Independent risk factors of morbidity in penetrating colon injuries.

BACKGROUND: The present study explored the factors effective on colon-related morbidity in patients with penetrating injury of the colon. METHODS: The medical records of 196 patients were reviewed for variables including age, gender, factor of trauma, time between injury and operation, shock, duration of operation, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), site of colon injury, Colon Injury Score, fecal contamination, number of associated intra- and extraabdominal organ injuries, units of transfused blood within the first 24 hours, and type of surgery. In order to determine the independent risk factors, multivariate logistic regression analysis was performed. RESULTS: Gunshot wounds, interval between injury and operation > or =6 hours, shock, duration of the operation > or =6 hours, PATI > or =25, ISS > or =20, Colon Injury Score > or = grade 3, major fecal contamination, number of associated intraabdominal organ injuries >2, number of associated extraabdominal organ injuries >2, multiple blood transfusions, and diversion were significantly associated with morbidity. Multivariate logistic regression analysis showed diversion and transfusion of > or =4 units in the first 24 hours as independent risk factors affecting colon-related morbidity. CONCLUSION: Diversion and transfusion of > or =4 units in the first 24 hours were determined to be independent risk factors for colon-related morbidity.

[Intussusception in adults]. / Eriskinlerde invajinasyon.

BACKGROUND: Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients. The purpose of this study was to determine the causes and management of intussusception in adults. METHODS: A retrospective review of patients with a diagnosis of gastrointestinal intussusception between 1986 and 2006 was conducted. All patients under the age of 18 and cases with rectal, ostomy, or gastroenterostomy prolapse were excluded. RESULTS: There were 28 cases of adult intussusception. Mean age was 38.6+/-16.7 years. A preoperative diagnosis of intussusception was made in 53.5% of the cases. There were 23 enteric, three colonic and two ileocolic intussusceptions. A lead point was identified in 25 patients (89.3%). Invagination was due to benign causes in 19 patients, malignant causes in six patients and idiopathic in three patients. Complication was seen in three (10.3%) cases. CONCLUSION: In this series, the mean age of the patients was younger than in the literature. Since intussusception was due to small bowel pathologies, the proportion of benign/malignant lesions favored benign lesions. Although it is encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of the clinical settings.

[The evaluation of 250 patients with thoracoabdominal injuries]. / Torakoabdominal yaralanma: 250 hastanin degerlendirilmesi.

BACKGROUND: Prognostic factors affecting mortality and morbidity in thoracoabdominal injuries were evaluated. METHODS: Two hundred and fifty patients (227 males, 23 females; mean age 30.1+/-5.11; range 15 to 71 years) who had been exposed to thoracoabdominal injuries and underwent laparotomy between June 1996 and November 2005 were investigated retrospectively. Patients were assessed according to age, sex, trauma-operation interval, shock, hospitalization period, number of injured organs, blood transfusion, timing of closed thorax drainage, thoracotomy, Abdominal Trauma Index, Injury Severity Score, Abbreviated Injury Score, Revised Trauma Score, and complications. RESULTS: Mortality and morbidity ratios were 15.6% and 53.5%, respectively. The factors effective on mortality were trauma-operation interval >or=3 hours (p=0.03), presence of shock (p=0.03), increase in the rate of blood transfusion (p=0.001), injured organ number >or=3 (p=0.001), and not performing early-term closed thorax drainage (p=0.005). Trauma-operation interval <3 (p=0.02), increase in the rate of blood transfusion (p=0.02), injured organ number >or=3 (p=0.001), and not performing early-term closed thorax drainage (p=0.005) were the factors effective on morbidity. CONCLUSION: It was determined that trauma-operation period >or=3 hours, number of injured organs >or=3, and increased number of blood transfusions increased both mortality and morbidity. However, presence of shock increased only mortality. On the other hand, application of closed thorax drainage within a reasonable time period was determined to decrease mortality and morbidity.

[Evaluation of surgical methods in patients with blunt liver trauma]. / Künt karaciger travmasinda uyguladigimiz cerrahi yöntemlerin degerlendirilmesi.

