Introduction: Bee stings are the most common among insect emergencies. Presentation of case: We present a 47-year-old male patient who was admitted to the emergency department with complaints of pallor, chills, numbness and bruising on the left palm one hour after a bee sting on his left leg, and a very rare case of brachial artery stenosis in Dopler ultrasonography. Discussion: Often bee stings occur only with local allergic reactions; sometimes it can also cause myocardial infarction, pulmonary edema, bleeding, hemolytic anemia, and kidney disease and neurological manifestations. Side effects are generally thought to be related to the dose of this venom in these patients who are admitted to the emergency room with a bruise extending from the left hand to the arm after bee bites. Conclusion: With this case presented, we wanted to emphasize that thrombosis may occur due to bee stings, albeit rarely, and doctors in emergency departments should recognize these very rare cases. Highlights:

En tr EVALUATION RESULTS OF THE CASES APPLIED TO THE EMERGENCY UNIT WITH CAUSE OF HEAD TRAUMA SUMMARY: Objective: Brain and spinal cord injuries causing permanent damage and death continue to present a significant health problem in developed societies. Accidents are the most important cause of injuries. Our aim in our work is to examine the frequency, causes and consequences of head trauma and to emphasize the importance of pathological findings. Materials and methods: Descriptive analyzes of 100 consecutive patients evaluated by the neurosurgery who applied for the cause of head trauma between the dates of 2015 and 2016 in the emergency department of Kırıkkale University Faculty of Medicine were performed. Of these patients, 69 were males and 31 were females. Patients' cranial CTs were analyzed with the Marshall score. Patients' age, sex, causes of head trauma, GCS and GOS were noted. Findings: The Marshall score of the patients was 94% 1, 4% 2, 1% 3, 2% 4. GCS at arrival was 92%, 15%, 6% 14, 2% 3. GOS 96% 5, 1% 3, 3% 1. The mean age of the cases was 34.2 + 22.2. (1-83 years) According to the gender group, the incidence of car accidents (6.5% vs. 13%) and fights (3.2% vs 11.6%) were more frequent in males than females. In contrast, female traffic accidents (45.2% vs. 23.2%) were observed more frequently in males than females. As a result of falling in females, the injury was slightly higher than males. The results show that the greatest cause of head trauma in all groups outside the age range of 16-30 years is falling. In the 16-30 age group, the traffic accidents was responsible. Conclusion: It is thought that the reason for the drop in each age group is the most frequent reason for being a region where the rural characteristics of the region and the agricultural economy are protected. Ergonomic working and living conditions will increase the economic level, which will contribute to the solution of this result. KEY WORDS: traffic accidents, emergency unıt, head trauma ACİL ÜNİTESİNE KAFA TRAVMASI NEDENİ İLE BAŞVURAN OLGULARIN DEĞERLENDİRME SONUÇLARI: ÖZET: Amaç: Kalıcı hasara ve ölüme neden olan beyin ve omurilik yaralanmaları gelişmiş toplumlarda önemli bir sağlık sorunu oluşturmaya devam etmektedir (1). Kazalar yaralanmaların en önemli nedenini oluşturmaktadır. Çalışmamızda amacımız kafa travmalarının sıklığını, nedenlerini ve sonuçlarını incelemek, oluşan patolojik bulguların önemini vurgulamaktır. Gereç ve yöntem: Kırıkkale Üniversitesi Tıp Fakültesi acil bölümüne 2015- 2016 tarihleri arasında kafa travması nedeni ile Beyin cerrahisi bölümünce değerlendirilen ardışık 100 olgunun tanımlayıcı analizleri gerçekleştirildi. Bu hastaların 69’u erkek, 31’i bayandı. Hastaların çekilen Kranial BT’leri Marshall skoru ile analiz edildi. Hastaların yaş, cins, kafa travma nedenleri, geliş GKS ve çıkış GOS’ları not edildi. Bulgular: Hastaların Marshall skoru %94 ünde 1 di. 4 olguda 2, 1 olguda 3, 2 olguda 4 idi. Geliş GKS %92 sinde 15, 6 olguda 14, 2 olguda 3 idi. GOS ise 96 olguda 5, 1 olguda 3, 3 olguda 1 idi. Olguların yaş ortalaması 34.2+22.2 idi. (1-83 yaş) Olguların cinsiyet grubuna göre kaza nedenlerine bakıldığında erkeklerde araç dışı trafik kazası (ADTK), (%13 ‘e karşılık % 6.5), darp (%11.6 ‘ya karşılık %3.2) bayanlara göre daha fazla gözlenmekteydi. Buna karşılık kadınlarda ise araç içi trafik kazası (AİTK) (%45.2 ‘ye karşılık %23.2 ) erkeklerden daha fazla gözlemlenmiştir. Kadınlarda düşme sonucunda yaralanma erkeklerden biraz daha yüksekti. Sonuçlara bakıldığında 16-30 yaş dışındaki tüm grublarda kafa travmasının en büyük nedeni düşme olarak saptandı. 16-30 yaş grubunda ise AİTK sorumluydu. Sonuç: Bölgenin kırsal özellikleri ve tarım ekonomisinin korunduğu bir bölge olması, her yaş grubunda düşmenin nedenle en sık neden olarak gözlendiği düşünülmüştür. Ergonomik çalışma ve yaşam koşullarının sağlanması ekonomik düzeyin yükseltilmesi bu sonucun çözümüne katkıda bulunacaktır. Anahtar kelime: acil ünitesi, kafa travması

Esthesioneuroblastoma accounted for only 6% of the malignant nasal cavity neoplasms (ENB) is a rare tumor which originates from the olfactory epithelium. ENB's are locally agresive and can metastasize by lymphatic and hematogenous routes. A patient with the mass on the nasal dorsum was reported in this article. A 52-year-old-man admitted to the hospital with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal dorsum. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and intranasal biopsy with local anesthesia was performed. Histopathologic diagnosis of the tumor was Kadish stage B esthesioneuroblastoma. Tumor was excised by using bilateral endoscopic endonasal resection and lateral rhinotomy approach and paranasal radiotherapy performed postoperatively. Ten months after surgery, neck metastasis was occured and patient was underwent neck dissection. Twenteeth months after initial treatment, distant metastasis was identified on the T 10 vertebra and following the cranial and spinal radiotherapy to the neck he was free of local recurrence at follow up 13 months after surgery. It has been known that the metastasis of the ENB to the spinal cord is an uncommon event, and it occurs often years after initial diagnosis. MRI scan is helpful for making the diagnosis, and surgery is the treatment of choice for obtaining diagnostic tissue and debulking the tumor. Radiotherapy is also a mainstay of postoperative treatment.

Background: Trauma-related pneumocephalus and subcutaneous emphysema are relatively common, but pneumocephalus and pneumorrachis that occur without surgery are very rare. We present a case of pneumorrachis and pnemocephalus developing in the literature for the first time after stabbing from the anterior cervical region and providing improvement with conservative treatment. Case presentation: A 42-year-old male patient was brought to the emergency department after stabbed in the neck. Anteromedial injury of the sternocloid muscle was followed by two lacerations with active bleeding from the same site. The patient was unconscious (Glasgow coma score 8(E2, M4, V2). The patient was intubated. Bleeding foci and lacerations were repaired in the emergency. Cranial, cervical, thoracic and lumbar non-contrast computed tomography scans were performed. Moderate pneumocephalus was seen in the subarachnoid space in the anterior of the bilateral frontal lobe and in the suprasellar cistern region. Pneumorrachis was seen in C2-C7 levels of cervical spinal canal. The patient was pentotalized. 100% oxygen treatment for 6 h was given from the ventilator in intensive unit. After 72 h, cranial, cervical, thoracic and lumbar CT were performed. Pneumorrachis and pneumocephalus were fully recovered. Conclusion: Pneumorrachis is usually asymptomatic and is self-limiting. It is a radiological diagnosis and is not a clinical diagnosis. CT scan is considered the preferred diagnostic method for reliable and rapid detection of pneumorrachis. In case of coexistence, The physician should be alert to diagnose and treat the underlying cause for related injuries.In such cases, successful results can be obtained with hyper-oxy therapy (100% oxygen inhalation) and antibiotic prophylaxis without the need for surgical treatment. Highlights: