Kienbock disease is a rare disorder involving the lunate, one of the carpal bones, and is therefore not generally included in the differential diagnosis of patients presenting to the emergency department with wrist pain. In this case report, we would like to highlight a case of Kienbock disease in a 28-year-old female patient without any medical or traumatic history. Although it is a very rare disease of the lunate, emergency physicians should consider Kienbock disease in those patients with complaints of pain, swelling and limitation of motion of the wrist. An overlooked diagnosis or misdiagnosis may lead to bony ischemia, necrosis, and ultimately collapse of the bone.
Özet Amaç: Birçok klinik değişken üst gastrointestinal sistem (GİS) kanamasında yüksek morbidite ve mortalite ile ilişkilendirilmiştir. Bu risk faktörlerine ek olarak, mevsimsel değişikliklerin üst GİS kanamasını etkileyebileceği öne sürülmektedir. Bu çalışma ile mevsimsel değişiklikler ile üst GİS kanamasının insidansı, Glasgow-Blactford risk skoru ve bazı klinik ve laboratuar değişkenler arasındaki ilişki araştırılmıştır. Materyal-Metot: Üst GİS kanama tanısıyla hastaneye yatırılan hastaların dosyaları tarandı. Yaş, cinsiyet, başvuru tarihi, başvurudaki laboratuar sonuçları, vital bulguları, Glasgow-Blacford skoru, yoğun bakım ihtiyacı, yatış süresi, eritrosit süspansiyonu ihtiyacı ve hasta sonlanımı kayıt edildi. Başka merkeze sevk edilen hastalar, yatışı süresinde üst GİS kanama tanısı dışlanan hastalar ve 18 yaş altı hastalar çalışma dışı bırakıldı. Bir yıllık süre kış, ilkbahar, yaz ve sonbahar olmak üzere 4 mevsime ayrıldı. Bulgular: Çalışmamıza 163 erkek, 108 kadın olmak üzere toplam 271 hasta dahil edildi. Yoğun bakıma yatan hasta sayısı 205, servise alınan hasta sayısı 66 idi. 187 hastaya eritrosit süspansiyonu uygulandığı, 35 hastanın ise öldüğü tespit edildi. Kan üre azotu, Glasgow-Blacford skoru, kalp hızı yüksekliği ile düşük sistolik ve diastolik kan basıncı değerleri yüksek mortalite ile ilişkili saptandı. Üst GİS kanamalı hasta sayısının özellikle mayıs ayında olmak üzere ilkbaharda arttığı, sonbaharda azaldığı saptandı. Mevsimler arasında klinik ve laboratuar bulgular açısından istatistiksel olarak anlamlı bir farklılık saptanmadı. Sonuç: Üst GİS kanamalı hasta sayısının ilkbahar aylarında arttığı görülmektedir. Acil servis hekimleri bu aylarda üst GİS kanama açısından daha dikkatli olmalıdırlar. Ayrıca mevsimler arasında hiçbir klinik ve laboratuar bulgusu açısından anlamlı farklılık olmadığı görülmektedir. Anahtar kelimeler: Acil Servis, Mevsimsel Değişiklikler, Üst GİS Kanama. AbstractObjective: Multiple factors are known to be associated with a high risk of morbidity and mortality in Upper Gastrointestinal Bleeding (UGB). In addition to these risk factors, it has been suggested that seasonal variations can influence UGB. In this study, it is investigated whether there is a relation between seasonal variation and the incidence of UGB, Glasgow-Blatchford risk score and clinical and laboratory parameters. Material-Method:We retrospectively reviewed the records of the patients who were diagnosed and hospitalized with UGB. Age, gender, admission date, laboratory parameters, vital signs and Glasgow-Blatchford risk score at admission, intensive care unit admission, length of stay, erythrocyte suspension transfusion requirement and outcome were all documented. Patients who were referred to another hospital despite having diagnosed UGB, patients who were found to have been misdiagnosed while follow-up and patients under 18 years old were excluded. The 12 months of the year were divided into four seasons as winter, spring, summer and autumn. Results: We included 271 patients, of whom 163 were males an...
Aim Allopregnanolone (AP) is a steroid of progesterone origin and it can readily pass through the blood–brain barrier. The aim of this study was to determine the AP levels occurring after head trauma in children and adults and to compare these results to the findings observed in the computed tomography (CT) of the respective individuals. Materials and Methods This study was conducted in the period from April 2018 to December 2018 on 92 patients admitted with isolated head trauma and on 80 healthy individuals in similar gender and age groups. The age, gender, and Glasgow Coma Scores of the patients; the cause of the head trauma; and the findings from CT imaging were recorded. Results The levels of AP were significantly lower in the head trauma patients both in the adult and pediatric groups compared with the healthy control groups of respective ages (p < 0.001). Furthermore, the levels of AP were significantly lower in both the pediatric and adult patients with identified pathologies in the CT images compared with their counterpart control groups (p < 0.001). In predicting an existing pathology in the CT, an AP level of > 138.5 was found to be 85.7% sensitive and 85.3% specific in the pediatric patients, and an AP level of >118.3 was 75% sensitive and 83.5% specific in the adult patients. Conclusion The levels of AP in head trauma patients were reduced in both the pediatric and adult patients and these low levels increase the likelihood of detecting pathology in CT images.
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