Imaging classification and analysis of the diagnosis and treatment of infected pancreatic necrosis:a report of 126 cases / 中华外科杂志

Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ2 test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ2=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ2=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.

Efeitos adversos locorregionais da terapêutica oncológica em mulheres com câncer de mama avançado: revisão integrativa / Efectos adversos locorregionales de la terapia oncológica en mujeres con cáncer de mama avanzado: una revisión integradora / Locoregional adverse effects of cancer therapy in women with advanced breast cancer: an integrative review

RESUMO Objetivo: identificar os efeitos adversos locorregionais da administração da terapêutica oncológica endovenosa em mulheres com câncer de mama avançado. Metodo: revisão integrativa da literatura, que utilizou as bases de dados PubMed/MEDLINE, CINAHL, LILACS e EMBASE, sem recorte temporal, além de busca reversa dos artigos selecionados, atualizada até maio de 2022 A população contemplou mulheres com câncer de mama avançado submetidas à intervenção com terapêutica oncológica endovenosa com quimioterapia ou hormonioterapia ou anticorpo monoclonal, e o desfecho avaliou efeitos adversos locorregionais Resultados: identificaram-se 2.789 estudos, e a amostra final foi composta por 8 ensaios clínicos e 1 estudo observacional retrospectivo, sendo todos estudos internacionais e publicados no período de 1986 a 2018. Predominantemente, as pacientes tinham câncer de mama em estádio IV, idade de 50 anos ou mais e múltiplas metástases. Os efeitos adversos locorregionais foram: flebite, ulceração e/ou necrose, dor, eritema e reação no local da injeção não especificada. Os estudos não trazem detalhamento do tipo de cateter venoso, osmolaridade dos fármacos e cuidados preventivos para diminuição desses efeitos adversos. Conclusão: as evidências desses artigos mostraram que os efeitos adversos locorregionais estão presentes em estudos de eficácia dos fármacos oncológicos em mulheres com câncer de mama avançado. No entanto, destaca-se que a segurança da administração dos fármacos oncológicos não se apresenta elucidada nessa revisão, indicando necessidade de estudos de acompanhamento dos efeitos adversos.

RESUMEN Objetivo: identificación de los efectos adversos locorregionales de la administración de la terapia oncológica intravenosa en mujeres con cáncer de mama avanzado. Método: revisión bibliográfica integradora, que utilizó las bases de datos PubMed/MEDLINE, CINAHL, LILACS y EMBASE, sin corte de tiempo, además de una búsqueda inversa de los artículos seleccionados, actualizada hasta mayo de 2022 La población incluyó mujeres con cáncer de mama avanzado, sometidas a intervención con terapia oncológica endovenosa con quimioterapia u hormonoterapia o anticuerpo monoclonal y el resultado evaluó los efectos adversos locorregionales Resultados: se identificaron 2.789 estudios y la muestra final se compuso de ocho ensayos clínicos, un estudio observacional retrospectivo, todos estudios internacionales, publicados desde 1986 hasta 2018. Predominantemente, las pacientes tenían cáncer de mama en estadio IV, edad de 50 años o más y metástasis múltiples. Los efectos adversos locorregionales fueron flebitis, ulceración y/o necrosis, dolor, eritema y reacción en el lugar de la inyección no especificada. Los estudios no detallan el tipo de catéter venoso, la osmolaridad de los fármacos y los cuidados preventivos para reducir estos efectos adversos. Conclusión: las pruebas de estos artículos mostraron que los efectos adversos locorregionales están presentes en los estudios de eficacia de los fármacos oncológicos en mujeres con cáncer de mama avanzado. Sin embargo, cabe destacar que la seguridad de la administración de los fármacos contra el cáncer no se dilucida en esta revisión, lo que indica la necesidad de realizar estudios de seguimiento sobre los efectos adversos.

