Gender differences in trauma mechanisms, and outcomes in a rural hospital which is not designed as trauma centre.

OBJECTIVES: This study aimed to investigate how trauma characteristics and outcomes differ between genders in a rural hospital. METHODS: Records of trauma patients admitted to a state emergency department (ED) in eastern Turkey, between January 2006 and December 2007 were reviewed and data were analysed based on gender. RESULTS: In total, 5379 (87.0%) men and 806 (13.0%) women, totalling 6185 patients, were assessed. Mean age was 26.5 (1 month - 80 years) years for men and 24.7 (2 month - 81 years) years for women. Men comprised 90.2%, 81.3% and 77.3% of the patients injured by assault, motor vehicle incidents and falls, respectively. Women comprised a significantly larger share of suicide attempts (70.8%) than men. Of the men injured, 90.6% were discharged after treatment in the ED. The per cent of hospitalised women (5.8%) was increased compared with the per cent of hospitalised men (p=0.011). There was a higher frequency of transfer among women (8.6%) when compared with men (p<0.001). Women had a mortality frequency of 1.2%, which was similar to the mortality per cent calculated for men. CONCLUSIONS: Men were at an increased risk for trauma, especially assault. The percentage of women injured and admitted to the ED due to assault was low compared with statistics reported in the literature. However, assault is the most common cause of trauma among women. The high per cent of hospitalisation and transfer among women may indicate that women are exposed to more severe trauma, and therefore experience increased morbidity compared with men.

Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial.

OBJECTIVE: The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. STUDY DESIGN: Randomized clinical trial. MATERIAL AND METHODS: Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. RESULTS: There were no differences in demographic variables, ease of gastric tube placement, ease of insertion and ventilation, number of insertion attempts, hemodynamic changes on insertion, postoperative complications and bloodstaining between the groups. Gastric insufflation was detected and gastric tube was placed in all patients except one in LMA Supreme. Postoperative cuff volumes were comparable with the preoperative values in group itself. Oropharyngeal leak pressures were higher in Laryngeal Mask Airway ProSeal (24.6±5.5 vs 21.3±4.2, respectively; p<0.01). CONCLUSION: As a result Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme can safely be used in spontaneously breathing pediatric population undergoing lower abdominal elective surgery.

Analysis of trauma patients in a rural hospital in Turkey.

BACKGROUND: There is a grey zone about the epidemiology of trauma in eastern Turkey. The present study was aimed at obtaining data on this subject. METHODS: Trauma patients who applied to the emergency department (ED) between January 2006 and December 2007 were analyzed. RESULTS: There were 6183 patients, of whom 87% were male. The mean age was 26.2 ± 13.6 years. Assault was the most common cause (63.2%). Motor vehicle injury (MVI) and fall were encountered at frequencies of 21.2% and 6.5%, respectively. The most frequently injured body regions were head-neck and extremities. The majority of patients were managed and discharged from the ED (89.8%) with no consultation (81.8%). Interestingly, the discharge rate of assault cases was 98.7%. Patients were hospitalized (4.2%) mostly for MVI (32.6%) and fall (19%); however, hospitalization rates for firearm and piercing/cutting injury (36.1% and 16.7%) were significantly high. Among the transported patients (5.3%), the rates of MVI and fall were high (41.5% and 24.3%, respectively). In groups, for burn and firearm injuries, these were 42.1% and 24.1%, respectively. Forty-eight patients (0.8%) died, mostly from MVI by number, but by self-infliction and firearm by rate (8.3% and 6%). CONCLUSION: Assault cases caused an excessive trauma patient density in the ED, as 98.7% were discharged from the ED. Further studies are needed regarding the high rate of assault cases.

Small-dose capsaicin reduces systemic inflammatory responses in septic rats.

We investigated the influence of small- and large-dose capsaicin in modulating systemic inflammatory responses during different stages of sepsis in rats. Rats were divided into six groups: group C, control; group S, sepsis; group CLC, small dose of capsaicin (1 mg/kg subcutaneously); group SLC, small dose of capsaicin plus sepsis; group CHC, large dose of capsaicin (150 mg/kg subcutaneously); group SHC, large dose of capsaicin plus sepsis. Rats were made septic by cecal ligation and puncture (CLP). Each group was subdivided into two subgroups. The animals were killed at 9 or 18 h after CLP. Plasma concentrations of calcitonin gene-related peptide (CGRP), tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, and total nitrite/nitrate (NOx) were measured. Superoxide dismutase and malondialdehyde (MDA) were determined in liver, lung, and heart tissues. CGRP was increased in groups S, CLC, and SLC when compared with the other groups. In the SLC group, plasma concentrations of TNF-alpha, IL-6, NOx, and tissue MDA levels were reduced and IL-10 level was increased when compared with groups S and SHC 18 h after CLP (P < 0.05). Small-dose capsaicin treatment increased antiinflammatory IL-10 levels and attenuated the increases in proinflammatory cytokines, NOx, and tissue MDA in septic rats.

