Our experience with dermal substitute Nevelia® in the treatment of severely burned patients.

BACKGROUND: This research aims to retrospectively evaluate the effectiveness and safety of dermal substitute (DS), Nevelia®, for the treatment of severely burned patients. METHODS: Twenty severely burned patients were enrolled in this study between May 2017 and May 2018. After escharotomy of the wound, the treatment protocol was applied following a two-step procedure -DS implantation followed by split-thickness skin graft (STSG) application. Need for surgery, complications, hospitalisation duration and overall survival were analysed. RESULTS: Mean age was 40.1±4 (18-86) years old; female/male: 5/15. Mean burn surface area was 50.1%±2 (25-96). Two patients died under hospital treatment due to the severity of their burn trauma and comorbidities. For the rest of the cases, STSG was performed after Nevelia® at mean 21.2 days. No complications due to Nevelia® were detected. The patients were discharged with a mean total recovery of 55.2±4 days. CONCLUSION: This study showed that Nevelia® can be used safely and effectively in severely burned patients with low complication rates and short hospital stay.

Delayed presentation of posttraumatic diaphragmatic hernia.

BACKGROUND: Missed diaphragmatic injuries after trauma may present with herniation of intraabdominal organs into the thoracic cavity. We aimed to review our patients who presented with delayed posttraumatic diaphragmatic hernia. METHODS: A retrospective review of the medical records of patients with delayed diagnosis of posttraumatic diaphragmatic hernia between 2001 and 2009 was performed. RESULTS: Ten patients with a mean age of 44.3 years were included. Six patients were female. Blunt injuries (n: 7) were more common. Mean duration between trauma and presentation to the hospital was 5.9 years (4 months - 19 years). Nine patients had left-sided diaphragmatic hernia. All patients had chest X-ray and most were diagnostic (n: 8). Additional diagnostic imaging with computerized tomography (CT) and magnetic resonance (MR) was used in seven patients. For the repair, laparotomy incision was chosen for seven patients and thoracotomy incision for two patients. One patient underwent left thoracoabdominal approach. Mesh repair was used in seven patients. Postoperative mean hospitalization was 10.6 days. Empyema and atelectasis were the morbidities in one patient. No postoperative mortality was detected. CONCLUSION: Delayed presentation of posttraumatic diaphragmatic hernia is a serious challenge for trauma surgeons. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and/or perforation of the herniated organ.

[Color flow duplex ultrasonography is an effective alternative method]. / Renkli Doppler Ultrasonografi, Psödoanevrizmalarda Tanisinda Oldugu Kadar Tedavisinde De Etkin Bir Seçenektir.

Increasing use of percutaneous interventional cardiac and peripheral arterial procedures has resulted in high incidence of femoral pseudoaneurysms. This case report presents a 68 year-old male with a femoral pseudoaneurysms after percutaneous iliac transluminal angioplasty, who was treated with ultrasound guided compression successfully. Although surgical procedures are widely performed in Turkey, it should be kept in mind that compression therapy is effective and may present as an initial step in the management of femoral pseudoaneurysms.

[The role of supplementation or inhibition of nitric oxide production in burn injury to reduce ischemic damage]. / Yanikta nitrik oksit üremtiminin desteklenmesi veya azaltilmasinin iskemik hasari azaltmadaki rolü.

BACKGROUND: To determine the role of nitric oxide (NO) which is vasodilator agent and inflammatory cytokine, in burn injury. METHODS: Rats were divided into 5 groups, and a 30 % burn was inflicted. In addition to sham control and burn control groups, other 3 groups were given L-Arginine, and L-nitro-L-Arginine methylester (L-NAME), and both. Neutrophil and hematocrit percentage in blood, NO, TNF-alpha and malondialdehyde (MDA) levels in plasma and neutrophil infiltration in the lung were evaluated at 24 hours after thermal injury. RESULTS: The inhibition of NO production with L-NAME treatment significantly decreased these parameters when compared to burned control group. MDA was decreased significantly in all groups which were given drugs. CONCLUSION: The induction and inhibition of NO production both reduced lipid peroxidation but induction increased the mortality, plasma TNF-alpha and neutrophil in the blood. Inhibition of NO production is found more useful after thermal injury in rats.