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In this study, bodily injuries related to chest compression were examined in non-traumatic death cases that underwent autopsy. This study aimed to evaluate factors that can affect these injuries. Data were collected retrospectively, and injuries related to chest compression during cardiopulmonary resuscitation were determined over a 10-year period. Age, gender and cause of death were determined, and when cardiopulmonary resuscitation was performed, cardiopulmonary resuscitation duration, intubation and the injury that occurred due to chest compression were also determined. The study included data from 203 cases. The most frequent injuries were a single fracture in the left ribs (19.7%). Only the duration of cardiopulmonary resuscitation was determined to be associated with injuries. Ventricle rupture in 1 case and liver laceration in 2 cases were the most significant injuries. It has been shown that during cardiopulmonary resuscitation, severe injuries can occur due to thoracic compression. Only a positive correlation with the duration of cardiopulmonary resuscitation was found in our study.

SUMMARY: Objectives: In 1981, Peter A. Stewart published a paper describing his concept for employing Strong Ion Difference. In this study we compared the HCO3 levels and Anion Gap (AG) calculated using the classic method and the Stewart method. Methods: Four hundred nine (409) arterial blood gases of 90 patients were collected retrospectively. Some were obtained from the same patients in different times and conditions. All blood samples were evaluated using the same device (ABL 800 Blood Gas Analyzer). HCO3 level and AG were calculated using the Stewart method via the website AcidBase.org. HCO3 levels, AG and strong ion difference (SID) were calculated using the Stewart method, incorporating the parameters of age, serum lactate, glucose, sodium, and pH, etc. Results: According to classic method, the levels of HCO3 and AG were 22.4±7.2 mEq/L and 20.1±4.1 mEq/L respectively. According to Stewart method, the levels of HCO3 and AG were 22.6±7.4 and 19.9±4.5 mEq/L respectively. Conclusions: There was strong correlation between the classic method and the Stewart method for calculating HCO3 and AG. The Stewart method may be more effective in the evaluation of complex metabolic acidosis. Key words: Blood gases, Stewart method

Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as ...

Dysphagia lusoria is a secondary condition caused by the compression of the esophagus with an aberrant right subclavian artery. This anomaly usually involves the right subclavian artery and occasionally the left subclavian artery. Most cases remain asymptomatic. Therefore, dysphagia lusoria is quite a rare phenomenon, which doctors may not face throughout their careers. In this report, the aberrant right subclavian artery of a patient suffering from underestimated dysphagia, which was incidentally diagnosed using chest computed tomography, is presented.

Aim: To evaluate the relationship between pre-biopsy PSA levels, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), prostate volume and positive core numbers of histologically proved chronic prostatitis in the patients whom underwent transrectal ultrasound guided biopsy for elevated prostate specific antigen (PSA) levels. Material and Method: Between January 2012 and 2014, 152 patients underwent TRUS biopsy. Their medical records are examined retrospectively. The mean age of the patients were 62 (45-75). The pathologic specimens were evaluated for the number of cores with chronic prostatitis and percentage of prostatitis. Pre-biopsy levels of PSA, IPSS, maximum urinary flow rate, prostate volume are compared with the number positive cores for chronic prostatitis and their percentages. These variables also compared in the non-chronic prostatitis patients. Results: There was no statistically significant correlation between the positive number of cores for chronic prostatitis and age (P=0.5, r=0.055), a positive correlation was observed between IPSS (P

Soft tissue trauma is a type of acute traumatic ischemia. We investigated in this study whether the edema, inflammation and ischemia caused by the trauma could be affected positively by hyperbaric oxygen (HBO) and ozone therapy.Soft tissue trauma was generated in a total of 63 adult male Sprague-Dawley rats. Subsequently, rats were divided into three groups. The first group was treated with ozone, the second group with HBO, and the third group served as controls. Tissue and blood samples were taken at the end of the procedures. Tissue lipid peroxidation (LPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), inducible nitric oxide synthase (iNOS), heme oxygenase (HO)-1, and hypoxia-inducible factor (HIF)-1 levels were detected. Hematoxylin-eosin staining was used to determine the inflammation and edema histopathologically.We also detected HIF-1 activity, which decreases when the oxygen concentration increases, HO-1 activity, which has anti-inflammatory effects, and iNOS activity, which releases in any type of acute case. We determined a statistically significant reduction in iNOS and LPO levels in both the HBO and Ozone groups. A significant decrease in inflammation was detected in both the Ozone and HBO groups compared with the Control group, and a significant decrease in edema was detected in all three groups.We think that HBO and Ozone therapy have beneficial effects on biochemical and histopathological findings. Related clinical trials will be helpful in clarifying the effects.

