BACKGROUND: In this review we wanted to explane of opinions of The Turkish Association for Trauma and Emergency Surgery monthly inter-hospital meetings results.
METHODS: Opinions of meetings participants about blunt abdominal trauma were reviewed.
RESULTS: Haemodynamic stability and conscience situation are the main factors to determine the approach to blunt abdominal trauma patients. We generally prefer ultrasonography (USG) to first step diagnostic technique for haemodynamica/ly stable patients. IfUSG is not possible, diagnostic peritoneallavage (DPL) could be perform. We propose that DPL or USGcould be perform when the focus isnot known in the haemodynamica/ly unstable, multi-traumatised patients. But we don 't agree to perform any diagnostic techniques if we know that haemodynamic unstability is caused from intraperitoneal injury.
CONCLUTION: We prefer and propose resuscitation and emergency laparotomy for a/l patients of whom focus of the haemodynamica/ly un-stability is i1itra-abdominal damage. But ifthe haemodynamica/ly un-stable patients have pelvic bone fractures we don't propose the emergency laparotomy, because the probablefocus ofthe serious bleeding is pelvic vessels. In our opinion that patients must be resuscitated aggressively and evaluated with C1; because in this situations false positivity of the DPL is often. Surgeons must not take shelter the laparotomy for the name of life rescue, because negative and non- therapeutic laparotomy has high morbidity.

OBJECTIVE: To invstigte the physiologic effects and therapeutic management ofthe abdominal kompartm sendrome (ACS) Methods: A review ofthe recent Iiterature, experiences and opinions ofthe author are expressed in the papeý:
RESULTS AND CONCLUSIONS: Intraabdominal bleeding, peritonitis, ileus, shock-reperfusion syndrome, intestinal edema, Iaparoscopic procedures with gas, ciosure ofthe abdomen in spite ofincreased pressure and burns are some ofthefactors that take place in etiology. The critical intrabdominal pressure value that requires decompression is debatable. In patients with high abdominal pressures, the pressure should be decreased with Iaparotomy immediately and the abdomen should not be ciosed primarily. These measures will help us to Iower the rates of mortality and morbidity and improve the quality ofhealth services.

BACKGROUND: Obstruction ofthe extrahepati(biliary tree produces profound depression of many components ofthe immune system. G-CSF improves diseasedfiýnction fneutrophils in various conditions. In this study, we planned to investigate the changes on neutrophil phagocytosis in obstruct;ve jaundice and the effect ofG-CSF adm;nistration on thisfiýnction.
METHODS: Rats were divided into 5 groups as follows: the sham group and four other groups that underwent double ligation and division of common bile duct. Two of these four groups (Group 3 and 5) received G-CSF during experiment. Neutrophil hagocytosis index was determinedforgroup2and 3 attheend ofthe 15 daysand forgroup 1, 4and 5 attheend of the21 days.
RESULTS: Neutrophil phagocytosis index significantly increased at the end ofthe 15th day after the bile duct ligation (Group 2) and significantly decreased at the end ofthe 21th day after the bile duct ligation (Group 4). Neutrophil phagocytosis index in G-CSF-treated groups was significantly increased at the end ofthe 15'h days (Group 3) and increased at the end of the 21th day (Group 5).
CONCLUTION: As a result, neutrophil phagocytosis index is improved if G-CSF is administered later in the course of prolonged jaundice.

BACKGROUND: Despite decreasing incidence of peptic ulcer disease, peptic ulcer perforation remains a source of mortality. This retrospective study was performed to find riskfactors for mortality and to construct a score that predict outcome for patients with peptic ulcer perforation.
METHODS: A review of94 patients operated (primer ciosure and omentoplasty) for perforated peptic ulcer in Iast ten years was undertaken to study. lndependent risk factors for mortality were found with Iinear regression analysis and risk score was constructed using standardized coefficients of risk factors.
RESULTS: Acute renal failure (ARF) (p < 0,00 1 ), treatment delay more than 48 hours (> =48 hours) (p = 0,203 ) and age greater than 60 years (> 60 years) (p = 0, 199) were found signijicant factors independently injuencing mortality. The risk score was (Risk score = (ARF)XO,497 + (> =48 hours)XO,203 + (>60years)XO,199). The overall predictive accuracy of risk score was%95.
CONCLUTION: Treatment delay and related acute renal failure and advanced age are determining factors for survival after ulcer perforation. Delay of treatment may be only changeable factor for mortality. lt is ciear that, the early diagnosis and treatment aredecreasing operative mortality of peptic ulcer perforation. Every effort to decrease the mortality should be this manneý:

