坏死性筋膜炎合并溶血性贫血1例报道并文献复习

坏死性筋膜炎(NF)是临床上较为罕见的一种感染性疾病,发病后进展迅速,可在短时间内累及全身多个器官,严重者引起脓毒性休克,如治疗不及时则死亡率及致残率极高。为进一步探讨NF的诊断及治疗,本文分析1例收治于江苏省中医院,同时具有溶血性贫血及糖尿病等基础疾病,且长期服用激素药物的NF患者的病历资料,并复习近年来国内外相关文献,作如下报道。     

Facial necrotizing fasciitis secondary to accidental bite of the upper lip

We describe a case with facial wounds over the left upper lip that became contaminated with saliva. A facial necrotizing fasciitis developed 2 days after injury. This produced a serious and almost fatal infection.     

Necrotizing fasciitis: early sonographic diagnosis

Necrotizing fasciitis is a rare, but potentially fatal bacterial infection of the soft tissues. Establishing the diagnosis at the early stages of the disease remains the greatest challenge. We report a case of necrotizing fasciitis involving the upper extremity. Sonography revealed subcutaneous emphysema spreading along the deep fascia, swelling, and increased echogenicity of the overlying fatty tissue with interlacing fluid collections. The patient responded well to early surgical debridement and parenteral antibiotics.     

Sonographic appearance of isolated necrotizing vasculitis of the testis

The presentation of necrotizing vasculitis of the testis is variable and may mimic a testicular tumor. Necrotizing vasculitis of the testis is characterized by fibrinoid necrosis of the walls of small and medium-sized testicular arteries. We report a patient with isolated necrotizing vasculitis of the testis who presented with clinical imaging findings suspicious for testicular neoplasm. We describe the clinical course and sonographic characteristics of evolving necrotizing vasculitis of the testis, briefly review the literature, and discuss the implications for the diagnosis and management of this condition.     

Cervical necrotizing fasciitis: 10 years' experience at a single institution

Objective: To evaluate clinical and microbiologic characteristics, modalities of treatment and outcome of patients with cervical necrotizing fasciitis admitted to our institution. Design: Retrospective clinical investigation. Patients and methods: We reviewed the charts of 20 consecutive patients hospitalized in our Intensive Care Unit between January 1987 and June 1998 with the diagnosis of cervical necrotizing fasciitis. Results: All the patients required mechanical ventilation. Four of them had mediastinal involvement. The organisms most commonly implicated included Streptococcus, Prevotella, and Peptostreptococcus species. Patients with adequate surgery had a better outcome than those with inadequate surgical procedures. Because no evidence-based recommendations exist in the field of head and neck infections, hyperbaric oxygen was not used as adjunctive therapy. Of the 20 patients, 3 (15 %) died. Conclusion: The main finding of this study is that prompt, rather than delayed, surgical débridement correlates with a decrease in morbidity and mortality. However, no definite conclusion is justified due to the relatively small number of patients. Immediate radical débridement, and early redébridement if needed, appropriate antibiotics and intensive care support are critical in controlling these life-threatening infections. Received: 25 November 1998 Final revision received: 7 April 1999 Accepted: 1 June 1999     

Sonographic findings in a patient with cystic hypersecretory duct carcinoma of the breast

In this report, we describe a case of a rare form of intraductal carcinoma of the breast known as cystic hypersecretory duct carcinoma in a 49-year-old woman with a palpable mass and no history of breast disease. Mammography showed heterogeneous dense breast tissue with no definite abnormally increased density or microcalcifications. Gray-scale sonography detected multiple small aggregated, anechoic cysts with good through-transmission in the upper outer quadrant of the left breast, corresponding to the location of the palpable mass. The patient underwent an excision biopsy, and histopathologic examination of the surgical specimen revealed multiple cysts of different size containing an eosinophilic material resembling thyroid colloid. The locations of the cysts corresponded to those of the anechoic cysts detected on sonography. The epithelium lining the cysts showed micropapillary growth consistent with a diagnosis of cystic hypersecretory duct carcinoma. The mammographic and sonographic findings in this case differed somewhat from those reported previously for this rare form of breast carcinoma. Because the imaging findings and low-power microscopic appearance of the mass in our patient's case closely resembled those of some benign breast lesions, we recommend careful differentiation of this type of lesion using high-power microscopy during histopathologic evaluation.     

