Publications by authors named "Mucahit Emet"

47 Publications

Does contrast media volume affect long-term survival in patients with chronic kidney disease?

Arch Med Sci Atheroscler Dis 2017 9;2:e82-e89. Epub 2017 Nov 9.

Department of Cardiology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey.

Introduction: The aim of this study was to investigate the relationships between survival and related features in patients with chronic kidney disease undergoing cardiac catheterization and coronary angiography.

Material And Methods: Three hundred and seven consecutive patients with an estimated glomerular filtration rate (e-GFR) less than 60 ml/min/1.73 m undergoing coronary angiography were enrolled in the study. The study population was pursued with a median follow-up duration of 41.5 months.

Results: In the Cox proportional hazards regression model, age (HR = 1.047, 95% CI: 1.011-1.084, = 0.01), contrast media volume (HR = 1.004, 95% CI: 1.001-1.007, = 0.008), angiotensin II receptor blocker (ARB) use (HR = 0.485, 95% CI: 0.261-0.901, = 0.02), and e-GFR (HR = 0.978, 95% CI: 0.940-1.016, = 0.04) were found to be independent predictors of long-term all-cause mortality. The survival analysis showed that the long-term all-cause mortality rate was higher in patients using contrast media volume greater than 140 ml compared to patients given less than or equal to 140 ml during the coronary angiography (3.6% vs. 11.6% log-rank, = 0.001).

Conclusions: In patients with chronic kidney disease undergoing cardiac catheterization, age, contrast media volume, e-GFR and low ARB use were found to be independent predictors of long-term all-cause mortality. Contrast media volume used > 140 ml was independently associated with long-term all-cause mortality compared to less than or equal to 140 ml during cardiac catheterization.
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http://dx.doi.org/10.5114/amsad.2017.71280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728076PMC
November 2017

Lenalidomide Induced Late-Onset Acute Respiratory Distress Syndrome.

Eurasian J Med 2016 Oct 18;48(3):228-229. Epub 2016 Aug 18.

Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey.

A 77-year-old man with multiple myeloma (MM) presented with shortness of breath to the emergency department. He also had history of chronic obstructive pulmonary disease, chronic pulmonary embolism and nephrectomy due to malignancy 10 years ago. He had been treated for 9 months with lenalidomide because of MM. He diagnosed with adult respiratory distress syndrome due to lenalidomide. We aimed to demonstrate late onset and destructive effects of lenalidomide on the lungs.
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http://dx.doi.org/10.5152/eurasianjmed.2015.0150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268609PMC
October 2016

Is this a simple drug eruption to be discharged?

Turk J Emerg Med 2016 Dec 14;16(4):176-178. Epub 2016 Jun 14.

Ataturk University Education and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.

'Erythema Multiforme associated with Phenytoin And Cranial radiation Therapy' (EMPACT) is a very rare clinic situation and classified in EM-like drug reactions. It can be easily misdiagnosed as acute urticaria or drug eruption in ED. Initial symptoms may resemble a simple skin problem, but diagnosing and early hospitalization of the patients can be lifesaving. Here, we present a man with renal cell cancer and brain metastases who admitted to ED due to fever and generalized rash. His skin lesions beginning from his head and spreading through the torso appeared four days after the end of radiotherapy (11 days after the initial dose of both radiation and oral phenytoin). Inspection showed erythematous lesions on the scalp, neck, torso and arms. These lesions had desquomative character on the scalp. Erythematous maculopapular lesions with the tendency of fusion were also visible on the chest, abdomen, back, on the flexor areas of the arm, forearm and femoral region. Laboratory studies showed normal complete blood counts, high creatinine kinase, creatinine kinase-MB, gamma-glutamyl transpeptidase, aspartate aminotransferase, lactate dehydrogenase, albumin and total protein. After discontinuation of phenytoin and giving H1, H2 receptor blockers and steroid intravenously, he was discharged two weeks later with full recovery.
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http://dx.doi.org/10.1016/j.tjem.2016.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154579PMC
December 2016

Is this a simple drug eruption to be discharged?

Turk J Emerg Med 2016 Dec 14;16(4):176-178. Epub 2016 Jun 14.

Ataturk University Education and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.

