Ulusal Travma Ve Acil Cerrahi Dergisi-Turkish Journal of Trauma & Emergency Surgery最新文献

Background: Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic.

Methods: Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival.

Results: The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16-84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7-145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes.

Conclusion: Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.

Background: Controversy still exists for optimal treatment for displaced intra-articular calcaneal fractures (DIACFs). Conven-tionally, the extensile lateral approach (ELA) has been the most preferred approach. Although ELA provides excellent fracture access and direct evaluation of the depressed posterior facet, this approach has a high rate of serious complications, such as hematoma, superficial/deep infection, and wound healing issues. To overcome such complications, more minimally invasive techniques including external fixation, percutaneous fixation, arthroscopic assisted fixation, and sinus tarsi approach (STA) have been recently described. The primary aim of this study was to compare STA and LEA in the treatment of DIACFs.

Methods: Patients who were operated for DIACFs in our clinic were included in the study. Patients with closed DIACFs of Sanders Type II, III, IV, and over 18 years of age were identified. Physical examinations and radiological evaluations of the patients were per-formed, and clinical scores were filled. Patients were divided into subgroups according to the Sander's classification and comparisons were made again according to these subgroups.

Results: There were 37 patients (four female and 33 male) in STA group and 44 patients in LEA group (six female and 38 male). The mean age was 44.42±13.57 years (range, 18-61) for STA group and 37.32±11.09 years (range, 18-56) for the LEA group. In clinical outcomes, except for short-form survey (SF-12)/MCS-12 (Mental Score) and visual analog scale score, all the parameters were signifi-cantly better in STA group compared to LEA group. No significant difference was observed between the two groups in radiographic results, except for the Böhler angle. Significantly less infection occurred in the STA group compared to LEA group (P=0.021). According to Sander's classification, American Orthopedic Foot and Ankle Society, foot and ankle disability index, and SF-12/PCS-12 and foot function index scores, no significant differences were determined between STA and LEA groups for Sanders Type 2, whereas the values were considerably higher in STA group than in LEA group for Sanders Type 3 and 4.

Conclusion: In DIACFs, STA is considered a safe and effective method for restoring the width, height, and length of the calca-neus and reconstruction of joint alignment and has now become our standard technique for all calcaneal fractures requiring operative treatment.

Introduction and purpose: Acute mesenteric ischemia is especially seen in the elderly population. It has an increasing incidence in today's world where the average life expectancy is increasing. Early diagnosis is the most important factor reducing morbidity and mortality, and there is still no marker with high sensitivity and specificity for early diagnosis.In this study, we aimed to find a more sensitive and specific serum marker in the early diagnosis of mesenteric ischemia by comparing thiol with the currently used markers C-reactive protein and lactate.

Materials and methods: In our study, 32 Wistar Albino male rats, 10-12 weeks old, weighing 250-300 g, were used. 32 rats were divided into 4 groups, one of which was the control group. The superior mesenteric artery of the other 3 groups was ligated. Blood samples were taken after 2 hours from the first group, 4 hours from the second group, and 6 hours from the third group. Then the rats were sacrificed. Mesenteric ischemia and its level were observed in sacrificed subjects. The samples were separated under appropriate conditions and analyzed biochemically.

Results: As the ischemia time increased, CRP increased and this increase was found to be statistically insignificant (p>0.05). The changes in lactate were found to be statistically significant (p<0.05). The difference between the changes of total and native thiol values was found to be statistically significant (p<0.05).

Conclusion: Although CRP is a non-specific parameter in the early diagnosis of acute mesenteric ischemia, lactate maintains its importance as seen in our study. Differences in total thiol and native thiol changes were statistically significant. The fact that this significant difference is observed at the 4th hour values, reveals the importance of these parameters in early diagnosis. Thanks to the economic and fast results of thiol parameters, it is thought that new studies to be added to the literature can lead to the diagnosis of mesenteric ischemia.

Background: The diagnosis of a diaphragmatic rupture and the identification of patients for surgical repair is challenging despite current diagnostic algorithms and imaging technologies. Unless treated on time, acute traumatic diaphragmatic injury due to stab wounds has a high mortality and morbidity rate, with an increasing trend in the presence of organ herniation. In this study, we aimed to investigate the efficacy of diagnostic laparoscopy in patients with an anterior thoracoabdominal stab wound and to compare the follow-up outcomes of cases.

Methods: We retrospectively reviewed our institutional database of patients who were admitted with stab wounds between Oc-tober 2012 and 2022. Patients who underwent diagnostic laparoscopy were divided into two groups depending on the presence of a diaphragmatic injury. We analyzed demographics, the success of computed tomography (CT) imaging in the diagnosis, the presence of hemomediastinum, pneumomediastinum, tube thoracostomy application, associated organ injury, type of surgery, duration of surgery, complications, and the length of stay between the groups.

