Magnetic resonance imaging findings of nodular fasciitis in the mental region

Nodular fasciitis (NF) is a benign reactive lesion of the soft tissues related to the fascia and characterized by fibroblastic proliferation. The most common site is the upper extremities (46%), followed by the head and neck region (20%). In the orofacial region, the lesion typically develops within the subcutaneous structures overlying the angle and inferior border of the mandible and the zygoma. Magnetic resonance imaging (MRI) findings of NF in the orofacial region are almost unreported in the literature. In the present case report, we describe MRI findings of mental NF in a 19-year-old woman. MRI revealed a well-defined, round soft-tissue mass lying on the mentum. On T1-weighted MRI, the lesion was isointense to skeletal muscle; it was hyperintense to skeletal muscle on T2-weighted MRI, and was enhanced by Gd-diethylenetriamine pentaacetic acid (DTPA). Histologic examination revealed abundant myxoid degeneration dispersed in the lesion. The T2-weighted higher heterogeneous signal intensity was likely due to abundant myxoid degeneration or the cellular component of the lesion. A strong bright signal intensity belt appeared in the periphery of the lesion on Gd-DTPA enhancement. This rim enhancement appearred to represent small arterioles and venules that were visible in the peripheral area on histologic examination.     

托毒益气养阴汤治疗肛周坏死性筋膜炎(毒盛正虚证)的临床研究

目的观察托毒益气养阴汤治疗肛周坏死性筋膜炎(毒盛正虚证)的临床疗效。方法将66例患者随机分为治疗组与对照组各33例,对照组采用西医常规治疗,治疗组在对照组基础上采用内服托毒益气养阴汤治疗。两组均治疗2周。结果两组治疗后创面疼痛、病变范围、全身症状、坏死性筋膜炎实验室风险指数(LRINEC)评分及白细胞计数(WBC)、C反应蛋白(CRP)较治疗前均降低(P<0.05),且治疗组低于对照组(P<0.05);两组治疗后血红蛋白(Hb)较治疗前均升高(P<0.05),且治疗组高于对照组(P<0.05);治疗组创面表皮生长时间、创面愈合时间短于对照组(P<0.05);治疗组住院费用低于对照组(P<0.05);治疗组总有效率高于对照组(P<0.05)。结论托毒益气养阴汤治疗肛周坏死性筋膜炎(毒盛正虚证),能够抑制炎症因子表达,增加Hb含量,减轻肛周疼痛、肿胀范围及全身症状,促进创面表皮生长和创面愈合,降低住院费用,提高临床疗效。     

Impact of necrotising fasciitis on quality of life: A qualitative analysis

Mortality rates from severe necrotising soft tissue infections are improving progressively, therefore more emphasis should be placed on assessing and improving the quality of life of surviving patients. We investigated the functional and psychological issues, ability to social integration and self-perception of appearance in such patients presenting to our unit over 4 years. To conduct the study, we used the Short Form-36 and the Derriford Appearance Scale-24, which were distributed to those willing to participate. Ten patients have returned fully completed questionnaires. The overall quality of life and level of distress about the changed appearance were moderate (average SF-36 score of 65.8, DAS-24 score of 38). Statistical correlations between the scores and demographics were carried out using the Spearman rank correlation test. The capability of psychosocial adjustment was shown to improve with longer follow-up time and older age. However pain, physical limitations and energy levels were considerably more relevant in the older individuals and improved slower with time compared to psychological issues. Our results act as a good indicator of the quality of life in people dealing with the aftermath of necrotising soft tissue infections, but further, more extensive studies are required to achieve comprehensive and statistically significant results.     

Plantar fasciopathy: Revisiting the risk factors

BackgroundPlantar fasciopathy is the most common cause of acquired sub-calcaneal heel pain in adults. To-date, research of this condition has mainly focused on management rather than causal mechanisms. The aetiology of plantar fasciopathy is likely to be multifactorial, as both intrinsic and extrinsic risk factors have been reported. The purpose of this review is to critically reevaluate risk factors for plantar fasciopathy.MethodsA detailed literature review was undertaken using English language medical databases.ResultsNo clear consensus exists as to the relative strength of the risk factors reported.ConclusionsTo-date numerous studies have examined various intrinsic and extrinsic risk factors implicated in the aetiology of plantar fasciopathy. How these factors interact may provide useful data to establish an individuals’ risk profile for plantar fasciopathy and their potential for response to treatment. Further research is indicated to rank the relative significance of these risk factors.     

A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: A preliminary report

BackgroundPlantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis.MethodsWe undertook a prospective non-randomized study to compare the efficacy of traditional corticosteroid injection (Steroid group) to PRP injection (PRP group), in a cohort of patients.ResultsWe studied both groups of patients before and after the injections using Visual Analogue Score (VAS), the Foot & Ankle Disability Index (FADI) and American Foot and Ankle Score (AFAS). Our study confirms that there is significant clinical improvement in PRP group at three months after the injection.ConclusionThe use of PRP injection can be an attractive alternative in the treatment of disabling, recalcitrant plantar fasciitis.Study designCohort study.Level of clinical evidenceLevel 3.     

血液系统疾病合并嗜水气单胞菌血流感染4例报告

本文报道了昆明医科大学第二附属医院4例血液系统疾病合并嗜水气单胞菌血流感染患者的诊疗及转归,进一步明确血培养重要性以及加深临床对此病的认识。 选择2017—2021年昆明医科大学第二附属医院收治的血液系统疾病合并嗜水气单胞菌血流感染的4例患者,对患者临床表现、血培养采集及嗜水气单胞菌检出时间、实验室检查、治疗及预后等临床资料进行回顾性分析。本研究中4例病例均为男性血液系统疾病患者,处于化疗后骨髓抑制期粒细胞缺乏,出现发热后采集血培养并检出嗜水气单胞菌,4例患者血培养报阳时间4~11 h。药敏检测结果显示对二代、三代、四代头孢类抗生素、喹诺酮类抗生素、碳青霉烯类抗生素敏感性较高。4例患者早期均使用亚胺培南-西司他丁钠进行经验性抗感染治疗,1例患者经积极抗感染及升白细胞等治疗后痊愈。1例患者未完成化疗,患者要求出院,后续不详。2例患者迅速发展为坏死性筋膜炎,后患者死亡。研究表明,血液系统疾病合并嗜水气单胞菌血流感染罕见但死亡率高,对于反复发热考虑感染致病的患者需尽早进行血培养确认病原体并进行药敏试验,临床治疗时应结合患者情况及时调整治疗,除抗感染治疗外同时要提升患者免疫力,警惕发展为坏死性筋膜炎。     

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain

Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel.