Rectus sheath haematoma in elderly patients: a diagnostic challenge

BACKGROUND: Transarterial oily chemoembolization (TOCE) is frequently employed as a non-operative treatment for hepatocellular carcinoma (HCC). Serious complications of TOCE are well known but ruptured HCC as a fatal complication of TOCE has not been reported previously. METHODS: A retrospective study was performed on all patients who received TOCE for treatment of HCC from January 1989 to October 1996; the complication of ruptured HCC within 2 weeks from the procedure was recorded. RESULTS: During the study period, 391 patients received a total of 1443 sessions of TOCE (mean 3.7 sessions per patient) for the treatment of HCC, with an overall median survival of 10.4 months. Six patients developed ruptured tumour within 2 weeks after TOCE, resulting in an overall incidence of 1.5 per cent per patient or 0.4 per cent per procedure. All except one patient died 1-25 days after tumour rupture. Factors common to these six patients included: (1) male sex; (2) large tumour size (range 8-17 cm in diameter); (3) tumour located in the right lobe of the liver; (4) tumour ruptured after the first session of TOCE; and (5) TOCE performed as primary treatment without previous hepatic resection. CONCLUSION: Ruptured HCC is a serious complication of TOCE although the incidence is low. It occurred predominantly in men after the first session of TOCE for a large irresectable tumour of the right lobe.     

Surgical treatment and outcome in patients with a hepatocellular carcinoma greater than 10 cm in diameter

BACKGROUND: Hepatocellular carcinoma (HCC) over 10 cm in diameter at the time of diagnosis continues to account for a number of patients undergoing hepatic resection. This study evaluated the clinicopathological features and outcome following surgery for large HCC. METHODS: Forty patients with a large HCC (greater than 10 cm) (group 1) resected between 1991 and 1996 were studied retrospectively. They were compared with 245 patients who had smaller HCCs (10 cm or less) (group 2). RESULTS: No patient in group 1 had hepatitis C infection compared with 22.9 per cent in group 2 (P=0.001). Patients in group 1 were significantly younger, had higher alpha-fetoprotein levels (16750 versus 1864 ng/ml; P < 0.001), better liver function, a higher incidence of multiple tumours (27 of 40 versus 42.0 per cent; P=0.003) and venous invasion (35 of 40 versus 52.2 per cent; P < 0.001), and underwent more major resections (37 of 40 versus 26.5 per cent; P < 0.001) than those in group 2. Morbidity and mortality rates and hospital stay were comparable in the two groups. For group 1, the 1-, 3- and 5-year disease-free survival rates were 42, 30 and 28 per cent respectively. Multiple tumours, venous invasion and impaired liver function were factors associated with recurrence. CONCLUSION: Large HCC had specific clinicopathological features. In selected patients, resection is safe and offers the chance of long-term disease-free survival.     

Androgen and oestrogen receptors in hepatocellular carcinoma and surrounding liver parenchyma: impact on intrahepatic recurrence after hepatic resection

Seventy-eight patients in whom androgen or oestrogen receptors, or both, were assayed in hepatocellular carcinoma (HCC) and the surrounding liver were discharged from hospital after curative resection of the tumour. Intrahepatic recurrence was evaluated retrospectively after 28-128 months follow-up to determine the association with receptor status. Androgen and oestrogen receptors in HCC significantly influenced the intrahepatic recurrence rate. The recurrence-free 5-year survival rate was 55 per cent for patients who had androgen receptor-negative tumours, 24 per cent for oestrogen receptor-negative, 10 per cent for oestrogen receptor-positive and 0 for androgen receptor-positive (P = 0.0322). Recurrence-free 5-year survival in 57 patients who had both receptor assays was 75 per cent for patients who had androgen receptor-negative, oestrogen receptor-negative tumours, 50 per cent for androgen receptor-negative, oestrogen receptor-positive, but 0 for androgen receptor-positive, oestrogen receptor-positive and androgen receptor-positive, oestrogen receptor-negative (P = 0.0104). The presence or absence of androgen or oestrogen receptor in the liver, however, was not associated with intrahepatic recurrence (P = 0.7534). Thus, androgen receptors are strongly associated with intrahepatic recurrence of HCC, while oestrogen receptors are weakly associated. Receptor status in the normal liver was not related to intrahepatic recurrence.     

