Applicability of fetal renal artery Doppler values in determining pregnancy outcome and type of delivery in idiopathic oligohydramnios and polyhydramnios pregnancies

Aims: To investigate the relationship between fetal renal artery Doppler results and pregnancy outcomes in patients with idiopathic abnormal amniotic fluid indices. Material and method: A total of 110 patients without signs of fetal distress were included in the study: 31 idiopathic oligohydramnios and 29 idiopathic polyhydramnios pregnancies (study group) and 50 normal pregnancies (controls). Doppler investigation of the umbilical artery (UA), middle cerebral artery (MCA), fetal descendant thoracic aorta (DTA) and fetal renal artery (RA) was performed in all patients. Fetal RA resistive index (RI) and pulsatile index (PI) values were measured. Values pertaining to type of birth, newborn weight and APGAR scores were compared. Results: Average patient age, gravidity and week of pregnancy were 25±4, 1.6, and 37.4±1, respectively. There were no statistically significant differences between the groups as far as UA S/D, MCA S/D, DTA S/D, DTA RI, DTA PI, and RA S/D measurements were concerned. However, in the oligohydramnios group RA RI and RA PI values were significantly higher than the other two groups. Birth weight in the polyhydramnios group and cesarean section rate due to fetal distress in the oligohydramnios group were significantly higher. Conclusions: In the oligohydramnios group, without affecting fetal distress parameters, Doppler USG evaluation identified an increase in the RA resistance. Also in that group, cesarean rate due to fetal distress during labor was significantly higher than in the remaining two groups. Due to the predictive potential of values of fetal renal artery Doppler of fetal outcome further large sample-sized studies on the subject ought to be carried out

Dworkin's prudent insurance ideal: two revisions

This article offers two revisions to Dworkin’s ‘prudent insurance ideal’, which aims to account for justice in the distribution of healthcare so that (a) it can deal with market failures in healthcare and (b) when applied to unjust societies it addresses health problems caused by injustice in a fair manner

Optimal effective doses of cabergoline and bromocriptine and valvular leasions in men with prolactinomas

OBJECTIVES: Prolactinoma is the most common pituitary adenoma, and dopamine agonists( BRC, and CAB) is the primary therapy. Recently, the increased prevalance of cardiac valvular disease in patients treated with DAs for Parkinson's disease has raised concerns about the safety of this drug in patients with prolactinoma. CAB and pergolide are frequently reported to cause valvulopathy, there are very few studies showing this side effect in BRC administiration which has less potent agonism of 5-HT2B receptors. Male patients who are known to have higher prevalance of macroadenomas compared to women. The dosage of DAs administered were rarely evaluated

Activated flux TIG welding of non- ferrous metals

164-169TIG welding process has high levels of stability and permits more refined control than the majority of other arc welding processes. The principal disadvantages of TIG lie in the limited thickness of material which can be welded in a single pass. Activated Flux Tungsten Inert Gas (A-TIG) welding can increase the joint penetration and weld depth/width ratio, thereby reducing angular distortion of the weldment. In this review paper, A-TIG welding properties of nonferrous metals are examined. How the flux increases the penetration depth is explained and then the effects of the chemical composition and thickness of the flux are described in detail

Rates and Risk Factors of Diabetic Foot Reamputations

SUMMARY Aim: The aim of this study is to determine the reamputation rate in patients who had amputation surgery in our hospital with the diagnosis of diabetic foot and to analyze the comorbid factors. Material and Method: Of 131 patients with detailed information in their files 66 patients who had amputation surgery are included in the study. Age, gender, smoking habits, comorbid diseases, number, level, side and time period of amputation surgeries experienced, presence of infection, wound culture growth of microbes, presence of leukocytosis and method of treatment are recorded. Diabetic foot ulcers of the patients are graded with Wagner-Meggit classification depending on the depth of the wound. Wounds are also evaluated in three different pathophysiological groups as neuropathic, neuropathic-ischemic and ischemic. Levels of amputation were digital, ray, transmetatarsal, below-knee transtibial and above-knee transfemoral. Ipsilateral or contralateral reamputations in previosly amputated patients were investigated. Results: Of the 66 patients who experienced amputation or reamputation surgery 45 were males and 21 were females. Mean age was 63,2 ( 26-88 ). 11 patients had reamputation surgery. 7 patients had ipsilateral reamputations at a more proximal level, 2 patients had contralateral side amputations and ipsilateral more proximal level reampuations and 2 patients had contralateral side amputations. Wagner-Meggit classification of the wounds in amputated patients yielded 4 Grade3, 40 Grade4, 11 Grade5 wounds where as 7 Grade4, 4 Grade5 wounds in reampuatated patients. Pathophysiological classification yielded 6 neuropathic, 21 neuroischemic and 28 ischemic wounds in amputation group where as 4 neuroischemic and 7 ischemic wounds in reamputation group. Discussion: Evaluation of diabetes dependent and nondependent comorbid risk factors as well as the physiological capacity of the patients are important as much as selecting accurate level of amputation level with the aid of new diagnostic techniques in decreasing reamputation risk and rates. [Med-Science 2012; 1(4.000): 283-91

