Mehmet Yigit

Is signal peptide-CUB-EGF domain-containing protein1 a diagnostic biomarker in patients with hypertensive crises

BACKGROUND Platelet activation might play a significant role in the pathophysiology of cardiovascular and cerebrovascular events in hypertension (HT). Signal peptide-CUB-EGF domain-containing protein1 (SCUBE1), an indicator of platelet activation, is increased in HT. The aim of this study was to investigate the SCUBE1 in patients with hypertensive crises. METHODS This study included 33 hypertensive urgency (HU) and 39 hypertensive emergency (HI) patients admitted to our emergency department with a diagnosis of hypertensive crisis. Platelet activation was evaluated with biochemical markers such as SCUBE1, soluble CD40L (sCD40L), mean platelet volume, and platelet count. RESULTS The SCUBE1 values of the HE patients were significantly higher than other groups (1.09 ± 0.49, 0.71 ± 0.23 and 0.37 ± 0.02 ng/dl, respectively; p <  0.01). The sCD40L values were higher in the hypertensive crises compared with the control group (4.16 ± 1.82, 3.41 ± 1.76 and 1.76 ± 0.68 ng/ml, respectively; p <  0.01). More importantly, SCUBE1 had high sensitivity and specificity in the detection of target organ damage. CONCLUSION In present study showed that SCUBE1 was significantly higher in HE patients. In addition, sCD40L level, presence of diabetes, and systolic blood pressure were independently associated with increased SCUBE1. According to our results, SCUBE1 might be a diagnostic biomarker in hypertensive crisis patients.

Long-term results of nonoperative treatment for uncomplicated acute appendicitis.

BACKGROUND/AIMS This study aimed to assess the long-term (>12 months) efficacy of nonoperative treatment (antibiotic administration) in the management of uncomplicated acute appendicitis (AA). MATERIALS AND METHODS We surveyed uncomplicated AA patients who elected to undergo nonoperative treatment between 2010 and 2012. A binary logistic regression analysis was performed to identify the critical predictors of recurrence. Age, gender, presence of appendicolith, and white blood cell count on admission were analyzed as possible predictors of recurrence. RESULTS The median follow-up period of the study was 23 months. Twelve of 118 patients (10.2%) were diagnosed with recurrent appendicitis. Seven were retreated with the same antibiotic protocol and did not show further recurrence. The binary logistic regression analysis revealed statistical significance only for the presence of appendicolith [P=0.001, Exp (B)=0.058, B=-2.845]. Recurrence rate was lower in the presence of appendicolith. CONCLUSION Nonoperative treatment of uncomplicated AA is an effective option. Recurrence is rare and it can be addressed efficiently with the administration of a second course of antibiotics. The presence of appendicolith should not discourage physicians from prescribing nonoperative treatment for patients with uncomplicated AA.

Coffee bean sign, whirl sign and bird's beak sign in the diagnosis of sigmoid volvulus.

The patient, a 28-year-old man who had presented to our Emergency Department (ED) with constant abdominal pain and distension for one day, had no previous medical or surgical history. He denied that he had any nausea, vomiting, diarrhea or constipation. At admission, his physical examination revealed hypertension (TA: 152/97 mmHg) and a distended abdomen with generalised tenderness and hypoactive bowel sounds. There was no fever, abdominal guarding, rebound or rigidity. Laboratory results were within normal limits. A plain radiograph of the abdomen revealed a “coffee bean” sign. We also observed an impressive picture of a typical “whirl” sign and a “bird’s beak” sign on an emergent abdominal computed tomography (CT) scan. Also, his CT scan revealed marked distension and a twisted loop of sigmoid colon. Sigmoid volvulus (SV) was diagnosed rapidly with these characteristic radiological signs. Subsequently, with flexible sigmoidoscopy, the patient was successfully decompressed and detorsioned. SV is potentially life-threatening and requires emergency intervention. It is the third leading cause of colon obstruction in adults after cancer and diverticulitis. The primary emergency therapy for uncomplicated SV is endoscopic detorsion and decompression. Emergency physicians in particular should be aware of the typical radiographic CT signs, “coffee bean,” “whirl” and “bird’s beak,” which are indicative of SV and which will allow them to easily diagnose this condition in cases of acute abdominal obstruction. If emergency physicians delay diagnosis, the patients might require emergency surgical intervention.

