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Öğe Adult-Onset Still's Disease: Case Report(Aves, 2014) Gunduz, Ercan; Gullu, Mehmet Nezir; Zengin, Yilmaz; Dursun, Recep; Icer, Mustafa; Ozhasenekler, Ayhan; Karakoc, YenalIntroduction: Adult-onset Still's disease (ASD) is a systemic inflammatory disease of unknown etiology and pathogenesis. ASD, one of the most important causes of fever of unknown origin, is diagnosed after ruling out infection, malignancy, and rheumatologic diseases. It may also present with fever alone, without typical skin rash and articular manifestations. Case Report: There are no pathognomonic laboratory findings in ASD. In this paper, we report a case that presented to the emergency department with fever, malaise, and joint pain for 5 days and was subsequently diagnosed with ASD. Conclusion: In patients with prolonged fever combined with musculoskeletal symptoms and macular rash, the differential diagnosis should include ASD. Timely diagnosis and treatment of the disease can prevent complications and lead to a favorable prognosisÖğe 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 Atypical Presentation in Lymphoma; Cyanosis in Left Hand: Case Report(Aves, 2011) Ozhasenekler, Ayhan; Atilgan, Zuhal Ariturk; Bakir, Sule; Gokhan, Servan; Yilmaz, FevziA 17 year old female patient was admitted to the emergency service with complaints of cough, asthma, and cyanosis in the left hand. Expanding in the mediastinum, a rightward deviation of the trachea was specified in the posterior-anterior lung x-ray. In her thoracic computerised tomography, soft tissue density, rightward deviation of trachea, narrowing inwards from outside with the left major bronchus was observed and there were common lymph nodules on the upper section of the left trachea. These lymph nodes applied pressure on major vascular structures leading to the left arm. Primarily lymphoma was considered because she was a young patient. Diagnosis-based left axial and left nodule excision was carried out. Histopathologically, a non-Hodgkin lymphoma (NHL) was diagnosed. The patient was given chemotherapy. The cyanosis in the hand was healed after the mass decreased, thus decreasing pressure on vascular structures. Lymphoma, which is one of the mediastinal masses, is also considered with congenital cardiac illnesses such as pulmonary hypertension, improved Patent Ductus Arteriosis Eisenmenger Syndrome in young patients admitted to the emergency service with atypical complaints such as cyanosis in the left hand.Öğe Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department(Derman Medical Publ, 2015) Sonmez, Bedriye Muge; Yilmaz, Fevzi; Yilmaz, Muhittin Serkan; Kavalci, Cemil; Gokhan, Servan; Akbulut, Ahmet Sami; Ozhasenekler, AyhanEvaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2%) of patients were male and 28 (37.8%) were female. Mean age of the study population was 34.85 +/- 19.17 (min 7-max 80) years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%). 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose). Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.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 Easy and Rapid Diagnosis in Central Venous Catheter (CVC) Malpositions: Posterior-Anterior (PA) Lung Graphy: 3 Case Reports(Aves, 2010) Ozhasenekler, Ayhan; Gokhan, Servan; Icer, Mustafa; Orak, Murat; Ustundag, MehmetThe central venous catheter (CVC) interventions have recently become very important as a small surgery intervention. It has frequently been used in intensive care units and in emergency services for medicine and blood production infusion, central venous pressure observation, urgent dialysis access pathway, parenteral nutrition, infusion of chemothrapy drugs and in complicated cases which require long term follow-up and a wide vein passage. We aimed at stressing the importance PA lung graphy in early detection of CVC malposition, one of the complications encountered with the increase in frequency of usage.