Sadik Girisgin

Serum Ischemia-modified Albumin Levels in an Experimental Acute Mesenteric Ischemia Model

OBJECTIVES This experimental study aimed to assess the changes in the levels of serum ischemia-modified albumin (IMA) and interleukin-6 (IL-6) by time in cases of acute mesenteric ischemia due to superior mesenteric artery occlusion. METHODS Twenty-one New Zealand rabbits were randomly divided into three groups. Blood samples were collected at hours 0, 1, 3, and 6 from animals in a control group; a sham group following a simple laparotomy; and in an ischemia group following superior mesenteric artery ligation. All blood samples were analyzed for serum IMA and IL-6 levels, and then the time-dependent changes of biomarkers were investigated. RESULTS The serum IMA levels of the ischemia group at hours 3 and 6 were significantly higher than those of the control and sham groups (hour 3, p = 0.017; hour 6, p = 0.001). The increase in serum IL-6 levels in the ischemia group at hours 1, 3, and 6 compared to the control and sham groups was also significant (hour 1, p = 0.002; hour 3, p = 0.003; hour 6, p = 0.003). CONCLUSIONS IMA may be helpful as a marker in the diagnosis of acute mesenteric ischemia; however, its diagnostic value and use as a routine biochemical test should be assessed in further studies.

Stevens-Johnson Syndrome Due to Concomitant Use of Lamotrigine and Valproic Acid

Stevens-Johnson syndrome (SJS) is a rare but life-threatening acute mucocutaneous hypersensitivity reaction, usually related to drugs. Severe cutaneous adverse effects such as SJS and toxic epidermal necrolysis can arise during treatment with antiepileptic drugs (AEDs).and lamotrigine until 1 week prior to referral. Following consultations with a range of clinicians, the patient was diagnosed with SJS related to lamotrigine on the basis of her history and physical findings, and on consideration of current consensus definitions of this condition. The patient was followed up and treated in the emergency intensive care unit with intravenous fluids, antibacterial therapy, and methylprednisolone. After 18 days,the patient was considered to have made a sufficient recovery and was discharged rash appears.

The effectiveness of various doses of octreotide for sulfonylurea-induced hypoglycemia after overdose

This study was conducted to investigate the effectiveness of various doses of octreotide in reducing hypoglycemic attacks and the need for dextrose in patients with refractory and recurrent hypoglycemia related to sulfonylurea toxicity. This study was carried out at the Center of Experimental Research of Selcuk University Meram School of Medicine in Konya, Turkey. A total of 40 New Zealand rabbits of both sexes, weighing between 2500 and 3000 g, were used in this experiment. Rabbits were randomly divided into 4 groups, each of which consisted of 10 animals. All animals were given oral gliclazide 100 mg. For the treatment of hypoglycemic attacks in group I, only 15 mL of 50% dextrose (7.5 g) was given intravenously; in groups II, III, and IV, octreotide was given in doses of 25 μg, 50 μg, and 100 μg, respectively. Octreotide was given to groups II, III, and IV at the 8th hour (when hypoglycemic attacks were induced), along with an intravenous infusion of an additional 15 mL of 50% dextrose (7.5 g) for each hypoglycemic attack that occurred. After the toxic dose was given, the rabbits were given the amount of dextrose used before and after octreotide administration, and the numbers of hypoglycemic attacks were recorded. The values of blood glucose for all animals were read every hour on the hour from the beginning of the study, and the study ended at the 24th hour, when hypoglycemic attacks stopped. A significant difference was observed between groups I, II, and IV in numbers of hypoglycemic attacks that occurred and dextrose doses given between 9 and 24 h (P=.001). The findings of this study suggest that a single dose of octreotide 100 μg maybe used to reduce the number of refractory and recurrent hypoglycemic attacks that occur because of sulfonylurea overdose; large prospective studies are needed to validate these findings.

The effect of N-acetyl cysteine on serum glutathione, TNF-α and tissue malondialdehyde levels in the treatment of sepsis

BACKGROUND The aim of this study was to investigate the effects of Nacetyl cysteine (NAC) on the levels of reactive oxygen species in sepsis. METHODS In this study, 30 Sprague-Dawley female rats weighing 180- 200 g were used. Rats were randomized into three groups, each containing 10 rats, as follows: Group I: Sham, Group II: Sepsis and Group III: Sepsis+NAC. Group I underwent only laparotomy. In Groups II and III, sepsis was induced by cecal ligation and perforation (CLP) technique. NAC (20 mg/kg/ day) was administered orally to Group III at 0, 8 and 16 hours. At the 24th hour, tissue and blood samples were taken for erythrocyte glutathione (GSH) and serum tumor necrosis factor (TNF)-? levels, histopathological determination, and lung, liver and kidney tissue malondialdehyde (MDA) analyses. RESULTS Group III was significantly different from the other groups with respect to erythrocyte glutathione, serum TNF-? and kidney MDA levels (p<0.05). There was no significant difference between the groups regarding liver MDA levels and histopathological parameters for lung, liver and kidney (p>0.05). CONCLUSION NAC treatment had beneficial effects on erythrocyte GSH, serum TNF-?, lung function, and kidney MDA levels in sepsis-induced rats. However, this beneficial effect was not confirmed as histopathological improvement. Further research is needed to prove the effect of NAC in sepsis treatment.

