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Öğe Carotid Artery Dissection: A Case Report(Emergency Medicine Physicians Assoc Turkey, 2020) Ekmekyapar, Muhammed; Oguzturk, Hakan; Ekmekyapar, Tuba; Derya, Serdar; Gurbuz, SukruCarotid artery dissection, firstly described by Pratt-Thomas and Berger in 1947, typically begins in inner layer of artery wall, proceeds to the middle layer, and intramurally extends along length of the artery as a result of the pressure produced by blood stream. This study aims to report a case in which internal carotid artery dissection was diagnosed as secondary to trauma. A 24-year-old male patient was brought to the emergency room by 112 emergency service team after a motorcycle accident. Physical examination of the patient revealed a painful dermabrasion in his right neck region and other system examinations were normal. Carotid-vertebral color Doppler ultrasonography was performed on the patient because he had a right neck pain. Accordingly, an intimal flap appearance compatible with dissection was observed on the right internal carotid artery (ICA) proximal segment. Then, brain+cervical CT angiography was performed on the patient, and an appearance compatible with dissection was observed in the right ICA. Therefore, the patient was referred to neurology and neurosurgery consultation and accordingly admitted to neurosurgery intensive care unit. As a result, carotid artery dissection in addition to other intracranial pathologies should be considered among differential diagnoses for patients with head and/or neck pain complaints regardless of whether or not they have a trauma history.Öğe Causes of acute abdomen, preferred imaging methods, and prognoses in geriatric patients presenting to the emergency department with abdominal pain(Assoc Medica Brasileira, 2022) Ilgar, Mehtap; Akcicek, Mehmet; Ekmekyapar, MuhammedOBJECTIVE: Abdominal pain is one of the most common reasons for admission to the emergency department in the geriatric population. The aim of this study was to investigate the diseases frequently detected in elderly patients diagnosed with acute abdomen in the emergency department, the imaging methods used in the diagnostic processes of these diseases, and the prognosis of the patients. METHODS: In all, 175 patients who visited the emergency department due to abdominal pain and were hospitalized with a diagnosis of acute abdomen were evaluated. The patients were categorized into seven groups according to their diagnosis as biliary diseases, pancreatitis, appendicitis, gastrointestinal system perforation, ileus, mesenteric ischemia, and atypical causes. RESULTS: The mean age of the patients was 76.3 +/- 7.7 years (range 65-93), and 96 (54.9%) were women. The most common causes of acute abdomen were biliary diseases and pancreatitis. Ultrasonography (88.6%) was the most frequently preferred imaging method in the emergency department, and it was most frequently used for biliary diseases. Notably, 20 (11.4%) patients were treated in the intensive care unit, and 9 (5.1%) patients died. CONCLUSION: The most common causes of acute abdomen in the geriatric population were biliary diseases and pancreatitis, and ultrasonography imaging was the most common choice for the diagnosis of these diseases. In elderly patients with abdominal pain, rapid and accurate diagnosis and selection of the correct imaging method are extremely important.Öğe Chilaiditi Syndrome: A Rare Cause of Shortness of Breath and Abdominal Pain(Aves, 2018) Ekmekyapar, Muhammed; Turtay, Muhammet Gokhan; Yucel, Neslihan; Oguzturk, Hakan; Gurbuz, Sukru; Derya, SerdarIntroduction: Chilaiditi syndrome is a rare condition in which a segment of the small or large intestine is interposed in between the diaphragm and the liver. This case report presents a patient who was admitted to the Department of Emergency Medicine, Turgut Ozal Medical Center with complaints of respiratory distress and abdominal pain and then diagnosed with Chilaiditi syndrome. Case Report: An 81-year-old female patient was admitted to the emergency department with complaints of difficulty in breathing and abdominal pain. The patient's anamnesis indicated that difficulty of breathing increased when she had abdominal pain. There was no defense or rebound, but sensitivity was observed on abdominal examination. Other system examinations were normal. Abdominal ultrasonography performed on the patient was also normal. A dynamic thorax-abdominal tomography was obtained in terms of differential diagnosis of the patient who had abdominal pain. In the dynamic thorax-abdominal tomography of the patient, loops of the colon were visualized in the vicinity of the liver anterior segment, and these images indicated with Chiliaditi syndrome. Conclusion: As a result, when the causes of shortness of breath and abdominal pain are investigated, Chiliaditi syndrome should be considered as a differential diagnosis.