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Öğe Akut apandisit tanısındaki güçlükler: İki olgu sunumu(Cumhuriyet Tıp Dergisi (ELEKTRONİK), 2009) Oğuztürk, Hakan; Ertan, Cem; Tekin, Yusuf Kenan; Eren, Şevki HakanÖz: Akut karın nedenleri arasında önemli bir yere sahip olan akut apandisitin tanısının geciktirilmesi veya karıştırılması istenmeyen komplikasyonlara yol açabilmektedir. Gebelikte ve bazı hastalıklarla akut apandisitin birlikteliği bu hastalığın akla getirilmesini zorlaştırabilmekte veya tanıda karışıklık ve gecikmeye yol açmaktadır. Bu olgu sunumunda gastroenterit ve gebelik birlikteliğinde olan akut apandisit klinik tabloları sunularak eksiksiz öykü, fizik muayene ve ayırıcı tanının önemi vurgulandı. Başlık (İngilizce): Complexities of the acute appendicitis diagnosis: Two case reports Öz (İngilizce): Acute appendicitis has an important place among causes of acute abdominal pain. Acute appendicitis can lead to unwanted complications if its diagnosis is confused or delayed. If acute appendicitis has occurred with pregnancy and other diseases such as gastroenteritis, diagnosis of acute appendicitis can be difficult as a result of confusion or delayed in its diagnosis. In the present study, we wanted to present and emphasize how definitive story, physical examination, and differential diagnosis are important in the diagnosis of acute appendicitis presented with pregnancy and gastroenteritis.Öğe Bir üniversite hastanesi acil servisine yapılan sevklerin incelenmesi(Türkiye Acil Tıp Dergisi, 2010) Ertan, Cem; Akgün, Feride Sinem; Yücel, NeslihanÖz: Amaç: Ülkemizde sağlık sisteminin basamaklı yapısı, basamaklar arası geçişlerin doğru kullanılması durumunda, hastaların ihtiyaç duydukları hizmeti almalarını sağlarken, kaynakların uygun kullanımına da yardımcı olabilir. Yürüttüğümüz bu kesitsel çalışmada bu sonucun elde edilmesine katkıda bulunmak amacıyla hastanemize sevk edilen hastaların özellikleri ve sevk koşulları incelendi. Gereç ve Yöntem: 2006 yılının ilk 2 ayı içerisinde hastanemiz acil servisine sevk edilen 541 hasta değerlendirildi. Hastaların demografik verileri, sevk sonundaki vital bulguları, sevk öncesi tanıları, sevk koşulları ve sevklerin günlere ve saatlere göre dağılımları kaydedildi. Bulgular: Acil servise sevk edilen hastaların yaş ortalaması 47.97±21.02 idi ve 245’i (%45.3) erkekti. Hastaların %98.5’inin sevk öncesinde görüşme olmaksızın gönderildiği saptandı. En sık sevk öncesi tanı %9.6 sıklıkla karın ağrısıydı. Sevklerin %87.2’si ambulans ile gerçekleştirilirken, bu sevklerin ancak %77.7’sine uygun sağlık personeli eşlik etmişti. Hasta sevklerinin haftanın günlerine göre dağılımı incelendiğinde en yoğun günler sırasıyla Cuma (%19.6), Pazar (%16.8) ve Cumartesi (%14.4) günleri olurken, gün içerisinde en yoğun sevkin saat 12: 00 ile gece 23: 59 arasındaki yaşandığı saptandı (%67.4). Sonuç: Çalışmamız hastanemize yapılan sevklerin büyük çoğunluğunun ilgili birimlere haber verilmeksizin kurum ambulasları gerçekleştirildiğini ortaya koymaktadır. Hastaların 1/5’i doktorsuz ambulansla gönderilmişti. Sevklerin çoğunluğu mesai saatleri dışında ve spesifik ön tanılar konulmadan yapıldığı dikkati çekmektedir. Hastaların büyük çoğunluğu ise bir epikriz olmaksızın gönderilmekte ve ilk başvurdukları merkezlerde yapılan uygulamalar sevk edildikleri kuruma bildirilmemektedir. Başlık (İngilizce): Evaluation of patient transfers to the emergency department of a university hospital Öz (İngilizce): Objective: The tiered health care delivery system helps patients get the medical care they need while avoiding unnecessary consumption of the limited sources in the case a proper patient flow is managed within the system. We aimed to analyze the profile and transfer conditions of the patients referred to our center with this cross-sectional study. Methods: A total of 541 patients who were referred to our emergency department within the first two months of 2006 were evaluated. The demographic data, vital signs and diagnoses at the time of referral, the means of patient transfer and the distribution patterns of the patient transfers based on the days of the week and the hours of the day were recorded. Results: The mean age of the patients was 47.97±21.02, and 