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Aim: To study brain natriuretic peptide (BNP) levels in three subgroups: patients having stroke with hypertension (HT), those having stroke without HT, and those with HT alone. We also tried to identify whether BNP levels predict the length of stay in hospital and mortality. Materials and Methods: The groups were formed by patients who had been admitted to the emergency department in the first 4-12 h after the onset of symptoms. There were 30 stroke patients with a history of HT (group I), 30 stroke patients without a history of HT (group II), and 20 HT patients without stroke (group III). Patients with congestive heart failure, chronic cor pulmonale, severe valvular heart disease, chronic renal failure, liver insufficiency, diabetes mellitus, atrial fibrillation, and those with a history of stroke were excluded from the study since these diseases can affect the plasma BNP levels. Results: The demographic characteristics, except the age distribution, were similar among the groups. The mean BNP levels in the three groups were 168.8 ± 223.9 pg/ml, 85.0 ± 75.1 pg/ml, and 84.8 ± 178.3 pg/ml, respectively. The differences between the groups were statistically significant. Conclusion: The mean BNP levels were affected by HT and/or stroke. The simultaneous presence of HT and stroke results in a more significant increase BNP than the presence of either stroke or HT alone. When diseases that can affect the plasma BNP levels are excluded, the BNP levels in stroke patients without a history of HT are similar to the levels seen in patients with only HT.

Cost-effective use of cardiac markers for the evaluation of ischemic chest pain (CP) patients at the emergency department (ED) is attracting the attention of researchers. The aim of this study is to define how cost-effective an approach should be for evaluate CP patients and to evaluate whether testing for cardiac markers is done cost-effectively in CP patients.In this retrospective study, 1028 ischemic CP patients (aged from 17-89 years, 389 female, 639 male) with non-diagnostic electrocardiography (ECG) who were admitted to the ED between September 2002 and September 2003 were enrolled into the study.The conditions of how diagnostic tests were actually ordered for these patients and how they should have been ordered cost-effectively were assessed and both the cost and effectiveness were compared. The actual total cost of the diagnostic tests ordered to investigate ischemic CP was $42,476. The cost would have been $32,342 if they had been ordered in the most cost-effective manner, for a total savings of $10,134. The ED cost, the calculated cost-effective cost and the lost amount were compared with the Student's t-test, and the differences between them was found to be statistically significant (p0.001). The effectiveness was compared using the chi-square test and was found to be significant (χ(2)= 12.20, SD= 1, p0.001).In conclusion, fast and effective evaluation of ischemic CP in the ED and correct management of patients by correct determination of the risk factors provides a high level of cost-effectiveness. Every ED should determine an algorithm for patients admitted with CP and physicians should obey this algorithm.Acil servislerde iskemik göğüs ağrılı (GA) hastaların değerlendirilmesinde kardiyak belirteçlerin bedel etkin kullanımı araştırıcıların dikkatini çekmektedir. Bu çalışmanın amacı, iskemik GA’lı hastalarda bedel etkin yaklaşımın nasıl olması gerektiğini belirlemek ve bu hastalarda kardiyak belirteçlerin bedel etkin olarak istenip istenmediğini değerlendirmektir.Bu retrospektif çalışma eylül 2002 eylül 2003 tarihleri arasında acil servise kabul edilen tanısal olmayan EKG’si olan 1028 iskemik göğüs ağrılı hasta (17–89 yaş arası, 389 kadın, 639 erkek) dahil edilmiştir. Bu hastalara tanısal testlerin nasıl istendiği araştırılmış, bedel-etkin yöntemle nasıl test isteneceği belirlenerek iki yöntemin bedeli ve etkinliği ayrı ayrı kıyaslanmıştır.Başvuran hastalara iskemik göğüs ağrısı yönünden istenen tetkiklerin toplam bedelinin 42476$ olduğu görülmüştür. Bedel etkinlik kurallarına göre tetkik istenmiş olsa idi 32342$ olacağı hesaplanmış ve ikisi arasındaki fark 10134$ bulunarak acil servis bedeli, bedel-etkin olacağı düşünülen bedeli ve bedel kaybı Student’s t testi ile kıyaslanmış anlamlı bulunmuştur (p0,001). Hastaların acil servis etkinliği, bedel-etkin olduğu düşünülen etkinlikle Chi-Square testi ile kıyaslanmış olup χSonuç olarak, akut travmatik olmayan göğüs ağrısının acil servislerde değerlendirilmesinde hızlı ve etkin bir hasta triajıyla, doğru risk ayrımı yapılarak hastaların doğru bir şekilde yönlendirilmesi, üst seviyede bedel-etkinlik sağlayabilir. Göğüs ağrılı hastaların acil serviste bedel-etkin değerlendirilmesi için, her acil servisin önceden belirlenmiş bir algoritimi olması gerektiğini göstermektedir.

