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Öğe Cerebrovascular ischaemia after carbon monoxide intoxication(SINGAPORE MEDICAL ASSOC, 2015) Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Degirmenci, SelimCarbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.Öğe Diagnostic value of neutrophil-to-lymphocyte ratio in emergency department patients diagnosed with acute pancreatitis(CUKUROVA UNIV, FAC MEDICINE, 2016) Kara, Hasan; Dogru, Ali; Degirmenci, Selim; Bayir, Aysegul; Ak, Ahmet; Kafali, Mehmet Ertugrul; Nazik, Emet EbruPurpose: Decreased lymphocyte count and increased neutrophil count may be associated with severe sepsis, bacteremia, and surgical stress. The neutrophil-to-lymphocyte ratio (NLR) may be used to assess inflammatory conditions and surgery. We evaluated whether NLR may be useful in the differentiation between biliary and nonbiliary acute pancreatitis. Material and Methods: Data from patients aged >18 years who were diagnosed with acute pancreatitis between January 2011 and July 2014 were evaluated retrospectively. Patients were grouped as having biliary or nonbiliary pancreatitis. The white blood cell, neutrophil, and lymphocyte counts and NLR were evaluated and compared between the 2 groups. Results: In the 225 patients with acute pancreatitis (mean age, 59+/-18 y; 81 male patients [36%]), most patients had biliary pancreatitis (biliary, 144 patients [64%]; nonbiliary, 81 patients [36%]). Frequency of hypertension and mean arterial pressure were lower in patients who had biliary than nonbiliary pancreatitis. The mean white blood cell, neutrophil, and platelet counts were greater in patients who had nonbiliary than biliary pancreatitis. Conclusions: Although the NLR was increased in acute pancreatitis, there were no differences in NLR between patients who had biliary or nonbiliary acute pancreatitis. Therefore, the NLR is not useful in differentiating biliary from nonbiliary acute pancreatitis.Öğe Dyspnoea and chest pain as the presenting symptoms of pneumomediastinum: two cases and a review of the literature(CLINICS CARDIVE PUBL PTY LTD, 2015) Kara, Hasan; Uyar, Hasan Gazi; Degirmenci, Selim; Bayir, Aysegul; Oncel, Murat; Ak, AhmetPneumomediastinum is the presence of air in the mediastinum. It may occur as spontaneous, traumatic, or iatrogenic pneumomediastinum. Although spontaneous pneumomediastinum is usually observed in healthy young men, traumatic pneumomediastinum may be caused by blunt or penetrating trauma to the chest and neck. Pneumomediastinum is a clinical condition with potential complications that cause high morbidity and mortality rates. Pneumomediastinum also may develop without tracheal or oesophageal injury after spontaneous or blunt chest, neck and facial injuries, and it may be accompanied by pneumothorax. We treated two patients who had pneumomediastinum. Case 1 was a 20-year-old man who had pain and dyspnoea around the sternum for one hour, as a result of a blow from an elbow during a football match. Case 2 was a 23-year-old man who had a two-day history of dyspnoea and chest pain with no history of trauma. In both patients, diagnosis of pneumomediastinum was confirmed with thoracic computed tomography scans, and the condition resolved within five days of in-patient observation. In conclusion, the diagnosis of pneumomediastinum should be considered for all patients who present to the emergency department with chest pain and dyspnoea.Öğe High-sensitivity C-reactive protein, lipoprotein-related phospholipase A(2), and acute ischemic stroke(DOVE MEDICAL PRESS LTD, 2014) Kara, Hasan; Akinci, Murat; Degirmenci, Selim; Bayir, Aysegul; Ak, Ahmet; Nayman, Alaaddin; Unlu, AliBackground: Serum biomarkers may be useful for early diagnosis of acute ischemic stroke, exclusion of other diseases that may mimic stroke, and prediction of infarct volume. We evaluated serum high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-related phospholipase A(2) (Lp-PLA2) in patients who had acute ischemic stroke. Methods: In 200 patients who presented to an emergency service (acute ischemic stroke, 102 patients; control with no stroke, 98 patients), stroke patients were evaluated with the Canadian neurological scale and diffusion-weighted magnetic resonance imaging, and all patients were evaluated with the Glasgow coma scale and their serum hs-CRP level and Lp-PLA2 activity were assessed. The volume of stroke lesions was calculated from magnetic resonance images. Results: Patients who had stroke had higher mean serum hs-CRP level (stroke, 7 +/- 6 mg/dL; control, mean +/- standard deviation 1 +/- 1 mg/dL; P <= 0.001) and Lp-PLA2 activity (stroke, mean +/- standard deviation 113 +/- 86 nmol/min/mL; control, mean +/- standard deviation 103 +/- 50 nmol/min/mL; P <= 0.001) than control patients who did not have stroke. The mean hs-CRP level and Lp-PLA2 activity were higher in patients who had greater stroke severity (lower Canadian neurological scale score) and were higher in patients who had larger volume strokes. Conclusion: Higher hs-CRP level and Lp-PLA2 activity are significantly associated with more severe neurologic impairment and larger infarct size in patients who have acute ischemic stroke. These biomarkers may be useful for rapid diagnosis and prediction of ischemic tissue volume in the early stage of ischemic stroke. These findings may be important for health care facilities that have limited access to emergency computed tomography scanning for the diagnosis of stroke.