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Öğe 74 Year-old-man with pneumopericardium due to blunt chest trauma: Case report(Dicle Üniversitesi Tıp Fakültesi, 2008) Orak, Murat; Üstündağ, Mehmet; Onat, Serdar; Doğan, Halil; Avcı, AlperPneumopericardium is the presence of air in the pericardial space. It may be seen in the context with severe blunt chest trauma. Usually, pneumopericardium is self-limiting and requiring no specific therapy. However, a continuous monitoring of the electrocardiography and the blood pressure is necessary at an intermediate care unit. We report a 74 year-old-man had been presented with Pneumopericardium, after a car striking. He had bilateral pneumohematothoraces, pneumomediastinum and bilateral multiple rib fractures. Pneumopericardium was diasappeared without surgical management like written in english literature. Frequent cardiac and vital signs monitoring and general support treatment were successful in our treatment.Öğe Abdominal Aortic Aneurysm(Elsevier Science Bv, 2008) Ustundag, Mehmet; Orak, Murat; Sayhan, Mustafa Burak[Abstract Not Available]Öğe Acil servise başvuran asi olgularında mortalite üzerine etkili faktörler(2007) Güloğlu, Cahfer; Üstündağ, Mehmet; Orak, Murat; Sayhan, Mustafa Burak; Taş, MahmutGiriş: Bu çalışmada, hastanemiz acil servisine "ası nedeniyle" başvuran hastalarda mortalite üzerine etkili faktörlerin araştırılması amaçlandı. Gereç ve Yöntem: Acil servisimize Mart 2004 ile Ocak 2007 tarihleri arasında "ası" nedeniyle başvuruda bulu¬nan hastalar bilgisayar kayıtlarından tespit edilmiş ve bu hastaların dosyaları arşivimizden bulunarak geriye dönük olarak incelenmiştir. Dosyalardan olguların yaşı, cinsiyeti, medeni durumu, mesleği, olay yeri, başvuru zamanı, oluş nedeni (özkıyım ya da başkası tarafından), vital bulguları, telem izi varlığı, Glaskow Koma Skoru (GKS), Elektrokardiyografi, bilgisayarlı beyin ve boyun tomografisi bulguları, arter kan gazı (AKG), tam kan ve biyokimya değerleri ile ilgili veriler çalışma formlarına aktarılmış ve daha sonra da istatiksel olarak analiz edilmiştir/ Bulgular: Çalışmaya alınan 28 hastanın %50'si (n=14) erkek, %50'si (n=14) kadındı. Ası nedeniyle başvuran 28 has¬tanın 11'i (%39.2) hayatını kaybetti. Mortalite gelişimi ile hastanın yaşı ve cinsiyeti arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p>0.05). Geliş anındaki GKS puanının 8 ve altında olması (p=0.000), AKG tetkiklerinde asidoz varlığı (p=0.041), serum laktik asit düzeyinin 4 katından fazla artmış olması (p=0.000), hyoid kemik ve servikal ver¬tebra fraktürünün varlığı (p=0.016), serebral ödemin olması (p=0.018) mortaliteyi artıran faktörler olarak bulundu. Ters olarak başvuru anında normal sinüs ritmi olan hastalarda mortalite oranı düşük bulundu (p=0.002). Sonuç: Acil servise "ası nedeniyle" başvuran hastalardan GKS puanı 8 ve altında olanlar, ilk başvuruda asidozu ve normalin 4 katından fazla artmış laktik asit düzeyi olanlar, hyoid kemik ve servikal vertebra fraktürü olanlar, serebral ödemi olanlar kötü prognoz ve yüksek mortalite oranına sahiptir. Ters olarak başvuru anında normal sinüs ritmi bulu¬nan hastaların prognozu iyi ve mortalite oranları düşüktür.Öğe Acil Servise Başvuran İnme Olgularında Laktat ve Laktat KlirensininMortalite Üzerine Etkileri(2021) Orak, Murat; Üstündağ, Mehmet; Güloğlu, Cahfer; Yaman, Mahmut; Aluçlu, Mehmet Ufuk; İpek, MustafaAmaç: İskemik ve hemorajik serebrovasküler hastalıklar, önemli bir morbidite ve mortalite nedenidir. Laktat klirensinin kritik hasta grubunda tüm mortaliteler ile ilişkili olduğu gösterilmiş. Biz bu çalışmada kritik hasta grubu içinde olabilecekinme ön tanılı hastalarda laktat ve laktat klirensinin prognozu tayin etmede yerini araştırmayı amaçladık.Yöntemler: 01.01.2018-31.12.2018 tarihleri arasında Dicle Üniversitesi acil servisine inme ön tanısıyla başvuran yaklaşık 300 hasta retrospektif olarak incelendi. Çalışma kriterlerine uyan 50 hastanın geliş anı laktat değeri, 