BACKGROUND: Carbon monoxide (CO) poisoning is a leading cause of toxicity related mortality and morbidity. Recent studies focused on cardiovascular consequences of CO poisoning. The aim of this study was to investigate asymmetric dimethylarginine (ADMA) and pro B-type natriuretic peptide (pro-BNP) levels in CO poisoned patients during normobaric oxygen treatment. METHODS: The patients treated for CO poisoning at the Emergency Department from October 2005 to May 2006 were consecutively included in this study. All patients received 100% oxygen at 10 L/min with a non-rebreather face mask for at least 240 min. On admission to the emergency department and at 6 h of treatment, blood samples were obtained for analysis. RESULTS: A total of 30 patients (30,8+/-11,3 years, 19 female) were included into the study. Mean COHb level decreased from 27,6 +/- 7,4% to 2.7 +/- 1.4%. ADMA level significantly increased in time after CO poisoning (0,92+/-0,2 umol/L vs. 1,13+/-0,26 umol/L; p

The aim of this study was to investigate the protective effects of taurine (Tau) on experimental acute pancreatitis (AP) in a rat model by measuring cytokines and oxidant stress markers. Forty rats were randomly divided into four groups: sham, AP, Tau and AP + Tau. AP was induced with sodium taurocholate. No treatment was given to the AP. All rats were killed 5 days later. Pancreatic tissues of rats and blood samples were obtained. Tau treatment significantly decreased serum amylase activity ( p < 0.001), total injury score ( p < 0.001), malondialdehyde levels ( p < 0.001) and myeloperoxidase (MPO) activity ( p < 0.001). There was no significant difference between the Tau and AP + Tau groups in serum and pancreatic tumor necrosis factor-α, interleukin (IL)-1β and IL-6 levels ( p = 1.000). Histopathologic scores in the AP + Tau and Tau groups were significantly lower compared with the AP group (both p < 0.001). These results showed that Tau reduces lipid peroxidation, amylase and MPO activities and the concentrations of proinflammatory cytokines secondary to AP and also increases superoxide dismutase and glutathione peroxidase activities in rats with sodium taurocholate-induced AP. It also has a marked ameliorative effect at histopathologic lesions. With these effects, Tau protects the cells from oxidative damage, reduces inflammation and promotes regression of pancreatic damage.

BACKGROUND: Firearm injuries (FI) are the most common cause of death among military personnel. In this study, postmortem examination and autopsy records of deaths resulting from firearm injuries recorded in the Department of Forensic Medicine of Gulhane Military Medical Academy between 1993-2010 were examined retrospectively. METHODS: We evaluated the characteristics of 153 firearm deaths accounting for 36.6% of all medical-legal autopsies. The cases included 152 men (99.3%) and 1 woman (0.7%). RESULTS: The mean age of the cases was 23.1 years (±4.7; range, 20-43 years). The manner of death was determined in all cases with 41.8% of cases identified as suicide and 39.9% as homicide. The most common sites of firearm entrance wounds were the head and neck region (n=109, 71.2%), the chest (n=26, 17%), or the abdomen (n=14, 9.2%). The type of firearm was not clear in most cases. CONCLUSION: In conclusion, complete forensic and medical records will facilitate the rapid and accurate conclusion of the legal process and will enhance future retrospective studies. Language: en