Öğe Neuroprotective effects of sildenafil in experimental spinal cord injury in rabbits(ASSOC BASIC MEDICAL SCI FEDERATION BOSNIA & HERZEGOVINA SARAJEVO, 2015) Kara, Hasan; Degirmenci, Selim; Ak, Ahmet; Bayir, Aysegul; Kayis, Seyit Ali; Uyar, Mehmet; Akinci, MuratNeuroprotective agents such as methylprednisolone and sildenafil may limit damage after spinal cord injury. We evaluated the effects of methylprednisolone and sildenafil on biochemical and histologic changes after spinal cord injury in a rabbit model. Female New Zealand rabbits (32 rabbits) were allocated to 4 equal groups: laminectomy only (sham control) or laminectomy and spinal trauma with no other treatment (trauma control) or treatment with either methylprednisolone or sildenafil. Gelsolin and caspase-3 levels in cerebrospinal fluid and plasma were determined, and spinal cord histology was evaluated at 24 hours after trauma. There were no differences in mean cerebrospinal fluid or plasma levels of caspase-3 between the groups or within the groups from 0 to 24 hours after injury. From 0 to 24 hours after trauma, mean cerebrospinal fluid gelsolin levels significantly increased in the sildenafil group and decreased in the sham control and the trauma control groups. Mean plasma gelsolin level was significantly higher at 8 and 24 hours after trauma in the sildenafil than other groups. Histologic examination indicated that general structural integrity was better in the methylprednisolone in comparison with the trauma control group. General structural integrity, leptomeninges, white and grey matter hematomas, and necrosis were significantly improved in the sildenafil compared with the trauma control group. Caspase-3 levels in the cerebrospinal fluid and blood were not increased but gelsolin levels were decreased after spinal cord injury in trauma control rabbits. Sildenafil caused an increase in gelsolin levels and may be more effective than methylprednisolone at decreasing secondary damage to the spinal cord.Öğe Skin hemorrhage due to uncontrolled warfarin therapy: case report(YERKURE TANITIM & YAYINCILIK HIZMETLERI A S, 2015) Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Degirmenci, Selim; Serin, HavvaAnticoagulant therapy is a vital method of treatment and prophylaxis of thromboembolic diseases which clinically have a wide spectrum. Sometimes the most important complication of anticoagulant therapy is bleeding that may threaten life. Therefore, it is vital that anticoagulant therapy be planned so that it does not lead to thrombosis or bleeding and clinical and laboratory follow-up should be performed carefully. Skin bleeding caused by oral anticoagulants rarely occurs. It is advised that the reversal of anticoagulation should be done with the treatment of vitamin K, prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) as soon as possible. In this article, a case, who developed skin bleeding caused by receiving warfarin as prophylaxis because of atrial fibrillation and aortic valve replacement (AVR), was presented.Öğe Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study(DOVE MEDICAL PRESS LTD, 2014) Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Akinci, Murat; Tufekci, Necmettin; Degirmenci, Selim; Azap, MelihPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged > 65 years admitted to an emergency department in Turkey because of blunt trauma. Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men) aged >= 65 years who were admitted to an emergency department of a tertiary care hospital. Results: Trauma was caused by low-energy fall in 379 patients (67%), traffic accident in 79 patients (14%), high-energy fall in 69 patients (12%), and other causes in 41 patients (7%). The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66%) were hospitalized. There were 31 patients (5%) who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury. Conclusion: Emergency department admission after trauma in patients aged > 65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Öğe Traumatic pneumorrhachis: 2 cases and review of the literature(W B SAUNDERS CO-ELSEVIER INC, 2015) Kara, Hasan; Akinci, Murat; Degirmenci, Selim; Bayir, Aysegul; Ak, AhmetThe presence of air in the spinal canal is known as pneumorrhachis (PNR), aerorachia, intraspinal pneumocele, pneumosaccus, pneumomyelogra, or intraspinal air. Pneumorrhachis may be iatrogenic, traumatic, and nontraumatic. We treated 2 patients who had posttraumatic PNR in the cervical spine region after stab injuries. Case 1 was a 31-year-old man who was stabbed in the C5 to C6 region. He had muscle weakness (3/5) and numbness on the right side of the body. Brain computed tomographic (CT) scan showed pneumocephalus, and cervical CT scan showed PNR at the C6 level. Treatment included observation, and symptoms and weakness improved within 7 days. Case 2 was a 40-year-old man who was stabbed in the C3 to C4 region. He hadmuscle weakness (1/5) and numbness on the left side of the body. Brain CT scan showed pneumocephalus, and cervical CT scan showed PNR at the C3 level. Cerebrospinal fluid drainage persisted, and he was treated with surgical repair of a dural laceration. Muscle strength improved. In summary, PNR is a rare condition that usually is treated nonoperatively. However, surgical treatment may be indicated for persistent neurologic symptoms or signs; the air detected in the spinal canal with radiographic imaging may be associated with an active cerebrospinal fluid leak and may cause spinal compression.
