Ozlem Bilir

A different reason for cerebrovascular disease

Bee stings are commonly encountered worldwide. Various manifestations after a bee sting have been described. Local reactions are common. Unusually, manifestations such as vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, hypotension, and collapse may occur. Rarely, vasculitis, serum sickness, neuritis, and encephalitis have been described, which generally develop days to weeks after a sting. We report a case of a 35-year-old man who developed neurologic deficit 6 hours after a bee sting, which was confirmed to be left parietooccipital infarction on magnetic resonance imaging scan. We report this case due to its rarity.

Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry.

AIM We used near-infrared spectrophotometry to assess the initial and final abdominal and cerebral saturations during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest to determine if there is a correlation between increase in these saturation values and return of spontaneous circulation. MATERIALS AND METHODS We evaluated 34 patients with out-of-hospital cardiac arrest without witnesses brought to our emergency department. Abdominal and cerebral saturations were measured using near-infrared spectrophotometry from the start of CPR. Cardiopulmonary resuscitation was performed for a maximum of 30 minutes. The effect of abdominal saturations in patients with or without spontaneous circulation restored through CPR was then assessed. RESULTS Thirty-four patients (17 males + females) with a mean age of 63.06 ± 11.66 years were included in the study. A significant correlation was determined between increase in abdominal saturations measured at the start and end of CPR and the return of spontaneous circulation (P < .001). A good positive correlation was also identified between abdominal saturation and return of spontaneous circulation. CONCLUSION Patients with increased abdominal and cerebral saturation values have a higher survival rate after appropriate CPR. This noninvasive measurement system and monitoring of patients during CPR may be a good method of predicting return of spontaneous circulation and assessing abdominal perfusion.

Publication rate of abstracts presented at the emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012.

Purpose The purpose of this study was to assess the publication rate of the abstracts presented at the 6th Mediterranean Emergency Medicine Congress, 2011 and the 7th European Congress on Emergency Medicine, 2012. Materials and methods All abstracts, both posters and oral presentations, from the international emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012 were identified. To establish whether these abstracts were subsequently published in peer-reviewed medical journals, the names of all the authors and the title of the abstracts were searched for in the databases of Clinical Key/Elsevier, EBSCO Discovery Service, MD Consult, Science Direct, Scopus, EMBASE, Medscape, Google Scholar and local ULAKBIM. The year of publication, consistency of author names and titles, the type of study, the journals in which papers were published and countries from which reports were submitted were all recorded. Results A total of 1721 abstracts were examined; 626 from 2011 (307 oral presentations and 319 posters) and 1095 from 2012 (154 oral presentations and 941 posters). Of all abstracts in 2011, 172 (27.5%) and of all abstracts in 2012, 265 (24.2%) were subsequently published as full-text reports in peer-reviewed journals. Of the 172 papers published in 2011, 152 (88.4%) were accepted by Science Citation Index (SCI) and/or SCI Expanded (SCI-E) journals and 155 (58.5%) of 265 papers were accepted by SCI and/or SCI-E journals in 2012 (p=0.0001). Conclusions The publication rate of abstracts submitted to international emergency medicine congresses held by EUSEM over those 2 years was low compared with that of abstracts presented in other emergency medicine congresses. Presenters should be encouraged to send their studies to peer-reviewed journals. During the selection process by the scientific panel, constructive critics should be notified to the presenters instead of simply accepting or rejecting the studies that submitted to the congress, which may increase the subsequent publication rate.

Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.

INTRODUCTION The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. RESULTS A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. CONCLUSION With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.

Incidental finding in a headache patient: intracranial lipoma.