Öğe Chilaiditi syndrome: a rare cause of shortness of breath and abdominal pain(Aves, buyukdere cad 105-9, mecıdıyekoy, sıslı, ıstanbul 34394, turkey, 2018) Ekmekyapar, Muhammed; Turtay, Muhammet Gokhan; Yucel, Neslihan; Oguzturk, Hakan; Gurbuz, Sukru; Derya, SerdarIntroduction: Chilaiditi syndrome is a rare condition in which a segment of the small or large intestine is interposed in between the diaphragm and the liver. This case report presents a patient who was admitted to the Department of Emergency Medicine, Turgut Ozal Medical Center with complaints of respiratory distress and abdominal pain and then diagnosed with Chilaiditi syndrome. Case Report: An 81-year-old female patient was admitted to the emergency department with complaints of difficulty in breathing and abdominal pain. The patient's anamnesis indicated that difficulty of breathing increased when she had abdominal pain. There was no defense or rebound, but sensitivity was observed on abdominal examination. Other system examinations were normal. Abdominal ultrasonography performed on the patient was also normal. A dynamic thorax-abdominal tomography was obtained in terms of differential diagnosis of the patient who had abdominal pain. In the dynamic thorax-abdominal tomography of the patient, loops of the colon were visualized in the vicinity of the liver anterior segment, and these images indicated with Chiliaditi syndrome. Conclusion: As a result, when the causes of shortness of breath and abdominal pain are investigated, Chiliaditi syndrome should be considered as a differential diagnosis.Öğe Clinical and radiological observation of stroke cases in the emergency department of a university hospital(2021) Ekmekyapar, Tuba; Ekmekyapar, Muhammed; Sahin, Levent; Solgun, Omer Faruk; Gurbuz, SukruStroke is an important cause of mortality and morbidity. In our study, the accuracy relationship of the radiological imaging methods within themselves, together with the existing risk factors of stroke patients diagnosed in the emergency department, and their mortality status were examined. This study was conducted with 252 patients. The patients' ages and sexes, clinical features, arterial blood pressure and laboratory findings, history of diseases, vascular imaging methods, thrombolytic therapy applications, length of stay, and mortality rates were examined retrospectively. There was no statistical difference between stroke types and age and sex (p=0.73, p=0.53). While 65 patients had a recurrent stroke, male patients were dominant in this group (p=0.00). Hypertension was the most common comorbid disease with a frequency of 64.4%. Hemiparesis, speech disorder, headache, and hypoesthesia symptoms were prominent symptoms in patients with ischemic stroke, while changes in consciousness were the most prominent symptom in patients with hemorrhagic stroke (p=0.00). In 90.9% of the 59 patients who underwent both doppler ultrasonography (USG) and angiography examinations, doppler USG determined cases without 70% and higher stenosis as significant. The length of intensive care unit stay for hemorrhagic stroke was significantly longer (p=0.03), and the mortality rates of patients with 70% and higher stenosis and undergoing digital subtraction angiography (DSA) were found to be significantly higher (p=0.01). We observed that doppler USG was not an adequate method in detecting significant stenoses (70% and higher), but it was an important examination method for showing cases without significant stenosis. Furthermore, the longer length of intensive care unit stay in patients with hemorrhagic stroke and the higher mortality rate in patients with 70% and higher stenosisand undergoing interventional angiography are other important resultsÖğe Comparison of Auxiliary Diagnostic Methods in Pulmonary Embolism(2021) Ekmekyapar, Muhammed; Gürbüz, Şükrü; Şahin, LeventAim: We investigated the