SUMMARY Status epilepticus (SE) can be divided into two subgroups, convul- sive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE). NCSE is clinically characterized by recurrence or persistence of absence or complex partial seizures which unconsciousness per- sists. Seizures are lasted more than 30 minutes, and accompanied by mental and behavioral changes. Although the main feature is the change of level of consciousness, affective, memory, cognitive, speech, motor systems, behavioral and psychiatric disorders can be also seen. Electroencephalography (EEG) is the single diagnos- tic method in this situation. NCSE constitutes approximately 25% of all SE, however it is thought that sometimes it is misdiagnosed and the incidence of NCSE may be higher. The causes are disorders of central nervous system (stroke, infection, trauma, tumor), and metabolic factors (hypoxia, renal diseases, drugs, failure to use an- tiepileptic drug). The treatment contains the standard therapy of SE. Short-acting benzodiazepines are preferred in initial treatment. For more resistant cases, loading of phenytoin is applied. If there is no response to treatment, midazolam and propofol additionally to barbiturates can be used. We aimed to present a case admitted to our ED with altered mental status and diagnosed as NCSE that is under-diagnosed.

The sudden onset of asthmalike symptoms and persistence of airway reactivity following an acute exposure to an irritant gas or vapor has been termed reactive airways dysfunction syndrome (RADS). A mixture of sodium hypochlorite (bleach, 40%) and hydrochloric acid (18%) is commonly used as a household cleaning solution in our region. From this mixture, chlorine gas is produced, which can cause airway damage and ensuing RADS. Here we describe findings of patients with RADS due to this cleaning mixture, and determine factors associated with a favorable outcome. Data were collected retrospectively on 55 symptomatic patients presenting to our emergency department after inhalation exposure to a mixture of bleach and hydrochloric acid. Symptoms, past medical and smoking history, details of the exposure, initial peak expiratory flow rate (PEFR) and oxygenation, and acute reversibility of airways obstruction were documented. All patients met previously defined criteria for the diagnosis of RADS, but did not undergo methacholine challenge testing and bronchoalveolar lavage or histopathologic study. Fifty patients were followed over the course of 3 mo. The majority of exposures (64%) occurred in the bathroom or kitchen. Only 21 of 55 (38%) patients showed an improvement in PEFR of 15% or greater following two beta(2)-agonist inhalation treatments. In follow-up, 48 patients (87%) improved clinically and functionally (FEV(1)). Seven patients (13%) deteriorated, with ARDS developing in two, one of whom died from respiratory failure. Advanced age, initial low PEFR, exposure in a small enclosed area, use immediately after mixing, and prolonged short- and long-term exposures were associated with a poorer prognosis. This descriptive study is the largest case series in the literature of RADS developing after exposure to a bleach-hydrochloric acid mixture. The optimum acute treatment and long-term outcomes for patients with RADS due to this combination still need to be determined.

The majority of proximal edge fractures of the humerus are either non-displaced or minimally displaced. Sometimes these fractures are accompanied by humerus head dislocations. These fractures and dislocations can be treated conservatively methods and some cases can be treated with surgery. The method which will be least harmful to the surrounding soft tissues should be preferred. In 25% of shoulder dislocations, a positive family history can be found. The majority of shoulder dislocations are anterior dislocations. As in our cases, some chronic diseases such as epilepsy can form bases for shoulder fracture and dislocations. If the interventions of these cases are performed more diligently, we consider that the patients can be treated more effectively with simpler methods.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Ozturk, Gurkan/0000-0001-8662-636X; Kandis, Hayati/0000-0001-9151-6050 WOS: 000332462600008 PubMed: 23728930 This study aims to analyze the epidemiological characteristics and predictors of mortality from burn injuries in childhood patients admitted to our hospital during an eight-year period. The medical records of acute childhood burn patients were reviewed retrospectively. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model (method = stepwise). The magnitude of risk was measured by the odds ratio, and the 95% confidence interval was estimated. A total of 2269 acute childhood burn patients were admitted during the study period. A total of 86 (3.8%) children died due to burn injuries. Deaths were seen 1.849 times more in males than in females. According to the 1%-10% total body surface area (TBSA) burned group, mortality occurred 121.116 times more in the >41% TBSA burned group. Most burn injuries can be avoided by keeping children away from hazardous and dangerous environments. Also, requiring a multidisciplinary management in these patients, quality of care services given by physicians and nurses certainly will create a positive impact on patients' outcomes.

