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Öğe Association of renal dysfunction with stroke subtypes in acute stroke patients(Medcom Ltd, 2010) Kavalci, C.; Guldiken, B.; Ustundag, S.; Guldiken, S.Objectives: There are conflicting published data about the association of renal dysfunction with cerebrovascular diseases. Both diseases have shared risk factors such as hypertension, diabetes mellitus and smoking. In the present study, the relationship of renal dysfunction with stroke subtypes and stroke severity was investigated. Materials and methods: One hundred and sixty-two acute stroke patients without known history of renal disease and 148 control subjects were enrolled in the study. Serum urea, serum creatinine level and glomerular filtration rate (GFR) as estimated by the Modification of Diet in Renal Disease formula were used to evaluate renal dysfunction. Stroke patients were divided into two groups as haemorrhagic and ischemic stroke, the latter being further subdivided into small and large vessel disease subtypes according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke severity was assessed by the modified Rankin Scale. Results: Serum creatinine and urea levels were significantly higher and GFR was significantly lower in the stroke group than the controls (p<0.001, p<0.001, p<0.001, respectively). Serum creatinine level was found significantly higher in haemorrhagic stroke than ischaemic stroke subtypes (p<0.001). There was no difference between ischemic subtypes regarding the measured renal parameters. Stroke severity correlated with increased creatinine levels (p<0.001, beta=0.404, 95% CI=1.85-3.50). Conclusion: Acute stoke patients have impaired renal function. Renal dysfunction is particularly more prominent in haemorrhagic stroke and exists probably prior to the stroke. Whether renal dysfunction is an independent risk factor for stroke needs to be clarified by large population studies. (Hong Kong j.emerg.med. 20 10; 17:22-26)Öğe Chewing gum as an unusual cause of systemic allergic reaction(Medcom Ltd, 2010) Cevik, Y.; Kavalci, C.Chewing gum allergy is a rare condition in emergency settings. A 48-year-old man presented to the emergency department with generalised itchiness which was more prominent on the periorbital areas, nausea, vomiting, and dyspnoea after taking chewing gum. Vital signs showed hypotension with a blood pressure of 72/45 mmHg, and heart rate 95 beats per minute. Auscultation of the chest revealed diffuse rhonchi and coarse crackles. There was blanchable skin rash over the body especially on the abdomen. As the symptoms were compatible with systemic allergic reactions after chewing gum, the patient was given supplemental oxygen, subcutaneous adrenaline, intravenous methylprednisolone and nebulised salbutamol. The patient responded dramatically. He was discharged with oral hydroxyzine (Atarax (R) tablet) prescription. Although there are lots of well-known allergic substances including foods and drugs, we may encounter allergic reactions associated with rare allergens like chewing gum. (Hong Kong j.ernerg.med. 2010;17:293-296)Öğe Complications of misuse of Bacillus Calmette-Guerin(Comenius Univ, 2011) Cevik, Y.; Ozer, M.; Das, M.; Ertok, I; Kavalci, C.; Ergul, E.; Durukan, P.Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also become a mortal toxin when applied in a wrong way. The application routes of the prescribed drug should be rigorously described to patients and detailed instructions regarding the ways of application such as intravesical application should be given to the persons taking this medicine (Ref. 9). Full Text in free PDF www.bmj.sk.Öğe Ipsilateral scapular fracture and contralateral fracture-dislocation of the humeral head due to electrocution(Medcom Ltd, 2010) Cevik, Y.; Memis, M.; Sahin, H.; Kilicarslan, K.; Kavalci, C.Scapular fractures and shoulder fracture-dislocations as a result of electrocution are rarely seen and reported. We present the case of a 31-year-old man who sustained an ipsilateral scapular fracture and contralateral shoulder fracture-dislocation after electrocution. (Hong Kong j.emerg.med. 2010;17:186-189)Öğe Poisoning from wild mushroom in the Trakya region: an analysis of seven years(Sage Publications Ltd, 2010) Kavalci, C.; Kavalci, G.; Guzel, A.; Inal, M.; Durukan, P.; Karasalihoglu, S.; Cevik, Y.Introduction: Mushroom poisoning is a medical emergency, diagnostic and treatment dilemma for physicians. Most cases present with self-limiting gastrointestinal symptoms. The regional profile of poisoning epidemiology in Turkey has previously been reported. However, information about mushrooms is still limited. The aim of this study was to identify the epidemiology of wild mushroom poisonings in the Trakya region in a 7-year period. Materials and methods:The study was designed retrospectively by examining the files of the patients who presented to the emergency department of Trakya University Faculty of Medicine from January 2002 to July 2008. Results: The overall male to female ratio was 0.88:1. All patients were intoxicated due to accidental pick up and consumption of wild mushrooms from open fields, woodlands and meadows. The most common findings on physical examination were epigastric pain. Fifty-six patients (74.7%) were discharged from the emergency department, 18 patients (24.0%) were hospitalized (one died on the 5th day), and one patient died in the emergency department. Conclusions: Care should be taken especially for patients presenting late. Patients may have hepatic dysfunction that needs haemodialysis or even liver transplantation. (Hong Kong j.emerg.med. 