Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis.

OBJECTIVE: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. MATERIALS AND METHODS: This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed. RESULTS: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001). CONCLUSION: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.

Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.

OBJECTIVE: The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain. METHODS: This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Children's Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt. RESULTS: Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different. CONCLUSION: The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.

[Juguler vein gunshot injury from blank cartridges]. / Kurusiki tabanca atisi sonucu gelisen juguler ven yaralanmasi.

Blank cartridge guns, which are produced for self-defence needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by gunshot from blank cartridges may be fatal and are rarely encountered in emergency departments. A 3-year-old boy was brought to the emergency department since he had a wound on his neck caused accidentally by gunshot from blank cartridges. He had a moderate general condition and pale appearance. There was an irregular-edged, defective wound 2 cm above the sternal notch in midline localization with a dimension of 3 x 4 cm. Computed tomography of the thorax revealed contusion in the apex of the left lung. A 2-mm plastic piece embedded in the left internal jugular vein was removed during the operation. A mass education on danger and harm of these guns as well as legal regulations for restricted use seem to be necessary. Also, physicians should keep in mind that blank cartridge guns can cause fatal injuries.