AIM We examined whether there is a relationship between vagal nerve root injury and the severity of respiration disorders associated with subarachnoid hemorrhage (SAH). MATERIAL AND METHODS This study was conducted on 20 rabbits. Experimental SAH was induced by injecting homologous blood into the cisterna magna. During the experiment, electrocardiography and respiratory rhythms were measured daily. After the experiment, any axonal injury or changes to the arterial nervorums of the vagal nerves were examined. All respiratory irregularities and vagal nerve degenerations were statistically analyzed. RESULTS Normal respiration rate, as measured in the control group, was 30 ± 6 bpm. In the SAH-induced group, respiration rates were initially 20 ± 4 bpm, increasing to 40 ± 9/min approximately ten hours later, with severe tachypneic and apneic variation. In histopathological examinations, axon density of vagal nerves was 28,500 ± 5,500 in both control and sham animals, whereas axon density was 22,250 ± 3,500 in survivors and 16,450 ± 2,750 in dead SAH animals. The severity of axonal degeneration of vagal nerves was greater in the six dead animals than in the survivors. CONCLUSION If vagal nerves are lesioned, the muscles of respiration are paralyzed and respiratory reflexes are disrupted. That the ischemic and mechanical factors created by SAH cause vagal nerve root injury and respiration disorders may be inevitable and fatal.

Air guns and blank guns may appear relatively harmless at first glance, but they are, in fact, potentially destructive, even lethal, weapons. Approximately 2 to 2.5 million nonpowder firearms are sold annually, and again approximately 12.9 per 100,000 population are treated for such injuries in hospital emergency departments each year in the United States. Unfortunately, these guns are considered to be a toy for children. Therefore, incidents of air gun injuries are gradually increasing. Although such injuries may initially be considered trivial, it may signify severe internal tissue pathologies. These apparently trivial injuries may have catastrophic consequences if unnoticed. In this study, we report 4 cases with head injury due to a shot by these guns. The cases indicate that these people had used the guns belonging to their parents for the purpose of suicide. The cases also show that these machines are not innocent.

Introduction In the environment, there are hundreds of poisonous and injurious plants with a wide variety of toxicity. Among all plants with anticholinergic effect, Hyoscyamus reticulatus is a species whose clinicopathological effects have been poorly described in literature. The paper is especially aimed at drawing attention to the possibly fatal syndrome of prolonged QT, as well as to clinical and laboratory changes in six members of a single family poisoned with this plant. Cases Six female patients aged from 19 to 49 presented to our emergency room with a suspicion of being poisoned after having ingested a plant known as 'the mad axe plant' (Hyoscyamus reticulatus). At least one of anticholinergic symptoms including flushing, mydriasis, dry mouth and tachycardia was present in all of the patients. In addition, different levels of agitation were observed in four of the patients. A euphoric emotional state was present in two patients. The corrected QT distances were found to be prolonged in three of the patients. Discussion and conclusion Based on economical, social and cultural reasons, it is a very common habit in our country, especially in our region in spring and summer months, to consume some plants growing spontaneously in rural areas as food. Intoxication with Hyoscyamus reticulatus is a plant poisoning that is poorly described in literature. Its classical symptoms are predominantly anticholinergic. Although it is commonly self-limited and can be corrected with close observation and supportive treatments, it should be kept in mind that the prolongation of QT interval can accompany the symptoms of poisoning with this plant (Tab. 1, Fig. 3, Ref. 19).

Background aims: Adipose tissue-derived mesenchymal stromal cells (MSCs) have a higher capacity for proliferation and differentiation compared with other cell lineages. Although distraction osteogenesis is the most important therapy for treating bone defects, this treatment is restricted in many situations. The aim of this study was to examine the therapeutic potential of adipose tissue-derived MSCs and osteoblasts differentiated from adipose tissue-derived MSCs in the treatment of bone defects. Methods: Bone defects were produced in the tibias of New Zealand rabbits that had previously undergone adipose tissue extraction. Tibial osteotomy was performed, and a distractor was placed on the right leg of the rabbits. The rabbits were placed in control (group I), stem cell (group II) and osteoblast-differentiated stem cell (group III) treatment groups. The rabbits were sacrificed, and the defect area was evaluated by radiologic, biomechanical and histopathologic tests to examine the therapeutic effects of adipose tissue-derived MSCs. Results: Radiologic analyses revealed that callus density and the ossification rate increased in group III compared with group I and group II. In biomechanical tests, the highest ossification rate was observed in group III. Histopathologic studies showed that the quality of newly formed bone and the number of cells active in bone formation were significantly higher in group III rabbits compared with group I and group II rabbits. Conclusions: These data reveal that osteoblasts differentiated from adipose tissue-derived MSCs shorten the consolidation period of distraction osteogenesis. Stem cells could be used as an effective treatment for bone defects., Dokuz Eylul University; Turkish Academy of Sciences, Outstanding Young Investigator Programme

