Ulus Travma Acil Cerrahi Derg: 9 (4)
Volume: 9  Issue: 4 - October 2003
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1.ROLE OF THE SURGEON IN THE HOSPITAL INFECTIONS CONTROL COMMITTEES
Mufide Nuran Akcay, Ayten Kadanalı, Gurkan Ozturk
PMID: 14569476  Pages 225 - 231
Hospital-acquired infections are the ones that develop within hospital stay or appear after discharge. These infections are associated with an increased rate of morbidity and mortality, longer hospital stay and higher hospital costs and Hospital Infections Control Committees have been founded to prevent it. In this review, we intended to investigate the role of the surgeon in this committee.

2.EFFECTS OF HEPATECTOMY AND ARGININE ENRICHED DIET ON COLONIC MUCOSA ORIGINATED INFLAMMATORY CYTOKINES
Cengiz Aydın, Ahmet Coker, Koray Atilla, Erdener Ozer, Isıl Coker, Afig Huseyinov
PMID: 14569477  Pages 232 - 238
Background: To assess the effects of arginine-enriched diet and partial hepatectomy in rats on gut-originated inflammatory cytokines.
Methods: Of 24 rats, Group 1 and 2 animals were fasted 24 hours before surgery, Group 3 and 4 animals received regular plus arginine-enriched diet(AED). Group 2 and 4 animals had undergone 30% hepatic resection. Leukotriene B4 (LT B4) levels were detected in colonic mucosa and mucosal perfusates immediately after resection. Mean leukocyte counts (MLC) were detected also in the mucosa. Results: In the basis of fasting situation regardless hepatectomy, all MLC were lower in Group 3 and 4 but LTB4 levels both in mucosa and perfusate were higher. On hepatectomy based comparison there was not any statistically significant difference between groups but mucosal perfusate LTB4 levels. But when hepatectomy added on fasted animals MLC levels were lower than fed by AED + sham operation. LTB4 levels were insignificant in both perfusate and mucosa. When
hepatectomy added on AED animals (Group 4), MLC decrased and mucosal LTB4 increased when they compared with fast without hepatectomy Group 1.
Conclusions: AED prior to extra-intestinal operations may trigger inflammatory cascade and complications via leucocyte degradation and LTB4.

3.THE EFFECTS OF LACTATED RINGER’S RESUSCITATION ON TISSUE BLOOD FLOWS AND OXIDANT INJURY IN EXPERIMENTAL CRUSH INJURY IN RATS
Veysel Balcı, Halil Ozguc, Sule Akkose, Nevzat Kahveci, Zehra Serdar, Rifat Tokyay
PMID: 14569478  Pages 239 - 245
Background: In an experimental model of crush injury, tissue blood flow, the extend of oxidant injury and the effect of lactated ringer’s resuscitation were investigated.
Methods: Rats were divided into sham (n: 8), crush injury (n: 8), and crush injury + lactated ringer’s resuscitation (n: 8) groups. Arterial and venous cathetherization were performed in all groups. Crush injury was done with intravenous infusion of allogenic muscle extract. In the crush injury + lactated ringer’s resuscitation group 30 ml/kg lactated ringer’s solution was infused in 30 minutes. Kidney and liver blood flow were measured by using a laser flowmeter.
To assess the oxidant injury blood, liver, and kidney tissue samples were collected for malondialdehyde and glutathione measurements.
Results: In the crush injury, diminished liver and kidney blood flow rates were improved with lactated ringer’s resuscitation.
In addition, glutathione levels decreased whereas malondialdehyde levels and base deficit increased. Lactated ringer’s resuscitation brought base deficit to the control levels. When compared with the crush injury, lactated ringer’s infusion increased the glutathione levels but could not decrease the malondialdehyde ones.
Conclusion: Lactated ringer’s resuscitation improved the blood flow rates but could not prevent oxidant injury totally.

