BACKGROUND: Sacral bone fractures after direct traumas such as gunshot wounds and blunt sacral traumas are rarely, whereas those occurring after indirect traumas with vertical shear mechanisms ( car accidents or falls) are more frequently seen. METHODS: A cadaver sacrum was modelled 3-dimensionally using finite element software. Left sacroiliac joint was modeled to simulate a 75- kg man falling on one leg from a height of 5 meters. An impact load of 10 kN was transferred to the sacrum via intervertebral disc surface and two facets. Von Mises equivalent stress distribution was estimated. RESULTS: Von Mises stress distribution was calculated for sacral ala (430 MPa), S1 pedicle (225 MPa), and S1 lamina (35 MPa). Stress values were 200 Mpa, 130 Mpa, 105 Mpa, and 55 MPa on ventrolateral, dorsomedial, ventromedial and dorsolateral sides of S1 foramen respectively. Vertical shear injury caused stress distribution to concentrate at sacral ala and S1 pedicle (zone I). Local stress distribution around S1 foramen is concentrated ventrolaterally CONCLUSION: High incidence of zone I sacral fractures and low incidence of neurological deficits could be explained by concentration of stress at sacral ala. Zone II fractures might be due to by transfer of triggered stresses from sacral ala and S1 pedicle to ventrolateral side of S1 foramen.

BACKGROUND: Microbial infections and translocation of intestinal bacteria are thought to contribute to multiple system organ failure, but bacterial cultures are often negative in patients with this complication. The purpose of this study was to determine the sensitivity of PCR for detecting microbial DNA in the blood of animals after conducting an experimental model of anastomotic leakage. METHODS: Fourty rats were divided into three groups as follows: Control Group; simple laparotomy group, Anastomosis Group; colon resection and anastomosis group, and Leakage Group; group with colon resection and an anastomosis leaving a 5 mm opening. Blood was drawn form rats before the procedure, and postoperative 3rd and 6th days. DNAs were extracted from these samples and PCR techniques were used to amplify genes of Escherichia coli. Statistical analysis for the percentage of rats with microbial DNA in the blood for all groups was done by Fisher’s exact chi- square test. The difference among groups was considered significant if the P value was less than 0.05. RESULTS: Most of the detected Escherichia coli genes were from the Leakage Group, and the detection rate was significant compared to other groups. CONCLUSION: We suggest that PCR could be a useful adjunct tool for immediate diagnosis of anastomotic leakages.

BACKGROUND: The objective of our study is to evaluate the preventive effects of selective digestive decontamination (SDD) and mechanical bowel preparation in rats with experimentally induced bacterial translocation. METHODS: Fourty adult male Sprague Dowley rats weighing 250-300 g. were divided equally into four groups as Group 1 (sham [control]), Group 2 (experimentally induced IAH at 19 mmHg), Group 3 ( SDD group) and Group 4 (SDD and mechanical bowel preparation with 19 mmHg intraabdominal pressure). Group 3 and 4 were treated at 12 hours intervals with oral gentamycine 5 mg/kg and IM sefotaxime 100mg/kg Mechanical bowel preparation was performed by oral administration of sodium phosphate. After 24 hours all rats were sacrified; mesenteric lymph nodes, spleen and liver biopsy specimens were harvested aseptically. Specimens were diluted and cultured in McConkey medium and the colony-forming units (CFU/gr ) were calculated. RESULTS: In Kruskal Wallis tests there were no significant differences between Group 1 and 3 or 4, and also Group 3 and 4 (p>0.05, p=0.872 respectively), while differences between Group 1 and 2, and also Group 3 and 4 were statistically significant (p<0.001) with respect to CFU/g estimates. CONCLUSION: These data indicate that selective intestinal decontamination and mechanical bowel preparation prevent bacterial translocation due to intraabdominal hypertension.

BACKGROUND: Patients with civil cranial gunshot injuries who were treated in our hospital were statistically analized for the factors acting on 7 days survival and prognosis without regarding treatment modalities. MATERIAL AND METHOD: Patients were divided into two groups according to the mortality rates in 7 days following the trauma without regarding treatment modalities. Initial GCS score, pupillary response to light, coagulopathy, ventricular penetration and number of hemispheres affected are 5 differentials evaluated separately and in combination for their effects on mortality rates within 7 days posttraumatically and their statistical significance. RESULTS: Thirty six male (75%) and 12 female (25%) patients included in the study. Total and 7 day- survival rates were 27% (13/48), and 31% (15/48) respectively. Among GCS scores, pupillary defects, coagulopathy, intraventricular penetration, the number of hemispheres affected, the most important prognostic factors of the patients living less than 7 days were found to be primarily coagulopathy and then pupillary defects. The other variables were not significantly effective and the results were in accordance with the literature. CONCLUSION: In civilian patients with cranial gunshot injuries pupillary defect and coagulopathy were statistically significant prognostic factors. We think that agressive medical and surgical treatment will be beneficial even if the patients’ neurological status is deteriorating.

