BACKGROUND: The aim of study was to investigate whether there is a difference in injury in intra-abdominal viscera due to blunt abdominal trauma sustained by rats with empty or full stomach and to examine which viscera is affected most, based on the direction of the trauma.
MEHTOHDS: Since there is no data in the literature on the force of trauma, a pilot study was carried out before commencing the experimental study. An apparatus was built to determine the trauma force that would not cause sudden death, and rats were allowed free fall from a height of 40 and 45 cm so that they would land on their abdomen. The most appropriate force of trauma (F= 69,978 N) and absorbed energy (E= ½mv2= 0,979 Joules) were obtained in rats weighing 250g that fell from a height of 40 cm.
RESULTS: Thirty six rats were included in the study. Rats were allocated into one of six groups. We investigated if there were statistically significant differences between groups with regard to the stomach being empty/full and the direction of the trauma (anterior, right/left sided).
DISCUSSION: It was observed there were differences in injuries sustained by the internal organs depending on the fullness/emptiness of the stomach and the direction of the trauma.

Background: The fate of suboptimal anastomosis is unknown and early detection of anastomotic leakage after colon resection is crucial for the proper management of patient. Methods: 26 rats were assigned to “Control”, “Leakage” and “Suboptimal anastomosis group” groups where they underwent either sham laparotomy, cecal ligation and puncture or anastomosis with 4 sutures following colon resection, respectively. At 5 hours, 3rd and 9th days; peripheral blood samples, peritoneal washing samples through relaparotomy were obtained. The abdomen was inspected macroscopically for the anastomotic healing. PCR with 16s rRNA and E.coli-specific primers were run on all samples along with aerobic and anaerobic cultures.
Results: The sensitivity and specificity of PCR on different body fluids with 16s rRNA and E.coli-specific primers were 100 % and 78 % respectively. All samples of peritoneal washing fluids at 3rd and 9th days showed presence of bacteria in both PCR and culture. The inspection of abdomen showed signs of anastomotic leakage in 8 rats (80%), whereas mortality related with anastomosis detected in 2 rats (20 %).
Conclusions: Anastomotic leakage with suboptimal anastomosis after colon resection is high and the early detection is possible by running PCR on peritoneal samples as early as 72 hours.

Introduction: Citicoline, a neuroprotective drug, has been suggested to improve level of consciousness, mitigating secondary brain damage and ectopic vascular calcification, following post-traumatic neurogenesis and angiogenesis, inducing calcification modulators, like fetuin-A and matrix Gla-protein(MGP). This study aimed to investigate effects of citicoline on levels of consciousness, serum levels of fetuin-A and MGP in patients with severe traumatic brain injury.
Materials & Methods: This double blind randomized controlled trial(RCT), on patients with diagnosis of diffuse axonal injury(DAI) and GCS≤8. The cases were treated with citicoline (500mg every 6 hours), intravenously, for 15 days. Daily GCS assessment and intermittent blood sampling were done for both cases and controls.
Results: 58 patients were included. During study period, mean GCS levels improved in both groups; however, the difference was inconsiderable(P>0.05). Serum levels of fetuin-A, a negative phase reactant, increased in group treated with citicoline(P=0.012); while these changes were insignificant for controls(P=0.455). Serum levels of MGP, a calcification inhibitor, increased in cases(P=0.046); The alterations were inconsequential in control group(P=0.405).
Conclusion: Our findings suggest neutral effects of citicoline on level of consciousness and GCS. Via increasing levels of fetuin-A and MGP, citicoline may have protective effects against inflammatory damage and vascular calcification secondary to head trauma.

Introduction
The purpose of this study was to investigate the diagnostic efficiency of multidetector computed tomography (MDCT) in the detection of blunt bowel and mesenteric injuries (BBMI), and the role of different experience levels in using MDCT.
Methods
This study included a test group of 27 patients with surgically important BBMI in whom the diagnoses were confirmed after surgical intervention (23 men and 4 women; mean age, 40.7 ± 16.2; range 18–76), and a control group of 21 matched patients without BBMI underwent laparotomy for trauma during the same time period (16 men and 5 women; mean age, 38.9 ± 14.5;range, 20–68) and 16-detector computed tomography prior to surgery. Intraoperative findings were compared with MDCT findings.
Results
We found high accuracy, specificity, and positive predictive values in MDCT findings with respect to intraperitoneal free air, mesenteric air, thickened (>4–5 mm) and defected bowel wall, increased contrast enhancement on bowel wall, and mesenteric hematoma among others (p < 0.01).
Sensitivities and specificities of the diagnosis of BBMI by the resident and staff radiologist was 74% and 71%, and 85% and 100%, respectively.
Conclusion
MDCT displays BBMI with high sensitivity and specificity, and can predict the need for surgery. Experience in radiology is an important factor for appropriate interpretation of the MDCT findings.

