Objective and aim: Traumatic brain edema is one of the most common problems encountered in neurosurgical practice and it leads to morbidity and mortality via increased intracranial pressure. The aim of this study was to examine the effect of hypertonic saline on traumatic brain edema to compare it with mannitol.
Methods: Eighty adult male Sprauge-Dawley rats weighting 300-350 g were used in this experimental study. Rats were randomly divided into control (C); trauma (T); trauma+mannitol; NaCl 3% only; Trauma+NaCl 3%; NaCl 7.5% only; trauma+NaCl 7.5%; NaCl 23.4% only and trauma+NaCl 23.4% groups. All medications were given intraperitoneally. Rats were sacrificed and decapitated 24 hours after trauma+medications and brains were examined histopatologically.
Results: Although no difference was observed with regard to hemorrhage between trauma only and trauma+NaCl 23.4% groups, there was a statistically significant difference for brain edema within these two groups (p=0.003). There were no statistically significant differences within groups with respect to plasma osmolarity and serum levels of sodium.
Conclusion: This study demonstrates that 23.4% NaCl is more effective than other hypertonic salines and mannitol in the prevention of posttraumatic brain edema. Further clinical studies with different dosages and concentrations of hypertonic salines are required.

Background Recent literature has shown a high rate of aseptic loosening of the tibial component in total ankle prostheses.
Methods We analyzed the interface between tibial bone and tibial component with a thermo-elastic stress analysis to demonstrate load transmission onto the distal tibia. We used two established ankle prostheses which were implanted in two human cadaveric and in two thrid-generation composite tibia bones. Subsequently the bones were attached to a hydropulser and a sinusoidal load of 700 N was applied.
Results Both prostheses had a inhomogeneous load transmission onto the distal tibia. Instead of distributing load equally to the subarticular bone, forces were focused around the bolting stem accumulating as stress maxima with forces up to 90 MPa.
Conclusions As demonstrated in this study, anchoring systems with stems used in all established total ankle prostheses, lead to an inhomogeneous load transmission onto the distal tibia and to a distribution of load into the weaker metaphyseal bone. For these reasons we favour a prosthesis design with minimal bone resection and without any stem or stem-like anchoring system and therefore ask for a homogenous load transmission onto the distal tibia. Further studies will have to proof our findings in other prostheses designs (e.g. Hintegra).

Background and objectives: The study has been conducted with the aim to assess the severity of acute pancreatitis.Design and Setting: Prospective.Patients and Methods: The study included 350 consecutive patients of acute pancreatitis admitted over a period of five years. All these patients were subjected to detailed history and clinical examination and investigations to ascertain the diagnosis.The severity was assed by Contrast enhanced computed tomography.Data collected was tabulated and subjected to appropriate statistical analysis.Results: On the basis of computed tomography severity index (CTSI), the severity of acute pancreatic was classified into group A(mild), group B (moderate), Group C (severe). Maximum complications were noted in Group C 77 (91.67%) patients and minimum complications were seen in Group A 7 (6.25%) patients. Mortality was found to be highest among Group C 14 (16.67%) patients indicating the severe nature of disease in them and no mortality was noted in Group A patients. The mean duration of hospital stay of patients in Group A was 9.25 days, Group B 12.0 days and in Group C 24.58 days.Conclusion: The use of contrast enhanced computed tomography as a routine investigation in patients to predict a severe attack of acute pancreatitis early in the course of disease, decreases overall mortality and burden of disease.

The sciatic and peroneal nerves are the most frequently injured, followed by tibial and femoral nerves in lower extremity. The aim of this study is to evaluate the functional results of the acute nerve grafting in traumatic sciatic nerve injuries.
A total number of 9 patients with sciatic nerve defect, treated with primary nerve grafting. The mean age was 31.7 years. The etiologic factors were gunshot wounds; traffic accident; and penetrating trauma. All of the patients had sciatic nerve defects ranging from 3.4 to 13.6 cm. The follow-up period ranged between 25 and 84 months. The tibial nerve motor function was “good” or “very good” (M3-M4) in 5 patients (55.6%). The plantar flexion was not sufficient for the rest of the patients. The peroneal nerve motor function was also “good” and “very good” in 3 patients (33.3%).
The functional results of the acute nerve grafting of the sciatic nerve within the first week after the injury are poorer than related literature. This protocol only should be applied to the selected patients who have adequate soft tissue coverage and healthy nerve endings.