Results: Of the 39 patients with penetrating left thoracoabdominal injury underwent diagnostic laparoscopy, CT had a diagnostic sensitivity of 63.16% (95% Confidence interval [CI] 38.36-83.71%), and a specificity of 100% (95% CI 82.35-100.00%). We could not find a statistically significant difference between the groups in terms of studied variables, while operation time was significantly higher in the diaphragmatic injury group (P<0.01). Fourteen patients had accompanied visceral injuries.

Conclusion: Diagnostic laparoscopy is still the gold standard particularly in the ER setting, particularly in the absence of an experienced radiologist for 24 h and when the close monitoring of the patient by the same team cannot be provided.

Background: Percutaneous cholecystostomy (PC) is a minimally invasive temporary treatment for patients with acute cholecys-titis (AC) who are at high risk for surgery. The aim of this study was to compare the characteristics of patients with AC treated with PC before and during the coronavirus disease 2019 (COVID 19) pandemic.

Methods: The data of patients who underwent PC with the diagnosis of AC between 2019 and 2021 were analyzed by scanning the hospital registry system. During the COVID 19 pandemic period of March 11, 2020, to March 11, 2021, 110 patients with AC were treated with PC. In the pre-pandemic period of March 2019 to March 2020, 99 patients who underwent PC were added to the study as a control group. The data of the 209 patients included in the study were recorded, and descriptive statistical analysis was performed. The patient characteristics of the two groups were compared.

Results: Evaluation was made of 209 patients who were diagnosed with AC between March 2019 and March 2021 and could not be operated on due to the high risk of surgery. The average age of the patients was 63.84 years (21-97) in the pandemic period and 68.43 years (31-100) in the pre-pandemic period. The rate of female patients was 45.5% in the pandemic group and 44.5% in the pre-pandemic group. The mean procedure-discharge time was 3.85 days in the pandemic period and 3.34 days pre-pandemic. The American Society of Anesthesiologists physical status classification (PS) was determined to be 1 or 2 in 56.4% of the pandemic group patients and 3 or 4 in 78.8% of the pre-pandemic group. There was no comorbidity accompanying AC in 45 (40.9%) patients in the pandemic period, and at least one comorbid condition accompanying AC was detected in 77 (77.8%) patients in the pre-pandemic period. The severity grading for AC was 2 (moderate) in 97.3% of the patients in the pandemic group and 3 (severe) in 26.3% of the patients in the pre-pandemic group. Of the 110 patients in the pandemic period, 14 were Covid 19 positive or suspected. PC-related mortality was not observed in either group.

Conclusion: PC is an effective and safe treatment method that reduced the operating room and intensive care burden during the exacerbation of the COVID 19 pandemic. Therefore, it seems like a logical option to expand the PC indications at times when the number of COVID 19 patients increases.

Background: We aimed to compare bioelectrical impedance analysis (BIA) body composition and to reveal predictive factors that may help prevent gallstone formation.

Methods: Patients with gallstones by ultrasonography were selected as the case group, while participants without stones were selected as the control group. The body composition of the participants in both groups was measured by BIA. Demographic charac-teristics, mean water intake daily of the participants (MWID) and body mass index (BMI), total body fat mass (TBFM), total body fat percentage (BFP), total body water (TBW), body fat mass of trunk (BFM of trunk), and visceral fat level (VFL) measured by BIA were recorded. Predictive risk factors for gallstone formation were revealed by statistical analysis.

Results: The data of a total of 191 participants, including 83 participants in the group with gallstones and 108 participants in the group without gallstones, were analyzed. Both groups were statistically similar in terms of age and sex (P>0.05). In univariate analysis, BMI, TBFM, BFP, BFM of trunk, and VFL were statistically significantly higher (P = 0.007, P=0.004, P=0.003, P=0.003, and P=0.005, respectively) while MWID was lower (P<0.001) in the group with gallstone. In multivariate analysis, MWID (ref: ≥1.5 odds ratio [OR]: 7.786 95% confidence interval [CI]: 3.612-16.781) and BFP (ref: ≥0.24 OR: 3.102 95%CI: 1.207-7.972) were independent factors in gallstone formation.

Conclusion: The MWID and BFP level measured by the BIA technique, which is an easily applicable, noninvasive method, are independent risk factors for gallstone formation.

Background: The aim of this study was to investigate the ability of a new marker that could be easily obtained to differentiate between complicated and uncomplicated appendicitis in a patients with a white blood cell (WBC) count within the normal range.

Methods: The patients who underwent surgery with histopathologically proven acute appendicitis (AA) between January 2021 and October 2022 were evaluated retrospectively. Patients were classified into two groups as uncomplicated and complicated appendicitis, based on the surgical and histopathological findings. Groups were compared in terms of laboratory parameters at the time of hospital admission.