'Erythema Multiforme associated with Phenytoin And Cranial radiation Therapy' (EMPACT) is a very rare clinic situation and classified in EM-like drug reactions. It can be easily misdiagnosed as acute urticaria or drug eruption in ED. Initial symptoms may resemble a simple skin problem, but diagnosing and early hospitalization of the patients can be lifesaving. Here, we present a man with renal cell cancer and brain metastases who admitted to ED due to fever and generalized rash. His skin lesions beginning from his head and spreading through the torso appeared four days after the end of radiotherapy (11 days after the initial dose of both radiation and oral phenytoin). Inspection showed erythematous lesions on the scalp, neck, torso and arms. These lesions had desquomative character on the scalp. Erythematous maculopapular lesions with the tendency of fusion were also visible on the chest, abdomen, back, on the flexor areas of the arm, forearm and femoral region. Laboratory studies showed normal complete blood counts, high creatinine kinase, creatinine kinase-MB, gamma-glutamyl transpeptidase, aspartate aminotransferase, lactate dehydrogenase, albumin and total protein. After discontinuation of phenytoin and giving H1, H2 receptor blockers and steroid intravenously, he was discharged two weeks later with full recovery.
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http://dx.doi.org/10.1016/j.tjem.2016.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154579PMC
December 2016

Cutaneous Anthrax.

J Emerg Med 2017 02 11;52(2):240-241. Epub 2016 Oct 11.

Department of Emergency Medicine, Faculty of Medicine, University of Ataturk, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.jemermed.2016.08.043DOI Listing
February 2017

Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial.

Am J Emerg Med 2016 Nov 5;34(11):2140-2145. Epub 2016 Aug 5.

Department of Emergency, Ataturk University Medical Faculty, Erzurum, Turkey. Electronic address:

Background: There is a lack of specificity of the analgesic agents used to treat headache and underlying acute carbon monoxide poisoning.

Objective: To compare effectiveness of "oxygen alone" vs "metoclopramide plus oxygen" vs "metamizole plus oxygen" therapy in treating carbon monoxide-induced headache.

Design: A prospective, multicenter, double-blind, controlled trial.

Setting: Three emergency departments in Turkey.

Population: Adult carbon monoxide poisoning patients with headache.

Methods: A total of 117 carbon monoxide-intoxicated patients with headache were randomized into 3 groups and assessed at baseline, 30 minutes, 90 minutes, and 4 hours.

Main Outcome Measure: The primary outcome was patient-reported improvement rates for headache. Secondary end points included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels.

Results: During observation, there was no statistical difference between drug type and visual analog scale score change at 30 minutes, 90 minutes, or 4 hours, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the 3 groups.

Conclusion: The use of "oxygen alone" is as efficacious as "oxygen plus metoclopramide" or "oxygen plus metamizole sodium" in the treatment of carbon monoxide-induced headache.
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http://dx.doi.org/10.1016/j.ajem.2016.08.002DOI Listing
November 2016

A Review of Melatonin, Its Receptors and Drugs.

Eurasian J Med 2016 Jun;48(2):135-41

Department of Medical Pharmacology, Atatürk University School of Medicine, Erzurum, Turkey.

After a Turkish scientist took Nobel Prize due to his contributions to understand clock genes, melatonin, closely related to these genes, may begin to shine. Melatonin, a hormone secreted from the pineal gland at night, plays roles in regulating sleep-wake cycle, pubertal development and seasonal adaptation. Melatonin has antinociceptive, antidepressant, anxiolytic, antineophobic, locomotor activity-regulating, neuroprotective, anti-inflammatory, pain-modulating, blood pressure-reducing, retinal, vascular, anti-tumor and antioxidant effects. It is related with memory, ovarian physiology, and osteoblast differentiation. Pathologies associated with an increase or decrease in melatonin levels are summarized in the review. Melatonin affects by four mechanisms: 1) Binding to melatonin receptors in plasma membrane, 2) Binding to intracellular proteins such as calmoduline, 3) Binding to Orphan nuclear receptors, and 4) Antioxidant effect. Receptors associated with melatonin are as follows: 1) Melatonin receptor type 1a: MT1 (on cell membrane), 2) Melatonin receptor type 1b: MT2 (on cell membrane), 3) Melatonin receptor type 1c (found in fish, amphibians and birds), 4) Quinone reductase 2 enzyme (MT3 receptor, a detoxification enzyme), 5) RZR/RORα: Retinoid-related Orphan nuclear hormone receptor (with this receptor, melatonin binds to the transcription factors in nucleus), and 6) GPR50: X-linked Melatonin-related Orphan receptor (it is effective in binding of melatonin to MT1). Melatonin agonists such as ramelteon, agomelatine, circadin, TIK-301 and tasimelteon are introduced and side effects will be discussed. In conclusion, melatonin and related drugs is a new and promising era for medicine. Melatonin receptors and melatonin drugs will take attention with greater interest day by day in the future.
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http://dx.doi.org/10.5152/eurasianjmed.2015.0267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970552PMC
June 2016

Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil.

