Aims: In this, a comparison of QT, QTC, QTDIS, P wave and PDIS values from the first ECG recordings in stroke patients and healthy individuals in emergency department was realized, and it was searched whether these values were predictors of prognosis within gender and age or not. Materials and Methods: Along with a control group of 90 patients, 76 patients with a diagnosis on ischemic stroke presenting neurological symptoms and brain CT and/or MRI evaluation in the emergency service were included in the study. All patients were analysed with 12-lead electrocardiograms and PMAX, PMIN, PDIS, QT, QTc, QTDIS and QTCDIS intervals were measured. Journal of Anatolian Medical Research 2017; 2(3):42-55 Orjinal Araştırma 43 Results: During the PDIS comparison in control and stroke groups, interval was detected significantly higher in the stroke group [95% CI; 39.55 to 49.40] compared to the control group [95% CI; 26.55 to 33.45]. QTDIS [95% CI; Vs 49.16 to 62.28 39.28 to 46.82] and QTCDIS values [95% CI; 54.22 to 72.83 vs 43,10-51,1739,28-46,82] were also detected statistically meaningful in stroke group compared to control cases. Conclusion: PDIS, QTDIS and QTCDIS intervals that were determined to be prolonged in stroke groups compared to the control group should be considered as important parameters in prognosis and clinical follow-up.

Amac: Bu calismada, acil serviste inme hastalarinda ve saglikli bireylerde ilk EKG kayitlarindan QT, QTc, QTdis, P dalga ve Pdis degerlerinin karsilastirilmasi yapildi ve bu degerlerin cinsiyet ve yas acisindan prognoz belirleyicileri olup olmadigi arastirildi.Gerec ve yontem: 90 hastadan olusan bir kontrol grubu ile birlikte, norolojik semptomlari olan ve iskemik inme tanisi konan 76 hastanin acil serviste beyin BT ve / veya MRG degerlendirmesi yapildi. Tum hastalar 12 derivasyonlu elektrokardiyografi ile analiz edildi ve PMAX, PMIN, pdis, QT, QTc, QTDIS ve QTCDIS araliklari olculdu. Bulgular: Kontrol grubu ve inme gruplarindaki Pdis karsilastirmasi sirasinda, aralik inmeli grupta [% 95 CI; 39.55 ila 49.40] kontrol grubuna [% 95 CI; 26.55 ila 33.45]. QTDIS [% 95 CI; Vs 49.16 ila 62.28 39.28 ila 46.82] ve QTCDIS degerleri [% 95 CI; 54.22 ila 72.83'e karsilik 43,10-51,1739,28-46,82] kontrol gruplarina kiyasla inmeli grupta istatistiksel olarak anlamli bulundu. Sonuc : Prognoz ve klinik takipte inme grubunda kontrol grubuna gore uzamis oldugu saptanan Pdis, QTDIS ve QTCDIS degerleri onemli parametreler olarak dusunulmelidir.

DOI: 10.4328/JCAM.826 Received: 25.11.2011 Accepted: 02.01.2012 Printed: 01.01.2015 J Clin Anal Med 2015;6(1): 109-11 Corresponding Author: Erhan Dedeoglu, Department of Emergency Medicine, Canakkale Public Hospital, Canakkale Devlet Hastanesi, Acil Servis, Canakkale, Turkiye. GSM: +905054423119 E-Mail: drerhandedeoglu@yahoo.com Ozet Jejunal divertikulleri cok nadirdir ve genellikle asemptomatiktir. Bu asemptomatik divertikullere laparatomi esnasinda veya cesitli radyolojik goruntuleme calismalari esnasinda tesadufen rastlanir. Akut komplikasyonlarin tanisindaki gecikmenin mortalite ve morbiditede belirgin artisa neden olmasi ve nadir gorulmesi nedeni ile acil servise akut karin tablosu gelen ve laparotomiye alinan jejunal divertikulozis tanisi konulan iki olgunun sunulmasi amaclandi.

Gallbladder stones are an endemic disease of hepatobiliary system. Whereas, cholecystoenteric fistules which develop by depending on gallbladder stone are rarely seen complications. A diagnosis is usually established during an operation. As is seen in our case too, in view of acute-stoned cholecystitis, laparoscopy has been carried out and a diagnosis of cholecystoduodenal fistule has been established during laparoscopy. Our case to whom laparoscopic duodenography and cholecystectomy has been applied is a rarely seen disease in literature. So, we aimed at sharing this information.