A Retrospective Analysis of Amputation Rates and Comorbidity in Patients with Diabetic Foot Ulcer

Abstract Diabetic foot ulcers cause elongated hospitalisations with high treatment costs and high rates of lower extremity amputations resulting with increased morbidity and decreased quality of life. The aim of this study was to determine amputation rate in patients admitted to our hospital with the diagnosis of diabetic foot and the most common risk factors in patients with diabetic foot ulcers. 131 patients admitted to outpatient clinics of Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2011 and December 2011 with the diagnosis of diabetic foot ulcer were retrospectively analyzed. Of these 96 were males and 35 were females. Age, gender, smoking and alcohol habits, comorbid diseases, presence of infection, growth of microorganism in medium, presence of leukocytes, hypertension, method of treatment and regimes of antibiotics are recorded. Mean age was 61,1 ( 26-90). Patients are divided into two groups according to treatment protocols, first group was consist of debriated and medicaly treated patients, while the second group covered amputated patients. 66 were amputated and the rest 65 had debridement-wound care and antibiotherapy after they were evaluated in the diabetic foot council of our hospital. Rate of amputation was 50 %. 36 of the amputated patients had major and the others had minor amputations. Most common comorbidities that related and nonrelated to diabetes were peripheral arterial disease ( 102 out of 131; 77% ) and hypertension ( 50 out of 131; 38% ); respectively. Grading of diabetic ulcers according to Wagner-Meggit classification yielded that most commonly seen wounds were grade 4 in the amputation group and grade 2 in the debridement group. According to pathophysiological classification most common cause were ischemic wounds in both groups. Compared to the literature, our amputation rates are higher. This issue can be attributed to high rates of comorbid factors, higher age and irregular follow-up. Key words: diabetic foot, amputation, comorbidity [Med-Science 2012; 1(4.000): 331-40

Investigation of Factors Affecting Friction Stir Welding of Polyethylene by ANOVA Analysis

The variables that are effective in joining high density polyethylene sheets by friction stir welding (FSW) have been investigated. In order to understand the effects of welding parameters, using Taguchi optimization, tool rotation speed, feed rate, shoulder diameter and pin diameter values were selected in a wide range. The results obtained with Taguchi optimization method were evaluated according to the highest / the best signal-noise ratio. Macro photographs taken cross-sectional view taken the weld seam, SEM images and hardness measurements were used to evaluate. As a result of the evaluation, the accuracy of the optimization was found to be approximately 96 %. As a result, feed rate and shoulder diameter were determined as the most effective parameter affecting the welding quality and welding performance. These two parameters (shoulder diameter and feed rate) have found to effect of approximately 65 % on tensile strength, weld quality and hardness. Finally, it has obtained that the most effective welding parameter was the shoulder diameter with 40.81 %

Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study

When perforining a medial opening wedge upper tibial osteotomy, a fracture into the lateral cortex can lead to loss of stability of the construct. The aim of this study was to assess different intra-operative techniques to overcome this problem, and test the stability under axial compression. Twenty eight calf tibias had a medial opening wedge osteotorny and lateral cortical fracture created and then were tested in four groups depending on how this fracture was fixed; none, a plate and screws, two staples, and a circular external fixator. Loss of medial height of the osteotomy line and lateral cortex micromotion was evaluated under maximal axial loading of 2500 N. No fixation had significantly inferior results compared with the other three types. The plate and screws and staples showed better results than circular external fixation in terms of preserving the medial height, whereas the plate and screws and circular extema[ fixator showed better results compared with staples in terins of lateral cortex stability. This study suggests that plate and screw fixation for lateral cortex disruption during the medial opening wedge upper tibial osteotomy has better stability under axial compression than staples or a circular external fixator. (c) 2008 Elsevier B.V. All rights reserved

The effects of focused ultrasound pulsation of nucleus accumbens in opioid-dependent rats

Background: Deep Brain Stimulation (DBS) is the only modality proven to be effective on selective stimulation of the deep brain structures. It was previously reported that, by using DBS, stimulation of nucleus accumbens (NA), a region that plays a pivotal role in the pathogenesis of substance addiction, is effective for the treatment of substance addiction. Objective: The purpose of the current study was to observe how the morphine-conditioned place preference changed in rats by stimulating NA with a non-invasive method, focused ultrasound (US) and to detect whether there would be any tissue damage caused by US waves. Methods: We used low-intensity focused ultrasound (LIFU), a noninvasive modality, in a place conditioning model to stimulate NA in rats. Results: At the initial stage of our study, we used morphine to induce place preference. As expected, morphine administration caused significant place preference. After the place preference was obtained by morphine, we divided the rats into two groups. One group received LIFU waves to NA and the other group received only sham, that is, no stimulation with US waves. Rats in both groups were continued to receive morphine. Then, we investigated whether LIFU and sham will reduce morphine-induced place preference or not. We observed that morphine-induced place preference had an ongoing raise in the sham group while no raise was detected in the ultrasound group. Although LIFU prevented the rats from the raise, it did not cause a significant reduction of morphine preference. Conclusion: We state that there is a need for future studies to investigate the effects of low-intensity focused ultrasound as an alternative treatment modality in addiction