Outcome analysis in patients with Fournier's gangrene: report of 45 cases

INTRODUCTION: Despite antibiotics and aggressive debridement, the mortality rate of Fournier’s gangrene remains high. Attempts have been made to study factors that may affect prognosis; however, reliable criteria are still lacking. METHODS: The medical records of 45 patients with Fournier’s gangrene who presented at the Ege University Medical Faculty Hospital from January 1990 to May 2001 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Univariate analysis was performed using the chi-squared test and Fisher’s exact probability test, then multivariate analysis of statistically significant variables was performed using logistic regression. RESULTS: The most prominent associated disease was diabetes, affecting 55.6 percent of the patients. The overall mortality rate was 20 percent. However, the mortality rate among diabetics was 36 percent (P = 0.002). The other statistically significant predictors of outcome were the interval from the onset of symptoms to the initial surgical intervention (P = 0.001) and the need of fecal diversion (P = 0.009). Multivariate regression analysis disclosed that the interval from the onset of symptoms to the initial surgical intervention and diabetes were independent predictors of mortality (P = 0.001 and P = 0.003, respectively). CONCLUSION: The interval from the onset of clinical symptoms to the initial surgical intervention seems to be the most important prognostic factor with a significant impact on outcome. Given the significantly high mortality rate among diabetics, diabetes is also an independent prognostic factor. Despite the decreased number of idiopathic cases and extensive therapeutic efforts, Fournier’s gangrene remains a surgical emergency, and early recognition with prompt radical debridement is the mainstays of management.     

Tissue parasites in patients with chronic urticaria

Chronic urticaria is an important diagnostic and therapeutic problem. We aimed to investigate the sero-prevalence of tissue parasites causing toxocariasis and fasciolosis in patients with chronic urticaria. All cases were analyzed for antibodies against Toxocara canis and Fasciola hepatica by modified (homemade) ELISA. The excretory/secretory products of Toxocara and Fasciola were used as antigens (ES-ELISA) in the test. In this study, the highest toxocariasis seropositivity (29.0%) rate and the highest fasciolosis seropositivity (14.5%) rate were found in patients with chronic urticaria. Fasciolosis seropositivity and total seropositivity of toxocariasis and fasciolosis in patients with chronic urticaria was significantly higher than in healthy controls (p<0.05). Toxocariasis seropositivity in patients with chronic urticaria was not significantly higher than that in healthy controls (p>0.05). We suggest that parasitic infections should be considered as an important cause of chronic urticaria. Serological methods should be used to expose the diagnosis of tissue parasites in such cases.     

Structure-activity study of LVV-hemorphin-7: angiotensin AT4 receptor ligand and inhibitor of insulin-regulated aminopeptidase

The decapeptide LVV-hemorphin-7 binds with high affinity to the angiotensin IV (Ang IV) receptor (AT(4) receptor), eliciting a number of physiological effects, including cellular proliferation and memory enhancement. We have recently shown that the AT(4) receptor is identical to insulin-regulated aminopeptidase (IRAP) and that both LVV-hemorphin-7 and Ang IV inhibit the catalytic activity of IRAP. In the current study, a series of alanine-substituted and N- or C-terminally modified analogs of LVV-hemorphin-7 were evaluated for their abilities to compete for (125)I-Ang IV binding in sheep adrenal and cerebellar membranes. Selected analogs were also analyzed for binding to recombinant human IRAP and inhibition of IRAP aminopeptidase activity. C-Terminal deletions of LVV-hemorphin-7 resulted in modest changes in affinity for IRAP, whereas deletion of the first three N-terminal residues abolished binding. Monosubstitutions of Tyr(4) and Trp(6) with alanine resulted in a 10-fold reduction in affinity. Competition binding studies using recombinant human IRAP demonstrated the same rank order of affinity as obtained for the ovine tissues. All LVV-hemorphin-7 analogs tested, except for Leu-Val-Val-Tyr, inhibit the cleavage of the synthetic substrate, leucine beta-naphthylamide, by IRAP, with K(i) values between 56 and 620 nM. We find that the Val(3) residue is crucial for LVV-hemorphin-7 binding to IRAP, whereas the C-terminal domain seems to play a minor role. The current study highlights the minimal residues necessary for binding and inhibition of IRAP and provides a basis to design peptidomimetic analogs for experimental and potentially clinical use.     

Correlation between blood group and noise-induced hearing loss

OBJECTIVE: To investigate the correlation between blood group and noise-induced hearing loss (NIHL). MATERIAL AND METHODS: The study was conducted in 176 factory workers who had been exposed to a noise level of 85-90 dB for 8 h a day for a period of > or = 10 years. Pure-tone audiometric measurements were performed in a standard silent room. The blood groups of the workers were obtained from the factory files. RESULTS: NIHL was found in 23 (32.0%), 35 (58.3%), 10 (38.5%) and 7 (38.9%) persons with blood groups A, O, B and AB, respectively. NIHL was determined to be significantly more frequent in workers with blood group O. CONCLUSION: We suggest that people with blood group O are more prone to develop NIHL.     

Rapidly growing sublingual dermoid cyst throughout pregnancy

Dermoid cysts (DCs) are subcutaneously located cystic masses that contain epithelium and adnexal structures. They are most commonly located in the ovaries and sacral region. Seven percent of DCs are found in the head and neck. Sublingual DCs may develop above the mylohyoid, presenting in the floor of the mouth or below it, causing a submental or submaxillary mass. We presented a case with a sublingual giant DC enlarged rapidly during pregnancy manifesting deglutition and mild respiratory problems. The growth of a DC of the neck may be accelerated in pregnancy period and may ensue severe symptoms challenging both mother and fetus. We proposed the removal of sublingual DCs before attempting to conceive to eliminate the risk of rapid growth of DC that results in respiratory and deglutition problems.     

Double-chambered right ventricle mimicking asymmetric septal hypertrophy

Double-chambered right ventricle (DCRV) is an uncommon congenital heart disease. Anomalous muscle bundles in the right ventricle divide the right ventricle into two portions and cause intracavitary obstruction of the right ventricle. We report a patient with DCRV mimicking asymmetric septal hypertrophy. We did clinical, echocardiographic and angiographic evaluation. Surgical intervention was successfully managed.