Can Aktas

Mushroom poisoning: retrospective analysis of 294 cases

OBJECTIVE The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS Of 294 patients between the ages of 3 and 72 (28.97 ± 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

Acute mercury poisoning: a case report

BackgroundMercury poisoning can occur as a result of occupational hazard or suicide attempt. This article presents a 36-year-old case admitted to emergency department (ED) due to exposure to metallic mercury.Case PresentatıonA 36-year-old woman presented to the ED with a three-day history of abdominal pain, diarrhea and fever. One week ago her daughter had brought mercury in the liquid form from the school. She had put it on the heating stove. One day later, her 14-month old sister baby got fever and died before admission to the hospital. Her blood pressure was 134/87 mmHg; temperature, 40.2°C; heart rate 105 bpm and regular; respiration, 18 bpm; O2 saturation, 96%. Nothing was remarkable on examination and routine laboratory tests. As serine or urinary mercury levels could not be tested in the city, symptomatic chelation treatment with N-acetyl cysteine (NAC) was instituted with regard to presumptive diagnosis and history. At the 7th day of admission she was discharged without any sequelae or complaint. At the discharge day blood was drawn and sent for mercury levels which turned out to be 30 μg/dL (normal range: 0 - 10 μg/dL).ConclusionPublic education on poisoning and the potential hazards of mercury are of vital importance for community health.

Role of Papaverine Hydrochloride Administration in Patients With Intractable Renal Colic: Randomized Prospective Trial

OBJECTIVES To evaluate the therapeutic effect of papaverine hydrochloride in the treatment of patients with renal colic pain unresponsive to conventional treatment. METHODS From March 2007 to January 2008, a total of 561 patients with severe renal colic pain due to a ureteral stone were treated with conventional agents (hyoscine-N-butylbromide and diclofenac sodium) in the emergency and urology departments. Of these 561 patients, 110, with no response to the treatment and persistent severe pain, were randomized into 3 groups for additional treatment. The patients in group 1 (n = 37) received intravenous hyoscine-N-butylbromide, those in group 2 (n = 37) received papaverine hydrochloride, and those in group 3 (n = 36) received pethidine. Before and after treatment, all patients completed a visual analog scale (VAS) questionnaire, with a scale of 0 (no pain) to 10 (maximal complaint), to measure their subjective pain. The mean VAS score of each group was compared with that of the other groups. RESULTS The pretreatment mean VAS scores of all 3 groups were not significantly different statistically from each other (4.02 +/- 1.20, 4.36 +/- 1.97, and 4.27 +/- 1.50; P > .05). However, after treatment, the mean VAS scores of the patients treated with papaverine (0.93 +/- 0.29) and pethidine (0.81 +/- 0.38) were significantly different from those of the hycosine group (3.67 +/- 2.21; P < .001). However, the mean VAS scores of groups 2 and 3 were comparable (P = .67). Unlike opioids, no papaverine-related severe side effects were observed. CONCLUSIONS Our results indicate that papaverine hydrochloride can used in an effective manner in the management of renal colic pain in patients unresponsive to commonly used conventional agents.

A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report.

BackgroundSplenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%.Case reportWe present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery.ConclusionIt is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.

Acute aortic dissection with painless paraplegia: report of 2 cases

Acute aortic dissection is often a life-threatening event that usually presents as a sudden, severe, exquisitely painful, ripping sensation in the chest or back. There are a few reports of atypical findings or no pain in the literature. We report 2 patients with painless acute aortic dissection who presented to the emergency department (ED) with sudden onset paraplegia.

An unusual cause of allergy: Case report of normal saline solution allergy.

Anaphylaxis and acute allergic reactions may sometimes be fatal. They occur within minutes in a sensitized individual. So quick diagnosis and management are necessary issues. In the literature, cases are widely reported against allergens found in drugs, foods and their additives, radiocontrast material, bee stings, and many other materials. Here, we present a 37-year-old woman who developed an anaphylactic reaction to normal saline infusion during evaluation for her acute abdominal pain. We found only one report about normal saline allergy in the literature (Litvin ME, Shemchuck AS, Lisetskii VA. Anaphylactic shock caused by intravenous injection of isotonic solution of sodium chloride. Klin Khir 1976;(7):59-61).