Öğe The effect of body mass index on trauma severity and prognosis in trauma patients(Turkish Assoc Trauma Emergency Surgery, 2016) Durgun, Hasan Mansur; Dursun, Recep; Zengin, Yilmaz; Ozhasenekler, Ayhan; Orak, Murat; Ustundag, Mehmet; Guloglu, CahferBACKGROUND: As in the rest of the world, the prevalence of obesity in Turkey has been increasing in recent years and has become a major public health issue. Although many trials have been conducted to study the effects of obesity on internal diseases, there are few studies investigating the effects of obesity on prognosis of trauma patients. The present study analyzed the effects of body mass index (BMI) on trauma severity and prognosis in trauma patients. METHODS: This study was prospectively conducted with trauma patients older than 15 years of age who presented at the Dicle University Faculty of Medicine emergency medicine department trauma unit between June I, 2013 and May 31, 2014. Patients were grouped into high-energy trauma and low-energy trauma groups based on trauma severity. In addition, 4 groups were made according to BMI value (kg/m(2)). Group I was defined as BMI <25 (normal weight). Group II patients had BMI of 25-29.9 (overweight). Group III had BMI of 30-34.9 (obese), and Group IV was made up of patients with BMI >= 35 (morbidly obese). RESULTS: Comparison of whole patient population for inter-group differences showed significant differences between rate of head injury, thoracic injury, extremity injury, multitrauma, clinic admission rate, and mortality rate (p<0.001). No significant difference was observed between groups in abdominal injury rate (p=0.347). CONCLUSION: Clinic admission rate, length of intensive care unit stay, mortality rate, multitrauma rate, and injury severity score increased in proportion to greater BMI.Öğe Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmaras Earthquakes(Cambridge Univ Press, 2023) Yilmaz, Sarper; Karakayali, Onur; Yilmaz, Serkan; Cetin, Murat; Eroglu, Serkan Emre; Dikme, Ozgur; Ozhasenekler, AyhanAn earthquake measuring 7.7 magnitude on the Richter scale occurred at 04:17am on February 6, 2023 in the Pazarcik district of Kahramanmaras province Turkey. In the hours following the 7.7 magnitude event in Kahramanmaras, a second 7.6 magnitude earthquake struck the region and a third 6.4 magnitude earthquake struck Gaziantep, causing extensive damage and death. A total of ten provinces directly experienced the earthquake, including Kahramanmaras, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakir, Sanliurfa, Adiyaman, and Kilis. The official figures indicate 31,643 people were killed, 80,278 were injured, and 6,444 buildings were destroyed within seven days of the earthquakes (as of 12:00pm/noon on Monday, February 13th). The area affected by the earthquake has been officially declared to be 500km in diameter. This report primarily relies on observations made by pioneer Emergency Physicians (EPs) who went to the disaster areas shortly after the first earthquake (in the early stages of the disaster). According to their observations: (1) Due to winter conditions, there were transportation problems and a shortage of personnel reaching disaster areas on the first day after the disaster; (2) On the second day of the disaster, health equipment was in short supply; (3) As of the third day, health workers were unprepared in terms of knowledge and experience for the disaster; and (4) The subsequent deployment of health personnel to the disaster area was uncoordinated and unplanned on the following days, which resulted in the health personnel working there not being able to meet even their basic needs (such as food, heating, and shelter). During the first week, coordination was most frequently reported as the most significant problem.Öğe Factors Affecting Mortality in Endosulfan Ingestion With Suicidal Intent(Aves, 2010) Orak, Murat; Ustundag, Mehmet; Ozhasenekler, Ayhan; Altunci, Yusuf Ali; Guloglu, Cahfer; Tamam, YusufObjective: Most pesticides containing Endosulfan have either been restricted or prohibited due to the fact that they remain active longer in nature, and have a long half-life and mid-level toxicity in the body. Acute or chronic exposure to Endosulfan, which may be life-threatening or at times fatal, has rarely been reported. Our aim was to analyze the aff ective factors of endosulfan toxicity on clinical fi ndings and mortality cases. Materials and Methods: In the study, all patients who called upon the emergency service due to suicidal endosulfan ingestion were retrospectively analyzed. Twenty-seven patients over the age of 15 years with defi nite proof that they used medicine containing an endosulfan substance were included into the study. Results: The average age of our patients was 26.56 +/- 13.6 years (15-68). The number of male patients was 10 (37.1%), while that of female patients was 17 (62.9%). There were 17 patients (62.9%) who presented with nausea and vomiting complaints, 12 (44.4%) patients with seizure, and 15 (55.5%) with loss of consciousness. The 5 patients who died had loss of consciousness and seizure, and required mechanical ventilation support during seizure and follow-up. In the surviving group, however, loss of consciousness was detected in 10 patients, seizure during follow-up in 5, and ventilation support was required in 5 patients. Conclusion: Loss of consciousness following suicidal endosulfan ingestion, seizure on arrival and/ or during follow-up and need for mechanical ventilation support were the factors which aff ected mortality.