Eurasian J Med 2016 Feb 7;48(1):20-3. Epub 2015 Jul 7.

Department of Emergency Medicine, Atatürk University School of Medicine, Erzurum, Turkey.

Objective: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB.

Materials And Methods: Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively.

Results: During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2(nd) degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died.

Conclusion: Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2(nd) degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre.
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http://dx.doi.org/10.5152/eurasianjmed.2015.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792491PMC
February 2016

Comparison of Intravenous Morphine Versus Paracetamol in Sciatica: A Randomized Placebo Controlled Trial.

Acad Emerg Med 2016 06 11;23(6):674-8. Epub 2016 May 11.

Department of Emergency Medicine, Antep University Hospital, Gaziantep, Turkey.

Objective: The objective was to compare intravenous morphine and intravenous acetaminophen (paracetamol) for pain treatment in patients presenting to the emergency department with sciatica.

Methods: Patients, between the ages of 21 and 65 years, suffering from pain in the sciatic nerve distribution and a positive straight leg-raise test composed the study population. Study patients were assigned to one of three intravenous interventions: morphine (0.1 mg/kg), acetaminophen (1 g), or placebo. Physicians, nurses, and patients were blinded to the study drug. Changes in pain intensity were measured at 15 and 30 minutes using a visual analog scale. Rescue drug (fentanyl) use and adverse effects were also recorded.

Results: Three-hundred patients were randomized. The median change in pain intensity between treatment arms at 30 minutes were as follows: morphine versus acetaminophen 25 mm (95% confidence interval [CI] = 20 to 29 mm), morphine versus placebo 41 mm (95% CI = 37 to 45 mm), and acetaminophen versus placebo 16 mm (95% CI = 12 to 20 mm). Eighty percent of the patients in the placebo group (95% CI = 63.0% to 99%), 18% of the patients in the acetaminophen group (95% CI = 10.7% to 28.5%), and 6% of those in the morphine group (95% CI = 2.0% to 13.2%) required a rescue drug. Adverse effects were similar between the morphine and acetaminophen groups.

Conclusion: Morphine and acetaminophen are both effective for treating sciatica at 30 minutes. However, morphine is superior to acetaminophen.
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http://dx.doi.org/10.1111/acem.12956DOI Listing
June 2016

Dual-energy CT shows brain ischemia and hyperbaric oxygen therapy efficacy in acute CO intoxication.

Am J Emerg Med 2016 Jul 17;34(7):1327.e3-4. Epub 2015 Dec 17.

Department of Emergency Medicine, Faculty of Medicine, University of Ataturk, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2015.12.031DOI Listing
July 2016

The utility of cardiac magnetic resonance imaging in Kounis syndrome.

Postepy Kardiol Interwencyjnej 2015 28;11(3):218-23. Epub 2015 Sep 28.

Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: Current diagnostic measurements used to assess myocardial involvement in Kounis syndrome, such as electrocardiography (ECG), cardiac enzymes, and troponin levels, are relatively insensitive to small but potentially significant functional change. According to our review of the literature, there has been no study using magnetic resonance imaging (MRI) on Kounis syndrome except for one case report.

Aim: To identify the findings of dynamic contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with Kounis syndrome (KS) type 1.

Material And Methods: We studied 26 patients (35 ±11.5 years, 53.8% male) with known or suspected KS type 1. The patients underwent precontrast, first-pass, and delayed enhancement cardiac MRI (DE-MRI). Contrast enhancement patterns, edema, hypokinesia, and localization for myocardial lesions were evaluated in all KS type 1 patients.

