YEAR: 2022

LUMBAR SPINAL STENOSIS FUSION SURGERY IN PARKINSON'S DISEASE: A CASE REPORT 

Lokman Kiran 

p. 31-35 

ABSTRACT

Parkinson's disease is a nervous system disorder that progressively affects and impairs movement. Spinal stenosis is more common in these patients due to spinal deformities and motor movement disorders. In addition, osteoporosis is more common in Parkinson's disease than in the general population. Lumbar decompression and fusion surgery is a frequently used surgical technique in lumbar degenerative spine diseases. In this case, it is aimed to present early spinal instability due to osteoporosis and posture after spinal fusion surgery in Parkinson's disease. 

Keywords: Parkinson's disease, lumbar stenosis, osteoporosis, lumbar instability

KYPHOTIC ANGLE INCREASE AFTER THORACAL VERTEBRA KYFOPLASTY: A CASE REPORT

Lokman Kiran 

p. 36-41

ABSTRACT 

There are many classifications for thoracolumbar and lumbar fractures and treatment methods have been determined according to these classifications. The main treatment method is anterior, posterior or combined fusion surgery in necessary patients. Recently, percutaneous in-terventions have gained importance, especially due to the advantage of the short duration of sur-gery. Post-traumatic kyphosis, which requires other surgical treatment depending on the degree of angulation, may occur in the follow-up after the surgery performed as a result of the classifi-cation of the fracture. In this study, a case requiring posterior fusion surgery as a result of increa-sed angulation in the follow-up after kyphoplasty procedure is presentedn. 

Keywords: Thoracic fracture, kyphoplasty, kyphotic angle

A SILENT BUT FATAL CASE OF AORTIC DISSECTION 

Dilek Atik, Esma Özdarendeli, Levent Albayrak, Hasan Burak Kaya

p. 42-46

ABSTRACT

Aortic dissection is defined as the separation of the tunica media of the aorta and the filling of blood into the aortic wall as a result of a tear in the aortic intima, with the contribution of various mechanisms, primarily blood pressure and structural anomalies of the aortic wall. Aortic dissec-tion is a life-threatening disease characterized by sudden chest and/or back pain. Aortic dissec-tion typically alerts us physicians to aortic dissection, with sudden onset symptoms such as chest, back, or abdominal pain defined as "tearing". Cases may have aortic dissection without pain and may present with neurological events. The diagnosis of aortic dissection should be kept in mind in patients who present to the emergency department with unexpected symptoms such as synco-pe, altered consciousness, and loss of strength in the extremities, apart from the typical symptoms of aortic dissection.

Keywords: Aortic dissection, neurological symptom, cerebral infarction, plegia

CAN HIGH-DOSE DRUG INTAKE BE PREDICTED? 

Hatice Şeyma Akça, Dilek Atik, Fulya Köse

p. 1-2 

ABSTRACT

Dear editor, In the approach to suicidal intoxications, we encounter many problems such as not being able to obtain sufficient information about the patient's complaints, the uncertainty of the level of medi-cation taken, patient non-compliance, and the patient's refusal to accept the treatment. It is also difficult to make the decision of service or intensive care follow-up. 

SPEECH IMPAIRMENT AND UNDETECTED ISCHEMIA

Hatice Şeyma Akça, Fulya Köse, Dilek Atik

p. 3-5

ABSTRACT 

It was aimed to present a patient who applied to the emergency department with speech impair-ment and clouding of consciousness, and whose clinical findings improved within 3 days and no vascular occlusion could be detected, and to show that a clinic resembling a transient ischemic attack can only be based on clinical findings. A 65-year-old female patient was brought to the emergency department due to gibberish, weak-ness, and confusion. The general condition was moderate, and the patient's glaskow coma scale was 12, with blurred consciousness. The patient was found to be disorientated. Brain computed tomography, diffusion MRI, and contrast-enhanced carotid vertebral artery brain CT angiog-raphy were found to be normal. The patient was admitted to the neurology service for follow-up with the suspicion of trans ischemic attack. 300 mg of acetylsalicylic acid 1x1 p.o. and intrave-nous saline was started. Neurological findings of the patient, who was followed up for 3 days, improved. It was detected as GCS:15. He was discharged with recommendations. We think that our case report will contribute to the literature, since transient ischemic attacks usually return to normal findings within 24 hours of diagnosis and may be accompanied by fin-dings such as plaque or vascular occlusion. 

