MPV and MPV/P were found to be associated with RV dysfunction and clinical severity in acute PE. Low MPV and MPV/P levels may be an indicator of low risk and, high WBC levels may be an indicator of high risk in patients with acute PE. RDW levels may not reflect severity of acute PE.

Aim: Palliative care is an increasingly important issue in emergency departments worldwide. The present study aimed to evaluate the perspectives and experienced problems of emergency physicians about palliative care. Materials and Methods:A questionnaire that includes main topics of palliative care was prepared, and it was sent through internet access to all emergency physicians who work in Turkey. The whole data were statistically analyzed by Predictive Analytics Software (PASW) 18 and Statistical Package for the Social Sciences (SPSS) software 15.0 for Windows.Results: Ninety-five emergency physicians participated in the study. Most respondents reported reported getting no training about palliative care (77%). Most agreed that special training is required to acquire palliative care skills (91%), and 69% of emergency physicians want to get training on palliative care. Conclusion:Increasing awareness about palliative care is important in emergency departments and makes it possible for an early recognition and appropriate management of palliative care patients. The present study not only indicates the importance of education about palliative care but also contributes to increasing awareness on this issue. (JAEM 2015; 14: 75-8)

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Paraduodenal hernia is a rare congenital anomaly; however, it is the most common cause of internal herniation. Clinical findings are often indeterminate. Computerized tomography is usually diagnostic; however, the diagnosis is often made intra-operatively. Paraduodenal hernia carries a risk of incarceration leading to bowel obstruction and strangulation; therefore, it should be repaired surgically when diagnosed. Here we present a case of left PDH that was diagnosed preoperatively and repaired laparoscopically.Keywords: Laparoscopy, paraduodenal, hernia INTRODUCTIONInternal hernias result from the extension of the intestine through a defect within the peritoneum or mesentery (1). They may be either congenital or acquired. Paraduodenal hernia (PDH) is a rare congenital anomaly that results from an error of rotation of the midgut (2). PDHs are the most common form of internal hernias, accounting for 53% of all internal hernias (1, 3). PDHs are difficult to diagnose because the clinical symptoms are variable (4). PDH can begin with symptoms of acute obstruction or recurring abdominal pain (43%) or can be asymptomatic throughout the patient's life. Between 10% and 50% of internal hernias are discovered during unrelated abdominal surgeries or imaging exams and autopsy (5). Preoperative computerized tomography scan of the abdomen is usually diagnostic; however, the diagnosis is often made intra-operatively. Surgical treatment can be performed with traditional open methods or minimally invasive laparoscopic techniques. We describe herein the preoperative radiological diagnosis and successful laparoscopic repair of a left PDH in an adult man. CASE PRESENTATIONA 39-year-old man was admitted to the emergency department with complaints of epigastric cramps and nausea and vomiting that persisted for almost one day. It was known that he had been suffering from similar problems for a long time, and he had applied to 3 different hospitals in the last 10 days. There was no specific finding except for upper left quadrant tenderness. He had no history of abdominal surgery. His vital signs were normal. On his plain abdominal film, vague and limited air-fluid levels and a mass-like lesion were found in the left quadrants. Laboratory results were normal, except his leukocyte count was 11600. He was hospitalized for follow-up. It was noticed that he was comfortable while resting on his left side; however, his pain worsened in the supine position. Encapsulated and moderately dilated small bowel loops were detected in the upper left quadrant between the stomach and pancreas by CT (Figure 1). He was preoperatively diagnosed with left PDH. Four ports were inserted; one 10 mm supraumblical port for the camera, another port 10 mm from the upper left quadrant, and two 5 mm ports in the upper right quadrant. During exploration, left PDH was observed on the left side of Treitz's ligament behind the inferior mesenteric vein. An entrapped jejunum loop of approximately 80 cm was then reduced from the hernia sac into the abdominal cavity with an ...

Objective:We aimed to determine the demographics, clinical findings and symptoms of the admissions of non-benzediazepine antiepileptic drugs patients (NBDAED) admitted to the University hospital Emergency Department (ED). Material and Methods: The exposures above 18 years between 01.01.2006-01.01.2010 were included in this study. We evaluated the age, sex, kind of drug ingested, kind of poisoning, clinical finding and symptoms, and the results of the exposures to NBDAED. Results: The exposures to NBDAED composed 3.2% of all the poisonings. 92.2% of the patients had ingested drugs intentionally, 67.1% were between 18-29 years and 64.1% were females. Patients ingested most frequently old generation drugs (81.3%); the most frequently ingested drugs were carbamezapine (34.4%) and valproic acid (29.7%); 72% of the patients ingested their own drugs and most frequently 39% of them admitted to ED within the first 2 hours.More clinical findings and symptoms developed in toxic dose ingestions and the mean hospital stay duration was longer than non-toxic dose ingestions. Conclusion: Intentional drug exposures are at a high prevalence in NBDAED ingestions. It is mostly seen in the young adult group and females. The most frequently ingested drugs are the old generation drugs and the most frequently used drugs are carbamazepine and valproic acid. ÖzetAmaç: Üniversite hastanesi acil servisine başvuran non-benzodiyazepin antiepileptik ilaçlara (NBDAEİ) bağlı zehirlenme vakalarının demografik özelliklerini, klinik bulgu ve sonuçlarını ortaya koymaktır. Gereç ve Yöntemler: 01.01.2006-01.01.2010 tarihleri arasında acil servise zehirlenme şikayeti ile başvuran 18 yaş üstü hastalar çalışmaya kabul edildi. Bu hastalardan antikonvülzan ilaçlara maruz kalan olgular; yaş, cinsiyet, alınan antikonvülzan ilaç, zehirlenme tipi, klinik belirti ve bulgular ve sonuç verileri değerlendirildi. Bulgular: Non-benzodiyazepin antiepileptik ilaçlar ile zehirlenmeler tüm ilaç zehirlenmelerinin %3,2'sini oluşturmaktaydı. Hastaların %92,2'si istemli ilaç alımı, %67,1'i 18-29 yaş aralığında idi ve %64,1'i kadındı. Hastaların en sık eski kuşak (%81,3) ilaçlar ile zehirlendiği, en çok zehirlenilen ajanların karbamezapin (%34,4) ve valproik asit (%29,7) olduğu %72'sinin kendi ilacı ile zehirlendiği ve %39 ile en sık ilk 2 saat içinde hastaneye başvurduğu belirlendi. Toksik dozda ilaç alan hastalarda daha çok klinik bulgu ve belirti gelişmiş ve ortalama hastanede kalış süresi toksik dozda ilaç almayanlara göre daha uzun bulunmuştur. Sonuç: Non-benzodiyazepin antiepileptik ilaç alımlarında istemli ilaç alımı yüksek oranda gözükmektedir. Hastaların büyük çoğunluğunu genç yetişkin grubu oluşturmaktadır. Kadınlarda antiepileptik ilaçlara maruziyet oranı erkeklerden fazladır. En sık maruz kalınan ilaçlar eski kuşak antiepileptik ilaçlar olup bunlar içinde en sık görülen ilaçlar karbamazepin ve valproik asittir.