245 were (45.3%) male. 98.5% of the patients were referred without prior consulting to the receiving facility. The most common pre-tranfer diagnosis was abdominal pain (9.6%). While 87.2% of the patients were transported with ambulances, only 77.7% of them had appropriate medical personnel accompanying them. The busiest days for patient transfers were Fridays (19.6%), Mondays (16.8%) and Saturdays (14.4%) respectively. The busiest interval of the day was between 12: 00 pm and 23: 59 pm (67.4%). Conclusions: Our study showed that most of the transfers were performed by hospital ambulance services without consulting to the receiving facility. Almost 20% of the patients were not accompanied by a doctor in the ambulance. Patients were transferred after business hours and without proper specific diagnoses made. Most the patients were transferred without an appropriate epicrisis; therefore the receiving facilities were not informed about the prior interventions performed on patients.Öğe Characteristics of patients who are newly diagnosed with cancer after visiting the emergency department(Drunpp-Sarajevo, 2011) Yucel, Neslihan; Akgun, Feride Sinem; Ertan, Cem; Serin, Meltem; Ozgur, KarciogluThe purpose of this study was to assess clinical characteristics and survival times for patients who presented to a university hospital emergency department with acute problems and were subsequently admitted and diagnosed with cancer. Methods: The patients were 143 individuals who were newly diagnosed with cancer after admission to the emergency department at a university hospital. Medical records were reviewed and data were retrospectively evaluated. Results: The patients included 90 males and 53 females, and the median age was 68 years. At time of diagnosis, 73 patients had locoregional disease and 70 had metastatic disease. Most common primary tumor sites were lung (n = 33), gastric (n = 28), colorectal region (n = 23) and brain (n = 13). Of 143 patients, 33 died of their disease in hospital and 110 were discharged. Most common signs and symptoms were pain (n = 35), bleeding (n = 24) and shortness of breath (n = 23). Medical conditions that necessitated emergency admission were increased intracranial pressure (n = 27), hemorrhage (n = 23), infection (n = 23) and intestinal obstruction (n = 21). The median survival time for the 143 patients total was 6.2 +/- 1.2 months (range, 4.1-8.3 months). Conclusion: Emergency departments play an important role in the diagnosis and treatment of cancer patients, and even in screening for this disease. Individuals with undiagnosed cancer often present an unique set of challenges for emergency physicians because their presentation can range from vague-related symptoms to clear symptoms of malignancy that demand immediate treatment. In order for emergency physicians to be able to diagnose cancer in this patient group, it is important to maximize awareness of the cancer-related symptoms that these individuals may display.Öğe Electrical Injuries: The Demographical and Clinical Features(Galenos Yayincilik, 2010) Oguzturk, Hakan; Turtay, Muhammet Gokhan; Ertan, Cem; Akgun, Feride Sinem; Tekin, Yusuf KenanAim: Electrical injuries are an important health problem in our country, as well as worldwide. The aim of this study was to explore the demographic characteristics, complications and mortality associated with electrical injuries. Methods: In this study, 38 patients who had been exposed to electrical injuries and treated at the Emergency Department of, Faculty of Medicine, Inonu University between October 2008 and October 2010 were reviewed. Data pertaining to the patients were analysed retrospectively. Results: Out of 38 patients, 28 (73.7%) were male and 10 (26.3%) female. Electrical injuries were most frequently encountered in the 17-29 year age group, constituting 39.5% of cases. Eight (21.1%) patients were exposed to high voltage and 30 (78.9%) to low voltage. Among the circumstances leading to electrical injury, household accidents (63.2%) prevailed over the occupational accidents (36.8%). Two patients died due to sepsis. The overall mortality rate was 5.3 % and the mean hospital stay was 4.1 +/- 5.2 days. Conclusion: The results obtained from this research with respect to the demographic and clinical features can help the development of a particular strategy for electirical injuries.