BACKGROUND: Slipped femoral capital epiphysis requires immediate surgical intervention. Because this condition is relatively rare, the diagnosis is frequently delayed in patients with complaints of knee and hip pain and limping. Middle term results of patients who were diagnosed early and treated with a single cannulated screw are evaluated. MATERIAL AND METHOD: Five hips of 4 patients (3 male, 1 female) with slipped femoral capital epiphysis treated with a single cannulated screw between the years of 2000-2003 were evaluated under the light of literature findings. RESULTS: Mean patient age was 13 (range 12-14) years; mean slip angle was 33.2° (range 26°-40°); mean body mass index was 27.3 kg/m2 (range 25.6-29.8 kg/m2 ). After immediate immobilization, internal fixation with a single screw was applied without any reduction. CONCLUSION: During the mean follow-up period of 24 months (range 12- 41) epiphysial slipping progression was not observed and new epiphysial slipping did not develop on the contalateral hips. We are of the opinion that intervention for slipped femoral capital epiphysis with a single cannulated screw is a beneficial treatment. Although the number of our cases is limited we believe a close follow-up of the hip without prophylactic pinning should be the preferable alternative.

BACKGROUND: To identify clinical parameters that may be associated with intracranial lesions in patients with mild head injuries, Glasgow Coma Scale (GCS) scores of 15 but without any focal neurological deficit. METHODS: All head trauma patients admitted to the emergency room within 3 months with GCS scores of 15 (n = 371) were evaluated. Patients with focal neurological deficits, penetrating or multiple traumas, gun shot wounds were not evaluated. RESULTS: Mean age of 222 male and 149 female patients was 22.4 years. Frequency of intracranial lesions detected in CT was higher in patients older than 60 years of age. A significant difference was not found between both genders. Detection rate of abnormalities was higher after motorway accidents. Loss of consciousness and post-traumatic fits were associated with higher rates of pathological sequelae. A significant difference was not found between patients with or without headache, nausea, and vomiting. Sensitivity and specificity of cranial x-ray were estimated to be 38.2% and 93.2% when compared with cranial CT respectively. CONCLUSION: The incidence of intracranial lesions in patients with mild head injuries, GCS scores of 15, younger than 60 years of age, and without any focal neurological deficits, loss of consciousness, post-traumatic fits, gun shot wound, and penetrating injury is 0.6%.

BACKGROUND: Fractures of the mandible are among frequently seen facial injuries and their reconstruction requires unique procedures. The purpose of this study is to demonstrate the efficacy of screw-wire combination osteosynthesis technique in the treatment of simple and displaced, symphisis and parasymphisis mandible fractures. METHODS: In our clinic 9 simple and displaced, symphysis and parasymphysis fractures of mandible were treated with screw-wire combination osteosynthesis technique. By intraoral approach 4 screws were applied to both sides of the fracture site 5 mm away from either side placed at superior (n = 2) and inferior (n = 2) localizations. Lower and upper wires were placed bicortically, and unicortically respectively . In order to surround them with wire, the screws were not fully tightened. After surrounding the screws, the wires were tightened in a manner that would properly face the fracture sites mutually. Intermaxillary fixation was applied for 7 to 10 days in all patients. RESULTS: During follow up period we did not encounter infection, malunion, nonunion, delayed union and patient discomfort necessitating extirpation of the materials fixed. CONCLUSION: We think that screw-wire combination technique is an easy and effective method with low cost and fast healing especially in reconstruction of anterior mandible fractures.

BACKGROUND: Since wound infection rates in patients with delayed admission seemed to be significantly higher, a retrospective study of bacteriology in 320 burn patients, over a 5-year period was carried out in order to analyze the relation between delayed admission and wound infection rates in our Burn unit of Uludað University, Faculty of Medicine.. METHODS: The patients were separated into moderate or major burn groups according to burn severity. Wound infection and contamination frequencies were analyzed according to time-delay between burn injury and hospitalization time. RESULTS: Delayed admission was found to be an important factor that causes an increase in wound infection and contamination frequency. This increase was significant especially among patients with moderate burn wounds. In patients with severe burns, wound infection and contamination frequencies were found to be higher for all admission time points. CONCLUSION: Systemic antibiotic prophylaxis should be discussed in patients with moderate burns whose admission-delay is more than 78 hours. Wound infection and contamination rates were high in patients with major burns independent of the admission time. Therefore, systemic antibiotic prophylaxis should also be discussed in this group of patients, although it results in elimination of the normal skin flora.