Outcome after 'curative' surgery for carcinoma of the lower third of the rectum

BACKGROUND: Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone. METHODS: Eighty-two consecutive patients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma at 3.5-7.5 cm from the anal margin. Cox proportional hazards technique with univariate and corrected (multivariate) analyses and the Kaplan-Meier life-table method were used to evaluate the data. RESULTS: Tumour wall penetration and lymph node involvement, but not the tumour level or the type of surgery, were found to be significant predictors of outcome. The local recurrence rate at 1, 2 and 5 years was 10, 22 and 26 per cent respectively after APRE, and 5, 13 and 21 per cent after SSO. The disease-free survival rate at 1, 2 and 5 years was 85, 67 and 58 per cent respectively after APRE, and 88, 78 and 62 per cent after SSO. CONCLUSION: Tumour-related factors are significant predictors of outcome. The type of surgery (APRE or SSO) did not seem to be a significant variable in this non-randomized study.     

Hepatocellular carcinoma outcomes based on indicated treatment strategy

Hepatocellular carcinoma (HCC) in Western populations historically has been associated with poor survival. In this study, we conducted a 7-year retrospective analysis of patients evaluated at our institution with HCC to determine the effects of newer treatment strategies on outcome. During the period of study, 117 patients [86 (74%) male; mean age, 59 years (range, 16-85)] were evaluated with treatment as follows: surgical resection in 22 (19%), chemoembolization with or without systemic chemotherapy in 40 (35%), systemic treatment alone in 16 (13%), orthotopic liver transplantation in 8 (7%), and supportive care only in 31 (26%). Sixty-nine patients (59%) had documented cirrhosis, with hepatitis C being the most common cause in 27 of 69 (39%). In patients receiving no treatment, median survival was just under 3 months, with only two 1-year survivors. Patients with orthotopic liver transplantation had 1-, 2-, and 3-year survival rates of 87, 87, and 58 per cent compared with 69, 52, and 43 per cent in surgically resected patients. Survival after chemoembolization was 35, 20, and 11 per cent at 1, 2, and 3 years, whereas survival after systemic chemotherapy was 30 and 15 per cent at 1 and 2 years, respectively. One-year survival was improved in noncirrhotic patients compared with cirrhotics (47% vs 29%; P < 0.05) but was no different in patients younger than 55 years compared with older patients (38% vs 38%). When possible, surgical treatment strategies offer superior survival.     

Influence of viral hepatitis status on operative morbidity and mortality in patients with primary hepatocellular carcinoma

The influence of associated viral hepatitis status on 119 patients with primary hepatocellular carcinoma (HCC) undergoing hepatic resection was investigated. Operative morbidity and mortality were examined in three patient groups: 31 patients (group B) positive for hepatitis B surface antigen (HBsAg), 14 (group Be) positive for both HBsAg and hepatitis B e antigen, and 74 (group C) positive for hepatitis C virus antibody (HCVAb). Preoperative liver function in groups Be and C was similar and more impaired than that of patients in group B; combined active hepatitis was seen most frequently in group C (68 per cent). The tumour size in group B was significantly greater than that in groups Be and C. Postoperative complications occurred more frequently in group C (39 per cent) and early postoperative deaths, other than those from cancer, were seen in nine patients positive for HCVAb, of whom three developed postoperative liver failure. Patients with HCC and hepatitis B without seroconversion as well as hepatitis C frequently have active hepatitis, which may impair liver function and play an important role in operative morbidity and mortality.     

Metastasis from an unknown tumour

A total of 121 patients were treated under the diagnosis: metastasis from an unknown primary tumour; 99 were irradiated. In 46 cases the primary tumour was detected from 6 months to 10 years after the primary treatment. The 3-year survival was 28.9 per cent, the 5-year 17.4 per cent and for 10 years or longer (up to 14 years) 9.1 per cent, after the primary treatment. The prognosis is correlated to the size of the metastases, their site and also their microscopic appearances.     

