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Öğe Atrial Fibrillation due to Blunt Cardiac Injury: Case Report(Aves, 2018) Turgut, Kasim; Yucel, Neslihan; Oguzturk, Hakan; Ulutas, Zeynep; Afsin, AbdulmecitIntroduction: Blunt cardiac injury secondary to chest trauma is an important cause of emergency department admissions. It can range from asymptomatic myocardial contusion to significant dysrhythmia, acute heart failure, valvular injury, or cardiac rupture. Case Report A 38-years-old patient was admitted to the emergency department with atrial fibrillation (AF) that occurred after a car accident. The patient had chest trauma caused by striking the steering wheel during the accident. The AF rhythm of the patient reverted to the normal sinus rhythm at the 3rd hour after trauma. Conclusion: Emergency medicine professionals should keep in mind arrhythmias due to blunt chest trauma and take electrocardiograms of patients to be able to provide treatment in time.Öğe Cerebral Venous Sinus Thrombosis After Spinal Anesthesia: Case Report(Elsevier Science Bv, 2011) Yucel, Neslihan; Akgun, Feride Sinem; Tekin, Yusuf Kenan; Altinayar, Sibel; Alkan, AlpayCerebral venous sinus thrombosis is a rare clinical disorder which frequently shows up as prolonged headache unresponsive to standard therapies following spinal anesthesia. In this study, a 24 years old male presenting to our emergency department (ED) after many visits to other ED with headache which started following spinal anesthesia underwent fifteen days ago and being diagnosed with cerebral sinus venous thrombosis upon the evaluations is reported.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 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 The effect of lactate levels on prognosis in patients with ST-segment elevation myocardial infarction(2020) Gur, Ali; Ulutas, Zeynep; Turgut, Kasim; Guven, Taner; Yucel, Neslihan; Ermis, NecipAim: The prognostic role of lactate for early mortality in patients with ST-segment elevation myocardial infarction (STEMI) submitted to primary percutaneous transluminal coronary angiography (PTCA) is not elucidated clearly. This study was conducted with patients that presented to the emergency department (ED) with STEMI and underwent PTCA to investigate whether the changes in lactate values from ED admission to 24 hours after PTCA affected mortality.Material and Methods: This prospective observational study on 143 patients with STEMI was conducted at emergency service and tertiary-level cardiology clinic in a public university hospital. The documentation for each patient included detailed information on demographics, type of myocardial infarction according to electrocardiography and PTCA results, duration of hospital stay, vital signs, laboratory findings on admission, lactate levels 24 hours after PTCA, and outcome (hospital discharge or death). Results: The lactate values are higher in non-surviving groups measured 24 hours after PTCA (P 0.001). The differences in the lactate levels from the time of admission to 24 hours after PTCA were significantly lower in the non-surviving group (P 0.001). Conclusion: Among patients presenting to the ED with STEMI, a high lactate level is associated with mortality. Also, the difference between lactate values of the patients after PTCA is associated with the risk of mortality. Therefore, we consider that first lactate levels in ED and last lactate levels after PTCA in patients with STEMI can provide physicians with an insight into the possibility of mortality.Öğe The effect of plasmapheresis therapy on management of patients with snakebite(2023) Bıcakcıoğlu, Murat; Kalkan, Serkan; Doğan, Zafer; Togal, Turkan; Yucel, Neslihan; Demircan, Selcuk; Duzenci, DeccaneAim: The aim of the study was to evaluate the effectiveness of plasmapheresis therapy in patients with snakebite who were admitted to intensive care unit in the setting of tertiary referral hospital. Materials and Methods: The retrospective study involved 114 adult patients with snakebite who were admitted to a referral hospital’s intensive care unit between January 2012 and December 2022. The patients were divided into four groups according to the treatments. Group AV performed antivenom (Group AV) alone. Group PP performed plasmapheresis alone. Group AV+PP performed antivenom and plasmapheresis. Group GST performed only general supportive therapy. Results: Fifty two of 114 were included in Group GST, 31 in Group AV, 18 in Group PP and 13 in Group AV+PP. APACHE score, SOFA score, GCS, stage of the bite, length of stay in the intensive care unit, acute kidney injury, and hematological disorders were higher while the platelet count at admission was lower in Group PP and Group AV+PP compared to Group AV and Group GST (p< 0.05). Conclusion: Antivenom and plasmapheresis are not alternatives to each other, antivenom should be performed to patients according to the severity of the bite, and plasmapheresis should be performed without delay in those with severe hematological effects.