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Öğe The effects of different fluid resuscitations in the acute phase of combined traumatic brain injury and hemorrhagic shock in an experimental rat model(2021) Pepele, Mustafa Safa; Yücel, Neslihan; Öztanır, Mustafa Namık; Karadağ, Neşe; Takmaz, Ali Alper; Ozyalin, FatmaIt was aimed to investigate the utility of different fluid replacement therapies in the acute phase of a combined experimental traumatic brain injury and hemorrhagic shock model in terms of biochemical, hemostatic and pathological changes in the brain. 48 rats were divided up into 6 groups (n=8). Control group (S) rats were subjected to sham experimental hemorrhagic shock after which they underwent a sham operation, while trauma group (T) rats were subjected to hemorrhagic shock and subsequent head trauma with no treatment. Among the rats subjected to hemorrhagic shock and subsequent head trauma, those given 3% NaCl after this were named as HS group; those given HyperHeas [7.2% NaCl / 6% poly (O-2-Hydroxyethyl) starch] were named as HyperHS group; those given 0.9% NaCl were determined as NS group and those given ringer lactate as RL group. 24-hours later, the fluids’ effects were evaluated. The brain fluid content and INR levels were significantly higher in all the experimental groups when set against those in the NS group (p ranged <0.01 to <0.001). aPTT was significantly longer in the T and HS groups than in that seen in the NS group (p<0.001 for each). Rats in the HS and RL groups showed significantly more bleeding than those in the NS group (p<0.05). Of the treatment groups, the HyperHS group had more brain edema when compared to the NS and RL groups (p<0.05). The proportion of red neuron and necrosis was partially decreased in the treatment groups, with no significant difference determined between the HS, HyperHS, NS and RL groups (p>0.05). In conclusion, study findings support the safely use of normal saline and Ringer lactate solutions in prompt fluid resuscitation where both traumatic brain injury and hemorrhagic shock have occurred, based on the overall advantages pertaining to each critical prognostic parameter.Öğe Fenitoin kullanımı sonrası gelişen toksik epidermal nekrolizis(2015) Oğuztürk, Hakan; Turtay, Muhammet Gökhan; Pepele, Mustafa Safa; Güven, Taner; Turgut, Kasım[Abstract Not Available]Öğe Kafa travması ve hemorajik şok oluşturulan sıçanlarda, farklı sıvı tedavilerinin beyin ödemi, koagülasyon parametreleri, serum ADH, ACTH ve aldosteron düzeyleri üzerine olan etkilerinin karşılaştırmalı değerlendirilmesi(İnönü Üniversitesi, 2013) Pepele, Mustafa SafaDeneysel kafa travması ve hemorajik şok oluşturulan sıçanlarda gelişen beyin ödemi, koagülasyon parametreleri, hipoksiyi gösteren laktat düzeyi, hipotalamik hipofizyel aksı gösteren hormonlar (ADH, Aldosteron ve ACTH) üzerine travmadan hemen sonra verilen sıvıların etkilerinin karşılaştırmalı değerlendirilmesi hedeflenmiştir. Ayrıca bu sıvıların travmatik beyin dokusundaki etkilerini histopatolojik olarak değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Çalışmada ağırlıkları 180-210 gram arasında değişen 48 adet Spraque-Dawley cinsi erkek sıçan kullanıldı. Her biri 8 adet sıçan içeren 6 deney grubu oluşturuldu. Bütün sıçanlara kafa travması modeli uygulandıktan hemen sonra vena cava inferior kateterize edilerek hemorajik şok yapıldı. Hemorajik şoktan hemen sonra yine aynı yolla %09 serum fizyolojik, ringer laktat, hiperheas ve %3 serum fizyolojik verildi. Her grupta yer alan toplam 48 sıçan travmadan 24 saat sonra yaş-kuru ağırlık, kan analizi (aPTT, INR, trombosit, fibrinojen, D-dimer, laktat, ADH, ACTH, aldosteron) ve beyin dokusu (hasarsız olarak çıkarıldı) patolojik değerlendirmesi için sakrifiye edildi. Bulgular: Yaş-kuru ağırlık metodu ile ölçülen beyin su oranı %9 serum fizyolojik ve ringer laktat grubunda diğer gruplarda daha düşük bulundu. Koagülasyon parametrelerinden ortalama trombosit sayıları gruplar arasında istatistiksel olarak anlamlı bir fark yoktu. Ringer laktat ve %09 serum fizyolojik grubunda ortalama aPTT süresi travma grubundan daha kısaydı. En düşük INR düzeyi %09 serum fizyolojik grubundaydı. Ringer laktat grubunda sadece bir sıçanda D-dimer yüksekliği görülürken kontrol grubu dışındaki diğer gruplarda birden fazla sıçanda D-dimer yüksekliği tespit edildi. Bu verilerden farklı olarak fibrinojen düzeyi en düşük grup hiperheas resüsitasyon grubunda bulundu. Doku hipoksisi göstergesi olan laktat düzeyi hiperheas ve ringer laktat grubunda travma grubundan daha düşük olarak bulundu. Hemorajik şokta sıvı kaybına bir yanıt olarak salınan ADH sadece hiperheas grubunda düşük olarak tespit edildi. Grupların ACTH düzeyleri arasında istatistiksel olarak anlamlı bir fark yoktu. Travma grubunda aldosteron düzeyi diğer gruplardan daha yüksekti. Histopatolojik olarak iskemik hasar göstergesi olan red nöron ortancası hiperheas grubunda en düşüktü. Ödem en düşük ringer laktat ve %09 serum fizyolojik grubundaydı. Hücre ölümü göstergesi olan nekroz en düşük hiperheas ve %09 serum fizyolojik grubunda görüldü. Kanama en yüksek %3 serum fizyolojik grubunda tespit edildi. Sonuç: Bu çalışmada, kafa travması ve hemorajik şok ile gelen hastalarda sahada yada acil serviste %09 serum fizyolojik yada hiperheas (poli (O-2-hidroksietil) nişasta ve %7.2 sodyum klorür) sıvı resüsitasyonunda ilk olarak verilmesinin hastaya yarar sağlayacağı düşünülmektedir. Bununla birlikte, hangi sıvının diğerinden daha üstün olduğunu söylemek pek mümkün değildir.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 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 incident
