ABSTRACT
Objective To investigate clinical features,treatments and prognostic factors of the patients with necrotizing fasciitis caused by vibrio infections and thus provide reference for the early treatment and prognostic assessment.Methods A retrospective analysis was conducted on clinical data of 56 patients with vibrio necrotizing fasciitis admitted to the emergency center of our hospital from May 1995 to June 2011.The clinical characteristics and treatments of the patients were summarized,and differences of clinical factors between the survival group and death group were compared.The possible influencing factors for prognosis were also analyzed.Results The main clinical manifestations included fever (61％),shock (84％) and organ dysfunction,of which renal insufficiency (88％) was the most common,with case fatality of 43％.Early pathological changes of limbs were only local swelling and pain,while skin ecchymosis,tension blood blisters,necrosis and subcutaneous crepitation were the signs of advanced stage.Comprehensive treatment regime including early administration of sensitive antibiotics plus surgical incision and drainage and medicine support was given.A series of factors were significantly different between the survival and death groups including the duration from the presentation of symptoms to hospital admission (P ＜ 0.05 ),limb lesions involving the trunk (P ＜ 0.01 ),creatine kinase level (P ＜ 0.05 ),and emergency incision and drainage ( P ＜ 0.01 ).Conclusions The most prominent clinical manifestations of vibrio necrotizing fasciitis are rapidly progressive local symptoms and signs,and sharp deterioration of systemic conditions.Delayed visiting,severe local lesions,and failure to emergency surgery may be the factors for poor prognosis.
ABSTRACT
ObjectiveTo explore the characteristics multi-detector-row computed tomography (MDCT)findings of ACTH-independent macronodular adrenal hyperplasia ( AIMAH ).Methods The un-enhanced and contrast-enhanced MDCT features in 24 patients ( 14 males and 10 females) with clinically confirmed AIMAH were retrospectively assessed for the morphology and enhancement patterns.ResultsThe adrenal glands were involved bilaterally in all of the 24 cases( 100％ ).24 patients had massively enlarged multinodular adrenal glands.Nodules were( 1.79 ± 1.02) cm (0.50 ～ 3.85 cm),which usually distorted and completely obscured the normal adrenal glands.The enlarged adrenal glands were still retained the adreniform contour,showed characteristic ginger-like.22 of the 24 ( 91.7 ％ ) hyperplastic nodular glands demonstrated mild homogeneous enhancement.Calcification was revealed in 1 adrenals ( 1/24,4.2％ ).Conclusion MDCT reveals the characteristic morphology and CT attenuation in AIMAH.Combined with its clinical presentation and biochemical findings,AIMAH is able to be diagnosed with high specificity and accuracy on MDCT.
ABSTRACT
Objective To investigate gene expressions of matrix metalloprotease (MMP-2, MMP-9) and tissue inhibitor of metalloproteinase-2 (TIMP-2) and RECK ( reversion inducing cysteine-rich protein with Kazal motifs) in the liver tissue of rats with Vibrio vulnificus sepsis. Methods Vibrio vulnificus sepsis model was induced by injection of 1 mL/100 g Vibrio vulnificus (9 × 106 cfu/mL) at hind limbs in 50 Sprague-Dawley male rats of clean grade, each time 10 animals were sacrificed at 2, 6, 9, 12 and 16 h after injection and liver samples were taken. Ten rats served as control group. The ethological changes were observed. The total RNA was extracted from liver tissue and the gene expressions of MMP-2, MMP-9, TIMP-2 and RECK were evaluated by semi-quantitative RT-PCR. Results The rats manifested shortness of breath, fever and swelling in hind limbs at 4 h after injection of Vibrio vulnificus. These symptoms gradually deteriorated, and the rats presented cyanosis and convulsion at 12 h. The gene expressions of MMP-2 and MMP-9 were markedly up-regulated, while those of TIMP-2 and RECK were down-regulated. Conclusion The study suggests that the elevation of MMP-2 and MMP-9 and down-regulation of TIMP-2 and RECK is associated with the development of Vibrio vulnificus sepsis.