Aim: In this study we assessed the results of staged abdominal repair (STAR) applications in our clinic.
METHODS: Retrospective analysis ofsix cases who were operated by staged abdominal repair (STAR) between December 1998-1January 2002 were assessed according to operation indications, type of operation, presentation ofthe complications and mortality.
RESULTS: The initial operations for two ischemic bowel disease cases were right hemicolectomy + end ileostomy + mucous fistula and partial small bowel resection + right hemicolectomy + ileotransversostomy. The operative indications were fistula formation following strangulatedfemoral hernia, diverticular perforation, diverticulitis + massive lower gastrointestinal bleeding and abdominal ! gunshot trauma, and operations were right hemicolectomy + ileotransversostomy, subtotal colectomy + ileorectostomy + diverting ileostomy, subtotal colectomy + Hartmann procedure and primary repair of vena cava + distal pancreatectomy + left hemicolectomy+ Hartmann procedure respectively. Median hospital stay was 28 days. Two cases had pulmonary problems (pleural effiýsion and 1 atelectasis). Gunshot trauma patient died four days after the abdominal closure probably due to pulmonary emboli.
CONCLUTIONS: Relaparotomy decision may be made prior to the operation but the final decision is made per-operatively. Staged abdominal repair gives an opportunity for sufficient debridement and peritoneallavage and also gives a chance to evaluate the anastomosis sites..

BACKGROUND: Traumatic diaphragma rupturesare difficult to diagnose and generally with associated organe injuries. The aim ofthe study is to evaluate the factors effect on mortality.
METHODS: Twenty-three patients with traumatic diaphragma injuries, admitted to our hospital were retrospectively evaluated for demographics, diagnosis, otherorgan injuries, treatment, mortalityand morbidity.
RESULTS: All patients were male and the mean age was 24.7± 10.0. The diaphragma injuries were observed during laparatomy in 19 patients (%82.6), during laparatomy and thoracotomy in 2 (%8.7). The injuries were diagnosed with fluid drainage from thorax tube during peritoneal lavage in 2 patients (%8. 7). All patients, but one, had other organ injuries (%95.7), most commonly in stomach, spleen and liver. Seven patients died during peroperative or postoperative peiod (%30.4). When these seven patients were compared to survived patients, it was observed that age and trauma score were statistically related to mortality rate (p<0.05), but the lenght ofthe diaphragmatic injury was not related to mortality rate (p > 0.05).
Conclusion: Traumatic diaphragma injuries are generally diagnosed during laparatomy and associated with other organ injuries. The high mortality rate in patients with traumatic diaphragma injuries, is not related to the characteristics ofthe diaphragma injury, but it is closely related to concomitant problems such as patient is age and trauma score.

BACKGROUND: This study was performed to contribute epidemiological data about pediatric trauma registry in our country.
METHODS: Ninety-four children with trauma who were admitted to the Pediatric Emergency Clinic of our hospital were prospective(jl evaluated
RESULTS: Forty-five percent patients were female and 55% were male with a mean age of79+52 months. Traffic accidents were the primary cause oftrauma (46%). The education level ofthe mothers were above high school in only 30.4 % patients. Forty-four percent of trauma took place during daytime, the incidence oftrauma was high in summer and autumn (p<0.05). Eighteen percent ofpatients required major and 31 % of patients required minor surgical treatment whereas 48% of patients were conservatively treated and 3% died. Forty-seven percent of patients were referred to our hospital from another hospital and surgical intervention requirement for referred patients werefound to be higher than the others (p<0.05).
CONCLUTION: Increasing the education level if mothers will contribute to the prevention of childhood
KEYWORDS: Pediatric trauma, childhood, epidemiology

BACKGROUND: The ambulance service is very important in emergency medicine. The aim of this study was to investigate the new governing statuate of private ambulance service and to propose some new ideas.
METHODS: We examinated the new governing statuate of private ambulance service, rules of patient transporte between the hospitals and reports written by SSK Göztepe Educational Hospital ambulance drivers.
CONCLUTION: We concluded that SSK Göztepe Educational Hospital ambulance drivers have a iot of problems especially at the rules of patient transport between the hospitals and there are some defiencies at the new governing statuate of private ambulance service.
RESULTS: We concluded that it is necesssary to manage all the ambulance services in one center; all the private ambulance services have to have a specialist and all these must be determinated by the special rules.