Öğe Hand and Wrist Injuries Caused by Glass Cuts: Accidental or Due to Sudden Anger?(Elsevier Science Bv, 2011) Gokhan, Servan; Altunci, Yusuf Ali; Orak, Murat; Ustundag, Mehmet; Sogut, Ozgur; Ozhasenekler, AyhanObjectives Traumatic hand and wrist injuries are the type of injuries commonly seen in the emergency department (ED). Hand and wrist injuries related to punching windows due to sudden discomposes are frequent in Turkey. The aim of this study was to analyze clinical and demographic specifications of hand and wrist injuries related to glass cuts and their underlying causes. Methods The patient files who presented to the Dicle University Hospital ED (Diyarbakir-Turkey) with injuries due to glass cuts have been examined. Demographic data of the patients have been recorded in the standard work form and then were analyzed. Results One hundred and fifty four patients were included in the study. 53.8% of the patients constituted those who punched on the glass during an angry episode. Punching on the glass was more frequently observed in men (n= 81, 97.6%), with cuts to the right hand being the most frequent type of resulting injury (n= 65, 78.3%). Twenty four (28.9%) of the patients with injuries related to glass punching were under the influence of alcohol during the incidents and injury rates of radial artery, ulnar nerve, median nerve and ulnar artery have been found considerably higher in this group. Conclusions A thorough artery, nerve and tendon examination of the patients presenting to the ED with hand and wrist injuries needed to be performed, and especially for those under the influence of alcohol in order to prevent functional losses of the underlying structures.Öğe Just Get Headache... Isolated Transverse Sinus Venous Thrombosis(Aves, 2013) Ozhasenekler, Ayhan; Durgun, Hasan Mansur; Kacmaz, Omer; Tunc, Ibrahim; Akil, Esref; oner, HakanCerebral venous thrombosis is a rare condition than arterial oclusive disease of brain. While sagittal and cavernous sinus thrombosis are frequently seen, transverse sinus thrombosis is rare. Clinically, headache is the most common and the initial symptom. The first diagnostic tool of cerebral venous thrombosis is non-contrast brain tomography. Non-contrast brain tomography, one of the imaging methods commonly used in patients with a headache in the emergency room, should be evaluated well.Öğe Lethal toxicity of propafenone in a case of suicidal attempt(Elsevier Science Bv, 2007) Ustundag, Mehmet; Orak, Murat; Guloglu, Cahfer; Ozhasenekler, Ayhan; Durgun, Hasan MansurPropafenone is a well-established IC class antiarrhythmic drug widely used in the treatment of a variety of supraventricular and ventricular tachyarrhythmias. Propafenone has been widely used in clinical practice in recent years. As a class IC antiarrhythmic agent it may show a significant proarrhythmogenic effect even at therapeutic doses. Toxic effects of high doses including fatal outcome have been sporadically described in the literature. Fatal course is usually associated with cardiac conduction abnormalities with progression to asystole or electromechanical dissociation. Since a specific treatment is not available and resuscitation techniques may be of limited value, early diagnosis and primary detoxication are essential. In this study, we present one case of suicidal attempt acute toxicity 7500 mg of propafenone that proceeded mortal and review the literature on this subject.