Results: Contrast-enhanced magnetic resonance imaging demonstrated an early-phase subendocardial contrast defect, and T2-weighted images showed high-signal intensity consistent with edema in lesion areas. None of the lesion areas was found upon contrast enhancement on DE-MRI. The area of early-phase subendocardial contrast defect was reported as follows: the interventricular septum in 14 (53.8%) patients, the left ventricular lateral wall in 8 (30.7%), and the left ventricular apex in 4 (15.4%).

Conclusions: Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1.
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http://dx.doi.org/10.5114/pwki.2015.54017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631737PMC
December 2015

Can we distinguish stroke and stroke mimics via red cell distribution width in young patients?

Arch Med Sci 2015 Oct;11(5):958-63

Department of Neurology, Medical School, Atatürk University, Erzurum, Turkey.

Introduction: Discrimination of stroke and stroke mimics is problematic in young patients. The aim of the study was to determine whether arterial ischemic stroke and stroke mimics can be differentiated via the red cell distribution width (RDW) value in young patients.

Material And Methods: In this retrospective cross-sectional study, a total of 236 patients hospitalized at the neurology ward were investigated. The patients were divided into 3 groups: the 1(st) group included young stroke patients, the 2(nd) group included patients with epilepsy, and the 3rd group included patients with multiple sclerosis (MS). Complete blood count and computed tomographic brain imaging tests were performed in all patients, and magnetic resonance imaging was done when necessary.

Results: A total of 236 patients were included in this study. Ninety-five (40%) patients were young stroke patients, 71 (30%) had epilepsy and 70 (30%) had MS. The mean RDW values of young patients with stroke were significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2, 13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the differentiation of patients with stroke is good (area under the curve (AUC) = 0.89). When an RDW cut-off value of 14.05% is accepted for differentiating young patients with stroke from other disorders, the sensitivity, specificity, positive predictive and negative predictive values were 73.7%, 87.9%, 6.1 and 0.043, respectively.

Conclusions: Red cell distribution width is a promising, rapid, easy and inexpensive parameter to distinguish young stroke from stroke mimics (such as epilepsy and MS) in young patients.
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http://dx.doi.org/10.5114/aoms.2014.40995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624731PMC
October 2015

A sesamoid ossicle of the nuchal ligament mimicking spinous avulsion fracture.

Spine J 2016 Feb 16;16(2):e39. Epub 2015 Sep 16.

Department of Radiology, School of Medicine, Ataturk University, 25100 Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.spinee.2015.09.020DOI Listing
February 2016

Spontaneous reduction of ileoileal adult intussusception after blunt abdominal injury.

Am J Emerg Med 2015 Oct 29;33(10):1542.e3-5. Epub 2015 Jul 29.

Department of General Surgery, Faculty of Medicine, University of Ataturk, Erzurum, Turkey. Electronic address:

This is the first case report of an adult who had spontaneous reduction of ileoileal intussusception occurred after punching to the abdomen. A 40-year-old man was brought to our emergency department by ground ambulance due to pounding and punching a few hours ago. Physical examination showed multiple dermabrasions on his face, abdomen, and lower extremities. All other examinations were unremarkable except that of mild abdominal pain. Laboratory results gave no clues. On abdominal x-ray, paucity of intestinal gas, pseudomass and surrounding gas appearances were visible. No nausea or vomiting occurred during observation. His abdominal pain resolved gradually. On the 24th hour after admission, control computed tomography showed that the findings of intussusception disappeared. He was discharged after 1 day of observation. Outpatient follow-up did not show any abnormality. We suggest that, in patients with mild to moderate trauma, even if the patient has mild abdominal pain, physicians should rule out invagination. Computed tomography is the suggested imaging modality. These patients should be kept in close follow-up. If symptoms resolve and intussusception findings disappear in computed tomography, no further treatment is required.
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http://dx.doi.org/10.1016/j.ajem.2015.07.053DOI Listing
October 2015

The role of vagal nerve root injury on respiration disturbances in subarachnoid hemorrhage.

Turk Neurosurg 2015 ;25(2):273-8

Ataturk University, School of Medicine, Department of Neurosurgery, Erzurum, Turkey.

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.
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http://dx.doi.org/10.5137/1019-5149.JTN.9964-13.1DOI Listing
December 2015

Familial Mediterranean fever gene mutations in north-eastern part of Anatolia with special respect to rare mutations.

Gene 2015 Sep 21;568(2):170-5. Epub 2015 May 21.

Department of Medical Biology and Genetics, Faculty of Medicine, Katip Celebi University, Izmir, Turkey.

