Contemporary management of penile fracture

Penile fracture (PF) is an uncommon injury defined as the rupture of the tunica albuginea and corpus cavernosum of the penis, usually resulting from direct blunt trauma to the erect penis during sexual intercourse or masturbation. PF is one of the few urologic emergencies. This article reviews the status, contemporary management, and the controversies of the diagnostic approaches and therapeutic modalities of penile fractures. It is usually diagnosed only clinically with the history of the patient, inspection, and physical examination. However, additional imaging procedures such as cavernosography, ultrasonography, magnetic resonance imaging, and retrograde ureterography may also be indicated whenever the diagnosis or the extent of the severity and location of the rupture is not clear, and/or when an accompanying urethral injury is suspected. Although the diagnosis of PF is usually easily recognized, optimal therapy remains controversial. The most widely accepted approach for the treatment of PF is early surgical treatment, but some investigators still advocate nonoperative conservative management.     

Palatal myoclonus occurring during complex partial status epilepticus

Summary Palatal myoclonus is thought to occur after damage to certain brain-stem structures, and with a delay following the causative lesion. A case of palatal myoclonus, probably of epileptic nature, is described.     

Rapidly progressive aphasic dementia and motor neuron disease

Articulatory and language impairment heralded rapidly progressive motor neuron disease in 7 patients aged 54 to 77 years. One patient had a family history of a similar disorder. Severe nonfluent aphasia developed in all 7 patients and 4 were anarthric within a year. Other cognitive domains were impaired, yet 2 patients lived alone until 1 month before their deaths. Four died within 2 years. Abnormalities were found on electromyography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, and electroencephalography. Neuropathological examination in 3 patients showed bilateral hemispheric atrophy with neuronal loss and gliosis predominantly of superficial cortical layers. Pigmented and hypoglossal nuclei were relatively preserved. At all spinal levels there was degeneration of corticospinal tracts and loss of anterior horn cells with gliosis. Rapidly progressive aphasic dementia and motor neuron disease are a distinctive clinical entity whose nosology is poorly understood.     

Laryngeal reconstruction with porous high-density polyethylene.

OBJECTIVE: This study was undertaken to evaluate the use of the Medpor (Porex Surgical, College Park, GA) implant in laryngeal reconstruction and to discuss potential indications of this material in head and neck surgeries. METHOD: Twelve rabbits were used in this particular study. Laryngoplasties were performed by extracting 5 x 10-mm thyroid cartilage and replacing it with Medpor implant. Animals were sacrificed in the 1st, 2nd, and 4th weeks and 2, 6, and 9 months after implantation. The degree of fibrous capsule formation, histiocytic reaction, foreign body giant cell reaction, lymphocytic and neutrophilic reactions, vocal fold changes, and hyaline cartilage formation in the implant bed were evaluated. RESULTS: Fibrous capsule was formed around the implant in 2 weeks. Four weeks after the implantation cellular reaction in the implant bed decreased significantly. Foreign body giant cell reaction was detected only the first 2 weeks after the implantation. CONCLUSION: According to the results of this study, the Medpor implant can be safely used in laryngeal reconstruction.     

CT staging of alveolar echinococcosis of the liver

The purpose of this study was to assess the usefulness of a new staging scheme for alveolar echinoccocosis un of the liver. A total of 28 patients with hepatic alveolar echinococcosis underwent CT examinations and were staged according to the proposed staging scheme (stage 1: lesion measuring less than 3 cm in diameter; stage 2: lesion greater than 3 cm, confined to less than three hepatic segments; stage 3 a: lesion with invasion of more than three hepatic segments; stage 3 b: invasion of liver hilum or suprahepatic vena cava; stage 4: invasion of surrounding organs and/or distant metastasis). Of the patients 16 underwent laparotomy, and results of the radiologic staging were correlated with surgical data. The CT findings correlated well with surgical findings. Patients were followed-up for a period of 6 months to 7 years. We concluded that the proposed staging scheme seemed to be useful for the therapeutic planning of patients with alveolar echinococcosis of the liver. Correspondence to: I. Rozanes     

A Newton-like approximation algorithm for the steady-state solution of the riccati equation for time-varying systems

An approximation technique is developed for the steady-state solution of the time-varying matrix Riccati equation. We show how the Newton-type algorithm of Kleinman, developed for computing the steady solution to the algebraic Riccati equation for time-invariant systems, can be extended for time-varying linear systems. The time-varying case is considerably more involved than the time-invariant one. Consider a linear time-varying system x (t) = F (t) x (t) + G (t) u (t). If ( F , G ) is uniformly completely controllable, we show how one can construct a recursive sequence of matrix functions (using linear techniques) which converge to the steady-state solution of the associated time-varying matrix Riccati equation (a non-linear object). At each successive state, the next approximation is in terms of the steady-state solution to a linear Lyapunov differential equation (which is the extension of the algebraic Lyapunov equations used by Kleinman) for which an explicit expression exists. This provides an approximation technique for obtaining infinite-time, linear-quadratic, optimal controllers and steady-state Kalman—Bucy filters for time-varying systems using purely linear techniques. Thus, we provide new types of suboptimal stabilizing feedback laws for linear time-varying systems.     