Oxidative/antioxidative status, lymphocyte DNA damage, and urotensin-2 receptor level in patients with migraine attacks

Background The present study investigated the potential roles of plasma lymphocyte DNA damage, the urotensin-2 receptor (UTS2R), and oxidative changes in patients with varying degrees of migraine-related disability who were in the ictal phase and presented to our emergency department. Methods This study enrolled 40 consecutive adult patients with migraine attack and 40 age- and sex-matched healthy controls. The same health care professional determined the headache-related disability of each patient’s migraine attack using the Migraine Disability Assessment Scale (MIDAS); patients were divided into three groups based on MIDAS score. Plasma lymphocyte DNA damage; UTS2R, malondialdehyde (MDA), and catalase (CAT) levels; total oxidant status (TOS); total antioxidant status (TAS); and the oxidative stress index (OSI) were used as predictors of early oxidative changes. Results Plasma lymphocyte DNA damage, TOS, MDA levels, and OSI values were significantly higher in patients with migraine compared to controls. Conversely, TAS and CAT and UTS2R levels were markedly lower in patients with migraine compared to controls. Comparisons of the patient groups by MIDAS score revealed significant differences in plasma lymphocyte DNA damage and CAT levels but no differences in TOS, MDA levels, OSI, TAS, or UTS2R levels. MIDAS scores were positively correlated with the degree of lymphocyte DNA damage, but neither of these factors was significantly related to CAT levels. Conclusion The present data suggest that lymphocyte DNA damage and changes in oxidative/antioxidative status may reflect an enhanced oxidative damage and an ineffective antioxidant defense system in migraineurs during headache attacks. In addition, lymphocyte DNA damage levels may be an indicator of the degree of migraine-related disability as assessed by MIDAS score.

Oxidative status and lymphocyte DNA damage in patients with acute pancreatitis and its relationship with severity of acute pancreatitis

BACKGROUND/AIMS Acute pancreatitis (AP) is a life-threatening disease with a rising incidence. The aim of this study was to investigate the association between oxidative status, lymphocyte deoxyribonucleic acid (DNA) damage, and acute pancreatitis. MATERIALS AND METHODS A total of 45 patients with AP and 35 healthy controls were included in the study. We assessed pancreatic enzymes, oxidative stress, and lymphocyte DNA damage. The severity of AP disease was determined by the Harmless Acute Pancreatitis Score (HAPS) and Balthazar scoring systems. RESULTS In AP patients, lymphocyte DNA damage was significantly higher than in controls [49.84±25.48 arbitrary units (AU) vs. 28.80±13.98 AU, p<0.001]. The plasma total oxidative status (TOS) and oxidative stress index (OSI) were higher in patients than in healthy controls (10.36±5.54 vs. 8.47±2.66, p<0.05; 0.64±0.35 vs. 0.45±0.13 AU, p<0.001, respectively). The plasma total antioxidant status level in patients was lower than in healthy controls (1.66±0.19 vs. 1.86±0.18, p<0.001). Lymphocyte DNA damage was correlated with TOS, OSI, and HAPS and Balthazar scores. CONCLUSION This study shows that patients with AP have higher lymphocyte DNA damage and more deteriorated oxidative status than healthy controls.

Interhemispheric Acute Subdural Hematoma: A Distinct Entity of Subdural Hematoma

We wish to notify the readers on a rare case of interhemispheric acute subdural hematoma (ASH) who presented to our emergency department (ED) with a falx syndrome of contralateral hemiparesis in lower extremity and severe headache. A 25-year-old previously healthy man was involved in a traffic accident and presented to our ED with complaints of repeated vomiting and severe headache. On arrival to the ED, he had an initial Glasgow coma scale (GCS) of 14 (opening her eyes with verbal stimuli, obeys commands, orientated) and normal vital signs (blood pressure: 130/85 mm Hg; heart rate: 86 bpm). No other injuries were noted. Neurological examination revealed mild weakness of the right lower extremity (strength score: 4/5). His routine blood tests, including complete blood counts, prothrombin time, and thromboplastin time were unremarkable. The plain films of the skull were normal. Non-enhanced cranial (CT) scan performed 4 h after the accident revealed a small left-sided acute interhemispheric subdural hematoma, which was posteriorly located (Fig. 1a). Magnetic resonance imaging (MRI) of the brain during the first 24 h after admission confirmed minimal ASH in the posterior interhemispheric fissure with subacute subdural hematoma in the left parietooccipital cortex and occipital regions (Fig. 1b). Considering the clinical condition of the patient, surgery was not planned by the neurosurgical department but the patient was kept under observation in the ED. He was discharged home 48 h after the trauma with a normal neurological examination and mild intermittent headaches. Interhemispheric ASH is a relatively uncommon type of ASH because of their unusual location [1]. They usually occur in patients with bleeding disorders and are associated with trauma in the majority of cases [2]. Computed tomography (CT) and MRI are important neuroradiological techniques for the accurate diagnosis of interhemispheric ASH [1, 2]. Although interhemispheric ASH is a rare form of subdural hematoma, early diagnosis and treatment is of great importance because of its emergent condition [2, 3]. CT and MRI are important diagnostic tools, as it was in this case. MRI may have the advantage rather than CT due to the absence of beam-hardening and multiplanar imaging. The best management modality for interhemispheric ASH depends upon the neurologic status on admission and clinical course [2]. If the patient is neurologically stable, conservative treatment is generally preferred. Surgical treatment is reserved in patients with disturbances of consciousness and for patients with progressive neurological deterioration [3].