We aimed to determine the frequency of mutations, carrier rates and the association of rare mutations with Familial Mediterranean Fever (FMF) symptoms. There is a need to evaluate as many different populations as possible in order to determine either specific rare mutations or a range of disease-associated mutations. The demographic data and FMF symptoms related to MEFV gene mutations were collected from 731 participants. Exon 2 and exon 10 of the MEFV gene were tested by DNA sequencing. The rare mutations were identified as: M694I (1.1%, n=12), E148V (0.6%, n=6), T267I (0.5%, n=5), L110P (0.2%, n=2), E167D (0.2%, n=2), K695R (0.1%, n=1) and an insertion G (Guanine) mutation (0.4%, n=4) at the 777th codon of exon 10. We used routine comprehensive detection systems such as Sanger sequence that can catch rare mutations, for definite diagnosis and treatment of FMF disease.
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http://dx.doi.org/10.1016/j.gene.2015.05.045DOI Listing
September 2015

Familial Mediterranean fever gene mutations in north-eastern part of Anatolia with special respect to rare mutations.

Gene 2015 Sep 21;568(2):170-5. Epub 2015 May 21.

Department of Medical Biology and Genetics, Faculty of Medicine, Katip Celebi University, Izmir, Turkey.

We aimed to determine the frequency of mutations, carrier rates and the association of rare mutations with Familial Mediterranean Fever (FMF) symptoms. There is a need to evaluate as many different populations as possible in order to determine either specific rare mutations or a range of disease-associated mutations. The demographic data and FMF symptoms related to MEFV gene mutations were collected from 731 participants. Exon 2 and exon 10 of the MEFV gene were tested by DNA sequencing. The rare mutations were identified as: M694I (1.1%, n=12), E148V (0.6%, n=6), T267I (0.5%, n=5), L110P (0.2%, n=2), E167D (0.2%, n=2), K695R (0.1%, n=1) and an insertion G (Guanine) mutation (0.4%, n=4) at the 777th codon of exon 10. We used routine comprehensive detection systems such as Sanger sequence that can catch rare mutations, for definite diagnosis and treatment of FMF disease.
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http://dx.doi.org/10.1016/j.gene.2015.05.045DOI Listing
September 2015

Red cell distribution width cannot predict acute mesenteric ischemia: reply.

World J Surg 2015 May;39(5):1327-8

Department of General Surgery, School of Medicine, Ataturk University, 25070, Erzurum, Turkey,

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http://dx.doi.org/10.1007/s00268-015-2968-xDOI Listing
May 2015

Dual-source computed tomography may define cardiac contusion in patients with blunt chest trauma in ED.

Am J Emerg Med 2015 Jun 31;33(6):865.e1-3. Epub 2014 Dec 31.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

We report a 20-year-old woman with blunt chest trauma because of a motor vehicle injury who has traumatic asphyxia and hypotension. The diagnosis of blunt cardiac injury was put by using dual-energy computed tomography in the emergency department because other laboratory and imaging modalities were useless. After hospitalization in intensive care unit, she was treated with supportive and antiedema therapy. The patient was extubated on the fifth day and discharged on the ninth day without any sequel. Coexistence of traumatic asphyxia with blunt cardiac injury is rare. Several imaging techniques such as transthoracic and transesophageal echocardiography, contrast-enhanced multislice thorax computed tomography or initial electrocardiogram, and troponin I levels are used to detect the myocardial damage, but diagnostic capability is low. Dual-energy computed tomography is a promising new technology with the ability of defining blunt cardiac injuries and may have an indication in the emergency setting in patients with hemodynamic instability to rule in traumatic cardiac complications especially when electrocardiogram and transthoracic echocardiography are useless in the emergency department.
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http://dx.doi.org/10.1016/j.ajem.2014.12.059DOI Listing
June 2015

A rare cause of acute abdomen for which broad-spectrum antibiotics should be initiated in emergency service: typhlitis.

Am J Emerg Med 2015 May 30;33(5):738.e1-3. Epub 2014 Oct 30.

Department of Emergency Medicine, Medical Faculty, Ataturk Unıversity, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2014.10.040DOI Listing
May 2015

A rare cause of acute abdomen for which broad-spectrum antibiotics should be initiated in emergency service: typhlitis.

Am J Emerg Med 2015 May 30;33(5):738.e1-3. Epub 2014 Oct 30.