importance of auxiliary diagnostic methods in cases when computed tomography pulmonary angiography (CTPA) cannot be used in pulmonary embolism (PE) with a high mortality rate. Materials and Methods: Patients were selected after the exclusion criteria were applied in a sample created from a single center. A total of 86 patients included in our study were examined in terms of clinical features, auxiliary diagnostic methods, anticoagulant use, and hospitalization and discharge status according to the massive or segmental involvement of PE in CTPA. Results: The mean age of the patients was 52.29±14.14 years. According to the CTPA results, there were 46 (53.5%) patients with massive involvement and 40 (46.5%) patients with segmental involvement. While there were 38 (82.6%) patients with massive involvement whose right chambers of the heart were dilated in echocardiography (ECHO) results, there were 19 (47.5%) patients with segmental involvement. There was a statistical significance between the massive involvement of CTPA and ECHO result (p=0.001). Conclusion: ECHO may be preferred as an auxiliary radiological method in the diagnosis of PE in emergency departments (ED), especially in massive embolisms.Öğe Importance of vertigo classification in the emergency department and its effects on economic burden(2023) Ekmekyapar, Muhammed; Ekmekyapar, Tuba; Gürbüz, ŞükrüAim: Patients with vertigo present to the emergency department with their clinical status and social comfort significantly impaired. More importantly, diseases that can pose a life-threatening risk may also underlying vertigo. In our study, we aimed to detect life- threatening conditions in vertigo patients early, and to alleviate the economic burden by preventing unnecessary radiological imaging in emergency services. Materials and Methods: Three hundred eighteen patients were included in the study. The patients were divided into two groups as peripheral and central vertigo. Patients’ age, sex, temperature, pulse, and arterial blood pressure values were examined. The complaints at admission were grouped as dizziness, dizziness+nausea-vomiting, and dizzi- ness+neurological complaint. Furthermore, patients’ examination findings, history of diseases, and laboratory data were recorded. Radiological imaging methods used in the emergency department, the requested consultations, peripheral-central vertigo, and hospitalization-discharge status were examined. Results: Of all patients, 287 (90.3%) and 31 (9.7%) had peripheral and central vertigo, respectively. The mean age of patients with peripheral vertigo was 52.34±17.38 years, while the mean age of patients with central vertigo was 68.06±19.56 years. There was a statistically significant difference between peripheral-central vertigo and age. A statis- tically significant difference was revealed between peripheral-central vertigo and systolic and diastolic blood pressure. In laboratory data, we found a significant difference between peripheral-central vertigo and glucose and CRP. Hypertension was the most common dis- ease in the history. Conclusion: The etiology of vertigo should be clarified quickly and reliably in emergency departments. To this end, the patient’s complaints and the findings obtained as a result of the examination along with auxiliary radiological imaging methods are vital. Thus, the diagnosis and treatment of patients with severe vertigo will be performed earlier, and unnecessary radiological imaging will be prevented. As a result, the economic burden will also decrease with the decrease in the examinations performed.Öğe An investigation of extremity injuries in school-aged children presenting to the emergency department(2020) Ekmekyapar, Muhammed; Sahin, LeventAim: It was aimed that various preventive measures should be taken with the demographic characteristics, trauma etiology, injury sites and radiological imaging results of school-age pediatric patients admitted to the emergency department after isolated extremity trauma.Material and Methods: In our two-center study, 748 patients with isolated limb injuries aged 6-17 years were prospectively evaluated. Their gender, age, causes of trauma, requested radiological imaging in patients classified according to injury sites, treatments, requested consultations, hospitalization and discharge rates were examined.Results: The mean age was 12.2 ± 3.2 years. The most common cause of