Case report of open appendectomy in treating acute perforated appendicitis with necrotizing fasciitis of the abdominal wall: A rare complication of a common disease

Acute appendicitis can be associated with uncommon complications such as necrotizing fasciitis. We present a case of a 37‐year‐old woman referred to our hospital with a 1‐week history of significant weakness, anorexia, and mild abdominal pain. According to laboratory and radiographic data, the patient was diagnosed with perforated appendicitis and gangrene.     

Sonographic findings in complications of cosmetic breast augmentation with autologous fat obtained by liposuction

A 37-year-old woman presented with breast pain after breast augmentation utilizing autologous fat obtained by liposuction. Mammography and sonography demonstrated fat necrosis in the right breast and a solid inflammatory mass in the left breast. The diagnoses were confirmed by biopsy.     

多发性嗜酸性筋膜炎超声表现1例

患者女,30岁,右侧面部、前臂、大腿及左小腿硬肿6年,未接受系统治疗;既往体健.查体:右面部、前臂、大腿及左小腿非凹陷性肿胀伴压痛,肢体较健侧增粗.实验室检查:嗜酸性粒细胞0.51×109/L.超声:右下颌区咬肌、右前臂尺侧腕伸肌、小指固有伸肌、指伸肌、拇长伸肌及示指固有伸肌、右大腿半腱肌及半膜肌、左小腿三头肌广泛增厚...     

Subcutaneous emphysema of the extremities: Be wary of necrotizing fasciitis,but also consider occult rupture or perforation

Not all causes of subcutaneous emphysema are attributable to necrotizing fasciitis. Consider other causes of subcutaneous emphysema in the differential diagnosis.     

Sonographic appearance of a carcinoma developed in ectopic axillary breast tissue

Primary breast cancer of ectopic axillary breast tissue is almost never diagnosed preoperatively. When not accompanied by nipple-areolar complex, the mass is often believed to be a lipoma, an enlarged lymph node, or a skin lesion such as a sebaceous cyst or hydradenitis suppurativa. When an axillary mass is found, a percutaneous needle biopsy is mandatory to rule out the diagnosis of cancer in ectopic breast tissue. We describe the sonographic findings of a case of ductal carcinoma in axillary ectopic breast tissue.     

Sonographic detection of multifocality in breast carcinoma

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy and clinical value of preoperative sonographic detection of multifocality in breast carcinoma. METHODS: Between November 1, 1999, and November 30, 2000, we prospectively compared the sonographic and histopathologic findings for all nodules measuring 1 cm or less in the longest dimension on sonography in 19 consecutive patients diagnosed with breast carcinoma. For each nodule, the final histopathologic diagnosis, size, and, in cases of nodules in the same breast as the primary lesion, the distance from that lesion were evaluated. RESULTS: The 19 patients examined, all of whom were women, had a mean age of 42.1 years (range, 28-62 years). Thirty nodules were detected on sonography: 15 patients had a total of 24 nodules in the ipsilateral breast, 2 patients each had 1 nodule in the contralateral breast, and 2 patients each had 1 nodule in the ipsilateral breast and 1 nodule in the contralateral breast, for a total of 26 ipsilateral and 4 contralateral nodules. Of the 30 lesions, 20 (67%) appeared to be malignant (ie, satellite nodules) on sonography. Histopathologic examination showed that of these malignant-looking lesions, 15 (75%), which were found in 10 patients, were malignant and 5 (25%), which were found in 4 patients, were benign. For 7 (70%) of the 10 patients whose nodules appeared malignant on sonography, the initial treatment plan was changed because of the sonographic findings. Ten lesions were assessed as benign on sonography; histopathologic examination confirmed that all 10 were benign. Sonography had a sensitivity of 100%, a specificity of 67%, a positive predictive value of 75%, a negative predictive value of 100%, and an accuracy rate of 83%. The mean size of the nodules was 0.8 cm (range, 0.3-1.4 cm). The mean distance of the 26 ipsilateral nodules from the primary lesion was 1.8 cm (range, 0.5-6 cm). CONCLUSIONS: Preoperative sonography is accurate and reliable for detecting small satellite nodules and can have an important role in the preoperative evaluation of patients for whom breast-conserving surgery is planned.     