Background: To determine factors that might be associated with intraocular pressure (IOP) elevation after anterior segment open globe injuries (zone I).
Methods: Data were obtained from the records of 68 patients who experienced zone I open globe injury between January 2008 and October 2010. Group I composed of patients with chronically elevated IOP of at least 21 mm Hg with in 1-year follow-up period. The rate of posttraumatic IOP elevation and associated structural and functional risk factors were evaluated.
Results: Of the 68 patients, 17 (25%) developed posttraumatic IOP elevation (Group 1). The mean age in group I was significantly older compared to group II (36.8±24.4 and 15.7±15.3 years respectively (p=0.003)). Iris damage, postoperative inflammation and use of long-term corticosteroids were significantly more often in group I (p<0.001, p<0.001, p=0.005 respectively). 13 of 17 patients (76.5%) in group I had a wound size larger than 6 mm compared to only one patient (1/51, 2%) in group II, and the result was statistically significant (p<0.001). The size of wound larger than 6mm was also retained its statistical significance in multivariate analysis (p<0.001, Odd Ratio: 162.5).
Conclusions: This study shows that significant relationship between larger wound size (>6 mm) and elevation of IOP after trauma in zone I open globe injuries.

Background: Pregnant women may experience acute presentation of hepatic hydatid disease. The available literature is limited to case reports.
Methods: The charts of 7 patients who underwent urgent treatment for hepatic hydatid disease during pregnancy between 1992 and 2010 were reviewed.
Results: Median (range) patient age was 27 (23-39) years and median (range) gestational age 18 (13-24) weeks. The symptoms were severe abdominal pain (4), vomiting (2), jaundice (2), pruritus (2) and severe dyspepsia (1); in the asymptomatic patient, a closed intraperitoneal rupture had been detected during gynecologic ultrasonography. Surgical drainage of the cysts was performed in all cases. The two patients with frank biliary rupture underwent choledochoduodenostomy or Roux-Y hepaticojejunostomy. Four patients required postoperative tocolysis. Albendazole was not used. All mothers gave birth to healthy babies at term. The patients could be followed for median (range) 9(4-19) years. Two patients developed recurrences at 2 and 7 years; these were treated with surgical drainage and albendazole.
Conclusions: This entity entails the responsibility of two human beings. Although it imposes limitations on the routine diagnostic and therapeutic options due to risk of premature labor or teratogenicity, acceptable results can be obtained in collaboration with the department of obstetrics and gynecology.

BACKGROUND
Many burns that occur in the first two decades of life are accidental and preventable. The aim of this study was to determine the factors and demographic features and mortality associated with pediatric burns in Istanbul, Turkey.
METHOD
Our retrospective study included 375 hospitalized pediatric patients aged 16 years or less admitted between January 2005 and January 2009. Each child’s medical record was reviewed and demographic features, mechanism of burn, place of residence, total body surface area (TBSA), surgical treatment, duration of hospital stay and mortality rates were analysed.
RESULT
Scalding was the predominant cause in all pediatric age groups. There were no differences between the age groups with respect to mean TBSA. Length of hospital stay in infants and toddler age group was significantly lower than the other age groups (p<0,005). 16 (4,3%) patients died during the study period. Electrical burns and flame had significantly higher mortality rates than the scalds ( p < 0,05).
CONCLUSION
Scalding was found to be the most important cause of burns and flame had the highest mortality rate in children. Only a specific preventive program for changing the traditional habits of the Turkish parents would prevent most of the burn injuries among children.

Background: Blunt thoracic trauma is usually associated with extra-thoracic injuries, but effect of blunt thoracic trauma on mortality is not known in.
Methods: Patients with blunt thoracic trauma were evaluated with regard to clinical findings and factors affecting mortality
Results: There were 76 patients (37.2±15 years) in study group. Traffic accidents (63%) were the most common reason. Pneumothorax (54%), rib fracture (42%), hemothorax (22%) and lung contusion (22%) were common thoracic injuries. Extra-thoracic injuries were most commonly seen in extremities (46%) and abdomen (40%). Glasgow Coma, Injury Severity and Revised Trauma Scores were 14±2.6, 19±13 and 7.4±1.5, respectively. Only non-operative management was effective in 37 (48.7%) patients, tube thoracostomy and thoracotomy were performed in 37 (48.7%) and 2 (2.6%) patients, respectively. Mortality rate was 10.5%. Systolic blood pressure lower than 90 mmHg and superficial and apneic respiration at the first admission, and values of trauma scoring systems had significantly related with mortality (p<0.05).
Conclusion: Effect of thoracic trauma on mortality with regard to thoracic pathology is not shown, although it is usually associated with extra-thoracic injuries. There were close relationship between pattern of respiration, values of systolic blood pressure and trauma scoring systems, and mortality. Non-operative management and tube thoracostomy were effective in most of the cases.