ABSTRACT Objective: to identify the locoregional adverse effects of administering intravenous oncologic therapy in women with advanced breast cancer. Method: this was an integrative literature review using the PubMed/MEDLINE, CINAHL, LILACS, and EMBASE databases, without a time cut, in addition to a reverse search of the selected articles updated until May 2022. The population included women with advanced breast cancer undergoing intervention with intravenous oncologic therapy with chemotherapy, hormone therapy, or monoclonal antibody, and the outcome assessed locoregional adverse effects. Results: 2,789 studies were identified, and the final sample consisted of 8 clinical trials and 1 retrospective observational study, all of which were international studies published from 1986 to 2018. Predominantly, patients with stage IV breast cancer, were aged 50 years or older, and had multiple metastases. Locoregional adverse effects were phlebitis, ulceration and/or necrosis, pain, erythema, and unspecified injection site reaction. The studies did not detail the type of venous catheter, the osmolarity of the drugs, and preventive care to reduce these adverse effects. Conclusion: the evidence from these articles showed that locoregional adverse effects are present in efficacy research of oncologic drugs in women with advanced breast cancer. Nonetheless, the safety of administering cancer drugs is not elucidated in this review, indicating the need for follow-up studies of adverse effects.

Laparoscopic transgastric necrosectomy in treatment of wall-off pancreatic necrosis / 中华外科杂志

Mini-invasive surgical or endoscopic step-up approach is the first choice of pancreatic necrosectomy for infected wall-off necrosis. Surgical debridement has the advantage of high efficiency,low cost and good accessibility,while the complication rate of pancreatic fistula and incision hernia after endoscopic necrosectomy is low.Laparoscopic transgastric necrosectomy(LTGN) can combine the advantages of surgical and endoscopic debridement,and may become one of the important methods for the surgical treatment of necrotizing pancreatitis in the future. This paper focuses on the technical advantages,surgical points,indications and application status of LTGN,so as to provide reference for the technical promotion.

Síndrome de nicolau en paciente pediátrico: reporte de caso / Case report: Nicolau síndrome in a pediatric patient

El síndrome de Nicolau o Embolia cutis medicamentosa o Dermatitis livedoide, es un síndrome raro en pediatría que se presenta como complicación de una inyección intramuscular con múltiples grados de daño tisular, in- cluyendo la necrosis de la piel y de los tejidos profundos. Reportamos el caso de un paciente masculino de 2 años de edad, sin antecedentes patológicos que acudió a la emergencia de pediatría del Hospital "Mario Catarino Rivas" (HMCR) en San Pedro Sula, Cortes, con historia de presentar lesión necrótica en la extremidad inferior y glúteo izquierdo, dolorosa a la palpación, que apa- reció posterior a la administración de un medicamen- to compuesto por vía intramuscular. Al examen físico se encontró una extensa placa necrótica dolorosa a la palpación y a la movilización del miembro, con pulsos periféricos conservados y sin frialdad distal. A través de abordaje multidisciplinario se brindó limpieza qui- rúrgica, cobertura antibiótica, manejo antitrombótico e injerto, con evolución favorable, por lo que resalta- mos que la identificación y manejo multidisciplinario oportuno es fundamental, como lo fue en este caso...(AU)

Calcifilaxis / Calciphylaxis

Resumen La calcifilaxis es una enfermedad poco frecuente, aunque presenta una elevada tasa de mortalidad debido sobre todo a complicaciones como sepsis o gangrena. Generalmente se asocia a insuficiencia renal severa. Se define como la calcificación de la capa media de vasos de pequeño y mediano tamaño de la dermis y tejido celular subcutáneo. Clínicamente se manifiesta como un síndrome de livedoracemosa que progresa a púrpura retiforme y necrosis cutánea. La primera línea de tratamiento es el tiosulfato sódico.

Abstract Calciphylaxis is a rare disease, although it has a high mortality rate due mainly to complications such as sepsis or gangrene. It is usually associated with severe renal failure. It is defined as the calcification of the middle layer of small and medium-sized vessels of the dermis and subcutaneous cellular tissue. Clinically it manifests as a livedoracemosa syndrome that progresses to retinal purpura and cutaneous necrosis. The first line of treatment is sodium thiosulfate.

Embolia colesterínica en miembro superior izquierdo asociado a fístula arteriovenosa / Cholesterol embolism in the left upper limb associated with venous artery fistula

RESUMEN El embolismo por cristales de colesterol (ECC) es una complicación de la enfermedad arterioesclerótica en la que el desprendimiento de fragmentos de placa de ateroma, principalmente de grandes arterias, provoca oclusión de pequeños vasos. Esta entidad, también llamada ateroembolia o síndrome de los dedos del pie azules, es más frecuente en pacientes de edad avanzada y después de procedimientos invasivos intravasculares. Se manifiesta con cianosis, livedo reticularis, necrosis y úlceras asociado a manifestaciones renales y gastrointestinales. Se presenta un paciente trasplantado renal y portador de fístula arteriovenosa trombosada izquierda con ateroembolia localizada en mano homolateral.

