Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES最新文献

Background: Abdominal gunshot wounds contribute significantly to trauma-related morbidity and mortality. Computed tomog-raphy (CT) can provide valuable diagnostic information but may potentially delay definitive treatment. This study aimed to evaluate the role of abdominal CT in surgical decision-making and timing among patients with abdominal gunshot injuries.

Methods: We retrospectively analyzed patients with abdominal gunshot wounds treated at a tertiary university hospital between January 2013 and January 2023. Collected data included demographic characteristics, physiological parameters, trauma scores, CT find-ings, time intervals (from admission to CT and to surgery), and clinical outcomes. Patients were classified as hemodynamically stable or unstable based on admission parameters and their response to resuscitation. The two groups were compared.

Results: A total of 74 patients were included (94.5% male; median age, 32 years). Of these, 47 (63.5%) were hemodynamically stable at presentation, while 27 (36.5%) were unstable. Abdominal CT was performed in 67 patients (90.5%), with a median time of 28 minutes from admission. The median time to CT was similar between stable (28 minutes) and unstable (30 minutes) patients (p=0.934). Based on CT findings, nonoperative management was feasible in 10 patients (13.5%). Among the unstable group, CT was performed in 7 of 11 nonresponders, of whom six (54.5%) died. Among patients who underwent surgery, the mean time to operation was significantly shorter in unstable patients compared to stable patients (60.4±36.7 vs. 93.2±76.6 minut±es; p=0.034). The perioperative mortality rate was 9.3%, with all deaths occurring in hemodynamically unstable nonresponders.

Conclusion: Abdominal CT can aid surgical planning without causing significant delays in definitive treatment, even in initially unstable patients who respond to resuscitation. CT findings may support nonoperative management in selected cases and guide targeted surgical interventions in patients requiring operative treatment. However, these findings apply to carefully selected patients and should be interpreted cautiously, as this study does not establish the safety of CT in unselected hemodynamically unstable patients. The proximity of the CT scanner to the resuscitation area facilitated rapid imaging; therefore, the findings may not be generalizable to institutions with remotely located CT facilities.

Isolated hypoglossal nerve injury is an infrequent occurrence in clinical and forensic traumatology practice. Its etiology includes trauma, malignancy, vascular events, autoimmune diseases, and complications of surgical procedures. Clinical manifestations resulting from nerve damage may present early or be delayed. We present the case of a 44-year-old woman who sustained a fracture of the third cervical vertebra following a traffic accident. An anterior approach was employed for instrumentation using an anterior plate spanning two cervical segments. The patient developed dysphagia and swallowing difficulties and subsequently underwent evaluation for disability status. Physical examination revealed significant atrophy and asymmetry of the right half of the tongue body, slight rightward deviation of the tongue apex at rest, and fasciculations. Electromyography performed 22 months after the injury demonstrated chronic axonal injury of the right hypoglossal nerve. Causality assessment favored the traffic accident as the initiating event, with postoperative edema and retraction likely contributing to progression. The condition was classified as permanent, and a 25% functional loss was assigned for tongue paralysis according to national disability criteria. This report highlights the diagnostic, prognostic, and legal complexities of delayed hypoglossal nerve palsy following cervical trauma and underscores the importance of a multidisciplinary approach in determining the etiology and prognosis of isolated hypoglossal nerve paralysis, as well as in establishing medical causality.

Objective This study aims to reveal the multidimensional effects of migraine on driving by evaluating the driving habits of individuals with migraine and patients' adherence to safety strategies. Materials and Methods This multicenter, hospital-based, cross-sectional study was conducted between May and July 2024. Volunteers with migraine, aged 18-65 years, and with a driving history were included in the study after their consent. Detailed face-to-face interviews were conducted using a form adapted from the Driving Habit Questionnaire to assess the patients' demographic characteristics, individual driving experiences, driving preferences and habits. Finally, the impact of driving on the patients' quality of life was assessed using the Headache Impact Test-6 (HIT-6). Results Of the 2548 patients evaluated in our study, 1333 had driving experience; the mean age of the drivers was 36.7±9.5 years, and 64.4% were female. Patients with migraine drove approximately 4.86 days/week; 64.1% had driving experience of more than 10 years. They generally complied with safety precautions: 92.2% of participants always fastened their seat belts, and 85.2% regularly checked their rearview mirrors before driving. 28.8% of patients always wanted to be drivers, and 26.3% drove faster than the speed limit, contrary to traffic flow. Common factors related to frequent driving behaviour, higher driving speeds, and a tendency to perceive themselves as better drivers were male gender, smoking and alcohol use, longer driving experience, and lower HIT-6. The mean HIT-6 score was 62.2±7.1 in drivers with migraine. Conclusion Our findings suggest that migraine shapes driving behaviors by affecting driving frequency, speed preferences, and subjective driving confidence, and this should be considered in clinical assessments.