The effectiveness of analgesics in traumatic injuries of the extremities

In this study, the effectiveness of different analgesics was investigated in patients who presented to the emergency room with traumatic injuries or fractures of the extremities. We observed 100 patients (42 male, 58 female) who presented to the Konya State Hospital emergency service with isolated traumatic injuries of the extremities. We used different analgesics intravenously or intramuscularly in those patients with a high or moderate level of pain according to a visual analog pain scale. Patient pain levels were assessed 15, 30, and 45 minutes after administration of the analgesics. Metamizole sodium 1 g IV was used in 36 patients and diclofenac sodium 75 mg IM was given to 40 patients; tramadol hydrochloride 100 mg IV was administered to 24 patients. Pain became less severe after 15 minutes in 92% of patients who received tramadol IV; pain became less severe after 30 minutes in 72% of those who received metamizole IV. In contrast, pain became less severe after 45 minutes in 65% of patients who received diclofenac IM. Tramadol was the most effective analgesic and was also more effective earlier than the other analgesics tested.

A Diagnosis of Total Abdominal Aortic Occlusion in a Patient Who Entered the Emergency Department by Walking

Giris: Tromboz riski hiperkoagulabilite durumlarinda artar. Hiperkoagulabilite, kalitsal veya kazanilmis olabilir. Burada; acil servise yuruyerek giren, kalitsal hiperkoagulabilitesi olan ve acil serviste total abdominal aort okluzyonu ile akut renal arter trombozu tanisi konan bir olgu sunacagiz. Olgu Sunumu: 48 yasinda bayan hasta, 30 dakika once baslayan sag yan agrisi sikayetiyle acil servise basvurdu. Agri aniden baslamisti ve surekli karakterdeydi. Hasta acil servise acil servise yuruyerek girdi. Kontrastli batin bilgisayarli tomografisinde; sag renal enfarkt, sag renal arter trombusu ve iliak arter bifurkasyonu seviyesinde abdominal aortta trombus tespit edildi. Sonuc: Abdominal aort okluzyonu, hiperkoagulabilitenin nadir gorulen komplikasyonlarindan biridir. Abdominal aortanin total okluzyonu, genellikle alt ekstremitelerde iskeminin kardinal bulgulari ile kendini gosterir. Bizim vakamizda, gelismis kollateral akim sayesinde alt ekstremitelerde kan akiminin azalmasina bagli bulgu tespit edilmemistir. Acil servise yuruyerek giren bir hastanin, total aort okluzyonu tanisi almasi acil servis hekimleri acisindan ilginc bir durumdur.

Bedside Sonography in Emergency Departments in Turkey

Emergency departments in Turkey have been steadily improving their services since emergency medicine began as a specialty over 12 years ago, but bedside ultrasound (US) has not been implemented widely. In order to learn the extent of ultrasound usage and training opportunities, a 27-question survey was distributed to emergency medicine-trained physicians working in emergency departments at ten university hospitals (the busiest one in each geographical region, plus three others), which are referral centres covering over half of the countrys population. Eight of the ten EM departments had an ultrasound machine in their ED (for a mean of 3·7 years), but the machines were used and controlled by the Department of EM in only four of the centres. While EM physicians knew how to perform US in seven centres, they routinely performed US themselves in only five. Of the 173 EM staff in the centres surveyed, 57 performed bedside US, and 28 possessed an US course certificate. All respondents wanted their EM residents to have formal US training, but such a rotation was present in only five centres. Bedside US was being performed in the following clinical situations: trauma (n=7), abdominal pain (n=7), renal colic (n=5), chest pain (n=3), assist to invasive procedures (n=3), locating subcutaneous foreign bodies (n=3), and dyspnea (n=1). Five departments had no form or system for documenting their US findings, and if finding anything suspicious, always sent the patients to radiology to have the US repeated. The mean duration from request-to-radiology-for-US to report-in-EM-physicians-hands was 47 minutes. Bedside US is performed by EM physicians in only half of the academic centers we surveyed. Documentation is absent in many, thus the quality or impact of this practice would be difficult, if not impossible, to determine. Formal educational programs are desired by all, but have yet to be implemented in half of the centres. Given the many benefits to patients of bedside US, diligent efforts still need to be made to improve this service in academic emergency departments in Turkey.