Background: Dieulafoy lesions (DL) are a rare cause of gastrointestinal bleeding (GIB) which is characterised by exteriorization of a large pulsatile arterial vessel through a minimal mucosal tear surrounded by normal mucosa. Endoscopic therapy is generally successful at achieving bleeding control, but the best way of endoscopic intervention is not precise. In the present study, we aimed to review the clinical experience with DL in our center, primarialy focusing on clinical features, endoscopic therapeutic preferences with success and outcomes.
Methods: Data from patients with upper GIB admitted to the Turkiye Yuksek Ihtisas Training and Research Hospital gastrointestinal endoscopy unit between 2007 and 2011 were reviewed for DL. Detailed clinical and endoscopic data were abstracted and collected.
Results: Twenty-seven patients were identified with DL. Their ages ranged from 24 to 85 years (median age 70). Fifteen patients were male and twelve were female. Most of the DL occurred in the stomach were localised in fundus (59,2%), followed by corpus (29,6%) and antrum (11,2%). The most common initial endoscopic threapeutic approaches were hemoclips application with (33,3%) or without adrenalin (40%) injection.
Conclusion: Our study revealed that DL occurred in relatively older patients with a male dominance. Primary hemostasis with endoscopic intervention is safe, successful and cost-effective.

BACKGROUND: We aimed to assess pediatric trauma score analysis in pediatric trauma cases due to shrapnel effect of explosives material with high kinetic energy.
METHODS: The data of 17 pediatric injuries were reviewed retrospectively between February 2002 and August 2005. The information about age, gender, trauma-hospital interval, trauma mechanism, the injured organs, pediatric Glasgow coma score(PGCS), pediatric trauma score(PTS), hemodynamic parameters, blood transfusion, interventions and length of hospital stay(LHS) were investigated.
RESULTS: While all patients suffered from extremity trauma, only four patients had traumatic lower-limb amputation. Transportation time was ≤1hour in 35% of cases, while >1hour in 65%. While PTS was found as ≤8 in 35.3%of cases(n=6), score was found higher than 8 in 64.7% of them(n: 11). Median heart rate in patients with PTS≤8 was 94/min. This value was 70/min in those of PTS>8(p=0.007). Morbidity rates of PTS≤8 cases and PTS>8 cases were 29.4%, and 5.9 %, respectively(p=0.026). While LHS was 22.8 days in PTS≤8 cases, LHS was found only 4 days in PTS>8 cases. This difference was found to be statistically significant(p=0.001).
CONCLUSİON: PTS is very efficient and time-saving procedure to assess the severity of trauma caused shrapnel effect. The median heart rate, morbidity, and HKS increase significantly in patients with PTS≤8.

İntroduction: The radiological and functional results of surgical treatment in intraarticular calcaneal fractures are presented in this study.
Method: 27 feet of 26 patients with displaced intraarticular fractures were treated surgically in our clinic between November 2003 and May 2009. 21 patients were male (81%), and 5 were female (19%). The average age was 29.2 (range, 18-61 years) at the time of the surgical treatment. Open reduction internal fixation was performed by using a calcaneal plate.
Results: The results were evaluated according to the Maryland foot score and Creighton-Nebraska scores.The radiological evaluation was made according to the mean value changes of Böhler and Gissena angles. The mean follow-up period was 34.4 months (range, 19 to 85 months). Except for 3 patients with Sanders type-4 fractures, good results were obtained with surgical treatment.
Conclusion: We conclude, open reduction and internal fixation methods yield reasonable outcome, even in patients with Sanders type 4 intraarticular fractures of the calcaneus.