a b s t r a c t Objectives: Acetaminophen (APAP) overdose may cause acute liver injury. Ozone therapy (OT) is shown to reduce inflammation and necrosis in several entities. Thus, we have designed this study to evaluate the efficacy of OT in a rat model of APAP-induced liver injury. Methods: Twenty-seven Sprague-Dawley rats were divided into three groups: sham, APAP and APAP+OT groups. In the APAP and the APAP+OT groups, liver injury was induced by oral administration of 1 g/kg APAP. The APAP+OT group received a single dose ozone/oxygen mixture (0.7 mg/kg) intraperitoneally 1 h after APAP administration. All animals were killed at 24 hour after APAP administration. Blood samples and liver tissues were harvested to determine liver injury and oxidative stress parameters. Liver tissues and blood samples were obtained for biochemical and histopathological analyses. Results: APAP administration caused necrosis in the liver after 24 h. The degrees of liver necrosis of the APAP group were higher than the other groups (in both p < 0.05, respectively). In the APAP+OT group, liver antioxidant enzymes activities were significantly higher than the APAP group (p < 0.05), but were lower than the sham group (p < 0.05). In the sham group, serum neopterin, a marker of cell-mediated immunity, concentrations (4.8 ± 1.2 nmol/L) were lower than the APAP (14.7 ± 1.4 nmol/L) and APAP+OT groups (7.5 ± 2.4 nmol/L) (in both p < 0.05, respectively). Conclusion: Our results showed that OT prevented liver necrosis in rats and reduced neopterin levels. These findings suggest that the use of OT as an adjuvant therapy which might improve the outcome in APAP induced liver injury.

Background/aim: Urticaria is a vascular skin reaction characterized with papules and plaques. Neopterin is accepted as an immunologic marker and an indicator of activation of the immune system. Homocysteine and asymmetric dimethylarginine (ADMA) are the markers of increased vascular resistance. Alteration in vascular resistance has a role in the pathogenesis of urticaria. We aimed to investigate whether there is a relationship between urticaria and neopterin, homocysteine, or ADMA. Materials and methods: The study is designed as a prospective descriptive study and patients with a diagnosis of urticaria in the emergency department were included in the study. Demographic data and characteristics of the disease were recorded. Neopterin, homocysteine, and ADMA levels were measured both during and after urticaria attacks. All data were statistically analyzed. Results: The differences between neopterin levels measured during and after urticaria attacks were statistically significant (P < 0.001). The differences between homocysteine and ADMA levels measured during and after urticaria attacks were not statistically significant (P > 0.05). Conclusion: Our results indicate that neopterin levels in patients with urticaria attacks are increased and the level of neopterin is also a useful parameter in acute urticaria. Further studies should clarify whether homocysteine levels contribute to diagnosis of acute urticaria. However, no relation was found between ADMA and urticaria.

Narghile known in different names as shisha, hookah, hubble-bubble, waterpipe has been smoked widely in Middle East countries traditionally and recently began to spread to European countries and USA. Narghile is consumed particularly by university youth in cafes as a social activity in Turkey. We report a case series of five patients presented with narghile induced carbon monoxide (CO) poisoning. We believe that this problem might be overlooked and underreported. We want to emphasize that, in the differential diagnosis of nonspecific neurological complaints (especially headache, nausea, vomiting and vertigo) CO poisoning must be considered and patient must be questioned about the usage of narghile smoking especially in areas popular of it.

Various therapeutic protocols were used for the management of sepsis including hyperbaric oxygen (HBO) therapy. It has been shown that ozone therapy (OT) reduced inflammation in several entities and exhibits some similarity with HBO in regard to mechanisms of action. We designed a study to evaluate the efficacy of OT in an experimental rat model of sepsis to compare with HBO. Male Wistar rats were divided into sham, sepsis+cefepime, sepsis+cefepime+HBO, and sepsis+cefepime+OT groups. Sepsis was induced by an intraperitoneal injection of Escherichia coli; HBO was administered twice daily; OT was set as intraperitoneal injections once a day. The treatments were continued for 5 days after the induction of sepsis. At the end of experiment, the lung tissues and blood samples were harvested for biochemical and histological analysis. Myeloperoxidase activities and oxidative stress parameters, and serum proinflammatory cytokine levels, IL-1β and TNF-α, were found to be ameliorated by the adjuvant use of HBO and OT in the lung tissue when compared with the antibiotherapy only group. Histologic evaluation of the lung tissue samples confirmed the biochemical outcome. Our data presented that both HBO and OT reduced inflammation and injury in the septic rats' lungs; a greater benefit was obtained for OT. The current study demonstrated that the administration of OT as well as HBO as adjuvant therapy may support antibiotherapy in protecting the lung against septic injury. HBO and OT reduced tissue oxidative stress, regulated the systemic inflammatory response, and abated cellular infiltration to the lung demonstrated by findings of MPO activity and histopathologic examination. These findings indicated that OT tended to be more effective than HBO, in particular regarding serum IL-1β, lung GSH-Px and histologic outcome.

