Purpose: Fournier gangrene (FG) is a life-threatening condition characterized by rapid tissue necrosis in the perineal and genital regions. Early identification of risk factors is essential for improving prognosis and reducing mortality rates. This study aimed to identify predictive factors associated with mortality in patients with FG. Methods: A multi-institutional retrospective study was conducted across four tertiary care centers in Korea, including patients diagnosed with FG between January 2014 and December 2023. Data on demographic characteristics, laboratory findings, and clinical outcomes were collected. Independent risk factors for mortality were identified using multivariate logistic regression analysis, and optimal cutoff values for these predictors were determined. Results: A total of 133 patients were included. The findings showed that age, initial lactate level, hemoglobin level, platelet count, and albumin level were significant predictors of mortality. Age was associated with an odds ratio of 1.105 (95% confidence interval [CI], 1.038–1.177; P=0.0018), while initial lactate level exhibited an odds ratio of 1.820 (95% CI, 1.335–2.480; P=0.0002). The optimal cutoff values identified were 64.5 years for age, 3.15 mmol/L for lactate, 8.65 g/dL for hemoglobin, 208×109/L for platelet count, and 3.05 g/dL for albumin, with varying sensitivity and specificity. Conclusion The study concluded that age, and initial levels of lactate, hemoglobin, albumin, and platelet count are independently predictive of mortality in patients with FG. These findings underscore the importance of aggressive management for patients presenting with abnormal serum values at admission to improve clinical outcomes. Further research is warranted to validate these results and to refine management strategies for FG.

PURPOSE: The aim of this study was to evaluate antibacterial activity and osteoblast-like cell viability according to the ratio of titanium nitride and zirconium nitride coating on commercially pure titanium using an arc ion plating system. MATERIALS AND METHODS: Polished titanium surfaces were used as controls. Surface topography was observed by scanning electron microscopy, and surface roughness was measured using a two-dimensional contact stylus profilometer. Antibacterial activity was evaluated against Streptococcus mutans and Porphyromonas gingivalis with the colony-forming unit assay. Cell compatibility, mRNA expression, and morphology related to human osteoblast-like cells (MG-63) on the coated specimens were determined by the XTT assay and reverse transcriptase-polymerase chain reaction. RESULTS: The number of S. mutans colonies on the TiN, ZrN and (Ti(1-x)Zr(x))N coated surface decreased significantly compared to those on the non-coated titanium surface (P<0.05). CONCLUSION: The number of P. gingivalis colonies on all surfaces showed no significant differences. TiN, ZrN and (Ti(1-x)Zr(x))N coated titanium showed antibacterial activity against S. mutans related to initial biofilm formation but not P. gingivalis associated with advanced periimplantitis, and did not influence osteoblast-like cell viability.
Biofilms ; Cell Survival* ; Humans ; Microscopy, Electron, Scanning ; Peri-Implantitis ; Porphyromonas gingivalis ; RNA, Messenger ; Stem Cells ; Streptococcus mutans ; Tin* ; Titanium* ; Zirconium

PURPOSE: The aim of this study was to evaluate antibacterial activity and osteoblast-like cell viability according to the ratio of titanium nitride and zirconium nitride coating on commercially pure titanium using an arc ion plating system. MATERIALS AND METHODS: Polished titanium surfaces were used as controls. Surface topography was observed by scanning electron microscopy, and surface roughness was measured using a two-dimensional contact stylus profilometer. Antibacterial activity was evaluated against Streptococcus mutans and Porphyromonas gingivalis with the colony-forming unit assay. Cell compatibility, mRNA expression, and morphology related to human osteoblast-like cells (MG-63) on the coated specimens were determined by the XTT assay and reverse transcriptase-polymerase chain reaction. RESULTS: The number of S. mutans colonies on the TiN, ZrN and (Ti(1-x)Zr(x))N coated surface decreased significantly compared to those on the non-coated titanium surface (P<0.05). CONCLUSION: The number of P. gingivalis colonies on all surfaces showed no significant differences. TiN, ZrN and (Ti(1-x)Zr(x))N coated titanium showed antibacterial activity against S. mutans related to initial biofilm formation but not P. gingivalis associated with advanced periimplantitis, and did not influence osteoblast-like cell viability.
Biofilms ; Cell Survival* ; Humans ; Microscopy, Electron, Scanning ; Peri-Implantitis ; Porphyromonas gingivalis ; RNA, Messenger ; Stem Cells ; Streptococcus mutans ; Tin* ; Titanium* ; Zirconium

