Cem Ertan

Vasospastic myocardial infarction: An even rarer occurrence of a rare entity.

Vasospastic angina (VSA) is an important functional cardiac disorder that leads to transient myocardial ischemia and is caused by sudden, intense and reversible coronary artery spasm resulting in subtotal or total occlusion.[1,2] VSA is associated with cardiac conditions such as stable or unstable angina, acute coronary syndromes and lethal arrhythmias. The patients usually present with chest pain, which might or might not be accompanied with ischemic ECG changes.[1,3] Vasospasm is predominantly caused by hyper-reactive vascular smooth muscle cells and probably endothelial dysfunction.[4] It is also reported that prolonged VSA may cause acute myocardial infarction.[2] The prevalence of VSA is known to be as low as 1% to 1.5% of angina admissions.[2] Although the widespread use of calcium channel blockers (CCB) in patients with coronary artery disease (CAD) prevents the occurrence of VSA attacks in susceptible population, 10% to 20% of VSA patients are either resistant or cannot use CCBs due to side effects.[2] Here we report a patient who suffered acute myocardial infarction (AMI) due to documented VSA with no critical coronary lesions.

The importance of routine bedside biliary ultrasonography in the management of patients admitted to the emergency department with isolated acute epigastric pain

Background/aim: The aim of our study was to emphasize the importance of routine bedside biliary ultrasonography (USG) for the differential diagnosis of biliary tract disorders in patients admitted with acute isolated epigastric pain. Materials and methods: Adult patients who were admitted to the emergency department with acute isolated epigastric pain were included in the study. Emergency residents (ERs) were asked whether they planned to perform biliary USG during the initial evaluation and following diagnosis/treatment (secondary evaluation) of these patients. Bedside biliary USG examinations were performed by a sonologist and a radiologist evaluated the video recordings. Results: A total of 103 patients were enrolled, 29 of whom were diagnosed with biliary tract disease (BTD). In the 29 patients diagnosed with BTD, 27 had gallstones (biliary colic, 18; acute cholecystitis, 7; acute pancreatitis, 2) and two had biliary sludge. USG was not ordered by the ERs for 44.8% of the 29 patients with a final diagnosis of BTD, 58.8% of 17 patients with normal liver function tests and BTD, and 35.3% of the 17 hospitalized patients. Conclusion: Emergency physicians should routinely use biliary USG along with clinical judgement and laboratory studies in order to rule out BTD in patients with acute isolated epigastric pain.

Tek doz duloksetin genç erkek hastada hiponatremiye neden olabilir mi

Somatik semptomlari olan orta yasli bir erkek hastada tek doz duloksetin tedavi sonrasi hizlica gelisen bir hiponatremi olgusunu rapor ettik. Yirmi sekiz yasinda erkek hasta halsizlik ve basdonmesi sikayeti ile basvurdu. Duloksetinin kesilmesi ve normal salin tedavisinden uc gun sonra tamamen normale dondu. Duloksetin ile tedavi edilen hastalarin hiponatremi acisindan yakin takiplerinin yapilmasi gereklidir.

Moxifloxacin Hydrochloride Related Visual Hallucinations: A Case Presentation

Giriş 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. Moksifloksasin florokinolon grubundan geniş etki spektrumuna sahip yeni nesil bir antibiyotiktir. Başlıca endikasyonları komplike idrar yolu enfeksiyonları ve alt solunum yolu enfeksiyonları olarak sayılabilir. Halsizlik, baş dönmesi, çarpıntı, döküntüler gibi görece olarak sık görülebilen yan etkilerinin SUMMARY 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.