Abdominal pain is one of the most common reasons for admission to the emergency department in the geriatric population. The aim of this study was to investigate the diseases frequently detected in elderly patients diagnosed with acute abdomen in the emergency department, the imaging methods used in the diagnostic processes of these diseases, and the prognosis of the patients. In all, 175 patients who visited the emergency department due to abdominal pain and were hospitalized with a diagnosis of acute abdomen were evaluated. The patients were categorized into seven groups according to their diagnosis as biliary diseases, pancreatitis, appendicitis, gastrointestinal system perforation, ileus, mesenteric ischemia, and atypical causes. The mean age of the patients was 76.3±7.7 years (range 65–93), and 96 (54.9%) were women. The most common causes of acute abdomen were biliary diseases and pancreatitis. Ultrasonography (88.6%) was the most frequently preferred imaging method in the emergency department, and it was most frequently used for biliary diseases. Notably, 20 (11.4%) patients were treated in the intensive care unit, and 9 (5.1%) patients died. The most common causes of acute abdomen in the geriatric population were biliary diseases and pancreatitis, and ultrasonography imaging was the most common choice for the diagnosis of these diseases. In elderly patients with abdominal pain, rapid and accurate diagnosis and selection of the correct imaging method are extremely important.

Background and Objectives: The neutrophil-percentage-to-albumin ratio (NPAR) has been recognized as an independent risk factor for cardiovascular diseases. In our study, we investigated whether the NPAR is associated with the formation of coronary collateral circulation (CCC) in patients with chronic coronary syndrome (CCS). Materials and Methods: A total of 681 patients with CCS were included in this study. Of these patients, 571 had chronic total occlusion in at least one major vessel and developed collateral vessels. In total, 110 patients were in the control group, who had CCS but did not have complete occlusion in a major vessel and did not develop collateral vessels. Patients with collateral vessels on coronary angiography were divided into two groups according to the Rentrop score: poor CCC (Rentrop 0–1) and good CCC (Rentrop 2–3). Blood samples were taken for the NPAR and other biochemical parameters in all patients during hospitalization. The NPAR was calculated as the neutrophil-percentage-to-albumin ratio. Results: The group of patients with poor CCC had a higher white blood count (WBC), neutrophil, C-reactive protein (CRP), neutrophil–lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and NPAR values than patients with good CCC (p < 0.001, for all). Multivariate logistic regression analysis showed that high NPAR levels were an independent predictor of poor CCC (OR: 2.79, 95% CI:1.7–4.6, p < 0.001), accompanied by neutrophil, CRP, CAR, and NLR levels. In the receiver operator characteristic curve (ROC analysis), the cut-off value for the NPAR to indicate poor CCC was 1.78 with a sensitivity of 76.6% and specificity of 81.4% (area under ROC curve = 0.804 95% CI (0.753–0.854), p < 0.001). Conclusions: We demonstrated that the NPAR may be an independent predictor of poor CCC development in clinical practice.

Introduction: Both acute aorta dissection and ruptured aorta aneurism are prominent causes of death in cardiovascular diseases. The frequency of developing neurological complications in aortic dissections is reported to be between 2 to 8%. Stroke is more common in dissections involving the proximal aorta, but paraparesis is more common in distal aortic dissections due to circulatory impairment in the spinal arteries. Case: The 70-year-old male patient was referred to our emergency service from an external center with diagnosis of acute ischemic stroke. The patient had experienced loss of strength on his left side and had syncope one hour before. After his physical examination, the patient received computerized brain tomography and diffusion MR imaging with the pre-diagnosis of acute stroke. For the patient who had an appearance of acute diffusion restriction in the right parietal region in the diffusion MRI and had a chance of thrombolytic treatment, thrombolytic treatment was planned. However, the general status of the patient was worsened in this checkup examination, and his GCS score regressed down to 7. The poor current condition of the patient could not be explained by the acute ischemic stroke in the right parietal region. Aorta dissection, which may progress with clinical signs of stroke, was considered for the patient, and as an advanced test, dynamic thorax CT angiography was taken. In the dynamic thorax CT angiography of the patient, aneurism in the ascending aorta, dissection and fluid around the pericardium and left lung (hemorrhage?) were observed. The echocardiography of the patient revealed that the fluid around the pericardium caused tamponade. Discussion: Cardiovascular system diseases are the most common cause of natural sudden deaths and are mostly seen in middle and older ages. Acute myocardial infarction and coronary artery disease are the most common cardiovascular diseases, however, sudden deaths due to aortic dissection and rupture have been reported less frequently. The most typical symptom is the sudden start of severe chest or back pain. Patients typically visit with complaints of tearing chest and back pain, while they may visit with atypical clinical pictures wementioned in our cases such as abdominal pain, syncope, stroke. Sensory loss may also be seen in patients, and this is a neurological symptom which may extend from falling as leep to deep coma. Conclusion: Patients who visit emergency services with symptoms that are not expected for aorta dissection such as syncope, altered consciousness, hypotension, atypical abdominal pain and loss of strength in the extremities.

Aim: We investigated the importance of auxiliary diagnostic methods in cases when computed tomography pulmonary angiography (CTPA) cannot be used in pulmonary embolism (PE) with a high mortality rate.Materials and Methods: Patients were selected after the exclusion criteria were applied in a sample created from a single center. A total of 86 patients included in our study were examined in terms of clinical features, auxiliary diagnostic methods, anticoagulant use, and hospitalization and discharge status according to the massive or segmental involvement of PE in CTPA.Results: The mean age of the patients was 52.29±14.14 years. According to the CTPA results, there were 46 (53.5%) patients with massive involvement and 40 (46.5%) patients with segmental involvement. While there were 38 (82.6%) patients with massive involvement whose right chambers of the heart were dilated in echocardiography (ECHO) results, there were 19 (47.5%) patients with segmental involvement. There was a statistical significance between the massive involvement of CTPA and ECHO result (p=0.001).Conclusion: ECHO may be preferred as an auxiliary radiological method in the diagnosis of PE in emergency departments (ED), especially in massive embolisms.