4.COMPLICATED MECKEL’S DIVERTICULUM
Adem Akcakaya, Orhan Alimoglu, Orhan Veli Ozkan, Mustafa Sahin
PMID: 14569479  Pages 246 - 249
Background: In this study we present our experience in the surgical treatment of complicated Meckel’s diverticulum.
Methods: The data of eight patients who underwent surgery due to complications of Meckel’s diverticulum between 1994 – 2001 was retrospectively assessed.
Results: There were six males and two females with a mean age of 31 years (range 13 to 65). Preoperative diagnoses were acute surgical abdomen in six and incarcerated inguinal hernias in two patients. Intraoperative diagnoses were as follows; Littre’s hernia in two, diverticulitis in two, perforation of the diverticulum in one and intestinal obstruction in three patients (there was a band extending from diverticulum to the umblicus in two patients and a mesodiverticular band in the remaining one). While diverticulectomies were performed in five patients, three had small bowel resections. The mean diameter of the diverticulas was 2.3 cm (range 2 to 4) and the mean lenght was 3.5 cm (range 3 to 8). Postoperative intestinal obstruction was observed in one patient who had underwent diverticulectomy and subsequently a small bowel resection was performed.
Conclusion: Being aware of the complications of the Meckel’s diverticulum is necessary in correct timing of the surgery and selecting the proper incision in patients with acute abdomen. This will result in decreased morbidity.

5.THE EVALUATION OF THE PATIENTS ADMITTED TO A BURN CENTER IN TURKEY
Arife Polat Duzgun, Emrah Senel, M.Mahir Ozmen, Hakan Kulacoglu, Yusuf Isık, Faruk Coskun
PMID: 14569480  Pages 250 - 256
Background: Burns constitute an important part of the accident-related deaths due to high morbidity and mortality.
Methods: The medical records of 778 (279 female) patients who were treated during last three years period were retrospectively analyzed concerning age, gender, the cause of the burn, the month when the burn occurred, admission date, duration of the hospital stay, area of the burn. The relationship between these parameters and the mortality was analyzed. Results: The average age of the patients was 20 years. The burns were related to accidents in 87% patients, abuse in 8%, co-morbid diseases in 3% and suicidal attempts in 2%. In 48% of the cases there were hot fluid burns and in 37% (284) fire-flames. The burns were due to electrical burns in 13% patients and to other reasons in the remaining 2%. One hundred and seventy - two patients had fatal courses. The mortality rate was 75% in 12 patients who were above 60 years. Average burn area was 24% (10-100) and average hospital stay was 13 days.
Conclusion: As most of the burns were due to accidents, the number of burns might be reduced by prioritizing preventive measures and better results could be obtained when the quality and the number of the burn centers is increased.

6.EVALUTION OF PHYSICAL FINDINGS IN ACUTE WRIST TRAUMA IN THE EMERGENCY DEPARTMENT
Arif Alper Cevik, Izge Gunal, Metin Manisalı, Sedat Yanturalı, Rıdvan Atilla, Murat Pekdemir, Ali Binerli, Cecil James Holliman
PMID: 14569481  Pages 257 - 261
Background: The aim of the study was to evaluate the value of physical findings to predict fracture in patients with acute wrist trauma.
Methods: This prospective clinical study was conducted over a period of four months from December 1998. The patients who were older than 18 years and presenting with acute wrist trauma within 24 hours of the time of injury were included in the study. Magnetic resonance imaging (MRI) was done for the patients who had inconsistency between clinical and radiographic diagnosis.
Results: Fifty-five patients were included in the study. Four fractures were diagnosed on the MRI of eight patients who have contradiction between clinical diagnosis and X-ray studies. The positive predictive values of edema, localized tenderness, pain on active and passive motion, pain with grip and pain in supination were found as 95.2%, 67.3%, 77.3%, 91,7%, 89.3%, and 96%, respectively. Physical findings having high sensitivity were found as localized tenderness (94.3%), pain on the active and passive motion (97.1%, 94.3%, respectively). Pain on the active and passive motion were determined as physical findings with highest negative predictive values (%90.9, %89.5, respectively).
Conclusion: Edema, pain on grip and supination, and especially pain on passive and active motion and localized tenderness can be valuable to predict or rule out fracture in acute wrist trauma cases who have no deformity.