ABSTRACT The cholesterol crystal embolism (ECC) is a complication of arteriosclerotic disease in which the detachment of fragments of atheromatous plaque mainly from large arteries, causes occlusion of small vessels. This entity, also called atheroembolism or blue toe syndrome, is more common in elderly patients and after intravascular invasive procedures. It manifests with cyanosis, livedo reticularis, necrosis and ulcers associated with renal and gastrointestinal manifestations. We present a renal transplant patient with a left thrombosed arteriovenous fistula with atheroembolism located in homolateral hand.

Glicose como causa e tratamento de necrose cutânea / Glucose as a cause of and treatment for cutaneous necrosis

A escleroterapia continua sendo um dos procedimentos mais executados pelos cirurgiões vasculares brasileiros. O conhecimento das suas complicações é imprescindível para que possamos evitá-las. Os efeitos colaterais graves desse método de tratamento para as telangiectasias dos membros inferiores são raros e frequentemente associados a um erro técnico ou à dosagem injetada. São predominantemente locais, apresentando-se, algumas vezes, como uma situação de difícil resolução. Relatamos um caso de formação de necrose cutânea após escleroterapia química com glicose hipertônica (75%) e sua cicatrização utilizando preparação tópica contendo vaselina e glicose 60%, cujo resultado estético foi satisfatório

Sclerotherapy remains one of the procedures most frequently performed by Brazilian vascular surgeons. Knowledge of its complications is indispensable to enable us to avoid them. The severe side effects of this method of treatment for telangiectasias of the lower limbs are rare and are often associated with technical errors or the dose injected. Complications are predominantly local, but are sometimes difficult to resolve. We report a case of formation of cutaneous necrosis after chemical sclerotherapy using hypertonic glucose (75%), which healed when treated with a topical preparation containing vaseline and 60% glucose, with satisfactory esthetic results

Reconstrução mamária com loja de retalho retropeitoral superior e subcutâneo misto inferior / Breast reconstruction with creation of upper retropectoral and lower mixed subcutaneous cavities and use of flaps

Introdução: Segundo dados do Instituto Nacional de Câncer (INCA) de 2016, estima-se em 57.960 novos casos de câncer de mama no Brasil, o que corresponde a 25% dentre todos os tipos de cânceres no país (excluindo-se os tumores de pele não melanoma). O presente artigo visa apresentar uma forma de abordagem para as reconstruções mamárias imediatas com loja retropeitoral superior e subcutânea mista inferior. Métodos: Os autores descrevem da técnica de reconstrução mamária com retalho do músculo peitoral e pedículo cutâneo inferior, associado à inclusão de implante mamário de silicone. Foi realizada análise retrospectiva de prontuários das pacientes operadas entre os anos 2012 e 2016 no Serviço de Cirurgia Plástica da clínica privada do autor sênior, no Hospital Daher e no Hospital das Forças Armadas. Resultados: Os resultados são satisfatórios, com baixos índices de complicações e com satisfação elevada para os pacientes e os autores. Trinta e seis pacientes foram submetidas à reconstrução mamária com a técnica descrita, com média de idade de 59 anos. As complicações apresentadas foram necrose de complexo areolopapilar, deiscência, seroma, hematoma, liponecrose, deslocamento do implante e trombose venosa profunda. Nenhuma paciente teve necessidade de resgate da reconstrução ou apresentou recidiva da neoplasia mamária durante o período do estudo. Conclusão: Trata-se de técnica que preserva a pele da mama em sua parte inferior, com baixa possibilidade de deiscência ou extrusão do implante nesta região, proporcionando uma dupla proteção deste implante com o músculo peitoral maior nos dois terços superiores e o retalho cutâneo-dermogorduroso no terço inferior, caracterizando um "dual-plane".