Necrotizing fasciitis and gangrene associated with topical herbs in an infant

A 4-mo-old Chinese infant developed necrotizing fasciitis and gangrene from a small skin infection on his buttock that was treated with topical herbs. Sequential cultures revealed a number of organisms:Enterococcus species, sensitive to ampicillin, were isolated throughout the course, and coagulasenegative staphylococci replaced gram-negative rods during the later phase of the illness. The infant required prolonged intravenous antibiotic treatment and underwent multiple surgical procedures for debridement and reconstruction. This report serves to alert the public of the importance of avoiding application of unknown topical herbs in children with skin disease. A seemingly small wound, if inappropriately treated, may result in extensive tissue destruction and require extensive surgery.     

Necrotizing fasciitis as the clinical presentation of a retroperitoneal abscess

Infections of the retroperitoneal space may present with insidiously vague symptoms and non-specific clinical signs. We report a case of a retroperitoneal abscess presenting as necrotizing fasciitis of the thigh from direct spread over the iliac crest. In cases of necrotizing fasciitis of the thigh with no obvious source, an intra-abdominal nidus of infection may be considered.     

Yokenella regensburgei necrotizing fasciitis in an immunocompromised host

We report a case of necrotizing skin infection caused by Yokenella regensburgei in an immunosuppressed patient with orthotopic liver transplantation. Initial bacterial culture identification was suggestive of Hafnia alvei. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed identification of Y. regensburgei. Necrotizing fasciitis is potentially fatal and requires aggressive management, including early diagnosis, appropriate antibiotic selection, and operative debridement.     

Rapidly progressive septic shock,associated with necrotizing fasciitis

A case is presented of a 59-year-old male with rapidly progressive septic shock and necrotizing fasciitis. The patient was admitted in shock with an extensive skin lesion on the anterior chest wall. The history was relatively short and there was only a questionable history of preceding trauma. Necrotizing fasciitis was suspected from the appearance of the lesion. Antibiotics and anti-shock therapy were given but despite this, his condition deteriorated and he died from septic shock. At autopsy, the diagnosis of necrotizing fasciitis was confirmed. The importance of rapid diagnosis and primary surgical therapy is emphasized.     

Ultrasonographic Screening of Clinically-suspected Necrotizing Fasciitis

OBJECTIVE: To determine the accuracy of ultrasonography for the diagnosis of necrotizing fasciitis. METHODS: This study was a prospective observational review of patients with clinically-suspected necrotizing fasciitis presenting to the emergency department of an urban (Taipei) medical center between October 1996 and May 1998. All patients underwent ultrasonographic examination, with the ultrasonographic diagnosis of necrotizing fasciitis based on the criterion of a diffuse thickening of the subcutaneous tissue accompanied by a layer of fluid accumulation more than 4 millimeters in depth along the deep fascial layer, when compared with the contralateral position on the corresponding normal limb. The final diagnosis of necrotizing fasciitis was determined by pathological findings for patients who underwent fasciotomy or biopsy results for patients managed nonoperatively. RESULTS: Data were collected for 62 patients, of whom 17 (27.4%) were considered to suffer from necrotizing fasciitis. Ultrasonography revealed a sensitivity of 88.2%, a specificity of 93.3%, a positive predictive value of 83.3%, a negative predictive value of 95.4%, and an accuracy of 91.9% as regards the diagnosis of necrotizing fasciitis. CONCLUSIONS: Ultrasonography can provide accurate information for emergency physicians for the diagnosis of necrotizing fasciitis.