7.TRACHEOBRONCHIAL FOREIGN BODIES: A 10 YEAR EXPERIENCE
Atilla Eroglu, İbrahim Can Kurkcu, Nurettin Karaoglanoglu, Erdal Yekeler, Sahin Aslan, Ahmet Basoglu
PMID: 14569482  Pages 262 - 266
Background: Our aim is to describe foreign body aspiration in the tracheobronchial tree, a common emergency with serious consequences.
Methods: We reviewed the records of 357 patients who were admitted to our hospital during a 10-year period for the treatment of aspirated foreign body into the tracheobronchial tree.
Results: Of these cases, 42.4% were male and 57.6% female. Their ages ranged from 4 months to 70 years (average of 10.8 years). The most common manifestation was coughing, with subsequent dyspnea and wheezing. All underwent rigid bronchoscopy for the removal of the foreign body. Foreign bodies were localized in the right bronchial tree in 188 cases (52.7%), the left in 107 cases (30%) and trachea in 39 cases (10.9%). Foreign bodies were not found during bronchoscopy in 23 cases (6.4%). The foreign bodies were: needles (n=125), peanuts (n=110), plastic objects (n=52), and miscellaneous (n=47). Foreign bodies were removed by bronchoscopy in all but six cases (1.7%), who underwent limited thoracotomy. The present series had a mortality of 0.56 percent (two deaths) following removal of foreign body.
Conclusions: Foreign body aspiration are rapidly recognized from the patient’s history and easily treated by bronchoscopy and extraction of the aspirated foreign body. A high index of suspicion is crucial for early diagnosis.
However, education is the best preventive measure for decreasing the incidence of this matter.

8.CLINICAL RESULTS OF FOUR HUNDRED AND TWENTY-FOUR CASES WITH CHEST TRAUMA
Metin Er, Ahmet Feridun Isık, Mehmet Kurnaz, Ufuk Cobanoglu, Serkan Sagay, İrfan Yalcınkaya
PMID: 14569483  Pages 267 - 274
Background: In this retrospective study, we aimed to emphasize that thoracentesis is a fast and safe method to evaluate indication for thoracotomy in patients with thoracic trauma who have preshock or shock findings, without losing time by other examinations such as X - ray studies.
Methods: File records of 424 patients who were admitted to Thoracic Surgery Deparments of Adiyaman State Hospital and Medical School of Yuzuncu Yil University between December 1994 and March 2002, were investigated.
Results: There were 371(87,5%) male and 53 (12,5%) female patients, aged 5 to 89 (mean, 38,35). Most of the patients (n:382, 90%) were recovered by tube drainage and conservative management. There were 30 (7.1%) cases who underwent thoracotomy or median sternotomy. Nine patients underwent thoracotomy after being diagnosed by only thoracentesis without X - ray and 8 (89,9%) of them survived. The overall mortality was 2,8% (12 cases).
Conclusion: Diagnostic thoracentesis has to be one of the indications for emergency thoracotomy after prompt systemic physical examination in the approach to thoracic trauma patient.

