Asim Kalkan

Combination technique of tumescent anesthesia during endovenous laser therapy of saphenous vein insufficiency

OBJECTIVE This study aimed at evaluating the efficiency of applying tumescent anesthesia before an ablation procedure and continuously during endovenous laser treatment (EVLT) (combined tumescent technique) of saphenous vein insufficiency to reduce the patients pain and discomfort. METHODS Twenty-five patients with 31 duplex-confirmed great saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment between December 2009 and April 2010. The patients were randomized in two groups. In group A (15 patients) tumescent anesthesia was used before the ablation procedure and in group B (10 patients) tumescent anesthesia was used before and continuously during the procedure. Patients were scheduled for a three-day examination after EVLT to assess the level of pain experienced. RESULTS According to the statistic analysis we observed that the mean level of pain score for the patients given classical tumescent anesthesia showed a higher level (P=0.003) compared with the patients given tumescent anesthesia in the combined procedure. CONCLUSION Combination technique of administering tumescent anesthesia before ablation and continuously during the EVLT procedure may be an alternative way to reduce the patients peroperative pain and discomfort.

Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm

Various removal techniques for rings trapped on the finger have been described in the current literature. However, despite this being a frequently encountered situation in emergency departments, there is no comprehensive algorithm to manage and follow these patients in the current literature. The purposes of this study were to describe the most commonly used ring removal techniques and to establish an algorithm for the removal of rings trapped on fingers. We performed a comprehensive literature search in several databases to identify all articles, case reports, letters, and book chapters that focus on ring removal techniques in English language from 1960 to the present. There are 2 methods of removal: (1) noncutting techniques in which the rings can be removed without breaking the integrity of the ring and (2) various ring-cutting equipments and tools. All these techniques are classified into distinct groups and described in detail with illustrations. Furthermore, an algorithm for handling such patients is established according to case-based patient care. Following an algorithm for the removal of trapped rings on the finger will be useful for patients and emergency physicians. It will also prevent possible complications and will save time.

A different reason for cerebrovascular disease

Bee stings are commonly encountered worldwide. Various manifestations after a bee sting have been described. Local reactions are common. Unusually, manifestations such as vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, hypotension, and collapse may occur. Rarely, vasculitis, serum sickness, neuritis, and encephalitis have been described, which generally develop days to weeks after a sting. We report a case of a 35-year-old man who developed neurologic deficit 6 hours after a bee sting, which was confirmed to be left parietooccipital infarction on magnetic resonance imaging scan. We report this case due to its rarity.

Behçet's disease with aneurysm of internal iliac artery and percutaneous treatment

Behçets disease (BD), described in 1937 by Hulusi Behçet, is a multisystemic inflammatory disorder. In this paper, we report a large pseudoaneurysm of the internal iliac artery in a patient who had BD, and was admitted to emergency service complaining of leg pain and the percutaneous treatment of the pathology which followed.

Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry.

AIM We used near-infrared spectrophotometry to assess the initial and final abdominal and cerebral saturations during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest to determine if there is a correlation between increase in these saturation values and return of spontaneous circulation. MATERIALS AND METHODS We evaluated 34 patients with out-of-hospital cardiac arrest without witnesses brought to our emergency department. Abdominal and cerebral saturations were measured using near-infrared spectrophotometry from the start of CPR. Cardiopulmonary resuscitation was performed for a maximum of 30 minutes. The effect of abdominal saturations in patients with or without spontaneous circulation restored through CPR was then assessed. RESULTS Thirty-four patients (17 males + females) with a mean age of 63.06 ± 11.66 years were included in the study. A significant correlation was determined between increase in abdominal saturations measured at the start and end of CPR and the return of spontaneous circulation (P < .001). A good positive correlation was also identified between abdominal saturation and return of spontaneous circulation. CONCLUSION Patients with increased abdominal and cerebral saturation values have a higher survival rate after appropriate CPR. This noninvasive measurement system and monitoring of patients during CPR may be a good method of predicting return of spontaneous circulation and assessing abdominal perfusion.

An unusual clinical state: atrial fibrillation due to mad-honey intoxication.

The honey which is produced in the Karadeniz Region of Turkey and known as the ``mad honey`` contains Rhododendron ponticum nectar. Grayanotoxin is only produced by Ericaceae plants and thought to be responsible for toxicity. The typical symptoms are gastrointestinal and may sometimes cause cardiac complications, such as severe bradycardia and hypotension. In our case, we report a patient with unusual cardiac toxicity symptom such as atrial fibrillation, following ``mad honey`` ingestion and give a review of clinical presentation and treatment of grayanotoxin poisoning.