Öğe Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases(Springer London Ltd, 2010) Gokhan, Servan; Kose, Ozkan; Ozhasenekler, Ayhan; Orak, Murat; Ustundag, Mehmet; Guloglu, CahferBackground Femoral artery pseudoaneurysm following cardiac catheterization is a serious groin complication requiring careful assessment and prompt intervention. Aims The risk of femoral artery pseudoaneurysm is estimated at 0.6 to 17% following diagnostic and interventional procedures. Methods The clinical use of bedside ultrasonography as part of the physical examination by attending emergency physicians has increased significantly over recent years. Results Bedside emergency department ultrasonography provides the clinician with critical information noninvasively, rapidly determining various anatomical structures. Conclusions We present the case of a patient with femoral artery pseudoaneurysm detected by bedside emergency department ultrasonography secondary to angiographic catheterization.Öğe Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases(Springer London Ltd, 2011) Gokhan, Servan; Kose, Ozkan; Ozhasenekler, Ayhan; Orak, Murat; Ustundag, Mehmet; Guloglu, CahferObjectives: To quantify injuries in children that result from toppled televisions. Methods: Children presenting directly to emergency department due to injuries caused by falling televisions were identified from our digital patient database, and a retrospective chart review of 71 children was performed. Descriptive statistics were applied. Results: 71(1.8%) out of 3856 admissions due to injuries sustained at home were TV-related injuries. There were 50 (70.4%) boys and 21(29.6%) girls. Mean age was 39.79 +/- 20.14 SD months. Almost three quarters of the children (49/71) sustained various head and facial injuries. There was traumatic brain injury in 14 patients, extremity injuries in 30 patients, thoracic injuries in 13 patients and abdominal injuries in ten patients. 16 patients were hospitalized. 14 of them required follow-up in intensive care unit. Two patients (one with epidural hematoma and one with subdural hematoma) underwent surgical intervention. Four patients with subarachnoid bleeding died. The mean length of hospital stay was 71.25 hours (range, 48-168) in hospitalised patients. The overall mortality rate was 5.6%. Conclusions: Falling TVs may cause significant morbidity and mortality in children particularly those younger than 3 years old. Head and facial injuries are the most common body region involved and traumatic brain injury is the major cause of death.Öğe Neuroleptic Malignant Syndrome Associated with Quetiapine Treatment in a Patient with Ventriculoperitoneal Shunt(Aves, 2014) Zengin, Yilmaz; Icer, Mustafa; Gunduz, Ercan; Ozhasenekler, Ayhan; Dursun, Recep; Orak, Murat; Guloglu, CahferIntroduction: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening idiosyncratic reaction during the use of antipsychotic drugs, usually beginning in the first 2 weeks of the treatment. NMS is generally manifested by muscle rigidity, hyperthermia, autonomic instability, altered mental status, tremors, elevated serum creatinine phosphokinase, and leukocytosis. Case Report: A 26-year-old male patient who had a ventriculoperitoneal (V-P) shunt was admitted to the emergency department with complaints of loss of consciousness, fever, respiratory distress, and palpitations. In his history, we learned that treatment of quetiapine 25 mg/day was initiated 6 months ago. After physical examination and laboratory results, the patient, who had a V-P shunt, was primarily considered shunt dysfunction or infection. But, with laboratory parameters and radiographic examinations, we moved away from this diagnosis. He was evaluated as NMS due to the history of antipsychotic drug using, fever, rigidity, tachycardia, tachypnea, confusion, and increase of creatine phosphokinase for the preliminary diagnosis. Since there was no any etiological factor that could explain the clinical process, he was admitted to the medical intensive care with a diagnosis of NMS. Conclusion: NMS is a disorder that can be life-threatening and must be recognized by clinicians.Öğe Pneumomediastinum and Pneumothorax After Blunt Neck Trauma(Emergency Medicine Physicians Assoc Turkey, 2010) Ozhasenekler, Ayhan; Gokhan, Servan; Yilmaz, Fevzi; Tas, Mahmut; Tan, Omer; Nasir, AhmetPneumomediastinum is air presence in mediastinum. It is spontaneously and traumatically divided into two. While spontaneous pneumomediastinum is generally found in healthy young men, traumatic pneumomediastinum may develop due to skull, neck, chest traumas and intraoral injuries. Pneumomediastinum is a clinical state with high morbidity and mortality due to complications it causes. It should be considered that it can improve and also accompanied by pneumothorax even without trachea and esophagus injury after blunt neck, face and eye traumas.