Ultrasonography in soft-tissue foreign-body detection: a phantom study.

PURPOSE: Foreign body implantation into the soft tissues, either in the early period or late period, is a common cause of emergency department admissions. Direct X-rays are preferred in the diagnosis of soft-tissue foreign-bodies. Herein, we aimed to analyse the detection rates of foreign bodies of various sizes placed in phantoms implanted into soft tissue by ultrasonography. MATERIAL AND METHODS: A total of 740 pieces of chicken fillet were prepared as phantoms. No objects were implanted into 100 phantoms. We inserted glass, porcelain, plastic, wood, pencil tip, chicken bone, iron, walnut shell, and fishbone with a length of < 1 cm, 1-3 cm, and 3-5 cm into 20 pieces of chicken phantom in each size of foreign body (FB). In addition, 1-3 cm long peanut shell, < 1 cm rose spikes, < 1 cm cactus thorns, < 1 cm pellets, and < 1 cm staples were inserted into 20 pieces of chicken for each object. Each of the chicken pieces was placed inside a latex glove and examined by ultrasonography. RESULTS: The sensitivity of ultrasonography in the detection of the cactus thorn was 5%, whereas it ranged between 82.5 and 100% for other objects. For glass, plastic, wood, iron, and fishbone, we found that when the size exceeded 1 cm, the sensitivity increased. CONCLUSIONS: In the evaluation of soft tissue FBs, as the size of the FBs increases, the diagnostic value of ultrasonography increases.

Beneficial effects of bardoxolone methyl, an Nrf2 activator, on crush-related acute kidney injury in rats.

PURPOSE: The purpose of this study was to investigate the effects of bardoxolone methyl (BM), a nuclear factor erythroid 2-related factor 2 (Nrf2) activator, on acute kidney injury in a rat model of crush syndrome model. METHODS: Sixty-four rats were separated equally into eight groups, sham (sterile saline ip), crush, crush + vehicle (DMSO ip), and crush + BM (10 mg/kg ip) (n = 8). All groups were also divided as 3 and 24 h after decompression. Crush injury was induced by 6 h of direct compression to both hind limbs of the rats with blocks weighing 3.6 kg on each side, followed by 3 and 24 h of decompression. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), tumor necrotizing factor-α (TNF-α), transforming growth factor-ß1 (TGF-ß1) concentrations, tissue total oxidant status (TOS) and total antioxidant status (TAS) were measured in the kidneys. Serum creatine kinase (CK), blood urea nitrogen (BUN) and creatinine concentrations were also measured. Glomerular and tubular structures were examined histopathologically. Bcl-2 was measured using immunohistochemistry. Apoptosis was assessed using the TUNEL method. RESULTS: BM treatment reduced KIM-1, NGAL, TNF-α, TGF-ß1, TOS concentrations, and increased TAS concentrations in the kidneys 3 and 24 h after decompression. Serum CK, BUN and creatinine concentrations were also reduced with BM. BM treatment decreased apoptosis in crush-related AKI. The Nrf2 activator BM reversed the crush-induced changes in the experimental rats. CONCLUSION: BM treatment prevented the progression of crush-related AKI in rats possibly through its cytoprotective effects of being an antioxidant, anti-inflammatory and anti-apoptotic agent.

Transversus abdominis plane block: A new method in renal colic pain management.

In recent decades, regional plane blocks via ultrasonography have become very popular in regional anesthesia and are more commonly used in pain management. The transversus abdominis plane (TAP) block is a procedure where local anesthetics are applied to block the anterior divisions of the tenth thoracic intercostal through the first lumbar nerves (T10-L1) into the anatomic space formed amidst the internal oblique and transversus abdominis muscles located in the antero-lateral part of the abdomen wall. The most important advantage of this block method is that ultrasonographic identification is easier and its complications are fewer compared with central neuroaxial or paravertebral blocks. Here, we describe three cases where pain management in renal colic was treated with the TAP block.

Effect of Hydrogen Sulfide on Kidney Injury in Rat Model of Crush Syndrome.