Publication rate of abstracts presented at the emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012.

Purpose The purpose of this study was to assess the publication rate of the abstracts presented at the 6th Mediterranean Emergency Medicine Congress, 2011 and the 7th European Congress on Emergency Medicine, 2012. Materials and methods All abstracts, both posters and oral presentations, from the international emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012 were identified. To establish whether these abstracts were subsequently published in peer-reviewed medical journals, the names of all the authors and the title of the abstracts were searched for in the databases of Clinical Key/Elsevier, EBSCO Discovery Service, MD Consult, Science Direct, Scopus, EMBASE, Medscape, Google Scholar and local ULAKBIM. The year of publication, consistency of author names and titles, the type of study, the journals in which papers were published and countries from which reports were submitted were all recorded. Results A total of 1721 abstracts were examined; 626 from 2011 (307 oral presentations and 319 posters) and 1095 from 2012 (154 oral presentations and 941 posters). Of all abstracts in 2011, 172 (27.5%) and of all abstracts in 2012, 265 (24.2%) were subsequently published as full-text reports in peer-reviewed journals. Of the 172 papers published in 2011, 152 (88.4%) were accepted by Science Citation Index (SCI) and/or SCI Expanded (SCI-E) journals and 155 (58.5%) of 265 papers were accepted by SCI and/or SCI-E journals in 2012 (p=0.0001). Conclusions The publication rate of abstracts submitted to international emergency medicine congresses held by EUSEM over those 2 years was low compared with that of abstracts presented in other emergency medicine congresses. Presenters should be encouraged to send their studies to peer-reviewed journals. During the selection process by the scientific panel, constructive critics should be notified to the presenters instead of simply accepting or rejecting the studies that submitted to the congress, which may increase the subsequent publication rate.

Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis

1Department of Emergency Medicine, Recep Tayyip Erdogan University Faculty of Medicine, Rize; Departments of 2Cardiovascular Surgery, 3Cardiology, Gumushane State Hospital, Gumushane; 4Department of Thoracic Medicine, Erciyes Univercity Faculty of Medicine, Kayseri, Turkey. Asim KALKAN,1 Mehmet Erdem MEMETOĞLU,2 Ozlem BILIR,1 Gokhan ERSUNAN,1 Rasim KUTLU,3 Nuri TUTAR4 Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis?

Fluorescein-related extensive jaundice

Fluorescein is a chemical dye frequently used in eye diseases to assess blood flow in the retina, choroid tissue, and iris. Although it has many known adverse effects, it has not previously been reported to lead to jaundice. The purpose of this case report was to emphasize that for patients presenting at the emergency department with jaundice symptoms, it should not be forgotten by emergency physicians that jaundice can develop after fluorescein angiography. Case: A 65-year-old woman presented at the emergency department with extensive jaundice that had developed on her entire body a few hours after fluorescein angiography applied because of vision impairment. The test results for all the diseases considered to cause jaundice were normal,and fluorescein-related jaundice was diagnosed. Conclusion: A detailed anamnesis should be taken when jaundice is seen in patients who have undergone fluorescein angiography, and it should not be forgotten that fluorescein dye is a rare cause of jaundice.

Utility of near infrared spectrophotometry in mesenteric ischemia: An experimental study

This study investigated the effectiveness of near infrared (NIR) spectrophotometry for measuring abdominal saturation in a rat model of induced mesenteric ischemia. This was a randomized, controlled, non-blinded interventional animal study. Twenty-eight male Sprague Dawley rats were randomly allocated into four groups. Following induction of anesthesia, the abdominal region was shaved and intra-abdominal access was achieved through a 4-cm midline incision and basal measurements were performed using an INVOS-5100c device. The rats were grouped on the basis of rSO2 measurement times. Mesenteric artery ligation was not performed on the control group rats. From the rest of the mesenteric artery ligated rats, measurements were taken at 30 min, at 2 h and at 6 h. Measurements were repeated using NIR spectrophotometry probes after the abdomen was surgically closed. Following the measurements, the abdomen was re-opened and small intestine tissue specimens were taken for histopathological examination. Initial and final NIR spectrophotometry measurements were compared. No statistically significant difference was found in the group 1 between basal rSO2 values and post-incision values (p = 0.748). There was a significant variation between the initial and final measurements in groups 2, 3, and 4 (p = 0.018). Although various radiological or biochemical markers are available for detecting mesenteric ischemia, the use of NIR spectrophotometry can be considered a good non-invasive alternative method for early diagnosis of acute mesenteric ischemia.