MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury.

PURPOSE: To evaluate the occurrence and distribution of mild traumatic brain injury (MTBI) caused by diffuse axonal injury (DAI) using magnetic resonance (MR) imaging and to attempt to correlate MR findings with post-concussion symptoms (PCS). PATIENTS AND METHODS: Forty MTBI patients (mean age: 32.5 years) with normal cranial computed tomography (CT) findings were examined with standard MR protocol including T(1)-weighted, T(2)-weighted, fluid attenuated inversion recovery (FLAIR), gradient echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed within 24 hours of injury. The lesions were classified as DAI based on their location and morphologic appearance. RESULTS: In MR imaging of five (12.5%) of the patients, the lesions compatible with DAI were observed. Four patients (10%) had the foci of low signal intensity compatible with hemorrhagic shear injury on the GRE sequence, and five (12.5%) patients had high signal intensity on FLAIR and DW sequence. CONCLUSION: MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.

Factors affecting mortality and morbidity after traumatic diaphragmatic injury.

PURPOSE: We review our 11-year experience of treating diaphragmatic injury (DI), to identify the factors determining mortality and morbidity. METHODS: We analyzed the effects of demographic characteristics, type of injury (blunt or penetrating), number of injured organs, injury severity score (ISS), revised trauma score (RTS), Glasgow coma score, and intensive care unit and hospital stay, on complications and mortality, in 51 patients treated for DI between January 1995 and December 2005. RESULTS: Twenty-six (51%) patients suffered blunt injury and 25 (49%) suffered penetrating injury. The left diaphragm was injured in 40 (78%) patients, the right in 10 (19%), and both sides in 1 (2%). Only three (5.8%) patients had no concomitant injury. The diagnosis was made by the findings of laparotomy on 34 patients (65%), preoperative chest X-ray on 13 (25%), computed tomography on 2 (3.9%), and laparoscopy on 2 (3.9%). Complications developed in 23 (44%) patients and overall mortality was 19.6% (10/51). An ISS > 13 was found to be an independent prognostic factor for morbidity, whereas an RTS < or = 11, age > or = 48 years, and a major postoperative complication were independent prognostic factors for mortality. CONCLUSION: Establishing a preoperative diagnosis of DI is still problematic. Aggressive treatment and close monitoring of patients with an ISS > 13, an RTS < or = 11, an age > or = 48 years, or a postoperative complication may decrease morbidity and mortality.

Relationships between markers of inflammation, severity of injury, and clinical outcomes in hemorrhagic shock.

This study was performed to investigate the relationships between markers of inflammation in serum (interleukin-6 [IL-6], interleukin-10 [IL-10], and granulocyte elastase [GE]), severity of injury, and clinical outcomes, and to evaluate the predictive value of these markers for major complications and mortality. This study, which was conducted between August 2003 and May 2005, examined patients older than 16 y who were admitted to the Emergency Unit of the Uludag University Medical School within 12 h after trauma, and who had traumatic hemorrhagic shock (THS) at admission. Three groups were established: the THS group (n=20), the pure hemorrhagic shock (PHS) group (n=20), and the healthy control group (n=20). Demographic data were recorded for all subjects, and blood samples were taken for lactate, base excess, GE, IL-6, and IL-10 measurements. The Glasgow Coma Score, the Revised Trauma Score, the Injury Severity Score, the New Injury Severity Score, and the Trauma Score-Injury Severity Score were calculated; complications and final clinical outcomes were monitored. A total of 35 men and 25 women were included in the study; mean patient age was 41+/-17 y. In the THS group, scores were as follows: Revised Trauma Score, 10.2+/-2.2; Trauma Score-Injury Severity Score, 0.86+/-0.2; Injury Severity Score, 24.8+/-9.0; and New Injury Severity Score, 32.7+/-9.0. IL-6, IL-10, lactate, and base excess levels in the THS group were significantly higher than those in the PHS and healthy control groups. The serum GE level of the THS group was significantly higher than that of the healthy control group, but it did not differ significantly from that of the PHS group. Complications such as sepsis, acute respiratory distress syndrome, and multiple organ failure occurred in 50% of the THS group and in 20% of the PHS group. Mortality was 30% in the THS group and 10% in the PHS group. In the THS group, no significant differences were noted between markers of inflammation and trauma scores of patients who died and those who survived. The investigators concluded that although the levels of markers of inflammation increased in THS patients, they were inadequate for predicting mortality and the development of complications such as acute respiratory distress syndrome, multiple organ failure, and sepsis. A larger study based on the use of serial marker measurements is warranted.