injury (52.8%) was fall while playing. Fall while playing (FWP) and extremity injuries occurring during sport were more in males than females (p = 0.020). When injury sites were compared according to trauma etiologies, injuries were observed mostly in the left upper extremity in FWPs and mostly in the right upper extremity in school accidents (p = 0.009). An orthopedic consultation request was high in patients who underwent splinting and surgical treatment (p = 0.000). While fracture was detected in 136 (18.1%) patients included in the study, splint or Velpeau bandage treatments were applied to 314 (41.9%) patients. Conclusion: In school-aged child injuries, the most common cause was observed to be "fall," which is a preventable cause. Protective measures that will be taken for the safety of children at home, playgrounds, and schools can reduce these injuries.Öğe Long term analysis of patients admitted to the emergency room as a result of occupational accidents(Biomedical Research, 2016) Gürbüz, Şükrü; Aydoğan, Mustafa Said; Çolak, Cemil; Turtay, Muhammet Gökhan; Oğuztürk, Hakan; Gür, Ali; Ekmekyapar, Muhammed; Ercan, AbdullahObjective: We aimed to describe the demographic and clinical features and healthcare costs associated with occupation related injuries between 2010 and 2015. Method: The patients of occupational accidents were evaluated according to age, gender, accident type, trauma localization, duration of hospitalization in the emergency department, prognosis, imperfection types causing to accidents and outcomes and cost spent. Results: 449 patients diagnosed with occupational accidents from January 2010 to December 2014 were included in the analysis. Of injury referring distribution the most common cause of occupational accidents (type of accidents) was extremities injury 141 (31.4%). About 50.1% of all estimated construction occupational accidents treated in the emergency department affected upper extremities. Remaining injuries primarily affected the head, lower extremities and thorax (45%). The mean cost of an inpatient admission following occupational accidents was $232, and the overall costs of patient care for the study sample during this time frame exceeded $26.142 annually. Conclusions: Occupational injuries, illnesses, and fatalities remain a major public health and economic concern around the world. The findings from this study may be beneficial in the development, implementation, and evaluation of injury prevention policies and prevention programs.Öğe Long term analysis of patients admitted to the emergency room as a result of occupational accidents(Biomedical Research, 2016) Gürbüz, Sükrü; Aydoğan, Mustafa Said; Çolak, Cemil; Turtay, Gökhan; Ögüztürk, Hakan; Gür, Ali; Ekmekyapar, Muhammed; Ercan, AbdullahObjective: We aimed to describe the demographic and clinical features and healthcare costs associated with occupation related injuries between 2010 and 2015. Method: The patients of occupational accidents were evaluated according to age, gender, accident type, trauma localization, duration of hospitalization in the emergency department, prognosis, imperfection types causing to accidents and outcomes and cost spent. Results: 449 patients diagnosed with occupational accidents from January 2010 to December 2014 were included in the analysis. Of injury referring distribution the most common cause of occupational accidents (type of accidents) was extremities injury 141 (31.4%). About 50.1% of all estimated construction occupational accidents treated in the emergency department affected upper extremities. Remaining injuries primarily affected the head, lower extremities and thorax (45%). The mean cost of an inpatient admission following occupational accidents was $232, and the overall costs of patient care for the study sample during this time frame exceeded $26.142 annually. Conclusions: Occupational injuries, illnesses, and fatalities remain a major public health and economic concern around the world. The findings from this study may be beneficial in the development, implementation, and evaluation of injury prevention policies and prevention programs.