BACKGROUND: Clinical and radiological results ofthe patients with humeral shaftfractures who underwent Iocked intramedullary nailing are retrospectively evaluated in this study.
METHODS: 29 patients (17 males, 12 females; mean age 43.6; range 26 to 68 years) who underwent Iocked intramedullary nailing were evaluated retrospectively. 17 patients had major and seven patients had minor traumas. ln three patients the fractures were, pathological and also two patients had additional hypertrophic non-union. Closed intramedullary nailing was performed in 21 patients. Three patients (two with non-union) were treated by using autogenous graft. Nine patients were nailed antegradely and 20 retrogradely.
RESULTS: The meanfollow-up period was 16.2 months (range 8 to 47 months). The mean time ofunion was 18 weeks (range 8 to 36 weeks) in 26 patients (% 90) but non-union occured in three patients.Functional end results ofshoulderand elbow were excellent in 23 (%79) patients, moderate infour (%13) patients and bad in two %8) patients. Postoperative complications included radial nerve palsy, breakaie of the distal locking screw and superficial infection in one patient each. Nail migration also occured in an osteoporotic patient.
CONCLUTIONS: Locked intramedullary nailing is the treatment ofchoicefor humeral shaftfractures in osteopenic bone, pathological fractures, comminuted or segmentalfractures and also for humeral shaftfractures in polytraumatised patients who may need to use the injured armfor early rehabilitation and mobilization.

BACKGROUND: In orthopaedic traumatology; acute compartment syndrome is a common complication associated with tibial fractures. In our study, we investigate differences, if any, between open and closed tibialfractures in terms oftheir risk of compartment syndrome.
METHODS: Fourty-two tibial fractures of 39 patients, 29 (69%) closed and 13 (31%) open, having the risk of acute compartment syndrome according to the clinical examination, were monitored following traumas during which their DP (DP= Diastolic blood pressure -Absolute compartment pressure) and absolute compartment pressures were measured via intracompartmental pressure measuring equipment.
RESULTS: Average absolute compartment pressure was found to be 31.25 mmHg in open and 29,32 mmHg in closed fractures (p=O,484) whereas average DP was measured to be 47,46 mmHg in open and 49,66 mmHg in closedfractures (p=O,415). According to student's test, the difference between the two groups was not significant. We found the incidence of acute compartment syndrome as 7, 7% in open fractures, 6.9% in closed and 7, 1 % in overall tibial fractures andfasciotomy was carried out in those cases.
CONCLUTION: Statistically not significant difference between the pressure levels,found in open and closed tibialfractures, showed that open type oftibialfractures holds the risk of compartment syndrome as much as the closed one.

A patient with blunt abdokminal trauma due to a traffic accident was admitted to our clinic and operated urgently because of hemodynamic shock. Operative exploration revealed rupture of a congenital giant cavernous liver hemangioma, then a partial hepatic resection was performed. Liver abscess and pleural effusion occurred in the postoperative period and the abscess was drained by a CT- guided catheteý: However the catheter drainage get infected. As a conclusion, if a liver hemangioma is detected incidentally on routine check-up studies, these people, carrying potential risk ofrupture should be warned about high risk jobs.

This rare syndrome first described by Bouveret in 1896, occurs when a stone migrates through a cholecysto or choledochoduodenal jistula lodging in the duodenal bulb and resulting in obstruction. Up to date, less than 100 cases reported in the literature. This rare type of gallstone ileus can be diagnosed and treated endoscopically, although there are a few previous reports of successful endoscopic, removal. However, surgical removal is safe and effective but the most controversial aspect is the proper treatment, simple enterotomy and removal ofthe gallstone alone or enterolithotomy in association with cholecystectomy and dejinitive correction ofthe biliodigestive fistula. This paper presents a case report of a 65 year old man with gastric outlet obstruction caused by a large gallstone. The diagnose and treatment of this case who was admitted in 1.General Surgical Department of Taksim Teaching and Research Hospital was researched under the reference of recent literature.

We examined the fact that 12 years old obese girl who applied to our clinic with acute abdomen symptoms and we determined primer omental torsion (POT) at laparotomy in this case. This disease is rare in childhood and imitates the signs of acute appendicitis. Obesity and anatomic variations ofthe omentum are predisposingfactorsfor POI ln this study we wanted to share our experiences in diagnosis and treatment ofPOI

We report herein two patients in whom bullets migrated into adjacent lateral ventricles in the brain and moved freely as a consequence of gravity. A rewiew ofthe literature suggests that spontaneous migration ofintracerebral bullets is being eased by cerebral softness, specific gravity of the bullet compared with brain tissue. ln patients undergoing the surgical removal of intracerebral or intraventricular bullets, an x-ray is recommended after final positioning.