BACKGROUND:In this study, we compared the anatomical, and physiological scoring systems trauma revised injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS) to each other, to find out the most accurate and reliable trauma score for the risk classification of morbidity and mortality among the trauma patients.

INTRODUCTION:Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs.MATERIALS AND METHODS:Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems.FINDINGS:The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p<0.05). Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p<0.05). Two patients (4%) in group RF1, 2 patients (3.8%) in group RF2, and 5 patients (4.5%) in group RF3 (total n = 9; 4.2%) died.CONCLUSION:Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.

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The aim of this study is to assess patients treated for esophageal foreign bodies. The charts of patients (n=177), between January 1994 and April 2009, were investigated retrospectively. Patients' age and gender, locations and types of foreign bodies (FBs) and interventions were taken into consideration. Fifty-seven percent of the patients were male. The youngest patient was 6 months, whereas the oldest was 83 years old. The median age was 9 years. Half of the patients were in their first decade. Treatment took place 11 h (ranging from 1 to 120 h) after impaction of the FB. One hundred fifty-two FBs were removed in 177 patients. Our negative esophagoscopy (n=25) rate was 14%. The FBs were radiopaque in 75% (n=114) and were commonly (71%; n=109) located in the cervical esophagus. Metallic coins (n=81-53%) were the most commonly observed inorganic FB while bones and/or meat impaction (n=54-35%) were the most frequent organic FB. A total of 182 endoscopic interventions were performed on these patients. One hundred eleven of them were esophagoscopy and the remaining 71 were direct laryngoscopy. The FB was pushed into the stomach in 11 patients. Our morbidity rate was 1.6% (n=3). Iatrogenic perforation occurred in two patients. There was no mortality. Esophageal FBs may vary in type: sharp or round objects, metallic, plastic or organic material. FBs are commonly found at pharyngoesophageal junction and usually removed by McGill forceps. Rigid esophagoscopy is used for children and adults because of its large working channel. Rigid instruments are considered reliable and safe for extracting foreign bodies.

Background: An elastofibroma is a benign, soft-tissue tumor and is important in the differential diagnosis of thoracic wall masses. Here, patients with elastofibromas who underwent thoracic surgery were retrospectively reviewed to elucidate elastofibroma formation and to facilitate the differential diagnosis. Methods: This is a retrospective and descriptive study of a series of 30 patients with elastofibroma dorsi. The data was obtained by review of the hospital records. Results: There were 27 female and three male patients (mean age, 55.13 Ϯ 8.7 years) with a total of 42 elastofibroma dorsi tumors (12 bilateral cases, 18 unilateral cases) diagnosed between January 2004 and October 2011. Twenty patients (67%) underwent surgery as a result of subscapular swelling and pain. In 10 (33%) asymptomatic patients, elastofibromas were found incidentally during a thoracotomy. Imaging methods in symptomatic patients included computerized tomography (15 cases), magnetic resonance (three), and ultrasonography (two). For five patients, fluorodeoxyglucose uptake values were available and revealed mild metabolic activity in the elastofibromas. Elastofibromas were significantly larger in symptomatic patients (8.15 Ϯ 1.9 vs. 6.2 Ϯ 2.3; P = 0.02). Exposure to long-term repetitive micro-trauma was a precipitating factor in 23 (77%) patients. Seroma formation, the most common surgical complication, was observed in 40% of patients. Conclusion: The differential diagnosis of elastofibroma dorsi is straightforward, and preoperative histology is unnecessary when the clinical, radiological, and metabolic characteristics are known. Repetitive micro-trauma may predispose to hyperproliferation of fibroelastic tissue, and genetics may also play a role. Surgical treatment can be reserved for cases with severe symptoms.