24. saat laktat değeri ve 24. saat laktat klirensi değerlerine bakıldı. Çıkan sonuçların mortalite üzerine etkileri incelendi.Bulgular: Çalışmaya 50 hasta dahil edildi. Bu hastaların 23’ü erkek, 27’si kadındı. Hastaların yaş ortalaması 64,18±17.80 yıl olarak hesaplandı. Ölen hastaların 6’sı erkek, 13’ü kadın olup yaş ortalaması 66.11±19.95 yıl idi. Sağ kalan ve ölen hastalarımızın laktat düzeyleri ve laktat klirenslerine göre değerlendirildiğinde ölen hastalarımızda 24’üncü saatteki laktat düzeyi anlamlı derecede yüksektirSonuç: İnme ön tanısıyla acile başvuran hastalarda laktat klirensinin prognoz tayini açısından iyi bir marker olamayacağı, 24. Saat laktat değerinin daha anlamlı olduğu ortaya çıktı.Öğe Acil servise başvuran özkıyım olgularının kullandığı yöntemler ve demografik verilerinin mortalite ile ilişkisi(2009) Güloğlu, Cahfer; Üstündağ, Mehmet; Orak, Murat; Gökhan, ŞervanAmaç: Bu çalışmanın amacı, özkıyım davranışı nedeniyle başvuran hastaların demografik özellikleri ile özkıyım yöntemleri ve mortalite arasındaki ilişkiyi incelemektir. Gereç ve Yöntem: 01.01.2003 ile 31.12.2007 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’na özkıyım davranışı nedeniyle başvuran hastaların dosyaları geriye dönük olarak incelendi. Hastaların yaş, cinsiyet, sosyodemografik özellikleri, özkıyım yöntemleri, oluş saati ve başvuru süreleri ile mortalite oranları kaydedildi. Bulgular: Çalışmaya 1281 hasta dâhil edildi. Çalışma hastalarının 901’i (%70.4) kadın, 380’i (%29.6) erkek olup yaş ortalamaları 23.36±7.53 idi. Özkıyım yöntemi olarak 855 hastada (%66.7) ilaç alımı, 337 hastada (%26.3) insektisid alımı, 33’ünde (%2.6) kendini asma, 19’unda (%1.5) ateşli silah, 13’ünde (%1) yüksekten atlama ve 24 hastada (%1.9) ise koroziv madde alımı saptandı. Hastaların 946’sı (%73.9) kent merkezlerinden, 335’i (% 26.1) ise kırsal kesimden gelmişti. Hastaların 577’si (%45) evli, 704’ü (%55) ise bekârdı. Hastaların 293’ü (%22.9) çalışıyorken, 988’nin (%77.1) çalışmadığı saptandı. Mortalite 74 olgu ile %5.78 olarak saptandı. Kadın cinsiyette, insektisit alımı, ası, ateşli silahla yaralanma ve yüksekten atlama yoluyla özkıyım yöntemini kullananlarda ve kırsal kesimden gelen hastalarda mortalite oranı istatistiksel olarak anlamlı derecede daha yüksekti. Sonuç: Özkıyım, hasta ile birlikte yakın çevresi ve toplumu da yakından ilgilendiren önemli bir halk sağlığı sorunudur. Mortalitenin önlenebilmesi için hastaların sosyodemografik özellikleri göz önünde bulundurularak multidisipliner bir şekilde yaklaşım gösterilmelidir.Öğe Acil serviste olanzapin zehirlenmelerinin klinik özellikleri: Üç yıllık tecrübemiz(2010) Güloğlu, Cahfer; Doğan, Halil; Altuncı, Yusuf Ali; Tamam, Yusuf; Orak, Murat; Üstündağ, MehmetAmaç: Dünyada yaygın olarak kullanılmaya başlanmasından beri olanzapin zehirlenmesinin klinik özellikleri acil servis için önemli olmaya başlamıştır. Çalışmamızda olanzapin zehirlenmesi olan hastaları geriye dönük olarak araştırmayı amaçladık. Yöntem: Şubat 2004-Nisan 2007 tarihleri arasında acil servisimize olanzapin zehirlenmesi nedeniyle başvuran hastaların kayıtları arşivimizden geriye dönük olarak tarandı. Zehirlenmenin ciddiyetini belirle-mede Avrupa PSS skoru (The Poisoning Severity Score of the European Association of Poison Centers and Clini-cal Toxicologists: EAPCCT) kullanıldı. Bulgular: Çalışmamız olanzapin zehirlenmesi olan 15 hastayı içermekte-dir. Kadın/erkek oranı ikidir. Ortalama yaş 27.33±9.27 yıl (aralık: 17-48) ve hastaneye başvuru ile zehirlenme arasında geçen süre ortalama 3.96±2.38 saat (aralık: 1.5-10) idi. Alınan olanzapin miktarı 50-600 mg arasında değişmekteydi. Tek başına olanzapin alan dokuz hastanın dördünde (%44.4) PSS puanı düşük, dördünde (%44.4) orta ve birinde (11.2) yüksek bulundu. PSS puanı düşük olan grupta ortalama alınan olanzapin dozu 50-75 mg arasında değişirken, PSS puanı orta olan grupta alınan en düşük doz 140 mg idi. Sonuçta 13 hasta şifa ile taburcu edildi ve iki hasta öldü. Sonuç: Çalışmamızdaki bulgular göstermiştir ki, akut olanzapin zehirlenmesi görece iyi tolere edilmesine karşın, özellikle diğer ilaçlarla birlikte ve yüksek doz alımlarında yaşamı tehdit edebil-mektedir. Doz ile klinik özellikler ve prognoz arasında ilişki vardır.