Background: Nasal fracture generally encountered alone or in combination with other serious injuries. The objective of this study was to analyze the patients who had pure nasal fracture.
Methods: Forty-five records from patients with pure nasal fracture treated in the hospital, from 7 October 2005 to 14 December 2011, were included. The following criteria of nasal fractures were evaluated: age at the time of nasal trauma, gender, accident type, use of alcohol, findings of the physical examination, admitted and treatment time after the nasal fracture, year and seasonal distribution.
Results: The age ranged from 6-32 years, with a mean of 21 years. The most frequent reasons of the injury were violence 60 % (27 cases) followed by falling down 31 % (14 cases), accident 4.5 % (2 cases) and sport injuries 4.5 % (2 cases). The most frequent findings were tenderness 71.1 % (32 cases) followed by swelling 51.1 % (23 cases), nasal deviation 42.2 % (19 cases), and epistaxis 15.6 % (7 cases). Nasal bone fracture was diagnosed exactly by plain X-ray films in 91.1 % (41 cases).
Conclusion: In this study; pure nasal bone fractures occurred primarily among men under 25 years of age, and fights were found as the main etiologic factor.

Background: CT is a very useful diagnostic method in orthopedic emergency cases where we suspect about fractures but cannot detect through direct graphy or when the fracture is detected in direct graphy but the anatomical structure needs to be evaluated better. In this study, we present our experience by missed fractures in radiographs, subsequently diagnosed in CT scans.

Methods: This was a retrospective study. We examined the medical records of all orthopedic trauma patients who visited our hospital’s emergency room because of orthopedic trauma between January 2010 and January 2011 and whose spine, pelvis and extremity CTs were taken.

Results: As a result, occult fractures were detected using CT in 12 of the (6.6%) children and 102 (6.8%) of the adults. We detected cervical vertebra fracture in 23 patients, femoral neck fractures in 6 patients and tibia plato fracture in 5 patients, which can cause complications unless intervened in emergency room.

Conclusion: CT revealed most of the missed diagnosis and proved that direct radiography is less capable to detect the fractures of some critical regions. Where there is clinical suspicion, we recommend that before the conservative treatment of the patients especially with cervical spine and pelvic region CT should be requested, even if the radiography is normal.

A case underwent aortobifemoral bypass surgery due to abdominal aortic aneurism and developed internal herniation postoperatively was reviewed in the light of the literature.

Background: Active liver hemorrhage with hemodynamic instability is a serious situation often requiring surgical intervention. The most common causes of hepatic bleeding are trauma and tumors of the liver parenchyma, mainly hepatocellular carcinoma and adenoma. Liver hemorrhage from blunt trauma or spontaneous tumor rupture is sometimes difficult to be controlled with traditional methods and postoperative complications are frequent. Recently, radiofrequency ablation system (RF) has been used for obtaining haemostasis of ruptured hepatic tumors or for controlling hemorrhage due to liver trauma in experimental models.
Methods: We report two cases where the radiofrequency ablation system (RF) has been efficiently used during emergency laparotomy in humans, in order to control massive hemorrhage from spontaneous rupture of a liver metastatic testicular germ cell tumor and from a Grade IV blunt liver trauma.
Results: RF ablation system combined with traditional techniques was effective in controlling liver bleeding during laparotomy in both cases. No recurrence of the hemorrhage or any side effects associated with the RF system were recorded postoperatively.
Conclusion: RF system is an effective strategy for achieving hemostasis in patients with active liver hemorrhage. In cases of bleeding liver tumors, RFA could also be helpful in synchronous tumor elimination, maximizing the chances of longer term survival.

Coronary artery dissection is a rare complication after blunt chest trauma. Patients usually present with sudden death and the diagnosis is frequently missed. In this report, we present a case of a 46-year-old with a hyperacute anterior wall myocardial infarction after a blunt chest trauma. Diagnostic coronary angiography showed total occlusion of left anterior descending coronary artery (LAD) starting at the takeoff of the vessel from the left main coronary artery (LMCA). A bare-metal stent was immediately deployed at the proximal LAD and TIMI 3 flow was achieved; however post-procedural images revealed no satisfactory results. A proximal dissection and intraluminal thrombus extending to LMCA was observed. Because of the proximity of the lesion to the LMCA, re-intervention was considered to be risky and urgent coronary artery bypass grafting (CABG) was planned.
Coronary artery stenting is the advised treatment modality for coronary occlusion after blunt chest trauma However, post-traumatic percutaneous coronary intervention was sometimes considered to be risky because of the anatomic features of the lesion. Timing is cardinal in achieving early reperfusion in the course of myocardial infarction after blunt chest trauma and CABG should be the preferred procedure for initial reperfusion treatment especially in proximal LAD dissections with subsequent thrombus formation leading to total occlusion of the artery.

