Hüseyin Taş

Increased intra-abdominal pressure causes bacterial translocation in rabbits

Background: Abdominal compartment syndrome (ACS) is defined as intra‐abdominal hypertension associated with organ dysfunction. Subsequently, increased intra‐abdominal pressure (IAP) adversely affects the pulmonary, cardiovascular, renal, musculoskeletal/integumentary and central nervous systems. Bacterial translocation (BT), which is defined as the movement of viable enteric bacteria to the mesenteric lymph nodes, liver and spleen, occurs after various types of stress and results in splanchnic ischemia. In this experimental study, we aimed to investigate the effects of various levels of increased IAP on BT in rabbits; IAP was increased by the intra‐abdominal balloon‐insufflation method, thus simulating noncompliant abdominal‐wall closure under tension. Methods: Fifty rabbits were randomly assigned to 1 of 5 groups, with each group comprising 10 animals. In group I (control group), an intra‐abdominal balloon was placed without inflation. In groups II, III, IV and V, IAPs of 10, 15, 20 and 25 mmHg, respectively, were established via inflation of the intra‐abdominal balloon. All groups underwent laparotomy after 12 hours. Multiple biopsies were taken from ileocecal lymph nodes, the spleen and liver. Results: BT was observed to some degree in all 4 experimental groups. A gradual increase in the phenomenon was noted as IAP increased from 10 to 15 mmHg; and BT was overt at 20 mmHg, and significant at 25 mmHg. Klebsiella pneumoniae, Serratia marcescens, and Escherichia coli were the predominant pathogens identified by culture. Conclusion: We propose that an intravesical pressure (IVP) of 15 mmHg is the critical point for BT in patients with increased IAP. In this experimental study, BT occurred when IVP reached 20 mmHg. We suggest that IVP monitoring is desirable in the management of patients with ACS, and that decompressive laparotomy should be performed in patients with IVP > 20 mmHg.

Comparison of Modified Darn Repair and Lichtenstein Repair of Primary Inguinal Hernias

OBJECTIVE This study was designed to compare the results of the Modified Darn Repair through Lichtenstein procedure in inguinal hernias. MATERIALS AND METHODS The study involved 322 patients with inguinal hernia, operated in General Surgery Departments of Gulhane Military Medical Academy and Sirnak Military Hospital between 1998 and 2004. The durations of operation time, hospitalization, and time to return to daily activities and postoperative complication and recurrence rates were evaluated. Lichtenstein procedure was applied on 170 patients (Group 1), and modified darn repair was applied on 152 patients (Group 2). RESULTS The average follow-up period was 56 months. For the Lichtenstein procedure, the average duration of operation was 56 min; the average time to return to routine activities was 20 days. The number of patients with postoperative complications was 20 (11.7%), and the number of patients with recurrence was 1 (0.6%). For modified darn repair, the average duration of operation was 48 min; the time to return to daily activities was 20 days. The number of patients with postoperative complication was three (1.9%), and no recurrences were noted. The hospitalization time of the groups was similar. DISCUSSION Modified darn repair is a reliable method for inguinal hernia repair with short hospitalization time, low rate of postoperative complications, and recurrence.

Enteric and rectal duplications and duplication cysts in the adult.

Alimentary tract duplication and duplication cysts are rare congenital malformations. The ileum is the most frequently affected site. However, alimentary tract duplication and duplication cysts can occur at any point along the gastrointestinal tract. Early diagnosis and prompt surgical treatment is the best way to prevent associated morbidity. This article presents the cases of three patients admitted to Gulhane Military Medical Academy with signs of acute abdomen, intra‐abdominal mass and chronic abdominal pain. These patients were found to have enteric duplication, duplication cyst and/or retro‐rectal cyst. The literature on alimentary tract duplications is reviewed.

The affecting factors on the complication ratio in abdominal gunshot wounds

BACKGROUND We aimed to investigate the affecting factors on the complication ratio in abdominal gunshot wounds. METHODS Twenty-one patients with abdominal gunshot wounds were analyzed between February 2002 and May 2005. The effects of the interval between trauma and presentation to the hospital, the number of injured abdominal and extra-abdominal organs, penetrating abdominal trauma index (PATI), and blood transfusion were evaluated. RESULTS 90.4% of all patients were transported to the hospital and underwent their first evaluation in the first two hours. The complication rate was 7.1% in patients who had <3 injured organs and 71% in the others (p<0.0001). 71.4% of the patients had isolated abdominal trauma, while 28.6% had additional extra-abdominal organ trauma. The complication rate was 7.7% in 13 patients with PATI score <25 and 62.5% in 8 patients with a PATI score ≥25 (p<0.0001). In 10 patients who underwent blood transfusion of ≥3 units, the complication rate was 50% (p<0.0001). CONCLUSION In our study, PATI score, multiple blood transfusions and the number of injured intra-abdominal organs were the most important factors affecting the rate of postoperative complications in penetrating abdominal gunshot wounds. We found that the interval between trauma and presentation to the hospital and number of injured extra-abdominal organs did not affect the complication rate.

