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    Accidental oral poisoning caused by RDX (cyclonite): a report of 5 cases
    (SageJournals, 2003) Küçükardalı, Yaşar; Acar, H. Volkan; Özkan, Sezai; Nalbant, Selim; Yazgan, Yusuf; Atasoyu, Enes Murat; Keskin, Özcan; Naz, Alişan; Akyatan, Nevzat; Gökben, Melih; Danacı, Mehmet
    The explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.
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    Cerebrovascular reactivity in multiple sclerosis patients
    (Sage Publications, 2007) Uzuner, Nevzat; Özkan, Sezai; Çınar, Nilgün
    A close relationship between multiple sclerosis (MS) lesions and the cerebral vasculature has long been recognised. Some studies have suggested that vascular endothelial cell activation might be an early event in the evolution of MS, and demyelisation may have an ischemic basis in this condition. Hypoxia caused by breath holding (BH) results in autoregulatory vasodilatation, and an increase in CBF to the cortex. The increased CBF can be evaluated by transcranial Doppler (TCD), and can provide information about the vascular integrity. In this study, we aimed to examine the vascular integrity and assess the vasomotor reactivity of MS patients in response to BH in different activation phases of the disease by means of TCD. We studied 12 patients with clinically diagnosed relapsing remitting (RR) MS, according to the Poser criteria. The initial TCD examination was performed in the first two days of an acute exacerbation of disease and prior to any treatment. The second test was performed just after iv methylprednisolone (IVMP) treatment, and the third examination occurred one month later, when the patient was in the remission phase. A group of 11 healthy subjects was also examined by TCD as control. Blood flow velocities were recorded during 30 seconds of normal breathing and 15 seconds BH. Vasomotor reactivity was calculated as a ratio of difference of cerebral flow velocities during BH. There were no significant vasomotor reactivity differences between the controls (55.7%) and the patients during attacks (46.5%), as well as after treatment (48.3%) and during attack free periods (50.9%). There were also no significant changes amongst the patients groups throughout the study. In this study, in different disease activity stages, we observed non-significant cerebrovascular vasomotor reactivity difference between the RRMS patients and the healthy controls, although it was slightly lower in the MS patients. This observation suggests that cerebrovascular reactivity is normal in different disease activity levels.
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    Comparison of hemodynamic and neuroendocrine changes during total intravenous anesthesia and inhalation anesthesia
    (Elsevier, 2001) Özkan, Sezai; Usyılmaz, Serdar; Çankır, Zeki; Cebeci, Bekir Sıtkı; Gökben, Merih
    Background: Various aspects of anesthesia and surgery cause stress-induced endocrine and metabolic changes in organisms due to stimulation of the sympathoadrenergic system. Intravenous and inhalation anesthetic agents alter endocrine and metabolic responses to surgical stimuli. Objective: The objective of this study was to compare the effects of 2 anesthesia methods on patient response to surgical stress. Three components of general anesthesia were involved: hypnosis, analgesia, and muscle relaxation. Methods: Patients were randomly assigned to 1 of 3 groups: Group I received total intravenous anesthesia (TIVA) using propofol and alfentanil. Group II received inhalation anesthesia and was divided into 2 subgroups: group IIA received isoflurane, and group IIB received sevoflurane. Patients from all 3 groups underwent assessment of hemodynamic variables (heart rate, systolic blood pressure [SBP], and diastolic blood pressure [DBP]) and endocrinologic variables (plasma levels of blood glucose, C peptide, insulin, catecholamines [epinephrine, norepinephrine], and cortisol). Results: Sixty patients were enrolled in the study and assigned to 1 of the 3 groups (20 per group). Heart rate decreased significantly (P < 0.05) after induction and remained lower than the preinduction value throughout surgery in the TIVA group. Significant increases in heart rate occurred in both inhalation anesthesia groups: after intubation (P < 0.01) and after extubation (P < 0.05) in the isoflurane group; after induction, intubation, and extubation (P < 0.05) in the sevoflurane group. SBP decreased significantly in the TIVA group (P < 0.01 after induction and P < 0.05 thereafter); significant increases (P < 0.05) were seen after intubation and after extubation in both inhalation anesthesia groups. DBP decreased (P < 0.05) after intubation in the TIVA group and increased in the isoflurane group (P < 0.01 after intubation and incision, P < 0.05 after extubation). At the first intraoperative hour, significant increases compared with preinduction values (P < 0.05) were observed in C peptide and insulin levels in the TIVA group, epinephrine in the isoflurane group, and blood glucose and norepinephrine in both inhalation anesthesia groups. Significant decreases (P < 0.05) were found in C peptide and insulin levels in the 2 inhalation anesthesia groups. Measurements taken at the second postoperative hour and compared with preinduction values revealed significant increases (P < 0.05) in C peptide in all groups, norepinephrine in the TIVA group, and insulin and cortisol in the 2 inhalation anesthesia groups. Conclusions: Based on our results, we concluded that hemodynamic and neuroendocrine responses to surgical stress are better controlled with TIVA compared with inhalation anesthesia.
