OBJECTIVE: To investigate the protective effect of antibiotherapy in the early phase of acute pancreatitis on cellular injury induced in lungs and liver. BACKGROUND: Cellular viability and plasma nitric oxide (NO) levels were assessed to determine the efficacy of highly bactericidal imipenem and quinolones on liver and lung injury. METHODS: Imipenem, levofloxacin or saline were administered to rats with caerulein induced pancreatitis. Twenty-four hours later serum amylase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and NO levels, pancreatic interstitial inflammation, acinar cell necrosis, acinar cell vacuolisation, peripancreatic fat necrosis; spotty necrosis, focal inflammation of liver and inflammatory processes in the lungs were assessed. RESULTS: Enzyme levels in the antibiotherapy groups were lower than in the control group. Serum NO levels were higher only in the imipenem group. Levofloxacin decreased acinar cell vacuolisation in the pancreas; interstitial edema, neutrophilic infiltration and interstitial enlargement in the lungs. Antibiotherapy decreased spotty necrosis, apoptosis and focal inflammation in the liver. CONCLUSIONS: Although treatment with imipenem is associated with higher NO levels than levofloxacin, levofloxacin prevents organ injury more effectively than imipenem in acute pancreatitis. Our results indicate that antibiotherapy in the early period of necrotizing pancreatitis prevents cellular damage induced in pancreas, liver and lungs.

BACKGROUND: To investigate the relationship between oxidative stress and pro-inflammatory response of the renal tissue at different ischemia times in I/R mice. METHODS:
Twenty-four male Swiss dormice were subjected to 30, 45 or 60 minutes of ischemia and then 60 minutes of reperfusion (Group 1 I 30/R60, Group 2, .I45/R60, and Group 3, I 60/R60 respectively). As markers of oxidative stress and antioxidant activity, levels of thiobarbituric acid reactive substances (TBARS), protein carbonyls and protein sulfhydryls (SH), tissue superoxide dismutase (SOD) and catalase (CAT) activities of the renal tissue and also renal tissue pro-inflammatory marker TNF-alpha levels were assessed. RESULTS: The levels of TBARS and protein carbonyl rised in I30/R60 group (p=0.01). In I45/R60 group, levels of TBARS, protein carbonyls and TNF-alpha levels were significantly higher while SOD and CAT activities (p=0.01), and the levels of SH were significantly decreased (p=0.05). These findings were more relevant for I60/R60 group. Higher TNF-alpha levels correlated positively with higher levels of TBARS, and protein carbonyls and negatively with SOD, CAT and renal tissue SH (p=0.001). CONCLUSIONS: In mice, oxidative stress after 45 minutes ischemia and 60 min reperfusion could induce pro-inflammatory cascade mediated through TNF-alpha.

BACKGROUND: The objective of the present study was to test and compare the effect of floroquinolones on fracture healing as assessed histopathologically. METHODS: A total of twenty five Wistar rats were arbitrarily assigned to five groups with five animals each. Bilateral closed femoral fracture was constructed manually in all groups. The first group did not receive any drug as control (C). The 2nd, 3rd, 4th, and the last group were treated with norfloxacin (N), ofloxacin (O), pefloxacin (P) and ciprofloxacin (Ci) respectively. Antibiotic administration was started on the 7th day after the fracture incident. All the treatments were discontinued twenty days after the incident all the rats were sacrificed , and the fracture calluses together with affected femurs were resected en bloc at the fourth week after fracture. RESULTS: Average healing grades of control group was higher than all the other antibiotic groups. Mean healing grades of control ( 5 ; n:8), ofloxacin (4.1; n:7), ciprofloxacin (3.9; n:8), norfloxacin (3.4 ; n:9) and pefloxacin groups (2.6 ; n:10) were recorded.. Statistically significant differences between antibiotherapy groups ( excluding. norfloxacin) and the control group were detected. CONCLUSIONS: The current histopathological study has shown that all the studied floroquinolones retarded fracture healing in rats.

