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Öğe Diagnostic and prognostic value of procalcitonin and phosphorus in acute mesenteric ischemia(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2011) Karabulut, Keziban; Gul, Mehmet; Dundar, Zerrin Defne; Cander, Basar; Kurban, Sevil; Toy, HaticeBACKGROUND In this study, using an animal model of acute mesenteric ischemia (AMI), we investigated the possible use of procalcitonin and phosphorus in the early diagnosis of AMI. METHODS In this study, 21 New Zealand rabbits were used. Subjects were allocated into three groups as Control, Sham and Ischemia. No intervention was performed in the subjects in the Control group. In the subjects in the Sham and Ischemia groups, laparotomy was performed with midline incision. In the Ischemia group, the superior mesenteric artery was found and tied after laparotomy. Blood was drawn from the animals in all groups at 0, 1, 3 and 6 hours, and procalcitonin and phosphorus levels were studied in these samples. RESULTS In the Ischemia group, the increase in the levels of serum phosphorus and procalcitonin was found to be statistically significant compared to the Control and Sham groups (p < 0.05). The levels of phosphorus and procalcitonin were detected to increase from the 1st hour after ischemia onset, and the increase continued for the following 6 hours (p < 0.05). CONCLUSION Phosphorus and procalcitonin may be important parameters for use in the early diagnosis and prognosis of AMI.Öğe The effect of N-acetyl cysteine on serum glutathione, TNF-alpha and tissue malondialdehyde levels in the treatment of sepsis(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2011) Gul, Mehmet; Ayan, Murat; Seydanoglu, Abdusselam; Cander, Basar; Girisgin, Sadik; Erayman, Ibrahim; Erdem, SamiBACKGROUND The aim of this study was to investigate the effects of N-acetyl 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)-alpha 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-alpha 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-alpha, 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.Öğe Fibrinolytic markers and neurologic outcome in traumatic brain injury(NEUROL SOC INDIA, 2006) Bayir, Aysegul; Kalkan, Erdal; Kocak, Sedat; Ak, Ahmet; Cander, Basar; Bodur, SaidAims: To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma. Materials and Methods: Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P <= 0.05. Results: A marked negative relationship was found between GCS and PT, PTT, FDP and D-climer levels (P < 0.001). Plt levels did not correlate with GCS. Mortality was most strongly related to GCS, PT, FDP and D-dimer levels (P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). We found no relationship between mortality and CT findings, nor was there any significant relationship between Plt, PTT and fibrinogen levels. Conclusion: GCS and fibrinolytic markers measured within the first three hours were useful in determining the prognosis of patients with isolated head trauma.Öğe Is There a Difference Between the Readabilities of Informed Consent Forms Used for Procedures in the Emergency Services of State and University Hospitals in Turkey?(EMERGENCY MEDICINE PHYSICIANS ASSOC TURKEY, 2018) Sonmez, Leyla Ozturk; Sonmez, Mehmet Giray; Ayranci, Mustafa Kursat; Evrin, Togay; Katipoglu, Burak; Cander, BasarAim: The aim of the present study was to evaluate the readability levels of informed consent forms (ICFs) used for procedures in the emergency services of state and university hospitals by comparing through readability formulas. Materials and Methods: ICFs used in emergency medicine clinics in different university and state hospitals in Turkey were collected, and forms that were the same were included in the evaluation only once. A total of 32 ICFs, with 15 from university hospitals and 17 from state hospitals, were evaluated. Average word number, syllable number, and words with syllable number of four and above were calculated. Different formulas were used to determine readability levels. Results: Although the readability of ICFs used in university hospitals was found to be better than those in state hospitals, the readability levels of the ICFs for both groups were detected to have medium difficulty according to the Atesman formula, very difficult according to the Flesch-Kincaid formula, difficult according to the Gunning-Fog formula, and at high school level according to the Bezirci-Yilmaz formula. Conclusion: In conclusion, the readability rates of emergency procedure ICFs in both state hospitals and university hospitals were detected to be rather low according to the present study. The education level of our country and the local environment should be considered while preparing these ICFs.Öğe Morphologic and quantitative analyses of leukocytes in patients with multiple system trauma(HEALTH COMMUNICATIONS INC, 2007) Cander, Basar; Tosun, Murat; Kalkan, ErdalMultiple system trauma can occur in accidents, natural disasters, and deliberate attacks, and vital areas of the body, such as the head, chest, and abdomen, may be affected. Investigators in the present study sought to examine morphologic and morphometric alterations of leukocyte responses in patients with multiple trauma during the first 4 h after a traumatic event. Venous blood samples were drawn from 51 patients, 30 male and 21 female, aged 16 to 59 y. The number of leukocytes increased significantly in all patients, but no significant differences were noted between the male and female groups. Complete blood counts revealed normal ratios of leukocyte types. It is suggested that in patients who have experienced multiple trauma, aggressive antibiotic therapy should be initiated to prevent posttraumatic infection and to protect against secondary organ failure.