Mucahit Emet | Istinye University (original) (raw)
Papers by Mucahit Emet
A 77-year-old man with multiple myeloma (MM) presented with shortness of breath to the emergency ... more A 77-year-old man with multiple myeloma (MM) presented with
shortness of breath to the emergency department. He also had
history of chronic obstructive pulmonary disease, chronic pulmonary
embolism and nephrectomy due to malignancy 10 years
ago. He had been treated for 9 months with lenalidomide because
of MM. He diagnosed with adult respiratory distress syndrome
due to lenalidomide. We aimed to demonstrate late onset
and destructive effects of lenalidomide on the lungs.
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ÖZET Dünyada en çok kullanılan analjezik olan asetaminofen (N-asetil-p-aminofenol, paraseta-mol, ... more ÖZET Dünyada en çok kullanılan analjezik olan asetaminofen (N-asetil-p-aminofenol, paraseta-mol, APAP) Türkiye'de 300'den fazla ilaç preparatının içinde mevcuttur. Parasetamol zehirlen-mesi, istemli ilaç alımları içinde en sık rastlananıdır. Avrupa ve Kuzey Amerika'da karaciğer yetmezliğinin en sık nedenidir. Ciddi karaciğer toksisitesi aminotransferazların 1000 IU/L'nin üze-rinde olarak tanımlanmaktadır ve 350 mg/kg'ın üzerinde alımlarda gelişir. Tedavi dozlarında alın-dığında parasetamolün %90'ı karaciğerde sülfat ve glukronit ile konguje edilerek metabolize olur, %8'lik kısım hepatik sitokrom p450 enzimleri ile (özellikle CYP2E1) N-asetil p-benzokinon imin (NAPQI)'e dönüştürülür. Glutatyon eksikliğiyle seyreden durumlarda (aşırı asetaminofen alımı gibi), NAPQI toksik olmayan metabolitlere dönüştürülemez ve karaciğer hasarına neden olur. Aktif kömür oral alımdan sonra 4 saat içinde verilmelidir, sonrasında bir yararı gösterilmemiştir. Eğer hasta kademeli ve mükerrer dozlarda parasetamol alarak zehirlenmişse tedavi kriteri olarak Ru-mack-Matthew nomogramına uymaz. Toksik doz alımından sonra erken verilen N-asetil-sistein te-davisi, akut karaciğer yetmezliğinin ilerlemesini yavaşlatmada etkilidir. Ancak akut karaciğer yetmezliği geliştiğinde, karaciğer transplantasyonu tek hayat kurtarıcı tedavidir. A Anahtar Kelimeler : Aşırıdoz; asetaminofen; klinik protokolleri; acil tedavi; tedavi; zehirlenme ABSTRACT Acetaminophen (N-acetyl-p-aminophenol, paracetamol, APAP), the most used analgesic in the World, exists in more than 300 pharmaceutical preparations in Turkey. Paracetamol intoxication is the most encountered among intentional overdoses. It is the most common reason of hepatic failure in Europe and North America. Severe hepatotoxicity is defined as aminotransferase levels more than 1000 IU/L and generally seen in patients ingested acetaminophen more than 350 mg/kg. When ingested in therapeutic doses, paracetamol is metabolized via sulfate and glucuronide conjugation in the liver (90%), 8% of the drug is transformed into N-acetyl-p-benzoquinone imine (NAPQI) via hepatic cytochrome enzymes (mainly CYP2E1). In situations with glutathione depletion (like acetaminophen overdose), NAPQI cannot be converted into non-toxic metabolites causing hepatic injury. Activated charcoal should be given within the 4 hours of ingestion, later use is not found to be helpful. If the patient took multiple doses at different times, Rumack-Matthew nomogram is useless. N-acetylcysteine treatment after toxic exposure was found effective to slow the progression of acute liver failure. However, if hepatic failure develops, liver transplantation is the only life-saving treatment.
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Aim: Bibliographic work in the Turkish emergency medicine community is very scarce. We aim to imp... more Aim: Bibliographic work in the Turkish emergency medicine community is very scarce. We aim to improve upon the shortcomings in this area.
Materials and Methods: Original research published in the Eurasian Journal of Emergency Medicine (EAJEM) (formerly known as the Academic Journal of Emergency Medicine) within the 5-year period between 2010 and 2014 was retrospectively reviewed.
Results: While retrospective publications stood out the most (n=81, 54.7%), they were followed by prospective (n=38, 25.7%) and sectional (n=29, 93.9%) works. A vast majority of the work was concentric (n=139, 93.9%). Here 6.1% publications were sourced overseas. The most commonly studied subjects in the articles published in the EAJEM were medical emergencies (26.35%), trauma (20.27%), and emergency service (19.59%). Further, 52.7% (n=78) texts were written in English and 47.3% (n=70) were written in Turkish. In 15.5% (n=23) articles, an emergency medicine resident and/or emergency medicine specialist was not among the authors. The original research most commonly had 3 keywords (n=73, 49.3%). There were 12 (8.1%) articles in which no tables were used and 70 (47.3%) articles in which there were no figures. According to our findings, a total of 2981 references were used in the 148 articles that were reviewed, and the median reference value per article was 17 (min: 6; max: 50). In our study, 38 references were self-references (12.85) and 727 (24.4%) references were references to texts published in journals in the Turkish index. Within all the references, there were 43 (14.4%) references to the Turkish Journal of Emergency Medicine (TJEM), 41 (13.8%) references to the EAJEM, and only 3 (1.1%) references to Journal of Emergency Medicine Case Reports (JEMCR). The median value of references made to texts in the journals in the Turkish index per article was 2 (min: 0; max: 32). The number of references to the TJEM per article was 43/148 (29.1%), that to the EAJEM was 41/148 (27.7%), and that to JEMCR was 3/148 (2%). While the acceptance period ranged between 1 and 350 days, the average period was 49 days.
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Objective To compare effectiveness of “oxygen alone” versus “metoclopramide plus oxygen” versus “... more Objective
To compare effectiveness of “oxygen alone” versus “metoclopramide plus oxygen” versus “metamizole plus oxygen” therapy in treating carbon monoxide-induced headache.
Design
A prospective, multicenter, double-blind, controlled trial.
Setting
Three EDs in Turkey.
Population
Adult carbon monoxide poisoning patients with headache.
Methods
A total of 117 carbon monoxide-intoxicated patients with headache were randomized into three groups and assessed at baseline, 30 min, 90 min, and 4 h.
Main outcome measure
The primary outcome was patient-reported improvement rates for headache. Secondary endpoints included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels.
Results
During observation, there was no statistical difference between drug type and VAS score change at 30 min, 90 min or 4 h, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the three groups.
Conclusion
The use of “oxygen alone” is as efficacious as “oxygen plus metoclopramide” or “oxygen plus metamizole sodium” in the treatment of carbon monoxide-induced headache.
