Diffuse fasciitis with eosinophilia (Shulman's disease).

A case of diffuse fasciitis with eosinophilia (DFE, or Shulman's disease) is presented. A review of the literature of the condition is presented, and the salient features are summarized. Diagnostic criteria and the management of patients with this unusual condition are discussed.     

Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome

Objective

Necrotizing fasciitis is a life threatening soft-tissue infection with a high morbidity and mortality. Prompt treatment based on extensive surgical debridement and antibiotic therapies are the therapeutic principles.

Methods

The medical records of patients with necrotizing fasciitis (n = 26) from 1996 to 2005 were retrospectively analyzed.

Results

The localization of necrotizing fasciitis was most commonly the trunk (42.3%). Type I polymicrobial infection was the dominating infection. The involvement of anaerobic bacteria was associated with an increase in the number of surgical revisions (p = 0.005). Length of postoperative intensive care unit stay, duration of postoperative ventilation and mortality were significantly increased in the ASA IV-V group. Computed tomography displayed only a limited significance as diagnostic tool for initial diagnosis.

Conclusions

In severe cases the combination of necrotic skin and soft tissue gas facilitates the correct diagnosis, which should than be followed by immediate - and most often - repeated debridement. If anaerobes are isolated an early and aggressive second look is necessary.

     

男性外生殖器严重撕脱伤的诊治体会

目的 探讨男性外生殖器严重撕脱伤的治疗原则.方法 选择1998年2月-2006年6月邢台市人民医院泌尿外科收治的男性外生殖器严重撕脱伤患者12例,患者均知情同意.阴茎皮肤撕脱伤3例,阴茎阴囊皮肤撕脱伤6例,阴茎海绵体损伤3例,尿道海绵体损伤2例,一侧精索完全断裂睾丸坏死2例,两侧精索完全断裂睾丸丢失1例.全部施行清创缝合、转移皮辩覆盖创面.结果 行睾丸切除3个(2例),阴茎切除2例,尿道海绵体修补1例,尿道及尿道口成形2例,睾丸异位固定2例.术后随访6～24个月,观察阴茎、阴囊皮肤愈合情况及阴茎、睾丸、尿道功能.12例全部进入结果分析无脱落.皮肤甲级愈合6例,乙级愈合5例,丙级愈合1例;阴茎无硬结、畸形,1例因阴茎内缩影响阴茎勃起,其余无性功能障碍;无睾丸萎缩及尿道狭窄.结论 对男性外生殖器严重撕脱伤的患者,应准确评估病员的损伤程度,有针对性地制定综合治疗方案,在保证生命体征平稳的同时,首先应考虑阴茎、尿道、睾丸、精索等重要器官功能的保护,同时依据伤情及皮肤受损程度.确定转移皮瓣或二期植皮,以企最佳治疗效果.     

Necrotising fasciitis of the submandibular region

SummaryTwo cases of necrotizing fasciitis (NF) complicating different conditions of the maxillofacial region, treated at the Korle Bu Teaching Hospital are reported. These were managed by an early diagnosis, aggressive surgical exploration, fasciotomies and debridement of necrotic tissue. In addition, frequent irrigation within the fascial planes with eusol and saline solutions plus the administration of broad spectrum antibiotics ensured early containment of the spread of the infection. Our early recognition of the signs and symptoms of NF led to an early intervention resulting in minimal residual skin defects which even though were not skin-grafted healed satisfactorily.     

输尿管镜下气压弹道碎石术治疗男性尿道结石20例临床分析

目的：分析输尿管镜下气压弹道碎石术治疗男性尿道结石的临床效果。方法：应用输尿管镜下气压弹道碎石术进行治疗20例男性尿道结石病人。结果：全组病例均一次性碎石成功,术后无明显出血、感染及尿道狭窄等并发症发生。结论：输尿管镜下气压弹道碎石术治疗治疗男性尿道结石是一种安全,高效,容易操作的方法,值得推广。     

Sequelae of gangrene of the ileum in childhood

An 81-year-old woman, who, at the age of 5 1/2 years, had undergone a series of operations for gangrene of the ileum, presented in 1983 with acquired megacolon and chronic malabsorption caused by the persistence of a jejunosigmoid fistula for 76 years. Follow-up in this case thus spans 76 years.