Öğe Prediction of prognosis in patients with epidural hematoma by a new stereological method(TOHOKU UNIV MEDICAL PRESS, 2007) Kalkan, Erdal; Cander, Basar; Gul, Mehmet; Girisgin, Sadik; Karabagli, Hakan; Sahin, BunyaminEpidural hematoma (EH) is a serious clinical event observed in 2% of head trauma patients. Studies regarding the effects of epidural hematoma volume (EHV) on prognosis are not sufficient. In this study, we applied the volume fraction approach of the stereological method to estimate the hematoma to brain volume fraction (HBVF), and investigated the relation between the HBVF and prognosis. Fifty-nine EH patients (46 male and 13 female subjects, with average age of 21 years) admitted to the emergency clinic were included. The HBVF was estimated on the printed films of cranial computed tomography scans. For this purpose, common point counting grids were superimposed over the scan frames. According to the clinical results, patients were divided into three groups as complete recovery (43), disability (8) and exitus (8). The HBVF was compared with the clinical results. HBVF was determined as 4.6% in the patients with recovery, 8.1% in disability, and 7.6% in exitus patients. The HBVF values were lowest in recovery patients, and the difference between the recovery and the other two groups was statistically significant (p = 0.007). However, there was no statistically significant difference in HBVF between disability and exitus patients (p > 0.05). In conclusion, the HBVF can be an important tool to determine prognosis, and it can be measured using the volume fraction approach of stereological methods as developed in the present study.Öğe Prognostic value of serum zinc levels in critically ill patients(W B SAUNDERS CO-ELSEVIER INC, 2011) Cander, Basar; Dundar, Zerrin Defne; Gul, Mehmet; Girisgin, SadikPurpose: We investigated the hypothesis that a decline in serum zinc concentrations among critically ill patients is related to mortality, length of stay in the intensive care unit, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores. Materials and Methods: All the patients (>= 18 years old) presenting to the intensive care unit from September 2009 through November 2009 were enrolled the study. Patients' demographic characteristics and Acute Physiology and Chronic Health Evaluation and SOFA scores were recorded. Blood samples were collected within 24 hours after admission and analyzed for serum zinc, copper, C-reactive protein, and albumin levels. Patients were followed up for mortality and length of stay in the intensive care unit for 28 days. Results: A total of 36 patients, with a median age of 70.5 years (range, 18-87 years), were enrolled during the study period. Serum zinc levels were found to be inversely correlated with SOFA scores (r = -0.41, P < .01). Patients with SOFA scores of 8 or higher had significantly lower serum zinc levels compared with patients with SOFA scores lower than 8 (6.74 +/- 1.63 and 9.17 +/- 2.76 mu mol/L, respectively; P < .01). Conclusion: The result of this study supports the fact that organ failure and critical illness lead to a decline in serum zinc concentrations and that administration of zinc may be beneficial for critically ill patients. (C) 2011 Elsevier Inc. All rights reserved.Öğe The prognostic value of the Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus poisoning(K FAISAL SPEC HOSP RES CENTRE, 2011) Cander, Basar; Dur, Ali; Yildiz, Mesut; Koyuncu, Feridun; Girisgin, Abdullah Sadik; Gul, Mehmet; Okumus, MehmetBACKGROUND AND OBJECTIVES: Organophosphate poisoning (OP) is a serious clinical condition that may sometimes be fatal. The aim of this study was to determine whether the Glasgow coma scale (GCS), and serum acetylcholinesterase and leukocyte levels have prognostic value in acute OP poisoning. DESIGN AND SETTING: Retrospective review of records of patients admitted to the intensive care unit of Selcuk University, Meram Medical Faculty, Emergency Department, Konya, Turkey, between January 2006 and January 2009. METHODS: We studied acutely OP-poisoned patients admitted within 24 hours after OP exposure. RESULTS: The mean age of the 25 patients was 37 years (range, 20-80 years). Three (12%) of the 25 patients (male-female ratio, 12: 13) died. The mean GCS values of the patients who died were significantly lower compared to those of the group that survived (4 vs 11.7, respectively P <.05). While the mean serum acetylcholinesterase levels were lower in the patients who died, the difference in the mean serum acetylcholinesterase levels between the patients who died and the ones who survived was not statistically significant (3841 IU/L vs. 1768 IU/L, respectively). CONCLUSION: Although serum cholinesterase values can be used in the quick diagnosis, their efficiency at predicting outcome in patients with OP poisoning has not been established. It has also been determined that serum leukocyte values have no prognostic value in OP poisoning, but GCS values have been found to be effective in predicting the outcome.