[The role of diagnostic laparoscopy in treatment of penetrating injuries of the lower thoracic wall and anterior abdominal wall]. / Die Rolle der diagnostischen Laparoskopie bei der Behandlung von penetrierenden Verletzungen des unteren Brustkorbs und der vorderen Bauchwand.

Penetrating injuries of the lower thoracic wall and anterior abdominal wall cause difficulties in the decision for laparotomy. For gunshot wounds laparotomy without further investigations is in most cases justified, but in other penetrating traumata one should use every diagnostic modality to prevent unacceptably high negative laparotomy rates. We performed diagnostic laparoscopy (DL) on 39 patients with penetrating injuries of the anterior abdominal wall and/or lower thoracic wall. Of these 39 patients, 25 had negative and 14 positive results. We had only one false-negative finding. No false-positive result occurred. We think that DL is a very reliable diagnostic tool which requires a relatively high technology.

Management of vascular injuries of the extremities. One hundred and fifteen cases.

In between the years 1984-1989, 115 peripheral arterial injuries were admitted to the Emergency Surgical Unit of Istanbul Medical Faculty. Seventy-two patients (62%) had upper extremity and 43 patients (38%) had lower extremity vascular injuries. Twenty-eight of these cases (24%) were due to blunt trauma, angiographic studies were obtained in 26 patients. There were 9.5% mortality and 7% amputation rate. We conclude that arterial injuries deserves early recognition, rapid fixation of osseous injuries, wide debridement, fasciotomy in blunt injuries and proper antimicrobial therapy.

[The role of peritoneal lavage in treatment of penetrating abdominal injuries]. / Die Rolle der Peritoneallavage bei der Behandlung der penetrierenden Bauchverletzungen.

Preventing negative laparotomies is one of the most challenging problems in the management of penetrating abdominal injuries. The term "selective laparotomy" has been therefore introduced and has found an ever increasing acceptance. The peritoneal lavage is a useful tool in patient selection for laparotomy but the main problem is where to set the boundary between a positive and a negative peritoneal lavage. The manipulation of this boundary leads to significant changes in the sensitivity and specificity of the peritoneal lavage. Here we are presenting 162 consecutive cases of penetrating abdominal trauma and discussing our methods of evaluation and management.

Spontaneous perirenal haematoma due to polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a systemic disease which involves the kidneys in 70% of cases. We report a case in which the pre-operative diagnosis was perirenal abscess or perirenal tumour, but at operation a perirenal haematoma was found. After pathological examination, it was recognised as renal involvement with PAN. The diagnosis of PAN is often difficult. Renal arterial changes, including aneurysm formation, are frequent. Since Kussmaul and Maier first described PAN in 1866, diagnosis has remained difficult because it is based upon tissue examination obtained at biopsy or post-mortem. In this report we present a case of renal involvement of PAN resulting in a perirenal haematoma due to spontaneous rupture of intrarenal arterial aneurysms.

[Blunt kidney injuries in children]. / Stumpfe Nierenverletzungen im Kindesalter.

Trauma, primarily due to traffic accidents, is the most common cause of death in childhood. In the context of abdominal trauma, the probability of injuries to urinary organs in children is higher than in adults. Peritoneal lavage and use of the CRAMS scale have proved to be reliable methods for assessment and planning of therapy for traumatised children. When it comes to treatment for splenic rupture, efforts should be made to preserve the greatest possible amount of splenic tissue to prevent post-splenectomy sepsis.

[Blunt diaphragmatic rupture in children]. / Stumpfe Zwerchfellrupturen im Kindesalter.

The incidence of traumatic diaphragmatic hernia due to blunt trauma, an uncommon injury in children, has been increased with the increase in automobile and pedestrian accidents. During a 5 year period, 9 patients 3-14 years of age, with acutely ruptured diaphragms following blunt trauma were treated in our institution. Diaphragmatic injury was detected within 6 hours of admission to the hospital. In 2 patients the diagnosis was suggested by upright chest X-ray. In the remaining 7 patients, the diaphragmatic ruptures were diagnosed at laparotomy performed for hemiperitoneum diagnosed by peritoneal lavage. At initial evaluation hypotension was present in all but one patient. Intraabdominal organs were herniated through the diaphragmatic defect in 3 patients. All patients had associated extraabdominal injuries and 90% had associated intraabdominal injuries. The diaphragmatic tear was repaired via abdomen in all patients and all defects were closed primarily. The mortality rate was 33.3%. Early deaths were attributable to hemorrhage and severe head injury, the single late death to sepsis and progressive multiorgan-failure.

Acute occlusive disease of the brachial artery.

Acute occlusive disease of the brachial artery has been increasing in frequency due to the aging of the population and the developing modalities in the treatment of cardiac patients and in the diagnosis of vascular diseases. In this study, we discussed 54 cases of acute occlusion of the brachial artery that we encountered in the 5 year period between 1982 and 1987. We performed embolectomy or thrombectomy in 49 patients and carried out conservative treatment in 5 patients. Amputation and mortality rates were 13% and 5.6% respectively. The disease was observed to be mode common in women and in the winter months.