The proapoptotic Bcl-2 protein Bax can commit a cell to apoptosis by translocation from the cytosol to the mitochondria and permeabilization of the outer mitochondrial membrane. Prosurvival Bcl-2 family members, such as Bcl-x(L), control Bax activity. Bcl-x(L) recognizes Bax after a conformational change in the N-terminal segment of Bax on the mitochondria and retrotranslocates it back into the cytoplasm, stabilizing the inactive form of Bax. Here we show that Bax retrotranslocation depends on the C-terminal helix of Bcl-x(L). Deletion or substitution of this segment reduces Bax retrotranslocation and correlates with the accumulation of GFP-tagged or endogenous Bax on the mitochondria of non-apoptotic cells. Unexpectedly, the substitution of the Bcl-x(L) membrane anchor by the corresponding Bax segment reverses the Bax retrotranslocation activity of Bcl-x(L), but not that of Bcl-x(L) shuttling. Bax retrotranslocation depends on interaction to the Bcl-x(L) membrane anchor and interaction between the Bax BH3 domain and the Bcl-x(L) hydrophobic cleft. Interference with either interaction increases mitochondrial levels of endogenous Bax. In healthy cells, mitochondrial Bax does not permeabilize the outer mitochondrial membrane, but increases cell death after apoptosis induction.

To examine the antiproliferative and apoptotic effects of resveratrol on imatinib-sensitive and imatinib-resistant K562 chronic myeloid leukemia cells.Antiproliferative effects of resveratrol were determined by the 3-Bis[2-methoxy-4-nitro-5-sulphophenyl]-2H-tetrazolium-5-carboxanilide inner salt (XTT) cell proliferation assay. Apoptotic effects of resveratrol on sensitive K562 and resistant K562/IMA-3 cells were determined through changes in caspase-3 activity, loss of mitochondrial membrane potential (MMP), and apoptosis by annexin V-(FITC).The concentrations of resveratrol that inhibited cell growth by 50% (IC(50)) were calculated as 85 and 122 μM for K562 and K562/IMA-3 cells, respectively. There were 1.91-, 7.42- and 14.73-fold increases in loss of MMP in K562 cells treated with 10, 50, and 100 μM resveratrol, respectively. The same concentrations of resveratrol resulted in 2.21-, 3.30- and 7.65-fold increases in loss of MMP in K562/IMA-3 cells. Caspase-3 activity increased 1.04-, 2.77- and 4.8-fold in K562 and 1.02-, 1.41- and 3.46-fold in K562/IMA-3 cells in response to the same concentrations of resveratrol, respectively. Apoptosis was induced in 58.7%- and 43.3% of K562 and K562/IMA-3 cells, respectively, in response to 100 μM resveratrol.Taken together these results may suggest potential use of resveratrol in CML, as well as in patients with primary and/or acquired resistance to imatinib.

The aim of this study was to determine the relationship between ischemic neurodegeneration, of the petrosal ganglion of the glossopharyngeal nerve, and BP fluctuations, after subarachnoid hemorrhage (SAH).Twenty-four rabbits had their blood pressure and heart rhythms studied daily over 20 days. Then, the histopathology of the petrosal ganglion was examined in all animals. Normal and apoptotic neuron density of the petrosal ganglion and blood pressure values were compared statistically.Mean total volume of the petrosal ganglia was calculated as 0.9 ± 0.34/mm3. BP level of control group was 96.1 ± 2.1 mmHg; 116.5 ± 4 mmHg of mild hypertension (HT) group and 128.1 ± 3.6mmHg in the severe HT group. When the groups were compared to each other they were significantly different. The level of normal-apoptotic neuron in control group was 11,240 ± 802/mm³ -40 ± 6.3/mm³; 9730 ± 148.7/mm³ - 1560 ± 256.2/mm³ in the mild HT group and 6870 ± 378.8/mm³-4240 ± 628.2/mm³ in the severe HT group. When the groups were compared to each other there was significantly difference.Blood pressure variability observed in this study may be explained by ischemic neurodegeneration of petrosal ganglia caused by SAH. The results of this study suggest that petrosal ganglion ischemia has potential implications for the development of hypertension. These findings suggest that new treatment strategies should be considered for the treatment of SAH.

WOS: 000286106000012, PubMed ID: 20401667, Acute promyelocytic leukemia results from a translocation between 15 and 17 chromosomes that produce PML/RAR alpha fusion protein. PML/RAR alpha inhibits differentiation of myeloid precursor cells at stem cell level. Resveratrol is a phytoalexin that exerts cytotoxic effects on cancer cells. Ceramides have crucial roles in cell growth, proliferation, differentiation, drug resistance, and apoptosis. In this study, we examined the possible cytotoxic effects of resveratrol on acute myeloid leukemia cells and determined the roles of ceramide-metabolizing genes in resveratrol-induced apoptosis, in addition to investigating the possibility of increasing the sensitivity of HL60 cells to resveratrol by manipulating sphingolipids. Cytotoxic effects of resveratrol, C8:ceramide, PDMP, and SK-1 inhibitor were determined by XTT cell proliferation assay. Changes in caspase-3 enzyme activity and mitochondrial membrane potential (MMP) were measured using caspase-3 colorimetric assay and JC-1 MMP detection kit. Expression levels of ceramide-metabolizing genes were examined by RT-PCR. The results revealed that manipulations of ceramide metabolism toward generation or accumulation of apoptotic ceramides increased apoptotic effects of resveratrol in HL60 cells, synergistically. More importantly, gene expression analyses revealed that resveratrol-induced apoptosis via increasing expression levels of ceramide-generating genes and decreasing expression levels of antiapoptotic sphingosine kinase-1 and glucosylceramide synthase genes. These results showed for the first time that increasing intracellular levels of ceramides by biochemical approaches has also increased sensitivity of HL60 cells to resveratrol. We also showed that resveratrol induces apoptosis through manipulating ceramide-metabolizing genes that resulted in the accumulation of ceramides in HL60 cells., Turkish Society of Hematology, This study was supported by the Turkish Society of Hematology. We thank the staff of Biotechnology and Bioengineering Center of Izmir Institute of Technology for their help and technical support.

