Background:Acute appendicitis (AA) is one of the most common causes of emergent surgeries. Many methods are used for its diagnosis.Objectives:This study was conducted to investigate the diagnostic value of MPV and RDW in acute appendicitis.Patients and Methods:This study was a retrospective multi-center cross sectional planned study. The study included 260 patients operated for AA and 158 patients as the control group. Groups were compared in terms of MPV, RDW, white blood cell count (WBC), neutrophil predominance (NP) and platelet count (PC).Results:MPV was significantly lower in AA group, compared to the control group (P < 0.001). The best cut-off level for MVP in AA was ≤ 7.3 fL and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy ratio were 45%, 89.2%, 87.3%, 49.6% and 61.7%, respectively. There was no significant difference between the two groups in terms of RDW and platelet values.Conclusions:MPV is a routinely measured parameter in complete blood count (CBC) and requires no additional cost. It significantly decreased in AA, having a greater sensitivity and NPV when combined with WBC and NP.

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Vertigo is a common complaint in the emergency room. Vertigo can be central or peripheral in origin and it is important for an emergency physician to make a correct differential diagnosis. The purpose of our study was to emphasize the role of cranial magnetic resonance imaging (MRI) and audiological tests in differential diagnosis of patients who present with vertigo to the emergency room. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Fifty patients (31 female, 19 male, mean age 50.84 years) with vertigo who were admitted to the Hacettepe University Faculty of Medicine Emergency Room (ER) between 01.10.2004 and 31.01.2005 were included in the study. Physical and neurological examinations of all patients were performed by senior residents and all patients were evaluated by Ear Nose Throat specialists. Audiologic and vestibular tests and MRI with 3T (Tesla) magnetic field power were performed in all patients. R Re es su ul lt ts s: : Among 29 patients with normal neurological examination, only 3 (10.3%) had lesions on MRI. MRI scans revealed lesions suggesting central vertigo etiology in six (18.2%) patients out of 33 with abnormal audiological test suggesting peripheral vestibulopathy. C Co on nc cl lu us si io on n: : In conclusion, in our prospective study, urgent cranial MRI technique in patients presenting to the emergency room with vertigo may reveal significant findings regarding the differential diagnosis and concomitant pathologies. However, meticulous neurological examination can exclude central vertigo in the majority of the patients.

A 21-year-old male presented to the emergency department with the complaint of muscle weakness. The patient had used a powderized over-the-counter product named 'Tekumut' for 2 weeks to quit smoking. The granulated product was studied and determined to contain 'licorice' containing glycyrrhizic acid.Licorice (a plant which contain glycyrrhizic acid) -induced hypokalemia usually has a mild progression. However, it may cause a critical failure in physical action by means of weakness followed by paralysis and may cause rhabdomyolysis or ventricular fibrillation, leading to death, when left untreated.This report has presented the first case with hypocalemia due to licorice consumption in granulated form from Turkey. In addition, the report has aimed to emphasize the importance of obtaining the detailed history of a patient in diagnosis.

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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.Keywords: Procalcitonin, acute cholecystitis, severity of illness index ÖZ Amaç: Bu çalışmanın amacı akut kolesistitin şiddeti ile prokalsitonin (PCT) seviyesi arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Bu çalışmaya akut kolesistit tanısı alan 200 hasta alındı. Tanıyı koymak ve akut kolesistitin şiddetini belirlemek için; fizik muayene ve abdominal ulltrasonografi bulguları değerlendirildi ve beyaz küre sayımı (BKS), eritrosit sedimentasyon hızı (ESH), koagülasyon faktörleri, kan gazı, C-reaktif protein (CRP) ve PCT düzeylerini belirlemek için kan örnekleri alındı. Hastalar akut kolesistitin şiddetine göre Tokyo klavuzu kullanılarak hafif, orta ve ağır olmak üzere üç evrede sınıflandırıldı. Akut kolesistitin şiddetini değerlendirmede PCT düzeylerinin yeri ve PCT düzeyi ile evreler arasındaki korelasyon istatiksel olarak analiz edildi.Bulgular: Akut kolesistitli hastaların; 110 (%55)'u hafif, 61 (%30,5)'i orta ve 29 (14,5)'u ağır olarak sınıflan-dırıldı. Hastaların %48,5'inde lökositoz veya lökopeni, %72,5'inde ESH yüksekliği, %55,5'inde CRP pozitifliği, %27' sinde PCT yüksekliği ve %54,5'inde pozitif ultrasonografi bulguları saptandı. Serum BKS, ESH, CRP ve PCT düzeyleri hastalığın şiddetiyle beraber artış gösterdi...

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