A. Tarim

Quality of Life After Burn Injury: The Impact of Joint Contracture

We sought to investigate quality of life, and to specifically assess how joint contracture affects it, in patients with burn injuries. The study is involved 22 adults with burn injuries. Patients were divided into two groups according to the presence (n = 11) or absence (n = 11) of any joint contracture. Patient age, sex, date of burn injury, burn type, location, and extent of burn (TBSA) were recorded for each case. Each individual underwent a thorough musculoskeletal system examination, with special focus on range of motion of the joints. Quality of life was evaluated using the Short Form 36 (SF-36). Eight (36.4%) of the patients were women, and 14 (63.6%) were men, and their mean age (± SE) was 24.7 ± 4.68 years. The mean interval from injury to the study assessment was 21.45 ± 14.69 months. Eleven patients (50%) had at least one joint contracture. The patients with one or more contractures had significantly lower scores for the SF-36 subscales of physical functioning, physical role limitations, bodily pain, and vitality (P = .05, P = .01, P = .04, and P = .02, respectively). In the 22 patients overall, TBSA was negatively correlated with the scores for the SF-36 subscales vitality and emotional role limitations (r = −.586 and r = −.805, respectively). Joint contracture does impact burn patients’ quality of life, especially with respect to physical functioning, physical role limitations, bodily pain, and vitality. In addition, the amount of BSA burned is correlated with psychosocial problems and poorer quality of life, regardless of whether joint contractures develop.

Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center

Background and aimsThe objective of this study was to present the etiology, clinical presentation, diagnosis, and management for 14 cases of gossypiboma [retained surgical sponge (RSS)] treated at a single center and to emphasize the importance of this potential complication.MethodsData for 14 cases of RSS treated between January 1999 and December 2004 were retrospectively assessed. The details of preoperative evaluation, demographic features, and operative findings were recorded. Use of, and findings from, abdominal x-ray, ultrasonography, computed tomography, magnetic resonance imaging, and upper-gastrointestinal endoscopy were also noted.ResultsIn all cases, the RSS was surgically removed. Thirteen of the 14 patients were symptomatic, and the most frequent finding was nonspecific abdominal pain and intestinal obstruction. Four patients required urgent surgery because the sponges were causing intestinal obstruction or intraabdominal sepsis. Based on history, physical examination findings, and diagnostic imaging, RSS was diagnosed preoperatively in five of the patients. Postoperative complications, including surgical site infection and evisceration, occurred in five cases.ConclusionRSS can lead to significant medical and legal problems between the patient and the doctor. RSS may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. Strict measures must be taken to prevent this complication.

Epidemiology of pediatric burn injuries in southern Turkey.

The aim of this study was to identify the epidemiological features of pediatric burn injuries in southern part of Turkey. In this retrospective study, 137 hospitalized pediatric patients (85 men and 52 women) who were admitted to our burn unit during a period of 3 years were analyzed. Pediatric patients were categorized into three groups: the infants and toddlers (0-2 years), early childhood (3-6 years), and late childhood (7-15 years). Epidemiological data included age, sex, location, the cause and type, and place of burn. In the first two groups, scalding (95.1% and 86.7%, respectively) was the predominant cause of burn whereas in late childhood electric burns (51.4%) were a more common occurrence. No differences were found between the groups with respect to mean TBSA and full-thickness burns. A total of 15 (10.1%) patients died during the study period. A total of 74.4% of burn injuries occurred at home, and almost all were preventable, with 16 % of the burns occurring in the autumn; however, 42% occurred in the summer. These findings will be used as a basis for developing targeted preventive programs to protect children from burns. We also consider it is necessary to educate children and their parents about the prevention of burn injuries.

A rare cause of acute appendicitis: Parasitic infection

The role of parasitic infection in the aetiology of acute appendicitis has been discussed for more than 100 years. The aim of this retrospective study was to determine the prevalence of parasitic infection in surgically removed appendices, and to identify whether this type of infection is associated with appendicitis. 104 appendices were removed from patients clinically diagnosed with acute appendicitis, and 30 were removed in the course of other surgical procedures. All the operations were performed at Baskent University Adana Hospital between January 1999 and December 2004. Enterobius vermicularis was identified in 4 (3.8%) appendices from patients with clinical appendicitis, and Entamoeba histolytica was detected in 1 (1.0%) appendix from this group. No parasites were found in the 30 appendices that were removed during other surgical procedures. Specimens from 3 of the 4 appendices with E. vermicularis showed no histological evidence of acute inflammation. It is concluded that parasites in the appendix may produce symptoms which resemble acute appendicitis, but parasitic infection rarely causes acute appendicitis.

Burns in southern Turkey: electrical burns remain a major problem.

In Turkey, burns represent a relatively small number of injuries overall, but they continue to be a major public health problem. Our aim in this study was to identify risk factors that affect outcome in burn patients hospitalized in the southern part of our country, with special emphasis on electrical burns. The database for 109 burn patients who were admitted to our burn center from April, 2000, through August, 2001, was retrospectively analyzed. Electrical injury was the cause of burn in 23 (21%) of the 109 cases. The burn causes differed among age groups and between the sexes, with males constituting 95% of the electrical burn patients. The mortality rate for the electrical burn group was lower than the rate for the rest of the burn patients (1/23 vs 17/86, respectively; P <.001); however, the opposite was true for complication rate (10/23 vs 5/86, respectively; P <.001), cost of treatment (8351 US dollars vs 5122 US dollars, respectively; P =.009), and length of hospital stay (39.9 vs 26.2 days, respectively; P < 0.001). The rate of electrical burn injury in Turkey has changed very little in the past two decades. This underlines the need for stronger efforts aimed at prevention, such as better public education and strict regulations regarding the distribution and use of electricity.

Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units

OBJECTIVE This study investigated the use of telemedicine in decision-making and follow-up of burn patients. METHODS The Konya Burn Unit was established in July 2003, and up to December 2009, 187 patients were admitted to this unit, all of them were consulted-via audiovisual transmission of data (telemedicine)-to the same burn surgeon at the Ankara Burn Referral Center of our hospital network. Three basic systems are currently used: live interactive video, store-and-forward images, and telephone. The demographic data and burn criteria of the patients were investigated. Changes in the number of televisits and patient management were analyzed. RESULTS During the 66-month timeframe, 525 televisits were performed on 187 patients. There were 126 males (67.4%) and 61 females (32.6%). The mean total burn surface area (percentage of total burn surface area burned) was 23.3 ± 17.8% (range, 3-95%). Nine of the 187 patients (4.8%) died owing to multiorgan failure and sepsis. As a result of these televisits, 21 patients (11.2%) were transferred to our referral center. The number of dead and transferred patients decreased during the study. CONCLUSIONS Telemedicine is appropriate and cost-effective for treatment and follow-up of patients in burn units with personnel with limited experience.

Bone loss during the acute stage following burn injury.

The aim of this study was to investigate the effect of burn injury on bone metabolism and bone densitometry in the early period. Twenty-one patients with >25% total body surface area (TBSA) burns and 20 healthy controls participated. TBSA burned, ambulation, and functional status were recorded. After 30 days, we measured bone mineral densities of the L1–L4 vertebrae, the left distal forearm, and the left proximal femur in the patients. At 1 and 4 weeks after the burn, changes in bone turnover were assessed in patients by changes in deoxypyridinoline levels in the urine and osteocalcin in the serum and compared with the values of control group. In patients, Z-scores < −1 were found in 71.42% of left distal forearm, 23.80% of left proximal femur, and in 42.85% of L1–L4 vertebrae measurements. No significant correlations existed between Z-scores and TBSA, Functional Ambulation Scale, or Functional Independent Measure. When compared with controls, there was no statistically significant decrease of osteocalcin (a marker of bone formation) levels in patients 1 and 4 weeks after burn injury. However, when compared with controls, a statistically significant difference was found regarding deoxypyridinoline (a marker for bone resorption) in patients 1 and 4 weeks after burn injury (P < .001 and P < .001, respectively). Decreases in bone mineral density occurred during the first month following burn injury, which seemed to be linked with increases in bone resorption during this period. No correlation existed between reduction in bone mineral density and functional status.

Brachial artery pseudoaneurysm: a rare complication after haemodialysis therapy.

Abstract Haemodialysis patients carry a high risk of pseudoaneurysm due to inadvertent puncture of the brachial artery during venous cannulation for haemodialysis. Signs and symptoms are pulsatile mass and a systolic murmur. Complications are rupture, infection, haemorrhage, distal arterial insufficiency, venous thrombosis and neuropathy. Early diagnosis is essential to plan adequate treatment. Doppler US and angiography usually confirm the lesion accurately. Ultrasound guided compression, percutaneous injection of thrombin, endovascular covered stent exclusion, aneurysmectomy and surgical repair are different treatment options. We report clinical and radiological findings and treatment strategies in four dialysed patients who developed brachial artery pseudoaneurysms.

Electrical burn is still a major risk factor for amputations.

Many difficult decisions are faced in the early management of severely burned patient. The decision to amputate an extremity or extremities may be very difficult but reduce morbidity and enhance survival of the patient. In a total of 1144 patients from January 2000 and June 2011, there were 44 patients (3.8%) undergoing amputations of the digits or upper extremity proximal to the wrist or lower extremity above the ankle. Amputations were significantly higher in males and the mean hospitalization time was also significantly higher in these patients. Majority of the patients had non-viable tissue (79.5%) and nine patients (20.5%) had a septic focus as cause of amputation. The majority of amputations were caused by high-voltage electrical injury. Education and compliance with safety measures, as well as common sense and respect for the potential danger of electricity, are still essential for avoiding these injuries.

Laparoscopic repair of bilateral morgagni hernia.

Morgagni hernias are rare and comprise approximately 3% of the congenital diaphragmatic hernias that are observed in 1 in 4800 live births. A 50-year-old female patient who complained of nonspecific chest pain radiating to the right arm for approximately 1 year presented. Chest x-ray revealed a right-sided paracardiac mass diagnosed Morgagni hernia by computerized tomography of the thorax. Laparoscopic exploration showed that the retrosternal hernia was actually a bilateral one. After reducing the contents of the hernial sacs, the defects were closed as a single defect with hernia stapler starting from each end and an appropriate sized polyprolene mesh was closed over the repair site. The patient did not have any symptoms of recurrence after 3 months. Recent advances in video-endoscopic surgery made it possible to perform repairs of these hernias less traumatic and more comfortable to the patients than the conventional transabdominal or transthoracic methods.