Urakus mesane çatısı ile umbilikus arasında uzanan embriyolojik dönemdeki allantois ve fetal mesanenin artığıdır. Urakus kisti olarak ortaya çıkabildiği gibi ürogenital anomaliler, enfeksiyonlar, neoplaziler gibi patolojiler olarak da karşımıza çıkabilir. Urakus kisti acil servislerde nadir görülür ve tanı konur. Tanıda düşünülmediği takdirde atlanabilir. Tanı için genelikle batın ultrasonografisi ve batın tomografisi yeterlidir. Özellikle acil servislere orta hatta karın ağrısı, umbilikal akıntı ve umbilikus altında kitle ile başvurabilir. Biz burada 21 yaşında acil serviste urakus kist enfeksiyonu tanısı alan olguyu, literatür eşliğinde tartışmayı amaçladık., Urachus lies between the umbilicus and the bladder dome and is the remnant of the allantois of the embriologic period and the fetal bladder. It may appear both as urachus cyst and also as pathologies like urogenital anomalies, infections and neoplasias. The urachus cyst is rarely seen and diagnosed in emergency departments. If it is not suspected, it may be skipped. Ultrasonography and computed tomography of the abdomen are usually enough for diagnosis. They may admit to emergency departments especially with abdominal pain in the midline, umbilical leakage and a mass inferior to the umbilicus. We aimed to discuss a 21 year old urachus cyst case diagnosed in the emergency department in association with the literature.

Background: Pesticides are extensively used in developed and developing countries. Objectives: The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED). Methods: All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively. Results: A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32 ± 13.1 years (range 1670 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 2436 h, with a mean total dose of 13.75 ± 6.75 mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7 ± 2.2 days. The overall mortality rate was 10.2%. Conclusion: Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints. © 2011 Elsevier Inc. All rights reserved.

Haemodialysis that involves diffusion of solutes across a semi-permeable membrane allows excretion of harmful solutes and excess fluids. All dialysis machines are disinfected by chemical agents (e.g. sodium hypochlorite, formaldehyde, glutaraldehyde, peroxyacetic acid). Sodium hypochlorite (NaOCl), which is known as household bleach, is a whitening agent and used in medical treatment and disinfection of tap water. Herein, we present a 66-year-old female patient who was inadvertently connected to NaOCl solution infusion in a routine haemodialysis session. By the time the accident was noticed, approximately 200 ml of undiluted NaOCl cleaning solution (concentration 1.21-1.23 g/ml) had been added to the dialysis bath, soaking the membrane fibres. The patient was admitted to the hospital about 30 minutes after the exposure, and her Glasgow Coma Scale score was recorded as 5/15 (E1, V1, M3). In conclusion, more stringent standards should be enforced in the sterilization of haemodialysis machines and related equipments. Accidental contacts with disinfectants should be prevented in dialysis units.

Background The heart is innervated by several systems that contribute to the control of the heart's rhythm. The cardiac fibers of the vagus nerve have an important role in the regulation of heart rhythm under many emotional and physical conditions. Severe electrocardiographic disturbances have been reported following subarachnoid hemorrhage (SAH), but ischemic neuronal degeneration of the nodose ganglion of the vagus nerve has not been previously investigated. We examined if there is a relationship between ischemic injury of the nodose ganglion of the vagus nerve and the severity of heart rhythm disorders after subarachnoid hemorrhage. Methods This study was conducted on 20 rabbits. Four rabbits were used as a baseline group. Experimental subarachnoid hemorrhage was applied to half of the remaining animals (n = 8) by injecting homologous blood into the cisterna magna, and the others (SHAM group, n = 8) were injected with isotonic saline solution in the same manner. For 20 days after the injection, heart rhythm changes were observed daily. After the experiment, normal and ischemic neuron densities in the nodose ganglia of the vagus nerves were examined stereologically. The number of heart rhythm irregularities and the number of degenerated neurons in the nodose ganglia were compared statistically. Results The normal heart rhythm rate was 280 ± 45/min. At the beginning of the SAH, the average heart rate was 220 ± 30/min; about 10 hours later, it decreased to 189 ± 30/min, indicating severe bradycardia. However, after 7 days, the average heart rate had increased to 350 ± 30/min. Six animals died due to irregularities in cardiac function and respiration. Histopathological examinations showed that the average density of normal neurons in the nodose ganglion was 10,500 ± 2500 in the baseline animals and the SHAM group, but the normal neuron density was 8250 ± 1500 in survivors and 6450 ± 1330 in dead animals. The ischemic neuronal degeneration in the nodose ganglia was more severe in the dead animals than in the survivors (p Conclusion Afferent vagus nerves originating from the nodose ganglia have an important role in regulating heart rhythm via their afferent fibers and efferent connections. If neurons of the nodose ganglia are lesioned due to ischemic insult during subarachnoid hemorrhage, heart rhythm regulation by vagus afferent reflexes is disturbed. Vagus pathway paralysis may result in indirect sympathetic overactivity. The development of tachycardia causes depletion of the heart's reserves, and cardiac arrest may be inevitable following extensive subarachnoid hemorrhage.