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Introduction Femoral dislocation constitutes an orthopaedic emergency. For pain control in these cases, apart from procedural sedation, a regional block can be applied. Case report A 26-year old male was brought to the emergency centre after being struck by a motor vehicle. Dislocation of the left femur was determined on direct radiograph. It was decided to apply a fascia iliaca compartment block instead of procedural sedation due to the risk of side effects. After sufficient anaesthesia was provided, the dislocation was successfully reduced on the first attempt with the Allis technique. Conclusion The fascia iliaca compartment block (FICB) can be performed easily and successfully under ultrasound guidance. The pain associated with femoral dislocation is decreased and the reduction procedure can be achieved successfully. In many cases, FICB is easy to apply and carries a low risk of side effects.

The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths.A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskişehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors.A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1).High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma centres would enable the development of trauma care and reduce the rates of preventable deaths.

Derginizin 2014-3. sayisindaki “Lise Ogrencilerinin Hepatit B Hastaligi Konusunda Bilgi Duzeyleri” (1) baslikli Sayin Keten ve arkadaslari tarafindan yazilan makaleyi ilgi ile okuduk. Deneyimlerini bizlerle paylastiklari icin tesekkur ederiz. Yazarlarin arastirdiklari HBV hastaligina ait bilgi duzeyleri konusunda calismanin bazi kisitliliklarindan bahsederek arastirmaya katkida bulunmak istiyoruz.

BACKGROUND: The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths. METHODS: A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskisehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors. RESULTS: A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1). CONCLUSION: High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma centres would enable the development of trauma care and reduce the rates of preventable deaths. Language: en

Dear Editor, We read the article ‘‘An outbreak of forty five cases of Pseudomonas aeruginosa acute endophthalmitis after phacoemulsification” written by Guerra et al with interest (1). They described an outbreak of Pseudomonas aeruginosa endophthalmitis post cataract surgery and discussed clinical findings, treatment and outcomes. We thank to the authors for their lightening analysis and we would like to make some contributions.

Paraquat (PQ) overdose can cause acute lung injury and death. Ozone therapy (OT) was previously demonstrated to alleviate inflammation and necrosis in various pathologies. We therefore hypothesized that OT has ameliorative and preventive effects on PQ-induced lung damage due to anti-inflammatory and antioxidants properties. Sprague-Dawley rats ( n = 24) were separated into three groups: sham, PQ, and PQ+OT groups. 15 mg/kg PQ was administered intraperitoneally in PQ and PQ+OT groups to induce experimental lung injury. One hour after PQ treatment, PQ+OT group was administered a single dose of ozone–oxygen mixture (1 mg/kg/day) by intraperitoneal route for four consecutive days. The animals were sacrificed on fifth day after PQ administration. Blood samples and lung tissues were collected to evaluate the inflammatory processes, antioxidant defense and pulmonary damage. Serum lactate dehydrogenase (LDH) and neopterin levels, tissue oxidative stress parameters, total TGF-β1 levels, and histological injury scores in PQ+OT group were significantly lower than PQ group ( P

With great interest, we have read the article, “Dislocation of a total hip arthroplasty: acute management in the emergency room” by Fillingham et al [1]. We appreciate the authors sharing their enlightening study. We believe that one of the causes of reduction failure is a lack of peripheral nerve blocks or procedural sedation.We would like to contribute information about fascia iliaca compartment block to make the reduction of hip dislocations easier for the authors of this study. Hip dislocations are more frequent in patients who undergo total hip arthroplasty than in the healthy population. The reduction process for these patients is difficult and immensely painful. The reduction success rate in these cases increases when pain control and procedural sedation are used [2]. Fascia iliaca compartment block is commonly used for pain control in patients with hip fractures [3,4]. In addition, it has been shown that fascia iliaca compartment block can be used successfully in patients with hip dislocations [5]. Ultrasonography guidance is recommended to increase the ease and safety of this procedure [6]. As fascia iliaca compartment block avoids the adverse effects and complications of agents used in procedural sedation and general anesthesia, especially in elderly patients, it may also shorten the length of emergency service stay [5].

Objectives Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application. Methods The study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The χ 2 test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P Results The study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age ( P = .916), sex ( P = .972), reduction success ( P = .540), and patient-physician satisfaction ( P = .198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group. Conclusions Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations.