Introduction: A total of 57,960 new cases of breast cancer were expected in Brazil in 2016 according to data from the National Cancer Institute, corresponding to 25% of cancers in the country (excluding non-melanoma skin tumors). This study aims at presenting a surgical approach for immediate breast reconstructions with upper retropectoral and lower mixed subcutaneous cavities. Methods: The authors performed breast reconstruction using flaps of the pectoral muscle and inferior cutaneous pedicle associated with insertion of silicone breast implants. The medical records of patients operated between 2012 and 2016 at the Plastic Surgery Service of the senior author's private clinic at Daher Hospital and Armed Forces Hospital were retrospectively analyzed. Results: The results were satisfactory, with low complication rates and high patient and author satisfaction. Thirty-six patients, with a mean age of 59 years, underwent breast reconstruction using the described technique. The complications were nipple-areola complex necrosis, dehiscence, seroma, hematoma, liponecrosis, implant displacement, and deep venous thrombosis. No patient needed salvage surgery or had recurrence of mammary neoplasia during the study period. Conclusion: The present technique preserves the skin located at the lower portion of the breast, with a low risk of dehiscence or extrusion of the implant in this region, providing a double protection of the implant, with the pectoralis major muscle in the upper two thirds and the cutaneous-dermis-fat flap in the lower third, characterizing a "dual-plane" positioning.

Como evitar uma retração no meio da cicatriz horizontal e minimizar o risco de necrose nas abdominoplastias clássicas / How to avoid a retraction in the middle of the horizontal scar and minimize the risk of necrosis in the classic abdominoplasty

Introdução: Nas abdominoplastias clássicas, um resultado indesejado após o tracionamento do retalho abdominal é a ocorrência de uma retração suprapúbica, no meio da cicatriz horizontal quando esta coincide com o ponto superior da antiga cicatriz umbilical. Métodos: Foram avaliadas 45 pacientes submetidas à dermolipectomia abdominal associada à lipoaspiração de todo o abdome e flancos, com decorticação de uma área suprapúbica cerca de 5 cm acima da marcação inicial da linha de incisão, com posterior fixação na borda inferior do retalho abdominal. Resultados: Não foram observadas depressões ou necroses na região suprapúbica. Conclusão: Observamos, nos casos operados, que a presença de um coxim dermogorduroso na porção central da linha de sutura nas abdominoplastias clássicas, associada à reconstituição completa dos planos cirúrgicos e fixação deste coxim no retalho abdominal superior, evita a ocorrência de depressões nesta região, evita ocorrência de necroses e melhora a qualidade da cicatriz por redução da tensão de tração sobre os tecidos.

Introduction: In classic abdominoplasty, an undesirable result after abdominal flap traction is the occurrence of a suprapubic retraction in the middle of the horizontal scar when it coincides with the superior point of the old umbilical scar. Methods: Forty-five patients underwent abdominal dermolipectomy associated with liposuction of the entire abdomen and flanks, with decortication of the suprapubic area approximately 5 cm above the initial marking of the incision line, with posterior fixation at the lower border of the abdominal flap. Results: No depressions or necroses were observed in the suprapubic region. Conclusion: We observed that the presence of a dermofat flap in the central portion of the suture line in the classic abdominoplasties associated with the complete reconstruction of the surgical planes and the fixation of this flap in the upper abdominal flap avoids the occurrence of depressions in this region, prevents occurrence of necrosis, and improves the quality of the scar by reducing the tensile stress on the tissues.

Abdominal dermocutaneous flap for reconstruction of a bleeding area in necrotizing fasciitis / Retalho dermocutâneo abdominal para reconstrução de área cruenta pós-fasceíte necrotizante

Introduction: The sequelae caused by Fournier's syndrome are extensive, systemic, debilitating, and deforming. They require both general and local treatments with antibiotics and subsequent debridement to delimit non-necrotic margins, which result from extensive bleeding areas. Methods: The area affected and described in this study is the upper third of the right thigh. The goal was to use the dermocutaneous excess, usually removed in abdominoplasties. Abdominoplasty was routinely performed, and the cutaneous excess of the hypogastrium was transferred to cover a bleeding area in the upper third of the thigh throughout its extension. In the bleeding region, adequate occlusion was performed, and a tissue with similar thickness and elasticity was used to minimize the deformities that affected both the donor and receiving areas. Results: The bleeding area was covered in a single surgery. Conclusion: The use of the cutaneous excess of the hypogastrium to cover the bleeding region of the upper third of the thigh is an alternative technique, which can be conducted in a single surgery in patients presenting excess abdominal skin.