In this paper two new conceptual robotic system designs, called Șaerial-retrievalș and Șaerial-rescueș are presented and demonstrated by simulation results. The Unmanned air vehicles (UAV) used in this design are thrust vector controlled robotic systems. The Șaerial-retrievalș concept aims at entrapping and retrieving a (lost) floating object in the air. The second concept, Șaerial-rescueș aims at rescuing a free falling object (e.g. a person) in the air using a stretched net attached to the UAV's. Position and angular control are applied in both systems.

To determine the extent of missed injuries in patients hospitalized with major trauma in a Turkish Level 1 emergency department. We also tried to identify the primary factors contributing to each missed injury and to determine their subsequent adverse short-term clinical outcomes. This is a retrospective analysis of prospectively collected data on a cohort of trauma patients. Trauma patients were divided into two groups: patients with missed injury and others. Logistic regression was used to define factors affecting “missed injury”. A total of 670 hospitalized trauma patients were included. The incidence of missed injuries in the patients and the rate of missed injury per patient were 13.3% (95% CI 6–20) and 1.64, respectively. The most frequently missed diagnosis was injuries of the musculoskeletal system (38%; 95% CI 30–46). It was “clavicle fracture and/or dislocation” (35%; 95% CI 16–53) when the rate of missed diagnosis according to the frequency of the specific injury was calculated. A multiple logistic regression analysis showed that the predictors of missed injuries were patient’s age (OR 0.74, 95% CI 0.63–0.87), total number of injuries (OR 1.74, 95% CI 1.38–2.20), and ISS (OR 1.10, 95% CI 1.03–1.18). Radiological errors were prominent in almost 90% (95% CI 85–95). Missed injury caused additional hospital stay (30%; 95% CI 21–40) and additional surgery was required (15%; 95% CI 8–23). The study highlights the need for a trauma team approach and the need for support of radiological report in the ED.

There has been difficulty in the appropriate determination of blunt cardiac injury (BCI) related to blunt thoracic trauma (BTT). The aim of this study is to assess BCI and the effectiveness of diagnostic tests in BTT in patients admitted to the emergency department (ED). Eighty-eight patients with suspected myocardial injury in BTT were enrolled. The diagnostic criteria for BCI were: elevation of troponin I, arrhythmia requiring treatment, unexplained low voltage on electrocardiography (ECG), unexplained hypotension requiring vasopressor, cardiogenic shock requiring inotropes, and transthoracic echocardiographic (TTE) findings suggestive of BCI. Patients with arrhythmia in the medical history, congestive heart failure, ischemic heart disease, history of cardiac surgery, and those

Hyponatremia is the most frequent electrolyte disorder of hospitalized patients and is associated with a longer hospital stay and serious symptoms. The syndromes of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting (CSW) are 2 potential causes of hyponatremia in patients with disorders of the central nervous system. In both syndromes, serum osmolality and plasma uric acid are decreased; blood antidiuretic hormone and urine sodium levels are increased; and plasma albumin concentration and plasma K+ levels are normal. This case report highlights the link between lightning-induced brain injury and CSW syndrome. A 16-year-old boy was admitted to our emergency department because of lightning injury and was unconscious. His Glasgow Coma Scale score was 13. Second-degree burns at the left knee and ankle, at the right leg, and at the occipitoparietal region with a 3-cm area of singed hair were noted. On the second day, the examination showed dry mucous membranes and slightly decreased skin turgidity. He had normal blood pressure throughout hospitalization, and excessive urine output was noted. A decrease in body weight (maximum of 0.450 kg) was observed. Biochemical examination found a rapid drop in serum sodium levels after admission. The diagnosis of central hyponatremia and CSW in the context of lightning injury was made owing to negative salt and water balance. Hypertonic saline solution was given. The patient was discharged home on the fifth day of hospitalization with normal serum chemistries and without the need for sodium supplementation.

Carbon monoxide poisoning in pregnant women is a relatively rare condition. We report a 32-year-old woman in her 32nd week of pregnancy found unconscious in the bathroom. On arrival, her pulse and blood pressure were undetectable. Cardiopulmonary resuscitation was applied. The mother's carboxyhaemoglobin level was 57%. Due to foetal distress, Caesarean section was performed in the emergency department. The baby was intubated due to the absence of spontaneous respiration. The level of carboxyhaemoglobin in the cord blood was 32%. After staying in the newborn unit for 47 days, the baby was discharged with a sequela of cerebral palsy. (Hong Kong j.emerg. med. 2009;16:176-178)

Introduction Carbon monoxide (CO) toxicity may cause persistent injuries in tissues sensitive to hypoxia. Neuropsychiatric sequelae may be observed in about 67% of cases after severe CO exposure. Aim The aims of this study were to demonstrate the usefulness of S-100 β and neuron-specific enolase (NSE) in CO intoxications, show the degree of neurological response, and determine the indications for hyperbaric oxygen treatment (HBOT) as biochemical markers. Results The S-100 β and NSE levels of the sera of 30 patients were studied upon admittance and at the third and sixth hours. S-100 β levels were found to be high in all 3 analyses. There was no significant change in NSE levels. When the S-100 β levels were compared with Glasgow Coma Scale levels, a strong negative correlation was found for all hours ( r = −0.7, −0.8; P = .00). The correlation between S-100 β and carboxyhemoglobin levels at the initial hour was found to be statistically significant ( r = 0.4; P = .01). The S-100 β levels in patients receiving HBOT showed a considerable decrease compared with those in patients not receiving the treatment. The same decrease was valid for NSE, although it was insignificant. Conclusion S-100 β may be useful in evaluating intoxications as an early biochemical marker in CO intoxications, as well as in the differential diagnosis due to other causes, and in determining HBOT indications.

Although previous scientific articles claim that morbidity and mortality are low in pure skeletal muscle relaxant ingestion, this is the 10th leading cause of death recently; however, this represents only a 2.1% ratio in adult toxic exposures in the United States. We report the case of a patient with phenprobamate overdose whose neurologic and psychiatric symptoms were the dominant findings. We were unable to perform hemoperfusion because of insufficient equipment. Thus, the patient was taken to for hemodialysis for 3 hours. However, the clinical response was inadequate. Furthermore, plasmapheresis was applied using 12 U of fresh frozen plasma for the consecutive 2 days. This caused resolution of neurologic and psychiatric symptoms. The patient was released with no residual complication on the fifth day of admission. We conclude that in phenprobamate intoxication, if hemoperfusion is impossible, plasmapheresis seems to be the best modality.

We report a 23-year-old man presenting with chest pain. He denoted skin eruptions on his hands, lips, mouth, and penis 24 to 36 hours after he had taken flurbiprofen 10 days ago. Detailed examination showed an ulcerated, pitching lesion with a dimension of approximately 2x2 cm on his penis; however, other explained skin lesions were ameliorated. ST elevations were present in the electrocardiogram. Cardiac biomarkers gradually rose. The scintigraphy showed myocardial hypoperfusion in the inferoseptal wall. This phenomenon is a rare case of myocarditis due to hypersensitivity reaction. In the case of nonspecific angina pectoris accompanied by electrocardiogram changes, drug-induced myocarditis must hold a place in differential diagnoses.

• One of the diagnoses that should be kept in mind in neutropenic patients admitted to the emergency department for abdominal pain is typhlitis.

Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17-56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd-even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting beta2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p.05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p.001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.

Poisoning with carbon monoxide (CO) due to flash gas heater or stove being an important health problem in our region, causes significant pathologies in the body as well as death by decreasing oxygen-carrying capacity of blood. This study was planned to assess whether or not myocardial damage occurs in patients with CO poisoning.Forty consecutive adult patients with CO poisoning (30 females and 10 males) were included in this study. The mean age of the patients was 28.5+/-9.9 years (range: 15-56). The demographic characteristics, vital signs, the origin of CO gas, risk factors for coronary artery disease (CAD) and smoking habit of the patients were recorded. The evaluation of Glasgow Coma Scale score, electrocardiogram (ECG), peripheral arterial blood gases, complete blood count, creatine kinase (CK), creatine kinase-myocardial band (CKMB), troponin-T measurements were performed in all cases. Additionally, myocardial perfusion SPECT was performed in three cases with carboxyhemoglobin (COHb) levels over 50%.Sinus tachycardia, was observed in 9 cases. Ventricular bigeminy was seen in a case with troponin-T positive test. Six of 40 cases (15%) had significantly increased CK and CK-MB levels with normal troponin-T measurements. High troponin-T levels (0.13 ng/ml) were detected only in 1 case with COHb level of 61.3%. Myocardial SPECT was performed in 3 cases with COHb levels higher than 50% and no images compatible with defects could be identified.The results suggested that significant myocardial damage and life-threatening cardiac hemodynamic changes do not develop in CO-poisoned patients with COHb level below 60 % and without any known underlying CAD. It is not necessary to routinely measure CK, CK-MB and troponin-T, and perform myocardial perfusion SPECT in acute CO poisoning cases without any ECG abnormality, ischemic cardiac symptoms or known CAD.