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Introduction Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by subse... more Introduction Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by subserosal or submucosal air within the intestine wall. PCI cysts can be localized anywhere from the mouth to the rectum with walls full of air (1). It was first defined in 1730 by DuVernoi in the small intestine (2, 3). The worst presentation is pneumoperitoneum due to rupture of cysts. The management of this situation comprises a wide variability from supportive therapy to intestinal resection (4). Here, we present a case who was admitted to Emergency Unite (EU) with intestinal ileus symptoms. PCI was obvious based on the abdominal computed tomography (CT) scan. She was discharged with supportive therapy. Case Report A 77-year-old female patient presented to EU with abdominal pain, nausea, vomiting, constipation, and abdominal distention. The patient's vital signs were in the normal range. Based on her physical examination, there was abdominal distention and general abdominal tenderness in all quadrants, especially on the right upper side, with palpation. Other system examinations were normal. She underwent a hysterectomy operation 1 year ago. Patient's routine blood tests and kidney and liver function tests were in the normal range. Intestinal-type air-fluid level (Figure 1) was seen on direct abdominal radiography. Abdominal CT showed a gall stone, with free air around the stone, and PCI was obvious on the intestinal wall (Figure 2a, b). The patient underwent general surgery consultation. Surgeons suggested operation, but she rejected the suggestion. Thus, she underwent supportive therapy. The patient's clinical condition degraded and she was discharged on the third day of hospitalization in the surgery service. ABSTRACT Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition with an unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to other clinical origins. Radiological imaging has been suggested for diagnosis. The treatment varies according to the patient's clinical condition and radiological imagings from conservative treatment to the intestinal resection. Case Report: A 77 year-old female patient presented to the emergency room with abdominal pain, nausea, vomiting, constipation, and abdominal distention. The patient's vital signs were in the normal range. Physical examination revealed an abdominal distention with inspection and general abdominal tenderness in all quadrants, especially the right upper side, with palpation. Intestinal-type air-fluid level was seen on direct abdominal radiography; therefore, we performed abdominal CT. CT detected the gall stone with free air around the stone and PCI view on the intestinal wall Conclusion: An emergency physician should keep PCI in mind; they should not misinterpret findings with intestinal obstruction and mesenteric ischemia on radiological scans and clinical signs. An emergency physician should keep PCI in mind. They should not misinterpret findings with intestinal obstruction and mesenteric ischemia on radiological scans and clinical signs.
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Background/aim: Suicide is a complex behavior concerning a number of psychological, biological, s... more Background/aim: Suicide is a complex behavior concerning a number of psychological, biological, social and cultural factors. It is also an important public issue, as well as one of the leading causes of death. We aimed to explore the relationship between suicide attempters and healthy controls, with regard to thyroid hormones and to clarify whether any of the thyroid hormone
levels may predict current or future suicide attempts among the total group or not.
Method: This study comprised 358 participants (115 suicide attempters, 243 controls). Thyroid hormone levels including free T3, free T4 and TSH of all participants were explored.
For predicting future suicide attempts using our hospital database and the database of the Republic of Turkey Social Security Institution, via International Classification of Diseases
(ICD) diagnostic codes related to suicide data of future suicide attempts of the study participants were collected. Participants were people without previous history of any thyroid disorder or chronic disease (endocrinological, pulmonary, gastrointestinal, neurological, infectious and neoplastic diseases, hepatic, renal or cardiac failure) that may affect thyroid hormone levels. The participants also comprised those using any thyroid hormone or drug that may affect thyroid hormone levels (such as lithium, carbamazepine, oral contraceptives etc.) alcoholism or drug abuse other than nicotine, pregnancy, detected possible thyroid disease during procedure, intellectual disability, rejection of blood tests, missing data on topics mentioned above, were excluded.
Results: Thyroid hormone levels of both groups were within normal range. Groups differed with regard to FT4 (thyroxin), TSH and FT3/FT4 levels. A logistic regression model indicated
that suicide attempters were 32.7 times more likely to have higher FT4 levels (OR: 32.7; 95%CI: 5.3-202.9; P<0.0001), 1.7 times more likely to have higher TSH levels (OR: 1.7; 95%CI: 1.2-2.3; P=0.002), 2.5 times more likely to have lower FT3/FT4 levels (OR :0.4; 95%CI: 0.2-0.8; P=0.008) than controls. Diagnostic validity of FT4 was found to be good in differentiating patients with both groups (ROC area under the curve=0.821; 95%CI: 0.77-0.87; P<0.0001). The cutoff point for FT4 of 1.15 ng/dl gave a high sensitivity (85%) and specificity (70%).
Conclusion: Thyroid function test measurement, may be used as discriminative cutoffs between suicide attempters and healthy subjects. None of the thyroid hormones indicated future suicide attempts. Higher FT4, TSH and lower FT3/FT4 levels are independently associated with suicide attempt. FT4 may be a useful marker to predict current suicide attempt.