Tumour bed positivity predicts outcome after breast-conserving surgery

BACKGROUND: Local recurrence after breast-conserving surgery is associated with a short distant disease-free survival, particularly if it occurs early. Early recurrence is caused by residual disease left at the time of surgery. Previous studies have demonstrated that disease in the tumour bed is a common finding after breast-conserving surgery. METHODS: The follow-up (mean 4.4 years) of 300 patients who had tumour bed analysis performed by the cavity shaving technique following breast-conserving surgery is presented. Postoperative radiotherapy was administered to all patients. RESULTS: The incidence of tumour bed positivity was 39.3 per cent. With a selective re-excision policy the local recurrence rate was 2.0 per cent and distant recurrence rate 10.4 per cent. Multivariate analysis identified lymphovascular invasion, oestrogen receptor status and tumour bed status as independent predictors of time to distant recurrence. CONCLUSION: A low rate of local recurrence can be achieved using this technique of margin assessment. Tumour bed status may be a useful prognostic factor following breast-conserving surgery.     

Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: report of 90 patients

Ninety patients with carcinoma of the hypopharynx underwent pharyngolaryngectomy and reconstruction with a jejunal free autograft. Fifty-five patients had primary surgery and 35 salvage surgery for recurrence after radiotherapy. Following primary surgery 28 patients had postoperative radiotherapy and 27 did not. Complications occurred in 51 per cent of patients, the most common being necrosis of the jejunal graft (19 per cent); 12 per cent developed significant stenosis and 4 per cent died in the perioperative period. Eleven per cent of patients developed a fistula. The total number of complications diminished as the experience of the unit increased. Median follow-up was 4.9 years. Of patients treated with primary surgery, 48 per cent developed primary site recurrence (at 3 years) and 53 per cent neck node recurrence (at 5 years). The tumour-specific 5-year survival rate for all patients was 42 per cent. Following primary surgery 28 per cent survived for 5 years and after salvage surgery the rate was 59 per cent. Positive resection margins and extensive neck disease adversely affected survival (P = 0.02 and P = 0.001 respectively). The free revascularized jejunal graft is a safe and predictable method of repair following total pharyngolaryngectomy.     

Surgical and nonsurgical management of primary and metastatic liver tumors

The medical records of 267 patients who had liver tumors, primary and metastatic, from 1988 to 1995 were retrospectively reviewed. Two hundred thirteen patients (80%) had metastatic disease, and 54 patients (20%) had primary liver disease. Their clinical manifestations and laboratory values were evaluated as factors predictive of diagnosis and survival. There was a significant increase in the occurrence of upper abdominal pain, weight loss, extrahepatic symptoms due to the metastatic origin, and hepatomegaly. Metastases from colorectal primary lesions were synchronous in 34 patients and metachronous in 31 patients. Stomach, lung, and pancreatic primaries were more commonly synchronous. Breast metastases were more commonly metachronous. Elevated serum glutamic-oxaloecetic transaminase and alkaline phosphatase and decreased albumin were the most common liver test abnormalities at diagnosis. Carcinoembryonic antigen values were elevated in the majority of colon cancer patients. Eighty-one percent of patients with primary liver cancer had elevated levels of alpha-fetoprotein, 40 per cent were seropositive for hepatitis B, and 23 per cent were seropositive for hepatitis C. Seventy-nine patients (30%) underwent surgery for their cancer, 37 (47%) had resections, 38 (48%) were unresectable, and 4 (5%) underwent liver transplantation. The patients who underwent surgery had a 32 per cent 5-year survival rate compared to a 0 per cent 5-year survival in the patients who did not have surgery (p = 0.0001). The patients who had resections had a better survival rate than those deemed unresectable at surgery (62% versus 0% at 5-years with p = 0.0008). The perioperative morbidity rate was 16 per cent, with lobectomies having the best rate and trisegmentectomies having the worst. Perioperative mortality rate was zero for all liver resections. Hepatic resection and, in selected patients, liver transplantation are the only two available therapeutic modalities that produce long-term survival with a possible cure in patients with primary and metastatic liver tumor.     

Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients

BACKGROUND: Recent reports of decreased morbidity and mortality following palliative surgery for patients with irresectable pancreatic head carcinoma prompted a review of the results in 126 patients (median age 64 (range 39-90) years) who had undergone palliative biliary and gastric bypass surgery. METHODS: The indication for surgical palliation was the finding of an irresectable tumour at laparotomy (n = 44), failure of endoscopic treatment (n = 43), clinical symptoms of gastric outlet obstruction (n = 28) and miscellaneous (n = 11). Biliary and gastric bypass was performed in 118 patients, biliary bypass alone in six and gastrojejunostomy alone in two. The indication for gastrojejunostomy was symptoms in 28 patients (23 per cent) and prophylaxis in 92 patients (77 per cent). RESULTS: Postoperative local complications occurred in 17 per cent of patients, general complications in 10 per cent and delayed gastric emptying in 14 per cent of patients. The 30-day mortality rate was 1 per cent and overall hospital mortality rate 2 per cent. Median hospital stay was 17 (range 5-80) days. Median overall postoperative survival was 190 (range 14-830) days. Late obstructive gastrointestinal symptoms occurred in 14 patients (11 per cent) after a median of 141 (range 21-356) days. CONCLUSION: Roux-en-Y hepaticojejunostomy combined with gastrojejunostomy offers effective palliation for irresectable pancreatic head cancer and can be performed with low mortality and acceptable morbidity rates.     

Reconstruction of the mandible with conventional bone graft: an evaluation

Eighteen patients with bony defects of the mandible had the mandible reconstructed using conventional nonvascularized bone grafts from the iliac crest. After surgery they received radiotherapy for cancer in the oropharynx or oral cavity. This study was carried out over a 10-year period. All patients were followed-up both for their tumour growth and the results of their reconstruction. Four to 10 years after surgery 55.5 per cent were alive and well. Full dental rehabilitation was achieved in 33 percent and 12.5 percent were without dental rehabilitation.     

The key informant technique

The clinical outcome of 152 patients aged 65 years or over who were referred to the author's institute between August 1990 and August 1991 with certain specified gastrointestinal malignancies and acute, life-threatening abdominal conditions, were audited concurrently. Two groups were considered: patients aged 65-79 years and those over 80 years. The mortality rate within 30 days of surgery was 14 per cent in both age groups, although significantly fewer patients aged over 80 years (35 of 54) were considered suitable for surgery than in the 65-79 years age group (84 of 98) (0.01 > P > 0.001). Morbidity after operation and cost of treatment were not significantly different between the two groups. Two years after surgery 40 per cent of the patients aged over 80 years and 58 per cent of those aged 65-79 years were alive. Quality of life in these survivors was good with 85 per cent of those aged over 80 years living at home and 72 per cent fit enough to undertake light work.     

Gas in the temporomandibular joint: computed tomography findings. Report of 3 cases

BACKGROUND: The advantages of pancreatogastrostomy over pancreatojejunostomy after pancreaticoduodenectomy are still debated. This study analyses the results of pancreatogastrostomy to identify factors that could influence immediate outcome. METHODS: During a 10-year period, 160 consecutive patients underwent a pancreatogastrostomy. There were 109 men (68 per cent) and 51 women (32 per cent) with a mean(s.d.) age of 59(10) (range 22-82) years; 27 patients were older than 70 years. The following parameters were assessed: mortality rate, morbidity, reasons for reoperation, length of hospital stay, duration of nasogastric tube and drainage. RESULTS: Hospital mortality rate was 3 per cent; overall morbidity rate was 30 per cent. The reoperation rate was 12 per cent, mainly because of bleeding at the pancreatic margin. Delayed gastric emptying occurred in 36 patients. The overall rate of pancreatic fistula was 2.5 per cent. Age, sex, indications for pancreatoduodenectomy, and the texture of the pancreatic remnant did not influence the occurrence of pancreatic fistula or delayed gastric emptying. CONCLUSION: This study confirmed that pancreatogastrostomy is a safe procedure with low mortality and morbidity rates.     

