Evaluation of management of postpneumonic empyema thoracis in children

Background Empyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children.Materials and methods A total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n= 11), chest tube drainage (n= 229), chest tube drainage with intrapleural fibrinolytic therapy (n =117), video-assisted thoracoscopic surgery (VATS) (n =35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n =94).Results Variable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n = 10), atelectasis (n= 18), delayed expansion (n= 7), and need for reoperation (n= 2). Four patients died (1.21%), two of them  following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely.Conclusion New therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy.Keywords: decortication, empyema, fibrinolysis, thoracotom

Histopathological effects on kidney of diclofenac potassium and diazepam used in an experimental epilepsy model

Aim: To investigate the effects of diazepam, which has anticonvulsant and anxiolytic effects, and diclofenac potassium, which has anti-inflammatory, analgesic and antipyretic effects, on rat kidney tissue, used in an experimental epilepsy model. Methods: 32 Wistar albino rats (2-4 months old, 200-250 gr) were used in the study. The rats were grouped in four as 8 rats in each group: Epilepsy, Epilepsy + Diazepam, Epilepsy + Diclofenac potassium, Epilepsy + Diazepam + Diclofenac potassium. Epileptic seizure model was created with penicillin (500.000 IU) injected intracortically under urethane anesthesia. 30 minutes later, diazepam (0.1 mg/kg) and diclofenac potassium (10 mg/kg) were administered intraperitoneally. At the end of the study, rat kidneys were removed and evaluated histopathologically in terms of inflammation, glomerular shrinkage, tubular dilatation, tubular epithelial thinning, desquame epithelium, brush epithelial loss, vacuolization, hemorrhage and congestion. Results: No difference was found between diazepam and diclofenac potassium in terms of vacuolization, glomerular shrinkage, tubular dilatation and hemorrhage. Inflammation, congestion and tubular epithelial thinning rate were found to be lower inEpilepsy + Diclofenac potassium and Epilepsy + Diazepam + Diclofenac potassium group when compared with Epilepsy + Diazepam group. While brush epithelial loss and desquame epithelial rate was found to be lowest in the epilepsy group, these parameters were not found to show a significant difference between drug groups. Conclusion: It was concluded that combined use of diazepam and diclofenac potassium in their effects on kidney are more useful than their single use

A Color Stability Comparison of Conventional and CAD/CAM Polymethyl Methacrylate Denture Base Materials

Cilj: Željela se procijeniti stabilnost boje toplinski polimerizirajuće smole, autopolimerizirajuće smole, uretan-dimetakrilatne smole i CAD/CAM bloka od polimetilmetakrilata (PMMA) pohranjenih u različitim medijima. Materijali i metode: Za svaku skupinu proizvedeno je 60 uzoraka u obliku pločica (15 × 2 mm). Ukupno 240 uzoraka termociklirano je u 5000 ciklusa. Zatim su uzorci slučajnim odabirom podijeljeni u četiri skupine (n = 15) prema mediju za pohranu: kava, kola, crno vino i destilirana voda (kontrolna skupina). Mjerenje boje svakog uzorka obavljeno je spektrofotometrom prije pohranjivanja i poslije toga postupka (nakon 7 i 30 dana) te su izračunate razlike u boji (ΔE). Rezultati: U svim materijalima za bazu proteze dogodile su se promjene boje različitog stupnja nakon pohranjivanja u različitim medijima tijekom obaju mjerenja. U svim medijima za pohranjivanje CAD/CAM materijali minimalno su promijenili boju. U svim materijalima za izradu baze proteze crno vino uzrokovalo je veći stupanj promjene boje od kole ili kave. Zaključak: Stabilnost boje CAD/CAM materijala za izradu baze proteze bila je bolja od bilo koje druge vrste materijala. Vrijednosti promjene boje u svim skupinama pohranjenima u crnom vinu bile su klinički vidljive (osim Eclypsea).Objective: The aim of this study was to evaluate the color stability of a heat polymerized resin, an auto-polymerizing resin, a urethane dimethacrylate resin and a CAD/CAM PMMA block resin stored in different storage media. Material and methods: 60 disc-shaped specimens (15×2 mm) were fabricated for each group. A total of 240 disc-shaped specimens were thermal-cycled for 5,000 cycles. Then specimens were randomized into 4 groups (n= 15) according to storage media: coffee, coke, red wine and distilled water (control group). The color measurement of each sample was performed using a spectrophotometer before and after storage (after 7 and 30 days), and color changes (ΔE) were calculated. Results: All the denture base materials demonstrated dissimilar color changes after stored in the different storage media in both evaluation stages. In all storage media, CAD-CAM denture base resins showed the minimum in color change. In all denture base resins, red wine showed a higher degree of color change than coke or coffee. Conclusion: The color stability of CAD-CAM denture base resins is better than any of the other kind of denture base resins. The color change values of all groups except Eclypse stored in red wine had clinically detectable values