Öğe Evaluation of Oxidant Injury Induced by Irradiation in Brain Tissues of Rats of Different Ages(Aves Yayincilik, Ibrahim Kara, 2009) Uyumlu, Ayse Burcin; Erkal, Haldun Suekrue; Batcioglu, Kadir; Serin, Meltem; Yucel, NeslihanObjectives: We aimed to evaluate the age-related changes of oxidative injury in the brain tissues of rats produced by radiotherapy that is widely used on cancer treatment. Study Design: Fifty-five male Wistar albino rats [ages of rats were 1, 4, 12 weeks (n=10) and 1 year (n=5)] were divided into four groups. Irradiation were performed on a Cobalt-60 unit using a single fraction of 8 Gy. The brain tissues were homogenized and divided into two portions. One portion was used for the measurement of the malondialdehyde (MDA). The other portion was used for the measurement of the protein concentration, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx) enzyme activities. Results: The SOD activity decreased significantly in 1-week-old rats (p<0.05). The decreases in GSHPx and CAT activities were more obvious in 1-week and 1-year-old rats than that in others. No significant changes were observed in adolescent and adult rats. The MDA levels of all groups increased. The highest MDA levels were seen in 1-year-old rats (p<0.05). Conclusion: Ionizing radiation used in radiotherapy affected antioxidant systems and increased MDA levels. These changes were more in the 1-week and 1-year-old rats than in others. This can be due to incomplete development of many systems in newborn rats and the loss of physiological capacities associated with aging in 1 -year-old rats.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 Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital(Taylor & Francis Inc, 2017) Gedik, Ender; Yucel, Neslihan; Sahin, Taylan; Koca, Erdinc; Colak, Yusuf Ziya; Togal, TurkanPurpose: The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care. Materials and Methods: The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients. Results: Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p < 0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p < 0.0001); higher alanine aminotransferase (ALT) (p < 0.0001); higher lactate dehydrogenase (LDH) (p < 0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005). Conclusion: DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.Öğe Histopathological evaluation of melatonin as a protective agent in heart injury induced by radiation in a rat model(Elsevier Gmbh, Urban & Fischer Verlag, 2014) Gurses, Iclal; Ozeren, Murat; Serin, Meltem; Yucel, Neslihan; Erkal, Haldun SukruIntroduction: Melatonin is a hormone which is known to be a powerful cardioprotective agent due to its free radical-scavenging properties. This study was carried out to evaluate whether melatonin administration prior to irradiation would have a protective effect on cardiac histopathological changes in an experimental rat model. Methods: Rats were divided into four groups. Single dose of 18 Gy radiation and sham radiation exposure were used in related groups. 50 mg/kg dose of melatonin were injected intraperitonally 15 min prior to radiation exposure. Analyses and assessments were performed 6 months after radiation exposure. Results: Severe myocardial fibrosis was observed prominently in three regions: the apex, tips of papillary muscles and adjacent to the atrioventricular valves. Inflammation was found to be more in irradiated groups. Increased inflammation and fibrosis were in concordance. The number of mast cells was found to be decreased in irradiated groups. Myocyte necrosis and fibrosis were diminished with melatonin while vasculitis was prevented. Conclusions: Elementary pathological lesions of radiation-induced heart disease (RIHD) are fibrosis, vascular damage, vasculitis and myocyte necrosis. Development of vasculitis was prevented by the use of melatonin. Fibrosis and necrosis were prominently decreased. Prevention of RIHD with the use of melatonin at the long term is encouraging according to the histopathological results. (C) 2014 Elsevier GmbH. All rights reserved.