The management and natural history of severe dysplasia and carcinoma in situ of the uterine cervix

From 1951 to 1972, a total of 631 cases of invasive carcinoma of the cervix were diagnosed in Frederiksberg, Copenhagen, Denmark. Treatment was either by surgery or radiotherapy, a combination of both being rarely used. The crude five-year survival rates were 99 per cent in stage Ia, 79 per cent in stage Ib, 67 per cent in stage IIa, 45 per cent in stage IIb, 23 per cent in stage III, 5 per cent in stage IV and 63 per cent for all stages. The relative survival rates were respectively 100 per cent, 81 per cent, 73 per cent, 48 per cent, 26 per cent, 5 per cent and 66 per cent. Radical hysterectomy were found more effective than radiotherapy in stage Ib carcinoma of the cervix. This difference was not explained by age but other factors possibly playing a role are considered. The combination of surgery and radiotherapy is discussed and only seems indicated for patients with stage Ib carcinoma and lymph node metastases.     

Thermal injury functionally alters bone marrow-derived macrophages: a study of monocyte-hepatocyte interactions

PURPOSE OF THE STUDY: The purpose of this study was to evaluate the results of the anterior cruciate ligament (A.C.L.) reconstruction according to two scoring systems (Arpege and IKDC), to analyse the influence of different factors on the results, to study the effect of a lateral extra-articular tenodesis, the morbidity of patellar tendon graft harvesting, and the advantage of arthroscopically assisted reconstruction. MATERIAL: Seventy nine patients, 17 to 39 years old (average 27 years), underwent an anterior cruciate ligament reconstruction for chronic instability, using a free bone-patellar tendon-bone graft. In 43 cases, a lateral extra-articular plasty was added (Lemaire's procedure). The reconstruction was arthroscopically assisted in 17 cases. Interval between initial injury and surgery was 24 months (2 months to 9 years and 7 months). The average follow-up was 2.5 years (range 1 to 18). METHOD: All patients were reviewed for evaluation with two scoring systems (Arpege and IKDC). Roentgenograms of both knees, including antero-posterior weight-bearing and lateral view, patellar view, dynamic radiographs, allowed evaluation of post-operative arthrosis and residual anterior laxity in extension. Fischer's test and chi square test were used for statistical evaluation. RESULTS: Using the Arpege CLAS system, functional results were excellent or good in 75.9 per cent of cases (excellent in 44.3 per cent, good in 31.6 per cent), fair in 15.2 per cent, poor in 8.9 per cent; according to the IKDC system, 65.8 per cent were excellent or good. 84.8 per cent of the patients were satisfied in Arpege system and 91.2 per cent in IKDC system. The pivot-shift test was negative in 86 per cent, equivocal in 7.6 per cent and positive in 6.4 per cent. The radiological Lachman's test (difference between control and affected knee) was 0-2 mm in 53.2 per cent, 3-5 mm in 39.2 per cent, 6-10 mm in 7.6 per cent, never greater than 10 mm. Antero-posterior weight-bearing radiographs were normal in 83.5 per cent, showed joint remodeling in 10.1 per cent pre-arthrosis in 6.3 per cent but no arthrosis. Functional results were not correlated with age at time of surgery, interval between initial injury and surgery, nor clinical Lachman's test. Competitive sportsmen had a better result (p = 0.001). Residual laxity in extension was correlated with lesions of medial meniscus (p = 0.035). Degenerative changes in femoro-tibial joint were correlated with residual laxity in extension (p = 0.019). There was no significative difference between A.C.L. reconstruction isolated or associated with lateral extra-articular tenodesis. Time to return to work was shorter for patients with arthroscopically assisted procedure (p = 0.067). DISCUSSION AND CONCLUSION: Functional results after A.C.L. reconstruction using a free bone-patellar tendon-bone graft are satisfactory and confirm the reliability of this procedure. Arpege CLAS and IKDC systems give comparable functional results, but IKDC evaluate anatomical results, residual laxity and degenerative changes of the joint, that constitute essential long-term pronostic factors. Morbidity of patellar tendon harvesting appears to be of short duration and largely reversible. Added lateral extra-articular tenodesis doesn't improve the results. Arthroscopically assisted procedure seems to allow a faster rehabilitation.     