BACKGROUND: We evaluated the surgical methods, morbidity and mortality in patients who had surgery for blunt liver trauma. METHODS: We retrospectively reviewed 159 patients (116 males, 43 females; mean age 33.6; range 15 to 67 years) with blunt hepatic trauma regarding the cause and severity of liver injury, diagnostic procedures, associated injuries, management, morbidity, and mortality. Simple hepatorrhaphy was done in minor liver injuries (Grade I, II). To manage severe liver trauma (Grade III-V), debridement, selective hepatic artery ligation and omentum packing of the laceration (DSO) in 40; resectional debridement (RD) with direct control of bleeding vessels within the liver by the Pringle maneuver in 12; deep matress suture (DMS) in 23; and perihepatic packing (PP) in 9 patients were performed. RESULTS: The causes of trauma were motor vehicle accidents in 102, falls from height in 43 and violence induced blunt trauma in 14 patients. Among 159 patients, 84 had severe liver injuries and 75 had minor liver injuries. Associated organ injuries were present in 104 patients and splenic injury was the most common. Mean units of blood transfusions in DSO, DMS, RD and PP were 4.3, 6.2, 5.5 and 9.5 respectively. Mean time for liver surgery in DSO, RD, DMS and PP were 34.7, 38.1, 26 and 18.2 minutes respectively. Morbidity rate was higher in DMS group than in DSO and RD groups, and the difference was statistically significant (p<0.001). Twenty-five patients (29.4%) died of severe liver injuries and 9 (12%) died of minor liver injuries. The overall mortality rate was 21.3%. CONCLUSION: DSO, and RD methods don't increase operation time and amount of blood transfusion. They cause less morbidity and mortality when compared to DMS.

Micronized purified flavonoid fraction may prevent formation of intraperitoneal adhesions in rats.

OBJECTIVE: To evaluate the efficacy of an anti-inflammatory and capillary regulator drug, micronized purified flavonoid fraction (MPFF), in the prevention of postoperative formation of adhesions. DESIGN: A double-blind, controlled study evaluated the efficacy of MPFF in reducing postoperative adhesion formation in a rat model. SETTING: Animal care facility of an academic research setting. ANIMAL(S): Thirty Sprague-Dawley female rats randomly divided into three groups. INTERVENTION(S): Starting on day of surgery, group 2 rats received oral MPFF (100 mg/kg per day for 7 days). Group 3 rats were intraperitoneally injected with 5 mL of saline (containing 200 mg/kg per day of MPFF for 3 days). Control rats received no medication. A standardized surgical trauma was applied in all animals. Three weeks after surgery, the rats were killed, and the adhesions were scored according to macroscopic and microscopic scales. MAIN OUTCOME MEASURE(S): Postoperative adhesions. RESULT(S): Both oral and intraperitoneal administration of MPFF reduced the scores of adhesions according to macroscopic and microscopic scales. There was no difference between the routes of administration. CONCLUSION(S): A statistically significant reduction in postoperative formation of adhesions was observed after oral and intraperitoneal administration of MPFF in our experimental animal model. However, further studies are required to reveal its mechanism of action.

Retrospective analysis of 135 renal trauma cases.

BACKGROUND: We review our trauma cases over the last 11 years and discuss our diagnosis and treatment modalities. METHODS: One hundred and thirty-five patients with renal injuries who had been hospitalized in the Urology and General Surgery clinics of Dicle University hospital between 1990 and 2001 were reviewed retrospectively. Patients were evaluated with regard to age, sex, cause of trauma, transport time, diagnostic methods, grade of injuries, associated organ injuries, treatments and complications. RESULTS: One hundred and forty-one renal injuries were established in 135 patients. The patients were between 5 and 65 years old; 114 (84.4%) were male and 21 (15.6%) were female. The most common cause of injuries (99 patients) was penetrating injuries. The transport time to hospital after injury was approximately 116 min. Immediate laparotomy was performed in 95 hemodynamically unstable patients. Radiological investigations were carried out in the remaining 40 patients. Most of the injuries were grade 4 (28, 19.86%) or 5 (60, 42.55%). Isolated renal injury was established in only 22 of 135 patients. Nephrorrhaphy was performed in 45 of 141 kidneys. Twelve injured kidneys were managed conservatively. Nephrectomy was performed in 66 of 141 kidneys. The remaining injured kidneys were managed with different treatment methods. Twenty-nine (21.48%) patients were lost intraoperatively or during the early postoperative period. CONCLUSION: We believe that our rates of nephrectomy and mortality were high because of the long transport time, unsuitable transport type, frequent high grade and high rate of associated organ injuries.