Keywords: Trans Ischemic Attack, Confusion, Cerebrovascular Disease

RHABDOMYOLYSIS AND ACUTE RENAL FAILURE DUE TO GABAPENTINE USE; CASE REPORT 

Dilek Atik, Nuray Kılıç, Fulya Köse, Hatice Şeyma Akça, Yasin Karaman 

p. 6-9

ABSTRACT

Gabapentin is an anticonvulsion drug and is used especially in diseases with neuropathic  pain. The side effects of gabapentin, whose usage areas are expanding, are pain, drowsiness, fatigue, headache, and muscle twitching are among the most common symptoms.  A 31-year-old male patient was admitted to the emergency service after complaining of pain in all muscles and joint pain for 2 days. The patient with a previous cervical disc herniation was treated with 600 mg gabapentin every 12 hours for 3 days. The patient was conscious, cooperati-ve and oriented well. Respiratory system examination; It was normal. No additional pathology was detected in his neurological and other system examinations. In the blood and urine analysis of the patient; Blood: glucose: 111mg/dl; AST: 20IU/l; ALT: 65 IU/l; bilirubin: 0.8mg/dl; LDH: 2520 U/l; C-reactive protein: 258; CK: 14911 U/l; CKMB: 60.1; creatinine: 7.46 mg/dl; urea: 165mg/dl; Na: 140 mmol/1; K: 3.4 mmol/1; Ca: 5.5mg/dl; pH 7.35; bicarbonate: 19 mmol/l. Hydration and Ca infusion of the patient was started. Forced diuresis was started. Hydration was planned for the patient because the patient had a tendency to decrease in urea and creatinine, had urination and did not have acidosis in blood gas.  In conclusion, we can conclude that gabapentin can cause myotoxicity, rhabdomyolysis and renal failure even in patients with previously normal renal function, even at therapeutic doses. For this reason, we should pay special attention to the drug dosage, concurrently the patient's lifestyle, the drugs he uses and the patient's comorbidities.

Keywords: Gabapentin, Rhabdomyolysis, Renal failure.

AĞZI SULANDIRAN ŞEYLER PAROTİT VE SİYALOLİTİAZİS: VAKA TAKDİMİ  

Fulya Köse, Nuray Kılıç, Hatice Şeyma Akça, Dilek Atik, Eray Zeybekoğlu 

p. 10-12

ÖZET

Siyalolitiazis tükrük bezi kanalında tükürük akışının durması sonucu kalsiyum karbonat ve kalsi-yum fosfat taşının (siyalotit)oluşmasıdır. Ağrı, şişlik ve hassasiyet belirtileri parotitit taklit edebi-lir. Siyalolitiazis parotitten daha sıklıkla ayıran tipik bulgu olarak tek taraflıdır.  37 Yaşında erkek hasta acil servise çenede şişlik şikayeti ile başvuruyor. Hastanın alınan anam-nezinde hasta nar yerken birden dişlerinde bir kamaşma hissi olduğu ardında birden çenesinin tek taraflı şiştiği bilgisi öğrenildi. Hastanın bakılan labaratuvar sonuçlarında Wbc:10.12 K/uL Hb:15 g/dL Plt:230 K/uL CRP:18,9 mg/L Amilaz:1029 U/L Lipaz: 39.9 U/L, üre: 27 mg/dL krea-tin:0.99 mg/dL idi. Parotit tipik olarak çene bölgesinin tutulumu ile karakterizedir. Viral parotit, diğer tükürük bezle-rini kapsayabilir. Bazı hastalarda göğüs duvarına kadar uzanabilen yumuşak dokuları kapsayan yüz şişmesine neden olabilir. Hastalarda ağızda salivasyon artışına sebep ola-cak şeylerden sonra parotit ve siyaladenitis taşı tıkanıkları oluşabilmektedir.  Bu vakayı takdim etmekteki amacımız hastanın yemek yerken aniden çenesinde şişlik oluşması üzerine acil servise başvurması idi. Bu tür ani şişlik olaylarında hastaların allerjik reaksiyonlarla karışabileceği unutulmamalı ve hastaların anamnezleri ayrıntılı alınarak dikkatli muayene edilmeliler. 