BACKGROUND: Acute kidney injury is the most serious complication of crush syndrome. Hydrogen sulfide (H2S) is an endogenously produced gaseous signaling molecule. It is involved in homeostatic functions, such as blood pressure control, apoptosis, oxidative stress, and inflammation. In this study, effects of H2S on kidney injury were investigated in a rat model of crush syndrome. METHODS: Rats were divided into six groups (n = 8): Sham (steril saline ip), crush (sterile saline ip), crush + NaHS (sodium hydrosulfide, an H2S donor) (100 µmol/kg ip). All these groups were also separated as 3 and 24 h after decompression. Crush injury was induced by 6 h of direct compression to both hindlimbs of anesthetized rats with blocks weighing 3.6 kg each sides, followed by 3 or 24 h of decompression. Kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, tumor-necrotizing factor-α, transforming growth factor-ß, tissue total oxidant status, and total antioxidant status levels were measured in kidney homogenates 3 and 24 h after decompression. Serum creatine kinase, blood urea nitrogen, and creatinine levels were also measured. Apoptosis was assessed by TUNEL method. Bcl-2 was assessed by immunohistochemistry. Glomerular and tubular structures were also examined histopathologically. RESULTS: NaHS reduced kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, tumor-necrotizing factor-α, transforming growth factor-ß, total oxidant status levels, and increased total antioxidant status levels in kidney 3 and 24 h after decompression. Serum urea, creatinine, and creatine kinase levels also reduced with NaHS. NaHS decreased renal damage and apoptosis in crush-related acute kidney injury. CONCLUSIONS: These results suggest that H2S could reduce crush-related acute kidney injury via anti-inflammatory, antioxidant, and antiapoptotic effects.

Effects of hydrogen sulfide on acetaminophen-induced acute renal toxicity in rats.

INTRODUCTION AND AIM: Hydrogen sulfide (H2S) is an endogenously produced gas-structure mediator. It is proposed to have antioxidant, anti-inflammatory and antiapoptotic effects. Acetaminophen (N-acetyl-P-aminophenol; APAP) is an antipyretic and analgesic medication known as paracetamol. When taken at therapeutic doses there are few side-effects, but at high doses APAP can cause clear liver and kidney damage in humans and experimental animals. In this study, the effects of the H2S donor of sodium hydrosulfide (NaHS) on acute renal toxicity induced by APAP in rats were researched in comparison with N-acetyl cysteine (NAC). METHOD: Rats were divided into six groups (n = 7) as control. APAP, APAP + NAC, APAP + NaHS 25 µmol/kg, NaHS 50 µmol/kg and NaHS 100 µmol/kg. After oral dose of 2 g/kg APAP, NAC and NaHS were administered via the i.p. route for 7 days. In renal homogenates, KIM-1 (Kidney Injury Molecule-1), NGAL (neutrophil gelatinase-associated lipocalin), TNF-α and TGFß levels were measured with the ELISA method for tissue injury and inflammation. In renal tissue, oxidative stress levels were identified by spectrophotometric measurement of TAS and TOS. Histopathologic investigation of renal tissue used caspase 3 staining for apoptotic changes, Masson trichrome and H&E staining for variations occurring in glomerular and tubular systems. RESULTS: NaHS lowered KIM-1, NGAL, TNF-α, TGF-ß and TOS levels elevated in renal tissue linked to APAP and increased TAS values. NaHS prevented apoptosis in the kidney and was identified to ensure histologic amelioration in glomerular and tubular structures. NaHS at 50 µmol/kg dose was more effective, with the effect reduced with 100 µmol/kg dose. CONCLUSION: H2S shows protective effect against acute renal injury linked to APAP. This protective effect reduces with high doses of H2S. The anti-inflammatory and antioxidant activity of H2S may play a role in the renoprotective effect.

Effectiveness of Bedside Lung Ultrasound for Clinical Follow-Up of Primary Spontaneous Pneumothorax Patients Treated With Tube Thoracostomy.

