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Objective: In our study, in addition to evaluating the relation between Pro-Brain natriuretic peptide (Pro-BNP), myoglobin and creatinine kinase (CK) levels and morbidity and mortality, we aimed at identifying the demographic characteristics of patients admited to emergency service after exposure to high electrical voltage., Methods: In this prospective study, 48 emergency service patients exposed to high electric voltage were included; 19 healthy individuals were included as the control group. Their blood samples and electrocardiographies (ECG) were taken at the time of recourse upon their written approval. Demographic data and laboratory data were checked and compared among the patient group. We investigated the correlation between inpatients that had special clinical manifestations (escaratomy, fasciotomy, exitus, myoglobulinuria, third-degree burn, arrhythmia and etc.) and serum Pro-BNP, myoglobin and CK levels., Results: When serum Pro-BNP, myoglobulin and CK levels were compared for the special clinical manifestations; the pro-BNP levels were statistically significantly higher in patients who had arrhythmia than in those without arrhythmia, and significantly higher in patients who died than in those who healed (respectively p=0.002 and p=0.007). In contrast, serum CK and myoglobin levels were not statistically significant. The serum CK and myoglobin levels were statistically significantly higher in patients who had third-degree burn than the others (p<0.001)., Conclusion: Serum pro-BNP level is a marker that can be used for mortality and morbidity with patients exposed to high voltage electrical injuries.

Use of cigarettes and smokeless tobacco is a considerable public health problem. In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the Southeastern region. We present a case of paroxysmal atrial fibrillation that was suspected to be caused by the use of MP, which has never previously been noted in the literature. A 46-year-old man was admitted to our emergency department with angina pectoris and palpitation. He was a long time cigarette smoker and had begun using MP the fortnight before. Electrocardiography showed atrial fibrillation with rapid ventricular response. The patient had no medical history of alcohol use, surgery, palpitation, coronary arterial illness, hypertension or chronic bronchitis. Atrial fibrillation was converted to sinus rhythm after antiarrhythmic medication. Our patient was discharged from the emergency department with a suggestion to quit MP usage immediately. In conclusion, the use of MP may lead to the occurrence of paroxysmal atrial fibrillation.

Neuroleptic malignant syndrome (NMS) is a life-threatening medical complication that occurs as a result of dopaminergic receptor blockage in nigrostriatal pathways. This syndrome is mainly accepted to be an idiosyncratic reaction for antipsychotic medications. Incidence of NMS induced by olanzapine - an atypical antipsychotic - is extremely rare. However, there has been contradiction on postpartum period as a risk factor for NMS. This case is of interest due to the fact that it happens on postpartum period and is induced by olanzapine. We aimed in this study to evaluate the successfully cured case of neuroleptic malignant syndrome induced by olanzapine in postpartum period with the literature view.

Objective: 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.

Purpose: High falls from flat-roofed houses are a common cause of death and disability in the south-east part of Turkey; the aim of this study was to describe our experience of such falls seen over a 4-year period in Diyarbakir., Methods: One thousand six hundred and forty-three patients (570 females and 1073 males) who sustained injuries after an accidental fall from a flat-roofed house were entered into the study., Results: The mean age was 18 (1-95) years; 49.4% of patients were under 10 years old; 81.5% were under 30 years old. The mean fall height was 4.5m (1-20 m). The mortality rate was 5.8% (96 patients). The mean fall height in children under the age of 15 years who died from the fall was 4m (67 patients) and in patients over the age of 15 years, 9m (29 patients). The most common injuries were to the head (45.1%) and 93.75% of those (n = 90) who died had a head injury. One hundred patients (6%) were followed because of abdominal bleeding: one of these had fallen from 2m, the reminder from 4 to 9 m; 12 were operated on and 88 treated conservatively., Conclusion: Craniocerebral trauma is the most common injury in fatal falls from flat roofs and blunt abdominal trauma is an uncommon injury after falling from less than 4m.

Objectives: We evaluated fixation in high tibial osteotomy with the use of a modified Weber technique (MWT), together with its advantages., Methods: Thirty-nine patients (40 knees) underwent high tibial osteotomy for varus deformities of the knee joint and medial compartment degeneration. Fixation was performed by a modified Weber technique in which a semi-tubular plate and a long leg screw were used in place of the original Weber instrumentation. Thirty-five patients were women and four were men, with a mean age of 52.5 years (range 25 to 67 years). The patients were evaluated before surgery both clinically and by HSS scores and the advantages and disadvantages of the technique were assessed. The mean follow-up was 22 months (range 8 to 45 months)., Results: All patients were allowed to give weight on the affected leg to the extent of utmost tolerability on the forth postoperative day. At the end of two weeks, 60% of the patients could bear half of the body weight. Screw breakage occurred in one patient due to faulty application of the technique. Pseudoarthrosis was seen in none of the patients, nor were there any early or late complications. Radiologic evidence of union was observed in all osteotomy sites. All patients achieved full extension except two who had a flexion deformity of 5 degrees. The mean knee flexion was 130.2 degrees., Conclusion: High tibial osteotomy may provide a rigid fixation, postoperative early motion and low complication rates in varus deformities and medial gonarthrosis of the knee. Our data suggest that MWT results in good stability both statically and dynamically in the fixation of high tibial osteotomy.

In this study, sociodemographic, laboratory, and clinical features of cases of organic phosphorus (OP) intoxication in the Southeast Anatolian region of Turkey were investigated. Patients with OP intoxication admitted to the Emergency Service of Dicle University Hospital in Diyarbakyir City between May and August 1998 were evaluated. This prospective cohort study included five male (M) and 19 female (F) consecutive patients. Five cases were accidental intoxication; however, 19 cases were suicide attempts. Mean age of cases was 24+/-11 years; 54.2% of them were under the age of 20 years and 83.3% of them were under the age of 30 years. The M/F ratio was 1.0/3.8. The cases of suicidal purposeful intoxications were mostly determined in singles (58.3%, P<0.05). Most of the cases had a primary education level (16, 66.7%) and a lower socioeconomic status (14, 58.3%); 79.2% of cases admitted to our emergency service received atropine in primary health care centers. In emergency service, pralidoxime (PAM) was administered to only 29.2% of cases. According to ECG examination, tachycardia (14, 58.3%), ST changes (13, 54.2%), and T changes (3, 12.5%) were mostly seen; bradycardia and serious ventricular arrhythmias were not seen in any case. Patients who received atropine plus PAM had higher rates of arrhythmias, but this was not statistically significant (P>0.05). The most observed biochemical features of cases were leukocytosis (21 cases), hypokalemia (18 cases), and hyponatremia (4 cases). Other biochemical features were not evidently altered. In present cases, the most frequently seen symptoms and findings were vomiting (18, 75%), feeling faint (17, 70.8%), and tachycardia and dozing off (14, 58.3%). Serious ventricular arrhythmias were not observed, and in our region, OP intoxication especially affected young unmarried females, and most of them resulted from a suicidal purpose.