Öğe A Rare Cause of Neck Abcess; Scrofuloderma(Aves, 2013) Ozhasenekler, Ayhan; Durgun, Hasan Mansur; Kacmaz, Omer; Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer[Abstract Not Available]Öğe Retrospective evaluation of eye injury victims presented to emergency department(Elsevier Science Bv, 2007) Ustundag, Mehmet; Orak, Murat; Guloglu, Cahfer; Sayhan, Mustafa Burak; Ozhasenekler, AyhanObjectives: In this study we purpose that to research demographic characteristics and trauma origins of emergency department patients with eye injury. Materials and Methods: We scanned emergency patients with eye injury data, retrospectively between June 2005 and February 2007. We confirm patients' age, sex (gender), injury localizations and time, objects which cause injury, affected eye and tissues, examination findings, treatment, hospitalization period and conclusions with a form than statistical analyses have been done. Results: We accepted 180 patients with eye injury between June 2005 and February 2007. In this study 126 (70%) patients were males and 54 (30%) were females. Age average was 19.29 +/- 17.44 (2-79). The number of patients under age of 15 was 101 (56.1%). Eye injury events happened in house rate was 39.4% (n=71), in business office 26.1% (n=47) and other places (school, park, street) 34.5% (n=62). Affected eyes ratios were 46.1% right eye (n=83), 46.1% left eye (n=83), 7.8% both of two eyes (n=14). Explosive material (sparkler, cracker) and toy guns (shoot plastic bead) were injury reasons for 35 (19.4%) patients. For the diagnosis of injuries, conjunctivae hyperemia was the most common with the ratio of 44.4% (n=142) and corneal perforation follows it with the ratio of 22.2% (n=71). Entire loss of sight developed in 4 (2.2%) patients, partial loss of sight developed in 45 (25%) patients and 131 patients (72.8%) didn't loss their sights. Conclusion: Eye injuries were seen frequently in males than females and children particularly male children which play toy guns that shoot plastic bead or explosive material (sparkler, cracker) than adults. Injuries which happened in house for children was remarkably.Öğe The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform(W B Saunders Co-Elsevier Inc, 2010) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Ozhasenekler, Ayhan; Alyan, Omer; Kale, EbruObjectives: The aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain. Equipment and Method: A total of 83 patients admitted with chest pain to our ES were included in this study. The patients were divided into 2 groups: those with a diagnosed ACS and those diagnosed with non cardiac-related chest pain. Patients were also were divided into 2 groups according to the time of admission: those admitted within 0 to 3 hours and 3 to 6 hours of onset of chest pain. Peripheral venous blood samples were obtained from all patients for H-FABP, troponin I, and creatine kinase-MB (CK-MB) serum concentration measurements. Results: Of a total of 83 patients, 21.6% (n = 18) were in the control group and 78.3% (n = 65) were in the ACS group. The average H-FABP value for the patients in the control group was 0.86 +/- 0.54 ng/mL. When the ACS and control groups were compared in means of cardiac markers for CK-MB (P = .000) and H-FABP (P = .000), there was a statistically significant difference, whereas no difference was observed for troponin I (P = .013). In the ACS group, H-FABP sensitivity for diagnosis was found to be 98% and specificity was 71%; CK-MB sensitivity was 86% and specificity was 52%; and troponin 1 sensitivity was 77% and specificity was 20%. Conclusions: For patients admitted with chest pain to ES, H-FABP was found to be more sensitive and specific than troponin I and CK-MB in the early diagnosis of ACS. (C) 2010 Elsevier Inc. All rights reserved.Öğe Vacuum Phenomenon(Emergency Medicine Physicians Assoc Turkey, 2013) Durgun, Hasan Mansur; Ozhasenekler, Ayhan; Onder, Hakan; Orak, Murat; Ustundag, MehmetVacuum phenomenon is the accumulation of gas in the intervertebral region. This gas image is seen as a radiolucent area in the synovial space, intervertebral discs and vertebrae. The majority of the gas is nitrogen. Intervertebral disc degeneration is often accused on etiology. The mechanism is unknown. Vacuum phenomenon can especially be seen from radiography and spine tomography in elderly patients with disc degeneration who are admitted to the emergency room because of back pain.