Öğe The prognostic value of trauma scoring systems for gunshot injuries(PROFESSIONAL MEDICAL PUBLICATIONS, 2011) Bozdemir, Mehmet Nuri; Cander, Basar; Dur, Ali; Kocak, Sedat; Dundar, Defne Zerrin; Uyar, Mehmet; Girisgin, SadikObjective: We aimed to evaluate the trauma scoring systems on gunshot injured patients to predict trauma severity. Methodology: All patients with gunshot injury admitted to the emergency department (ED) from January 2007 through January 2009 were enrolled in the study. The demographic characteristics of patients such as age, gender, cause of the injury, type of the weapon used, the injured body parts, Glasgow Coma Scale (GCS), Shock Index (SI), the length of stay in the hospital and mortality were recorded from the patient charts. Injury Severity Score (ISS), Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS) have been calculated. The differences between the groups for these parameters were compared using the Mann-Whitney U test. Results: The mean age of patients was 33.2 +/- 16.1 and 79 of 87 patients were mate. The causes of GSIs were homicidal in 73.6% and bullet cartridge in 51.7%. Calculated GCS, ISS, RTS, TRISS and SI were 13.8 +/- 2.9, 13.0 +/- 9.3, 7.38 +/- 1.1, 93.9 +/- 14.9% and 1.9 +/- 0.9 respectively. GCS, RTS and TRISS scores for survivors were significantly higher than non-survivors (p<0.001). ISS score and SI for survivors were significantly lower than non-survivors (p<0.001). There were no statistically significant differences between the groups in terms of the length of stay in hospital (p>0.05). There was no statistically significant correlation of the length of stay in hospital with GCS, RTS and TRISS (p>0.05). The length of stay in hospital was found to correlate with ISS and SI positively (p<0.001). Conclusion: It is concluded that Gun Shot Injury (GSI) is much more likely in young males than the other types of trauma in the population. We recommend that trauma scoring systems should be used to show trauma severity and mortality.Öğe The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure(B M J PUBLISHING GROUP, 2007) Girisgin, Abdullah Sadik; Kalkan, Erdal; Kocak, Sedat; Cander, Basar; Gul, Mehmet; Semiz, MustafaObjective: To evaluate the convenience and utility of optic nerve ultrasonography ( ONUS) in the evaluation of emergency patients with elevated intracranial pressure (EICP) due to traumatic or non-traumatic causes. Methods: This study was conducted between May 2005 and December 2005 in the emergency department of Meram Faculty of Medicine, Selcuk University. Patients with traumatic or non-traumatic EICP were included in the study. Among these, 28 patients with EICP determined on cranial computed tomography (CCT) and a control group of 26 patients with no disease had the vertical and horizontal diameters of the optic nerves (ONs) of both eyes measured by ultrasonography ( US). The measurements were done by wetting the closed eyelids and using a 7.5-MHz linear probe. Results: Horizontal and vertical diameters of both ONs of the 54 patients were measured and the averages calculated. The mean (SD) ON diameter for the group suspected of having EICP was found to be 6.4 (0.7) mm, and that for the control group to be 4.6 (0.3) mm. In the statistical analysis carried out between these two groups (t test), the difference was found to be significant at p< 0.001. Conclusions: In detection and follow-up of EICP cases, such as cerebrovascular accident and trauma, ONUS is a practical, risk-free, inexpensive, convenient and, if performed by experts, reliable method. As a result, although CCT may be more useful in diagnosis, ONUS may be more efficient in detecting EICP. In those cases where CCT and other conventional imaging methods are not available, ONUS can facilitate the diagnosis and help in treatment.Öğe Stevens-Johnson syndrome due to concomitant use of lamotrigine and valproic acid(ADIS INT LTD, 2007) Kocak, Sedat; Girisgin, Sadik A.; Gul, Mehmet; Cander, Basar; Kaya, Halil; Kaya, EsengulStevens-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). A 23-year-old female patient with idiopathic epilepsy was referred to the emergency service with fever, oral and genital mucosal lesions, generalized rash, and weakness. She had been taking carbamazepine, valproic acid, 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. Patients who undergo therapy with AEDs, particularly new users of these agents, should be informed of and monitored for possible systemic and cutaneous adverse effects of AEDs. Polytherapy should be avoided for as long as possible as this increases the frequency of adverse effects, and treatment should be discontinued if any rash appears.Öğe Succesful treatment of prolonged sulfonylurea-induced hypoglycemia with octreotide in a patient with chronic renal failure: Case report(ORTADOGU AD PRES & PUBL CO, 2008) Guel, Mehmet; Cander, Basar; Ahmet, A. K.; Girisgin, A. Sadik; Bayir, Ayseguel; Kocak, SedatPatients who present to the emergency department after ingestion of excessive amounts of suflonylurea medications have hypoglycemia refractory to dextrose administration. Recently, the use of octreotide was described as an alternative treatment in such patients. A diabetic patient with chronic renal failure who ingested excessive amounts of sulfonylurea medications causing refractory hypoglycemia resistant to treatment with large doses of intravenous dextrose was presented here. Octreotide administration rapidly reversed hypoglycemia allowing the patient's stabilization and eventual discharge without any significant adverse events. We believe that octreotide may be an effective therapy in refractory sulfonylurea-induced hypoglycemia.