BACKGROUND: Our aim was to evaluate the clinical efficacy of Ilizarov external fixator used for the management of shotgun induced open humeral fractures with special emphasize on neurovascular sequelae. METHODS: The authors retrospectively reviewed eleven shotgun induced open humeral fractures managed with emergent application of Ilizarov external fixator. No patient had associated neurovascular injury. All fractures were stabilized with Ilizarov external fixator immediately after meticulous debridement and irrigation under emergent conditions . RESULTS: With Ilizarov fixation technique complete bony union occurred in all patients within 14 to 44 weeks (average, 21 weeks) postoperatively.. One patient required a second intervention in order to adjust the external fixator rings. Two patients required a rotational fasciocutaneous flap so as to handle the soft tissue coverage problem. Superficial pin tract infection was present in eight patients, however in none of the patients deep tissue infection or osteomyelitis has been observed. Good to excellent results were achieved in 10 patients with Ilizarov fixation technique according to the rating system proposed by Smith and Cooney. CONCLUSION: Emergent Ilizarov external fixation is a safe method of obtaining a functional limb in the management of shotgun induced open humeral fractures with severe soft tissue damage.

BACKGROUND: The aim of the current prospective study was to examine the prognostic value of APACHE II, APACHE III (Acute Physiology and Chronic Health Evakuation II and III) and SOFA (Sepsis-related Organ Failure Assessment) scores and platelet counts in septic and nonseptic patients hospitalized and treated in ICU units. METHODS: One hundred and twenty ICU patients were included in this study. Patients were grouped as septic survivors, septic nonsurvivors, nonseptic survivors and nonseptic nonsurvivors. The SOFA, APACHE II and III scores, and platelet counts were recorded at the admission in the ICU units and discharge.from the hospital. RESULTS: Patients were grouped as septic survivors (n=42), septic nonsurvivors (n=14), nonseptic survivors (n=48) and nonseptic nonsurvivors (n=16). The highest SOFA, APACHE II and III scores and the lowest platelet counts were observed in septic nonsurvivors when compared with the other patient groups.. All score values and platelet counts were found to be significant in prediction of mortality in septic patients. CONCLUSIONS: According to our results obtained in septic and non-septic patients, we concluded that SOFA, APACHE II and III scores and platelet counts might be used in the prediction of mortality in septic patients.

BACKGROUND: Electric burns are serious public health problems that comprise 3.5% of the burns that refer to the hospital. By biting and sucking the electric cords, mouth and lip burns occur in the children. The mortality rate is 90% in the children who had cardiac arrest before coming to the hospital. In this study, the electric burns that were followed-up in our clinic were reported. MATERIAL AND METHODS: Four cases with electric burns followed-up in our clinic between September 2002 February 2003; were assessed. The cases were called back to control one and six months after the burn incident and the indoor precautions required were appraised. RESULTS: The mean ages of two male and two female children were respectively 23,6±10,6 months (10 - 36 months) Two of the four cases with burns had played with electric plugs and the other two had bitten the cords. The indoor precautions had still not been taken at the first and six months of the follow up period. CONCLUSIONS: House visits are important since the preventive measures are not usually taken at home.. In consideration of higher incidence of exposure to indoor accidents during childhood, the best way to avoid accidents is to take preventive measures against them.

BACKGROUND: Our aim was to evaluate the efficacy and safety of intermittent pneumatic compression methods (IPC) in the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in high-risk patients followed in our intensive care unit (ICU) for whom anticoagulation is contraindicated due to high risk of bleeding. MATERIALS AND METHODS: This prospective study was conducted between October 2001 and June 2002 at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty. Thirty eight surgical ICU patients who used IPC devices for prophylaxis of venous thromboembolisim were evaluated retrospectively. RESULTS: There were 27 male (71%) and 11 female patients (29%) with a mean age of 49.69 ± 18.61 years. Their diagnoses were as follows; 21 multi-trauma, 11 major abdominal surgery, 11 severe gastrointestinal bleeding. None of the patients had manifested DVT by venous duplex scans. A leg swelling was present in one patient without evidence of DVT by duplex scans. Symptomatic and fatal pulmonary embolism were not detected. Asymptomatic pulmonary embolism was detected by spiral thorax CT examination in one patient (2.6%). CONCLUSIONS: IPC seems to be an effective and a safe modality in preventing both DVT and PE in high-risk ICU patients with severe trauma and for those undergoing major surgery.