BACKGROUND: It was reported that pediatric trauma score (PTS) is an important tool for the initial assesment of injury severity and could help in the triage of injured children as well. The aim of this study is to investigate the prognostic value of PTS in blunt abdominal traumas. METHODS: Between 1997 and 2003, children with blunt abdominal trauma who treated in the Department of Pediatric Surgery, Trakya University Medical Faculty were evaluated with retrospective analysis. PTS was resignated for each case. Individual morbidity and mortality were correlated with PTS. Data analysis were performed with Mann Whitney U test and ROC curve statistically. RESULTS: Seventy five patients were included in this study. The mean age of children was 7.5±4.2 years (10 months-15 years). Mechanisms of injury were as follows: automobile versus pedestrian 30, falls 18, motor vehicle crashes 14, bicycle accidents 7 and others 6. Forty two abdominal organ injuries were found.. PTS of the patients who had abdominal injuries were different statistically from others (p<0.05). On the ROC curve sensitivity and specificity were found as %74 and %12 respectively in those with PTS scores of 8. CONCLUSION: PTS was found to be of low sensitivity and specificity for blunt abdominal trauma patients.

A 44 year-old man presented to the Emergency Department of American Hospital with severe pain persisting in the left upper quadrant for several hours. A computed tomographic scanning (CT scan) and celiac digital substraction angiography (DSA) of the abdomen demonstrated a splenic infarct. Histopathological examinations showed diffuse acute vasculitis, thrombosis, panvasculitis which led us to diagnose the case as "polyarteritis nodosa". The diagnosis is usually difficult to establish and it is usually delayed due to variable clinical manifestations dependent on the site and the extent of arterial involvement.

Most colonic polyps are asymptomatic and the incidence rises during sixth and seventh decades. Symptoms and signs may vary with histological types and location. Clinical features include fresh rectal bleeding, mucoid diarrhea and prolapsus of stalked rectal polyps located near distal segment. Here we discuss a case with a rare clinical presentation, who had sessile malign villous adenoma located in the descending colon, which caused colocolic intussusception and prolapsed through the anus.

We will discuss clinical and radiological findings of a woman who attempted suicide by hanging. We report a 19-year-old women attempted suicide by hanging herself. There was no known period of global brain ischemia. She had a score of 7 on the Glasgow coma scale. CT scan showed bitemporal hippocampal atrophy and SPECT showed non-activated area on right temporal and temporo-occipital regions. There has been few reports relating to the involvement of the brain as documented on CT and SPECT. Hanging leads to global hypoxic damage resulting in hypo-perfusion changes mainly cerebral in temporal lobes and atrophy.

Blank cartridge guns, which are produced for self-defence needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by gunshot from blank cartridges may be fatal and are rarely encountered in emergency departments. A 3-year-old boy was brought to the emergency department since he had a wound on his neck caused accidentally by gunshot from blank cartridges. He had a moderate general condition and pale appearance. There was an irregularedged, defective wound 2 cm above the sternal notch in midline localization with a dimension of 3x4 cm. Computed tomography of the thorax revealed contusion in the apex of the left lung. A 2-mm plastic piece embedded in the left internal jugular vein was removed during the operation. A mass education on danger and harm of these guns as well as legal regulations for restricted use seem to be necessary. Also, physicians should keep in mind that blank cartridge guns can cause fatal injuries.

Reconstruction of the soft tissue defects around the Achilles tendon is a difficult challenge. This condition traditionally has been treated with staged procedures. We report a case treated with a one stage procedure. A neuromusculocutaneous radial forearm free flap was used for the reconstruction of an achilles tendon and for covering the overlying large soft tissue defect caused by a gun shot injury. The defect on the Achilles tendon was 15 cm in length and soft tissue loss was 18 x 10 cm. The flap including flexor carpi radialis muscle tendon was applied over the Achilles tendon. A terminolateral arterial anostomosis was performed on the tibialis posterior artery. There was no complication except a mild superficial infection on the lateral side of the flap treated by antibiotherapy. A satisfactory functional result was obtained. Application of a free neuromusculocutaneous radial forearm composite flap is a good technique to cover achilles tendon and soft tissue defects and to restore the function as a one stage procedure.