Aims: The aim of our study was to investigate QT, and QTc interval durations and P-wave dispersion (PWD) in the electrocardiography (ECG) records of patients diagnosed with acute pancreatitis (AP).Materials and methods: Fifty patients who were diagnosed with AP (AP group) and 50 healthy subjects (N Group) were enrolled in this study. A diagnosis of acute pancreatitis was established through histories, physical examinations, laboratory and typical radiological findings. All patients' 12 lead electrocardiograms were analysed, and the PWD, QT and Qrc intervals were measured.Results: Maximum and minimum P wave durations and PWD were significantly higher in AP group (90.40 +/- 15.24 ins versus 82.60 +/- 1337 ms, P = 0.008; 54.20 +/- 12.63 ms versus 41.60 +/- 12.67; P < 0.001; 48.80 +/- 14.09 ms versus 28.00 +/- 11.24 ms; P < 0.001 respectively). QTc intervals were significantly higher in AP group (412.22 +/- 25.78ms versus 397.88 +/- 15.86 ms; P = 0.001).Conclusion: PWD and QTc intervals in the patients with acute pancreatitis were found to be significantly prolonged in comparison to healthy cases ones. AP patients may have a higher likelihood of arrhythmias due to prolonged QTc and PWD.

Although esophageal foreign bodies are mostly encountered in children, they also continue to constitute a life threatening problem in adults. Because of severe complications possibly to occur, esophageal foreign bodies should be extracted as soon as the diagnosis is made. A 30 year-old male patient who had a sense of blockage in the throat after taking two amino acid tablets and who was admitted to our emergency room and was discussed in this case report. In endoscopy performed with the initial diagnosis of esophageal foreign body, two attached tablets which completely obstruct lower lumen were removed immediately below the upper esophageal sphincter. In recent years, we wanted to share this case in order to express that increasing amino acid tablet usage will lead to serious complications.

Propafenone may cause mental depression, mania, convulsion, metabolic acidosis, hypotension, prolonged QRS, atrioventricular block, and cardiac arrest if it is taken at a dose greater than recommended. There is no standard specific treatment or antidote for a propafenone overdose, and life-supporting treatments are applied in these cases. In this case report, we report a case of a 15-year-old female patient who experienced cardiac arrest after an oral propafenone overdose. She was successfully treated using cardiopulmonary resuscitation, which took approximately 1.5 hours. Dopamine infusion, sodium bicarbonate, and insulin treatment were also administered to the patient. High-dose insulin treatment may be an effective treatment of propafenone poisoning.

Introduction: Diaphragmatic rupture is rarely a cause of death by itself. It is especially difficult to diagnose diaphragmatic ruptures in patients with unstable vital signs who present at the emergency service with concurrent chest, abdomen, and extremity injuries as a result of blunt trauma. We evaluated the diagnostic processes, clinical findings and treatment results of acute and delayed traumatic diaphragmatic ruptures (TDR) cases that presented at the emergency service. Methods: A total of 29 patients that underwent surgical treatment with a diagnosis of TDR among 1021 patients that presented at the Canakkale State Hospital Emergency Service with acute or delayed thoracoabdominal trauma were retrospectively investigated. The age, gender, trauma etiology, diagnosis duration, injury severity score (ISS), rupture location, accompanying organ injuries, operation type, inpatient duration, morbidity and mortality were recorded on prepared forms to analyse the cases. Results: The mean age of the 29 patients with TDR was 45.31 +/- 17.76 years with and 20 (69%) males and 9 (31%) females. The trauma was blunt in 22 (76%) and penetrating in 7 (24%) cases. The TDR was acute in 16 (55%) and delayed in 13 (45%) patients. The surgery for TDR treatment consisted of with thoracotomy in 16 (55%) patients, laparotomy in 11 (38%) patients and both thoracotomy and laparotomy in 2 (7%) cases. Mortality occurred in 3 (10%) patients that presented at the acute stage. Conclusions: The patients undergoing thoracoabdominal trauma, should be explained the probability, although low, of rupture of the diaphragm. These patients should be followed up and it should be emphasized that they should absolutely tell this trauma history to the physician who examines them when they present at the emergency service.

