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Correspondence to / Yazisma Adresi: Atif Bayramoglu, Erzurum Bolge Egitim ve Arastirma Hastanesi, Acil Servisi, Cat Yolu 25170 Erzurum, Turkiye Phone: +90 442 317 27 92 e.mail: atifbay@gmail.com doi:10.5152/jaem.2012.016 Zeynep Gokcan Cakir1, Atif Bayramoglu2, Ayhan Akoz1, Sule Esen Turkyilmaz1, Mucahit Emet1, Mustafa Uzkeser1 1Erzurum Ataturk Universitesi Tip Fakultesi, Acil Tip Anabilim Dali, Erzurum, Turkiye 2Erzurum Bolge Egitim ve Arastirma Hastanesi, Acil Servisi, Erzurum, Turkiye

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.

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.