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11.
Summary The rectus abdommis myocutaneous flap, based on the deep inferior epigastric vessels, is an excellent flap for reconstructing
large wounds of the groin and perineum. However, wound infection in the donor site is a potential complication, even with
thorough preparation of the recipient site. We present one such case in a diabetic patient who developed a necrotizing fasciitis
and evisceration following transfer of an inferiorly based myocutaneous flap. 相似文献
12.
A 30-year-old male with eosinophilic fasciitis (EF) associated with morphoea and vitiligo is described. The patient showed a partial response to prednisone, but did not respond to hydroxychloroquine, D-penicillamine and cimetidine. In the light of reports of increased plasma histamine levels, and a putative role of mast cells in the pathogenesis of EF, ketotifen (a mast cell stabilizer) was prescribed. This non-toxic drug has allowed the patient to continue hard physical labour without further relapses and without corticosteroid therapy. 相似文献
13.
Nuri Karabay MD Tulgar Toros MD Can Hurel MD 《The Journal of foot and ankle surgery》2007,46(6):442-446
The heels of 23 patients who were diagnosed with unilateral/bilateral plantar fasciitis were evaluated via ultrasonography and compared with their asymptomatic feet and a control group of 23 people. Plantar fascial thickness, echogenity, and heel pad thickness were evaluated, and the results were statistically analyzed. For symptomatic feet, increased thickness of the fascia and reduced echogenity were constant ultrasonographic findings (mean, 4.79 mm for symptomatic feet; 2.17 mm for control group, P < .05). No significant difference was found between heel pads of the diseased and healthy feet (mean, 12.96 mm for symptomatic feet; 13.10 mm for control group; P > .05). Ultrasonography seems to be a valuable, noninvasive diagnostic tool for the evaluation of plantar fasciitis. 相似文献
14.
The plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing.
For the forefoot surgeon, knowledge of the variations in the anatomy of communicating branches is important for plantar reconstruction,
local injection therapy and an excision of interdigital neuroma. The anatomy of the communicating branches of the plantar
nerves between the fourth and third common plantar digital nerves in the foot were studied in 50 adult men cadaveric feet.
A communicating branch was present between the third and fourth intermetatarsal spaces nerves in all eight left feet and in
six right feet (overall, 28%), and absent in 36 (72%). A communicating branch was found in 14 ft. Ten of the 14 communications
were from the lateral to the medial plantar nerve. The length of the communicating branch ranged from 8 to 56 mm (average
16.4 mm) and its diameter was 0.2–0.6 times of the fourth common plantar digital nerve. The angle of the communicating branch
with the common plantar digital nerve from which it originated was less than 30° in 11 ft, 30–59° in 27 ft, 60–80° in 8 ft,
and more than 80° in 4 ft. Classification of the branch is based on the branching pattern of the communicating branch and
explains variations in plantar sensory innervations. We think that the perpendicular coursing communicating branch is at higher
risk to be severed during surgery. 相似文献
15.
A. Tarnutzer F. Andreoni N. Keller C. Zürcher A. Norrby-Teglund R.A. Schüpbach A.S. Zinkernagel 《Clinical microbiology and infection》2019,21(4):512.e7-512.e13
Objectives
Streptococcus pyogenes causes life-threatening invasive infections including necrotizing fasciitis (NF). Current treatment guidelines recommend the use of a cell-wall–active antibiotic combined with a protein synthesis inhibitor and surgical debridement in NF patients. Adjunctive therapy with intravenous immunoglobulin (IVIG) has been proposed for superantigen-associated streptococcal toxic shock syndrome. So far, benefits of IVIG treatment remain unclear and prospective clinical studies are scarce. Thus, we aimed to assess the effects of IVIG on virulence factor activity in vitro, ex vivo in patients and in vivo in a NF mouse model.Methods
We investigated the effect of IVIG on the activity of the virulence factors streptolysin O (SLO), streptodornase 1 (Sda1), S. pyogenes cell envelope protease and streptococcal pyrogenic exotoxin B in vitro and ex vivo in patient sera. Additionally, we assessed the influence of IVIG on the clinical outcome in a murine NF model.Results
In vitro, IVIG inhibited various streptococcal virulence factors. Further, IVIG treatment of group A Streptococcus–infected mice led to a reduced skin lesion size (median (interquartile range) day 3 intraperitoneal administration: 12 mm2 (9–14.5) vs. 4 mm2 (0.8–10.5), subcutaneous: 10.3 mm2 (6.9–18.6) vs. 0.5 mm2 (0.1–6.8)) and lower SLO activity. After treatment with IVIG, patient sera showed an elevated titre of specific SLO (7/9) and Sda1 (5/9) antibodies, reducing SLO and Sda1 activity.Conclusions
The clear reduction in disease severity in IVIG-treated mice and inhibition of virulence factor activity in mouse and human sera suggest that IVIG may be beneficial in invasive group A Streptococcus infections such as NF in addition to streptococcal toxic shock syndrome. 相似文献16.
Yamamoto T Marui T Mizuno K Obayashi C Minami R Inaba M Hayashi Y 《Pathology international》2000,50(12):987-991
A rare case of parosteal fasciitis arising from the periosteum of the left clavicle in a 27-year-old woman is reported. Magnetic resonance imaging demonstrated the lesion surrounding the periosteum of the clavicle. The lesion was iso-intense with muscle on T(1)-weighted images and hyperintense on T(2)-weighted images. At surgery, the lesion was discovered to be densely adherent with the periosteum, and excised along with the periosteum. Histopathological examination revealed the proliferation of myofibroblasts in a vague storiform or short fascicular pattern. A large amount of extravasated erythrocytes, and a few lymphocytes were present in the matrix. There were some foci of abundant myxoid materials. Immunohistochemical study showed the cells to be positive for vimentin, alpha-smooth muscle actin and HHF35, but negative for desmin. There was no local recurrence at a 6 months postoperative follow up. 相似文献
17.
A case of ossifying fasciitis occurring in the left femoral region of a 57-year-old male is reported. The patient complained of pain in his left lower extremity which was the site of previous catheterization. During a left femoropopliteal by-pass, a firm and cylindric mass measuring 5 x 3 x 2.5 cm in size was found and extracted from the left groin. Histologically, a reactional lymph node and an irregularly shaped lesion extended into the perinodal fat tissue which is composed of proliferating fibroblasts with occasional mitotic activity. Within this fibroblastic proliferation, immature woven bone composed of osteoid with calcification and chondroid differentiation were seen. Metaplastic bone is an uncommon finding in cases of nodular fasciitis, parosteal fasciitis, cranial fasciitis and florid reactive periostitis. Ossifying fasciitis is known as an uncommon variant of nodular fasciitis. It is an uncommon post-traumatic benign lesion of subcutaneous tissue with an unclear etiology of ossification which is neither related with a bony structure nor contains any muscle tissue. This lesion has been reported only once previously, in the femoral region after a trauma history of catheterization. 相似文献
18.
19.
[目的] 探讨解毒消痈饮治疗肛周坏死性筋膜炎术后热毒炽盛期的临床效果。[方法] 将60例肛周坏死性筋膜炎患者随机分为对照组和观察组,各30例。对照组采用术后对症支持的常规治疗+痛痒消洗剂坐浴,观察组在对照组的基础上,术后口服解毒消痈饮治疗。[结果] 观察组治疗后第3、7、14天视觉模拟评分量表(VAS)评分均低于对照组,差异具有统计学意义(P<0.05);两组治疗14 d后白细胞(WBC)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)较治疗前显著减低,且观察组明显低于对照组(P<0.05),而血红蛋白(Hb)较治疗前明显升高,且观察组优于对照组(P<0.05);两组治疗14 d后坏死性筋膜炎实验室风险指数评分(LRINEC)、Fournier坏疽严重程度指数(FGSI)均较治疗前显著减低,且观察组明显低于对照组(P<0.05);观察组治疗后第7、14天创面渗液和创面水肿情况评分均低于对照组,差异具有统计学意义(P<0.05);观察组创面愈合时间较对照组短(P<0.05);观察组的总有效率优于对照组(P<0.05)。[结论] 肛周坏死性筋膜炎术后热毒炽盛期应用解毒消痈饮疗效确切,能够有效缓解术后疼痛,降低炎症反应,提高血红蛋白含量,有利于评估患者术后病情及预后,减轻术后创面渗液和创面水肿,加速创面愈合。 相似文献
20.
Eva M. Hoefnagels Lucas Weerheijm Angelique GM Witteveen Jan-Willem K Louwerens Noel Keijsers 《Foot and Ankle Surgery》2021,27(5):543-549
BackgroundThe aetiology of chronic therapy resistant plantar fasciitis (CTRPF) is multifactorial with more focus in recent times on the gastroc-soleus complex. This study evaluates the effect of lengthening the gastrocnemius muscle in CTRPF.MethodsAll patients with CRTPF complaints for at least one year underwent the same standard conservative treatment prior to surgery. 32 patients failed this treatment and underwent gastrocnemius recession. Silfverskiöld test, questionnaires and plantar pressure measurements were obtained at 5 visits.ResultsOne year follow up showed a significantly increase in dorsiflexion of the ankle (16 degrees), a decrease in VAS; 78 (SD: 19) to 20 (SD: 24) and significant improved functional scores. Plantar pressure measurements showed an increase of pressure under the medial proximal part of the midfoot and the 1 st metatarsal and a decrease under the hallux.ConclusionsA gastrocnemius recession results in a significant gain in dorsiflexion, altered loading of the foot and good clinical outcome in patients with CTRPF.Level of EvidenceLevel 2 相似文献