Background: This study aimed to investigate the factors affecting mortality in Fournier's gangrene (FG) and to establish a simplified scoring system that enables practical bedside assessment for clinicians.

Methods: The medical records of 130 patients treated for FG between February 2012 and January 2025 were retrospectively reviewed. Survivors (Group 1, n=101) were analyzed separately from non-survivors (Group 2, n=29). The collected data included sex, age, infection spread score, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI) scores, source of infection, presence of diabetes mellitus (DM), obesity, and other comorbidities. Additional variables included the presence of a diverting stoma, duration of vacuum-assisted closure (VAC) therapy, length of hospital stay, intensive care period (ICP), and isolated bacterial species. Associations between mortality and factors such as age, infection spread score, comorbidities other than DM and obesity (CADO), and ICP were examined.

Results: A significant difference was observed between the groups in terms of age and age score. The infection spread score was significantly higher in Group 2. While 60 patients in Group 1 had CADO, all patients in Group 2 had CADO, demonstrating a statistically significant difference. ICP was also significantly longer among non-survivors. Receiver operating characteristic (ROC) analysis demonstrated that the Eğin score had a sensitivity of 96.6% and a specificity of 63.4% at a threshold value of >3.

Conclusion: Age, infection spread score, CADO, and ICP, which constitute the Eğin score, demonstrated significant differences between survivors and non-survivors. These parameters are crucial for predicting mortality in patients with FG.

Background: Testicular torsion is an important urologic emergency, and early identification is crucial. This study aimed to evaluate the diagnostic value of hematological parameters-particularly immature granulocytes (IGs) in differentiating epididymo-orchitis from testicular torsion in patients presenting with acute scrotal pain.

Methods: This retrospective cohort study included 301 male patients presenting with acute scrotal pain between January 2020 and December 2024. Diagnoses were confirmed by Doppler ultrasonography or surgical exploration. Patients were classified into epididymo-orchitis (n=200), testicular torsion (n=37), and control (n=64) groups. Complete blood count parameters (WBC, neutrophil, lymphocyte, platelet, IG, NLR, PLR) were analyzed. Nonparametric tests were used for group comparisons, and ROC curve analyses were performed to determine diagnostic performance. Multivariable logistic regression adjusted for age identified independent predictors.

Results: NLR (cut-off=2.19, AUC=0.644, p<0.001) and IG count (cut-off = 0.06, AUC=0.590, p=0.011) were significantly elevated in epididymo-orchitis compared with controls. No parameter showed diagnostic significance for testicular torsion. In the epididymo-orchitis vs torsion comparison, NLR (AUC=0.781, p<0.001) and IG count (AUC=0.730, p<0.001) demonstrated the best discriminative ability. Multivariable regression confirmed NLR (OR=1.17, 95% CI 1.05-1.31, p=0.005) and IG (OR=2.26, 95% CI 1.10-4.63, p=0.027) as independent predictors of epididymo-orchitis.

Conclusion: Immature granulocyte count and NLR are valuable and accessible hematological biomarkers that can assist in differentiating epididymo-orchitis from testicular torsion. Their integration into diagnostic evaluation may enhance clinical decision-making in the emergency management of acute scrotum.

Background: The Kahramanmaraş earthquake that occurred in Türkiye in 2023 affected 14 million people, resulting in 53,537 deaths and more than 100,000 injuries. In large-scale disasters, it is crucial to rapidly initiate complex treatment processes in hospitals equipped with tertiary intensive care units following the initial on-site response. In this study, we aimed to retrospectively analyze the types of trauma and the associated surgical and medical treatments of patients affected by the earthquake who were admitted to our level 3 intensive care unit. Our objective was to contribute to future disaster preparedness planning in healthcare institutions and to improve intensive care treatment strategies.

Methods: This retrospective single-center study was conducted at Mersin City Training and Research Hospital. Clinical data of patients treated in the tertiary intensive care unit were reviewed. The recorded variables included demographic characteristics, time of hospital admission, length of hospital stay, complete blood count, creatine kinase, myoglobin, albumin levels, liver and renal func-tion tests, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, type of trauma, presence of crush syndrome and acute kidney injury, surgical interventions and types of surgery, renal replacement therapy, blood transfusion, fluid therapy, nutritional support, requirement for mechanical ventilation, psychiatric support, hyperbaric oxygen therapy, mortality, and referral to another hospital.

Results: A total of 80 patients were included in the study; 53.8% were female, and the mean age was 49.93 years. The overall mortality rate was 22.5%. The mean age was higher in the mortality group, and lymphocyte count was also significantly higher in this group. The proportion of patients receiving renal replacement therapy was greater in the mortality group compared to survivors (p=0.035). Eleven patients died within the first five days of admission, and 13 of the deceased patients had acute kidney injury. Mechanical ventilation and total parenteral nutrition were more frequently required in the mortality group.

Conclusion: Advanced age, the need for total parenteral nutrition, renal replacement therapy, and mechanical ventilation were identified as predictors of mortality among trauma patients followed in a tertiary intensive care unit.

