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    A Diagnosis ofTotal Abdominal Aortic Occlusion in a Patient Who Entered the Emergency Department by Walking
    (Aves, 2014) Dundar, Zerrin Defne; Guven, Merve; Ergin, Mehmet; Cander, Basar; Girisgin, Sadik
    Introduction: The risk of thrombosis is increased in hypercoagulability. Hypercoagulability can be inherited or acquired. Here, we want to present a patient with inherited hypercoagulability who came to the emergency department by walking and was diagnosed with total abdominal aortic thrombosis and acute renal artery thrombosis. Case Report: A 48-year-old female patient presented to our emergency medicine department with a history of right flank pain for 30 minutes. The pain had started abruptly and was continuous. She came to the emergency medicine department by walking. The contrast-enhanced abdominal computed tomography showed right renal infarction, right artery occlusion, and abdominal aortic thrombus at the level of the iliac bifurcation. Conclusion: Abdominal aortic thrombus is a relatively rare complication of hypercoagulability. Total occlusion of the aorta is generally presented with pain, pallor, weakness, and numbness of the lower limbs. In our case, there was none of these signs due to the blood flow supplied by collaterals. It is a challenge to diagnose total aortic occlusion in a patient that comes to the emergency department by walking.
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    A new marker identification of high risk stroke patients: Jugular saturation
    (W B Saunders Co-Elsevier Inc, 2020) Guven, Mevlut; Akilli, Nazire Belgin; Koylu, Ramazan; Oner, Vefa; Guven, Merve; Ozer, Muhammed Rasit
    Objectives: The aim of this prospective study; to investigate in emergency patients with stroke the relationship between jugular saturation and National Institutes of Health Stroke Scale (NIHSS), lesion volume and mortality score. Materials and methods: In this prospective study, 82 patients who fulfilling the criteria for inclusion in diagnosed with were enrolled in the study. Patients' demographic data, comorbid conditions and stroke type were recorded. The arterial blood pressure, heart rate, and consciousness were recorded at the emergency department. Glasgow Coma Score (GCS) and National Health Institutions Stroke Scale (NIHSS) scores were calculated. Complete Blood Count (CBC) and biochemical values were obtained at the time of admission to the emergency department. Arterial blood gas and jugular venous blood gas were taken and pO2, SpO2 and lactate values were recorded. Patients were grouped according to jugular desaturation (<50%). After imaging, the lesion was located by a specialist radiologist and the lesion volume was calculated. Afterwards, it was followed up by means of the hospital registry system where the patients were followed up (service, intensive care), hospitalization time and whether in-hospital mortality occurred. Results: 82 patients were included in the study. Of the 82 patients, 36 (43.9%) were male and 46 (56.1%) were female. The mean age was 69.8 +/- 13.3. Patients were divided into two groups, jugular venous saturation <50% and >= 50%. 16 patients with J.SpO2 <50% were detected. There was no difference between the two groups in terms of age, sex, Glasgow Coma Scale (GCS), National Health Institutions Stroke Scale (NIHSS) score, laboratory data other than hemoglobin and lesion volume (p > 0,05). In-hospital mortality occurred in 9 (13.6%) of patients with J.SpO2 >=% 50; In the group with J.SpO2 < % 50, 6 patients (37.5%) died within the hospital and this difference was statistically significant (p < 0,05). Conclusion: SjVO2 measurement can be used to identify high-risk stroke patients and to direct critical interventions. However, no correlation was found between this value and lesion volume and NIHSS scale. (C) 2019 Published by Elsevier Inc.
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    The role of heparin-binding protein in the diagnosis of acute mesenteric ischemia
    (Turkish Assoc Trauma Emergency Surgery, 2019) Kocak, Sedat; Acar, Tarik; Ertekin, Birsen; Guven, Merve; Dundar, Zerrin Defne
    BACKGROUND: Acute mesenteric ischemia (AMI) is associated with a high mortality rate, yet diagnostic difficulties persist. Although many biomarkers have been investigated for diagnostic purposes, as well as imaging methods, a sufficiently specific and sensitive marker has not been identified. This research was designed to examine whether heparin-binding protein (HBP), which has a role in the early phase of inflammation, could be useful in the diagnosis of AMI. METHODS: Serum samples obtained from a previously performed rabbit model of AMI were used in the study. HBP, C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured in blood samples obtained at baseline and 1, 3, and 6 hours from subjects that were separated into 3 groups: control, sham, and ischemia. The change in each marker over time and comparisons of the groups were evaluated statistically. RESULTS: A significant difference was not detected at the first hour in any of the studied markers. At the third hour, the CRP and IL-6 levels in the ischemia group indicated a significant increase in comparison with the control and sham groups (p<0.001). The HBP values showed a significant increase at the sixth hour in the ischemia group in comparison with the others (p<0.001). CONCLUSION: The HBP level demonstrated a slower increase in a rabbit model of AMI compared with CRP and IL-6. However, it still has the potential to become an early diagnostic biomarker. Diagnostic sensitivity and specificity should be evaluated in further clinical trials.