Introdução: As sequelas decorrentes da síndrome de Fournier são extensas, de repercussão sistêmica, debilitantes e deformantes, que exigem tratamento geral e local com o uso de antibióticos e sucessivos desbridamentos para delimitar os limites sem necroses resultando áreas cruentas e extensas. Métodos: O caso presente envolveu o terço superior da coxa direita. A proposta foi a de utilizar o excedente dermocutâneo, que normalmente é eliminado nas abdominoplastias. A abdominoplastia foi realizada dentro da rotina em que este excedente cutâneo do hipogástrio foi transferido para cobrir a área cruenta em toda a sua extensão no terço superior da coxa. A oclusão foi adequada na área cruenta, com um tecido semelhante em espessura e elasticidade, minimizando a deformidade tanto na área doadora quanto na receptora. Resultados: Foi obtida total cobertura da área cruenta num único tempo operatório. Conclusão: A utilização dos excessos cutâneos do hipogástrio para recobrir a área cruenta no terço superior da coxa segue como mais uma opção técnica num único tempo operatório em pacientes com excesso cutâneo abdominal.

Necrose facial após enxerto de gordura e tratamento com oxigenioterapia hiperbárica / Facial necrosis after fat grafting and treatment with hyperbaric oxygen therapy

A lipoenxertia de face, apesar de consagrada, não é isenta de riscos e complicações. Neste relato de caso, descrevemos de forma inédita uma complicação isquêmica local, causada por enxerto de gordura. Simultaneamente, propomos a terapêutica com Oxigenioterapia Hiperbárica para o tratamento desta situação, não se limitando exclusivamente à gordura, mas principalmente ao PMMA, em que esta complicação é muito mais frequente.

Facial fat grafting is not devoid of risks and complications, despite being a widely practiced procedure. In this case report, we describe a novel form of local ischemic complication that occurred secondary to fat grafting. Simultaneously, we propose Hyperbaric Oxygen therapy for the treatment of this situation. We propose that Hyperbaric Oxygen therapy should not be limited solely to fat graft-related ischemia, but should be effective in the management of the more frequently encountered complications associated with polymethylmethacrylate fillers.

Reconstrução do complexo areolomamilar da mama queimada com retalho trilobado autonomizado / Reconstruction of a burned nipple-areola complex using an autonomized star flap

Introdução: A reconstrução do complexo areolomamilar é a fase final da reconstrução mamária. As técnicas de reconstrução do mamilo mais utilizadas são com retalhos locais ou enxertos. A utilização destas técnicas em mamas que sofreram queimaduras apresenta resultados indesejados, em decorrência da menor vascularização da pele lesada. O objetivo deste trabalho foi avaliar a utilização do retalho trilobado autonomizado na reconstrução do mamilo em mamas queimadas. Métodos: Oito pacientes do sexo feminino tiveram seus mamilos reconstruídas em dois tempos cirúrgicos. Resultados: Não ocorreram complicações, como necrose, deiscência, perda completa da projeção do novo mamilo ou infecção. A projeção média ao término da cirurgia foi de 15,25 mm e, após seis meses de reconstrução, foi de 3 mm, permanecendo estável. Todas as pacientes ficaram satisfeitas com os resultados. Conclusão: Concluímos que a autonomização deu segurança à reconstrução do mamilo em mamas queimadas e manteve projeção mínima satisfatória do mamilo reconstruído.

Introduction: Reconstruction of the nipple-areola complex is the final stage of breast reconstruction. The most common nipple reconstruction techniques use local flaps or grafts. However, these techniques in cases of burns produce undesirable outcomes due to the decreased vascularization of damaged skin. The objective of this work was to evaluate the use of the autonomized star flap in the nipple reconstruction of burned breasts. Methods: Nipples were reconstructed in eight female patients in two surgeries each. Results: There were no complications such as necrosis, dehiscence, complete loss of projection of the new nipple, or infection. The mean projection at the end of surgery was 15.25 mm; 6 months after reconstruction, it was 3 mm, showing stability. All patients were satisfied with their results. Conclusion: We conclude that autonomization leads to safe reconstruction of the nipple on burned breasts and maintains a satisfactory minimal projection of the reconstructed nipple.