Öğe Long-term analysis of patients admitted to the emergency room as a result of occupational accidents(Allied Acad, 2016) Gurbuz, Sukru; Aydogan, Mustafa Said; Colak, Cemil; Turtay, Muhammet Gokhan; Oguzturk, Hakan; Gur, Ali; Ekmekyapar, MuhammedObjective: We aimed to describe the demographic and clinical features and healthcare costs associated with occupation related injuries between 2010 and 2015. Method: The patients of occupational accidents were evaluated according to age, gender, accident type, trauma localization, duration of hospitalization in the emergency department, prognosis, imperfection types causing to accidents and outcomes and cost spent. Results: 449 patients diagnosed with occupational accidents from January 2010 to December 2014 were included in the analysis. Of injury referring distribution the most common cause of occupational accidents (type of accidents) was extremities injury 141 (31.4%). About 50.1% of all estimated construction occupational accidents treated in the emergency department affected upper extremities. Remaining injuries primarily affected the head, lower extremities and thorax (45%). The mean cost of an inpatient admission following occupational accidents was $232, and the overall costs of patient care for the study sample during this time frame exceeded $26.142 annually. Conclusions: Occupational injuries, illnesses, and fatalities remain a major public health and economic concern around the world. The findings from this study may be beneficial in the development, implementation, and evaluation of injury prevention policies and prevention programs.Öğe Rupture of testicle accompanying multiple traumas: A case report(2020) Ekmekyapar, Muhammed; Turtay, Muhammed Gökhan; Gürbüz, Şükrü; Derya, Serdar; Gökçe, Hasan; Solgun, Ömer FarukIn this case report, we aimed to present an 18-year-old male patient who had ruptured testicle after severe testicular trauma that developed due to a motorcycle accident. An eighteen-year-old male patient was brought to the emergency service after a motorcycle accident. There were open fractures in the left arm and left leg. The scrotum was ruptured, both testicles were outside, and the right testicle was ruptured. The patient was underwent emergency surgery for intraabdominal hemorrhage and liver laceration by general surgery. Also urology joined the operation. Urology carried out right orchiectomy and left testicular fixation on the patient. Although rupture of testicles is a rare condition, it may accompany the diagnosis in patients with multiple traumas. Early urology consultation should be sought to be able to save testicles and minimize complications.Öğe Rupture of testicle accompanying multiple traumas: A case report(2020) Ekmekyapar, Muhammed; Turtay, Muhammed; Gurbuz, Sukru; Derya, Serdar; Gokce, HasanÖğe Secret Carbon Monoxide Intoxication Assessments of the Patients Who Presented to Emergency(2022) Derya, Serdar; Gürbüz, Şükrü; Oğuztürk, Hakan; Yücel, Neslihan; Turtay, Muhammet Gökhan; Ekmekyapar, Muhammed; Uyanık, ÖmürAim: The primary aim of this study is to evaluate patients who present to the emergency department with atypical symptoms in terms of occult Carbon monoxide (CO) poisoning, and the secondary aim is to compare the invasive and non-invasive values of Carboxyhemglobin (COHb) levels in patients with high CO levels. Material and Method: This prospective and descriptive study was conducted on 2775 adult patients who visited the Emergency Department (ED) between January 1 and March 31, 2015. The COHb levels of the individuals who applied to the emergency department with non-specific complaints were measured with a non-invasive multiwave pulse oximeter device and the date of application, age, gender, complaint, smoking history, pregnancy status, pulse COHb, blood COHb and blood metHb parameters were recorded in the preformed form. Values under 10% in smokers and under 6.6% in non-smokers were recorded as secret COHb intoxication. Results: 52.8% of the patients were male and 34.4% were smokers. The rate of pregnant women among female patients was 13.4%. The first three complaints were shortness of breath, chest pain and stomach ache. It was determined that the mean COHb of the patients was 1.44±1.65 in arterial blood gas and 1.75±1.63 in finger measurement. A highly significant positive correlation was found between the two averages. The COHb value measured by both techniques was higher in male patients and in smokers and non-pregnant patients. The rate of latent COHb intoxication was determined as 1% in smokers and 0.1% in non-smokers. Conclusion: We came to the conclusion that non-invasive COHb measurement can make positive contributions to the diagnosis of secret carbonmonoxyde intoxications.