9.CHEST TRAUMA: ANALYSIS OF 592 CASES
Celal Tekinbas, Atilla Eroglu, Ibrahim Can Kurkcuoglu, Atila Turkyılmaz, Erdal Yekeler, Nurettin Karaoglanoglu
PMID: 14569484  Pages 275 - 280
Background: Thoracic traumas constitute an important part of the patients who are being admitted to the emergency units and deaths due to trauma. The aim of this study was to compare our clinical experience and results of the literature.
Methods: 592 patients with thoracic trauma who were admitted to our clinic between 1996 and 2000 were evaluated retrospectively.
Results: 449 patients (75.8%) had blunt and 43 patients (24.2%) had penetrating thorax trauma. There was rib fracture in 448 patients (75.7%), clavicula fracture in 55 (9.2%), scapula fracture in 31 (5.2%) and sternal fracture in 20 (3.4%). In addition, flail chest was detected in 79 cases (13.3%). The most frequent complications were pneumothorax (n: 158; 26.7%), and hemothorax ( n: 119 ; 20.1% ). Three hundred and thirty - nine patients (57.2%) were treated by tube thoracostomy and 190 by conservative management (32.1%). Surgical treatment was performed in 99 (16.7%) patients. Morbidity was 18.4% ( n: 109 ) and mortality, 6.4% ( n: 38 ). Mean hospital stay time was 13.4 days (2 - 93 days).
Conclusion: Thoracic traumas can cause vital organ injuries and impaired cardio-respiratory hemodynamics should be treated immediately.

10.TRACHEOBRONCHIAL INJURIES
Refik Ulku, Mehmet Nesimi Eren, Sevval Eren, Serdar Onat, Celal Yavuz
PMID: 14569485  Pages 281 - 284
Bacground: Tracheobronchial injuries are among the least common sort of thoracic traumas. This injury can be life threatening. However, successful diagnosis and treatment can prevent devastating acute or delayed complications. The aim of this study was to rewiew the authors’ surgical experience in tracheobronchial injuries.
Methods: We reviewed our records of 29 patients with tracheobronchial injuries from January 1979 to December 2000. The median age was 22.7. Twenty-seven patients were male and two were females.
Results: The causes of traumas were penetrating injury in seventeen, blunt injury in eleven patients and animal bite in one. In sixteen patients cervical trachea, in nine main stem bronchus, in 3 lobar bronchus and in one patient mediastinal trachea were found to be injured. In seven of twenty-nine patients there were combined tracheal and esophageal injuries. Surgical approach was made by oblique incision, collar incisions and thoracotomy. In general we prefered primary repair. The overall mortality rate was 24%.
Conclusion: In our opinion, the number of complications and mortality can be diminished by early recognition of the injuries and treatment.

11.DIAPHRAGMATIC RUPTURE IN ABDOMINAL TRAUMA
Celalettin Vatansev, Faruk Aksoy, Sakir Tekin, Ahmet Tekin, Metin Belviranlı, Adnan Kaynak
PMID: 14569486  Pages 285 - 290
Background: The aim of the study is to evaluate the patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma.
Methods: Thirty-eight patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma were investigated retrospectively.
Results: The average age was 41,72 and there were 31 male and seven female patients. The injury forms were penetrating trauma in 22 (58%) and blunt trauma in 16 (42%) cases. Associated abdominal organ injuries were found in 27 (71%) cases. Among 47 diapragmatic ruptures, 27 (57%) were on the left and 20 (43%) were on the right side. The average diameter of the rupture was 5,45 (1-20) cm. Management of the diaphragmatic rupture and other associated organ injuries were accomplished through laparotomy. Morbidity was developed in 18 cases and mortality in four cases with associated abdominal organ injuries.
Conclusion: Diaphragmatic rupture results in high morbidity and mortality due to associated organ injuries.

12.IATROGENIC HYPERNATREMIA DURING HYDATID CYST OPERATION
Perihan Ergin Ozcan, Aysen Yavru, Simru Tugrul, Ozkan Akıncı, Mert Erkan, Nahit Cakar
PMID: 14569487  Pages 291 - 293
Hypernatremia due to salt gain is generally iatrogenic. This case report presents a 55 year-old woman who was operated because of hepatic hydatid cyst. At the end of the operation, following extubation the patient was unconscious and serum sodium concentration was found to be 185 mEq/ L. The patient was entubated again and transferred to the intensive care unit. When the patient awaked and became conscious at 36th hour in intensive care unit, she was extubated and transferred to ward with serum sodium concentration of 142 mEq/L. The serum sodium concentration should be monitored carefully in hydatid cyst operation, during which hypertonic saline is used for scelosidal effects as general anesthesia can mask neurologic signs due to hypernatremia.