BACKGROUND: The aim of this study was to establish the diagnostic value of leucocyte count and neutruphil percentage in both diagnosing simple appendicitis and predicting complicated appendicitis.
MATERIAL AND METHOD: The patients who underwent appendectomy with a clinical diagnosis of AA between January 2011 and December 2012 were studied retrospectively. Analysis of the data of total WBC count, neutrophil ratio, physical findings were performed. Sensitivities and specificities of leucocyte count and neutrophil ratio were calculated.
RESULTS: 159 patients were operated with the diagnosis of acute appendicitis. Simple appendicitis was detected in 82.4% and complicated appendicitis was detected in 17.6%. Leucocyte count has low sensitivity and specificity for diagnosing acute appendicitis (67.5 % and 36.3% respectively). Neutrophil ratio has a sensitivity rate of 60.1% and specificity rate of 90.9%. The complicated appendicitis was more common in male patients. Leucocyte count was statistically higher in patients with complicated appendicitis.
CONCLUSION: Two inflammatory markers, leucocyte count and neutrophil ratio were evaluated for diagnosis of acute appendicitis.Neutrophil ratio has higher sensitivity and spesificity for acute appendicitis. On the other hand increased leucocyte count and male gender was found to be a risk factor for complicated appendicitis.

Background: To evaluate the succes of penil fasciocutaneous flap urethroplasty in treatment of long segment urethral stricture.
Methods: In this study, 17 patients with long segment urethral stricture were included. According to lenght of the narrow segment, vertical or circular penile skin fasciocutaneous flap was anastomosed on 18 F urethral catheter. In first week and 6th month after removal of urethral catheter, patients were controlled by uroflowmetry and postvoiding residual urine volume measurement by ultrasound.
Results: The mean age of the patients were 52 (range; 17 to 67) years. The mean follow up-time was 60 (12-96) months. Mean length of stricture was 105 (40-150) mm. Vertical and circular penile fasciocutaneous flaps were used in 4 and 13 patients, respectively. Maximum urine flow rate and postvoiding residual urine assessment in first week after removal of urethral catheter were 19.1 (range; 9 to 31) ml/s and 12.9 (range; 0 to 40) cm3, respectively. Same parameters in postoperative 6th months were 17.4 (range; 8 to 25) ml/s and 15.2 (range; 0 to 40) cm3 respectively.
Conclusion: Our long term results showed that penile fasciocutaneous flap urethroplasty method seems to be a reasonable treatment option in treatment of long segment urethral stricture.

Objective: The aim of this study was to examine the association of the response of headache to morphine with the findings of brain CT scan in minor head injury (MHI), and to propose a new risk indicator to identify patients that require CT scanning.
Methods: A total of 1857 MHI patients ≥15 years old, presenting with headache and a GCS score of 14 or 15 were enrolled. Intravenous morphine sulfate was administered and patients were assessed for the relief or persistence of headache thereafter. Subsequently, a brain CT scan was obtained from all patients.
Results: Patients were divided into two age groups: 15-60 and >60 years. There was significant association between the response of headache to morphine and the result of CT in both groups (p<0.001). In patients aged 15-60, none of those whose headache had responded to morphine showed any abnormal findings in the CT scan (sensitivity=100%). In the >60 group, sensitivity was 58.3% for abnormal CT and 71.4% for neurosurgical interventions.
Conclusion: This study suggests that a headache not relieved by morphine is a risk indicator for intracranial injury. This protocol can be used in rural areas with limited access to CT as an adjunct to the existing criteria for selecting the patients with MHI for CT scanning.

