Seckin Akkucuk

The reflection of the Syrian civil war on the emergency department and assessment of hospital costs.

BACKGROUND In the present study, it was aimed to assess the demographics, clinical features, and treatment costs of cases referred to our hospital after the Syrian civil war. METHODS Of 1355 Syrian civil war victims referred to our hospital during the 14-month period between June 2011 and July 2012, 482 cases presenting to the emergency department were included in the study. The electronic data of these patients were retrospectively analyzed. RESULTS Of 482 cases, 428 were male (88.8%) and 54 (11.2%) were female, with a mean age of 30.4±14.9 years (1-79 years). The mean age was 30.8±17.2 years (1-79 years) in males and 27.3±16.9 years (1.5-66 years) in females. There was a significant difference in terms of sex (p=0.007). It was found that the majority of the cases (41.1%) were aged 21-30 years. The highest number of admissions was recorded in June 2011 (159 patients, 33%), whereas the lowest number of admissions was in September 2011 (5 patients, 1%). All cases were transported to our hospital from nearby district hospitals and camps by emergency medical services. The most frequent presenting complaint was gunshot injury (338 cases, 70.1%). The most common diagnosis was extremity injury (153 cases, 31.7%). The number of forensic cases was found as 364 (75.5%). Of all the cases, 136 cases (28.2%) were managed in the emergency service, and the remaining cases were admitted to other services. They were most frequently admitted to the orthopedics ward (146 cases, 30.3%). The mean length of the hospital stay was 9.9 days (1-141).Overall, 456 cases (94.6%) were discharged, 22 cases died, and 4 cases were transferred to other facilities. The mean cost per case was estimated as 3723Turkish lira (TL) (15-69556). A positive correlation was found between cost and length of hospital stay. CONCLUSION Among all Syrian cases, the majorities of young males and gunshot injuries was striking. Most of the cases were discharged after appropriate management. Preventive measures can avoid these negative outcomes and so avoidable costs will not occur, and this can preclude the damage to the budgets of the countries.

Thyroid Hemiagenesis, Ectopic Submandibular Thyroid Tissue, and Apparent Persistent Subclinical Thyrotoxicosis

BACKGROUND Ectopic thyroid tissue (ETT) is a rare embryological abnormality characterized by the occurrence of thyroid tissue in a site other than its usual location. Thyroid hemiagenesis (HA) is also a very rare abnormality in which one thyroid lobe does not develop properly during embryology. We report a patient with left HA, submandibular ETT, and persistent mildly suppressed serum thyrotropin (TSH). PATIENT A 38-year-old female patient was admitted with complaints of sweating and palpitations. She had no symptoms of neck compression. Thyroid ultrasonography revealed heterogeneity and hypoechogenicity of the right lobe and absence of the left lobe, the latter being confirmed by computed tomography. There was no ETT in the neck. A thyroid Tc-99m pertechnetate scan demonstrated two distinct areas of radiotracer uptake, one in the right lobe of the thyroid gland and one in the right submandibular region and lobe, but no uptake in the left thyroid bed. The serum free triiodothyronine was 2.89 pg/mL (2.5-3.9 pg/mL), and the serum free thyroxine was 0.86 ng/dL (0.61-1.12 ng/mL). The serum TSH was 0.11 mIU/L (0.34-5.60 mIU/L). CONCLUSIONS This may be the first reported patient with HA and submandibular ETT. The patient probably also had thyroiditis with mild intermittent thyrotoxicosis based on her suppressed TSH and ultrasonography imaging of the right thyroid lobe.

Effect of radioactive iodine therapy on lacrimal gland functions in patients with hyperthyroidism.

Background Radioactive iodine (RAI) therapy is preferred in the treatment of hyperthyroidism because of its effectiveness, noninvasiveness, and low costs. 131I has been detected in extrathyroidal tissues, such as in gastric mucosa, salivary glands, and lacrimal glands. To the best of our knowledge, there is no publication concerning the effects of RAI therapy for hyperthyroidism on tear production. In the present study, we evaluated whether or not the lacrimal glands are affected after RAI therapy when compared with pretreatment period. Methods The Schirmer and tear break-up time (TBUT) tests were used to assess 32 eyes of 16 patients with conditions that were diagnosed as hyperthyroidism before and at 3 and 6 months after RAI treatment. In addition, pretreatment values of patients were compared with that of controls. It was evaluated whether or not a correlation exists between the results and the dose or iodine uptake values. Results There was no significant difference between pretreatment values of Schirmer and TBUT tests obtained in the patient group and those of the control group (P > 0.05). In the patient group, there was a significant difference between the posttreatment and pretreatment values (P < 0.05). There was a positive correlation between uptake values obtained at 24 hours and the values obtained by TBUT and Schirmer tests on both eyes at 3 and 6 months. At 6 months, the uptake value at 24 hours was 28.83 ± 60 for both eyes in patients with TBUT test values less than 10, whereas it was 39.25 ± 7.88 for the right eye and 39.00 ± 6.85 for the left eyes in patients with TBUT test values greater than 10. The difference was statistically significant (P < 0.05). Conclusions In our study, we concluded that the decrease in mucin and aqueous production occurs due to affected lacrimal glands by RAI therapy; however, this effect is not dose dependent.