Introduction Pulmonary pseudocyst is an uncommon condition that may occur after blunt thoracic trauma. Traumatic pulmonary pseudocysts develop in less than 3% of patients after blunt thoracic trauma. In this study we share a “formation of a pulmonary pseudocyst following a blunt thoracic trauma” case. Case presentation A 34-year-old male patient suffering from a motor vehicle accident, who had admitted to another medical unit, was referred to our ED for advanced treatment after the first intervention. Due to wide hemopneumothorax, bilateral tube thoracostomy had been performed when patient arrived. Thorax CT revealed a pulmonary pseudocyst in the right lung beside diffuse bilateral pulmonary contusions, hemopneumothorax and rib fracture. Following necessary medical treatments, patient was admitted to the intensive care unit. After three months with clinical and radiological follow-up, traumatic pulmonary pseudocyst in the right lung was fully healed. Discussion and Conclusion Pulmonary pseudocysts are air cysts that may occur in the lung parenchyma after blunt thoracic trauma. Around 85% of cases reported in the literature involved young and male patients. Tears occurring in the lung parenchyma are one of the underlying mechanisms of pseudocyst formation. In these cases there is no need for further treatment of these cysts which are known to recede spontaneously unless no complication occurs.

Introduction Carbon monoxide (CO) poisoning is a life threatening emergency. Oxygen delivery to tissues is reduced and hypoxia develops. Most affected systems are the central nervous system and cardiovascular system. For the diagnosis of CO poisoning, first poisoning should be suspected and then blood carboxyhaemoglobin (COHb) levels should be measured. For cardiovascular evaluation ECG is required. Case 1 A 56-year-old male patient admitted to ED with complaints of syncope, headache, dizziness and blurred vision. Patient was mentally confused and on ECG sinus tachycardia was present (Fig. 1). On blood gas analysis COHb value was measured 33.3%. Due to syncope and ECG changes hyperbaric oxygen (HBO) therapy initiated. After the treatment, COHb value was measured 4.5% and ECG showed normal sinus rhythm. Patient was discharged with recommendations. Case 2 An unconscious 36-year-old female patient admitted to ED with a diagnosis of CO poisoning. ECG revealed ST depression on DII-DIII-AVF leads (Fig. 2) and elevated troponin I (0.1ng/ml) and CK-MB (47U/L) values were determined. On blood gas analysis, COHb value was measured 39.8%. HBO therapy initiated. After HBO therapy patient was conscious and for further follow-up patient was admitted to intensive care unit. Discussion and Conclusion Although there is no classic "carbon monoxide" ECG pattern, sinus tachycardia and ST-T depressions are the most common ECG findings. Even a small amount of exposure to CO can cause myocardial infarction, especially in patients with coronary artery disease. Patients admitting to ED with chest pain and ECG changes may be considered as a possible CO poisoning and patients with CO poisoning must be carefully evaluated for cardiovascular disease.

Introduction Pelvic apophysis avulsion fractures in adolescent athletes are rare injuries and these fractures occur on the growth cartilage on the apophysis plates. Case presentation A 17-year-old male patient admitted to ED suffering from sharp pain in the right hip and difficulty in walking after kicking ball severely during playing football. On physical examination, there was tenderness in the right thigh consistent with spina iliaca anterior superior (SIAS). Hip movements were within normal range except pain during movement. Neurovascular examination was within normal range. On Pelvic X-ray revealed a crescent shaped avulsion fracture of the right SIAS. The patient was treated conservatively and discharged with recommendations. Discussion and conclusion The epiphyses and the apophyses are the weakest part of all the skeletal system. In these regions, avulsion fractures may occur with sudden and severe spasm of the muscles. Avulsion fractures of SIAS are mostly treated conservatively unless there is more than 2cm fragment separated and non-union case in which case surgery is recommended. This type of injuries can be easily overlooked or misdiagnosed due to history of trauma free. It may also effects