Öğe How to treat hemorrhagic shock and head trauma in the emergency department: isotonic or hypertonic saline?(E-Century Publishing Corp, 2019) Yucel, Neslihan; Sarikaya, Sezgin; Aktas, Can; Ay, Didem; Ekci, Baki; Comunoglu, Nil; Celikmen, Mustafa FeridunAims: This study was performed to compare the effects of physiological saline and hypertonic saline administered at an early stage in a model of traumatic brain injury associated with hemorrhagic shock. Material and methods: Twenty-eight male Sprague Dawley rats were divided into four groups. The rats in the control group (S) underwent a sham experimental hemorrhagic shock followed by a sham operation. The rats in the trauma group (T) underwent a hemorrhagic shock followed by head trauma and no treatment. The rats in the NS group underwent a hemorrhagic shock followed by head trauma and received 0.9% NaCl. The rats in the HS group underwent a hemorrhagic shock followed by head trauma and received a 7.5% NaCl solution. The weight-drop method was used for achieving head trauma. After the head trauma, hypovolemia was induced by the controlled hemorrhage of 30% of the blood volume. The animals were exposed to hypovolemic shock for a further 30 min prior to fluid resuscitation. Each animal received a single volume infusion of their assigned fluid within few minutes. The effects of different fluids were evaluated after 24-hours by their brain water contents, and histological, and biochemical tests. Results: Group T had a significantly higher mean value for brain water content than did the NS group (P < 0.0001). Also, the HS group had significantly higher mean values for brain water content than the NS group (P = 0.003). Edema and bleeding were more marked in the HS group compared to the NS group (both, P < 0.001) in the histopathological evaluation. Leukocyte accumulation was significantly increased in the untreated rats compared to the HS and NS groups (both, P < 0.001). More red neurons were observed in the rats in the T group than in the NS and HS groups (both, P < 0.001). The mean serum osmolarity was higher in the T group compared to NS, HS, and S groups (all, P < 0.001). The mean plasma ADH levels and the mean plasma aldosterone levels were significantly higher in the T group than in the S, NS, and HS groups (all, P < 0.0001). Conclusion: Although not significantly different in biochemistry, animals treated with HS early in hemorrhagic shock secondary to head injury had more brain water than those the received NS as defined histopathologically. Therefore, in emergency settings, NS should be used safely in the early stage of hemorrhagic shock secondary to head trauma.Öğe Hydrocortisone may act through the angiotensin II receptor-2 level in patients with catecholamine-resistant septic shock(Edizioni Minerva Medica, 2023) Baykan, Seyma; Bicakcioglu, Murat; Bulut, Nilufer; Yucel, Neslihan; Ersoy, Yasemin; Uysal, Nermin Kibrislioglu; Ozer, Ayse B.BACKGROUND: This study aimed to compare the serum angiotensin II and its receptor levels (AT1, AT2) in septic patients with catecholamine-responsive or resistant. The effect of hydrocortisone treatment on angiotensin II levels in the catecholamine-resistant septic patients was evaluated.METHODS: This prospective observational study enrolled 40 patients diagnosed with septic shock based on sepsis-3 cri-teria. Patients were divided into two groups according to the noradrenalin infusion rate required to keep the mean arterial pressure above 65 mmHg: control group and hydrocortisone group (control group: below 0.5 mu g/kg/min, hydrocortisone group: above 0.5 mu g/kg/min). Serum angiotensin II, AT1, AT2 levels were measured at the time of diagnosis (A), one hour after hydrocortisone treatment (B), and three days later (C).RESULTS: In the catecholamine-resistant group, angiotensin II and AT1 levels were higher than the catecholamine-responder group in all periods. The sensitivity and specificity of AT-1 was observed to be high in all periods. AT2 levels decreased after hydrocortisone treatment in the catecholamine-resistant group and cut-off value was found 11%.CONCLUSIONS: It was concluded that angiotensin II and AT1 can be used as a biomarker of refractory septic shock and hydrocortisone may provide their blood pressure correcting effect by reducing AT2 level in these patients. AT2 can be a therapeutic target in the catecholamine-resistant septic shock patients.