Effects of different resuscitation fluids on tissue blood flow and oxidant injury in experimental rhabdomyolysis.

OBJECTIVE: This study was performed to evaluate the effects of 0.9% saline (SAL), 0.9% saline + sodium bicarbonate + mannitol (SAL/BIC/MAN), and hypertonic saline-dextran (HSD) on hemodynamic variables, tissue blood flow, and oxidant injuries in experimental traumatic rhabdomyolysis (TR) in rats subjected allogeneic muscle extract infusion. DESIGN: Prospective, randomized, experimental. SETTING: Physiology experiment laboratory. SUBJECTS: Male Sprague-Dawley rats, weighing 250-300 g. INTERVENTIONS: All groups (n = 8 each) underwent femoral artery and vein catheterization. The animals in the TR, SAL, SAL/BIC/MAN, and HSD groups received an infusion of 2 mL of autologous muscle extract for 60 mins. After autologous muscle extract infusion, the SAL and HSD groups received 30 mL/kg 0.9% saline for 30 mins or 4 mL/kg HSD for 5 mins, respectively. The SAL/BIC/MAN group received 30 mL/kg 0.9% saline for 30 mins plus a bolus of 1 g/kg mannitol and a bolus of 2 mEq/kg sodium bicarbonate diluted in 1 mL of saline. At 2 hrs of autologous muscle extract infusion, erythrocyte flows in liver and kidney were measured by using a laser Doppler flowmeter. Then, blood samples and kidney and liver biopsies were taken to measure levels of glutathione and malondialdehyde. MEASUREMENTS AND MAIN RESULTS: TR caused decreases in mean arterial pressure, tissue blood flow, and tissue glutathione and an increase in malondialdehyde. Rats in the HSD group had significant metabolic acidosis. SAL resuscitation did not correct tissue blood flow and prevent oxidant injury. HSD increased tissue blood flow, mean arterial pressure, and liver and kidney glutathione and decreased serum, liver, and kidney malondialdehyde. SAL/BIC/MAN resuscitation corrected all oxidant damage variables but did not increase tissue blood flow. SAL/BIC/MAN preserved serum malondialdehyde and liver glutathione better than the HSD did. CONCLUSIONS: HSD prevented oxidant injury and restored tissue blood flow but increased metabolic acidosis that followed autologous muscle extract infusion. SAL/BIC/MAN seems to be more effective than HSD in decreasing oxidant injury. Further research on the effects of the solute overload and metabolic acidosis due to HSD resuscitation on renal function in experimental rhabdomyolysis is warranted.

Acute poisoning in adults in the years 1996-2001 treated in the Uludag University Hospital, Marmara Region, Turkey.

BACKGROUND: Acute poisonings are frequent causes of admission to emergency departments and these cases may have hazardous outcomes. METHODS: In the present study, medical records of 1818 poisoned patients admitted to Uludag University Medical School's Emergency Department between January 1996 and December 2001 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. RESULTS: . The mean age for females (63% of the patients) was 27 years, whilst the mean age of male patients was 31 years. The major types of poisonings were ingestions of medications (59.6%), mushrooms (3.3%), corrosives (2.5%), organophosphates (3.2%), and methyl alcohol (0.4%). Carbon monoxide accounted for 6.9% of intoxications. Approximately 65% of the patients survived, while the methyl alcohol and corrosive ingestions led to the highest fatality averages (100% and 14.8%, respectively). CONCLUSIONS: The demographic and diagnostic features of acute poisoning cases treated in our hospital are similar to those reported in the literature. Adults and women are in a high-risk group for acute poisonings and medicine poisoning, which is the most common type of poisoning.