Results: During the study period, 2589 patients underwent an appendectomy, among these 612 patients who had a WBC count within the normal range at the time of admission were analyzed. Uncomplicated appendicitis was detected in 79.6% of the patients and complicated appendicitis in 20.4%. Neutrophil%, neutrophil-to-lymphocyte ratio, C-reactive protein, and total bilirubin levels were significantly higher, whereas lymphocyte%, lymphocyte count, lymphocyte-to-monocyte ratio, sodium levels, and large unstained cells (LUC)% were significantly lower in patients with complicated appendicitis. Multiple logistic regression analysis revealed that lower LUC% (Odds Ratio [OR]: 0.45; 95% Confidence Intervals [CI]: 1.08-2.09; P=0.01) and higher total bilirubin levels (OR: 1.50; 95% CI: 1.08-2.09; P=0.01) were independent risk factors for complicated appendicitis.

Conclusion: In patients with a diagnosis of AA with a normal WBC value, LUC% obtained from the complete blood count can be used as a new parameter predicting the diagnosis of complicated appendicitis.

Background: The article was planned to make the first evaluation in terms of acute subdural hemorrhages, thinking that it can help in appropriate pathologies by tomography interpretation with the artificial intelligence (AI) method, at least in a way to quickly warn the responsible doctor.

Methods: A two-level AI-based hybrid method was developed. The proposed model uses the mask-region convolutional neural network (Mask R-CNN) technique, which is a deep learning model, in the hemorrhagic region's mask generation stage, and a problem-specific, optimized support vector machines (SVM) technique which is a machine learning model in the binary classification stage. Furthermore, the bee colony algorithm was used for the optimization of SVM algorithms' parameters.

Results: In the first stage, the mean average precision (mAP) value was obtained as 0.754 when the intercept over union (IOU) value was taken as 0.5 with the Mask R-CNN architecture used. At the same time, when a 5-fold cross-validation was applied, the mAP value was obtained 0.736. With the hyperparameter optimization for both Mask R-CNN and the SVM algorithm, the accuracy of the two-level classification process was obtained as 96.36%. Furthermore, final false-negative rate and false-positive rate values were obtained as 6.20%, and 2.57%, respectively.

Conclusion: With the proposed model, both the detection of hemorrhage and the presentation of the suspicious area to the physician were performed more successfully on two dimensional (2D) images with low cost and high accuracy compared to similar studies and today's interpretations with telemedicine techniques.

Background: As far as we could detect, we could not find any study in literature on the analgesic efficacy of spray forms of lidocaine and etofenamate in rib fractures. In this study, our aim is to empirically compare the analgesic efficacy of etofenamate spray, lidocaine 10% spray and placebo spray in the management of pain secondary to trauma secondary to isolated rib fractures.

Methods: The study was designed according to a single-center, prospective, randomized, placebo-controlled double-blind study model. About 30 sealed envelopes were prepared for each of the 3 groups and 30 patients were included in each group. A total of 84 cases were included in the study (three groups: 27, 28, 29).

Results: Numeric rating scale (NRS) grades at admission and at 15-30-60-120 min were similar between the three groups (P>0.05). Analysis findings of NRS perception differences between the initial NRS level and the 15-30-60-120th min NRS difference at the 0-120th min showed more lidocaine spray organs, and it was not clearly perceived that these four parameters went between the 3 groups for the outline.

Conclusion: The analgesic efficacy of lidocaine 10% spray, etofenamate spray, and placebo spray used together with standard dexketoprofen 50 mg intravenous treatment in the pain management of rib fractures were similar to each other and although there was a difference at the 120th min, this difference was not statistically significant.

Background: Subdural hematoma (SDH) is usually an emergent clinical condition in neurosurgery. The relationship between the SDH and epilepsy is not well established. Therefore, the use of anti-convulsive treatment in patients with SDH is controversial. The aim of this study is to analyze the presence of seizures in patients who underwent surgery for SDH.

Methods: Patients who were operated on for SDH in our department between 2016 and 2021 were reviewed retrospectively. Demographic features, Glasgow Coma Scale (GCS) score at admission, type of SDH, location, etiology, type of surgical intervention, presence of seizures, and re-operation were evaluated.

Results: There were 175 patients with SDH. There is a statistically significant difference between the frequency of seizures and the type of SDH. More seizures were observed in acute SDH than in the others. There is also a statistically significant difference between the GCS score and the frequency of seizures. Patients with a GCS score <12 at admission had more frequent seizures than patients with a score of 12 or higher. No statistically significant difference was found between factors such as etiology, re-operation, hematoma location, and the development of seizures.

Conclusion: Anti-convulsive treatment may be recommended in patients with acute SDH and a low GCS score at admission. Further studies with larger series should be performed to determine the most appropriate anti-convulsive agent for patients with SDH.