Selman Yeniocak

Carbon monoxide poisoning associated with water pipe smoking.

The water pipe is a means of tobacco consumption widespread in Turkey and Arab countries. We present two patients brought to our emergency department due to a syncopal attack secondary to carbon monoxide toxicity following water pipe use. This rare form of poisoning should be borne in mind by emergency physicians as a differential diagnosis in water pipe smokers. Water pipes should be used where there is adequate ventilation.

A Rare Cause of Air Inside an Aortic Aneurysm Thrombus

ORCID ID of the author: A.K. 0000-0002-5800-0201. A 59-year-old male patient presented to our emergency department with abdominal pain and fever. He had undergone endovascular aneurysm repair (EVAR) due to the presence of a thoracoabdominal aortic aneurysm approximately 2 years ago. His vital signs were as follows: arterial blood pressure: 90/50 mmHg, respiration rate: 22/ min, heart rate: 120/min, body temperature: 39°C, and fingertip oxygen saturation: 95%. His abdo men was tender during the physical examination, but there was no rebound or defense. Other system examinations were normal. His laboratory test results were as follows: leukocyte count: 14,100 μL (normal: 4230-10200), hemoglobin level: 11.3 g/dL (normal: 12.2-16.2), platelet count: 381,000 μL (normal: 142000-424000), and CRP level: 113.5 mg/L (normal: 0–5 mg/L). Liver and kidney function test results were normal. Thoracic and abdominal contrast computed tomography (CT) were performed (Figure 1). Diffuse air was seen around the thrombus inside the aneurysm lumen from the lower thorax to the renal artery. We suspected that the air inside the aneurysm lumen was associated with the presence of an aortoenteric fistula. Intravenous and oral contrast CT were performed, but no fistula was observed (Figure 2).

The Diagnostic Value of Irisin in Pediatric Patients with Acute Abdominal Pain

Objectives Diagnosis of pediatric patients presenting to the Emergency Department with acute abdominal pain is not always easy. The purpose of this study was to investigate the effectiveness of irisin, a peptide hormone with reactivity shown in the appendix and neutrophils, in the differential diagnosis of pediatric patients with acute abdominal pain. Methods 162 subjects consenting to participate, including 112 patients presenting to the Pediatric Emergency and Pediatric Surgery clinics with acute abdominal pain and 50 controls, were enrolled in the study. Blood was collected from all patients following initial examination for irisin, WBC, and CRP investigation. Results Mean irisin levels in cases of acute appendicitis (AA) and perforated appendicitis (PA) were statistically significantly higher compared to nonspecific abdominal pains and the control group. No statistically significant difference was observed in irisin levels between AA and PA cases. WBC and CRP levels were also significantly higher in cases of AA and PA compared to nonspecific abdominal pains. Conclusions Differential diagnosis of acute abdominal pains in children and deciding on surgery are a difficult and complex process. Our study shows that irisin can be a useful biomarker in differentiating AA and PA from other acute abdominal pains in children.