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

Background: We evaluated the results of urgent intralesional bleomycin injection (IBI) treatment of intra-abdominal lymphan-giomas (IAL) presenting with acute abdomen in children.

Methods: The records of patients who underwent urgent IBI due to acutely presenting IAL between January 2013 and January 2020 were reviewed retrospectively in terms of age, presenting symptoms, cyst type, number of injections, pre- and post-treatment cyst volume, clinical response, complications, and follow-up.

Results: Six patients with a mean age of 4.3 years (2-13 years) were treated. Presenting symptoms were acute abdominal pain (n=4), abdominal distention (n=1), hypoproteinemia and chylous ascites (n=1). Lesions were of macrocystic type in four and macro and micro cystic in two patients. The median number of injections performed was 2 (1-11). Mean cyst volume reduced dramatically from 567 cm3 (range 117-1656) to 3.4 cm3 (range 0-13.8) after treatment (p=0.028). Treatment response was excellent in four patients with complete resolution of the cysts, while good in the remaining two. No early or late complications or recurrence was observed in a mean follow-up period of 40 months (16-56 months).

Conclusion: IBI is a safe, fast, and easily applicable method with satisfactory results in the treatment of acutely presenting IAL. It may be recommended in primary as well as recurrent lesions.

Background: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs).

Methods: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random.

Results: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32-40) seconds and 35.8 (IQR: 30-40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001).

Conclusion: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

Background: Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods.

Methods: In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann-Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis.

Results: Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19-88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797-41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI 95%: 2.520-26.082, p<0.0001), potassium ≥3.85 mmoL/L (OR: 3.889; 95% CI): 1.333-11.345, p=0.013), and LDH ≥288 U/L (OR: 3.889; CI 95%: 1.333-11.345, p=0.013), whereas, in multivariate analyzes, only CRP ≥0.71 mg/dL (OR: 3.965; CI 95%: 1.071-15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737-0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was ≥7 (OR: 9.846; 95% CI: 3.016-32.145, p<0.0001).

Conclusion: Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.

Traumatic asphyxia, which is manifested by facial edema, cyanosis, subconjunctival hemorrhage, and petechiae on the upper chest and abdomen, is a very rare clinical syndrome in children. In adults, the incidence of traumatic asphyxia was reported as 1 case/18,500 accidents, but the actual incidence is not known for pediatric population. Traumatic asphyxia is a mechanical cause of hypoxia resulting from sudden compression of the thoracic-abdominal region and the valsalva maneuver is necessary for the development of this syn-drome. Here, we describe a case of traumatic asphyxia with an ecchymotic mask in a 14-year-old boy who was referred to our pediatric emergency department.

Congenital diaphragmatic hernias are rarely seen and they are usually diagnosed in the neonatal period. Congenital diaphragmatic de-fect, also known as Bochdalek hernia, usually occurs with the persistence of the pleuroperitoneal canal in the left posterolateral region of the diaphragm in the embryological period. Although it is rarely seen in the adults, conditions such as intestinal volvulus, strangulation, or perforation with congenital diaphragm defect progress with high mortality and morbidity. In this study, we reported our case that we operated for intrathoracic gastric perforation with congenital diaphragmatic defect. When the patient admitted to the hospital, he had an atypical abdominal pain, significant back pain, and suspicious respiratory complaints. Radiological imaging showed that the stomach and the spleen were located in the left hemithorax due to diaphragmatic hernia also stomach was very dilated. Tachycardia, hypotension, and low saturation developed on the 2nd day of the patient's hospitalization. In the control imaging of the patient, in the left hemithorax, stomach was collapsed and the surrounding appearance compatible with hydropneumothorax, after that findings emergency laparotomy was decided. During the operation, as demonstrated by the radiological findings, a diaphragm defect was seen in the left posterolateral region of the diaphragm. The stomach and spleen were herniated to the left hemithorax from this defect. The stomach and spleen were reduced into the abdomen. The left hemithorax was lavaged with 2000 cc isotonic, left tube thoracostomy was applied, and the diaphragm was repaired. The anterior stomach was primarily repaired. In post-operative follow-up, there were no complications other than wound infection and thoracic tube of the patient was removed. The patient who tolerated enteral food was discharged from hospital with full recovery.

Background: The continuous open-loop technique accelerates anastomosis and eliminates the risk of inadvertently catching the back wall, which is the primary cause of technical failure when using interrupted sutures in microsurgical anastomosis. Combined with airborne suture tying, the total anastomosis time is significantly reduced. We conducted an experimental and clinical study to compare this combination to the conventional technique.

Methods: Experimentally, anastomoses were performed on the femoral arteries (0.60 mm) of rats in two groups. The control group used simple interrupted suturing with conventional tying, while the experimental group employed open-loop suturing with air-borne tying. We recorded the total time taken for anastomosis completion and patency rates. Clinically, we retrospectively analyzed replantation and free flap transfer cases using the open-loop suture and airborne tying technique for arterial and venous microvascular anastomoses, assessing total anastomosis time and patency rates.

Results: Experimentally, a total of 40 anastomoses were performed in two groups. The control group required 779.65 seconds, and the experimental group needed 527.4 seconds for anastomosis completion; this difference was statistically significant (p<0.001). Immediate and long-term patency rates were similar (p=0.5483). Clinically, 18 replantations were performed on 16 patients, and 17 free flap transfers were performed on 15 patients, totaling 104 anastomoses. The anastomosis success rate was 94.2% (33 of 35) for free flap transfers and 95.1% (39 of 41) for replantation cases.

Conclusion: The open-loop suture technique with airborne knot tying allows surgeons to complete microvascular anastomoses safely and in less time with minimal assistance when compared to the simple interrupted suture technique.