[Traumatic aortic rupture: a case report]. / Travmatik aort yirtigi: olgu sunumu.

Aortic injuries can easily be missed in polytraumatized patients due to either associated injuries or vagueness of physical examination findings. Especially in young adults without associated injuries, relatively low atherosclerotic changes may limit the dissection of traumatic descending aortic injuries. We present a 34-year-old male patient who only had a complaint of back pain following a traffic accident. Upon detection of no abnormalities on plain X-ray films, he was discharged home with analgesics. One week later, he presented with dypsnea and dysphagia. Aortography showed rupture of the aorta and a pseudoaneurysm near the isthmus. Following surgical excision of the pseudoaneurysm and aortic repair with a Dacron graft interposition he was discharged with complete relief of symptoms. This case emphasizes the need for a high index of clinical suspicion in timely diagnosis and prompt treatment of traumatic aortic ruptures.

[The effects of lactated ringer's resuscitation on tissue blood flows and oxidant injury in experimental crush injury in rats]. / Deneysel Crush Yaralanmada Ringer Laktat Resusitasyonunun Doku Kan Ve Oksidan Hasara Etkisi.

BACKGROUND: In an experimental model of crush injury, tissue blood flow, the extend of oxidant injury and the effect of lactated ringer's resuscitation were investigated. MATERIAL AND METHOD: Rats were divided into sham (n: 8), crush injury (n: 8), and crush injury + lactated ringer's resuscitation (n: 8) groups. Arterial and venous catheterization were performed in all groups. Crush injury was done with intravenous infusion of allogenic muscle extract. In the crush injury + lactated ringer's resuscitation group 30 ml/kg lactated ringer's solution was infused in 30 minutes. Kidney and liver blood flow were measured by using a laser flowmeter. To assess the oxidant injury blood, liver, and kidney tissue samples were collected for malondialdehyde and glutathione measurements. RESULTS: In the crush injury, diminished liver and kidney blood flow rates were improved with lactated ringer's resuscitation. In addition, glutathione levels decreased whereas malondialdehyde levels and base deficit increased. Lactated ringer's resuscitation brought base deficit to the control levels. When compared with the crush injury, lactated ringer's infusion increased the glutathione levels but could not decrease the malondialdehyde ones. CONCLUSION: Lactated ringer's resuscitation improved the blood flow rates but could not prevent oxidant injury totally.

[Does the leukocyte count correlate with the severity of injury?]. / Kan lökosit degeri travmanin siddetini yansitir mi?

BACKGROUND: Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients. METHODS: 713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at presentation. RESULTS: Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS. CONCLUSIONS: The leukocyte count at presentation can be used as an adjunct in the evaluation of the severity of injury in blunt trauma patients.

[Epidemiologic and clinical features of childhood falls]. / COCUKLUK CAGINDAKI DUSMELERIN EPIDEMIYOLOJIK VE KLINIK OZELLIKLERI.

BACKGROUND: Trauma is a leading cause of morbidity and mortality for childhood and young adults. Falls are the most common mechanism. for injury children. Aim of this study is to determine the epidemiology and clinical features of falls among children. METHODS: We retrospectively analysed children under 14 years of age sustained from falls admitted to the our emergency service between January 1997- June 2001. RESULTS: A total of 1039 children were admitted during the study period. Fa/ls comprised 38% these admissions, and 47% of falls were from balconies.252 patients were male and 141 patients were female. Mean age was 5.23. 62.3 % of children were under the 5 years old. Major injuries included head trauma (57%) extremity trauma ( 16%), and abdominal trauma (11%). Mean ISS score was 9.16 and 32% of children had an, 1SS score was 9,16. Overall mortality rate was 2.23 %. CONCLUSION: Although falls are the significant cause of childhood injury, these injuries are rarely fatal. Most, common type of injury is head trauma. ISS, age, and height are significantly associated with mortality. Key words: Children, trauma,fa/l, epidemiology, mortality.