The Thin Border between Life and Death

We aimed to represent the case of a gunshot injury which was so close to the center that it could have affected the vital functions. Here you will find the imaging studies regarding this case. A 17-year-old male patient presented to the emergency department with the claim of a gunshot injury. It was observed that the patient was conscious, cooperative, and oriented. During examination, a defect, consistent with a 5 × 5 mm bullet inlet, was seen in the left zygomatic region as an extracranial finding. Minimal tenderness was elicited with palpation on left zygomatic region and his Glascow coma score was 15/15. His pupils were isocoric, light reflex was bilaterally positive, eye movements and vision were normal, diplopia was not present, and otorrhea and rhinorea were absent. Cranial nerves and motor function examinations were intact. When the patient was admitted to the hospital, his vital signs were as follows: blood pressure, 100/60; pulse, 80/min; inspiration rate, 22/min; temperature, 26.6°C; and oxygen saturation, 97%. Laboratory revealed no significant pathological findings. Cranial and maxillofacial computed tomography revealed that the bullet inlet was located anteriorly in the left maxillary sinus, the bullet was located in the left suboccipital condyle, and the lateral wall was destroyed (Figure 1, 2a, b). The patient was referred to the neurology clinic. His neurological examination revealed no sign of any deficit. Radiological imaging revealed that the bullet was located in a place which could not be easily reached with surgical instruments; therefore, a conservative approach was thought to be suitable for this case (Figure 3a-c, 4). Surgery for a gunshot head injury is intended to achieveof revitalized in the entrance and exit wounds, evacuation of all significant mass lesions, hemostasis, and meticulous dural and scalp closure (1). The indication for surgery to remove a bullet is controversial because presence of retained bullets or bone fragments do not increase intracranial infection rate and removal of the same to prevent infection is unnecessary (1, 2). However, the common complications of retained intracranial foreign bodies are abscess formation, cerebrospinal fluid fistulas, post-traumatic epilepsy, hematomas, and infection (3). The patient was observed for 24 h in our emergency clinic and then discharged. He was instructed to come back for follow-up visits for 3 months. During the follow-up visits, no pathology was observed.

Rare and Emergency Gastric Bleeding Cause – Dieulafoy's Lesion

Gastrointestinal bleeding is among the most common causes of emergency admissions. Having high mortality rates, high diagnosis and treatment costs, this condition constitutes a clinical problem that requires a multidisciplinary approach. Extra-varicose bleeding of the upper gastrointestinal system has still been frequent and it usually stops spontaneously. However, recurrent bleeding is the most important cause of mortality and morbidity. (Erickson & Glick, 1986; Rivkin & Lyakhovetskiy, 2005; Pfau et al., 2004) Any remarkable cause could not be demonstrated in approximately 4-9% of massive upper gastrointestinal hemorrhage. (Cotton et al., 1973; Palmer, 1969). Bleeding and anemia might be associated with gastrointestinal vascular malformations. Some epidemiological studies suggest that symptomatic vascular anomalies may be present in approximately 1/10000 individuals (Hodgson et al., 2001). Dieulafoys lesion is a rarely found vascular malformation in symptomatic vascular anomalies group of disease. It is commonly located in the proximal aspect of the stomach. Dieulafoys lesion constitutes 1% to 5.8% of nonvariceal bleeds and is more common in men than in women (2:1) (Garg, 2007). Pathogenesis is still unknown, but it is assumed that it might be a congenital lesion (Regula et al.,2008). The typical lesion is generally located in the submucosa and described as a large tortuous vessel and a small defect in the overlying mucosal surface (Ekci et al., 2010; Vats et al., 2006). (Fig 1 & 2 & 3). In 1884, Gallard first described this lesion, but it was attributed to a French surgeon Dieulafoy in literature (Alva et al., 2006). This medical condition usually presents with a large tortuous arteriole in the stomach wall that erodes and bleeds. In addition, this lesion is generally located at the lesser curvature of the stomach within 6 to 10 cm of the esophagogastric junction (Stojakov et al., 2007). It consists of a single large tortuous arteriole that does not exert normal branching or has a branch 1–5 mm in diameter(Fig 2 & 3). This size is more than the normal diameter of mucosal capillaries. The most common location of the lesion is the body of stomach, followed by the cardia and the esophagus, but they have also been reported in the esophagus, small and large bowel (Ekci et al., 2010; Turan et al., 2008). This condition is commonly seen in elder males (Schmulewitz & Baillie, 2001; Stark et al, 1992). Large majority of patients having Dieulafoys lesion might present with comorbidity