Background: Patients with hand tendon injuries may present to the hand surgery clinic in the late stage after being examined in emergency departments. Even if an approximate idea has been obtained in physical examination of these patients, diagnostic imaging is usually requested for reconstructive approach, correct planning of surgical incisions and medicolegal reasons. The primary purpose of this study was to determine the overall accuracy of Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in patients with late presentation of a tendon injury.

Methods: The surgical findings and imaging reports of 60 patients (32 females, 28 males) who underwent surgical exploration, late secondary tendon repair or reconstruction with a diagnosis of late-presenting tendon injury in our clinic were evaluated. Comparisons were made of 47 preoperative USG images (18-874 days) and 28 MRI (19-717 days) results for 39 extensor and 21 flexor tendon injuries. The imaging reports were interpreted as partial rupture, complete rupture, healed tendon and adhesion formation and these were compared with the surgical reports in terms of accuracy.

Results: In extensor tendon injuries, the sensitivity and accuracy values were both 84% for USG and 44% and 47% for MRI, respec-tively. In flexor tendon injuries, the sensitivity and accuracy values were 100% for MRI and 50% and 53%, respectively, for USG. Of the 4 sensory nerve injuries, 4 were missed on USG and 1 on MRI. The results obtained with USG and MRI in the late-presenting patients in this study were lower than those reported in previous USG and MRI studies in the literature.

Conclusion: Scar formation with tendon healing causes a change in anatomy, which could prevent accurate evaluation. There-fore, it would be beneficial for surgeons to start evaluating their patients with easily accessible ultrasonography; thus, surgical morbid-ity should be reduced.

Background: In brachial plexus birth palsy (BPBP), botulinum toxin may be utilized to prevent glenohumeral dysplasia and to maintain the stable growth of the glenohumeral joint. Repeated injections may cause muscular atrophy and their functional effects are uncertain. The aim of this study was to compare the microstructure and the function of the muscles that received two injections before transfer with the muscles that were not injected.

Methods: BPBP patients that were operated between January 2013 and December 2015 were included in the study. Latissimus dorsi and teres major muscles were transferred to humerus in standard fashion. Patients were divided in two groups according to bo-tulinum toxin status. Group 1 was toxin negative whereas Group 2 was toxin positive. For each patient, mean latissimus dorsi myocyte thickness (LDMT) was measured with electron microscopy and pre-operative and post-operative active shoulder abduction, flexion, external and internal rotation, and Mallet scores were evaluated with goniometry.

Results: Fourteen patients (seven patients per group) were evaluated. Five patients were female whereas nine were male. Mean LDMT was not affected significantly (p>0.05). The operation improved shoulder abduction, flexion, and external rotation significantly (p<0.05), independent of the toxin status. The internal rotation decreased significantly only in Group 2 (p<0.05). The Mallet score increased in both groups, but it was not significant (p>0.05), independent of the toxin status.

Conclusion: Botulinum toxin that was applied twice prevented glenohumeral dysplasia and it did not cause permanent latissimus dorsi muscle atropy and function loss in late period. It augmented upper extremity functions by alleviating internal rotation contracture.

Background: This study explored the change of anesthesia management for emergent cesarean sections in our tertiary care hospital in the first year of pandemic. We searched primarily for the changes in spinal to general anesthesia rate and secondarily for presented adult and neonatal intensive care needs in comparison to the year before the pandemic. We also presented the postoperative PCR tests of the emergent cesarean sections as a tertiary outcome.

Methods: We retrospectively analyzed clinical data such as anesthetic technique, need for postoperative intensive care, duration of hospital stays, postoperative PCR result, and newborn status.

Results: The rate of spinal anesthesia changed remarkably from 44.1% to 72.1% after the pandemic (p=0.001). The comparison of the median duration of hospital stays of the pre-pandemic group and post-pandemic group was found significantly longer than that of the before COVID-19 group (p=0.001). The rate of need for postoperative intensive care in the after COVID-19 group was higher (p=0.058). The rate of postoperative intensive care of the newborns in the after COVID-19 group was significantly higher than that of the before COVID-19 group (p=0.001).

Conclusion: The spinal anesthesia rate for emergent cesarean sections increased significantly during the peak of the COVID-19 pandemic in tertiary care hospitals. Total health care services after the pandemic were enhanced as seen with elevated numbers of hospital stays, postoperative need of adult and neonatal intensive care.

Background: Traditional methods that evaluate the success of peripheral nerve block have been replaced by methods that allow objective evaluations over time. Multiple objective techniques for peripheral nerve block have been discussed in the literature. This study aims to investigate whether perfusion index (PI), non-invasive tissue hemoglobin monitoring (SpHb), tissue oxygen saturation (StO2), tissue hemoglobin index (THI), and body temperature are reliable and objective methods to evaluate the adequacy of infracla-vicular blockage.

Methods: Ultrasound-guided infraclavicular block in 100 patients undergoing forearm surgery. PI, SpHb, StO2, THI, and body tem-perature measurements was recorded 5 min before the block procedure, right after the procedure, and until the 25th min after the procedure at 5-min intervals. These values were compared between the blocked limbs and non-blocked limbs while being statistically compared between the successful and failed block groups.

Results: Although there were significant differences between the groups of blocked extremity and non-blocked extremity in terms of StO2, THI, PI, and body temperature, there was no significant difference between these groups in terms of SpHb. Moreover, a sig-nificant difference was detected between the groups of successful block and failed block in terms of StO2, PI and body temperature, while there was no significant difference between these groups in terms of THI and SpHb.

Conclusion: StO2, PI, and body temperature measurements are the simple, objective, and non-invasive techniques to be used to evaluate success of block procedures. According to the receiver operating characteristic analysis, StO2 is the specific parameter with the highest sensitivity among these parameters.