Hypothermia is defined as a core body temperature below 35°C. Hypothermia affects all organs, especially the brain and heart. Osborn wave (J) is a positive deflection that is seen at the end of the QRS wave in electrocardiography (ECG) and could be seen in cases such as intracranial events, and hypercalcemia besides hypothermia. An 85-year-old male patient was found unconscious in cold weather. He was hypothermic and J wave was detected in his ECG examination. His brain CT scan revealed intracerebral haematoma. Our aim is to reiterate that intracranial haemorrhage can be a differential diagnosis for patients who come to the emergency department with hypothermia and Osborn wave in ECG.

Tubal sterilization is a commonly used method of contraception. In the case of sterilization failure, the rate of intrauterine pregnancy is higher than that of ectopic pregnancy. In this article, we present a case of ruptured ectopic pregnancy with a previous history of bilateral tube ligation, presented to our hospital. We aim to underline the necessity of primarily considering ectopic pregnancy as a cause of abdominal pain, even in the presence of tube ligation history in females with childbearing potential.

Objectives In this study, we aimed to reveal the relationship between the intensity of chest pain and likelihood of ACS and ST segment deviation in electrocardiography (ECG) of the patients who presented with chest-pain.Methods Total of 232 patients, 18 years and older, who were admitted to the emergency department (ED) with chest pain complaints were included in the study. Upon arrival at the ED, the relationship of the intensity of chest pain, as determined by the Numeric Rating Scale (NRS) scores and the ST segment changes in patient ECGs, as well as the likelihood of ACS by evaluating their troponin I levels were analyzed.Results One hundred and twenty nine of the patients included in the study were male (55.6%). Mean NRS scores on admission of patients on their arrival at the ED was 5.5 +/- 2.8. While the mean of NRS scores of the 96 patients (41.4%) who were determined to have ST segment changes in their ECG on admission to the ED was found as 5.7 +/- 2.8, the mean NRS scores of 136 patients whose arrival ECGs were normal was found as 5.3 +/- 2.8 (p=0.281). The arrival NRS mean scores of the patients who were diagnosed with acute coronary syndrome was found 5.4 +/- 2.8, while the NRS mean scores of the 106 patients who was not diagnosed with ACS was found as 5.5 +/- 2.9 (p=0.853).Conclusions We conclude that the intensity of chest pain is not indicative whether the patient has ACS or not, nor and it has any relationship with changes detected in the ST segment of patient ECGs.

Ranitidine is a H2 receptor blocker and rarely cause bradycardia. A 28 years old male patient attended the emergency department for urticaria. He was given 45 mg of phenyramine and 50 mg of ranitidine intravenously. He then complained of dizziness and developed bradycardia and hypotension. Electrocardiogram detected junctional bradycardia rhythm. He was given 0.5 mg atropine intravenously and his rhythm then returned to normal. His symptoms subsided and the blood pressure improved. Ranitidine is a frequently used medication and this case illustrated a rare but serious side-effect of the medication.

Generalized tonic-clonic seizure induced by the extended- release bupropion hydrochloride formulationBupropion hydrochloride (HCl) is currently available in three formulations: immediate-release (IR), sustained-release (SR), and extended-release (ER). bupropion HCl immediate-release and sustained- release formulations have been known to trigger seizure activity. However, such an effect has been reported rarely in the medical literature for the extended release formulation. In this case report we discuss a 37 year old woman, who was taking extended-release bupropion (HCl) tablets and presented to our emergency room with generalized tonic-clonic seizures. While evaluating non-epilepsy patients for the etiology of their first seizures, antidepressant drugs should be considered in addition to other reasons.

ÖZETBupropion Hidroklorid (HCI), hızlı salınımlı (IR), sürekli salınımlı (SR) ve yavaş salınımlı (ER) olmak üzere üç farklı formu bulunmaktadır. Bupropion HCI'in özellikle sürekli ve hızlı salınımlı formlarının nöbeti tetiklediği bildirilmiştir. Yavaş salınımlı formunun nöbeti tetiklediği ise literatürde oldukça nadir olarak bildirilmiştir (1). Bu olgu sunumunda, bupropion'un yavaş salınımlı formunu kullanan ve acil servise jeneralize tonik klonik nöbetle gelen 37 yaşındaki bayan hasta tartışılmıştır. Daha önce epilepsi tanısı olmayan ve ilk nöbetle hastaneye başvuran hastaların değerlendirilmesi sırasında diğer nedenler araştırılırken, antidepressan ilaçların da sorgulanması gerekmektedir.