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No statistical data is available on the number of employees working on night shifts in Turkey. Wo... more No statistical data is available on the number of employees working on night shifts in Turkey. Working on shifts is associated with decreased sleep time, decreased daily sleep quality, and decreased alertness during night shifts. Increased incidences of cardiovascular disorders, peptic ulcers, and some types of cancer in shift workers are well known. Exposure to light at nighttime suppresses melatonin production. In non-synchronized circadian rhythm, disturbed melatonin secretion may lead to excessive sleep, hunger for carbohydrates, and weight gain. Melatonin is the hormone that governs sleep. It seems to be the key regulator of the sleep/wake rhythm. Exposure to light at night and disturbance of the circadian rhythm contribute to the health problems of night shift workers by disturbing melatonin production. In this review, the definitions of social jetlag, delayed sleep phase syndrome, and insomnia will be discussed. Sleep disorders in psychiatric diseases will be reviewed. Melatonergic drugs available on the market will be listed, including their contraindications and side effects. The physiopathology of sleep, sleep disorders, depression, and melatonin will be given with an extended discussion. Two recent reviews about the effect of melatonin on sleep patterns will be discussed. Finally, other treatments for sleep disorders will be summarized. In conclusion, in shift workers, sleep problems are a complex subject in which multiple pathophysiological mechanisms play roles. The double-blind randomized controlled studies, systematic reviews, and meta-analyses that have been conducted can provide only weakly positive data about the beneficial effect of melatonin use in shift workers. In the future, multi-centered and multi-participant studies will shed more light on this issue. (Eurasian J Emerg Med 2016; 15: 48-53)
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The Spine Journal, 2015
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Özet Hastamızda künt batın travması sonrası bilateral adrenal hematom tespit edildi. Komplikasyon... more Özet Hastamızda künt batın travması sonrası bilateral adrenal hematom tespit edildi. Komplikasyonsuz bir şekilde taburcu edildikten 6 ay sonrasında adrenal yetmezlik yönüyle araştırılmış olup hastamızda bilateral adrenal kanama olmasına rağmen adrenal yetmezlik gelişmemiştir. Abstract After blunt abdominal trauma patient bilateral adrenal hematoma detected. Discharged after uncomplicated shall after 6 months later. We researched for adrenal insufficiency. Bilateral adrenal hemorrhage despite being patient adrenal insufficiency is not dev
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Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license al... more Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license allows others to download the articles and share them with others as long as they credit you, but they can't change them in any way or use them commercially. A 21-year-old male patient was admitted to our emergency service with the complait of pain on his left elbow after slipping and falling on his palm a few hours ago. Significant sensitivity and edema were present on his left antecubital region through the proximal radius without any open wound. Radial and ulnar pulses were palpable and there were no motor or sensory deficits. Elbow movements in flexion and extension were limited and painful. In antero-posterior radiography, radial head fracture was hardly seen (figure 1a). Lateral radiography of the elbow showed fat pad sign which is highly suggestive of a hidden fracture (figure 1b).Computerized tomography showed vertical progression of a fissure line in the proximal radius extending from the neck to the interarticular region (figure 1c). The best elbow fat pad sign is radiographically seen in full lateral flexion of 90°, any obligation suppressing the view. It occurs due to the existence of an elbow joint effusion. In adult patients with trauma, clinicians should search for intracapsular radial head fractures. Bad position during shooting, extracapsular abnormalities or rupture of the capsules leads to a false negative fat pad sign. Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license allows others to download the articles and share them with others as long as they credit you, but they can't change them in any way or use them commercially. A 21-year-old male patient was admitted to our emergency service with the complait of pain on his left elbow after slipping and falling on his palm a few hours ago. Significant sensitivity and edema were present on his left antecubital region through the proximal radius without any open wound. Radial and ulnar pulses were palpable and there were no motor or sensory deficits. Elbow movements in flexion and extension were limited and painful. In antero-posterior radiography, radial head fracture was hardly seen (figure 1a). Lateral radiography of the elbow showed fat pad sign which is highly suggestive of a hidden fracture (figure 1b).Computerized tomography showed vertical progression of a fissure line in the proximal radius extending from the neck to the interarticular region (figure 1c). The best elbow fat pad sign is radiographically seen in full lateral flexion of 90°, any obligation suppressing the view. It occurs due to the existence of an elbow joint effusion. In adult patients with trauma, clinicians should search for intracapsular radial head fractures. Bad position during shooting, extracapsular abnormalities or rupture of the capsules leads to a false negative fat pad sign. Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license allows others to download the articles and share them with others as long as they credit you, but they can't change them in any way or use them commercially. A 21-year-old male patient was admitted to our emergency service with the complait of pain on his left elbow after slipping and falling on his palm a few hours ago. Significant sensitivity and edema were present on his left antecubital region through the proximal radius without any open wound. Radial and ulnar pulses were palpable and there were no motor or sensory deficits. Elbow movements in flexion and extension were limited and painful. In antero-posterior radiography, radial head fracture was hardly seen (figure 1a). Lateral radiography of the elbow showed fat pad sign which is highly suggestive of a hidden fracture (figure 1b).Computerized tomography showed vertical progression of a fissure line in the proximal radius extending from the neck to the interarticular region (figure 1c). The best elbow fat pad sign is radiographically seen in full lateral flexion of 90°, any obligation suppressing the view. It occurs due to the existence of an elbow joint effusion. In adult patients with trauma, clinicians should search for intracapsular radial head fractures. Bad position during shooting, extracapsular abnormalities or rupture of the capsules leads to a false negative fat pad sign.
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A 4-year-old boy was admitted to the emergency department because of color change and pain on fin... more A 4-year-old boy was admitted to the emergency department
because of color change and pain on fingers. Anamnesis revealed
that on the previous day, he played snowball without using his
gloves for approximately 1 hour with his friends. Physical examination
showed a well-demarcated color change in both fingers with
distal skins having milky brown color and edema (Figure 1 a, b, c).
On the left hand, this demarcation was evident on the proximal interphalangeal
joint (Figure 1 a, b, c). It was less evident but apparent on
the distal interphalangeal joint of the right hand (Figure 1a). Doppler
ultrasonography of the distal fingers showed normal arterial flow.
Superficial ultrasonography presented subcutaneous edema. Burn
dressings with silver sulfadiazine were applied to the fingers, and he
was hospitalized in the burn unit for 3 days before discharge without
any complications.
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Introduction: Discrimination of stroke and stroke mimics is problematic in young patients. The ai... more Introduction: Discrimination of stroke and stroke mimics is problematic in
young patients. The aim of the study was to determine whether arterial
ischemic stroke and stroke mimics can be differentiated via the red cell distribution
width (RDW) value in young patients.
Material and methods: In this retrospective cross-sectional study, a total
of 236 patients hospitalized at the neurology ward were investigated. The
patients were divided into 3 groups: the 1st group included young stroke
patients, the 2nd group included patients with epilepsy, and the 3rd group
included patients with multiple sclerosis (MS). Complete blood count and
computed tomographic brain imaging tests were performed in all patients,
and magnetic resonance imaging was done when necessary.
Results: A total of 236 patients were included in this study. Ninety-five
(40%) patients were young stroke patients, 71 (30%) had epilepsy and 70
(30%) had MS. The mean RDW values of young patients with stroke were
significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2,
13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the
differentiation of patients with stroke is good (area under the curve (AUC) =
0.89). When an RDW cut-off value of 14.05% is accepted for differentiating
young patients with stroke from other disorders, the sensitivity, specificity,
positive predictive and negative predictive values were 73.7%, 87.9%, 6.1
and 0.043, respectively.
Conclusions: Red cell distribution width is a promising, rapid, easy and inexpensive
parameter to distinguish young stroke from stroke mimics (such
as epilepsy and MS) in young patients.
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Introduction: Current diagnostic measurements used to assess myocardial involvement in Kounis syn... more Introduction: Current diagnostic measurements used to assess myocardial involvement in Kounis syndrome, such as electrocardiography (ECG), cardiac enzymes, and troponin levels, are relatively insensitive to small but potentially significant functional change. According to our review of the literature, there has been no study using magnetic resonance imaging (MRI) on Kounis syndrome except for one case report.
Aim: To identify the findings of dynamic contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with Kounis syndrome (KS) type 1.
Material and methods: We studied 26 patients (35 +/- 11.5 years, 53.8% male) with known or suspected KS type 1. The patients underwent precontrast, first-pass, and delayed enhancement cardiac MRI (DE-MR. Contrast enhancement patterns, edema, hypokinesia, and localization for myocardial lesions were evaluated in all KS type 1 patients.
Results: Contrast-enhanced magnetic resonance imaging demonstrated an early-phase subendocardial contrast defect, and T2-weighted images showed high-signal intensity consistent with edema in lesion areas. None of the lesion areas was found upon contrast enhancement on DE-MRI. The area of early-phase subendocardial contrast defect was reported as follows: the interventricular septum in 14 (53.8%) patients, the left ventricular lateral wall in 8 (30.7%), and the left ventricular apex in 4 (15.4%).
Conclusions: Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1.
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Turkish Journal of Emergency Medicine, 2012
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Turkish Journal of Emergency Medicine, 2013
Objectives Patients who have attempted suicide require a multidisciplinary approach. Currently, a... more Objectives Patients who have attempted suicide require a multidisciplinary approach. Currently, a large proportion of treatment and follow-up is performed in emergency departments (EDs) and intensive care units (ICUs). In our study, we aimed to investigate which clinics perform treatment, follow-up, and psychiatric evaluation of these patients, and differences in follow-up between patients with and without altered mental status (AMS) in our hospital. Methods Patients older than 16 years admitted to our ED between December 10, 2008 and February 15, 2011 for suicide attempts were reviewed retrospectively. Patients with Glasgow Coma scores ≤14 were determined to have AMS. Results A total of 304 patients were included in the study, 84 of which had AMS. Of the patients, 67.1% (n=204) were female and the mean age was 25.8±9.1 years. Of the patients with AMS, 92.9% (n=78) were admitted to the hospital, and 48.8% (n=41) were admitted to the observation room of the ED. The percentage of patients without AMS who were admitted was 69.5% (n=153), and 43.2% (n=95) were admitted to the ED. Of the patients, 13.1% (n=11) with AMS and 16.8% (n=37) without AMS had previously attempted suicide. The rate of suicide attempts with more than one drug was similar and quite high in both groups. Conclusions In cases of suicide attempts associated with trauma, EDs, ICUs, and surgical clinics play key roles in the treatment of these patients. Therefore, improved awareness of optimal treatment for AMS patients at these clinics will enhance the quality of care.
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Turkish Neurosurgery, 2014
We examined whether there is a relationship between vagal nerve root injury and the severity of r... more We examined whether there is a relationship between vagal nerve root injury and the severity of respiration disorders associated with subarachnoid hemorrhage (SAH). This study was conducted on 20 rabbits. Experimental SAH was induced by injecting homologous blood into the cisterna magna. During the experiment, electrocardiography and respiratory rhythms were measured daily. After the experiment, any axonal injury or changes to the arterial nervorums of the vagal nerves were examined. All respiratory irregularities and vagal nerve degenerations were statistically analyzed. Normal respiration rate, as measured in the control group, was 30±6 bpm. In the SAH-induced group, respiration rates were initially 20±4 bpm, increasing to 40±9/min approximately ten hours later, with severe tachypneic and apneic variation. In histopathological examinations, axon density of vagal nerves was 28500±5500 in both control and sham animals, whereas axon density was 22250±3500 in survivors and 16450±2750 in dead SAH animals. The severity of axonal degeneration of vagal nerves was greater in the six dead animals than in the survivors. If vagal nerves are lesioned, the muscles of respiration are paralyzed and respiratory reflexes are disrupted. That the ischemic and mechanical factors created by SAH cause vagal nerve root injury and respiration disorders may be inevitable and fatal.
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Experimental Neurology, 2011
The heart is innervated by several systems that contribute to the control of the heart&am... more The heart is innervated by several systems that contribute to the control of the heart&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rhythm. The cardiac fibers of the vagus nerve have an important role in the regulation of heart rhythm under many emotional and physical conditions. Severe electrocardiographic disturbances have been reported following subarachnoid hemorrhage (SAH), but ischemic neuronal degeneration of the nodose ganglion of the vagus nerve has not been previously investigated. We examined if there is a relationship between ischemic injury of the nodose ganglion of the vagus nerve and the severity of heart rhythm disorders after subarachnoid hemorrhage. This study was conducted on 20 rabbits. Four rabbits were used as a baseline group. Experimental subarachnoid hemorrhage was applied to half of the remaining animals (n = 8) by injecting homologous blood into the cisterna magna, and the others (SHAM group, n = 8) were injected with isotonic saline solution in the same manner. For 20 days after the injection, heart rhythm changes were observed daily. After the experiment, normal and ischemic neuron densities in the nodose ganglia of the vagus nerves were examined stereologically. The number of heart rhythm irregularities and the number of degenerated neurons in the nodose ganglia were compared statistically. The normal heart rhythm rate was 280 ± 45/min. At the beginning of the SAH, the average heart rate was 220 ± 30/min; about 10 hours later, it decreased to 189 ± 30/min, indicating severe bradycardia. However, after 7 days, the average heart rate had increased to 350 ± 30/min. Six animals died due to irregularities in cardiac function and respiration. Histopathological examinations showed that the average density of normal neurons in the nodose ganglion was 10,500 ± 2500 in the baseline animals and the SHAM group, but the normal neuron density was 8250 ± 1500 in survivors and 6450 ± 1330 in dead animals. The ischemic neuronal degeneration in the nodose ganglia was more severe in the dead animals than in the survivors (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Afferent vagus nerves originating from the nodose ganglia have an important role in regulating heart rhythm via their afferent fibers and efferent connections. If neurons of the nodose ganglia are lesioned due to ischemic insult during subarachnoid hemorrhage, heart rhythm regulation by vagus afferent reflexes is disturbed. Vagus pathway paralysis may result in indirect sympathetic overactivity. The development of tachycardia causes depletion of the heart&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s reserves, and cardiac arrest may be inevitable following extensive subarachnoid hemorrhage.
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Amyloid, 2008
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neurosurgery.dergisi.org
AIM: The aim of this study was to determine the relationship between ischemic neurodegeneration, ... more AIM: The aim of this study was to determine the relationship between ischemic neurodegeneration, of the petrosal ganglion of the glossopharyngeal nerve, and BP fluctuations, after subarachnoid hemorrhage (SAH).
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This is the first case report of an adult who had spontaneous reduction of ileoileal intussuscept... more This is the first case report of an adult who had spontaneous reduction
of ileoileal intussusception occurred after punching to the abdomen.
A 40-year-old man was brought to our emergency department
by ground ambulance due to pounding and punching a few hours ago.
Physical examination showed multiple dermabrasions on his face, abdomen,
and lower extremities. All other examinations were unremarkable
except that of mild abdominal pain. Laboratory results gave no
clues. On abdominal x-ray, paucity of intestinal gas, pseudomass and
surrounding gas appearances were visible. No nausea or vomiting occurred
during observation. His abdominal pain resolved gradually. On
the 24th hour after admission, control computed tomography showed
that the findings of intussusception disappeared. He was discharged
after 1 day of observation. Outpatient follow-up did not show any abnormality.
We suggest that, in patients with mild to moderate trauma,
even if the patient has mild abdominal pain, physicians should rule
out invagination. Computed tomography is the suggested imaging modality.
These patients should be kept in close follow-up. If symptoms resolve
and intussusception findings disappear in computed tomography,
no further treatment is required.
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A 77-year-old man with multiple myeloma (MM) presented with shortness of breath to the emergency ... more A 77-year-old man with multiple myeloma (MM) presented with
shortness of breath to the emergency department. He also had
history of chronic obstructive pulmonary disease, chronic pulmonary
embolism and nephrectomy due to malignancy 10 years
ago. He had been treated for 9 months with lenalidomide because
of MM. He diagnosed with adult respiratory distress syndrome
due to lenalidomide. We aimed to demonstrate late onset
and destructive effects of lenalidomide on the lungs.
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ÖZET Dünyada en çok kullanılan analjezik olan asetaminofen (N-asetil-p-aminofenol, paraseta-mol, ... more ÖZET Dünyada en çok kullanılan analjezik olan asetaminofen (N-asetil-p-aminofenol, paraseta-mol, APAP) Türkiye'de 300'den fazla ilaç preparatının içinde mevcuttur. Parasetamol zehirlen-mesi, istemli ilaç alımları içinde en sık rastlananıdır. Avrupa ve Kuzey Amerika'da karaciğer yetmezliğinin en sık nedenidir. Ciddi karaciğer toksisitesi aminotransferazların 1000 IU/L'nin üze-rinde olarak tanımlanmaktadır ve 350 mg/kg'ın üzerinde alımlarda gelişir. Tedavi dozlarında alın-dığında parasetamolün %90'ı karaciğerde sülfat ve glukronit ile konguje edilerek metabolize olur, %8'lik kısım hepatik sitokrom p450 enzimleri ile (özellikle CYP2E1) N-asetil p-benzokinon imin (NAPQI)'e dönüştürülür. Glutatyon eksikliğiyle seyreden durumlarda (aşırı asetaminofen alımı gibi), NAPQI toksik olmayan metabolitlere dönüştürülemez ve karaciğer hasarına neden olur. Aktif kömür oral alımdan sonra 4 saat içinde verilmelidir, sonrasında bir yararı gösterilmemiştir. Eğer hasta kademeli ve mükerrer dozlarda parasetamol alarak zehirlenmişse tedavi kriteri olarak Ru-mack-Matthew nomogramına uymaz. Toksik doz alımından sonra erken verilen N-asetil-sistein te-davisi, akut karaciğer yetmezliğinin ilerlemesini yavaşlatmada etkilidir. Ancak akut karaciğer yetmezliği geliştiğinde, karaciğer transplantasyonu tek hayat kurtarıcı tedavidir. A Anahtar Kelimeler : Aşırıdoz; asetaminofen; klinik protokolleri; acil tedavi; tedavi; zehirlenme ABSTRACT Acetaminophen (N-acetyl-p-aminophenol, paracetamol, APAP), the most used analgesic in the World, exists in more than 300 pharmaceutical preparations in Turkey. Paracetamol intoxication is the most encountered among intentional overdoses. It is the most common reason of hepatic failure in Europe and North America. Severe hepatotoxicity is defined as aminotransferase levels more than 1000 IU/L and generally seen in patients ingested acetaminophen more than 350 mg/kg. When ingested in therapeutic doses, paracetamol is metabolized via sulfate and glucuronide conjugation in the liver (90%), 8% of the drug is transformed into N-acetyl-p-benzoquinone imine (NAPQI) via hepatic cytochrome enzymes (mainly CYP2E1). In situations with glutathione depletion (like acetaminophen overdose), NAPQI cannot be converted into non-toxic metabolites causing hepatic injury. Activated charcoal should be given within the 4 hours of ingestion, later use is not found to be helpful. If the patient took multiple doses at different times, Rumack-Matthew nomogram is useless. N-acetylcysteine treatment after toxic exposure was found effective to slow the progression of acute liver failure. However, if hepatic failure develops, liver transplantation is the only life-saving treatment.
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Aim: Bibliographic work in the Turkish emergency medicine community is very scarce. We aim to imp... more Aim: Bibliographic work in the Turkish emergency medicine community is very scarce. We aim to improve upon the shortcomings in this area.
Materials and Methods: Original research published in the Eurasian Journal of Emergency Medicine (EAJEM) (formerly known as the Academic Journal of Emergency Medicine) within the 5-year period between 2010 and 2014 was retrospectively reviewed.
Results: While retrospective publications stood out the most (n=81, 54.7%), they were followed by prospective (n=38, 25.7%) and sectional (n=29, 93.9%) works. A vast majority of the work was concentric (n=139, 93.9%). Here 6.1% publications were sourced overseas. The most commonly studied subjects in the articles published in the EAJEM were medical emergencies (26.35%), trauma (20.27%), and emergency service (19.59%). Further, 52.7% (n=78) texts were written in English and 47.3% (n=70) were written in Turkish. In 15.5% (n=23) articles, an emergency medicine resident and/or emergency medicine specialist was not among the authors. The original research most commonly had 3 keywords (n=73, 49.3%). There were 12 (8.1%) articles in which no tables were used and 70 (47.3%) articles in which there were no figures. According to our findings, a total of 2981 references were used in the 148 articles that were reviewed, and the median reference value per article was 17 (min: 6; max: 50). In our study, 38 references were self-references (12.85) and 727 (24.4%) references were references to texts published in journals in the Turkish index. Within all the references, there were 43 (14.4%) references to the Turkish Journal of Emergency Medicine (TJEM), 41 (13.8%) references to the EAJEM, and only 3 (1.1%) references to Journal of Emergency Medicine Case Reports (JEMCR). The median value of references made to texts in the journals in the Turkish index per article was 2 (min: 0; max: 32). The number of references to the TJEM per article was 43/148 (29.1%), that to the EAJEM was 41/148 (27.7%), and that to JEMCR was 3/148 (2%). While the acceptance period ranged between 1 and 350 days, the average period was 49 days.
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Objective To compare effectiveness of “oxygen alone” versus “metoclopramide plus oxygen” versus “... more Objective
To compare effectiveness of “oxygen alone” versus “metoclopramide plus oxygen” versus “metamizole plus oxygen” therapy in treating carbon monoxide-induced headache.
Design
A prospective, multicenter, double-blind, controlled trial.
Setting
Three EDs in Turkey.
Population
Adult carbon monoxide poisoning patients with headache.
Methods
A total of 117 carbon monoxide-intoxicated patients with headache were randomized into three groups and assessed at baseline, 30 min, 90 min, and 4 h.
Main outcome measure
The primary outcome was patient-reported improvement rates for headache. Secondary endpoints included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels.
Results
During observation, there was no statistical difference between drug type and VAS score change at 30 min, 90 min or 4 h, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the three groups.
Conclusion
The use of “oxygen alone” is as efficacious as “oxygen plus metoclopramide” or “oxygen plus metamizole sodium” in the treatment of carbon monoxide-induced headache.
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Introduction Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by subse... more Introduction Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by subserosal or submucosal air within the intestine wall. PCI cysts can be localized anywhere from the mouth to the rectum with walls full of air (1). It was first defined in 1730 by DuVernoi in the small intestine (2, 3). The worst presentation is pneumoperitoneum due to rupture of cysts. The management of this situation comprises a wide variability from supportive therapy to intestinal resection (4). Here, we present a case who was admitted to Emergency Unite (EU) with intestinal ileus symptoms. PCI was obvious based on the abdominal computed tomography (CT) scan. She was discharged with supportive therapy. Case Report A 77-year-old female patient presented to EU with abdominal pain, nausea, vomiting, constipation, and abdominal distention. The patient's vital signs were in the normal range. Based on her physical examination, there was abdominal distention and general abdominal tenderness in all quadrants, especially on the right upper side, with palpation. Other system examinations were normal. She underwent a hysterectomy operation 1 year ago. Patient's routine blood tests and kidney and liver function tests were in the normal range. Intestinal-type air-fluid level (Figure 1) was seen on direct abdominal radiography. Abdominal CT showed a gall stone, with free air around the stone, and PCI was obvious on the intestinal wall (Figure 2a, b). The patient underwent general surgery consultation. Surgeons suggested operation, but she rejected the suggestion. Thus, she underwent supportive therapy. The patient's clinical condition degraded and she was discharged on the third day of hospitalization in the surgery service. ABSTRACT Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition with an unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to other clinical origins. Radiological imaging has been suggested for diagnosis. The treatment varies according to the patient's clinical condition and radiological imagings from conservative treatment to the intestinal resection. Case Report: A 77 year-old female patient presented to the emergency room with abdominal pain, nausea, vomiting, constipation, and abdominal distention. The patient's vital signs were in the normal range. Physical examination revealed an abdominal distention with inspection and general abdominal tenderness in all quadrants, especially the right upper side, with palpation. Intestinal-type air-fluid level was seen on direct abdominal radiography; therefore, we performed abdominal CT. CT detected the gall stone with free air around the stone and PCI view on the intestinal wall Conclusion: An emergency physician should keep PCI in mind; they should not misinterpret findings with intestinal obstruction and mesenteric ischemia on radiological scans and clinical signs. An emergency physician should keep PCI in mind. They should not misinterpret findings with intestinal obstruction and mesenteric ischemia on radiological scans and clinical signs.
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Background/aim: Suicide is a complex behavior concerning a number of psychological, biological, s... more Background/aim: Suicide is a complex behavior concerning a number of psychological, biological, social and cultural factors. It is also an important public issue, as well as one of the leading causes of death. We aimed to explore the relationship between suicide attempters and healthy controls, with regard to thyroid hormones and to clarify whether any of the thyroid hormone
levels may predict current or future suicide attempts among the total group or not.
Method: This study comprised 358 participants (115 suicide attempters, 243 controls). Thyroid hormone levels including free T3, free T4 and TSH of all participants were explored.
For predicting future suicide attempts using our hospital database and the database of the Republic of Turkey Social Security Institution, via International Classification of Diseases
(ICD) diagnostic codes related to suicide data of future suicide attempts of the study participants were collected. Participants were people without previous history of any thyroid disorder or chronic disease (endocrinological, pulmonary, gastrointestinal, neurological, infectious and neoplastic diseases, hepatic, renal or cardiac failure) that may affect thyroid hormone levels. The participants also comprised those using any thyroid hormone or drug that may affect thyroid hormone levels (such as lithium, carbamazepine, oral contraceptives etc.) alcoholism or drug abuse other than nicotine, pregnancy, detected possible thyroid disease during procedure, intellectual disability, rejection of blood tests, missing data on topics mentioned above, were excluded.
Results: Thyroid hormone levels of both groups were within normal range. Groups differed with regard to FT4 (thyroxin), TSH and FT3/FT4 levels. A logistic regression model indicated
that suicide attempters were 32.7 times more likely to have higher FT4 levels (OR: 32.7; 95%CI: 5.3-202.9; P<0.0001), 1.7 times more likely to have higher TSH levels (OR: 1.7; 95%CI: 1.2-2.3; P=0.002), 2.5 times more likely to have lower FT3/FT4 levels (OR :0.4; 95%CI: 0.2-0.8; P=0.008) than controls. Diagnostic validity of FT4 was found to be good in differentiating patients with both groups (ROC area under the curve=0.821; 95%CI: 0.77-0.87; P<0.0001). The cutoff point for FT4 of 1.15 ng/dl gave a high sensitivity (85%) and specificity (70%).
Conclusion: Thyroid function test measurement, may be used as discriminative cutoffs between suicide attempters and healthy subjects. None of the thyroid hormones indicated future suicide attempts. Higher FT4, TSH and lower FT3/FT4 levels are independently associated with suicide attempt. FT4 may be a useful marker to predict current suicide attempt.
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No statistical data is available on the number of employees working on night shifts in Turkey. Wo... more No statistical data is available on the number of employees working on night shifts in Turkey. Working on shifts is associated with decreased sleep time, decreased daily sleep quality, and decreased alertness during night shifts. Increased incidences of cardiovascular disorders, peptic ulcers, and some types of cancer in shift workers are well known. Exposure to light at nighttime suppresses melatonin production. In non-synchronized circadian rhythm, disturbed melatonin secretion may lead to excessive sleep, hunger for carbohydrates, and weight gain. Melatonin is the hormone that governs sleep. It seems to be the key regulator of the sleep/wake rhythm. Exposure to light at night and disturbance of the circadian rhythm contribute to the health problems of night shift workers by disturbing melatonin production. In this review, the definitions of social jetlag, delayed sleep phase syndrome, and insomnia will be discussed. Sleep disorders in psychiatric diseases will be reviewed. Melatonergic drugs available on the market will be listed, including their contraindications and side effects. The physiopathology of sleep, sleep disorders, depression, and melatonin will be given with an extended discussion. Two recent reviews about the effect of melatonin on sleep patterns will be discussed. Finally, other treatments for sleep disorders will be summarized. In conclusion, in shift workers, sleep problems are a complex subject in which multiple pathophysiological mechanisms play roles. The double-blind randomized controlled studies, systematic reviews, and meta-analyses that have been conducted can provide only weakly positive data about the beneficial effect of melatonin use in shift workers. In the future, multi-centered and multi-participant studies will shed more light on this issue. (Eurasian J Emerg Med 2016; 15: 48-53)
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The Spine Journal, 2015
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Özet Hastamızda künt batın travması sonrası bilateral adrenal hematom tespit edildi. Komplikasyon... more Özet Hastamızda künt batın travması sonrası bilateral adrenal hematom tespit edildi. Komplikasyonsuz bir şekilde taburcu edildikten 6 ay sonrasında adrenal yetmezlik yönüyle araştırılmış olup hastamızda bilateral adrenal kanama olmasına rağmen adrenal yetmezlik gelişmemiştir. Abstract After blunt abdominal trauma patient bilateral adrenal hematoma detected. Discharged after uncomplicated shall after 6 months later. We researched for adrenal insufficiency. Bilateral adrenal hemorrhage despite being patient adrenal insufficiency is not dev