BACKGROUND: Early identification and appropriate management of mild chronic renal failure has been increasingly recognized as an important opportunity to delay the progression of renal disease. Many physicians rely on serum creatinine (Scr) as a screening test for renal impairment; however, Scr levels can remain within the normal range even when renal function is significantly impaired in certain group of patients. METHODS: The subjects were 20, 245 persons who were enrolled a regular health check up program, Jan. 1997 to Jun. 2001, at Ajou University Hospital, Korea. We identified GFR below 60 mL/min/1.73 m2 as abnormal and found the percentage of patients with Scr value from 1.1 mg/dL to 1.4 mg/dL and their sex and age distribution, using GFRs calculated by Cockroft-Gault Equation, MDRD Equation, and Kang's Equation. RESULTS: Average Scr was 1.07+-0.13 mg/dL in male and 0.82+-0.11 mg/dL in female. Among 34 University hospital in metro Seoul area, 11 hospital used 1.4 mg/dL as normal upper limit of Scr and 7 hospital used 1.3 mg/dL. Taking normal Scr upper limit as 1.3 or 1.4 mg/dL, the frequency of GFR below 60 mL/min/1.73 m2 was 3.9-50% in males and 75-100% in females, although some differences existed according to the equation used. CONCLUSION: Currently used normal Scr upper limit 1.3, 1.4 mL/dL was found to be much too high and we concluded a downward adjustment is needed and one-time test is not adequate to conclude renal impairment but several regular tests are required.
Age Distribution ; Creatinine* ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Mass Screening ; Reference Values* ; Seoul

BACKGROUND: Early escharectomy has been shown to improve survival rates and treatment outcomes in major burn patients. However, its mechanism, especially in human immune systems, has not been fully elucidated. This observational study, focusing on cytokines, was conducted to assess changes in the levels of tumor necrosis factor alpha (TNF alpha) and interleukin-10 (IL-10) in major burn patients that underwent early tissue excision. METHODS: Seventeen ASA physical status II or III adults major burn patients, admitted to general surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples was obtained four times at 72 and 24 hours preop and at 24 and 72 hours postop. Changing levels of TNF alpha and IL-10 were measured by quantitative sandwich immnuoassay. RESULTS: Subjects suffered from 70% TBSA burns. Both cytokines demonstrated a significant tendency to increase in the blood during the study period. Although they temporarily decreased 24 hours after surgery, this effect did not last. CONCLUSIONS: Burn injury certainly increases cytokine response. Early escharectomy appears to decrease the pro and anti-inflammatory cytokines only temporarily. It did not seem to have any long term effect in the human immune system in major burn patients, probably due to the complex nature of the injury.
Adult ; Burns* ; Cytokines* ; Humans ; Immune System ; Interleukin-10 ; Observational Study ; Survival Rate ; Tumor Necrosis Factor-alpha ; Wounds and Injuries

BACKGROUND/AIMS: Mirizzi syndrome is a rare complication of longstanding gallstone disease which resulting in obstructive Jaundice. It is benign stricture of common hepatic duct because of stone impacted with in the cystic duct or Hartmann pouch of the gallbladder. The aim of this study is to evaluate our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: During the years 1994 to 2001 at Asan medical center, 23 cases of Mirizzi syndrome were diagnosed on the basis of preoperative and postoperative findings and they were retrospectively reviewed. RESULTS: There were 12 patients with Csendes type I, 6 patients with type II, and 5 patients with Type III. Average age was 61 years (range: 31 to 83 years) For preoperative evaluation Endoscopic retrograde cholangiopancreatography (ERCP) and Ultrasonography were performed in all cases. Laparoscopic cholecystectomy was tried in 7 type I cases. 5 were successfully treated and 2 conversions were reported, all because of unclear anatomy. In 6 type II cases open cholecystrctomy, CHD repair and T tube insertion were performed. 5 patients with type III were required hepaticojejunostomy. CONCLUSIONS: High index of suspicion is required for diagnosis of Mirizzi syndrome and laparoscopic approach is permissible in specialized center especially in the case of suspected Mirizzi type I, under the recognition of biliary anatomy through preoperative imaging studies. If there is fistula or unclear anatomy, we recommend open operative techniques for the safety and the efficiency.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Chungcheongnam-do ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Fistula ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Mirizzi Syndrome* ; Retrospective Studies ; Ultrasonography