Öğe Hypernatremia in the Emergency Department(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2012) Yucel, Neslihan; Sahin, Idris; Akgun, Feride Sinem; Koz, Suleyman; Berber, Ilhami; Ozdemir, Muzaffer GalipINTRODUCTION: To determine the symptoms, clinical characteristics, prevalence and outcome of patients with hypernatremia who presented at the emergency department. MATERIA LAND METHODS: We retrospectively studied patients who presented at the emergency department with hypernatremia (Na>148 meq/l) from January 2008 to December 2008. RESULTS: A total of 25.545 cases presented at the Emergency Department and hypernatremia was seen in 86 patients. The prevalence of hypernatremia was 0.34%. The mean age was 69.5 +/- 15.2 (2096, median age: 75) years and 51 of them (59%) were male. Forty percent of the patients died. There were no significant differences according to age, gender and admission Na levels. A comorbid disease were seen 99% of patients. Cerebrovascular disease(CVD), dementia/Alzheimer and hypertension were the most common co-morbid diseases (respectively, 34%, 34%, and 27%). Central neurological system disorders (such as thrombotic or hemorrhagic CVD, Alzheimer, etc.) were seen in 72% of the cases. Fifty patients had acute infection at the time of admission. Acute urinary infection, pneumonia and acute CVD were the most common acute illnesses. CONCLUSION: Hypernatremia is usually seen in the geriatric population and associated with a high mortality and morbidity rate and the majority of patients with hypernatremia have a comorbid disease. The prevalence of hypernatremia was 0.34% in our emergency department.Öğe The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges(Turkish Assoc Orthopaedics Traumatology, 2023) Koroglu, Muhammed; Karakaplan, Mustafa; Ergen, Emre; Ertem, Kadir; Coban, Idris; Kose, Harun; Yucel, NeslihanObjective: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center.Methods: Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency depart-ment were recorded.Results: The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department.Conclusion: This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate man-agement. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.Level of Evidence: Level IV, Diagnostic StudyÖğe A Life-threatening Complication of Deep Venous Thrombosis; Phlegmesia Cerulea Dolens(Emergency Medicine Physicians Assoc Turkey, 2013) Kaya, Mer; Yucel, Neslihan; Gulbas, Gazi; Ermis, Hilal; Kutlu, RamazanPhlegmasia cerulea dolens is a rare condition caused by complete venous occlusion and often results in tissue necrosis, limb amputation, or death. In this study, a 51 year old female presenting at our emergency department with leg edema, leg pain and cyanosis and was diagnosed with phlegmesia cerulea dolens, which is a life-threatening complication of deep venous thrombosis. Prompt diagnosis and treatment initiation are important to prevent pulmonary emboli, gangrene, amputation, and, ultimately, death.Öğe Management of the crush syndrome in critical patients: 10 cases(2017) Karakas, Bugra; Aydogan, Mustafa Said; Yucel, Aytac; Yucel, Neslihan; Kacmaz, Osman; Sari, Mirac SefaAbstract Introduction: Crush trauma may be life threating in extremities. Crush syndrome leads to a systemic disorder through muscle cytolysis and the spread of metabolic substance into the circulatory system. In the present study, we summarized the follow-up and treatment of 10 cases with intensive care unit (ICU) crush injury. Meterials and Methods: We have analyzed the clinical data of 10 patients with crush injury who were under treatment in the intensive care unit of our clinic. Age, sex, diagnosis, APACHE II score, sepsis, intensive care complications, treatment parameters in intensive care and arterial blood gases parameters, routine blood biochemistry, alanine aminotransferase, lactate dehydrogenase, creatine kinase, creatinine, existence of blood urea nitrogen, urinary protein and severity score of the patients have been recorded. Patients have been closely monitored for symptoms of crush injury, changes, crush area, urination and dangerous complications. Results: The mean age of 10 patients (10 male) was 41.3 ± 8.7 years. APACHE II score was 21,7. 8 out of 10 patients had traumatic shock, one showed acute renal failure and one presented with multiple organ dysfunction syndrome (MODS). In 3 patients presenting the criteria for crush syndrome, the symptoms of extremity distension and sensory function disorder were regulated with rapid surgical operation and hemodialysis, and urination increased, even in some patients, it reached the normal level. Serologic parameters were regulated in most of the patients after application. Amputation was applied to 5 (50%) patients in our group for serious infection and crush. 