Selcuk Yaylaci

Slow ventricular response atrial fibrillation related to mad honey poisoning.

Mad honey poisoning which is induced by Grayanotoxin (Andromedotoxin), is also known to have adverse effects in the cardiovascular system leading to different clinical entities. This toxin is produced by a member of the Rhododendron genus of plants of two R. Luteum and R. Panticum. In this article, we presented a case of slow ventricular response atrial fibrillation complaints with nausea, vomiting, dizziness and chest pain about an hour after eating honey produced in the Black Sea Region.

Allopurinol-induced DRESS syndrome.

A 70-year-old man was admitted to our clinic with complaints of fever, jaundice, dyspnea, and generalized rash after 3 months of allopurinol treatment for gout. On physical examination, he was found to have fever (38.5°C), jaundice, and generalized maculopapular rash. Leukocytosis, eosinophilia, elevation of liver enzymes, and hyperbilirubinemia were detected in his blood analysis. Skin biopsy was consistent with drug-induced hypersensitivity. He was diagnosed as Drug Rash with Eosinophilia and Systemic Symptoms (DRESS). Allopurinol treatment was stopped and steroid treatment was launched. At day 24 of admission, the patient died because of multiple organ failure.

Lack of Variation in Inflammatory Hematological Parameters between Benign Nodular Goiter and Papillary Thyroid Cancer

BACKGROUND Inflammatory hematological parameters like the neutrophil/lymphocyte (N/L) ratio have been investigated in many cancer types and significant relationships found with prognosis, for example. The aim of this present study was to investigate the impact of hematological parameters notably on N/L ratio and mean platelet volume (MPV) in papillary thyroid cancer cases. MATERIALS AND METHODS A total of 79 patients who underwent a thyroidectomy operation in Findikli, Goiter Research and Treatment Center during 2011- 2015 period were enrolled in the study, 41 with papillary thyroid cancer and 38 with benign goiter confirmed by pathological examination. We collected clinical and laboratory data for the patients from hospital records retrospectively. Blood samples taken at admission were assessed for parameters compared between the groups. RESULTS No significant differences between papillary thyroid cancer and benign goiter groups were apparent in terms of age, the N/L ratio, MPV, white blood cell count (WBC), red blood cell count (RBC), hemoglobin, hematocrit, platelet, neutrophil, lymphocyte, red blood cell distribution width (RDW) and platelet crit (PCT) levels (>0.05). Only the level of platelet distribution width (PDW) significantly differed, being lower in the papillary cancer group (<0.05). CONCLUSIONS No significant relationship between papillary thyroid cancer and inflammatory hematological parameters including in particular the N/L ratio and MPV. The relevance of the PDW values remains unclear.

Eosinophilic Gastroenteritis: A Rare Case Report

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. It is diagnosed in the biopsies taken during endoscopic examination to the patients with abdominal pain and chronic diarrhea. A 40-year-old woman was admitted with abdominal pain and chronic diarrhea. She has not any disease, food, pollen, or drug allergy in her medical history. Leukocyte: 19,400/mm3 (neutrophil: 19.9%, eosinophil: 57.4%, lymphocyte: 16.5%), platelet: 281,000/ mm3, immunoglobulin E: 1721 IU/mL (normal range: 20–100 IU/mL) was counted in her blood examination. The duodenal biopsy was reported as EGE. We applied methylprednisolone 20 mg/day. With this treatment, the patients symptoms regressed. In this article we present a case of chronic diarrhea diagnosed EGE. The first step in diagnosing is suspecting EGE. It should be borne in mind in patients with chronic diarrhea.

