Eralp Cetinalp, İbrahim Ekici, Ali Dalgic, Ahmed Deniz Belen
PMID: 24740342  doi: 10.5505/tjtes.2014.93902  Pages 139 - 142
Sfenoid sinüs içi yabancı cisim genellikle kraniyal ve/veya orbital travma ve intrakraniyal lezyonlarla ilişkili olarak görülen çok nadir olaylardır. Biz bu yazıda iş kazası sonrasında gelişen, intrakraniyal uzanımı olan sfenoid sinüs içi metalik yabancı cisim olgusunu sunmaktayız. Yirmi dokuz yaşında erkek hasta sağ orbial travma sonrası kliniğimize gönderilmiş. Çekilen kafa grafisi ve bilgisayarlı tomografide sol temporal fosaysa invazyon gösteren sfenoid sinüs içinde yabancı cisim saptandı. Hasta endoskopik endozal teknikle opere edilerek yabancı cisim çıkartıldı ve defekt bulunan kafa kaidesi çok tabakalı olarak tamir edildi. Operasyon anında ve sonrasında komplikasyon görülmeyen hastanın 3 aylık takiplerinde de sorun yaşanmadı.
Sphenoidal sinus foreign bodies are very rare entities which are often associated with a cranial and/or orbital trauma. In this paper, a case of a metallic foreign body pierced the sphenoid sinus and penetrated into the intracranial space due to a work accident was presented. Twenty-nine year old male was refered to our clinic because of a right orbital penetrating trauma. Skull x-ray and computed tomography (CT) scans demonstrated a foreign body inside the sphenoidal sinus, extending to the left temporal fossa. The foreign body was removed using endoscopic endonasal technique and skull base was reconstructed with multilayer closure technique. There were no complications during or after the operation. Postoperative result was perfect with 3 months of follow up.

13.Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture – case report
Vanja Pecic, Milica Nestorovic, Predrag Kovacevic, Dragan Tasic, Goran Stanojevic
PMID: 24740343  doi: 10.5505/tjtes.2014.64249  Pages 143 - 146
Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death.
We present a case of 27 year old male with NF. He was admitted to the regional hospital the day after blunt abdominal trauma. The following day he was referred to our hospital where he was operated on urgently. Previously he was treated in a regional hospital immediately after injury for diffuse abdominal pain and large hematoma of anterior abdominal wall. Injury was obtained while driving a bike and falling over handlebar. Due to worsening of general condition he was referred to our hospital. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery the fulminant necrotizing fasciitis has developed. The antibiotics were prescribed according to wound cultures. Subsequent necrectomies were performed and after 25 days the reconstruction of abdominal wall with skin graft was obtained. Despite all resuscitation measures including fluids, blood transfusions and parenteral nutrition, the lung infection and MODS caused death 42 days after initial operation.
Blunt abdominal trauma could bring rupture of intestine, and in early signs of peritoneal irritation the emergency laparotomy should be performed. Disastrous complication are rare but lethal.

14.Subcutaneous Emphysema, Pneumo-Orbita and Pneumomediastinum Following a Facial Trauma Caused by a High-Pressure Car Washer
Fevzi Yılmaz, Orcun Ciftci, Miray Özlem, Erdal Komut, Ertuğrul Altunbilek
PMID: 24740344  doi: 10.5505/tjtes.2014.14237  Pages 147 - 150
Pneumomediastinum is air leakage to mediastinal space from various potential sites, including lung, esophagus, trachea, and neck. It is a rare condition that develops either spontaneously with increased intraalveolar or intrabronchial pressure, or due to trauma. Although cases with face or neck trauma with subcutaneous emphysema that extended to mediastinal cavity via anatomical connections in face and neck have been reported, orbital traumas leading to pneumomediastinum is a very rare occurence that that has only been reported in a few reports. This paper reports a 17-year-old male who presented with diffuse subcutaneous emphysema involving paraorbital, facial areas, which extended to neck and mediastinal cavity from there.

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