Öğe Analysis of amitriptyline overdose in emergency medicine(B M J Publishing Group, 2011) Guloglu, Cahfer; Orak, Murat; Ustundag, Mehmet; Altunci, Yusuf AliIntroduction Amitriptyline is a tricyclic antidepressant. In general, toxicity effects develop within 30 min of overdose and peak from 2 h to 6 h. Anticholinergic effects predominate in cases of low dose ingestion. In cases of high dose ingestion, marked depression of the central nervous system is coupled with cardiotoxicity, seizures and hypotension. Patients and methods Amitriptyline-intoxicated patients admitted to the emergency department (ED) of Dicle University Hospital were evaluated between January 2005 and April 2007. Social and demographic status, clinical and laboratory findings, treatments and outcomes were recorded. Age, sex, marital status, time of hospital admission, consciousness levels, ECG findings, requirement for respiratory support, follow-up periods and antidepressant overdose risk assessment (ADORA) criteria were analysed using SPSS software. Results A total of 110 cases of overdose by amitriptyline was evaluated. Suicide attempts by amitriptyline overdose in adult single women were the commonest finding. The commonest symptoms seen during initial examinations were sinus tachycardia (66.3%), altered mental state (78.1%) and hypotension (7.3%). Mechanical ventilatory support was required in 9.1% of cases. Most patients (n = 76, 69.1%) were treated in the ED (p = 0.001). 60 (54.5%) patients were discharged from the ED within 24 h after admission (p < 0.0001). Conclusion Most of the patients were young single women. Altered mental state and tachycardia were the commonest symptoms. The initial symptoms of amytriptyline overdose patients may be life threatening, but effective supportive treatments were helpful. There was high correlation between ADORA criteria and the dose ingested.Öğe The Analysis of Generalized Tonic Clonic Seizures Associated Injuries in Emergency Department(Elsevier Science Bv, 2010) Altunci, Yusuf Ali; Gokhan, Servan; Ustundag, Mehmet; Orak, Murat; Ozhasenekler, Ayhan; Guloglu, CahferObjectives: Persons with epilepsy are believed to be at greater risk of incurring accidental injury than those without seizures. During generalized seizures the individual is unable to utilize protective reflexes during falls and may consequently suffer head, orthopedic, or soft tissue injury. Our aim is to evaluate the spectrum of trauma in epilepsy patients presenting to our emergency department as a result of generalized tonic-clonic seizure (GTCS). Methods: We retrospectively reviewed patient records collected between January 2004 and December 2007 at the Emergency Department of Dicle University Medical School. All patients aged 15 years or more with epilepsy and trauma due to generalized tonic clonic seizures were included in the study. Records were analyzed for age, gender, type of injury, sufficiency of anti-epileptic medication, and mortality. Results: The average age of the 51 patients included in the study was 26.02 +/- 9.86 years, range 15-52 years. Thirty-three patients (64.7%) were male; the male female ratio was 1.83. Soft tissue injuries were the most common injury (26 instances). Head trauma, cuts, dental and tongue injuries were less common. Blood levels of anti-epileptic medication were in the therapeutic range in 9 (17.6%) patients, while 42 (82.4%) had sub therapeutic levels for effective treatment. Four (7.8%) of the patients died. The trauma in 2 mortalities involved burns; remaining deaths were associated with submersion injury and fall (subarachnoidal hemorrhage). Conclusions: There was no significant association between sub therapeutic levels of anti-epileptic medication and mortality.