Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Assessment of Traumatic Deaths in A Level One Trauma Center in Ankara, Turkey(2015) Arslan, E. D.; Kaya, E.; Sonmez, M.; Kavalci, C.; Solakoglu, A.; Yilmaz, F.; Durdu, T.; Karakilic, E.; 0000-0003-2529-2946; 26037980; AGG-1308-2022Trauma management shows significant progress in last decades. Determining the time and place of deaths indicate where to focus to improve our knowledge about trauma. We conducted this retrospective study from data of trauma victims who were brought to a major tertiary hospital which is a level one trauma center in Ankara, Turkey, and died even if during transport or in the hospital between 1 March 2010 and 1 March 2013. The patients' demographic characteristics, trauma mechanisms, time frames and causes of deaths determined by physicians were recorded. Traumas were grouped as "high energy trauma" (HET) and "low energy trauma" (LET). Falls from ground level were defined as LET. 209 traumatic deaths due to trauma or trauma-related conditions were found in the study period. 161 of 209 (78 %) patients suffered from HET. Motor vehicle collisions (MVC) (56 %) were the most common mechanism of trauma followed by burns (16 %), falls (11 %), gunshots (9 %) and stabs (6 %) in this group and traumatic brain injuries (TBI) (41 %) were the most common cause of death followed by circulatory collapse (22 %) and multi-organ failure (20 %). 36 % of deaths occurred before arrival at hospital, 25 % in the first 24 h of admission, 18 % between 2nd and 7th day and 21 % after first week. Trimodal distribution of traumatic deaths was not valid for all types of injuries and the most important factor to decrease traumatic deaths is still prevention. Also we have to keep on searching to improve our knowledge about trauma management.Item A Comparison of 2 Surgical Treatments for Thoracolumbar Burst Fractures: Temporary Osteosynthesis and Arthrodesis(2022) Ibrahim Suner, Halil; Luque Perez, Rafael; Garriguez-Perez, Daniel; Echevarria Marin, Marta; Luis Perez, Jose; Dominguez, IgnacioBACKGROUND: We compared the clinical and radiological outcomes and complications of patients treated for thoracolumbar burst fractures via temporary percutaneous osteosynthesis or open definitive arthrodesis. METHODS: A retrospective case-control study was performed including patients treated between 2017 and 2019 for a burst fracture of the thoracolumbar junction, either with percutaneous osteosynthesis (case group) or open arthrodesis (control group). Clinical, functional, and radiographic results were analyzed and compared between treatment groups. RESULTS: We included 112 patients (56 osteosynthesis/ 56 arthrodesis, P = 1) in our study. The mean follow-up and mean age were 20 +/- 3 months (20 +/- 2/20 +/- 3, P = 1), and 41 +/- 10 years (40 +/- 11/42 +/- 10, P = 0.3), respectively. Fracture level was L1/L2 in 75% and T11/T12 in 25% of patients. The osteosynthesis group showed significantly shorter operative times (104 +/- 20 minutes/ 176 +/- 18 minutes, P < 0.01) and inpatient stays (11.6 +/- 1.5 days/15.6 +/- 3.8 days, P < 0.01). Both groups showed similar correction over kyphosis angle at final follow-up (5.8 degrees +/- 2.8 degrees/6 degrees +/- 0.2 degrees P = 0.57), but the osteosynthesis group showed increased segment mobility after hardware removal (3.8 degrees +/- 1.2 degrees/0.9 degrees +/- 0.3 degrees , P < 0.01). There were no significant differences in complications, although the osteosynthesis group showed a significantly lower need for blood transfusion (21%/43%, P = 0.02). CONCLUSIONS: Both methods of treatment yielded good clinical and radiological results with similar complication rates. Temporary osteosynthesis seems to be more beneficial than open arthrodesis because it requires shorter operative time and hospitalization, causes less bleeding, and facilitates spinal movement.Item Pain Management of a Critically Ill Oldest-old Trauma Patient with Multiple Rib Fractures in Intensive Care Unit(2022) Yazar, Cagla; Yesiler, Fatma Irem; Sahinturk, Helin; Araz, Coskun; Zeyneloglu, Pinar; 0000-0002-3887-0314; 0000-0002-0612-8481; 0000-0003-0159-4771; AAJ-4212-2021; AAJ-1419-2021Rib fracture due to blunt chest trauma is a painful condition with high morbidity and mortality and it is two times prevalent among the elderly compared to young people. If adequate an analgesic treatment is not administered, respiratory complications, need for mechanical ventilation, and length of stay in intensive care unit may increase. Erector spinal plane (ESP) block is a regional unaesthetic method that can provide effective analgesia in the unilateral thoracic region. In this study, we present ESP block, which is used successfully in pain management of a critically ill old patient with multiple rib fractures.Item Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital(2019) Giray, Tufan Akin; Kayipmaz, Afsin Emre; Sonmez, Erkin; Haberal, Kemal Murat; Yilmaz, Cem; Kavalci, Cemil; Oguzturk, HakanObjective: To retrospectively analyze patients aged 65 years and over, who were admitted to a level II trauma center in Turkey due to minor spinal trauma in a period of 4 years. Methods: The study included 64 patients aged 65 years and over, who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma. The information of the patients was obtained from the medical records. The clinical characteristics of patients including localizations and types of fracture, presence of additional system injuries and treatment options were investigated. Results: The most common cause was fall, accounting for 51 (79.7%), with 7 (10.9%) due to intra-vehicle traffic accident, and 6 (9.4%) due to out-of-vehicle pedestrian injury. The most common site of trauma was the lumbar region. Of the fractures, 46.9% (n=30) were in the lumbar region, 37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region. Fourteen (21.9%) patients had an additional injury. Given the fracture types, 47 fractures (74.6%) were compression, 14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures. Twenty patients (31.2%) had multilevel vertebral fractures. Conclusions: The results of our study demonstrated the importance of vertebral fractures in the geriatric age group. In this age group, falls and motor vehicle accidents are the leading causes of vertebral traumas. Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.Item An Analyses of Bicycle Accidents in Ankara: Analyses of 5 Years(2016) Yilmaz, Muhittin Serkan; Durdu, Tamer; Kavalci, Cemil; Sonmez, Bedriye Muge; Yilmaz, Fevzi; Kavalci, Gulsum; Yel, Cihat; Hakbilir, OktayAim: Bicycles are used for transportation, exercise and recreation. In this study we aimed to investigate the epidemiological, clinical and economic aspects of bicycle injuries. Material and Method: We included in the study who admitted to the Emergency Department with a bicycle accident between January 2008 and July 2012. Patient age and sex, accident pattern, presence of personal protective measures, injured body part, Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS), radiological findings, requested consultations, duration of hospital stay, season of injury, and average cost rates were recorded. The study population was divided into 2 age groups as 0-14 years and over 14 years. Results: A patients were 238 (81.2%) male and their mean age was 31.5 +/- 14.1 years. Fifty-five (18.8%) patients were female and their mean age was 34.5 +/- 15.9 years. Males had significantly higher rate of bicycle injury (p<0.001). The most common injuries occured to lower and upper extremities. Inspection of hospital bills revealed that median patient cost was $175. Discussion: In this study bicycle accidents were more common occured in males and during summer months. The most common injuries was in the lower extremities.Item IROA: International Register of Open Abdomen, preliminary results(2017) Tezcaner, Tugan; 0000-0002-3641-8674; 28239409; AAD-9865-2021Background: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers (R)) through a dedicated website: www.clinicalregisters.org. Results: Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39 +/- 18.37; 56% male; Mean BMI: 36 +/- 5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%), Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(+/- 4.83) days; Mean number of dressing changes: 0.88(+/- 0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p = 0.016). Pediatric patients: 33 patients. Mean age: 5.91 +/-(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(+/- 3.09) days. Conclusion: Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogota-bag seem to improve results.Item Analysis of the patients admitted to emergency department due to urogenital trauma and investigation of factors that affect mortality(2017) Kavalci, Cemil; Sozen, Semih; Celik, Simsek; Akpinar, Cafer; Guven, Fatma Mutlu Kukul; Yel, Cihat; Sait, OmerObjective: To determine the general characteristics of urogenital trauma, and the factors that impact on mortality. Methods: Patients who were over 18 years of age admitted to the emergency service with urogenital injury between 1 January 2010 and 31 December 2014 were evaluated retrospectively. Age, gender, type of trauma, injured urogenital organs, vital parameters, additional organ injuries and mortality rate were investigated. Categorical variables were compared by using Chi-square test and comparing to groups data were performed with the Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was considered statistically significant. Results: The median age of 174 patients was 35 years (interquartile range: 22), and 150 patients (86.2%) were males. It was determined that the incidence of urogenital trauma increased in August and September. The kidney was the most frequently injured organ (41.4%) and the most common cause of injury was traffic accidents (49.4%). Mean arterial pressure and revised trauma score were the lowest while pulse rate was the highest in renal trauma patients (P < 0.05). Mean arterial pressure, revised trauma score and respiratory rate were low in mortal group while pulse rate and Glasgow coma scale scores were significantly higher (P < 0.05). Conclusions: It is determined that the most common injured organs in trauma patients are kidneys and bladder and also no single factor is effective on mortality.Item Effect of gabapentin on primary surgical treatment of experimental sciatic nerve injury in rats(2018) Kardes, Ozgur; Civi, Soner; Bulduk, Erkut Baha; Selcuk, Fazilet Kaya; Suner, Halil İbrahim; Durdag, Emre; Tufan, Kadir; 30394505BACKGROUND: The aim of our study is to minimize the morbidity related to nerve injury by determining the protective effects of gabapentin in experimental sciatic nerve injury and end-to-end anastomosis model in rats and to guide clinical studies on this subject. METHOD: In our study, 40 adult male Sprague-Dawley rats were randomly divided into the following five groups: I: Only surgical intervention was applied; II: The sciatic nerve was cut properly and was repaired by end-to-end anastomosis. No additional procedure was performed; III: A single dose of gabapentin at 30 mg/kg was given after anastomosis; IV: 30 mg/kg gabapentin was given for 3 days after anastomosis; and V: 30 mg/kg gabapentin was given for 7 days after anastomosis. The experiment was terminated with high-dose thiopental (50 mg/kg) 60 days after the surgical intervention. The right sciatic nerve was taken from all animals. The obtained sections were examined immunohistopathologically. RESULT: Immunohistochemical properties and Schwann cell proliferation were found to be statistically significantly lower in the control group than in the other groups. Schwann cell proliferation was higher in Group 3 than in Group 5. Immunohistochemical changes were significantly lower in Group 4 than in Group 3. Axonal degeneration was also higher in Group 4 than in Group 3. CONCLUSION: Gabapentin promotes neurological recovery histopathologically in peripheral nerve injury due to its neuroprotective properties. Our study results show that gabapentin can be used as an adjunctive therapy to primary surgical treatment after peripheral nerve injury.