Department of Emergency Medicine, Medical Faculty, Ataturk Unıversity, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2014.10.040DOI Listing
May 2015

Spotted lipid sign floating on the blood to differentiate obscured open fractures from simple wound lacerations.

Am J Emerg Med 2015 Feb 8;33(2):312.e1-2. Epub 2014 Aug 8.

Ataturk University Medical Faculty, Department of Emergency, Erzurum, Turkey.

Open fractures are not so obvious sometimes, and in the case of multiorgan injuries, they may be misdiagnosed in emergency department. Here, we report a 48-year old man with motor vehicle crash injury. There were ominous facial, vertebral, thoracic, and abdominal injuries as well as distal femoral shaft fracture and multiple skin lacerations in different parts of the body in the initial examination. On the tertiary examination, we incidentally caught an important finding showing an open fracture: oily (greasy) bleeding from the wound (Video 1, Fig. 1 and 2). We think that the characteristic of the blood, namely, the spotted lipid sign floating on the blood, is a unique and pathognomonic finding differentiating between simple wound lacerations and obscured open fractures.
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http://dx.doi.org/10.1016/j.ajem.2014.08.009DOI Listing
February 2015

Sensitivity and specificity of red cell distribution width in diagnosing acute mesenteric ischemia in patients with abdominal pain.

World J Surg 2014 Nov;38(11):2770-6

Department of General Surgery, School of Medicine, Ataturk University, 25070, Erzurum, Turkey,

Background: We investigated the utility of the red cell distribution width (RDW) in diagnosing acute mesenteric ischemia (AMI) in patients with abdominal pain.

Methods: The patients were divided into two groups in this retrospective case-control study: patients with AMI and patients with abdominal pain who did not require urgent surgery. Venous blood was collected from the patients upon admission to the emergency department, and abdominal computed tomography angiography was performed. The RDW and hematological and biochemical parameters of the groups were compared. The primary outcome was AMI among the patients with abdominal pain. The secondary outcome was mortality, complaint period, and size of ischemia/necrosis among the AMI patients.

Results: The RDW, white blood cell lactate dehydrogenase, and blood urea nitrogen of the patients with AMI were significantly different from those of the control group. When the average RDW (15.04 %) of the patients with AMI was used as a cut-off value, the sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood (-LR) were 40.8 %, 81.2 %, 2.17, and 0.73, respectively. When patients with AMI and anemia were included in the group, the sensitivity and specificity values did not change. There was no relation between the RDW and mortality, size of the ischemia/necrosis, and complaint period. Furthermore, there was no significant difference in the average RDW between the patients with ischemia/necrosis in the small intestine only and those with ischemia/necrosis in the colon.

Conclusion: The RDW on admission is of marginal help to diagnose AMI among patients with abdominal pain.
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http://dx.doi.org/10.1007/s00268-014-2706-9DOI Listing
November 2014

A novel insertion mutation identified in exon 10 of the MEFV gene associated with Familial Mediterranean Fever.

BMC Med Genet 2014 Jul 1;15:74. Epub 2014 Jul 1.

Department of Medical Biology, Medicine Faculty, Ataturk University, 25240 Erzurum, Turkey.

Background: Familial Mediterranean Fever (FMF), characterized by recurrent fever and inflammation of serous membranes, is an autosomal recessive disease caused by mutations in the Mediterranean fever (MEFV) gene. Around 296 mutations have been reported to date.

Methods: Two two-generation Turkish families with a total of four members diagnosed with FMF clinically were screened with DNA sequencing performed on exon 2 and exon 10 of the MEFV genes. Then, complete exome sequencing analysis of MEFV gene was done for four patients in whom novel mutation was detected.

Results: A novel single base Guanine (G) insertion mutation in the coding region of MEFV gene, named c.2330dupG (p.Gln778Serfs*4 or Q778SfsX4) resulting in a mutated Pyrin/Marenostrin protein was identified.

Conclusions: This is the first report of a new mutation in exon 10 of the MEFV gene in two Turkish families. This novel pattern of insertion mutation may provide important information for further studies on FMF pathogenesis.
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http://dx.doi.org/10.1186/1471-2350-15-74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094690PMC
July 2014

Red cell distribution width identifies cerebral venous sinus thrombosis in patients with headache.

