Cemil Kavalci

Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning

The aim of this study was to investigate effectiveness of the poisoning severity score (PSS), Glasgow coma scale (GCS), and corrected QT (QTc) interval in predicting outcomes in acute organophosphates (OP) poisoning. Over a period of 2 years, 62 patients with OP poisoning were admitted to emergency department (ED) of Erciyes University Medical School Hospital. The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. GCS and poisoning severity score (PSS) was calculated for each patient. Electrocardiogram (ECG) analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Sixty-two patients with OP poisoning presented to our ED from January 2007 to December 2008 from which 54 patients were included in the study. The mean age was 34.1 ± 14.8 years. Of the cases, 53.7% were female. Twenty-six patients had a prolonged QTc interval. Mean PSS of men and women was 1.8 ± 1.0. No statistically significant correlation was found between the PSS and QTc intervals of the cases. A significant correlation was determined between the GCS and PSS of grade 3 and grade 4 cases. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.

Tibial intercondylar eminence fractures in adults.

A 42-year-old man entered our Emergency Department (ED) with pain and swelling in the right knee. The patient gave a history of fall onto the right knee while playing football with his friends. He came to the ED by taxi. During the fall, the knee was in a flexed position. No torsion movement was described by the patient. On physical examination, the affected knee was swollen, and there was tenderness with palpation and movement. After the initial examination, the knee was splinted by a long leg inflatable splint. The X-ray study revealed a tibial intercondylar eminence fracture; Meyers type I (Figs. 1, 2) and orthopedics were consulted. No ligament or meniscus injuries were detected. The fracture was treated by a long leg splint for 2 months. During the follow-up visit at 2 months, the fracture was healing properly (Figs. 3, 4). He was referred for physical therapy without subsequent complications. In this paper, we aimed to review diagnosis and management of tibial intercondylar eminence fractures.

Fournier’s gangrene

Case reportA 40-years-old man presented to the emergency depart-ment (ED) with edema and pain of the scrotal and perinealregion. The patient’s symptoms began 10 day prior. Noconcomitant diseases were present. There were no drugallergies. The patient had intermittent problems withhemorrhoids for 10 years. On physical examination, thepatient was responsive and alert. The blood pressure was100/60 mmHg, the pulse was 72/min. Perineal examinationrevealed the entire perineal skin to be gangrenous andnecrotic and very malodorous (Fig. 1). The leukocytecount was 21,000 mm

A vivid example of angioedema

Case reportA 68-year-old hypertensive woman, who had been using25 mg of carvedilol daily for the past 5 years, woke up withedema of the tongue and dyspnea. At the admission to therural hospital, 5 mg of hydrocortisone and 5 mg of dex-chlorpheniramine were given intravenously, and the patientwas sent to our department. It was learned from relatives ofthe patient that she had been given sublingual captopril inanother hospital where she had been treated the day beforefor hypertension. Additionally, it was reported that thepatient hadalsosufferedfromtongueedema intheprioryearafter using the same medication, sublingual captopril. Onphysical examination, she was alert, with vital signs: bloodpressure 130/80 mmHg, pulse rate 94 beats per minute,respiration rate 14 breathes per minute (Fig. 1). Inspiratorystridor was heard on auscultation, and the patient was notable to speak. She was breathing supplemental oxygen,placed on a cardiac monitor, and intravenous lines wereestablished. Therapy was commenced with 0.3 mg of a1:10,000 epinephrine subcutaneously, 40 mg methylpred-nisolone, 50 mg diphenhydramine administered intra-venously. Over the following 10 min, subcutaneous 0.3 mgof a 1:10,000 epinephrine was repeated a single time. Thetongue of the patient decreased in size and she became ableto speak. The patient stayed in the observation unit for 24 hand was discharged without any further problems.DiscussionAngiotensin-converting enzyme (ACE) inhibitors are fre-quently used in the treatment of hypertension. Side effectprofiles vary from minor allergic reactions to anaphylactic