2 (20%) patients died, one because of MODS and one because of acute renal failure. Conclusion: Early and aggressive resuscitation, emergency treatment and close monitoring of serious complications are of great importance for saving the lives of the patients with crush syndrome under intensive careÖğe 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 N-terminal pro-B-type natriuretic peptide as a marker of blunt cardiac contusion in trauma(E-Century Publishing Corp, 2015) Dogan, Halil; Sarikaya, Sezgin; Neijmann, Sebnem Tekin; Uysal, Emin; Yucel, Neslihan; Ozucelik, Dogac Niyazi; Okuturlar, YildizCardiac contusion is usually caused by blunt chest trauma and, although it is potentially a life-threatening condition, the diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac enzymes, such as creatine kinase (CK), creatine kinase MB fraction (CK-MB), cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) were used in previous studies to demonstrate the blunt cardiac contusion (BCC). Each of these diagnostic tests alone is not effective for diagnosis of BCC. The aim of this study was to investigate the serum heart-type fatty acid binding protein (h-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), CK, CK-MB, and cTn-I levels as a marker of BCC in blunt chest trauma in rats. The eighteen Wistar albino rats were randomly allocated to two groups; group I (control) (n=8) and group II (blunt chest trauma) (n=10). Isolated BCC was induced by the method described by Raghavendran et al. (2005). All rats were observed in their cages and blood samples were collected after five hours of trauma for the analysis of serum hFABP, NT-pro BNP, CK, CK-MB, and cTn-I levels. The mean serum NT-pro BNP was significantly different between group I and II (10.3 +/- 2.10 ng/L versus 15.4 +/- 3.68 ng/L, respectively; P=0.0001). NT-pro BNP level >13 ng/ml had a sensitivity of 87.5%, a specificity of 70%, a positive predictive value of 70%, and a negative predictive value of 87.5% for predicting blunt chest trauma (area under curve was 0.794 and P=0.037). There was no significant difference between two groups in serum h-FABP, CK, CK-MB and c Tn-I levels. A relation between NT-Pro BNP and BCC was shown in this study. Serum NT-proBNP levels significantly increased with BCC after 5 hours of the blunt chest trauma. The use of NT-proBNP as an adjunct to other diagnostic tests, such as troponins, electrocardiography (ECG), chest x-ray and echocardiogram may be beneficial for diagnosis of BCC.Öğe Neuroprotective effect of etomidate on functional recovery in experimental spinal cord injury(Pergamon-Elsevier Science Ltd, 2006) Cayli, Suleyman R.; Ates, Ozkan; Karadag, Nese; Altinoz, Eyup; Yucel, Neslihan; Yologlu, Saim; Kocak, AyhanObjective: Primary impact to the spinal cord causes rapid oxidative stress after injury. To protect neural tissue, it is important to prevent secondary pathophysiological mechanisms. Etomidate, a strong antiexcitotoxic agent, stimulates the gamma aminobutyric acid (GABA) receptors. The purpose of this study was to investigate neurobehavioral and histological recovery and to evaluate the biochemical responses to treatment of experimental spinal cord injury (SCI) in rats with etomidate or methylprednisolone (MP) or both etomidate and MP. Material and methods: Seventy-two rats were randomly allocated into six groups: a control group (laminectomy alone), a trauma group (laminectomy + trauma), a methylprednisolone group (30 mg/kg MP), an etomidate group (2 mg/kg), a methylprednisolone, and etomidate combined treatment group (30 mg/kg MP and 2 mg/kg etomidate) and a vehicle group. Six rats from each group were killed at the 24th hour after the injury. Malondialdehyde, glutathione, nitric oxide and xanthine oxidase levels were measured. Neurological functions of the remaining rats were recorded weekly. Six weeks after injury, all of those rats were killed for histopathological assesssment. Conclusion: Etomidate treatment immediately after spinal cord injury has similar neuroprotection to MR In spite of different neuroprotection mechanisms, combined treatment with MP and etomidate does not provide extra protection. (c) 2006 ISDN. Published by Elsevier Ltd. All rights reserved.