Clin Appl Thromb Hemost 2015 May 1;21(4):354-8. Epub 2013 Oct 1.

Department of Neurology, Atatürk University Medical School, Erzurum, Turkey.

Background: Diagnosing cerebral venous sinus thrombosis (CVST) in patients referring to emergency service or neurology outpatient unit with complaints of headache is a challenging task. Magnetic resonance (MR) venography is the gold standard, but there are limitations regarding its use.

Aim: To evaluate the validity of red cell distribution width (RDW) in CVST diagnosis in patients presenting with headache.

Methods: A total of 138 patients comprising 37 patients with CVST and 101 control primer headache cases were included in this retrospective cross-sectional study. Control group consists of hospitalized patients with primary headache. Venous blood hemoglobin (Hb), platelet, mean corpuscular volume (MCV), RDW, fibrinogen, and vitamin B12 levels of the patients were recorded at the first referral. Diagnosis of CVST was established by MR venography.

Results: The RDW ratio of patients with a diagnosis of CVST was significantly higher than that in patients with primary headache (15.3 ± 1.4 vs 13.3 ± 0.5; P <.0001). Fibrinogen and vitamin B12 levels were not significantly different between the 2 groups. In a total of 11 patients, there was more than 1 thrombosis. In 21 of the patients with CVST, gene mutation was detected. There was no significant difference between the patients with and without mutations regarding RDW values. Diagnostic validity of RDW was found to be excellent in differentiating patients with CVST and primary headache (area under the curve = 0.996; 95% CI: 0.990-1.000). Optimum RDW cutoff value was determined as 14.1% (sensitivity: 91.9%, specificity: 99%, positive predictive value: 92.8, negative predictive value: 0.082).

Conclusion: We suppose that among patients presenting with the complaint of headache, RDW value may lead to diagnose CVST.
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http://dx.doi.org/10.1177/1076029613505764DOI Listing
May 2015

Defining the percentage of intra-abdominal hemorrhage in abdominal computerized tomography using stereology in patients with blunt liver injury and determining its relationship with outcomes.

J Trauma Acute Care Surg 2013 Jan;74(1):224-9

Department of Emergency Medicine, Medical Faculty, Ataturk University, Erzurum, Turkey.

Background: The aim of this study is to determine the percentage of intra-abdominal hemorrhage (PIAH) on computerized tomographic (CT) scan via the Cavalieri method and to define whether this is correlated with the outcome.

Methods: Fifty-one patients (24 children and 27 adults) with blunt hepatic injury were studied in this Level III prognostic clinical cohort study. The stereologic method of point counting based on the Cavalieri approach was adapted to CT data so as to assess IAH and abdominal volume. PIAH was calculated as intra-abdominal fluid volume/whole abdominal volume × 100.

Results: Mean PIAHs in children and adults were 4.20% ± 2.85% and 6.28% ± 5.21%, respectively. Coexisting intra-abdominal injuries in children and in adults were as follows: splenic injury (29.2, 11.1%; p = 0.012), kidney (25, 11.1%), bladder (4.2, 14.8%), and pelvic fracture (12.5, 11.1%). PIAH was moderately negatively associated with hemoglobin levels (r = -0.301; p = 0.032), hematocrit levels (r = -0.322; p = 0.021), and GCS (Glasgow Coma Scale) score (r = -0.276; p = 0.05). Neither receiver operating characteristic curve analyses for PIAH nor outcomes were statistically significant in children. In adults, sensitivity and specificity of PIAH in predicting the prognoses when the cutoff levels were taken as 5.39%, 9.9%, and 12.4%, respectively, were as follows: operation (71, 84%), mortality (36, 93%), and intensive care unit admission (25, 94%).

Conclusion: In patients with blunt hepatic injury, the Cavalieri principle of stereology can easily be added to the CT slices to calculate PIAH. This method is repeatable in other institutions and can be used as a guide to predict outcomes. It is suitable for a universal parameter to measure intra-abdominal fluid in blunt injury. PIAH has low sensitivity but high specificity to predict intensive care unit admission and mortality in cases of blunt hepatic injury in adults. Its specificity in predicting the need for operation is better than that of the anatomic liver injury grading systems in computerized tomography.

Level Of Evidence: Prognostic study, level III.
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http://dx.doi.org/10.1097/TA.0b013e318270df0eDOI Listing
January 2013

Wide central pontine, bulbar and thalamic myelinolysis with sequela.