BACKGROUND: We retrospectively analyzed six acute traumatic hip dislocations in pediatric patients. We reviewed types of dislocations, associated lesions, treatment methods, complications, clinical and radiological outcomes.
METHODS: Six child patients treated due to traumatic hip dislocation between 2007 and 2011 in our clinic were included the study. Five of the patients were male; one of them was female, average age was 8 years and 8 months. The mean follow-up was 25.2±10 months. There were posterior dislocation in five cases and transepiphyseal fractured dislocation in one case. Four cases were treated by closed reduction while two cases were treated with open reduction method.
RESULTS: In the last control of the patients, asymmetric widening in the hip joint was found due to osteochondral fracture in one patient and coxa magna occurred in one patient. Avascular necrosis developed in one case with transepiphyseal fractured dislocation. Harris hip score evaluation was found excellent in five cases and bad in the case with fractured dislocation.
CONCLUSION: Traumatic hip dislocation is a rare condition. It should be treated with preferably closed method as soon as possible. Repetitive reduction trials should be avoided. Open reduction should be performed to recognize accompanying lesions after advanced radiologic examinations such as computerized tomography and magnetic resonance imaging.

A series of previously described but rarely used variation of the pedicled extended or vertical rectus abdominis musculocutaneous flap (Extended RAM, VRAM) was reviewed. Skin paddle dimensions ranged from 8 to 28 cm in width and from 10 to 35 cm in length in 5 consecutive patients. Four flaps were placed through deep to the inguinal ligament to repair the thigh as far as the proximal to the knee region; the remaining one flap was passed transabdominally to cover the defect of the lumbar region. No flaps necroses were seen, and one case wound healing problems required minimal operative intervention.
Successful transfer of the VRAM and extended RAM with low rate of complication for the thigh and lumbar region defects was demonstrated to be safe and reasonable option of flap reconstruction. The flaps had the advantages of being robust and a well vascularized flap, easy and fast to harvest, and not requiring microsurgery experience.

Gunshot injuries are common medical-legal issues. Atypical tract lines which are resulted from this type of injuries cause difficulties in diagnosis and treatment. In this paper, we presented gunshot injury at right anterior thigh extending to the right hemithorax. Syrian refugee patient who was 67 years old was brought to emergency service because of gunshot injury. Bullet entrance hole was determined at right anterior thigh region, but exit side could not be seen. Bullet was determined at right thorax at tomography, and patient was taken to operation because of diaphragma rupture and lung paranchymal injury. Other body parts must be examined radiologically for bullet which can not be determined at gunshot injury side.

Background:
Necrotising fascitis is a critical illness involving skin and soft tissues, which may develope after blunt abdominal trauma trauma causing abdominal wall hernia, representing a great challenge for physicians.
Case Report:
A 52-year-old man was brought to the emergency department after a road accident presenting blunt abdominal trauma, with a large non-reducible mass in the lower-right abdomen. A first CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore a new CT scan was requested, which showed signs of hernia complication. He was moved to the operating room, where a complete transversal section of an ileal loop was identified. Five hours after the surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotising fascitis developing, wide debridement was performed.
Conclusions:
Following Traumatic Abdominal Wall Hernia (TAWH) patients can present unsuspected injuries in the abdominal organs. Helical CT can be falsely negative in the early moments leading to a misdiagnosis. Necrotising fascitis is a potentially fatal infection, and consequently resuscitation measures, wide-spectrum antibiotics and early surgical debridement are required. This type of fascitis can be developed after blunt abdominal trauma following wall hernia without skin disruption.

We report the survival of a rare case of complete tracheal transection following blunt neck trauma. A 66-year-old man presented at emergency room after a motorcycle accident in which his neck was caught in a rope. He was alert but in respiratory distress. A computed tomographic scan showed a transection of the cervical trachea. Emergency neck exploration revealed that the tracheal laceration had cut from the tracheal anterior 3rd ring to the posterior 1st ring and the anterior esophageal wall had ruptured. A laryngectomy, tracheostomy, and esophagopharyngeal anastomosis were performed. Prompt airway management and immediate neck exploration is important for survival in these cases.

The traumatic diaphragm rupture occurs frequenty after the motor vehicle accidents via penetrating traumas. In 90 % of patients, traumatic diaphragm rupture commonly coexists with other organ injuries. Posteroanterior chest x-ray, computed tomography, magnetic resonance imaging, upper gastrointestinal system contrast-enhanced examinations and thoraxoscopy /laparoscopy are several modalities can be used for diagnosing traumatic diaphragm rupture in clinical practice.
We present a case of right ventricle collaps secondary to hepatothorax caused by diaphragm rupture. Patient was diagnosed by posteroanterior chest x-ray and computed tomography. Emergency surgery was planned due to the hemodynamic instability. When the mechanical pressure on right ventricle was disappeared, at the time hemodynamic improvement was observed.