[Peritoneal lavage and blunt abdominal injuries in childhood]. / Peritonealspülung und stumpfe Bauchverletzungen im Kindesalter.

Traffic accidents are increasingly responsible for mortality in childhood in Turkey. Between 1982 and 1984, 197 children were admitted for contused abdominal injuries to the surgical casualty ward at the School of Medicine of Istanbul University. Most of these children had been involved in traffic accidents, and peritoneal lavage was applied to all of them. The diagnosis on admission was confirmed by laparotomy in 90 per cent of all cases. 20 children died (10.1 per cent). Uncontrollable abdominal bleeding was the cause of ten deaths and massive brain lesion of another six.

[Isolated injuries of the small intestine following blunt abdominal injuries]. / Isolierte Dünndarmverletzungen nach stumpfen Bauchverletzungen.

Operations were performed on 327 patients for blunt abdominal trauma at the casualty ward of the Istanbul University Hospital, over the past three years. Isolated injuries to small intestines were recorded by laparotomy from 22 of these cases. Peritoneal lavage was applied to 18 patients. Only one patient was operated on with 24-hour delay because of false negative result of lavage. Six of the above 22 patients died (27.2 per cent) despite early surgical action. Five of these six had been admitted to the casualty ward with hypovolaemic shock as well as head and extremity injuries after a traffic accident.

[Laparotomy indications in pelvic fractures]. / Laparotomieindikationen bei Beckenbrüchen.

Infra-umbilical abdominal section concomitant with peritoneal lavage was applied to 74 patients with pelvic fracture and has proved to be helpful in early diagnosis of intra-abdominal organ injuries. However, the percentage of falsely positive results was found to be as high as 17.3 per cent, in the context of pelvic fractures. This has been attributable to the fact that the pelvic floor is likely to be elevated by the haematoma caused by a pelvic fracture, and the syringe may thus get accidentally into the haematoma.

[Negative laparotomies in gunshot and stab injuries of the abdomen]. / Negative Laparotomien bei Schuss- und Stichverletzungen des Bauches.

A selective approach is taken, as a matter of principle, to cases of abdominal injuries at the Traumatological Department of the Faculty of Medicine at Instanbul University. Surgical treatment was applied to 378 in 2,968 hospitalised patients for contused or penetrating abdominal injuries, in 1983 and 1984. The rate of negative laparotomy was as low as 7.3 per cent owing to routine peritoneal flushing. However, laparotomy has been preferred and resulted in a negative laparotomy rate of 21 per cent, since problems are quite often faced in the diagnosis of stab injuries.

[Splenorrhaphy]. / Die Splenorraphie.

In 59 splenic injuries, with 2 of them being caused by penetrating abdominal trauma, and 57 caused by blunt abdominal trauma the feasibility of splenorrhaphy instead of splenectomy was evaluated. In 22 cases out of a total of 59 splenic tissue preventing intervention like splenorrhaphy and partial splenectomy could be practiced.

[Blunt abdominal injuries. Retrospective study of 697 cases]. / Stumpfe Bauchverletzungen. Retrospektive anhand von 697 Fällen.

In our country the number of abdominal traumata is steadily increasing. Mostly they are caused by traffic accidents in the overcrowded cities. In this retrospective study we analyse all our cases of the last 4 years, which were admitted to our clinic. Only in rare cases diagnosis could be made immediately on the basis of clinical symptoms. The decision to operate or not could only be taken after diagnostic irrigation of the abdominal cavity. In this way early diagnosis could also be made in doubtful cases and the patients operated in time.

[Peritoneal lavage in children]. / Peritonealspülung im Kindesalter.

Blunt abdominal injuries are associated with a high mortality rate. Particularly in children, the most important cause of deaths is delay in diagnosis and treatment. In recent years, peritoneal lavage has been gaining importance as a diagnostic method in such injuries.--Between 1977 to 1980, 315 patients (under the age of 14) suffering from blunt abdominal trauma were treated in our Emergency Department. Peritoneal lavage was performed in 268 of them. In this article, results of routinely performed peritoneal lavage are discussed and the diagnostic importance of this test evaluated.

[Peritoneal lavage in blunt abdominal trauma]. / Die peritoneale Spülung bei stumpfen Bauchtraumen.

In this study the results of the peritoneal lavage performed in 128 cases suffering from blunt abdominal trauma has been documented. Peritoneal lavage is a valuable method in diagnosis, it is a safe procedure and easy to perform. It is highly recommanded as a diagnostic method in cases with blunt abdominal trauma in which a visceral lesion is suspected.

[Blunt abdominal injuries in childhood (author's transl)]. / Stumpfe Leber- und Milzverletzungen im Kindesalter.

Traffic accidents are among the most important causes of child death. It is sometimes quite difficult to diagnose blunt abdominal traumata due to traffic accidents. 35 blunt hepatic and splenic injuries treated in our clinic during the period of 1971 to 1976 have been evaluated and pertinent references reviewed.