Atrıal fıbrıllatıon due to olanzapıne overdose

Olanzapine is an atypical antipsychotic used in the treatment of schizophrenia and bipolar disorder. There are several case reports of antipsychotic drugs associated with atrial fi brillation (AF). We present a case of new onset AF after a suicide attempt with an overdose of olanzapine. A 21-year-old woman presented to the emergency room with nausea, dizziness, and vomiting after attempting to commit suicide by ingesting 14 olanzapine tablets (10 mg) approximately 1 h before admission. She was a nonsmoker and did not consume other medicines, alcohol, or excess caffeinated beverages. She had no signifi cant medical history. Her family history was negative for heart disease. Her blood pressure was 110/80 mmHg and her pulse was 70 beats per minute and regular. Oxygen saturation was 100% on room air. Cardiovascular examination revealed normal heart sounds without any rubs, murmurs, or gallop; the chest was clear on auscultation. An abdominal and neurological examination was normal. Gastric aspiration and lavage was performed with the patient ’ s cooperation. Activated charcoal was given after gastric lavage. She was admitted to the intensive care unit for monitoring. A 12-lead ECG showed normal sinus rhythm. Four hours later, we observed AF on the monitor, with large fi brillatory waves and normal ventricular rate. The electrocardiogram showed no ST segment or T wave abnormalities. Monitoring was for 72 h. The arrhythmia converted to normal sinus rhythm spontaneously after 10 min. Chest radiograph and routine laboratories, including cardiac enzymes and thyroid function tests, were normal. Repeat cardiac enzyme tests were also within normal ranges. An echocardiographic study showed preserved systolic function without any valve dis order. She was discharged without antiarrhythmic medication. AF is the most common rhythm disorder observed in clinical practice. Several case reports have associated this condition with the use of antipsychotic drugs. However, to our knowledge, only one case of AF by olanzapine has been reported previously. 1,2

Successful treatment of excessive dose of carbamazepine

Carbamazepine is used in the treatment of epilepsy; it is also prescribed for treatment of neuralgic pain syndromes and certain affective disorders. Carbamazepine intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, arrhythmia, hemodynamic instability, and death. There is no specific antidote. Multiple-dose activated charcoal and hemodialysis are the main treatment for carbamazepine intoxication. In this paper, we report the case of a 19-year-old woman with excessive dose carbamazepin intoxication and our successful treatment with multiple-dose activated charcoal and hemodialysis.

Propylthiouracil induced leukocytoclastic vasculitis: A rare manifestation.

Propylthiouracil (PTU) is a common drug used in patients with hyperthyroidism. It may cause perinuclearantineutrophil cytoplasmic antibodies (p-ANCA) in few patients with Graves’ disease. This antibody has been associated with different forms of vasculitis. We report a patient who presented with cutaneous manifestations of leukocytoclasticvasculitis with simultaneous development of p-ANCAs during PTU therapy for Graves’ disease.

Torsades de pointes induced by concomitant use of chlorpheniramine and propranolol: An unusual presentation with no QT prolongation

Drug-induced torsades de pointes (TdP) is a rare but potentially fatal adverse effect of commonly prescribed medications including cardiac and noncardiac drugs. Importantly, many drugs have been reported to cause the characteristic Brugada syndrome-linked electrocardiography (ECG) abnormalities and/or (fatal) ventricular tachyarrhythmias. Chlorpheniramine and propranolol have the arrhythmogenic effects reported previously. A review of literature revealed a large number of case reports of chlorpheniramine or propranolol use resulting in QTc prolongation, TdP, or both. However, we wish to report the case of a patient who was treated with a combination of chlorpheniramine and propranolol, whose ECG showed no QT prolongation but who suffered from cardiac arrest due to TdP.

A rare cause of pancytopenia: Sheehan's syndrome

Sheehans syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. Pancytopenia is rarely observed in patients with Sheehans syndrome. We present a patient of Sheehans syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment. Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehans syndrome.

Cerrahi girişimlerin Lewy body demansa etkisi: iki olgu sunumu

Lewy body demans Alzheimer hastaligindan sonra ikinci siklikta gorulen norodejeneratif demanstir. Kardinal bulgulari bilissel bozukluk, gorsel halusinasyonlar ve motor bulgular (parkinsonizm) dir. Ayni zamanda REM (rapid eye movement) uyku davranis bozuklugu ve ciddi noroleptik duyarliligi ve disotonominin varligi taniyi destekleyici bulgulardir. Lewy body demans tanili olgularda post operatif bilissel bozuklukta artis ve post operatif deliryum normal yasli po pulasyonu ile Alzheimer hastaligi ve diger demans olgularina gore daha sik gorulmektedir. Bu yazida biri 65 yasinda kalca kirigi nedeniyle cerrahi operasyon sonrasi hipoaktif deliryum ve sonrasinda bilissel fonksiyonlarda bozulmada artis gozlenen, digeri 60 yasinda sonrasi hiperaktif deliryum ve bilissel bozulmada artis gozlenen iki adet erkek olasi Lewy body demans olgusu sunduk. Lewy body demans olgularinda cerrahi sonrasi komplikasyonlarin erken tanisi ve tedavisinin ciddi morbidite ve mortaliteyi onlemede oldukca etkin oldugu akilda tutulmalidir. Ayrica klinisyenler Lewy body demans olgularinda preoperatif ve intraoperatif donemde komplikasyon gelisimini azaltmak icin olasi riskleri saptamali ve en aza indirgemeye calismalidirlar.