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    Comparison of the therapeutic efficacy of 4-methylpyrazole and N-acetylcysteine on acetaminophen (paracetamol) hepatotoxicity in rats
    (Taylor & Francis Online, 2002) Küçükardalı, Yaşar; Cinan, U; Acar, H. Volkan; Özkan, Sezai; Top, Cihan; Nalbant, Selim; Çermik, Hakan; Çankır, M. Salih Zeki; Danacı, Mustafa
    Obtaining effective analgesia with a minimal erosive effect on gastric mucosal tissue has increased the consumption of acetaminophen (paracetamol), especially among the elderly. However, the hepatotoxic effects of acetaminophen have also increased. We aimed to compare the effects of 4-methylpyrazole (4-MP), N-acetylcysteine (NAC) and their combined use on the hepatotoxicity of acetaminophen in a rat model. Male Wistar Albino rats were divided into six groups. Groups 1-5 received 2,000 mg/kg acetaminophen by gavage while the control group was group 6. Group 2 animals were given NAC (loading dose 140 mg/kg followed by seven doses at 4 h intervals); group 3 received 50 mg/kg 4-MP; group 4 received 200mg/kg 4-MP; and group 5 received NAC as in group 2 plus 200 mg/kg 4-MP. Blood samples were taken for measurements of serum AST and ALT levels. The livers of the rats were removed for microscopic examination and grading of hepatic necrosis. AST and ALT levels in groups 2-5 were lower than that of group 1 (p < 0.001), although no significant difference was noted between groups 2-5 (p > 0.05). Higher levels of ALT were found in group 5 than in group 2 (p < 0.05), and higher levels of AST were found in group 5 than in group 3 (p < 0.01). Median necrosis scores were 3.36 for rats receiving acetaminophen alone (p < 0.001, compared with groups 2-6), 1.45-1.81 for groups 2-5 (p > 0.05, compared with each other), and 0.18 for control rats (p < 0.001, compared with groups 1-5). In conclusion, the administration of 4-MP and/or NAC after 4 h of administering toxic dose of acetaminophen, inhibits hepatotoxicity in rats. There was no difference between the 4-MP and NAC-treated groups as reflected by comparable levels of serum transaminases and the degree of hepatic necrosis. Combining of 4-MP and NAC offers no benefit.
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    Kikuchi's disease: Report of one case and an overview
    (Internet scientific publications, 2002) Küçükardalı, Yaşar; Çankır, M. Salih Zeki; Top, Cihan; Özkan, Sezai; Nalbant, Selim; Baloğlu, Hüseyin; Danacı, Mehmet; Öncül, Oral
    We describe , to our knowledge, the first Turkish patient with Kikuchi’s disease which is characterized by histiocytic necrotizing lymphadenitis with skin, liver, and lymph node involvement. The diagnosis was based on histopathological findings in open biopsy. Our patient was a young man, who had bilaterally, tender axillary lymphadenopathy, fever, arthralgia, cutaneous rash, and fatigue. Laboratory analyses identified an elevation of C-reactive protein 96 mg/L, lactate dehydrogenase 2558 U/L, aspartate transaminase 404 U/L, alanine transaminase up to 196 U/L. The erythrocyte sedimentation rate was 80 mm/h. Hematologic investigations revealed mild leukopenia, 3.4 x 109 /L, neutropenia, 1.4 x 109 / L, and hemoglobin 99 g/L. Viral, Toxoplasma, Mcoplasma, Brucella, and syphilis serology were negative. Also immunological and rheumatological tests were normal. A biopsy from an axillary lymph node findings confirmed the diagnosis of Kikuchi’s diseases. After the diagnosis, the patient received oral corticosteroid therapy, and one month after the onset of therapy he was totally symptomless and lymph nodes was normal. The cause of Kikuchi’s disease is unknown. A viral or postviral hyperimmune reaction has been proposed as its etiology. It is uncommon cause of fever of unknown origin. Malignant lymphoma and systemic lupus erythematosus should be considered differential diagnosis. Early recognition of Kikuchi’s disease will minimize potentially harmful and unnecessary evaluations and treatments.