Consecuencias del seudofisiculturismo en adolescentes / Conséquences du pseudo-culturisme chez les adolescents / Consequences of seuophysiculturism in adolescents

En la actualidad en Cuba algunos adolescentes y jóvenes, en su afán de aumentar rápido el tamaño de sus músculos se están inyectando aceite de soya de uso doméstico, lo cual les ha conducido a graves lesiones que incluso han puesto en peligro sus vidas. El objetivo de este trabajo es presentar una nueva afección, mostrar las características de las lesiones y divulgar los resultados con fines educativos y de prevención. Se presentaron 3 casos sobre los efectos nocivos de la inyección de aceite de uso doméstico en músculos, en pacientes ingresados en el Hospital Pediátrico Eliseo ¨Noel¨ Caamaño de Matanzas de diciembre 2010 a mayo 2011. Sus características clínicas son gran aumento de volumen en músculos inyectados, el calor, rubor, intenso dolor e impotencia funcional con toma del estado general. El tratamiento quirúrgico fue incisión, desbridamiento y drenaje, que mostró abundante aceite, pus, sangre y fibras musculares necrosadas; proceder que se debe realizar múltiples veces. Las lesiones no ocurren de inmediato sino con intervalos variables, no al unísono sino desorganizadamente, con gran dificultad para su cicatrización. Se utilizó además tratamiento antibiótico de amplio espectro y cámara hiperbárica. Se concluye que la utilización de aceite de uso doméstico trae graves consecuencias a la salud, como la sepsis y necrosis severa de los músculos, hepatitis C, septicemia y peligro para la vida de quienes lo usan(AU)

At present, some teenagers and young people in Cuba, in their desire to quickly increase the size of their muscles, are injecting soybean oil for domestic use, which has led them to serious injuries and even risk to their lives. The aim of this work is to present this new condition, to show the characteristics of the lesions and spread the results for education and prevention. We presented three cases on the adverse effects of oil injection into muscles in patients who were admitted to the Paediatric Hospital Eliseo ¨Noel¨ Caamaño of Matanzas from December 2010 to May 2011. Their clinical features were a high increase in volume of the injected muscles, heat, redness, intense pain and functional impotence with general malaise. The surgical treatment consisted on the incision, debridement and drainage which showed abundant oil, pus, blood and necrotic muscle fibres, procedure that had to be performed many times. The lesions did not occur immediately, but with varying intervals and not in unison but in a disorganized form with great difficulty in healing. Treatment with broad-spectrum antibiotic was also used as well as hyperbaric chamber. We conclude that the use of domestic oil provokes serious consequences to health such as sepsis and serious muscle necrosis, Hepatitis C, septicaemia and danger to the lives of those who use it(AU)

Afin de développer rapidement leur masse musculaire, les adolescents et jeunes gens à Cuba ont l'habitude de s'injecter par voie intramusculaire de l'huile de soya à usage domestique, résultant en graves lésions et mettant même leurs vies en péril. Le but de ce travail est de présenter cette nouvelle affection, de montrer les caractéristiques des lésions, et de diffuser les résultats à des fins éducative et préventive. Les cas des trois jeunes patients hospitalisés à l'hôpital pédiatrique Eliseo Noel Camaño, à Matanzas, depuis décembre 2010 jusqu'à mais 2011, montrant les effets néfastes de l'injection intramusculaire de l'huile à usage domestique, sont présentés. Les caractéristiques cliniques comprennent une grande augmentation du volume des muscles injectés, chaleur, douleur intense, rougeur, impotence fonctionnelle, et malaise générale. Le traitement chirurgical a consisté en incision, débridement et drainage, montrant une quantité excessive d'huile, pus, sang et fibres musculaires nécrosées; cette opération a été répétée plusieurs fois. Les lésions ne se produisent pas d'immédiat, mais en intervalles variables et de façon désorganisée, rendant la cicatrisation difficile. Les patients ont été aussi traités par des antibiotiques à large spectre et par oxygénothérapie hyperbare. On conclu que l'emploi de l'huile à usage domestique a des conséquences nuisibles pour la santé telles que l'infection et la nécrose sévère des muscles, hépatite C, septicémie et danger pour la vie de ceux qui l'utilisent(AU)

Polioencefalomalacia experimental em bovinos induzida por toxicose por enxofre / Experimental polioencephalomalacia in cattle induced by sulfur toxicosis

O presente trabalho teve como objetivos avaliar os sinais clínicos, as concentrações do sulfeto de hidrogênio ruminal e as alterações anatomopatológicas associadas à intoxicação experimental por enxofre em bovinos. Foram utilizados dez bezerros mestiços leiteiros, sendo que quatro bovinos ingeriram ração sem sulfato de sódio (G1) e seis consumiram ração com sulfato de sódio (G2). Exames clínicos (temperatura retal, frequência cardíaca e respiratória e motricidade ruminal) e laboratoriais (hemograma, fibrinogênio, proteína plasmática, pH do fluido ruminal, concentração do sulfeto de hidrogênio ruminal, líquido cerebrospinal e histopatológico) foram realizados. A temperatura retal, frequência cardíaca, hemograma, fibrinogênio, proteína plasmática, pH do fluido ruminal e os valores do líquido cerebrospinal estavam dentro dos valores de referência para a espécie. Taquipnéia, hipomotricidade ruminal e elevados valores de sulfeto de hidrogênio ruminal foram observados nos bezerros do grupo G2. Um bezerro do grupo G2 apresentou sinais neurológicos e lesões histopatológicas de PEM. Dois animais de cada grupo foram eutanasiados. Lesões microscópicas foram observadas nos bezerros do G2. Histologicamente as alterações observadas foram necrose neuronal cortical e lesões hemorrágicas nos núcleos basais, tálamo, mesencéfalo, ponte e bulbo. O protocolo experimental constituído por uma dieta rica em carboidrato de alta fermentação, baixa quantidade de fibra efetiva e altos níveis de enxofre (0,52%) ocasionou alterações clinicas e histológicas e elevadas concentrações de sulfeto de hidrogênio ruminal compatíveis com quadro de intoxicação por enxofre.

The aims of this study were to evaluate the clinical signs, the ruminal hydrogen sulfide concentration and the histological lesions induced by sulfur toxicosis in cattle. Ten crossbred calves were fed an experimental diet, four without sodium sulfate (G1) and six with (G2). The calves were submitted to clinical (rectal temperature, cardiac and respiratory rate and ruminal motricity) and laboratorial (hemogram, fibrinogen, total plasma protein, ruminal fluid pH, ruminal hydrogen sulfide concentration, cerebrospinal fluid and histopathological) evaluations. Rectal temperature, cardiac rate, hemogram, fibrinogen, total plasma protein, ruminal fluid pH and cerebrospinal fluid values were within normal reference ranges in animals from both groups. Ruminal hypomotricity and increased respiratory rate and ruminal hydrogen sulfide concentration occurred in G2 animals. One out of six calves in G2 developed neurological signs and lesions of PEM. Two calves of each Group were euthanized. Microscopic lesions of PEM were observed in G2 animals. Histologically there were cortical neuronal necrosis and hemorrhagic lesions in basal nuclei, thalamus, midbrain, pons and medulla oblongata. The experimental model consisting of a diet with high carbohydrate and low in long fiber content with high sulfur concentrations (0.52%) resulted in clinical and histological abnormalities and high ruminal hydrogen sulfide concentration consistent with sulpur toxicosis in cattle.

Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Causas y complicaciones infecciosas de la pancreatitis aguda / Infectious complications in acute pancreatitis

La pancreatitis aguda es una enfermedad prevalente. En los últimos años hemos asistido a un progresivo aumento de la sobrevida conforme a los avances en el manejo intensivo. El grupo de pacientes con infección de la necrosis mantiene una elevada mortalidad (30-50 por ciento). Las estrategias preventivas de la infección de la necrosis se basan en el soporte nutricional y la profilaxis antibiótica. El manejo se fundamenta en el soporte general y en técnicas de drenaje desde las mínimamente invasivas, que se han desarrollado en los últimos años, hasta la cirugía tradicional. Se discute en detalle la profilaxis, diagnóstico y manejo de la necrosis infectada.

Acute pancreatitis is a prevalent disease that has experienced a progressive decline in mortality in last years due to intensive supportive care. Patients with necrosis infection still have worse prognosis with mortality ranging between 30-50 percent. Strategies to prevent necrosis infection include early enteral nutrition and antibiotic prophylaxis. Management is based on general support and removal of infected necrotic debris, including recently developed minimally invasive techniques and traditional surgery. This article discusses in detail topics on prophylaxis, diagnosis and treatment of infected necrosis.

Antepartum Pituitary Necrosis Occurring In Pregnancy with Uncontrolled Gestational Diabetes Mellitus: A Case Report

Antepartum pituitary necrosis is a rare medical condition that has only been reported in pregnant women with type I diabetes attributable to diabetes-related vasculopathy and hypercoagulability. We present for the first time a case of antepartum pituitary necrosis occurring in an uncontrolled gestational diabetes mellitus (GDM) patient. The patient was a 32-yr-old woman at 33 weeks and 2 days of gestation. She suffered from severe headache, blurred vision, dizziness, and vomiting. Her baby was delivered by Cesarean section. The brain magnetic resonance images revealed pituitary necrosis. This suggests that pituitary gland necrosis may also complicate GDM pregnancy when glucose levels are uncontrolled.

Acute retinal necrosis / Necrosis retiniana aguda: informe de un caso

Purpose: Clinical features in a case of acute retinal necrosis are described as well as its diagnostic approach and response to early treatment. Methods: This is a descriptive and retrospective study case report of a 26 year old male patient who arrived to the emergency room with a three day history of sudden visual loss in the right eye (RE). At initial evaluation a visual acuity of hand movements in the RE, 20/15 in the left eye (LE) and a right relative afferent pupillary defect were found. Fundoscopy revealed profuse soft exudates and hemorrhages involving posterior pole, inferior hemiretina and superotemporal periphery. Infectious workup and fluoresceinic angiography were made and positive serologies for herpes virus types 1 and 2, without HIV, were found. A diagnosis of acute retinal necrosis was made and treatment with intravenous valgancyclovir for two weeks and intra-vitreous triamcinolone for severe vasculitis, was given. Then a 3 months treatment with oral antiviral agents was prescribed. Results: Patient’s evolution showed improvement with treatment and at two and a half months of follow up, visual acuity was 20/50 in the right eye, normal slit lamp examination, tonometry of 12 mm Hg and fundoscopy improved when compared to initial pictures. Conclusions: A high index of suspicion is needed for diagnosing ARN taking into account clinical findings. Prompt intravenous and intra-vitreous treatments are needed to achieve good clinical and functional outcomes and to avoid central nervous system complications.

Objetivo: Describir un caso de necrosis retiniana aguda, las características clínicas, el enfoque diagnóstico y la respuesta al tratamiento. Método: Se realiza un estudio descriptivo, retrospectivo tipo informe de caso en un paciente de sexo masculino, 26 años de edad, que consulta al Servicio de Urgencias con historia de pérdida visual del ojo derecho (OD) de 3 días de evolución. Al examen de ingreso se encontró una agudeza visual del OD de movimiento de manos y defecto pupilar aferente, y 20/15 en el ojo izquierdo (OI). En el estudio del fondo de ojo derecho se encontraron exudados blandos abundantes y hemorragias que comprometen todo el polo posterior, la hemirretina inferior y la periferia supero temporal. En los exámenes para clínicos se evidenciaron serologías positivas para herpes tipo 1 y 2 en ausencia de VIH y a la angiografía con fluoresceína cambios vasculares con zonas de no perfusión. Se llega al diagnóstico de necrosis retiniana aguda y se decide manejar con valganciclovir endovenoso durante dos semanas, triamcinolona intravítrea y fotocoagulación retiniana con laser para el manejo de la vasculitis severa y zonas isquémicas; luego se continuó con antivirales orales por 3 meses. Resultados: Después de 2 meses y medio de seguimiento, hay una agudeza visual de 20/50 del OD, un examen biomicroscópico normal, presión intraocular de 12 mm Hg y el fondo de ojo muestra mejoría del cuadro al compararlo con las fotos iniciales.Conclusiones: Al diagnóstico de NRA se llega con la sospecha clínica, de acuerdo con los signos del examen; se requiere un manejo endovenoso e intravítreo oportuno, para lograr buenos resultados tanto clínicos como funcionales y evitar complicaciones a nivel del sistema nervioso central.

Sudden death due to aortic rupture while swimming: A case report.

An eleven year old, healthy boy with no past history of illness suddenly felt acute excruciating chest pain which was radiating to back, while he was swimming in a private swimming pool. He was immediately transferred to a hospital where he was declared dead on arrival. Autopsy and histopathological findings were suggestive of death was due to extensive advential haemorrhge due to inherent weakness in aortic wall.