Öğe The analysis of generalized tonic clonic seizures associated ınjuries in emergency department(2010) Güloğlu, Cahfer; Üstündağ, Mehmet; Özhasaneker, Ayhan; Gökhan, Şervan; Altuncı, Yusuf Ali; Orak, MuratAmaç: Epilepsi hastalarının hasta olmayanlara göre, gelişebilecek kazalara karşı daha yüksek riske sahip olduğuna inanılır. Jeneralize nöbet boyunca hastalar, düşme sonucunda oluşabilecek, kafa travması, ortopedik ya da yumuşak doku yaralanmasından kendilerini koruyacak reflekslerden yoksundurlar. Amacımız, jeneralize tonik klonik nöbet sonrası travma nedeniyle acil servisimize başvuran hastaların travma spektrumunu değerlendirmektir. Gereç ve Yöntem: Dicle Üniversitesi Acil Servisine Ocak 2004 ile Aralık 2007 arasında, jeneralize tonik klonik nöbet sonrası travma nedeni ile başvuran 15 yaş üstü epilepsi hastalarını ICD tanı kodlarını kullanarak geriye dönük tespit ettik. Kayıtlar hastaların yaşı, cinsiyeti, yaralanma tipi, antiepileptik tedavinin yeterliliği ve mortalite açısından analiz edildi. Bulgular: Çalışmaya alınan 51 hastanın yaş ortalaması 26.02±9.86 (15-52) idi. Otuz üç (%64.7) hasta erkek ve erkek kadın oranı 1.83 idi. En sık yaralanma tipinin yumuşak doku travması olduğu görüldü (26 olgu). Kafa travması, kesiler, diş ve dil yaralanmasının daha az sıklıkta olduğu belirlendi. Antiepileptik tedavinin kan düzeyleri 9 (%17.6) hastada yeterli seviyede iken, 42 (%82.4) hasta terapötik seviyenin altında düzeye sahipti. Hastaların 4’ü (%7.8) hayatını kaybetti. İki hasta yanık, diğerleri ise suda boğulma ve düşme snucu gelişen subaraknoid kanama nedeniyle kaybedildi. Sonuç: Hastaların antiepileptik ilaç düzeylerinin terapötik seviyenin altında olması ile mortalite arasında ilişki yoktur.Öğe Atypical Presentation of A Foreign Body: Case Report(Galenos Publ House, 2011) Sayhan, Mustafa Burak; Kavalci, Cemil; Orak, MuratForeign bodies are seen in all age groups. Foreign bodies are detected as a result of accidents or abuse. Diabetic neuropathy frequently occur as complications of diabetes. Our patient was a 55 year old female patient admitted to our emergency department with the complaint of insect bites. Atwo mm diameter redness was present on the right hip and a 15 cm needle was observed on the pelvis X-ray. The needle was removed surgically. Careful history and physical examination should be carried out especially in diabetic patients.Öğe A Bomb explosion in Diyarbakir: Clinical findings and management of emergency department(Dicle Üniversitesi Tıp Fakültesi, 2016) İçer, Mustafa; Zengin, Yılmaz; Durgun, Hasan Mansur; Dursun, Recep; Arı, Baran; Ekinci, Mustafa; Üstündağ, Mehmet; Orak, Murat; Güloğlu, CahferObjectives: In this study, we present management of emergency department, patients’ clinical findings and mortality analysis after a bomb explosion. Methods: Patients brought to Diyarbakır Dicle University Hospital emergency department after the explosion at 5 June 2015 were retrospectively examined. Patients’ age, gender, triage, system injuries, hypotension, blood transfusion, admission to the ICU, Intensive care unit surgical treatment, amputation and trauma scores (Glasgow Coma Score (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Score-Injury Severity Score (TRISS), Shock index) were studied. Factors affecting emergency department management and mortality were analyzed. Results: The mean age was found as 29.64±12.88 years in survivors and 36±19.98 years in deaths. GCS, ISS and shock index were found as the factors affecting mortality (p≤0.05). Wounded taken to the resuscitation room, hypotension, blood transfusion, intubation, treatment in ICU and amputation were correlated with mortality (p<0.05). Conclusion: A fast and effective triage system must be applied in EDs following a bomb explosion. The explosion of a bomb on the open areas are the most common injury to the lower extremity injury. Mortality is most often associated with lower limb amputations.Öğe Characteristics of Suicides Cases in Batman, South East of Turkey(Ortadogu Ad Pres & Publ Co, 2010) Al, Behcet; Orak, Murat; Ustundag, Mehmet; Sogut, OzgurObjective: The objective in this prospective study is to evaluate the frequency, mortality and demographic properties of suicides in our province (Batman City, Turkey). Material and Methods: All cases of suicides who admitted to the emergency department of the Batman State Hospital between April 2005 and November 2007 were included in the study. Patients' gender, age, history, educational and martial status, time and method preferred for suicide, suicide causes and mortality rate were reported. The results were discussed with similar studies in literature. Results: There were 328 (0.2%) suicide cases among 146.000 patients who admitted to our emergency department. Of the suicide cases, 75.9% were females and 24.1% were males. The mean age of cases was 23.5 +/- 7.4 years. The suicide made a peak between the ages of 15 and 24. The majority of cases attempted suicide by taking drugs orally (93.0%). Antidepressants were the most common agents (74.4%) among the drugs incriminated in suicide. The majority of cases attempted suicide due to family problems (39.2%). Nineteen patients were taken to intensive care unit (ICU). Organophosphates and hanging for suicide attempts were the main cause of suicide in the patients who admitted to ICU. The majority of deaths occurred clue to hanging (91.7%). The mortality rate for all patients was 3.7%. Conclusion: In our study the the most common method for suicide attempt was drugs. Martality was most frequent with hanging. Females attempted suicide more frequently. The suicide made a peak between the ages of 15 and 24. The majority of cases attempted suicide due to family problemsÖğe The clinical features of olanzapine overdose in emergency department; a three years experience(Cumhuriyet Univ Tip Fak Psikiyatri Anabilim Dali, 2010) Uestuendag, Mehmet; Gueloglu, Cahfer; Orak, Murat; Altunci, Yusuf Ali; Dogan, Halil; Tamam, YusufObjective: Since using of olanzapine becomes widespread in the world, clinical features of olanzapine intoxication become important for emergency departments. In our study, we evaluated the patients with Olanzapine intoxication retrospectively. Methods: Olanzapine overdose patients who were admitted to an emergency department between February 2004 and April 2007 were included in the study. The Poisoning Severity Score of the European Association of Poison Centers and Clinical Toxicologists was used to assess intoxication severity. Results: In our study we include fifteen olanzapine overdose patients. Female and male ratio was two (10/5). The average age was 27.33 +/- 9.27 years (range: 17-48 years). The ingested olanzapine doses ranged from 50 to 600 mg whereas the mean of admission time was 3.96 +/- 2.38 (range: 1.5-10) hours after ingestion. For a subgroup of patients ingesting olanzapine alone, The Poisoning Severity Score was 'minor' in four (44.4%), 'moderate' in four (44.4%), and 'severe' in one (11.2%) patients. While minor intoxication symptoms occurred in a broad range of ingested doses (50-75 mg), moderate intoxications were observed at a minimal ingested reported dose of 140 mg. Finally 13 patients were discharged after full recovery and two patients died. Conclusion: Our findings showed that olanzapine overdose is relatively well tolerated especially when it is not accompanied by any co-ingestant. However, it can be life threaten when it is high doses are ingested or in association with other ingestants. There is correlation between dose and clinical features or prognosis. (Anatolian Journal of Psychiatry 2010; 11:145-150)Öğe Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma(2010) Orak, Murat; Güloğlu, Cahfer; Üstündağ, Mehmet; Erdoğan, Mehmet Özgür; Al, Behçet; Gökdemir, Mehmet TahirAMAÇ Bu çalışmada, pediyatrik künt