Keywords: Siyalolitiazis, Parotit, Allerjik reaksiyon

DELİCİ KESİCİ ALET İLE PERİFERİK ARTER YARALANMASINA BAĞLI ARRESTTEN DÖNEN BİR OLGU SUNUMU 

Fulya Köse, Nuray Kılıç, Dilek Atik, Hatice Şeyma Akça 

p. 13-15
 

ÖZET

Perferik damar yaralanmaları acil müdahale gerektiren önemli bir sağlık sorunu olup ülkemizde hızla artmaktadır. Periferik damar yaralanmalarında hasta hayatı ve ekstremitenin kurtarılabilmesi için erken tanı ve acil müdahalenin önemi büyüktür.  57 yaşında erkek hasta delici kesici alet yaralanması sonucu 112 ile acil servisimize getirildi. Hasta GKS: 14 Ateş: 36.0 Nabız: 90, Kan basıncı: 130/80 SPO2 %93 olarak geldi. Sol alt extremitede dizden medial kısmında yaklaşık 5-10 cm kadar yukarıda 1 adet 1-2 cm genişliğinde düzgün sınırlı laserasyon mevcuttu. Hastaya bilateral alt extremite bilgisayarlı tomaografi (BT) anjiografi çekildi. Bt anjiografi de sağ femoral arter yaralanması tespit edildi. Hastanın ilk geliş GKS 14 olup, hızlı bir şekilde GKS 10 gerileyerek hemorajik şok tablosuna giren hasta acil müdahaleleri yapıldıktan sonra operasyona çıkarıldı. Hemorajik şok hayatı tehdit eden ve sağkalım için acil tıbbi tedavi gerektiren acil bir klinik durumdur. Hemorajik şokun temelde 4 evresi vardır. Total kan volümünün %15’inden azının kaybı (750 ml’ye kadar) neticesinde 1.evre, %15-30’u (750- 1500 ml) kaybedilince 2.evre, %30-40’ı (1500-200 ml) kaybı neticesinde 3.evre ve %40 üzeri kayıpla ölüm söz konusu olan 4. evre mevcuttur. Bu çalışmada sunulan vakada mental konfüzyon, ajitasyon ve ciddi metabolik asidoz gözlenen 3. evre hemorajik şok söz konusudur. Arter yaralanmalarında arterial rekonstrüksiyonun başarılı sonuç vermesinin ilk şartı rekonstrüksiyonun yaralanmayı takiben ilk 8 saat içerisinde gerçekleştirilmesidir.  Sonuç olarak; delici kesici alet yaralanmaları yüksek mortaliteye sahip olup, hastaların vital bulguları ve genel durumları prognozu belirler. Bu hastalarda hemorajik şok neticesinde hastalar arrest olabilir.  

Anahtar kelimeler: Perferik damar yaralanmaları, Hemorajik şok, Hemorajik şok evrelemesi

METOCLOPRAMIDE-INDUCED DYSTONIA; CASE REPORT

Nuray Kılıç, Fulya Köse, Dilek Atik 

p. 16-19
 

ABSTRACT 

Aim 

In this case, we aimed to describe the acute dystonia disease developed after the use of metoclopramide in an 8-year-old boy who started with complaints of nausea and vomiting. 

Case Report 

An 8-year-old boy was brought to our emergency department by his family because of a sudden onset of postural disorder about 2 hours after ingesting metoclpramide oral solution. The patient's physical vision was torticollis (deviated neck to the right), mouth deviated to the left, left elbow flexed and left wrist externally rotated. His left hand was clenched into fists. Our patient was admitted to the hospital for treatment and observation after receiving the opinion of the pe-diatrician. 

Conclusion 

When using metoclopramide hydrochloride in adult or pediatric patients in our emergency de-partments, we should be very careful and be prepared for its side effects. Acute dystonia muscle disease after metoclopramide, which is used very frequently, is a condition that must be kept in mind of emergency medicine physicians. 

Keywords: Metoclopramide, Acute dystonia, Pediatric emergency medicine. 

ABDOMINAL AORTIC ANEURYSM RUPTURE 

Nuray Kılıç, Fulya Köse, Dilek Atik 

p. 20-23
 

ABSTRACT

An increase in the diameter of the vessel wall more than one and a half times is called an aneurysm. Abdominal aortic aneurysm is defined as aortic diameter ≥3 cm and repair is conside-red when ≥5 cm. In the United States, the most common cause of death in middle-aged individuals is complications from abdominal aortic aneurysm (1). Today, aneurysms are common in our country due to increasing risk factors. In this case, we aimed to describe a ruptured abdominal aortic aneurysm in a 64-year-old male patient who applied to the emergency department with the complaint of abdominal pain.

Keywords: Abdominal aortic aneurysm, Abdominal pain, Emergency department.

