Cem Oruc

Surgical outcomes of a civil war in a neighbouring country

Objectives The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. Methods 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. Results The median age of the patients was 30.05 (18–66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). Conclusions In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Stroke in Severity of Sickle Cell Diseases

Background: Sickle cell diseases (SCDs) are chronic inflammatory process on capillary level. We tried to understand whether or not there are some positive correlations between stroke and severity of SCDs. Methods: All patients with SCDs were taken into the study. Results: The study included 343 patients (169 females and 174 males). There were 30 cases (8.7%) with stroke. The mean ages were similar in both groups (32.5 versus 29.1 years in the stroke group and other, respectively, p>0.05). The female ratios were similar in both groups, too (43.3% versus 49.8%, respectively, p>0.05). Prevalences of associated thalassemia minors were also similar in them (73.3% versus 65.1%, respectively, p>0.05). Smoking was higher among the stroke cases (26.6% versus 13.0%, p 0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, chronic renal disease, rheumatic heart disease, avascular necrosis of bones, cirrhosis, and mortality were all higher in the stroke group, the differences were only significant for digital clubbing, leg ulcers, and acute chest syndrome (p<0.05 for all), probably due to the small sample size of the stroke group. Conclusion: SCDs are chronic destructive process on capillaries iniatiating at birth, and terminate with early organ failures in life. Probably stroke is one of the terminal consequences of the inflammatory process that may indicate shortened survival in such cases.

The role of co-administration of damage control surgery and vacuum-assisted closure in the treatment of perineal wounds

Perineal wounds caused by high-kinetic-energy shotgun blasts have a high mortality risk because they are often accompanied by injuries of the anus, rectum, genitourinary system, and extremities. Mortality often results from hemorrhage in the early stage and from multiple organ failure caused by sepsis in the late stage. The primary step in the treatment of patients presenting with perineal wound and hemodynamic instability caused by severe hemorrhage is to control hemorrhage and contamination using damage control surgery. After achieving hemodynamic stability, vacuum-assisted closure can be used to reduce the risks of infection and sepsis. In this report, we present a case who had a perineal wound caused by a mine blast and was successfully treated by damage control surgery and vacuum-assisted closure.

Missed injuries in explosion-related deaths

In this study we aim to compare clinical diagnoses and post-mortem diagnoses of explosion-related deaths and identify the unrevealed diagnoses missed by physicians. Forensic autopsy reports of three years between January 2012 and December 2014 were collected retrospectively and 277 explosion-related deaths are included in the study. Out of 277 cases, 245 (88.4%) of them are male and 32 (11.6%) of them are female. The mean age is 27.8 years. The mean injury severity score is 37.8 ± 14.54.90 and 32.5% of the cases died in the first 24 h after getting injured. The most frequent injury is head injury (39.0%) and the second most frequent is injuries to multiple body regions (27.8%). Of eight cases of lower extremity injuries, six were found to have injuries of large vessels in post-mortem examinations. Our conclusion is that injury severity scores in cases of explosion-related injuries are higher than those in cases of general trauma. The frequency of missed diagnoses is higher in cases of vessel injuries and multiple injuries. It can be thought that small but lethal lesions can be overlooked when a major trauma is dealt with. In addition, injuries of the internal organs due to blast effects without any macroscopic examination findings can be misleading for physicians.

Radyoaktif İyot Tedavisi Sonrası Diferansiye Tiroid Kanserlerinin Takibi-The Follow-up of Differentiated Thyroid Cancers After Radioactive Iodine Treatment

Differentiated thyroid cancerc (DTC) which have very good prognosis are the most common endocrine malignancies. Radioactive iodine treatment (RIT) applied to selected patients after thyroidectomy is a highly effective treatment method. Post-treatment follow-up of these patients exhibits a great importance because of the higher relapse rates and development of distant metastases in some cases. In this review, the methods used in the follow-up DTC patients after RIT are reported

WOLFF PARKiNSON WHiTE SENDROMLU HASTANIN ANESTEZİ YÖNETİMİ: OLGU SUNUMU

Wolff-Parkinson-White sendromu (WPW) nadir gorulen ventrikuler preeksitasyon tipidir. Bu sendrom delta dalgalari, uzamis QRS suresi, kisa PR araligi ile karakterizedir. WPW sendromlu hastalarin anestezi yonetimi hakkinda bilgi sahibi olmak gerekir. Biz bu olgu sunumunda WPW sendromlu hastanin anestezi yonetimini sunmayi amacladik. Anahtar kelimeler: Wolff-parkinson-white sendromu, anestezi, ventrikuler preeksitasyon