batın travmalı hastalarda organ hasarının bir göstergesi olarak ultrasonografiyle saptanan pelvik sıvı varlığının önemi değerlendirildi. GEREÇ VE YÖNTEM Ocak 2008 ve Aralık 2008 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine künt karın travması ile başvuran ardışık 85 pediyatrik hastanın kayıtları geriye doğru değerlendirildi. Hasta yaşı, cinsiyeti, yaralanma mekanizması, izole yaralanmalar, cerrahi girişimler, hastaneye yatış ve mortalite mayi yerleşimine göre değerlendirildi. BULGULAR Künt karın travması olan toplam 85 pediyatrik hasta (63 erkek, 22 kız; ortalama yaş 7,88±3,403 yıl) bu çalışmaya dahil edildi. Hastaların %40?ında intraperitoneal sıvı, %60?ında pelvik sıvı vardı. Hastaların çoğu (%35,3) yüksekten düşme nedeni ile başvurmuşlardı. Yaralanma mekanizması ile sıvı varlığı ve sıvı yerleşimi arasındaki fark istatistiksel olarak anlamlı değil idi (p>0,05). Yirmi dokuz hastada solid organ yaralanması vardı. İntraperitoneal sıvıyi en çok arttıran dalak yaralanması idi (p<0,001). Hastaların %15,3?üne laparotomi yapıldı (bunların tümünde intraperitoneal sıvı vardı) %44,7 hasta kan transfüzyonuna ihtiyaç duydu. İntraperitonal sıvı varlığı laparotomi olasılığını ve kan transfüzyon ihtiyacını istatistiksel olarak artırmıştı (p<0,001). Mortalite oranı %4,8 idi. SONUÇ Ultrasonografi incelemesinde pelvik sıvı varlığında solid organ yaralanma olasılığı daha düşük iken, pelvis dışı intraperitoneal sıvı varlığında solid organ yaralanma olasılığı daha yüksektir.Öğe Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma(Turkish Assoc Trauma Emergency Surgery, 2010) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Gokdemir, Mehmet Tahir; Erdogan, Mehmet Oezguer; Al, BehcetBACKGROUND The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma. METHODS We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid. RESULTS A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88 +/- 3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%. CONCLUSION In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.Öğe Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome(AVES Yayıncılık, 2011) Üstündağ, Mehmet; Orak, Murat; Güloğlu, Cahfer; Sayhan, Mustafa Burak; Alyan, Ömer; Kale, EbruObjective: We measured the levels of neutrophil activating peptide-2 (NAP-2) and pentraxin-3 (PTX-3) in acute coronary syndromes (ACS) patients and compared their diagnostic accuracy with cardiac troponin I (cTnI). Methods: We conducted a prospective cohort study to determine the diagnostic accuracy of PTX-3, NAP-2 and cTnI for the prediction of ACS. Consecutively eighty-three patients with sudden chest pain admitted to Dicle University Emergency Department within the first six hours of symptom onset were included in our study. Mean serum levels of PTX-3, NAP-2 and cTnI were compared between control and patient groups and ACS subgroups. Their sensitivities and specificities in early diagnosis of ACS were identified. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic validity of the markers, and areas under the ROC curve (AUC) were compared. Results: In the patient group, mean serum concentrations of NAP-2 (53.03+22.77 ng/ml) and PTX-3 (1.73+0.82 ng/ml) were considerably higher than those of the control group (24.54+9.50 and 0.50+0.39 ng/ml, respectively) (p<0.01). When compared with the control group, PTX-3 levels of all three ACS subtypes (unstable angina pectoris (USAP) - 1.62+0.41 ng/ml, non-ST elevation myocardial infarction (NSTEMI) -1.63+0.31 ng/ml and ST-elevation myocardial infarction (STEMI) - 1.75+0.89 ng/ml) were higher, whereas NAP-2 levels were higher in USAP (56.29+22.60 ng/ml) and STEMI (52.05+20.99 ng/ml) patients (p<0.01). For diagnosing ACS within the first six hours of presentation, PTX-3 sensitivity was 98.5% and specificity was 92.3%, and NAP-2 sensitivity - 98.1% and specificity - 41.3%. The ROC curve AUC values were: 0.962 for PTX-3 (95% CI 0.802 - 1.073), 0.840 for NAP-2 (95% CI 0.684 - 0.991), and 0.683 for cTnI (95% CI 0.610 - 0.940). Conclusion: Pentraxin-3 is a sensitive and specific marker for ACS diagnosis when compared with cardiac markers in patients admitted to the emergency department (ED) within the first six hours of onset of chest pain.