Interferon-alpha reduces the development of experimental necrotizing enterocolitis.

Cytokines had important role in the pathogenesis of necrotizing enterocolitis (NEC). The aim of this study is to investigate if IFN-alpha has a prophylaxic effect on experimental NEC development in newborn rat pups. Twenty eight Wistar Albino newborn rat pups were divided into three groups. Control group rats were breast-fed, NEC group and interferon (IFN) group rat pups were hand-fed with premature newborn formula. IFN-alpha was administered subcutaneously at a dose of 50,000 IU/rat/day in IFN group. NEC was induced experimentally by cold stress twice a day in IFN and NEC groups. On the fourth day, the rats were killed, and all the intestine were removed to determine the tissue level of malonaldehyde (MDA) and histologic changes. The microscopic lesions in the NEC group rats were virtually the same as those seen in neonatal NEC, with severe separation of submucosa and/or lamina propria, loss of villi and in some cases necrosis to extention the muscularis. In contrast, in the rats treated with IFN, lesions were moderate separation of submucosa and/or lamina propria, edema in submucosal and muscular layers. Intestinal injury score and MDA levels in NEC group were significantly higher than in the IFN group (P<0.05). In conclusion it was suggested that IFN-alpha was effective in reducing the severity of NEC in rat pups.

Protective effect of polyunsaturated phosphatidylcholine pretreatment on stress ulcer formation in rats.

PURPOSE: The aim of this study was to investigate whether polyunsaturated phosphatidylcholine. (PPC) pretreatment has any protective effect on gastric mucosal damage induced by cold-restraint stress (CRS) in rats. METHODS: Forty swiss albino rats were divided into 3 groups. Group 1 (n = 10) was control, group 2 (n = 15) was stress ulcer, and group 3 (n = 15) was PPC-treated rats with stress ulcer. Stress ulcer was induced by the cold-restraint method for 4 hours at 4 degrees C after a starvation period of 72 hours. In the group 3 rats, PPC treatment was started 10 days before stress at a dose of 100 mg/d by oral route. Rats were terminated, stomachs were excised. Macroscopic ulcer index (UI), gastric tissue malondialdehyde (MDA) and superoxide dismutase (SOD) activities, plasma total nitrite, and erythrocyte catalase (CAT) concentrations were assayed. RESULTS: Histopathologic examination showed a stress ulcer index of 0.12 +/- 0.19 mm in the treatment group and 23.6 +/- 8.97 mm in the stress ulcer group (P <.001). Tissue MDA and SOD concentrations were higher in the stress ulcer group than in the treatment group, the differences were statistically significant (P <.001). Plasma NO3-+ NO2- levels were higher (P<.005) and CAT levels were lower (P <.001) in the nontreatment group. There were no significant differences with respect to Ul, MDA, and SOD levels among the control and treatment groups (P >.05). CONCLUSIONS: These results suggest that pretreating rats with PPC inhibits cold-restraint stress-induced gastric mucosal injury and might be useful in preventing stress-induced stomach ulcers.

Protective effect of polyunsaturated phosphatidylcholine on liver damage induced by biliary obstruction in rats.

BACKGROUND/PURPOSE: Persistent inflammatory response secondary to congenital or acquired biliary choleastasis plays an important role in the pathophysiology of hepatic tissue damage. The polyunsaturated fatty acids (PUFA) have been shown to suppress the inflammatory reactions in vivo and in vitro. PUFA has been shown also to protect against various types of experimental liver damage in animal models and isolated hepatocytes. Therefore, the aim of this study was to investigate the protective effect of PUFA administration on liver damage using the rat chronic biliary obstruction model. METHODS: Swiss albino rats of either sex were divided into 4 groups as follows: control group (group 1, 10 rats); rats with sham operation and treated with saline group 2, 10 rats); rats with biliary obstruction (group 3, 15 rats); and polyunsaturated phophatidylcholine (PPC)-treated rats with biliary obstruction (Group 4, 15 rats). Biliary obstruction was induced by double ligation and division of the common bile duct. PUFA treatment was started 2 weeks later from biliary obstruction in doses of 50 mg/d per rat and continued for 2 weeks. All animals were killed after 4 weeks of common bile duct ligation or sham operation. Liver damage and cholestasis were determined by biochemical and histologic examinations. RESULTS: The data showed a decrease in plasma bilirubin level (both conjugated and unconjugated) and liver enzyme levels (AST, ALT, AP, GGT, 5'-NT) in group 4, when compared with group 3 (P <.05). Tissue levels of malondialdehyde (MDA) in group 4 was 20.00 +/- 2.93 compared with that in group 3, 27.12 +/- 2.96 (P <.05). Administration of PUFA to the biliary obstructed rats resulted in inhibition of collagen accumulation (P <.05) and ductal proliferation (P <.05). CONCLUSIONS: PUFA reduced liver damage, ductular proliferation, and fibrosis in biliary obstructed rats. These effects suggest that it might be a useful agent to preserve liver function in patients with biliary obstruction such as biliary atresia.

The use of silver nitrate for chemical de-epithelialization and urothelialization of intestine in a rabbit model of augmentation cystoplasty.

Urinary tract reconstruction using bowel segments can result in complications such as electrolyte abnormalities, infections, stones and cancer. Intestinal mucosa is the primary site responsible for these complications. De-epithelialization of the mucosa and subsequent urothelialization might alleviate these problems. We recently reported our success in de-epithelialization and subsequent uroepithelialization of intestinal segments using 10 g/100 ml AgNO(3) solution in a rat model of augmentation. In this study, chemical de-epithelialization of a colonic segment was attempted using 10 g/100 ml AgNO(3) solution in a rabbit model of augmentation. Sigmoid cystoplasty was performed in 20 male New Zealand rabbits using a 6 cm patch of sigmoid colon. There were two groups, including one group of five rabbits (control, group 1) that underwent augmentation alone, while another group (15 rabbits, treatment group or group 2) was treated with 10 g/100 ml AgNO(3 )solution before augmentation. Control rabbits were killed at the week 8 of experimentation. Treatment rabbits were killed at 2-, 4-, 6- and 8-week intervals. Immediately before augmentation and at the end of the 8 week experimental period each rabbit underwent cystometry. De-epithelialization of the bowel epithelium without urothelialization was apparent in the treatment rabbits killed at 2 and 4 weeks. Histological analysis revealed almost complete urothelialization of the augmented sections treated with 10 g/100 ml AgNO(3 )solution at the end of the 6 and 8 week of experimental periods. The preoperative and postoperative bladder capacities increased substantially in all groups. There was no obvious histologic difference in the amount of collagen present in the augmented tissues in any of the experimental groups. The present study confirmed that the treatment of intestinal segments with 10 g/100 ml AgNO(3 )solution led to chemical de-epithelialization and urothelialization of the augmented segments. This procedure could, theoretically, have applications to human surgery.

Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experience in 1,554 children.

BACKGROUND/PURPOSE: Although caudal and spinal blocks are modern and safe techniques, in many centers children still are operated on under general anesthesia (GA), or the blocks are used for postoperative analgesia after GA in infraumbilical operations. The authors aimed to document the results and the complications of 1,554 regional anesthesia cases, thereby assessing their validity. METHODS: The analysis of 1,459 caudal and 95 spinal blocks cases collected until January 2001 in children from newborn to 12 years of age are documented retrospectively. The types of anesthesia analyzed in the study were caudal block (CB) only, CB plus GA, GA plus CB, GA plus spinal block, and spinal block only. RESULTS: There were 1,338 caudal and 95 spinal block cases that clinically were satisfactory. Because the duration of CB was not sufficient in 39 cases, GA was used. Failure to produce a CB occurred in 82 cases (5.57%). There were 257 of 1,338 patients operated on under GA and supported by caudal block for postoperative analgesia. CONCLUSIONS: Caudal anesthesia seems to be an inexpensive, simple, and effective technique not only as a supplement for postoperative analgesia, but also as a single method of anesthesia. and the authors recommend its use in a wider setting of clinical entities in infraumbilical surgical procedures of children.