Hypothermia is generally defined as a core body temperature less than 35 degrees C (95 degrees F), and is one of the most common environmental emergencies encountered by emergency physicians. A 32-year-old male hunter was admitted to the hospital with altered mental status. He remained unconscious, Glasgow Coma Scale (GCS) score was recorded as 5/15, and pupils were dilated and unreactive. His vital signs showed a heart rate of 48 beats/min, respiratory rate of 10 breaths/min, blood pressure of 95/50 mm Hg, and rectal temperature of 31 degrees C. An electrocardiogram (ECG) was obtained and showed marked sinus bradycardia and J waves. His finger-stick glucose was 85. He was intubated. After 3 h of active rewarming, his temperature was 34 degrees C, and the repeat ECG showed near-complete resolution of the J waves and acceleration of the sinus rate to 68 beats/min. At the same time, emergency head computed tomography (CT) scan showed subarachnoid hemorrhage (SAH) and subdural hemorrhage. The patient died on the third day of admission. In this case we want to indicate that J waves and obtunded state could be due to either SAH or hypothermia, and SAH could have been missed if initial obvious hypothermia had been believed to cause all symptoms.

We report a 12-year-old lightning victim with right subcortical parenchymal and right lentiform nucleus haemorrhages documented by computed tomography (CT) and magnetic resonance imaging (MRI). A linear entry burn with an area of singed hair on the scalp was obvious. Neurological examination did not show any lateralized deficit. Cranial nerves were intact. A laceration on the right external auditory canal, elevated cardiac enzymes and electrocardiographic changes were also recorded. The boy was discharged on the sixth day. Prolonged loss of consciousness in lightning victims may suggest intracranial injury. Although brain CT can demonstrate intracranial haemorrhages, MRI is mandatory to show subcortical parenchymal haemorrhage in lightning victims.

Background/aim: This study aimed to evaluate the usefulness of blood gas and end-tidal carbon dioxide (EtCO2) measurements for predicting return of spontaneous circulation (ROSC) and for evaluating post-ROSC neurological survival.Materials and methods: This was a prospective case control study utilizing Atatürk University's database of adult nontraumatic patients (over 18 years old) with out-of-hospital cardiac arrest (OHCA) over the course of a year. The neurological status of the patients was evaluated after 1 h at ROSC and at hospital discharge, as defined by the cerebral performance category score. The blood gas parameters pH, PO2, PCO2, lactate, and BE were compared with EtCO2 from capnography and arteriol/alveolar carbon dioxide difference (AaDCO2) by using both blood gas and capnography upon admission to the emergency department and at ROSC.Results: A total of 155 patients were included in the study to form the control group with ROSC. The PO2, PCO2, and AaDCO2 values showed a prognostic marker for the supply of ROSC (P < 0.05). The EtCO2,lactate, and BE values measured by the blood gas were found to be insignificant in the prediction of ROSC (P > 0.05). Conversely, AaDCO2 was found to be significant in ROSC estimation (P < 0.05), but not in neurological evaluation (P > 0.05).Conclusion: Blood gas parameters and EtCO2 are sufficient in predicting ROSC. The value of AaDCO2 calculated using EtCO2 and PO2may be used in predicting the prognosis of OHCA patients, but this value does not provide any conclusions concerning neurological survival.

Epidural haematoma (EH) is a traumatic accumulation of blood between the inner table of the skull and the dural membrane. Epidural haematoma that occurs at the opposite side of the site of injury, namely contrecoup EH, is a rare entity. We present a 56-year-old man who sustained head injury. The initial examination showed a laceration at his left frontotemporal region. Computed tomography of brain showed left frontotemporal linear fracture and right temporoparietal contrecoup EH. The EH was operated on and the patient was discharged uneventfully. Acute EH is a neurosurgical emergency, early diagnosis and prompt treatment are essential for optimal outcomes. (Hong Kong j.emerg.med. 2009;16:252-254)

Hanging is a kind of strangulation that involves suspension by the neck. A case of near-hanging is reported. The patient was a 56-year-old man with incomplete hanging. His initial Glasgow Coma Scale score was 8. Mild elevation of cardiac biomarkers and hyperglycaemia were found. Hyoid fractures and a slight anterior dislocation of the C6 vertebra were observed. In near-hanging victims, all hypoxia-sensitive organs should be examined carefully. Notwithstanding the different types of hanging (complete vs. incomplete), all victims should be assumed to have cervical injury until proven otherwise.