Foreign body ingestion is a common clinical situation mostly diagnosed by emergency clinicians. Most of them can be evacuated without difficulty. Although rare, magnets that reach the lower intestinal tract may cause complications such as intestinal fistula formation, perforation, volvulus or appendicitis. We report herein a 2-year-old girl who admitted to our department 3 days ago with abdominal pain and non-bilious vomiting. Upon admission direct abdominal roentgenogram revealed a foreign body consisting of multiple spheric parts bound together forming a circle in the lower quadrants of the abdomen. Her family unaware of this ingestion stated that a magnetic toy exactly the same looking in the plain radiograph was lost several days ago. Surgical intervention showed a magnetic toy in the proximal part of the ileum causing multiple perforations in the intestinal wall and the neigbouring mesentery. The ileal part containing magnet toy was seen folded over itself forming a blind loop by taking its shape. She was discharged uneventfully in the 7th post operative day. Our case highlights a well known fact that foreign body ingestion in children may not have eye witnesses and it should be taken into consideration when evaluating children with abdominal pain.

A 41 year old man presented to emergency service with loss of consciousness lasting 20 minutes after a strike of a wood piece to right side of his face. Shortly after admission, he developed difficulty in swallowing. On admission, he was alert and had normal vital findings. There was no motor, sensorial, and cerebellar deficit. Deviation of the uvula to left side and pharyngeal reflex loss at the right side was obvious. The right vocal cord was paralyzed. Other cranial nerves were intact on examination. The patient’s cranial computed tomography (CT), CT-angiogram, cranial and neck magnetic resonance (MR) imaging, MR-angiogram, and cervical and lung X-ray were normal. We evaluated this case with isolated unilateral vagus nerve palsy (VNP) secondary to trauma at the emergency department. Our case illustrated that trauma can cause isolated VNP with the absence of abnormal findings on imaging modalities.

The incidence of mesenteric injury after blunt abdominal trauma (BAT) has increased in recent years, however, relatively little attention has been paid to instances of its sequels, especially in childhood. We present three children who had post-traumatic intestinal stenosis (PIS). A history of BAT was obtained in all. They had abdominal pain, bilious vomiting and peritoneal signs. The time intervals, the duration from the initial trauma to the onset of symptoms, ranged from 23 to 62 days. Stenotic segments were parallel to the location of the previously recognized mesenteric hematoma (MH) and resection with primary anatomosis was performed. Pathological examinations of subjects confirmed mucosal and mural ischemia, and full-thickness fibrosis of the intestinal wall. In our opinion, large MH may pose an increasing risk of narrowing in the adjacent intestine at different time periods. Therefore, if there is a large MH at laparotomy after BAT, it should be evacuated and bleeding halted. For the differential diagnosis, typical BAT should be carefully investigated in cases presenting with intermittent colic abdominal pain and/or partial intestinal obstruction findings.

Introduction: Bilateraly injuries of sensory branch of radial nerve(SBRN) usually occur as a result of tight handcuff neuropathy.In this case we aimed to present bilateral isolated cut of SBRN with an injury mechanism which has not been reported in the literature yet.
Case-presentation: Twenty-four years old, a worker in a glass factory, male patient was presented.His dorsolateral skin cut of wrists due to breaking of the glass as a result of occupational accident was primarily sutured in a healthcare center.The patient consulted again after a month because of the lingering numbness and pain, and surgery was planned.In the surgery observed scar tissue and neuroma around cut ends of SBRN were excised, and bilateral SBRN cut were repaired.Four weeks after operation, mild sensory deficit on dorsal side of bilateral thumbs, and left first web space, and flexion limitation on right wrist were detected. At postoperative 3rd month, right wrist joint range of motion were full, sensory deficits, and hyperesthesia was decreased.
Results: SBRN elicits the sensory innervation of thumb dorsum so its injury does not cause important functional deficit.However because of susceptibility of SBRN to develop painful neuroma, diagnosis, treatment and follow up of isolated SBRN injury would be worthwhile for prevention of possible painful neuropathy disturbing the quality of life.