OBJECTIVE: To evaluate the results we obtained from 37 patients referred to our clinics with resorbable plate-screw systems which have been claimed as biodegradable fixation materials and used in craniofacial, maxillofacial and orthopedic reconstructive procedures owing to their advantages such as biocompatibility, adequate biomechanical resistance, longer dwelling time, elimination through physiological routes without causing any foreign body reaction and/or significant sequaleae. METHODS: Resorbable plate-screw systems used in 37 patients between 2000-2003 for various craniofacial reconstructive procedures were evaluated as for their efficacy, and biocompatibility. RESULTS: Adequate fixation was obtained in all patients, excluding one case operated for mandibula fracture whose reconstruction was completed with titanium plate-screw system. No serious complication was seen except a granuloma and sinus formation on subciliary incision in one patient. CONCLUSION: Owing to their improved polylactic acid/polyglycolic acid ratio resorbable plate-screw systems which contain varying compositions of polylactic acid and polyglycolic acid copolymers are ideal fixation materials used favourably in maxillofacial, craniofacial and orthopedic reconstructive surgery in that they make effective fixation and have further advantages such as biocompatibility, adequate biomechanical resistance against distraction and compression forces in the early postoperative period, longer dwelling time and elimination from the body through physiological routes without causing any foreign body reaction or significant sequaleae.

BACKGROUND: Fournier’s gangrene is the most serious and life threatening infection. The aim of this retrospective study is to describe effective factors on mortality in Fournier’s gangrene. METHODS: Thirty three patients with Fournier’s gangrene were investigated retrospectively. The variables such as age, gender, etiological and predisposing factors, symptoms, physical signs, intervals between symptoms and hospital admission, laboratory findings, types of microorganisms isolated from the wound scrapings, the number of surgical debridements, the length of hospitalisations were evaluated and their effects on mortality were analysed. The diagnosis of Fournier’s gangrene was established with a detailed anamnesis nad physical examination. Ultrasonographic (US) and computerized tomographic examinations were performed in case of suspected involvement of adjacent tissues. RESULTS: The overall mortality rate was 33.3% in this series. The median duration of symptoms was 6.5 days in patients who survived and 10 days in patients who died (p<0.05). Only the increase in mortality in the presence of tachycardia and anaemia were was statistically significant. CONCLUSION: It was concluded that early diagnosis, stabilization of hemodynamic status, repeated debridements of whole necrotic tissue combined with antibiotherapy, before establishment of anemia and tachicardia due to multiple organ failure, might decrease mortality in patients with Fournier’s gangrene.

BACKGROUND: To evaluate the incidence and importance of lumbar vertebra transverse process fractures in polytraumatized patients who had undergone emergent laparatomy, and to find out the relevant risk factors. METHODS: The medical records of 312 laparotomized trauma patients who referred to our emergency department between January 2001 and January 2002 were retrospectively assessed. Hundred and six cases who met inclusion criteria were investigated. Data relevant to the trauma, demographics, hemoglobine levels, additional system traumas, complications were recorded. Correlations between collected data and the fractures were investigated. Results were evaluated statistically using SPSS 11,0 software package program. RESULTS: Lumbar vertebra transverse process fractures were detected in 58,5 % of the cases.They were more frequently encountered in women, elderly and after falls or traffic accidents.. Abdominal organ injuries were more common in these cases. These fractures are associated with hepatic and splenic injuries. Their presence also increases the risk of vertebra corpus fractures seven fold. CONCLUSIONS: Lumbar vertebra transverse process fractures usually occur after higher energy traumas They must be evaluated as serious findings which might lead to potential organ injuries. Once these fractures were detected in trauma patients, every attempt should be made to exclude probably fatal and more serious additional organ injuries.

BACKGROUND: We aimed to emphasize the importance of early diagnosis and treatment of traumatic diaphragmatic (TDR) rupture which is an uncommon but potentially life-threatening problem with a high incidence of associated injuries. METHODS: We presented 8 children with traumatic diaphragmatic ruptures who were admitted to our department within a 13 year period after the incident. Relevant information about clinical and radiological findings herniated organs into the thorax, type of injury and applied surgical intervention and outcome of patients were evaluated so as to draw important clues leading to early diagnosis and treatment of this potentially life threatening condition with associated morbidities. RESULTS: In five patients, TDR occurred after a blunt trauma. Five patients underwent laparotomy while 3 of them were managed with thoracotomy. The surgical interventions were performed successfully and only one patient failed to survive.. One patient died of associated severe head injury. CONCLUSIONS: The TDR in children could be promptly identified and easily diagnosed, only if this pathology is highly suspected. Since, TDR must be ruled out in all severe cases of trauma, information related to the experiences of various centers must be considered as important clues which might lead to earlier diagnosis and prompt treatment.

Necrotizing fasciitis is a rare, rapidly progressing soft tissue infection, characterised by extensive necrosis of subcutaneous fat and fascia with relative sparing of skin and underlying muscle. It is usually caused by toxin producing virulent bacteria. Although it can occur in otherwise healthy patients, the disease is usually seen in conjunction with immune deficiency disorders, intravenous drug abuse, peripheral vascular disease and diabetes. Necrotizing fasciitis is more frequent in abdominal wall, perineum and extremities. Involvement of the head and neck structures and especially the scalp is rare. We treated a diabetic and chronic renal failure patient with necrotizing fasciitis of the scalp without any complication.

The hypertension is an uncommon cause in acute spinal epidural haematomas. The severe motor disability and need to emergency treatment to avoid the permanent neurological impairments underline its importance. Seventy-five year old male, admitted with acute paraplegia, numbness in the lower extremities and urinary incontinence for 4 hours. The neurological examination showed complete paraplegia, numbness from the below of thoracal 9 dermatomes, and loss of all sensory motor reflexes including anal reflexes. The blood pressure was 210/120 mm Hg on his admission. Thoracolomber magnetic resonance examinations detected an acute epidural haematoma, which was compressing to the cord. The patient underwent emergent laminectomy involving T 9 to L 2 and clots were removed with microsurgical technique. The patient was mobilized on the 3. and discharged from the hospital on the 7. postoperative day without neurological impairment. Although majority of the spontaneous spinal epidural haematomas is a recognized idiopathic condition, hypertension is much more commonly seen etiological factor than estimated. Early diagnosis, surgical decompression of the spinal cord and high dose corticosteroids might result in complete recovery.

Since the electrosurgical instruments are commonly used in a wide variety of surgical specialities, understanding of the properties of these instruments is very important to prevent the potential complications. We report the case of a patient who sustained a third-degree dermal burn caused by contact with the ground plate of the electrosurgical system. This burn healed with surgical treatment. Since electrosurgery causes serious complications, surgeon and operating suite personnel should pay attention to the electrosurgical system during the operation. Additionally, patients must be informed about these complications.

The urachus is a vestigial remnant of the cloaca and allantois. It is usually obliterated at early postnatal life. When this obliteration is incomplete, in addition to congenital urachal anomalies such as patent urachus, umblical-urachal sinus, vesico-urachal diverticulum, and urachal cyst, acquired urachal pathologies as infections and neoplasms can emerge. In this case report we will evaluate an infected urachal cyst established in a 26 year-old female. She presented with complaints of abdominal pain and umblical discharge. suprapubic sensitivity, abdominal mass with an overlying hyperemic skin were detected. Patient whose clinical manifestations suggested the diagnosis of infected urachal cyst which was also supported by USG and CT findings was operated. Total cyst excision was performed.