Eurasian J Med 2012 Dec;44(3):179-81

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Although cases of hyponatremia during pregnancy have been described, it has rarely been possible to show demyelination lesions in central pons, bulbus as well as thalamus, by imaging techniques. We report a case that developed extensive myelinolysis due to the "rapid" correction of hyponatremia as a result of hyperemesis gravidarum. Magnetic resonance imaging showed bilaterally symmetric hyper-intense areas in the thalamus and cerebral crus and symmetric hyperintense area in the central pons, with sparing of the rim. In the second day of hospitalization, probably as a result of expansion of myelinolysis, she was intubated and received mechanical ventilator due to bradypnea and a GCS scale of E1M4V2. She was extubated in 11(th) day of hospitalization and physical therapy was started. She was discharged in 30(th) day of hospitalization with a GCS of 15. But she was tetraparetic (2/5). In the 3(rd) month of follow up, her quadriparesis improved to paraparesis in lower extremities (3/5). Her follow up examinations in the first year did not change although physical therapies go on. She delivered a normal child.
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http://dx.doi.org/10.5152/eajm.2012.42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261386PMC
December 2012

Intracranial hemorrhage with electrocardiographic abnormalities and troponin elevation.

Am J Emerg Med 2013 Jan 16;31(1):271.e5-7. Epub 2012 Jul 16.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Electrocardiographic (ECG) abnormalities and cardiac troponin I elevation are seen in addition to the classic clinical symptoms and signs of subarachnoid hemorrhage (SAH). We aimed to show that, in patients with ST elevation, troponin elevation, and altered consciousness, the reason may be SAH. A 36-year-old man presented to emergency service with ECG abnormalities, high level of cardiac troponin I, and neurologic symptoms. In the patient's initial ECG, there were sinus arrhythmia, bradycardia, T-wave inversions inferiorly, and concave ST elevations in V1 to V4. Three hours later, his ECG showed increased ST-segment elevations with normal heart rate. The patient's troponin I value was 10 mg/L. Ejection fraction was 60%, and there were no wall motion abnormalities on echocardiography. Computed tomographic scan of the brain demonstrated SAH with falx sign and midline cerebellar hematoma (3 × 4 cm in size) in the occipital region. The patient died on the 10th day of follow-up because of severe metabolic acidosis, multiorgan failure, and bradycardia. Cardiac evaluation is recommended in patients with intracranial hemorrhage in many studies. In our opinion, if there are neurologic symptoms or signs in patients diagnosed as acute myocardial infarction with ECG changes and troponin elevation, requesting threshold of brain computed tomography should be low before the thrombolytic therapy.
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http://dx.doi.org/10.1016/j.ajem.2012.05.007DOI Listing
January 2013

Complete atrioventricular block due to overdose of pregabalin.

Am J Emerg Med 2012 Nov 23;30(9):2101.e1-4. Epub 2012 May 23.

Department of Cardiology, Faculty of Medicine, Ataturk University, 25240 Erzurum, Turkey.

Pregabalin, a synthetic derivate of the inhibitory neurotransmitter γ-aminobutyric acid, shows antiepileptic, analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. The major advantage of pregabalin is its relative reliability, easy use, high tolerance, and lack of negative interaction with other drugs. A 65-year-old woman with medical histories of diabetes mellitus, lumbar spondylosis, diabetic nephropathy, chronic renal failure, and anemia of chronic disease was admitted with the complaint of dizziness and syncope. She had been taking pregabalin 300 mg daily for 8 months. Electrocardiogram revealed complete atrioventricular (AV) block and right bundle-brunch block with a heart rate of 39 per minute. Her creatinine was 1.8 mg/dL, and creatinine clearance was 50 mL/min. Pregabalin treatment was discontinued. Four days later, the complete AV block resolved spontaneously to Mobitz type II block and to sinus rhythm with right bundle-brunch block on the seventh day. To our knowledge, this is the first case of complete AV block associated with pregabalin. We believe that AV block occurred as a result of pregabalin's effect on L-type Ca++ channels in the heart. Pregabalin's different effects on electrocardiogram and on the heart in different individuals may have an association with the patterns of distribution of the L-type calcium channels in myocardium.
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http://dx.doi.org/10.1016/j.ajem.2012.02.008DOI Listing
November 2012