The relationship between vascular inflammation and target organ damage in hypertensive crises

OBJECTIVE Hypertensive crises, divided depending on the presence of target organ damage (TOD), are associated with increased cardiovascular mortality and morbidity. Monocyte chemoattractant protein-1 (MCP-1) is responsible for the recruitment of monocytes to sites of vascular inflammation. The aim of this study was to evaluate the role of vascular inflammation in development of TOD. METHOD The patients were categorized according to the presence of TOD. Thirty-three patients (15 female; mean age, 68 ± 12 y) with TOD and 30 patients (14 female; mean age, 64 ± 12 y) without TOD were included to the study. In addition to routine laboratory parameters, neutrophil-lymphocyte ratio, uric acid, C-reactive protein (CRP), high sensitive CRP, and plasma MCP-1 levels were evaluated. RESULTS Neutrophil counts, white blood cells, high sensitive CRP, and uric acid levels were higher in patients with hypertensive crises. More importantly, CRP (7.2 mg/dL [2-37.8 mg/dL] vs 4.6 mg/dL [1.5-14 mg/dL] vs 2.7 mg/dL [1-8.1 mg/dL], P < .01) and MCP-1 levels (546 pg/mL [236-1350 pg/mL] vs 407 pg/mL [78-942 pg/mL] vs 264 pg/mL [34-579 pg/mL], P < .01) were higher in the group with TOD compared with other groups. CONCLUSION In conclusion, plasma MCP-1 levels were significantly higher in patients with TOD. According to our results, we suggest that increased vascular inflammation and MCP-1 levels might be associated with the development of TOD in hypertensive crisis.

The relationship between anemia and recurrence of ischemic stroke in patients with Trousseau's syndrome: A retrospective cross-sectional study

Objectives The relationship between cancer and thrombosis was first recognized by the French internist Armand Trousseau in 1865. Trousseaus syndrome is a spectrum of symptoms that result from recurrent thromboembolism associated with cancer or malignancy-related hypercoagulability. In this study, we investigated whether demographics, clinical features, or laboratory findings were able to predict recurrent stroke episodes in patients with Trousseaus syndrome. Methods In total, 178 adult patients were enrolled in this retrospective cross-sectional study. All patients had been admitted to the emergency room of our hospital between January 2011 and September 2014 and were diagnosed with acute ischemic stroke. Patients were divided into two groups: patients with malignancy (Trousseaus syndrome), and patients without malignancy. Results There were several significant differences between the laboratory results of the two patient groups. For patients with Trousseaus, the hemoglobin levels for those with one stroke was 12.29 ± 1.81, while those in patients who had experienced more than one stroke was 10.94 ± 2.14 (p = 0.004). Conclusions Trousseaus syndrome is a cancer-associated coagulopathy associated with high morbidity and mortality rates. In this study, anemia was associated with increased stroke recurrence in patients with malignancy (Trousseaus syndrome).

A Rare Cause of Headache in the Emergency Department: Intraventricular Epidermoid Cyst Rupture With Hydrocephalus

Lateral intraventricular tumors are not frequently observed. Since these tumors grow linearly rather than exponentially, they grow gradually and thus do not cause mass effects and hydrocephalus. This study is the case report of a rare great volume left intraventricular epidermoid cyst rupture. The tumor was found to be associated with mass effect on neighboring structures and hydrocephalus.

A rare image phytobezoar in stomach.

42-year-old female patient came with complaints of 5 days abdominal pain, nausea, vomiting and constipation to our emergency service. No property was determined when chronic diseases of our patient, drugs used and history of surgery was questioned.It was learned that the purpose of slimming diet rich in fiber has been made for 10 days. Increase in bowel sounds on auscultation in the upper quadrant of the abdomen, while there was a decrease in the lower quadrant.The patients vital signs were normal with normal laboratory values. Nasogastric tube was inserted in patients with vomiting, abdominal distension and constipation. There were air and liquid levels in the intestine in her direct abdominal radiographs, there was severely distended stomach and the gastric lumen had been filling with opacities (A). Intense soft tissue and isodense density which fills the lumen are available in the abdominal tomography, fluid and air leveling were observed in intestinal (B). Oral in take was stopped and intravenous hydration were started.The patient was discharged on the 5th day of hospitalization with a poor diet in fiber. In patients with out under lying chronic disease and a history of previous surgery, the patient can be given the chance of treatment with conservative method.