A reflection on medical treatment of radionuclide-contaminated wounds during medical response to nuclear emergencies / 中国辐射卫生

Radionuclide-contaminated wounds are common in medical response to nuclear emergencies, which have different manifestations in different types of accidents. Medical treatment is the key part of the response. Based on the drill experience gained from medical response to nuclear emergencies, the authors summarize the research advances in radionuclide-contaminated wounds in recent years, mainly involving the biokinetic characteristics, medical response, surgical debridement, and prevention and treatment of internal contamination of radionuclide-contaminated wounds; the authors summarize the key points of technical operations and provide suggestions on improvements in the drills. The authors believe that medical treatment of radionuclide-contaminated wounds requires highly compatible integration of the practical skills from clinical medicine and radiological knowledge; emergency response, surgical debridement, and prevention and treatment of internal contamination all together constitute an integrated rescue and treatment strategy with internal logic correlations. However, targeted improvements are needed to achieve desired effects in the drills.

Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Pyoderma gangrenosum in a patient with type 2 diabetes: a case report / Pioderma gangrenosa en un paciente diabético tipo 2: reporte de un caso

We are presenting a case of patient with type 2 diabetes mellitus that was diagnosed with a soft tissue infection in the lower extremity. This was initially treated as cellulitis and antibiotic treatment was initiated. Due to a poor clinical response, the diagnosis of pyoderma gangrenosum was proposed as part of the differential diagnosis. Skin biopsies and pathology confirmed the diagnosis of pyoderma gangrenosum that had a satisfactory response to steroid treatment

Se presenta el caso de una paciente diabética tipo 2 que inicialmente fue diagnosticada como una celulitis complicada del miembro inferior izquierdo, pero ante la pobre respuesta con el tratamiento antibiótico, se consideró el diagnóstico de pioderma gangrenosa, confirmado anatomopatológicamente, con respuesta satisfactoria al tratamiento esteroideo tópico

Cervical vertebral osteomyelitis secondary to Streptococcus equi infection in an adult horse - case report / Osteomielite vertebral cervical secundária à infecção por Streptococcus equi em um cavalo adulto - relato de caso

A 15-year-old, mixed breed, male horse was attended with a history of multiple abscesses in the cervical region with a three-year evolution. Upon admission, three fistulous tracts with drainage of purulent secretions in the cervical region, low body score, restriction of cervical movements, and painful sensitivity to palpation were observed. The horse was diagnosed with osteomyelitis secondary to Streptococcus equi infection. The initial treatment was antibiotic therapy and local curative. Owing to the lack of response, surgical debridement was performed. An initial favorable response was observed; however, after 4 months, drainage recurred, and the animal was euthanized. A post-mortem computed tomography scan was performed to obtain details of the injury. Cervical osteomyelitis is rare, and its occurrence through hematogenous spread in adult horses and the tomographic findings had not been reported previously. The long period of evolution, difficulty in performing an aggressive debridement, and the presence of multi-drug resistant bacteria contributed to the negative outcome.(AU)

Um equino macho, sem raça definida, de 15 anos de idade, foi atendido com histórico de múltiplos abscessos cervicais com evolução de três anos. Na admissão, foram observados: três trajetos fistulosos com drenagem de material purulento na região cervical; baixo escore corporal; restrição de movimentos cervicais; e sensibilidade dolorosa à palpação da região. Foi diagnosticada osteomielite vertebral cervical secundária à infecção por Streptococcus equi. O tratamento inicial consistiu na administração de antibióticos e curativo local. Na ausência de resposta à terapia, realizou-se o debridamento cirúrgico. Inicialmente, obteve-se uma resposta favorável, entretanto, após quatro meses, houve recidiva da lesão e o animal foi submetido à eutanásia. Realizou-se tomografia computadorizada no post mortem para detalhamento da lesão. A osteomielite vertebral cervical é rara, e sua ocorrência por meio de disseminação hematógena em animais adultos não foi previamente reportada. O longo período de evolução, aliado à dificuldade de realização de um debridamento agressivo, e a característica multirresistente do agente etiológico contribuíram para o desfecho negativo do caso.(AU)

Treatment of sternal infection after cardiac surgery with pectoralis major muscle flap plasty in 247 cases / 中华胸心血管外科杂志

Objective To summarize the experience on the treatment of sternal infection after cardiac surgery,introduce the pectoralis major myocutaneous flap plasty.Methods The clinical data of 247 patients with sternal infection after cardiac surgery in our hospital from January 2014 to July 2017 were retrospectively analyzed.Including 176 males and 71 females,aged from 3 months to 92 years old(162 cases over 60 years old).Results 4 cases died postoperation.226 cases with stage Ⅰ healing,17 cases with stage Ⅱ healing(4 cases of tuberculosis infection cured by anti-tuberculosis treatment).201 cases were followed up,7 cases wound infection relapsed(6 cases with replacement of aortic dissection with artificial blood vessel,and 1 with congenital heart disease).The others had no recurrence.Conclusion The pectoralis major muscle flap inversion plasty for treatment of the median sternal and mediastinal chest incision infection after cardiac surgery can effectively cure the wound,shorten the treatment time,and prevent the secondary complications caused by wound infection.Most patients can obtain primary healing.

Nibble debridement combined with silver ions dressing in treatment of diabetic foot ulcer / 局解手术学杂志

Objective To explore the clinical efficacy of nibble debridement combined with silver ions dressing in treatment of diabetic foot ulcer.Methods The data of 238 patients with diabetic foot ulcer in people's hospital of Meishan from January 2012 to December 2016 were retrospectively analyzed.Of which 125 patients were treated by nibble debridement combined with silver ions dressing(nibble debridement group),113 patients were treated with surgical debridement combined with silver ions dressing(surgical debridement group).The clinical efficacy,wound healing time and complication between two groups were compared.Results The wound healing time of nibble debridement group was (37.5 ± 10.8) days,which was shorter than (45.3 ± 11.7) days of surgical debridement group,the difference was significant (P ＜0.05).The total effective rate of nibble debridement group was 92.80％,which was higher than 73.45％ of surgical debridement group,the difference was significant(P ＜ 0.05).No complication occurred in two groups.Conclusion The method of nibble debridement combined with silver ions dressing treatment has a better satisfactory clinical result,shorter wound healing time and lower medical costs for patients with diabetic foot ulcer.

Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

Two Cases of Rhinocerebral Mucormycosis in Diabetic Patients

Rhinocerebral mucormycosis is a rare fungal infection that involves the paranasal sinus and orbits and usually presents as acute invasive fungal sinusitis. It progresses rapidly, is often fatal, and occurs most commonly in patients with uncontrolled diabetes. If the condition is not treated, the fungal infection may disseminate into the brain and cause death within a week. We encountered two cases of rhinocerebral mucormycosis confirmed with histophathological examination. The cases were treated successfully with surgical debridement, a systematic application of amphotericin B, and irrigation and soakage with amphotericin B.