A 60 year old female, with a history of atrial fibrillation who was on warfarin therapy, presented to our emergency department with chief complaint of the most severe headache that she ever had. Her vital signs, systemic and neurological examinations were normal. She had emergency computed tomography (CT) of the brain with suspicion of intracranial hemorrhage that revealed a lesion in fat dansity in the lateral ventricle and interhemispheric fissure (Figure a). Her international normalized ratio was 3,2. She underwent cranial magnetic resonance imaging (MRI) that revealed a hyperintense lesion in T1 and T2 sequances in the lateral ventricles, pericallosal area and interhemispheric fissure that did not show contrast enhancement (Figure b and c). After the symptomatic relief by analgesics she was discharged from the emergency department for out-patient follow-up. Figure Image (a) shows cranial computed tomography. There is a homogenously hypodense lesion measuring 33 mm × 30 mm in the lateral and third ventricles with about −101 to −110 Hounsefield unit. Image (b) and (c) show magnetic resonance ... Intracranial lipomas are rare and benign congenital malformations accounting for 0,1% to 0,46% of all intracranial tumors.1 Since half of all cases are asymptomatic, they are usually an incidental finding during neuroimaging studies. Headache is the most common symptom in adults if it becomes symptomatic.2 The deep interhemispheric fissure, especially the corpus callosum, is the most common localization of intracranial lipomas.1 Intracranial lipomas are often associated with other malformations of the central nervous system, such as callosal agenesis or hypogenesis, spina bifida or a cranium bifidum.1,3 Noncontrast cranial CT and brain MRI allow definitive diagnosis. The appearance of the corpus callosum lipoma on the cranial CT scan is quite typical, with the low attenuation seen only in adipose tissue, which ranges from −40 to −100 hounsfield units.4,5 In the brain MRI the lesion presents characteristics of fatty tissue, with a hyperintense signal in both T1 and T2-weighted studies.6 Most lipomas are treated conservatively and rarely requires neurosurgical treatment because of their benign nature.1 Our patient did not have any accompanying lesion and was discharged to follow-up as an out-patient.

Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis

1Department of Emergency Medicine, Recep Tayyip Erdogan University Faculty of Medicine, Rize; Departments of 2Cardiovascular Surgery, 3Cardiology, Gumushane State Hospital, Gumushane; 4Department of Thoracic Medicine, Erciyes Univercity Faculty of Medicine, Kayseri, Turkey. Asim KALKAN,1 Mehmet Erdem MEMETOĞLU,2 Ozlem BILIR,1 Gokhan ERSUNAN,1 Rasim KUTLU,3 Nuri TUTAR4 Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis?

A Case of Ramsay Hunt Syndrome with Atypical Presentation

SUMMARY Ramsay Hunt syndrome is a rare complication of herpes zoster which results from the reactivation of the latent varicella-zoster virus in the geniculate ganglion. Although facial nerve is the most common affected nerve in Ramsay Hunt syndrome, other cranial and cervical nerves can also be affected. We present an atypical case of Ramsay Hunt syndrome in a 42-year-old male, with cervical nerve involvement. As spontaneous recovery rate in Ramsay Hunt syndrome is low, early diagnosis and treatment plays a key role in full recovery of paralysis.

Utility of near infrared spectrophotometry in mesenteric ischemia: An experimental study

This study investigated the effectiveness of near infrared (NIR) spectrophotometry for measuring abdominal saturation in a rat model of induced mesenteric ischemia. This was a randomized, controlled, non-blinded interventional animal study. Twenty-eight male Sprague Dawley rats were randomly allocated into four groups. Following induction of anesthesia, the abdominal region was shaved and intra-abdominal access was achieved through a 4-cm midline incision and basal measurements were performed using an INVOS-5100c device. The rats were grouped on the basis of rSO2 measurement times. Mesenteric artery ligation was not performed on the control group rats. From the rest of the mesenteric artery ligated rats, measurements were taken at 30 min, at 2 h and at 6 h. Measurements were repeated using NIR spectrophotometry probes after the abdomen was surgically closed. Following the measurements, the abdomen was re-opened and small intestine tissue specimens were taken for histopathological examination. Initial and final NIR spectrophotometry measurements were compared. No statistically significant difference was found in the group 1 between basal rSO2 values and post-incision values (p = 0.748). There was a significant variation between the initial and final measurements in groups 2, 3, and 4 (p = 0.018). Although various radiological or biochemical markers are available for detecting mesenteric ischemia, the use of NIR spectrophotometry can be considered a good non-invasive alternative method for early diagnosis of acute mesenteric ischemia.

Acute Dystonic Reaction Associated with Cefuroxime Axetil in a ChildRunning Title: Acute Dystonic Reaction

Dystonia is an extra-pyramidal motor function disorder characterized by intermittent spasmodic or sustained involuntary muscle contractions of the face, neck, trunk, pelvis and extremities causing repetitive movements and postural abnormalities. A 10-year-old male child was presented to the emergency department with complaint of regular rhythmic spasms on the head. He was diagnosed as dystonic reaction induced by cefuroxime axetil. After cessation of the therapy and administration of 2.5 mg of biperiden intravenously, the spasms were stopped. Our aim is to make up an awareness of this adverse drug reaction when prescribing such antibiotic in children.