Öğe A Story of Extraordinary Abdominally Perforation(Emergency Medicine Physicians Assoc Turkey, 2020) Ekmekyapar, Muhammed; Gurbuz, Sukru; Derya, Serdar; Oguzturk, Hakan; Yucel, Neslihan; Turtay, Muhammet Gokhan; Ercan, AbdullahPneumoperitoneum is the result of a gastrointestinal (GI) tract perforation in more than 90% of cases. Perforation of the stomach or duodenum caused by peptic ulcer is considered the most common cause of pneumoperitoneum. In this article, we present a case of pneumoperitoneum associated with sigmoid colon perforation, which is the result of the patient trying to create a laxative effect by inserting the hose attached to the wash basin into his rectum and opening the water afterwards. An 89 years old male patient was brought to the emergency department with complaints of abdominal pain starting about 2 hours ago. The patient's abdominal ultrasonography showed free fluid up to 10 cm in the lower abdomen. Posterior anterior chest X-ray and direct standing abdominal X-ray of the patient had subdiaphragmatic free air and images with free fluid, pneumoperitoneum and perforation were obtained in contrast enhanced abdominal tomography. As a result of surgery performed by general surgery it was seen approximately 30 cm proximal from the rectumthat there was a 4 cm perforation in the sigmoid colon. We must consider pneumoperitoneum, which is the result of colon perforation especially in elderly patients with acute abdominal pain, to be definitely among our differential diagnoses.Öğe Unexpected Acute Aorta Dissection with Ischemic Stroke: A Case Report(Emergency Medicine Physicians Assoc Turkey, 2020) Ekmekyapar, Tuba; Ekmekyapar, Muhammed; Gurbuz, Sukru; Oguzurk, HakanIntroduction: Both acute aorta dissection and ruptured aorta aneurism are prominent causes of death in cardiovascular diseases. The frequency of developing neurological complications in aortic dissections is reported to be between 2 to 8%. Stroke is more common in dissections involving the proximal aorta, but paraparesis is more common in distal aortic dissections due to circulatory impairment in the spinal arteries. Case: The 70-year-old male patient was referred to our emergency service from an external center with diagnosis of acute ischemic stroke. The patient had experienced loss of strength on his left side and had syncope one hour before. After his physical examination, the patient received computerized brain tomography and diffusion MR imaging with the pre-diagnosis of acute stroke. For the patient who had an appearance of acute diffusion restriction in the right parietal region in the diffusion MRI and had a chance of thrombolytic treatment, thrombolytic treatment was planned. However, the general status of the patient was worsened in this checkup examination, and his GCS score regressed down to 7. The poor current condition of the patient could not be explained by the acute ischemic stroke in the right parietal region. Aorta dissection, which may progress with clinical signs of stroke, was considered for the patient, and as an advanced test, dynamic thorax CT angiography was taken. In the dynamic thorax CT angiography of the patient, aneurism in the ascending aorta, dissection and fluid around the pericardium and left lung (hemorrhage?) were observed. The echocardiography of the patient revealed that the fluid around the pericardium caused tamponade. Discussion: Cardiovascular system diseases are the most common cause of natural sudden deaths and are mostly seen in middle and older ages. Acute myocardial infarction and coronary artery disease are the most common cardiovascular diseases, however, sudden deaths due to aortic dissection and rupture have been reported less frequently. The most typical symptom is the sudden start of severe chest or back pain. Patients typically visit with complaints of tearing chest and back pain, while they may visit with atypical clinical pictures wementioned in our cases such as abdominal pain, syncope, stroke. Sensory loss may also be seen in patients, and this is a neurological symptom which may extend from falling as leep to deep coma. Conclusion: Patients who visit emergency services with symptoms that are not expected for aorta dissection such as syncope, altered consciousness, hypotension, atypical abdominal pain and loss of strength in the extremities.
