Atif Bayramoglu

Obturator Hernia, a Rare Cause of Small Bowel Obstruction: Case Report

Obturator hernia is a rare hernia in the world, diagnosed late since it has no specific symptoms and findings and generally occur in thin and old women with comorbidity.For this reason obturator hernia has high morbidity and mortality rates. In this study, we present an obturator hernia case that Howship-Romberg sign is positive and has typical appearance in computerized tomography. Laparotomy was performed on 89 years old female patient with body mass index 18.08 kg/m(2) by low middle line incision. Following the segmentectomy to the strangulated small bowel loop, obturator canal is repaired by retroperitoneal application. No complication occurred in the postoperative period. Obturator hernia should be taken into consideration in old and thin female patients with intestinal obstruction. Computerized tomography should be performed for early diagnosis of the obturator hernia.

A rare cause of acute abdomen for which broad-spectrum antibiotics should be initiated in emergency service: typhlitis.

• One of the diagnoses that should be kept in mind in neutropenic patients admitted to the emergency department for abdominal pain is typhlitis.

Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels?

Kounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). His electrocardiogram (ECG) showed inferior ST elevations (2 mm) with normal cardiac biomarkers. His cardiac magnetic resonance imaging showed hypokinesis and myocardial hibernation on apical septum and on the left ventricle. The second patient took a pill of naproxen sodium. The ECG showed 1-mm ST elevation in leads DII, V5, and V6. His troponin was markedly elevated. These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS.

Patient-staff safety applications: the evaluation of blue code reports.

OBJECTIVE Blue code systems (BCS) are communication systems that ensure the most rapid and effective resuscitation when a patient is in respiratory or cardiac arrest. A hospital employee faced with the situation of a cardiopulmonary arrest (CPA) starts the system by dialing 6666 from any phone in the hospital. We created a five-person team that includes a doctor, nurse, anesthesia technician, stretcher officer and security guard. The purpose of this study is to share our experiences in initiating the use of the BCS in our hospital. MATERIALS AND METHODS In our hospital, the records of calls that were made by Callvision BCS were analyzed retrospectively from May 2010 to the end of January 2011. RESULTS A total of 474 calls were made using the blue code system. Of those calls, 402 (84.5%) were determined to be inappropriate calls. The remaining 72 calls were responded to. Of the 72 patients who were treated, 21 were discharged after they were hospitalized in the service or intensive care unit, 45 cases resulted in exitus, and 5 cases were referred to the Ataturk University faculty of medicine. CONCLUSION The BCS has achieved its goal. The discharge rate of 29.5% that we achieved is a successful result.

Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil.

OBJECTIVE Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB. MATERIALS AND METHODS Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively. RESULTS During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2(nd) degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died. CONCLUSION Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2(nd) degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre.

Laparascopic Splenectomy Due to Splenic Injury after Colonoscopy.

Colonoscopy, which is routinely performed in diagnosis and treatment of colorectal disorders, is a reliable procedure. Its most frequent complications are bleeding and perforation. Splenic rupture is a very rarely met complication of colonoscopy, and delay in its diagnosis leads to increased morbidity and mortality. We presented a 69 years old female patient, who was diagnosed by computerized abdominal tomography, performed for her abdominal pain, which started following the colonoscopy. After 15 days of medical treatment and follow-up, laparoscopic splenectomy was performed one month after her colonoscopy. The patient was discharged on her 4(th) postoperative day, with uneventful recovery. In patients who have complaint of abdominal pain following colonoscopy, an intraabdominal pathological condition should be considered and computerized abdominal tomography should be performed. If there is no detected intraperitoneal bleeding, in other words, if there is a sub-capsular hematoma of the spleen, medical management by monitoring the vital signs may be preferred. Then, splenectomy should be performed at an appropriate time.

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.

Evacuation of Hospitals during Disaster, Establishment of a Field Hospital, and Communication

The buildings, working personnel, and patients and their relatives may directly or indirectly be affected by the disasters. Here we will discuss evacuation, establishing a field hospital, communication, the role of the media in disasters, and defending against sabotage. The affected individuals should be evacuated and transferred to secure zones safely and rapidly. How the decision for evacuation should be made and how the evacuation triage should be performed are important issues. Field hospitals should be established within the bounds of possibility for continuation of the treatments of evacuated people. The standards for the field hospitals and its sections that may be created according to the needs will be explained. Undoubtedly, since one of the most important subjects in disasters is communication, the types of communication in disasters and their significance will be mentioned. How the relationships with the media should be an aspect of communication and how they can be beneficially used will also be mentioned. As in all organizations and institutions, sabotage attempts may also be present concerning health facilities. For this reason, during the preparation of the hospital disaster plan, defending against sabotage will be discussed, and what should be done at that stage will be mentioned.

Demographic and clinical differences of aggressive and non-aggressive suicide attempts in the emergency department in the eastern region of Turkey.

Background: Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years. An estimated 800000 people die by committing suicide annually. Objectives: To better understand the association between aggressive suicidal attempt and non-aggressive suicidal attempt in patients with suicide attempt in the emergency department. Patients and Methods: A cross-sectional observational study was conducted on suicide attempters of eastern region of Turkey between May 2008 and January 2012. Information of all adult suicide attempts was collected prospectively on a form. Suicide attempts were grouped as aggressive and non-aggressive attempts on a specially designed data-collection form. The aggressive suicide attempts contained violent suicide methods such as firearm, hanging, jumping, car exhaust or drowning. Results: A total of 533 patients were included. Sixty-four of these patients admitted to ED with aggressive suicide attempt (12%). Non-aggressive suicide attempts were consulted to psychiatry more compared to aggressive ones (%73.6, n = 345 vs. %32.8, n = 21, P < 0.0001). Agitation in ED and being male increased aggressive suicide attempt risk by 3.5 (%95 CI: 1.6-7.6) and 3.2 times (%95 CI: 1.8-5.5), agitated patients in ED group and male group respectively. Patients with aggressive suicide attempt were statistically more frequent among these patients; patients with agitation, those hospitalized in intensive care or surgical services and those whose length of stay in the emergency department was less than one day (P < 0.05 for all). Patients with non-aggressive suicide attempt were statistically more frequent in these patients; patients complained of nausea, vomiting, stomach pain, fatigue, those with confusion, those tending to sleep, those hospitalized in internal services or emergency ward and finally those whose length of stay in the emergency department was more than one day (P < 0.05 for all). Conclusions: Patients with aggressive suicide attempt who have high risk of dying should be recognized and requested psychiatric consultation even if not in the emergency department.

A Rare Cause of Compression of the Ulnar Nerve Neuritis: Deep Vein Thrombosis.

A 21-year-old woman presented to the emergency department with complaint of pain in the right elbow, and ring and pinky finger numbness. The patient had no prior history of systemic disease. The patient reported similar symptoms had occurred intermittently after physical exertion during the previous three months. However, the patient presented at the hospital after experiencing the symptoms while at rest. Physical examination identified a palpable soft mass at the beginning of the third distal humerus and extending to the cubital region on the inner side of the right elbow with the consistency of the dough. The Tinel test was positive. Other system examination findings were normal. The patients laboratory findings, complete blood count and blood chemistry tests were normal. Magnetic resonance imaging of the patient is shown in Figure 1 and Figure 2a, b. Figure 1 An increase in brachial diameter and thrombus in fat-suppressed proton density T1-weighted MR images sequences at the same level (*). Figure 2 (a) An increase in brachial diameter and thrombus in axial T1-weighted MR images. Thin white arrows: brachial vein filled within thrombus. *: m. pronator teres, **: m. brakialis, black triangles: a. brachialis, curved white arrow: v. basilica, thick white ... DIAGNOSIS: Cubital Tunnel Syndrome Cubital tunnel syndrome (CuTS) is the most common form of entrapment of the ulnar nerve and the second most common nerve compression syndrome of the upper extremities, the most common being carpal tunnel syndrome. The incidence is 24.7 cases per 100,000 person-years; men are affected twice as often as women. Clinical findings include paraesthesia and tingling in the lateral 2 fingers, pain related to the elbow joint, and in severe cases, weakness or atrophy of the intrinsic muscles of the hand.1, 2, 3 Soft tissue masses such as ganglia, lipomas, fibrolipomas, and epidermoid cysts can compress the ulnar nerve as it lies in the condylar groove or within the cubital tunnel. However, it was not reported that the ulnar nerve was wrapped and compressed by the DVT mass. In this respect, the present case has the distinction of being unique. We present the first case of CuTS due to DVT. Magnetic resonance imaging of the patient detected an acute phase deep vein thrombosis (DVT) that could not be compressed, causing an increase in the lumen diameter in the brachial vein and in the right elbow (Figure 1, Figure 2). After cardiovascular surgery, consulting physicians initiated medical treatment with enoxaparine (150 anti-Xa IU/kg, once-daily). Control returned to the patient and the patient was discharged. The patients symptoms completely resolved three months later.