The efficacy of oral glutamine in prevention of acute radiotherapy-induced esophagitis in patients with lung cancer

Aim of the study This study explores the efficacy of oral glutamine in the prevention of acute radiotherapy-induced esophagitis in patients with lung cancer who are treated with thoracic radiotherapy. Material and methods This study was planned as a retrospective randomized experimental study. Forty-six patients with lung cancer, who were treated and kept under control between January 2008 and January 2010, were included in the study by the Department of Radiation Oncology, Faculty of Medicine, Dicle University. The patients were divided into two groups. The first group (n = 21) was given prophylactic oral powder glutamine (daily 30 g), while the second group (n = 25) was not given oral glutamine. Results There were 21 patients in Group 1 (45.7%) and 25 patients in Group 2 (54.3%). No significant statistical difference was observed between the two groups in terms of age, gender, stage, histopathological type, treatment choice, received radiation doses, esophagus length in RT field, or location of the tumor (p > 0.05). A significant statistical difference was observed between the glutamine-supplemented group (first group) and the glutamine-free group (second group) according to the grade of esophagitis (p < 0.0001). Conclusions In our retrospective randomized experimental study, we determined that the severity of acute radiotherapy-induced esophagitis might be decreased with oral glutamine in patients with lung cancer who were treated with thoracic radiotherapy.

Gossypiboma causing mechanical intestinal obstruction: a case report.

Introduction. Gossypiboma (GP) is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it.

Massive upper gastrointestinal bleeding due to giant splenic artery aneurysm with gastric fistula

We aimed to report a case of a giant splenic artery aneurysm (SAA) with gastric fistula with the review of the literature. A female patient with splenic artery aneurysm was admitted to our hospital with abdominal pain and massive upper gastrointestinal bleeding. Hemorrhagic shock occurred. Despite the resuscitation, the patient died. Splenic artery aneurysms are the most common visceral aneurysm occurring predominantly in females with a ratio of 4:1. Giant aneurysm with thrombosis of the splenic artery is an extremely rare clinical entity and its size rarely exceeds to 3 centimeters. Although they are usually asymptomatic, SAA are clinically important because of the possibility of life-threatening rupture. Interventions or surgical treatment is indicated for symptomatic and giant aneurysms. Early diagnosis and prompt intervention is necessary for success of treatment.

Surgical outcomes of a civil war in a neighbouring country

Objectives The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. Methods 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. Results The median age of the patients was 30.05 (18–66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). Conclusions In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Stroke in Severity of Sickle Cell Diseases

Background: Sickle cell diseases (SCDs) are chronic inflammatory process on capillary level. We tried to understand whether or not there are some positive correlations between stroke and severity of SCDs. Methods: All patients with SCDs were taken into the study. Results: The study included 343 patients (169 females and 174 males). There were 30 cases (8.7%) with stroke. The mean ages were similar in both groups (32.5 versus 29.1 years in the stroke group and other, respectively, p>0.05). The female ratios were similar in both groups, too (43.3% versus 49.8%, respectively, p>0.05). Prevalences of associated thalassemia minors were also similar in them (73.3% versus 65.1%, respectively, p>0.05). Smoking was higher among the stroke cases (26.6% versus 13.0%, p 0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, chronic renal disease, rheumatic heart disease, avascular necrosis of bones, cirrhosis, and mortality were all higher in the stroke group, the differences were only significant for digital clubbing, leg ulcers, and acute chest syndrome (p<0.05 for all), probably due to the small sample size of the stroke group. Conclusion: SCDs are chronic destructive process on capillaries iniatiating at birth, and terminate with early organ failures in life. Probably stroke is one of the terminal consequences of the inflammatory process that may indicate shortened survival in such cases.

Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso

BACKGROUND AND OBJECTIVES Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. CASE REPORT A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patients arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patients unstable condition. CONCLUSION In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature.

Splenic Hematoma Mimicking Angiosarcoma: A Case Report

Introduction. Splenic hematomas usually occur after blunt abdominal trauma. Most of the subcapsular hematomas will be resolved and reabsorbed spontaneously. However in rare cases, some of them organize and form calcified splenic masses. Angiosarcoma is an uncommon primary tumor of the spleen. Splenic angiosarcoma behaves extremely aggressive and has poor prognosis. Case Presentation. We report a forty-nine-year-old white male with organized splenic hematoma due to traffic accident mimicking splenic angiosarcoma. Conclusion. Both angiosarcoma and splenic organized hematoma have nonspecific symptoms and clinical findings. Because of the risk of hemorrhage and rupture, fine-needle biopsy should not be preferred. In case of splenic masses, excision and spleen-conserving surgery or total splenectomy should be performed.