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.     

One-bone forearm operation for defective ulna osteomyelitis: a case report

A four-year-old boy with forearm instability secondary to defective ulna osteomyelitis underwent one-bone forearm operation in neutral supination-pronation position. A year after the operation, shortening (3 cm) of the forearm was detected. Radiographs showed delayed union; however, a stable and functional forearm was obtained. The patient was able to use his fingers.     

The association between thyroid hormones and arterial stiffness in peritoneal dialysis patients

Background/Aims  

The association between thyroid hormones and arterial stiffness is unclear. In this study, we investigated, for the first time in a large cohort of euthyroid peritoneal dialysis patients, the relationship between thyroid hormone levels and arterial stiffness.     

Tension-type headache in children: A clinical evaluation

BACKGROUND: Headache Society (IHS) criteria for episodic tension-type headache were included in the present study. Pain characteristics, associated symptoms, and stress-triggering factors were evaluated. Psychiatric and psychosocial evaluations were performed according to DSM-IV criteria. RESULTS: Pain was bilateral in 93.7% of patients and bitemporal in 50% of children. The intensity of pain increased with motion and stress in more than half of the patients, while pain decreased with rest and massage in 43.7% of patients. Ten of the 16 (62.5%) patients were diagnosed as having a psychiatric disorder. The most common stress-triggering factors were difficulty in adaptation at school and relationship problems with family members. All of the children reported 26 stress factors. Of these stress factors, 20 (76.9%) were reported by children diagnosed with psychiatric disorder. CONCLUSION: These results suggest that in children with tension-type headache a thorough psychiatric evaluation should be performed to rule out underlying psychiatric disorders.     

Effect of multivariate process instability on principal component analysis: A case study

With the rising use of principal component analysis/partial least squares (PCA/PLS) in the process analytical technology (PAT) initiative of the pharmaceutical industry, it seems appropriate to view that approach from a statistical process control (SPC) perspective. The purpose of this study was to demonstrate the effect of process instability (ie, state of statistical out-of-control) on use of PCA/PLS. The demonstrated differences in results should encourage PCA/PLS users to incorporate SPC as an active part of their process analytical control (PAC) toolkit to check for stability prior to drawing conclusions based on PCA/PLS analysis.     

Molecularly designed water soluble, intelligent, nanosize polymeric carriers

Intelligent polymers, also referred as "stimuli-responsive polymers" undergo strong property changes (in shape, surface characteristics, solubility, etc.) when only small changes in their environment (changes in temperature, pH, ionic strength light, electrical and magnetic field, etc.). They have been used in several novel applications, drug delivery systems, tissue engineering scaffolds, bioseparation, biomimetic actuators, etc. The most popular member of these type of polymers is poly(N-isopropylacrylamide) (poly(NIPA)) which exhibits temperature-sensitive character, in which the polymer chains change from water-soluble coils to water-insoluble globules in aqueous solution as temperature increases above the lower critical solution temperature (LCST) of the polymer. Copolymerization of NIPA with acrylic acid (AAc) allows the synthesis of both pH and temperature-responsive copolymers. This paper summarizes some of our related studies in which NIPA and its copolymers were synthesized and used as intelligent carriers in diverse applications.