Öğe Elektrik yaralanmaları: Demografik ve klinik özellikler(2010) Oğuztürk, Hakan; Turtay, Muhammet Gökhan; Ertan, Cem; Akgün, Feride Sinem; Tekin, Yusuf KenanÖz: Amaç: Elektrik yaralanmaları tüm dünyada oldu¤u gibi ülkemizde de önemli bir sağlık sorunu olup, bu yaralanmalarla ilgili ülkemiz için yeterli veri bulunmamaktadır. Çalışmamızın amacı elektrik yaralanmalarının demografik özellikleri, komplikasyonları ve bu yaralanmalara bağlı gelişen mortalitenin araştırılmasıdır. Yöntemler: Bu çalışmada Ekim 2008-Ekim 2010 tarihleri arasında İnönü Üniversitesi Tıp Fakültesi Acil Tıp Anabilim dalına elektrik yaralanması ile getirilen ve tedavi edilen 38 hasta araştırıldı. Hastalarla ilgili bilgiler retrospektif olarak incelendi Bulgular: Olguların 28’i (%73,7) erkek, 10’u (%26,3) kadındı. Elektrik yaralanmalarının en sık 17-29 yaş aralı¤ında olduğu saptandı. Olguların 30’u (%78,9) düşük voltaj, 8’i (%21,1) ise yüksek voltajlı elektrik yaralanmasıydı. Elektrik yaralanmasına yol açan koşullar arasında ev kazaları (%63,2) iş kazalarından (36,8%) daha çok görülmekteydi. İki hastada ölüm nedeni sepsisti. Mortalite oranı %5,3, ortalama hastanede kalış süresi ise 4,1±5,2 gündü. Sonuç: Bu araştırmadan elde edilen bulgular demografik ve klinik özellikleri göz önüne alarak elektrik yaralanmasını önlemeye yönelik farklı bir strateji oluşturmasına hizmet edebilir. (Haseki Tıp Bülteni 2010; 48: 139-41)Öğe Evaluation of Intestinal Parasites in Diarrheic Patients Refer to the Emergency Medicine Department of the Inonu University School of Medicine(Duzce Univ, 2010) Oguzturk, Hakan; Turtay, Muhammet Gokhan; Ertan, Cem; Kaya, Ozlem Makbule; Atambay, Metin; Tekin, Yusuf KenanPurpose: The infections caused by intestinal parasites are one of the leading health issues both by means of individuals and society, especially in developing countries. We analyzed stool samples of 54 patients aged 18 to 67, who presented at our emergency department during June 2009 - October 2009 period, for parasitological agents. Methods: Stool samples were examined using native-lugol, trichrome staining and Kinyoun acide fast methods. Entamoeba species (Entamoeba histolytica and/or dispar) were found to be the most common parasites. Results: Of 54 patients' samples 12 (22,2%) were found to be positive for parasites by microscopy, six (11,1%) by Thrichrome painted samples and one by Kinyoun acid fast painted samples. Most common detected parasites were Entemoeba species (Entamoeba histolytica and/or dispar) found in seven samples (12,9%). Seven of the patients found positive by microscopy were female (12,9%), male five (41,7%). The complaints and of all 54 patients were recorded. Malaise and nausea were found to be the most common symptoms in groups both with and without parasites. Conclusion: Parasitological agents have to be recalled in patients presenting to emergency departments with diarrhea as well as bacterial, viral and fungal pathogens.Öğe Evaluation of patient transfers to the emergency department of a university hospital(Elsevier Science Bv, 2010) Ertan, Cem; Akgun, Feride Sinem; Yucel, NeslihanObjective: The tiered health care delivery system helps patients get the medical care they need while avoiding unnecessary consumption of the limited sources in the case a proper patient flow is managed within the system. We aimed to analyze the profile and transfer conditions of the patients referred to our center with this cross-sectional study. Methods: A total of 541 patients who were referred to our emergency department within the first two months of 2006 were evaluated. The demographic data, vital signs and diagnoses at the time of referral, the means of patient transfer and the distribution patterns of the patient transfers based on the days of the week and the hours of the day were recorded. Results: The mean age of the patients was 47.97 +/- 21.02, and 245 were (45.3%) male. 98.5% of the patients were referred without prior consulting to the receiving facility. The most common pre-tranfer diagnosis was abdominal pain (9.6%). While 87.2% of the patients were transported with ambulances, only 77.7% of them had appropriate medical personnel accompanying them. The busiest days for patient transfers were Fridays (19.6%), Mondays (16.8%) and Saturdays (14.4%) respectively. The busiest interval of the day was between 12: 00 pm and 23: 59 pm (67.4%). Conclusions: Our study showed that most of the transfers were performed by hospital ambulance services without consulting to the receiving facility. Almost 20% of the patients were not accompanied by a doctor in the ambulance. Patients were transferred after business hours and without proper specific diagnoses made. Most the patients were transferred without an appropriate epicrisis; therefore the receiving facilities were not informed about the prior interventions performed on patients.Öğe Fahr's Syndrome: A Patient with Idiopathic Hypoparathyroidy in the Emergency Department(Emergency Medicine Physicians Assoc Turkey, 2013) Ertan, Cem; Karaman, Esra; Oguzturk, Hakan; Ertan, DilekPatients attending emergency departments (EDs) with nonspecific neurological symptoms have a wide range of differential diagnoses. In this case report, we present a female patient with episodic peripheral paresthaesia, who ended up with a diagnosis of Fahr's syndrome, a rare pathology characterised by bilateral striatopallydodental calcifications. A 78 year old female presented to our ED with numbness in the left arm and leg, and a history of four episodes of facial numbness which occurred during the previous day. Physical examination of the patient revealed no lateralising neurological deficits, but Chvostek's sign was (+). The only notable pathology of the patient arising from routine lab work was the Ca level of Ca++ (5.8 mg/dL). A computed tomography scan of the brain showed bilateral calcifications in the basal ganglia and cerebellum. The patient was examined by a neurology and endocrinology consultant in the ED and hospitalised for hypocalcaemia replacement and further diagnostic endocrinology investigations related to Fahr's syndrome. In patients with acute nonspecific neuropsychiatric symptoms, especially in the case of Ca++ metabolism disorders, Fahr's syndrome should be a part of differential diagnosis, and diagnostic investigations performed in the ED should include this syndrome.Öğe Moksifloksasine bağlı görsel halüsinasyonlar: bir olgu sunumu(Türkiye Acil Tıp Dergisi, 2013) Pepele, Mustafa Safa; Ertan, Cem; Yücel, NeslihanÖz: Acil servise nörolojik semptomlarla başvuran bir hastada organik beyin hastalıkları ve psikiyatrik nedenler öncelikli ayırıcı tanılar olsa da, diğer metabolik nedenler ve ilaç yan etkileri gibi olası etkenler de göz önünde bulundurulmalıdır. Bu yazıda, acil servisimize etrafa baktığında gözünün önünde turuncu renkli duvar kâğıdı görme, zemine baktığında yerden su kaynaması ve dalga dalga yayılması şikâyetiyle başvuran 65 yaşında bir kadın hasta sunuldu. Kronik obstrüktif akciğer hastalığı (KOAH) dışında altta yatan bir hastalığı olmayan hastanın düzenli kullandığı bir ilaç da mevcut değildi. Nöropsikiyatrik muayenesinde yer-zaman oryantasyonu yerindeydi ve nörolojik defisiti yoktu. Hastaya bir gün önce nefes darlığı nedeniyle gittiği hekim tarafından Moksifloksasin 400 mg tablet başlandığı ve ilk dozu takiben bahsi geçen bulguların geliştiği öğrenildi. Hastanın acil serviste yapılan laboratuvar incelemelerinde ve bilgisayarlı beyin tomografisinde patolojik görünüme rastlanmadı. Acil servisteki takibinin altıncı saatinde şikayetleri ortadan kalkan hasta, moksifloksasine bağlı görsel halüsinasyon ön tanısı ile, ilacı değiştirilerek taburcu edildi. Hastanın 24 saat sonra telefon ile genel durumu sorulduğunda her hangi bir semptomu olmadığı öğrenildi. Başlık (İngilizce): Moxifloxacin hydrochloride related visual hallucinations: a case presentation Öz (İngilizce): Although the foremost encountered differential diagnosis in patients with neurological complaints in the emergency departments (ED) are organic nervous system diseases and psychiatric disorders, other metabolic disturbances and drug related adverse effects shall be considered as well. We present a 65 year old female patient who attended to our ED with visual hallucinations such as orange colored wallpaper, boiling water on the ground