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma centers data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. Conclusion: MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation.

The relationship between Injury Severity Scores and transfusion requirements of 108 consecutive cases injured with high kinetic energy weapons: a tertiary center end-mode mortality analysis

BACKGROUND We aimed in this study to investigate the relationship between Injury Severity Score (ISS) and transfusion strategies required during medical intervention in patients wounded by high kinetic energy (HKE) gunshot, and to analyze end-mode mortality. METHODS The medical data of patients were included in the study. We evaluated whether there was any significant correlation in terms of demographic characteristics, HKE weapon type, ISSs, and transfusion strategy options and transfusion requirements. RESULTS Causes of mortality in cases resulting in mortality during hospitalization were evaluated. One hundred and eight consecutive patients were included in the study. All patients except one were male, with an average age of 25 years. 64.8% of them were injured by long-barreled firearms, whereas 35.2% were injured by explosives. Average ISS was 13.9. ISS values for the patients with and without transfusion were 16 (5-48) and 9 (3-36), respectively. Causes of mortality were evaluated in terms of systemic inflammatory response syndrome (SIRS), sepsis, and multiorgan dysfunction syndrome (MODS). DISCUSSION It was determined that there was a significant correlation between increase in ISS values in cases with HKE weapon wounds and their transfusion requirements, whereas this requirement was independent of the ISS value in cases with explosive wounds.

Giant Epidermal Cyst Unusually Located in Perianal Region

Address for Correspondence/Yazışma Adresi: Şahin Kaymak MD Gülhane Training and Research Hospital, Clinic of General Surgery, Ankara, Turkey Phone: +90 532 333 41 14 E-mail: sahinkaymak@hotmail.com ORCID ID: orcid.org/0000-0003-4717-5791 Received/Geliş Tarihi: 23.08.2017 Accepted/Kabul Tarihi: 20.10.2017 ©Copyright 2018 by Turkish Society of Colon and Rectal Surgery Turkish Journal of Colorectal Disease published by Galenos Publishing House. DOI: 10.4274/tjcd.46362 Turk J Colorectal Dis 2018;28:40-43 CASE REPORT

The Role of the Ultrasonography of Abdomen Performed by a General Surgeon on Diagnosis of Acute Appendicitis

Aim: In this study, we aimed to investigate whether abdominal ultrasonography (USG) performed by a general surgeon provides significant contribution to himself in diagnosing acute appendicitis. Method: This study was performed at two different hospitals where referral of patients to another hospital is not possible due to geographical reasons. Two hundred fifteen patients with suspicious diagnosis of acute appendicitis were included into the study among 2140 patients with abdominal pain at three different periods during 12 months. Data of the patients were evaluated retrospectively and patients were divided into three groups. Group 1 and 2 include patients followed and treated in the same hospital. Group 1 patients were followed and treated by general surgeon using conventional methods without abdominal USG. Group 2 patients were followed and treated by same general surgeon using both conventional methods and abdominal USG. Group 3 patients were followed and treated by a different general surgeon in a different hospital using conventional methods and abdominal USG performed by a radiologist. Results: Of patients, 200 male and 15 were female, and mean age was 23. A total of 66 patients from all groups underwent appendectomy. When the groups were compared with according to the pathological results which were consistent with acute appendicitis; there was not statistically significant difference among groups (p=0.362). Conservative treatment were applied to the patients with sonographically negative for appendicitis and with negative findings for physical examination and laboratory tests in their follow-up. When the groups were compared in terms of correctly identification of nonacute appendicitis and avoidance of negative appendectomy (laparotomy); statistically significant difference in favor of group 2 (p=0.002) was found. Conclusion: According to the results of the study; when surgeons use USG as an adjunctive method, the rate of negative appendectomy decreases.

[Analysis of the pediatric trauma score in patients wounded with shrapnel; the effect of explosives with high kinetic energy: results of the first intervention center].

BACKGROUND We aimed to assess the 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 trauma to the extremities, only four patients had traumatic lower-limb amputation. Transportation time was <=1 hour in 35% of cases, and >1 hour in 65% of cases. While PTS was found as <=8 in 35.3% of cases (n=6), the score was found to be higher than 8 in 64.7% of them (n=11). Median heart rate in patients with PTS <=8 was 94 beats/min. This value was 70 beats/min in those with 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 to be only 4 days in PTS >8 cases. This difference was found to be statistically significant (p=0.001). CONCLUSION PTS is very efficient and a time-saving procedure to assess the severity of trauma caused by the shrapnel effect. The median heart rate, morbidity, and LHS increased significantly in patients with PTS <=8.