Background: The aim of this study was to investigate whether allopurinol and oxypurinol treatment could mitigate oxidative stress and germ cell apoptosis in testicular ischemia-reperfusion (IR) injury.

Methods: Thirty-two male rats were divided into four groups: Group 1 (Sham-Operated, n=8), in which the testicle was exposed but torsion was not performed; Group 2 (IR + Saline, n=8), in which torsion/detorsion was applied to the left testicle and 1 mL of normal saline was administered; Group 3 (IR + Allopurinol, n=8), in which torsion/detorsion was applied to the left testicle and 50 mg/kg allopurinol was administered; and Group 4 (IR + Oxypurinol, n=8), in which torsion/detorsion was applied to the left testicle and 50 mg/kg oxypurinol was administered. On postoperative day 28, left testicular tissue samples were collected, and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured. Additionally, the gene expression levels of Bax, B-cell lymphoma 2 (Bcl-2), endothelial nitric oxide synthase (eNOS), and vascular endothelial growth factor A (VEGF-A) were analyzed.

Results: Allopurinol and oxypurinol significantly decreased OSI levels (p<0.001). Oxypurinol was found to be significantly more effective in reducing oxidative stress (p<0.001). Both allopurinol and oxypurinol significantly reduced Bax gene expression levels (p<0.001). Treatment with allopurinol (p=0.009) and oxypurinol (p=0.001) significantly increased Bcl-2 levels. Additionally, both agents significantly reduced the apoptosis index (p<0.001). Allopurinol (p1=0.007, p2<0.001) and oxypurinol (p1,2<0.001) treatments significantly increased eNOS and VEGF-A gene expression levels.

Conclusion: Allopurinol and oxypurinol reduce oxidative stress in the testis following IR injury, with oxypurinol demonstrating a greater antioxidant effect. Both treatments also reduce apoptosis by contributing positively to the eNOS and VEGF-A-mediated repair processes. Therefore, allopurinol and oxypurinol may serve as potential therapeutic agents for clinical application in testicular torsion.

Objective: This study aims to highlight the clinical course of genitourinary injuries associated with pelvic fractures following motorcycle accidents and to raise awareness of these traumas.

Materials and methods: This case report presents two young female patients who sustained pelvic fractures and genitourinary injuries as a result of motorcycle accidents. The cases are compared in terms of trauma severity, accompanying injuries, and treatment approaches.

Results: The first patient sustained a high-energy trauma resulting in severe soft tissue injuries involving the anterior vaginal wall, clitoris, and bladder neck, accompanied by active bleeding. Despite undergoing external fixation, the patient died due to multi-organ failure. The second patient had a less severe trauma, with a pelvic fracture and a superficial mons pubis laceration, which was successfully managed with conservative treatment and healed without complications.

Conclusion: These cases emphasize the importance of a thorough genital examination in female trauma patients, the necessity of a multidisciplinary approach, and the potential for timely surgical intervention to be life-saving. This report contributes to the limited body of literature on pelvic and genitourinary injuries in women caused by motorcycle accidents and highlights the need for further clinical research and documentation.

Background: Trauma during pregnancy presents unique clinical challenges due to physiological adaptations and the need to ensure fetal well-being. Although guidelines recommend a minimum period of maternal and fetal monitoring following trauma, the factors associated with prolonged emergency department (ED) observation in pregnant trauma patients remain insufficiently defined. Identifying these factors may help optimize clinical decision-making and resource utilization in emergency care settings.

Methods: This retrospective cohort study was conducted in a tertiary-care emergency department between January 2014 and January 2024. Patients were categorized according to ED observation duration as ≤6 hours or >6 hours. Demographic characteristics and clinical variables, including Injury Severity Score (ISS), gestational age, RhD status, trauma characteristics, and consultation requirements, were recorded. Univariate and multivariable logistic regression analyses were performed to identify predictors of prolonged ED observation.

Results: A total of 459 pregnant trauma patients were included in the analysis, of whom 238 (51.9%) were observed in the ED for more than 6 hours. Patients with prolonged observation had a significantly higher gestational age than those observed for ≤6 hours (median 24 weeks [interquartile range (IQR): 15-32] vs. 17 weeks [IQR: 11-23], p<0.001). In multivariable analysis, higher ISS (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.08-1.35, p<0.001), advancing gestational age (OR: 1.07 per week, 95% CI: 1.04-1.09, p<0.001), and RhD negativity (OR: 3.84, 95% CI: 1.33-11.14, p=0.013) were independently associated with ED observation exceeding 6 hours. Although the number of consultations was significantly associated with prolonged observation in univariate analysis, it did not remain an independent predictor after multivariable adjustment.

Conclusion: Higher ISS, advancing gestational age, and RhD negativity were independently associated with emergency department observation lasting more than 6 hours among pregnant trauma patients.