2010;17:341-346)Öğe The relationship among plasma copeptin, carboxyhemoglobin, and lactate levels in carbon monoxide poisoning(Sage Publications Ltd, 2020) Ozkan, S.; Salt, O.; Durukan, P.; Sen, A.; Bulbul, E.; Duman, A.; Kavalci, C.Objective: The aim of our study is to determine whether there is a change in the plasma levels of copeptin and there is a relationship among the plasma levels of carboxyhemoglobin (COHb), lactate, and copeptin levels in patients presenting to the emergency department with carbon monoxide (CO) poisoning. Methods: Fifty-seven patients admitted to the emergency department with CO poisoning were included in the study. The blood samples of the patients were collected on arrival 0th, 6th, and 12th hours for copeptin, lactate, and COHb levels. Data were analyzed using SPSS-17 statistical software. Results: Arrival serum copeptin levels of the patients were compared to copeptin levels of healthy individuals and a statistically significant difference was found between them (p = 0.008). There was a statistically significant difference between the arrival levels of copeptin and 6th-hour (p = 0.006) and 12th-hour (p = 0.001) levels of copeptin. There was no significant difference between 6th-hour and 12th-hour copeptin levels (p = 0.51). In terms of serum lactate levels, there was a significant difference between arrival and 6th h (p < 0.001), arrival and 12th h (p < 0.001), and 6th and 12th h (p < 0.001). Likewise, in terms of serum COHb levels, there was a significant difference between arrival and 6th h (p < 0.001), arrival and 12th h (p < 0.001), and 6th and 12th h (p < 0.001). There was a positive correlation between COHb and lactate levels on arrival (r = 0.52; p = 0.001). Conclusion: Copeptin as a stress hormone can be used in the diagnosis and monitoring of patients with CO poisoning. However, the copeptin level was not superior to COHb and lactate levels.Öğe Reversible increases in QT dispersion and P wave dispersion during carbon monoxide intoxication(Sage Publications Ltd, 2010) Cevik, Y.; Tanriverdi, F.; Delice, O.; Kavalci, C.; Sezigen, S.Objectives: Carbon monoxide (CO) is potent myocardial toxin. We investigated the association between acute CO intoxication and electrocardiographic QT interval (QTmax/QTmin), corrected QT interval (cQTmax/cQTmin), QT dispersion (QTd) and corrected QT dispersion (cQTd), P wave duration (Pmax/Pmin) and P wave dispersion (Pd), which were known as predictors of ventricular arrhythmias, atrial fibrillation and sudden death. Methods: Electrocardiography with 12-leads and blood gas were taken from 65 patients with CO intoxication as well as 65 control patients with similar age and gender distributing at the admission time to the emergency department and at the 4th hour post-therapy. The Carboxyhaemoglobin (COHb) levels and the relationships with electrocardiographic parameters were studied. Results: The mean COHb) levels and the relationships with electrocardiographic parameters were studied. Results: The mean COHb levels were 21.43 +/- 6.85% and 1.37 +/- 0.98% in intoxicated patients and in the control group respectively. Qtmax, QTd, cQTmax, cQTd, Pmax, and Pd were found significantly higher in intoxicated patients when compared to the control group (373.98 +/- 40.35 vs. 355.98 +/- 32.88, p=0.006; 49.29 +/- 22.66 vs. 20.43 +/- 11.16, p<0.001; 455.38 +/- 30.72 vs. 419.57 +/- 22.27, p<0.001; 60.88 +/- 25.99 vs. 25.75 +/- 13.13, p<0.001; 107.91 +/- 13.28 vs. 96.65 +/- 12.65, p<0.001 respectively). Conclusion: a correlation between reversible increases in QTd, cQTmax, cQTd, Pmax and Pd in the electrocardiogram and COHb can be observed in acute CO intoxication patients. (Hong Kong j.emerg.med. 2010;17:441-450)Öğe An unusual oesophageal foreign body: a total denture(Medcom Ltd, 2013) Kavalci, C.; Sayhan, M. B.; Durukan, D. B.; Sezenler, E.; Sogut, O.A mentally retarded man ingested a total denture and the denture was impacted at the cervical oesophagus. Plain X-ray imaging confirmed the diagnosis. The denture was removed via a rigid oesophagoscope. The clinical management was discussed. (Hong Kong j.emerg.med. 2013;20:317-319)Öğe Value of biomarker-based diagnostic test in differential diagnosis of hemorrhagic-ischemic stroke(Comenius Univ, 2011) Kavalci, C.; Genchallac, H.; Durukan, P.; Cevik, Y.Background and aim: Stroke is an emergency which threatens life and the third leading cause of death in developed countries and the leading cause of long-term disability. By means of this study, it was aimed to evaluate the position of triage stroke panel in differential diagnosis of acute hemorrhagic stroke and ischemic stroke and sub-types of ischemic stroke. Material and methods: Patients with acute stroke admitted to Emergency Department were prospectively recruited between June 2008-January 2009. BNP, D-dimer, MMP-9, S-100b levels were asseyed. Statistical significance for intergroup differences was assessed by Pearson's X-2 for categorical variables and Mann-Whitney U test or Kruskal-Wallis test for continuous variables. Results and conlusion: A total of 100 consecutive patients with a diagnosis of stroke were evaluated. Of these, 29 (29 %) patients had brain hemorrhages on the computed tomography scan performed the Emergency Department, 71 (71 %) patients had ischemic stroke. It was observed that the intercept obtained as a result of jointly evaluating BNP, D-dimer, MMP9 and S100b is more important in differential diagnosis (p<0.005). We suggest that using a combination of plasma biomarkers may be usefull to ischemic or hemorrhagic stroke for differential diagnosis (Tab. 4, Ref. 22). Full Text in free PDF www.bmj.sk.