Huseyin Narci

The Role of Mean Platelet Volume in the Diagnosis of Acute Appendicitis: A Retrospective Case-Controlled Study

Background: The level of platelet volume (MPV) has been reported to be a laboratory marker in inflammatory cases. Objectives: The aim of this study was to seek whether MPV has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of MPV with leukocyte count and C-reactive protein (CRP) level. Materials and Methods: This study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and December 2012 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. The number of essential cases was defined by performing power analysis. Age, gender, leukocyte count, CRP, and MPV values were recorded. This study is a case controlled retrospective clinical study. Results: A total of 503 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 624 subjects. The median MPV levels were 7.92 ± 1.68 fL in the acute appendicitis group, while 7.43 ± 1.34 fL in the control group. CRP, leukocyte count, and MPV level were significantly higher in the acute appendicitis group (P < 0.001). MPV, leukocyte count, and CRP had a sensitivity and specificity of 66% and 51%; 91% and 74%; and 97% and 41%, respectively. No correlation was found between MPV, CRP, and leukocyte count. Conclusions: MPV level was higher in patients with acute appendicitis. MPV may guide the diagnostic process of acute appendicitis. However, we detected that the sensitivity and specificity of leukocyte count and CRP were superior to those of MPV in the diagnosis of acute appendicitis.

The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study

PurposeThe aim of this study was to seek whether red cell distribution width (RDW) has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of RDW with leukocyte count and C-reactive protein (CRP) level.MethodsThis study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and February 2013 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. Age, gender, leukocyte count, CRP, and RDW values were recorded. This study is a case controlled retrospective clinical study.ResultsA total of 590 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 711 subjects. The mean RDW levels were 15.4 ± 1.5% in the acute appendicitis group, while 15.9 ± 1.4% in the control group. CRP, leukocyte count were significantly higher in the acute appendicitis group, and RDW level were significantly lower in the acute appendicitis group (p < 0.001, p < 0.001, p = 0.001, respectively). RDW, leukocyte count, and CRP had a sensitivity and specificity of 47% and 67%; 91% and 74%; and 97% and 41%, respectively in acute appendicitis. RDW was not correlated with CRP and leukocyte levels. However, we found a correlation between CRP and leukocyte levels.ConclusionRDW level was lower in patients with acute appendicitis. The magnitude of difference in RDW seen between acute appendicitis and controls was so slight as to be of no utility in diagnostic testing.

Diffuse thrombosis secondary to Behçet's disease: a case report

Behçets disease is a multisystemic, potentially life-threatening condition with vascular involvement and thrombotic tendency. The disease course is characterized by exacerbations and remissions. Lower extremity vein thrombosis is the most frequent manifestation of vascular involvement, followed by vena cava thrombosis, pulmonary artery aneurysms, peripheral artery aneurysms, dural sinus thrombosis and abdominal aorta aneurysms. The case in this report was considered worth reporting due to vena cava thrombosis extending from brachiocephalic to jugular vein, accompanying thrombosis of the contralateral brachiocephalic vein and jugular veins as well as simultaneous dural sinus thrombosis, and also benefit from thrombolytic therapy.

Association between Red Blood Cell Distribution Width and Acute Pancreatitis

Background We aimed to determine whether there are any alterations in red blood cell width in patients diagnosed with acute pancreatitis. Material/Methods This was a retrospective study of records of patients treated in emergency units and diagnosed with acute pancreatitis between January 2011 and April 2013. Records were investigated regarding patient age, sex, and causes of acute pancreatitis. Red blood cell width and amylase values obtained from the patients during diagnosis and after a full recovery from acute pancreatitis were added to the records. Results Recorded red blood cell width and amylase values of 104 patients diagnosed with acute pancreatitis were statistically compared according to the time of sample collection. Samples were collected in the post-diagnostic period and after full recovery. Values of red blood cell width and amylase were found to be significantly higher in samples collected during hospital admission in comparison to those obtained from patients after fully recovering from acute pancreatitis (p<0.05). Conclusions An increase in red blood cell width value is a marker of acute pancreatitis; therefore, we suggest that red blood cell width can be used as a tool for the early diagnosis and assessment of disease progression.

The value of serum mean platelet volume in testicular torsion

Objective To compare the serum mean platelet volume (MPV) in patients with testicular torsion and healthy control subjects. Methods This retrospective study compared clinical and demographic data from patients who underwent surgery for testicular torsion and healthy controls. Testicular torsion was diagnosed with a physical examination and Doppler ultrasonography. Age, leukocyte count, platelet count and MPV were recorded for all participants. Results A total of 50 patients with testicular torsion and 51 healthy control subjects were enrolled. There was no significant difference in age and platelet count between the two groups. Patients with testicular torsion had a significantly higher leukocyte count and MPV, compared with controls. According to receiver operating characteristic curve analysis performed for the prediction of testicular torsion, the best cut-off point for MPV was 7.7 fl (sensitivity 62%, specificity 96%), and the best cut-off point for leukocyte count was 9.5 × 109/l (sensitivity 58%, specificity 80%). Conclusions The MPV may be useful as an ancillary test for the diagnosis of testicular torsion. Further studies are needed in order to confirm these preliminary results.

Diamine oxidase in diagnosis of acute mesenteric ıschemia

OBJECTIVE Acute mesenteric ischemia (AMI) is an important clinical condition with a high mortality rate in abdominal emergencies due to delay in diagnosis in spite of the new strategies in the management. We have studied the role of diamine oxidase (DAO) in the early diagnosis of AMI. METHODS In the study, 21 New Zeland rabbits were used. Subjects were named as the groups of controls, sham, and ischemia. No intervention was performed in the subjects in the control group. In the subjects from sham and ischemia groups, laparotomy was performed with middle line incision. However, superior mesenteric artery was found and tied in those from ischemia group after the performance of laparotomy. From the animals in 3 groups, blood was drawn at the hours of 0, 1, 3, and 6, and DAO and amylase were studied in these samples. RESULTS The increase in serum amylase levels was found to be statistically significant in the ischemia group compared with the control and the sham groups (P < .05). The decrease in serum DAO levels was found to be statistically significant in the ischemia group compared with the control and the sham groups (P < .05). Diamine oxidase levels were found to decrease, beginning from the 1 hour after ischemia had been developed, and this rise was found to continue for 6 hours (P < .05). CONCLUSION Serum DAO levels were decreased in ischemia. Further clinical and experimental investigations would be valuable to confirm the probable role of DAO in AMI.

Determining risk factors of bleeding in patients on warfarin treatment.

Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0 ± 14.4 and 61.9 ± 14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P = 0.101 and P = 0.483, resp.). INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were also higher in the study group (1.14 ± 0.57 mg/dL versus 0.94 ± 0.38 mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.

The Impact of Acute Brucellosis on Mean Platelet Volume and Red Blood Cell Distribution

Background: Brucellosis is an inflammatory disease which may infect any organs or systems in the body. Mean Platelet Volume (MPV) is one of the most frequently used surrogate markers of platelet function. It reveals the presence of disease activity in many inflammatory diseases. Red blood cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. Its predictive value approves inflammatory and infectious diseases. Objectives: The current study aimed to determine the assessment levels of red blood cell distribution in cases with acute brucellosis. Patients and Methods: The current study investigated whether MPV and RDW played any roles in acute brucellosis diagnosis. The study was conducted from 2008 to 2014 through prospective examination of the inflammatory markers found in adult patients with acute brucellosis. Results: The follow-up within the year after treatment was examined. The values of age, gender, leukocyte count, C-reactive protein, RDW and MPV were recorded. The study included 351 subjects, 250 of them in the acute brucellosis group and 101 in the control group. The mean MPV levels were 7.64 ± 1.30 fL, and 7.67 ± 1.29 fL in the acute brucellosis and control groups, respectively (P > 0.05). The mean CRP levels were 32.57 ± 53.20 mg/dL, and 4.81 ± 4.89 mg/dL in the acute brucellosis and control groups, respectively (P < 0.05). There was no statistically significant difference between the two groups regarding the RDW level and the mean leukocyte count (P > 0.05). Conclusions: While the CRP value was in patients with acute brucellosis in the current study, the MPV, RDW and leukocyte counts were within the normal range. CRP value remains the most valuable inflammatory marker in cases of acute brucellosis.

Could there be an association between chronic brucellosis and endothelial damage

INTRODUCTION In this study, we examined the effects of Brucella infection on endothelial dysfunction. Flow-mediated dilatation (FMD) measurement is indicator of the endothelial function, and abnormal values indicating endothelial dysfunction are accepted as the first stage of atherosclerosis. METHODOLOGY Twenty-four patients who had been treated for acute brucellosis two years before, and who had had no relapses in the follow-up, were prospectively included in the study, along with 30 healthy individuals in the control group. RESULTS While the highly sensitive C-reactive protein (hs-CRP) value was 2.42 ± 1.45 in the patient group, it was 1.72 ± 0.61 in the control group (p = 0.025). While the FMD value was 3.50 ± 1.58 in the patient group, it was 5.88 ± 1.88 in the control group (p < 0.001). While the percentage increase in FMD was 9.88 ± 4.92 in the patient group, it was 17.49 ± 6.3 in the control group (p < 0.001). It was observed that FMD value, the percentage increase in FMD, and basal radius were correlated with hs-CRP (r = -0.644, p < 0.001; r = - 0.558, p = 0.002; r = 0.444, p = 0.018, respectively). The carotid artery intima media thickness (IMT) value was found to be 0.61 ± 0.17 in the patient group and 0.49 ± 0.12 in the control group (p = 0.004). CONCLUSIONS The abnormal FMD and IMT values observed in brucellosis patients might be an indicator of more frequent arterial dysfunction, increased cardiovascular risk, and atherosclerosis.

Acute Pulmonary Edema Due to Excessive Water Intake in Pyschiatric Patient

Water taking diseases are frequent in psychiatric patient. Approximately 3-6% of psychiatric patient water intoxication is seen. Although water intoxication is defined well, the metabolism of this is not understood. In psychiatric patients, headache, ataxia, confusion, urinary incontinence and electrolyte imbalance is reported. If not treated, confusion, acute delirium, coma and death is seen. Cerebellar edema, pulmonary edema, electrolyte imbalance and urinary incontinence due to water intoxication are reported (1). In this case diagnosis and treatment of psychiatric patient that take excessive water is discussed. The patient a 50-year-old woman schizophrenic had been drinking large amounts of water for several hours before and rapid onset respiratory distress and confusion. In history she started to have fear and stress before 6 years. These symptoms began to increase progressively and last year agitation also seen. Respiratory distress began due to water intake above 10 liters. She was confused, dispneic on admission. TA: 160/90 mmHg, pulse rate 90, respiration 26/min. Cardiovascular and neurologic system was normal and rales were heard in both lungs. In laboratory: Glucose: 100, BUN: 7, Creatinine: 0.8, Na: 129, CI: 87, K: 4.2, albumin:4.1, WBC:8000, Hb:12.2, platelet:367000. Blood gas analysis: Ph 7.32, Pco2 55 mmHg, po2 134 mmHg, Bicarbonate; 36.1 and O2Sat: 99.4. His chest X-ray showed bilateral patch consolidation of the lung fields, cardiomegaly was not seen. Echocardiography; ejection fraction 60 % and no failure. These were suggesting non –cardiogenic pulmonary edema due to excessive water intake and treatment started in our emergency department. 5-ml/min oxygen was given, 3 mg intravenous morphine was done and 5-mcg/kg/min nitroglycerin infusion started, 400 mg intravenous furosemide in 12 hours was given. Patient urinate 3500 cc totally in 12 hours.The clinical outcome was favourable after the treatment. She became alert and ralles decreased. After 24 hours all vital symptoms became stable and patient discharged. Water intoxication is reported in marathon runners, psychiatric patients and soldiers. Psychos, psycotrop drugs, diuretics, nicotine and alcohol can cause excessive water intake. Pyschogenic water intoxication is discussed in the light of 150 observations published in the literature since 1935. 87% of all patients were schizophrenic, and 13% had other psychoses (2). In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation.. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (3). In our case excessive water intake was due to schizophrenic condition. Pulmonary edema is a rare complication of water intoxication in a psychiatric patient.The physiology of pulmonary edema caused by excessive water intake can’t be explained. Furosemide and water restriction in these patients give good response (2). In our case, echo was normal, bilateral rales were heard and bilateral opacity was seen, these suggested is non –cardiogenic pulmonary edema.