13.RUPTURE OF OPERATED CELIAC ARTERY ANEURYSM
Hakan Bingol, Celalettin Gunay, Ertugrul Ozal, Harun Tatar
PMID: 14569488  Pages 294 - 296
Celiac artery aneurysm is a rare and its rupture is the most frequent and serious complication. The patient who underwent aneurysmectomy and aorto - celiac artery synthetic prosthesis graft interposition in another cardiovascular surgery center two years ago, was admitted to our department with complaints of fever and abdominal discomfort. Computed tomography revealed an aneurysm with 1 cm of diameter at the beginning of celiac artery and intraperitoneal hemorrhage. Acute hematocrit descent was occured and then cardiac arrest was taken place. So, emergency thoracotomy was done. Aorta was compressed with hand and at the same time internal cardiac ressusication was done then cross clamp was placed onto aorta. Median abdominal incision was done and ruptured celiac artery aneurysm was observed. Infected graft was removed and PTFE graft was interposed from descending aorta to a. hepatica propria, away from the infected area. During 17 months of follow-up period graft no complication was observed. We believe that because of its rarity, tendency
to be asymptomatic along with high incidence of rupture, celiac artery aneurysms should not be underestimated.

14.COLORECTAL PERFORATION DUE TO SELF ADMINISTERED RETROGRADE ENEMA
Tugba Topcu
PMID: 14569489  Pages 297 - 299
Retrograde irrigation enemas are commonly used in the treatment of chronic constipation especially in the elderly. We report a case of colorectal perforation due to self-administered retrograde water enema. A 55 year-old chronically constipated male patient was admitted to the emergency unit with severe diffuse abdominal pain. He administered rectal enema using a garden hose directly connected to the water two hours before admission, until he felt a sudden sharp abdominal pain. At the operation he was found to have a perforation along the antimesenteric border of distal sigmoid colon extending to the upper rectum. Primary resection and anastomosis with intraoperative colonic lavage was performed. Postoperative course was favorable without any wound infection or intraabdominal sepsis.

15.COLOR FLOW DUPLEX ULTRASONOGRAPHY IS AN EFFECTIVE ALTERNATIVE METHOD
Mehmet Kurtoglu, Murat Aksoy, Cihangir Karaaslan, Aydin Zilan
PMID: 14569490  Pages 300 - 303
Increasing use of percutaneous interventional cardiac and peripheral arterial procedures has resulted in high incidence of femoral pseudoaneurysms. This case report presents a 68 year-old male with a femoral pseudoaneurysm after percutaneous iliac transluminal angioplasty, who was treated with ultrasound guided compression successfully. Although surgical procedures are widely performed in Turkey, it should be kept in mind that compression therapy is effective and may present as an initial step in the management of femoral pseudoaneurysms.

16.TENSION PNEUMOPERICARDIUM IN CHEST TRAUMA WITH GUNSHOT WOUND
Osman Tansel Darcin, Hasan Ozdemir, Birol Yamak, Aydin Zilan
PMID: 14569491  Pages 304 - 306
Tension pneumopericardium is a rare complication of gunshot wounds. A 28 year-old male patient with tension pneumopericardium after chest trauma by gunshot bullet injury was reported. On initial examination, hemopneumothorax and fracture of the clavicle were found on the right side. Interestingly, there was no image of additional pneumopericardium on telecardiogram at the admission to the hospital. Following right tube thoracostomy, 900 ml of blood and some air were drained. Due to additional 400 ml blood drainage on the second day, right thoracotomy was performed. Laceration of the right lung and the bleeding from the right innominate vein were sutured. There was no visible pathology on pericardium. Tension pneumopericardium occured on the second day of admision and a tube was inserted in to the pericardial space through subxyphoid incision. No blood but some air was drained from pericardial space. After removing the pericardial and right thorax tubes on the fifth and sixth days respectively, the patient was discharged with complete recovery.

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