Microbial analysis of the autogenous bone collected by bone filter during oral surgery: a clinical study.

PURPOSE: The purposes of the study presented are to identify the microbial content of the collected bone debris and to determine the antibacterial efficiency of chlorhexidine mouth rinse in reducing the microbial content of the collected bone debris. PATIENTS AND METHODS: Twenty-five patients who had asymptomatic fully impacted mandibular third molars bilaterally underwent surgical removal for prophylactic and orthodontic considerations. Immediately before surgery all patients rinsed with 10 mL of their assigned solution (chlorhexidine or sterile saline) for 2 minutes. Before surgical removal of the teeth, bone debris was collected with a stringent aspiration protocol from the ramus by bone filter. The microbial content of the bone debris was assessed and the bacterial levels between the 2 groups were compared statistically. RESULTS: All samples from both groups (chlorhexidine or sterile saline) yielded viable microorganisms. There was no significant difference between the mean/median colony-forming units (CFU)/g values of both group samples, for aerobes (Streptococcus salivarius) and anaerobes (Bacteroides, Peptococcus, Peptostreptococcus, and Veillonella species). With regard to total microorganisms, the mean CFU/g derived from the chlorhexidine group samples were 1.5 x 10(8) CFU/g per bone sample compared with 1.5 x 10(9) CFU/g for the sterile saline control group (P < .05). CONCLUSION: Although chlorhexidine rinsing immediately before surgery reduced the levels of total microorganisms when compared with stringent aspiration protocol alone, it has not been found effective on aerobic Streptococcus salivarius and, importantly, on anaerobes. The reduced bacterial levels may still carry high infectious risk and may lead to failure in autogenous grafting procedures in oral surgery.     

Evaluation of the maternal and fetal risk factors associated with neonatal care unit hospitalization time

Objective: To evaluate maternal and neonatal risk factors associated with the length of hospital stay in the neonatal intensive care unit (NICU).

Material and method: This retrospective observational study was based on 3607 newborns who were admitted to the NICU of a tertiary teaching hospital from January 2012 through December 2014. Known obstetric risk factors associated with duration of hospitalization in NICUs were assessed including intrauterine growth restriction, maternal diabetes, oligohydramnios, chorioamnionitis, premeture rupture of membranes, preeclampsia, congenital malformations, neonatal sepsis, premature retinopathy, intracranial bleeding, necrotizing enterocolitis, meconium aspiration, maternal hypertension, fetal congenital cardiac malformations, congenital metabolic diseases, congenital hypothyroidism, pneumonia, pulmonary hypertension, bronchopulmonary dysplasia, pneumothorax and respiratory distress syndrome.

Results: Gestational age (beta coefficient:??0.244, p<0.001) and birth weight (beta coefficient:??0.237, p<0.001) were significant confounders for duration of hospitalization in newborns.

Conclusion: Gestational age and the birth weight were the most important confounders for duration of hospitalization. Neonate care in developing countries would further benefit from additional large population-based long-term studies with broad parameters.     

Does platelet mass influence the effectiveness of ibuprofen treatment for patent ductus arteriosus in preterm infants?

Objective: The aim of this study is to evaluate whether the platelet mass in the first 24?h of life is effective on closure of patent ductus arteriosus (PDA) or not.

Study design: Preterm infants with a gestational age of?<?32 weeks, hospitalized at a tertiary neonatal intensive care unit (NICU) and requiring medical treatment (intravenous or oral ibuprofen) for hemodinamically significant PDA (hsPDA) were enrolled in this study. The patients were divided into two groups after first course of pharmacologic treatment according to closure of PDA (Group 1: PDA closure, Group 2: PDA without closure). Groups were compared in terms of demographics findings, morbidities, platelet measurements like counts, mean platelet volume (MPV) and platelet mass (platelet count?×?mean platelet volume).

Results: The study included 77 preterm newborns in Group 1, and 30 preterms in Group 2. There were no differences in birth weight, gestational age, gender and maternal risk factors between the study groups. The mean platelet count in the first postnatal blood count was in Group 1: 211.3?±?89.2?×?10³/mm³ and in Group 2: 216.5?±?26?×?10³/mm³, respectively (p?=?0.783). The mean platelet volumes (MPV) were similar in both groups (p?=?0.535). No statistically significant difference between platelet mass values was detected (Group 1: 1811?±?884 fl/nl, Group 2: 1868?±?717 fl/nl) (p?=?0.753).

Conclusion: Our data suggest that platelet count, MPV and platelet mass did not affect the closure of hsPDA with ibuprofen.