Primary spontaneous pneumothorax (PSP) is a common cause of presentation to emergency departments and subsequent hospitalization. Patients with large PSP are treated with tube thoracostomy (TT) and followed up with x-rays. In this study, we investigated the efficiency of bedside ultrasound and compared it with x-ray imaging for the clinical follow-up of PSP patients treated with TT.This is a prospective observational study. After ethical committee approval and written informed consent were obtained, patients who were treated with TT because of PSP were screened. In the follow-up of these patients, a bedside lung ultrasound (BLUS) was performed before every chest x-ray by an emergency physician experienced in performing BLUSs. The performance of BLUSs in detecting free air in the pleural cavity was compared statistically with that of x-rays.Sixty-two patients were enrolled in the study. In total, 166 BLUSs and x-rays were compared. The sensitivity of BLUS was 95.65% (85.20-99.50), specificity was 100% (79.40-100.00), positive predictive value was 100% (92-100), negative predictive value was 88.90% (65.30-98.60), and the area under the curve was 0.99 (0.974-1.000; P = 0.001) for detecting air in the pleural cavity. These results showed that there was no statistically significant difference between BLUS and x-ray methods for detecting air in the pleural cavity.Our study revealed that BLUS can be safely used for the follow-up of PSP patients treated with TT to determine if air is present in the pleural cavity. Further studies are needed.

Effectiveness of the synthetic cannabinoids seminar.

OBJECTIVES: Synthetic cannabinoid or "Bonzai" use is a public health issue as its use has increased in Turkey as well as all over the world. The aim of this study is to evaluate the effectiveness of the "Synthetic Cannabinoids Seminar" that was provided to physicians who work in emergency services, using multiple choice questionnaires before and after the seminar as a tool for evaluation. MATERIAL AND METHOD: Synthetic cannabinoids seminars were provided to physicians who work in emergency services in two different cities, with the participation of 20 physicians in each scheduled seminar. The seminars were instructed by emergency medicine specialists and psychiatrists who were certified as an instructor by the Turkish Ministry of Health, after receiving an instructor course in synthetic cannabinoids. In order to measure basal knowledge levels of the participants, a pretest was performed for all participants before the seminar. After the seminar, a posttest was performed using the same questions in the pretest. The number of correct answers in both tests was then compared. RESULTS: In total, 85 individuals attended the seminars; 29 individuals from Dumlupinar University Evliya Çelebi Training and Research Hospital constituted first group, and 56 individuals from Denizli State Hospital constituted second group. In both groups, the ratios of correct answers in the posttest were determined to be higher when compared to the pretest. CONCLUSION: The seminars on synthetic cannabinoids are useful and necessary for physicians.

Acquired Solitary Glomangiomyoma on the Forearm: A Rare Case Report.

Glomus tumours are benign lesions which are frequently seen on hand (particularly subungual region). In this report a 52-year-old male patient with glomangiomyoma on the left forearm has been presented. With a preliminary diagnosis of haemangioma, a subcutaneous well-circumscribed nodular lesion of the patient was excised. On histomorphological examination glomus cells, vascular structures and spindle-shaped smooth muscle cells were seen around it. Immunohistochemistry of smooth muscle cells and glomus cells showed positivity for smooth muscle actin. By means of these findings, the patient was diagnosed with glomangiomyoma. Glomus tumours are rare in the forearm (In the literatüre there are two cases). Moreover, glomangiomyomas are the least common histomorphological type of glomus tumour and are generally seen in the lower extremity. In the literature, a few cases of glomangioma and solitary glomus tumour has been described on the forearm histologically and only a few glomangiomyoma cases on forearm location. We have presented the glomangiomyoma on the forearm as a rarely-seen case. Early diagnosis of the glomangiomyoma on the forearm is of importance for the prevention of morbidity.

Spontaneous splenic artery aneurysm rupture: mimicking acute myocardial infarct.

Spontaneous splenic artery aneurysm (SAA) is a rare but a life-threatening condition. Thus, early diagnoses may increase the chance of survival. A 52-year-old female patient was admitted to the emergency department with a pain that starts from the chest and epigastric region and radiates to back and left arm. The patient prediagnosed as having acute myocardial infarct and was under observation when acute abdomen and hemorrhagic shock developed. After further investigation, the patient was diagnosed as having SAA and has undergone a successful surgery. The patient was fully cured and discharged from the hospital on the seventh postoperative day. The patient originally presented with SAA, although she was primarily observed in the emergency department with acute myocardial infarct diagnosis because of similar symptoms and clinical findings to cardiovascular diseases. When changes in the clinical picture occurred, the patient was reevaluated and had undergone an operation because of SAA rupture. Therefore, physicians should take into consideration of aneurysm rupture in the differential diagnosis of the cardiovascular conditions; otherwise, the patient may lose his/her life.