An overdose of acetaminophen (APAP) produces centrilobular hepatocellular necrosis. We aimed to investigate the hepatoprotective effects of N-acetylcysteine (NAC) only and hyperbaric oxygen (O2) treatment (HBOT) combined with NAC, and their anti-inflammatory properties in liver tissue. In the current study, a total of 32 male Sprague Dawley rats were divided into 4 groups: sham, APAP, NAC, and NAC + HBOT. In the APAP, NAC, and NAC + HBOT groups, liver injury was induced by oral administration of 1 g/kg APAP. The NAC group received 100 mg/kg NAC per day. NAC + HBOT group received intraperitoneal injection of 100 mg/kg/day NAC and were given HBOT at 2.8 ATA pressure with 100% O2inhalation for 90 min every 12 h for 5 days. Rats in the sham group received distilled water only by gastric tube. All animals were killed on day 6 after APAP or distilled water administration. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities, hepatic neopterin, tumor necrosis factor-α (TNF-α), and interleukin 6 (IL-6) levels were measured. There was a significant increase in serum AST and ALT activities in the APAP group compared with the sham group (in both p = 0.001). NAC and NAC + HBOT groups had significant decreases in hepatic neopterin, TNF-α, and IL-6 levels compared with the APAP group. APAP administration caused extensive hepatic necrosis. NAC and NAC + HBO treatments significantly reduced APAP-induced liver injury. Our results showed that the liver damage in APAP toxicity was attenuated by NAC and NAC + HBO treatments. NAC + HBOT exhibit hepatoprotective activity against APAP-induced liver injury in rats.

Neurological symptoms can be seen in 5%-8% of lymphoma patients. The most frequent causes of neurological symptoms are herpes virus infection, neurotoxicity due to vincristine, Guillain–Barre syndrome, and the nerve involvement of the tumor [1]. Paraneoplastic polyneuropathy is a rare neurological complication of lymphoma [2]. Here we report a case of relapsed follicular lymphoma presenting with paraneoplastic sensory neuropathy (ganglioneuropathy). A 45-year-old woman was admitted to the hospital 2 years ago with the complaints of numbness in the hands and feet, unsteadiness, weight loss, fever, and swellings in the neck, axilla, and inguinal region. She was diagnosed with follicular lymphoma through the excisional biopsy of the cervical lymph node. She was diagnosed with stage 3B disease based on the presence of lymphadenopathies in the paratracheal, precarinal, axillary, and inguinal regions and no infiltration by bone marrow examination. The treatment started with rituximab (500 mg/day), cyclophosphamide (1125 mg/day), adriablastine (80 mg/day), vincristine (2 mg/day), and prednisolone (80 mg/day). Therapy was completed in 8 courses with 21-day intervals. After the therapy, all of the symptoms had regressed and the case was evaluated as in remission with a follow-up PET scan (Figure 1). Gradually increasing unsteadiness, numbness, and pain and burning sensation in the hands and feet developed 1 month following that PET study. She applied to the neurology service and it was found that she had normal muscle strength but mild ataxia, positive Romberg test, and prominent hypoesthesia in the distal regions of the extremities and bilateral impairment of the deep tendon reflexes and indifferent plantar responses. Informed consent was obtained. An electromyography revealed sensorial gangliopathy. On physical examination the positioning and the vibration sensations of the patient were found to be diminished. Intravenous pulse steroid therapy (1000 mg/day) was administered for 5 days. Two days after this therapy, a severe and generalized pain developed in all of the extremities and joints. In neurological examination, distinct quadriparesis, ataxia, dysmetria, dysdiadochokinesia, hypoesthesia of the 4 extremities, and bilateral abolished deep tendon reflex with indifferent plantar responses were determined. There was Letter to the Editor DOI: 10.4274/TJH-2013.0125

Hyperbaric oxygen (HBO) therapy has been shown to attenuate renal ischemia/reperfusion (I/R) injury in rats, when applied in the early reperfusion period. The aim of this study was to elucidate possible beneficial effects of HBO therapy on renal I/R injury, when applied 24 h after ischemia. Rats were randomized into three groups: (1) control group (n = 20), (2) I/R group (n = 20), and (3) I/R + HBO group (n = 20). Renal I/R injury was created by interrupting renal blood flow for 30 min with a non-traumatic vascular clamp. HBO therapy was administered 24 h after I/R injury and continued for 5 days. At the end of the study, rats were sacrificed under anesthesia, blood was drawn, and right kidneys were harvested for analysis. Renal I/R injury increased serum and tissue malondialdehyde (MDA) levels and reduced superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels. HBO therapy attenuated MDA levels by increasing SOD and GPx activities. HBO therapy also prevented neutrophil infiltration and tissue injury in kidneys. Taken together, HBO therapy has been found to be effective in the delayed period of I/R injury.