Surgery for left-sided pancreatic cancer

A total of 590 exocrine pancreatic cancers of the body or tail of the pancreas, operated on between January 1982 and December 1988, were analysed. There were 128 pancreatic resections (group 1), 164 palliative bypasses (group 2) and 293 exploratory laparotomies which included 74 splanchnicectomies (group 3). The mortality rate was lower in group 1 (9 per cent) than in group 2 (19 per cent) (P = 0.012). The mortality rate exceeded 40 per cent in groups 1 and 2 for patients aged more than 70 years with pre-existing organ failure. The morbidity rate was 32 per cent in group 1 and 29 per cent in group 2. Patients with metastases had a median survival of 3.4 months, whatever the operative treatment. In the presence of lymph node involvement there was no significant difference in survival between groups 1 and 2. Patients with no metastases and no lymph node involvement had 1- and 3-year survival rates of 38 and 12 per cent respectively after pancreatic resection. Only patients with a small tumour (< or = 4 cm), no lymph node involvement and no metastases achieved a significantly better survival after resection (P = 0.049). Curative resection should be reserved for a small tumour confined to the pancreas. Fewer than 10 per cent of patients will be suitable for surgery. For the other cases, resection must be considered as a palliative procedure without a significant improvement in survival. It seems justified to limit palliative surgery to candidates for digestive bypass and to use non-surgical palliation for the remainder.     

Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma

BACKGROUND: Pulmonary metastasis is the commonest site of extrahepatic spread from hepatocellular carcinoma (HCC). The aim of the present study was to evaluate the efficacy of surgical management in patients with solitary pulmonary metastases from HCC. METHODS: This was a retrospective study of patients with HCC admitted for hepatectomy from July 1972 to June 1995. The records of patients who had a pulmonary resection for histologically proven pulmonary recurrence after curative hepatectomy were selected for analysis. RESULTS: In the study interval, 380 patients with HCC underwent hepatectomy. Some 48 patients (12.6 per cent) developed pulmonary metastases documented pathologically or radiologically. Nine (seven men and two women) were suitable for curative pulmonary resection. The median disease-free survival between hepatectomy and appearance of the lung metastasis was 21 months. The median survival after pulmonary resection was 42 months, and the 1-, 2- and 5-year survival rates were 100, 78 and 67 per cent respectively. CONCLUSION: Pulmonary resection for metastases from HCC resulted in long-term survival in these highly selected patients.     

Multivariate analysis of risk factors for hepatocellular carcinoma in patients with hepatitis C virus-related liver cirrhosis

To elucidate the risk factors for hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-related liver cirrhosis (LC), we examined 204 cirrhotic patients negative for hepatitis B surface antigen and positive for HCV antibodies. The independent influence of various clinical characteristics in these patients was analyzed by multiple logistic regression, and the risk factors for HCC were identified. Multiple logistic regression analysis identified and ranked the following four risk factors: male sex (P < 0.001), habitual heavy drinking (P < 0.005), hepatitis B virus antibody positivity (anti-HBs and/or anti-HBc, P < 0.05), and age greater than 60 years (P < 0.05). The odds ratio of HCC was 4.20 (95% confidence interval; CI, 1.80-9.78) in male patients, 3.27 (95% CI, 1.46-7.30) in habitual heavy drinkers, 2.01 (95% CI, 1.01-3.99) in patients positive for hepatitis B virus antibodies, and 2.06 (95% CI, 1.00-4.23) in patients older than 60 years. The cumulative occurrence rates of HCC after blood transfusion were significantly higher in habitual heavy drinkers (4.8%, 49.4%, and 74.7% at 10, 20, and 30 years, respectively) than in non-drinkers (0%, 21.0%, and 23.3% at 10, 20, and 30 years, respectively, P < 0.0003). The mean interval for progression to LC after blood transfusion was significantly shorter in the habitual heavy drinkers than in the non-drinkers (22.4 +/- 4.4 years vs 28.4 +/- 3.9 years; P < 0.0003). This multivariate analysis revealed that habitual heavy drinking and hepatitis B virus antibody positivity are significant risk factors for HCC in HCV-related liver cirrhosis.     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.