Factors affecting postoperative mortality in abdominal trauma.

Records of 345 patients in whom laparatomies were performed because of blunt and penetrating abdominal trauma were reviewed retrospectively with respect to factors affecting mortality. One hundred and twenty-eight patients had blunt abdominal trauma (Group I), 114 patients had gunshot wounds of the abdomen (Group II), and 103 patients had stab wounds of the abdomen (Group III). Mortality rates were 14.8%, 12.3% and 1.9% in groups I, II and III respectively. The presence of head trauma especially if accompanied by hypotension in group I, and the presence of chest trauma (hemothorax and/or pneumothorax) and hypotension (less than 90 mmHg) in group II were associated with a high mortality rate (p less than 0.05). Of the two patients who died in group III, one had septic shock due to massive intestinal necrosis and the other had hemorrhagic shock due to multiple organ injury and bleeding from an injured internal thoracic artery as the cause of death.     

Spontaneous expulsion of a bullet, in the body of second cervical vertebrae, via the mouth.

Gunshot wounds to the upper cervical spine without neurological deficit occur infrequently. In this report, we describe a case with spontaneous expulsion of a bullet located in the body of second cervical vertebrae (C2) via mouth.     

Surgical treatment of intractable postpartum hemorrhage and changing trends in modern obstetric perspective

Purpose  To update the prevalence and risk factors of intractable postpartum hemorrhage (IPH) and evaluate the effectiveness of surgical treatment modalities. Methods  Between January 2002 and January 2008, IPH diagnosis was made in 86 cases. They were evaluated retrospectively. Results  Placental implantation abnormalities were the leading cause, responsible for 45.6% of cases. Organ preserving surgery (OPS) methods were utilized in 47 cases, with a success rate of 76.6%. Among these cases, 11 were proceeded to hysterectomy. Hysterectomy was performed in 45 cases as definitive treatment. Conclusions  Compression sutures were quite effective in controlling hemorrhage due to placenta accreta and previa. For women who are hemodynamically stable and desirous for future fertility, OPS modalities should be applied first. Shorter operating time, hospital stay and less blood transfusion were seen with subtotal type hysterectomy, so in case of nonbleeding lower uterine segment, subtotal type should be performed first.     

Reconstruction of full-thickness cheek defects using platysma myocutaneous flaps

Summary Myocutaneous flaps play an important role in reconstruction of full-thickness defects of the head and neck area. In this study, a different application of the platysma myocutaneous flap for the reconstruction of full-thickness cheek defects is presented. The technique described has provided an acceptable cosmetic and functional result. It was used in four patients operated on under local anesthesia. Reconstruction of full-thickness cheek defects is easily achieved, especially for palliation in poor risk patients.     

Influence of age and sex on lumbar vertebral morphometry determined using sagittal magnetic resonance imaging.

We evaluated age-related changes in the morphometric features of lumbar vertebrae in both sexes using magnetic resonance imaging (MRI). Midsagittal MRI scans of 366 individuals (156 males, 210 females; 25-82 years old) were evaluated retrospectively. The anterior height (H(a)), central height (H(c)), posterior height (H(p)), and anteroposterior diameter (D) of the body of each lumbar vertebra were measured. These measurements were used to calculate three indices, namely, the anterior wedge index (H(a)/H(p)), the biconcavity index (H(c)/H(p)), and the compression index (H(p)/D). The values of each of the three indices for the upper lumbar vertebrae of females were higher than those of the same vertebrae in males. The values of the compression index for all lumbar vertebrae decreased with age in females, whereas in males the compression index of the L1-L4 vertebrae decreased with age. No significant changes were observed in the value of the anterior wedge index in either sex. The biconcavity indices of the L1 and L5 vertebrae decreased with age in males. These results may be useful for evaluating age-related morphological changes that occur in the lumbar vertebrae.     

Reliability of mini nutritional assessment in hemodialysis compared with subjective global assessment.

Protein-energy malnutrition (PEM) is common in hemodialysis patients. Subjective Global Assesment (SGA) and Mini Nutritional Assessment (MNA) are two tools for monitoring PEM. Our aim was to determine reliability of MNA in detecting malnutrition in hemodialysis patients in comparison with SGA. The study population consisted of 137 patients with pure PEM with no signs of chronic inflammation. Nutritional statuses of patients were assessed concomitantly by SGA and MNA. Ninety-two patients were in SGA-A, 40 patients were in SGA-B, and 5 patients were in SGA-C. Forty-seven patients were in MNA-1, 77 patients were in MNA-2, and 13 patients were in MNA-3. Albumin (P = .0001), prealbumin (P = .0001), body mass index (P = .01), creatinine (P = .0001), and nPNA (P = .04) were statistically different between SGA groups. Creatinine (P = .001), blood urea nitrogen (P = .017), albumin (P = .001), prealbumin (P = .005), body mass index (P = .0001), and nPNA (P = .005) were statistically different between MNA groups. Fifty-two patients who had no evidence of malnutrition according to SGA were defined as having moderate malnutrition according to MNA. Seven patients who were in a state of moderate malnutrition determined by SGA were in good nutritional status according to MNA. SGA identified 8 patients as moderately malnourished; the same patients were defined as having severe malnutrition in MNA. Our results suggest that MNA might underestimate the nutritional status of hemodialysis patients who are not in an inflammatory state and may not be a reliable method for detecting moderate malnutrition when compared with SGA.