and wave patterns for the last 3 hours. Past medical history was clear for all but chronic obstructive pulmonary disease. Neuropsychiatric examination revealed a fully oriented, neurologically intact patient. After further questioning, we learned that the patient was on moxifloxacin 400 mg PO for two days and the symptoms started following the first dose of moxifloxacin. Laboratory and radiological work up including brain CT showed no pathognomonic findings. The patient, whose complaints totally resolved at the 6th hour of her follow-up in the ED was discharged with the diagnosis of Moxifloxacin related visual hallucinations with relevant modifications on her antibacterial treatment. Telephone follow-up 24 hours later revealed that our patient was symptom free.Öğe Moxifloxacin Hydrochloride Related Visual Hallucinations: A Case Presentation(Elsevier Science Bv, 2013) Pepele, Mustafa Safa; Ertan, Cem; Yucel, NeslihanAlthough the foremost encountered differential diagnosis in patients with neurological complaints in the emergency departments (ED) are organic nervous system diseases and psychiatric disorders, other metabolic disturbances and drug related adverse effects shall be considered as well. We present a 65 year old female patient who attended to our ED with visual hallucinations such as orange colored wallpaper, boiling water on the ground and wave patterns for the last 3 hours. Past medical history was clear for all but chronic obstructive pulmonary disease. Neuropsychiatric examination revealed a fully oriented, neurologically intact patient. After further questioning, we learned that the patient was on moxifloxacin 400 mg PO for two days and the symptoms started following the first dose of moxifloxacin. Laboratory and radiological work up including brain CT showed no pathognomonic findings. The patient, whose complaints totally resolved at the 6th hour of her follow-up in the ED was discharged with the diagnosis of Moxifloxacin related visual hallucinations with relevant modifications on her antibacterial treatment. Telephone follow-up 24 hours later revealed that our patient was symptom free.Öğe Paediatric trauma patients and attention deficit hyperactivity disorder: correlation and significance(Bmj Publishing Group, 2012) Ertan, Cem; Ozcan, Ozlem Ozel; Pepele, Mustafa SafaIntroduction Trauma is one of the leading reasons for emergency department (ED) visits in children. Hyperactivity, inattentiveness and impulsiveness may contribute to injury proneness. The aim of this study was to evaluate the prevalence and role of attention deficit hyperactivity disorder (ADHD) in children with trauma. Methods Trauma patients aged 3-17 attending the ED were included in the study group. Parents were informed after medical care had been given to their children, and demographic data and information about the trauma were collected. Later, parents were asked to complete the Conners' Parent Rating Scales-Revised questionnaire for ADHD symptoms. The control group consisted of children of similar age and sociocultural characteristics who attended the hospital for reasons other than trauma. Cases in which the child apparently had no active role in the trauma or where the parents did not complete the Conners' Parent Rating Scales-Revised questionnaire were excluded from the study. Results Fifty-five children were included in the study group (mean age 7.49 (range 3-14; SD 3.3); 33 (60%) were male). The control group was statistically similar to the study group. The most common trauma mechanism was falls (n = 31, 56.4%). All the subscale scores were significantly higher in the study group, and previous trauma-related ED visits were associated with significantly higher subscale scores. Conclusion The data suggest that children who make repeated trauma-related ED visits have a predisposition to ADHD, and they may benefit from screening for this disorder while in the ED.Öğe Retrospective Analysis of Intoxication Patients Admitted to Intensive Care Unit: Evidence Based Management vs Personal Experience(Drunpp-Sarajevo, 2011) Ertan, Cem; Gedik, Ender; Yucel, Neslihan; Akgun, F. Sinem; Aslan, Sibel; Togal, Turkan; Ersoy, M. OzcanObjective: Intoxication is a major problem in emergency departments (ED). Patients shall either be hospitalized or discharged after ED care. This decision requires a thorough evaluation of the patients' risk of mortality and cost effective approach. Aim of this study was to define characteristics of our poisoning patients and appropriateness of their hospitalization decisions to ICU. Methods: Adult patients hospitalized to ICU following admittance to ED within three years period with acute poisoning were retrospectively enrolled. Demographics, poisoning data, former psychiatric history, ICU follow up information, outcome at hospital discharge and in the first 28 days and predominant pathological clinical findings were recorded. Results: Our study group accounted for 3.6 per 1000 ED visits and 16.6% of ICU admittance. Mean age of the patients was 30.21 +/- 12.83 years, F/M ratio was 2.2 and 48.9% of the patients were married. Foremost encountered substances were psychoactive drugs (39.4%). 94.2% of our patients were suicidal and 39.8% of them used two or more agents. Intubation and mechanical ventilation was performed for 14 patients (5.1%), mean duration for intubated follow up was 7.07 days. Only two patients with caustic ingestions were dead (0.8%). Mean hospitalization period was 4.78 +/- 8.77 days and mean ICU bed use was 2.62 +/- 3.18 days. Total hospitalization duration was <= 48 hours 198 (72.3%) patients and > 48 hours in 76 patients (27.7%). Conclusion: We speculate that, high rates of early discharge from ICU may support the necessity of a solid ICU admission criterion.Öğe Traumatic central cord syndrome in a 2 year old child minor trauma but major complication(World J Emerg Med, 2014) Yücel, Neslihan; Ertan, Cem; Pepele, Mustafa Safa; Sığırcı, AhmetTraumatic central cord syndrome (TCCS) is the most frequently encountered incomplete spinal cord injury, and it is a relatively rare situation in children younger than 15 years, but may have serious consequences. METHODS: We report the case of a 2-year-old female child with upper extremity weakness following a simple fall. All vitals and systemic examination findings were normal, except for 2/5 muscular strength in the upper extremities. While radiographic imaging showed no pathologic fi ndings, MRI exposed spinal injury. The patient was treated conservatively with medication only. The medical treatment of the patient consisted of anti-edema treatment with methylprednisolone in the first 24 hours; 330 mg of methylprednisolone infused in the first hour, followed by 59 mg per hour during the next 23 hours. Along with pharmacological treatment, she received physiotherapy sessions during her 11-day hospitalization period. RESULTS: The child had full recovery within 6 months after conservative treatment. CONCLUSION: Neurological deficit without plain radiographic evidence in pediatric spinal trauma patients is a rare but signifi cant incidentÖğe Traumatic central cord syndrome in a 2-year-old child: minor trauma but major complication(Zhejiang Univ Sch Medicine, 2014) Yucel, Neslihan; Ertan, Cem; Pepele, Mustafa S.; Sigirci, AhmetBACKGROUND: Traumatic central cord syndrome (TCCS) is the most frequently encountered incomplete spinal cord injury, and it is a relatively rare situation in children younger than 15 years, but may have serious consequences. METHODS: We report the case of a 2-year-old female child with upper extremity weakness following a simple fall. All vitals and systemic examination findings were normal, except for 2/5 muscular strength in the upper extremities. While radiographic imaging showed no pathologic findings, MRI exposed spinal injury. The patient was treated conservatively with medication only. The medical treatment of the patient consisted of anti-edema treatment with methylprednisolone in the first 24 hours; 330 mg of methylprednisolone infused in the first hour, followed by 59 mg per hour during the next 23 hours. Along with pharmacological treatment, she received physiotherapy sessions during her 11-day hospitalization period. RESULTS: The child had full recovery within 6 months after conservative treatment. CONCLUSION: Neurological deficit without plain radiographic evidence in pediatric spinal trauma patients is a rare but significant incident.