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Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license al... more Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license allows others to download the articles and share them with others as long as they credit you, but they can't change them in any way or use them commercially. A 21-year-old male patient was admitted to our emergency service with the complait of pain on his left elbow after slipping and falling on his palm a few hours ago. Significant sensitivity and edema were present on his left antecubital region through the proximal radius without any open wound. Radial and ulnar pulses were palpable and there were no motor or sensory deficits. Elbow movements in flexion and extension were limited and painful. In antero-posterior radiography, radial head fracture was hardly seen (figure 1a). Lateral radiography of the elbow showed fat pad sign which is highly suggestive of a hidden fracture (figure 1b).Computerized tomography showed vertical progression of a fissure line in the proximal radius extending from the neck to the interarticular region (figure 1c). The best elbow fat pad sign is radiographically seen in full lateral flexion of 90°, any obligation suppressing the view. It occurs due to the existence of an elbow joint effusion. In adult patients with trauma, clinicians should search for intracapsular radial head fractures. Bad position during shooting, extracapsular abnormalities or rupture of the capsules leads to a false negative fat pad sign. Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license allows others to download the articles and share them with others as long as they credit you, but they can't change them in any way or use them commercially. A 21-year-old male patient was admitted to our emergency service with the complait of pain on his left elbow after slipping and falling on his palm a few hours ago. Significant sensitivity and edema were present on his left antecubital region through the proximal radius without any open wound. Radial and ulnar pulses were palpable and there were no motor or sensory deficits. Elbow movements in flexion and extension were limited and painful. In antero-posterior radiography, radial head fracture was hardly seen (figure 1a). Lateral radiography of the elbow showed fat pad sign which is highly suggestive of a hidden fracture (figure 1b).Computerized tomography showed vertical progression of a fissure line in the proximal radius extending from the neck to the interarticular region (figure 1c). The best elbow fat pad sign is radiographically seen in full lateral flexion of 90°, any obligation suppressing the view. It occurs due to the existence of an elbow joint effusion. In adult patients with trauma, clinicians should search for intracapsular radial head fractures. Bad position during shooting, extracapsular abnormalities or rupture of the capsules leads to a false negative fat pad sign. Attribution-NonCommercial-NoDerivs4.0 International Public License (CC BY-NC-ND). This license allows others to download the articles and share them with others as long as they credit you, but they can't change them in any way or use them commercially. A 21-year-old male patient was admitted to our emergency service with the complait of pain on his left elbow after slipping and falling on his palm a few hours ago. Significant sensitivity and edema were present on his left antecubital region through the proximal radius without any open wound. Radial and ulnar pulses were palpable and there were no motor or sensory deficits. Elbow movements in flexion and extension were limited and painful. In antero-posterior radiography, radial head fracture was hardly seen (figure 1a). Lateral radiography of the elbow showed fat pad sign which is highly suggestive of a hidden fracture (figure 1b).Computerized tomography showed vertical progression of a fissure line in the proximal radius extending from the neck to the interarticular region (figure 1c). The best elbow fat pad sign is radiographically seen in full lateral flexion of 90°, any obligation suppressing the view. It occurs due to the existence of an elbow joint effusion. In adult patients with trauma, clinicians should search for intracapsular radial head fractures. Bad position during shooting, extracapsular abnormalities or rupture of the capsules leads to a false negative fat pad sign.
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A 4-year-old boy was admitted to the emergency department because of color change and pain on fin... more A 4-year-old boy was admitted to the emergency department
because of color change and pain on fingers. Anamnesis revealed
that on the previous day, he played snowball without using his
gloves for approximately 1 hour with his friends. Physical examination
showed a well-demarcated color change in both fingers with
distal skins having milky brown color and edema (Figure 1 a, b, c).
On the left hand, this demarcation was evident on the proximal interphalangeal
joint (Figure 1 a, b, c). It was less evident but apparent on
the distal interphalangeal joint of the right hand (Figure 1a). Doppler
ultrasonography of the distal fingers showed normal arterial flow.
Superficial ultrasonography presented subcutaneous edema. Burn
dressings with silver sulfadiazine were applied to the fingers, and he
was hospitalized in the burn unit for 3 days before discharge without
any complications.
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Introduction: Discrimination of stroke and stroke mimics is problematic in young patients. The ai... more Introduction: Discrimination of stroke and stroke mimics is problematic in
young patients. The aim of the study was to determine whether arterial
ischemic stroke and stroke mimics can be differentiated via the red cell distribution
width (RDW) value in young patients.
Material and methods: In this retrospective cross-sectional study, a total
of 236 patients hospitalized at the neurology ward were investigated. The
patients were divided into 3 groups: the 1st group included young stroke
patients, the 2nd group included patients with epilepsy, and the 3rd group
included patients with multiple sclerosis (MS). Complete blood count and
computed tomographic brain imaging tests were performed in all patients,
and magnetic resonance imaging was done when necessary.
Results: A total of 236 patients were included in this study. Ninety-five
(40%) patients were young stroke patients, 71 (30%) had epilepsy and 70
(30%) had MS. The mean RDW values of young patients with stroke were
significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2,
13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the
differentiation of patients with stroke is good (area under the curve (AUC) =
0.89). When an RDW cut-off value of 14.05% is accepted for differentiating
young patients with stroke from other disorders, the sensitivity, specificity,
positive predictive and negative predictive values were 73.7%, 87.9%, 6.1
and 0.043, respectively.
Conclusions: Red cell distribution width is a promising, rapid, easy and inexpensive
parameter to distinguish young stroke from stroke mimics (such
as epilepsy and MS) in young patients.
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Introduction: Current diagnostic measurements used to assess myocardial involvement in Kounis syn... more Introduction: Current diagnostic measurements used to assess myocardial involvement in Kounis syndrome, such as electrocardiography (ECG), cardiac enzymes, and troponin levels, are relatively insensitive to small but potentially significant functional change. According to our review of the literature, there has been no study using magnetic resonance imaging (MRI) on Kounis syndrome except for one case report.
Aim: To identify the findings of dynamic contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with Kounis syndrome (KS) type 1.
Material and methods: We studied 26 patients (35 +/- 11.5 years, 53.8% male) with known or suspected KS type 1. The patients underwent precontrast, first-pass, and delayed enhancement cardiac MRI (DE-MR. Contrast enhancement patterns, edema, hypokinesia, and localization for myocardial lesions were evaluated in all KS type 1 patients.
Results: Contrast-enhanced magnetic resonance imaging demonstrated an early-phase subendocardial contrast defect, and T2-weighted images showed high-signal intensity consistent with edema in lesion areas. None of the lesion areas was found upon contrast enhancement on DE-MRI. The area of early-phase subendocardial contrast defect was reported as follows: the interventricular septum in 14 (53.8%) patients, the left ventricular lateral wall in 8 (30.7%), and the left ventricular apex in 4 (15.4%).