YILAN ISIRIĞINA GENEL YAKLAŞIM; VAKA BİLDİRİMİ 

Fulya Köse, Nuray Kılıç, Dilek Atik, Hatice Şeyma Akça 

p. 24-30
 

ÖZET 

Tüm dünyada olduğu gibi Türkiye’de de yılan ısırmaları önemli bir mortalite ve morbidite nedenidir. Yılan zehri, yaygın damar içi pıhtılaşma gibi sistemik zehirlenme durumuna yol açabileceği gibi, doku nekrozu etkisiyle ekstremite kaybına da neden olabilir.  30 yaşında erkek hasta sol ayak topuk bölgesinden yılan tarafından ısırılması sonucu servisimize başvurdu. Hasta gelir gelmez yapılan fizik muayenesinde Ateş: 36.4 °C  Nb: 78/dk Tansiyon: 110/80 mmHg Spo2 %98 Glaskow Koma Skalası (GKS) 15 idi. Hastanın ayağında ödem yoktu, dolaşım muayenesi doğaldı nabızlar açıktı. Hasta gelir gelmez acil takip ve tedavi protokolü baş-landı. hastanın yakın takibi sırasında hastanın tansiyonları 80/50 mm/Hg olup, nabız: 62, renginde solukluk oluştu. Hastanın yılan ısırığı olan bölgede şişlik, ağrı, ekimoz başladı ödem takibi yapıldı. Hastanın genel durum kötüleşmesi üzerine hastaya yılan antivenomu başlandıktan 4 saat sonra hemogram kontrolünde trombosit değeri 156 K/ul tespit edildi. Hasta yoğun bakımda yer açılması üzerine yoğun bakıma yatışı yapıldı. Biz bu vakada yılan ısırığına maruz kalan semptomsuz hastaların çok hızlı bir şekilde DİC tablo-suna doğru kayabildiklerini gördük. Bu yüzden yılan antivenomunun önemini ve hızlı müdahalenin hayat kurtarıcı olduğunu vurgulamak istedik. Yılan antivenomonun anaflaksi riski açısından kar zarar oranı değerlendirilerek ve hasta evrelemelerine dikkat edilerek hastaların mortalitesinin düşürülebileceği kanısına vardık.   

Anahtar Kelimeler: Yılan ısırığı, Antivenom, Yılan Isırmalarının Klinik Evreleri. 

1. THE IMPORTANCE OF BEDSIDE ULTRASOUND IN THE DIAGNOSIS OF TESTICULAR TORSION

Ramazan UNAL, Mert Rusen GULSEN, Ceren Ovacik KARAFILIK, Nurcan OZASLAN, Vedat AVCIERI

p. 23-27 

ABSTRACT

The acute scrotum is a broad definition used for all scrotal swellings with or without pain. The most common differential diagnoses include testicular torsion, testicular appendage torsion, and acute epididymitis or epididymo-orchitis. Testicular torsion usually occurs during adolescence. Testicular torsion accounts for approximately 25% of acute scrotum cases. According to the studies, normal testicular dimensions are preserved and only slight changes in morphology occur if the testes are operated within 8 hours after the onset of torsion symptoms. The early diagnosis together with intervention in testicular torsion prevents irreversible changes in testes. Bedside ultrasonography done by emergency medicine specialists, especially in health institutions that do not have on-duty radiology specialists, is of great importance in the early diagnosis of testicular torsion and in reducing morbidity, as in most emergencies. We will present 2 cases diagnosed with testicular torsion by bedside ultrasound and then operated.

Keywords; Bedside ultrasound, emergency medicine department, testicular torsion.

2. A CASE REPORT TO DEVELOP MYOCLONUS WITH THE USE OF FIRST DOSE GABAPENTIN

Dilek Atik, Nuray Kılıç, Fulya Köse

p. 29-31

ABSTRACT 

Gabapentin (GBP) has anticonvulsant and analgesic properties and is used in many ailments associated with chronic pain and neuropathic pain, mostly diabetes mellitus. In a study, they stated the incidence of myoclonus as 0.1% in epilepsy patients using Gabapentin. Case Report: A 39-year-old female patient was started by Gabapentin neurosurgery for pain in the legs due to herniated L3-4 disc in the lower back. The first dose of use to relieve paraesthesia was manifested in the form of twitching and subsequent contraction in the nasolabial groove of the left rim of the patient, who started using 300 mg/day gabapentin. In our case, the patient did not have any cerebral disease such as encephalopathy or epilepsy, and his kidney functions were also normal. We think that myoclonus may develop due to GBP in the first dose of treatment, and the severity of myoclonus may increase after dose increase, and it should be kept in mind that care should be taken in treatment arrangements.