Öğe Continuous infusion of small-volume fluid resuscitation in the treatment of combined uncontrolled hemorrhagic shock and Head Injury(Coll Physicians & Surgeons Pakistan, 2007) Ozturk, Hayrettin; Yagmur, Yusuf; Tas, Askin; Topcu, Soykan; Orak, MuratObjective: To determine-the effect of continuous limited fluid resuscitation on the hemodynamic response and survival in rats in a model of uncontrolled hemorrhage shock due to Massive Splenic Injury (MSI) and Head Injury (HI). Design: An experimental study. Place and Duration of Study: Dicle University Animal Research Laboratory, Turkey, between January and February 2005. Subjects and Methods: Seventy Sprague-Dawley rats were used in this study. Group 1 rats (n=10) was sham-operated. In group 2 (n=10), only Massive Splenic Injury (MSI) was performed and untreated. In group 3 (n=10), only head injury (HI) was performed and untreated. In group 4 (n=10), HI and MSI were performed and were untreated. In group 5 (n=10), HI and MSI were performed and 15 minutes later treated with 7.5% NaCl. In group 6 (n=10), HI and MSI were performed, and rats were treated with Ringer's Lactate (RL) solution. In group 7 (n=10), HI and MSI were performed, rats were treated with 0.9% NaCl. In groups 2,4,5,6 and 7 midline incision was reopened and splenectomy was performed at 45 minutes. Results: In group 4 rats, Mean Arterial Pressure (MAP) was decreased from 104 +/- 6.1 mmHg to 75 +/- 19.5 mmHg at 15 minutes; heart rate decreased from 357 +/- 24.9 beats/min to 321 +/- 62.1 beats/min and hematocrit decreased from 46 +/- 1.3% to 43 +/- 2.5% (p<0.01). Similar early changes in MAP, heart rate and hematocrit were observed in groups 5, 6, and 7, at 15 minutes. At 45,60 and 120 minutes, in fluid resuscitated rats (group 5,6,7) MAP, heart rate and hematocrit values were measured higher than group 2 and 4 (p<0.01 for all). At 120 min. in group 6, hematocrit was higher than group 4, 5 and 7, in group 6, total blood loss after splenectomy was calculated at 20 +/- 2.4% of blood volume and was the best value compared to other fluid resuscitated group 5 and 7 (28% and 27% of blood volume) (p<0.01). Mortality was lower in all fluid resuscitated groups when compared to group 3 and 4 (p<0.05). The median survival time was again higher in fluid resuscitated groups. Conclusion: Continuous infusion of 7.5% NaCl, RL and 0.9% NaCl following uncontrolled hemorrhagic shock with massive splenic injury and combined head injury resulted in better survival and RL did not increase abdominal bleeding before splenectomy was performed.Öğe Demographic Analysis of Complications of Warfarin Treatment and Factors Affecting Mortality(Aves, 2013) Orak, Murat; Dursun, Recep; Ustundag, Mehmet; Ozhasenekler, Ayhan; Durgun, Hasan Mansur; Guloglu, CahferObjective: This study investigated the demographic analysis of complications of warfarin therapy and the factors affecting mortality. Material and Methods: The digital medical records of patients who applied to our Emergency Clinic with warfarin overdose between September 2007 and September 2010 were retrieved and patient files were assessed retrospectively. Cases were classified into two groups in terms of INR level and hemorrhagic complications; patients with an INR level greater than 3.5 and a hemorrhagic complication, and patients with an INR level greater than 3.5 and no hemorrhagic complication. Furthermore, cases with a hemorrhagic complication were divided into two subgroups as those who died and those who survived. Results: The study enrolled 151 cases presenting to our emergency clinic with warfarin overdose. Among these, 50.3% (n = 76) were males and 49.7% (n = 75) were females. Mean age was 