Conclusions: Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1.
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Turkish Journal of Emergency Medicine, 2012
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Turkish Journal of Emergency Medicine, 2013
Objectives Patients who have attempted suicide require a multidisciplinary approach. Currently, a... more Objectives Patients who have attempted suicide require a multidisciplinary approach. Currently, a large proportion of treatment and follow-up is performed in emergency departments (EDs) and intensive care units (ICUs). In our study, we aimed to investigate which clinics perform treatment, follow-up, and psychiatric evaluation of these patients, and differences in follow-up between patients with and without altered mental status (AMS) in our hospital. Methods Patients older than 16 years admitted to our ED between December 10, 2008 and February 15, 2011 for suicide attempts were reviewed retrospectively. Patients with Glasgow Coma scores ≤14 were determined to have AMS. Results A total of 304 patients were included in the study, 84 of which had AMS. Of the patients, 67.1% (n=204) were female and the mean age was 25.8±9.1 years. Of the patients with AMS, 92.9% (n=78) were admitted to the hospital, and 48.8% (n=41) were admitted to the observation room of the ED. The percentage of patients without AMS who were admitted was 69.5% (n=153), and 43.2% (n=95) were admitted to the ED. Of the patients, 13.1% (n=11) with AMS and 16.8% (n=37) without AMS had previously attempted suicide. The rate of suicide attempts with more than one drug was similar and quite high in both groups. Conclusions In cases of suicide attempts associated with trauma, EDs, ICUs, and surgical clinics play key roles in the treatment of these patients. Therefore, improved awareness of optimal treatment for AMS patients at these clinics will enhance the quality of care.
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Turkish Neurosurgery, 2014
We examined whether there is a relationship between vagal nerve root injury and the severity of r... more We examined whether there is a relationship between vagal nerve root injury and the severity of respiration disorders associated with subarachnoid hemorrhage (SAH). This study was conducted on 20 rabbits. Experimental SAH was induced by injecting homologous blood into the cisterna magna. During the experiment, electrocardiography and respiratory rhythms were measured daily. After the experiment, any axonal injury or changes to the arterial nervorums of the vagal nerves were examined. All respiratory irregularities and vagal nerve degenerations were statistically analyzed. Normal respiration rate, as measured in the control group, was 30±6 bpm. In the SAH-induced group, respiration rates were initially 20±4 bpm, increasing to 40±9/min approximately ten hours later, with severe tachypneic and apneic variation. In histopathological examinations, axon density of vagal nerves was 28500±5500 in both control and sham animals, whereas axon density was 22250±3500 in survivors and 16450±2750 in dead SAH animals. The severity of axonal degeneration of vagal nerves was greater in the six dead animals than in the survivors. If vagal nerves are lesioned, the muscles of respiration are paralyzed and respiratory reflexes are disrupted. That the ischemic and mechanical factors created by SAH cause vagal nerve root injury and respiration disorders may be inevitable and fatal.
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Experimental Neurology, 2011
The heart is innervated by several systems that contribute to the control of the heart&am... more The heart is innervated by several systems that contribute to the control of the heart&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rhythm. The cardiac fibers of the vagus nerve have an important role in the regulation of heart rhythm under many emotional and physical conditions. Severe electrocardiographic disturbances have been reported following subarachnoid hemorrhage (SAH), but ischemic neuronal degeneration of the nodose ganglion of the vagus nerve has not been previously investigated. We examined if there is a relationship between ischemic injury of the nodose ganglion of the vagus nerve and the severity of heart rhythm disorders after subarachnoid hemorrhage. This study was conducted on 20 rabbits. Four rabbits were used as a baseline group. Experimental subarachnoid hemorrhage was applied to half of the remaining animals (n = 8) by injecting homologous blood into the cisterna magna, and the others (SHAM group, n = 8) were injected with isotonic saline solution in the same manner. For 20 days after the injection, heart rhythm changes were observed daily. After the experiment, normal and ischemic neuron densities in the nodose ganglia of the vagus nerves were examined stereologically. The number of heart rhythm irregularities and the number of degenerated neurons in the nodose ganglia were compared statistically. The normal heart rhythm rate was 280 ± 45/min. At the beginning of the SAH, the average heart rate was 220 ± 30/min; about 10 hours later, it decreased to 189 ± 30/min, indicating severe bradycardia. However, after 7 days, the average heart rate had increased to 350 ± 30/min. Six animals died due to irregularities in cardiac function and respiration. Histopathological examinations showed that the average density of normal neurons in the nodose ganglion was 10,500 ± 2500 in the baseline animals and the SHAM group, but the normal neuron density was 8250 ± 1500 in survivors and 6450 ± 1330 in dead animals. The ischemic neuronal degeneration in the nodose ganglia was more severe in the dead animals than in the survivors (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Afferent vagus nerves originating from the nodose ganglia have an important role in regulating heart rhythm via their afferent fibers and efferent connections. If neurons of the nodose ganglia are lesioned due to ischemic insult during subarachnoid hemorrhage, heart rhythm regulation by vagus afferent reflexes is disturbed. Vagus pathway paralysis may result in indirect sympathetic overactivity. The development of tachycardia causes depletion of the heart&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s reserves, and cardiac arrest may be inevitable following extensive subarachnoid hemorrhage.
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Amyloid, 2008
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neurosurgery.dergisi.org
AIM: The aim of this study was to determine the relationship between ischemic neurodegeneration, ... more AIM: The aim of this study was to determine the relationship between ischemic neurodegeneration, of the petrosal ganglion of the glossopharyngeal nerve, and BP fluctuations, after subarachnoid hemorrhage (SAH).
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This is the first case report of an adult who had spontaneous reduction of ileoileal intussuscept... more This is the first case report of an adult who had spontaneous reduction
of ileoileal intussusception occurred after punching to the abdomen.
A 40-year-old man was brought to our emergency department
by ground ambulance due to pounding and punching a few hours ago.
Physical examination showed multiple dermabrasions on his face, abdomen,
and lower extremities. All other examinations were unremarkable
except that of mild abdominal pain. Laboratory results gave no
clues. On abdominal x-ray, paucity of intestinal gas, pseudomass and
surrounding gas appearances were visible. No nausea or vomiting occurred
during observation. His abdominal pain resolved gradually. On
the 24th hour after admission, control computed tomography showed
that the findings of intussusception disappeared. He was discharged
after 1 day of observation. Outpatient follow-up did not show any abnormality.
We suggest that, in patients with mild to moderate trauma,
even if the patient has mild abdominal pain, physicians should rule
out invagination. Computed tomography is the suggested imaging modality.
These patients should be kept in close follow-up. If symptoms resolve
and intussusception findings disappear in computed tomography,
no further treatment is required.
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