Keywords: Gabapentin; myoclonus; Gabapentin side effect

3. NEW DIAGNOSIS OF HEPATIC HYDATID CYST PRESENTING WITH DYSPNEA

Mert Rusen GULSEN, Fahrunisa Meryem Betul EROL, Feride GUNEC, Ramazan UNAL

p. 33-35

ABSTRACT

Hydatid cyst is a parasitic disease, which is transmitted to humans mostly through dog feces and frequently seen in countries where agriculture and animal husbandry are common, caused by Echinococcus Granulosus. Hydatid cysts are frequently localized in the liver and the lungs. The disease may have different clinical course and cause various complications depending on location and size of the cysts.

In this article, we aimed to present a 72-year-old male, who was newly diagnosed with hepatic hydatid cyst with pulmonary fistulization, which was surgically drained.

Keywords: Hydatid disease, pulmonary fistulization, dyspnea.

4. ATYPICAL ABDOMINAL PAIN IN CHILDREN; CHOLELITHIASIS

Nuray Kılıç, Dilek Atik

p. 37-39

ABSTRACT 

The gallbladder is a pear-shaped sac-shaped organ that is 8-10 cm long and 4-5 cm wide in adults. The gallbladder stores bile, which is constantly secreted by the liver. Gallbladder pathologies have an important place in patients experiencing abdominal pain symptoms. Abdominal pain in children requires a multidisciplinary approach and treatment just like adults. However, it is not as common to encounter cholelithiasis in pediatric patients as in adults.

Case report: A 3-year-old boy was brought to the emergency room by his family with complaints of abdominal pain and occasional vomiting for 2-3 days. WBC 12.33, CRP 3.44, ALT 11, AST 31, total bilirubin 0.40, GGT 18, creatinine 0.26, and no obvious pathology was detected in the laboratory tests performed. Computed tomography was performed to detect acute intra-abdominal pathology for the patient who was not relieved by the treatment. A diagnosis of cholelithiasis was made.

Although rare, cholelithiasis should be kept in mind by emergency physicians in children who come to the emergency department with the complaint of abdominal pain, and their approach should be directed towards this. At the same time, more studies are needed to eliminate the deficiencies related to gallbladder stone management and treatment in children.

Keywords: Cholelithiasis; Gallbladder risk factors in children; abdominal pain

5. ALLERJİK REAKSİYON MU YOKSA PERİKONDRİT Mİ?

Fulya Köse, Dilek Atik, Arife Sezgin

p. 41-44
 

ÖZET

Auriküler perikondrit (aynı zamanda pinna perikondrit olarak da adlandırılır), enfeksiyöz ve inflamatuar bir durumdur. Genellikle travmaya ikincil olarak ortaya çıkan dış kulak (yani, yüksek kulak delme, künt travma, yanıklar, iyatrojenik), apse oluşumu olsun ya da olmasın enfeksiyona yol açar. Klasik olarak kızarıklık ve lobülün korunması ile kulak kepçesinin ağrılı şişmesi. Acil servis ve primer başvurular için önemlidir. Hekiminin perikondriti erken ve doğru bir şekilde tedavi etmesi önemlidir. Olgumuz 58 yaşında dm,ht si olan covid 19 aşısı sonrası önce boyundan başlayan daha sonra kulaklarda ve boyunda şişlik oluşması ile devam eden şikayetleri ağrısının artması nedeniyle servisimize başvurdu. Perikondrit tanısı ile yatırılarak tedavisi yapıldı. Kulak kepçesinin perikondriti, değişen derecelerde dış deformiteye yol açabilir ve tedavisi zor bir durumdur. Bu yüzden hastaların yatırılarak tedavi edilmesi daha ön plandadır. Hastamızın etyolojik neden olarak regüle olmayan diyabet varlığı ile immunsuprese durumu ile birlikte Covid 19 aşının hastanın immun sitemini daha da zayıflatması sonucu ortaya çıktığı düşüncesindeyiz. Hastamızın kulak burun boğaz (KBB) uzmanınca yatış yapılarak tedavisi yapılmış ve şifa ile taburculuğu sağlanmıştır.

Anahtar kelimeler: Perikondrit, Covid 19, Allerji, Diyabetes mellitus.