60.80 +/- 16.11 years. There was no significant difference between the groups in terms of sex and age. Hemorrhagic complication was present in 66.89% (n = 101) while absent in 33.11% (n = 50). PT and INR levels were significantly higher in patients with hemorrhage compared to those without (for PT 90.98 +/- 26.52 vs. 55.51 +/- 12.70, respectively; p < 0.001; for INR 8.97 +/- 11.29 vs. 4.63 +/- 0.68, respectively; p = 0.042). In patients with a hemorrhagic complication who died, the PT level was significantly higher, and hematocrit and platelet levels were significantly lower than those of patients who survived a hemorrhagic complication (p < 0.001, p = 0.033, and p = 0.009, respectively). Conclusion: Education in warfarin use, regular follow-ups, self-monitorization, and increased distribution of home-type coagulometry devices will decrease the frequency of complications.Öğe Demographic Properties of Civilians with Blast Injuries in Southeastern Anatolia Region(2015) Akdağ, Mehmet; Kaçmaz, Ömer; Dursun, Recep; Üstündağ, Mehmet; Durgun, Hasan Mansur; Gulloglu, Cahfer; Orak, MuratObjectivesThe present study conducted demographic analysis of blast injuries, with the authors aiming to guide the determination of groups and regions at risk, helping hospitals take preventive measures and providing information for accurate triage, rapid intervention, multidisciplinary approach, and lowering workforce losses.MethodsThis study retrospectively examined the demographic properties of civilians who presented to the Emergency Department of Dicle University after being injured in explosions of various origins between January 2005 and September 2013 in the Southeastern Anatolia Region of Turkey.ResultsOf the study population, 85.50% were male and 14.50% were female. The explosive responsible for injury was a mine in 20.51% of the cases, a bomb in 29.06%, a squib in 14.53%, dynamite in 7.69%, and some other explosive in the remaining 28.31%. Of those injured, 35.90% were students, 21.36% were farmers, 11.10% were shepherds or drivers, and 31.62% were from other occupational groups.ConclusionsIn conclusion, injuries resulting from explosions are associated with higher morbidity and mortality rates, making it necessary to increase the number of trauma centers and emergency action teams in that region, as well as demining the region and educating the native population about explosivesÖğe Demographic properties of civilians with blast injuries in Southeastern Anatolia Region(Türkiye Acil Tıp Derneği, 2015) Kaçmaz, Ömer; Dursun, Recep; Durgun, Hasan Mansur; Akdağ, Mehmet; Orak, Murat; Üstündağ, Mehmet; Güloğlu, CahferObjectives The present study conducted demographic analysis of blast injuries, with the authors aiming to guide the determination of groups and regions at risk, helping hospitals take preventive measures and providing information for accurate triage, rapid intervention, multidisciplinary approach, and lowering workforce losses. Methods This study retrospectively examined the demographic properties of civilians who presented to the Emergency Department of Dicle University after being injured in explosions of various origins between January 2005 and September 2013 in the Southeastern Anatolia Region of Turkey. Results Of the study population, 85.50% were male and 14.50% were female. The explosive responsible for injury was a mine in 20.51% of the cases, a bomb in 29.06%, a squib in 14.53%, dynamite in 7.69%, and some other explosive in the remaining 28.31%. Of those injured, 35.90% were students, 21.36% were farmers, 11.10% were shepherds or drivers, and 31.62% were from other occupational groups. Conclusions In conclusion, injuries resulting from explosions are associated with higher morbidity and mortality rates, making it necessary to increase the number of trauma centers and emergency action teams in that region, as well as demining the region and educating the native population about explosives.