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

Objectives: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study.Material and methods: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2–3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated.Results: Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups.Conclusions: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision

Perinatal and neonatal outcomes of adolescent pregnancies over a 10-year period

Objectives: Poor overall neonatal outcomes, small neonatal head circumference, neonatal hypoglycemia, need for Neonatal Intensive Care Unit and late-onset neonatal sepsis are more common in adolescents. The aim of this study is to draw attention to the outcomes of adolescent pregnancies. Material and methods: This retrospective study was conducted in adolescent singleton pregnancies with maternal age < 15 years (n = 20, group 1), 16–19 years (n = 1929, group 2), and 20 years (n = 866, group 3). Age, gravidity, parity, and body mass index (BMI) measurements of mothers; mode of delivery, maternal and neonatal outcomes were evaluated and compared. Results: The rate of preterm birth, postpartum hemorrhage, asymmetrical intra-uterine growth restriction (IUGR, as 3% percentile), macrosomia, and height of newborn of Group 3 was significantly higher. The rate of asymmetrical IUGR (as 10% percentile) was significantly lower in Group 3. The rate of severe preeclampsia and cesarean section was significantly higher in Group 3. The rate of Small for Gestational Age newborn, neonatal hypoglycemia, and late-onset neonatal sepsis was significantly higher in Group 1. Conclusions: Neonatal problems with poor obstetric outcomes are common in adolescent pregnant women, so that a family planning and baby care social trainings are important in achieving good long-term maternal and neonatal outcomes

Renal complications of lipodystrophy: A closer look at the natural history of kidney disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/1/cen13732_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/2/cen13732.pd

Existence and non-existence results for a nonlinear heat equation

In this study, we consider the nonlinear heat equation $$displaylines{ u_{t}(x,t) = Delta u(x,t) + u(x,t)^p quad hbox{in } Omega imes (0,T),cr Bu(x,t) = 0 quad hbox{on } partialOmega imes (0,T),cr u(x,0) = u_0(x) quad hbox{in } Omega,}$$ with Dirichlet and mixed boundary conditions, where $Omega subset mathbb{R}^n$ is a smooth bounded domain and $p = 1+ 2 /n$ is the critical exponent. For an initial condition $u_0 in L^1$, we prove the non-existence of local solution in $L^1$ for the mixed boundary condition. Our proof is based on comparison principle for Dirichlet and mixed boundary value problems. We also establish the global existence in $L^{1+epsilon}$ to the Dirichlet problem, for any fixed $epsilon > 0$ with $|u_0|_{1+epsilon}$ sufficiently small

Bifurcation analysis of a logistic predator–prey system with delay

We consider a coupled, logistic predator–prey system with delay. Mainly, by choosing the delay time $\tau$ as a bifurcation parameter, we show that Hopf bifurcation can occur as the delay time $\tau$ passes some critical values. Based on the normal-form theory and the centre manifold theorem, we also derive formulae to obtain the direction, stability and the period of the bifurcating periodic solution at critical values of $\tau$. Finally, numerical simulations are investigated to support our theoretical results. doi:10.1017/S144618111600005