ABSTRACT
Necrotising fasciitis is a severe, life-threatening and rapidly progressive soft tissue infection that often requires aggressive surgical management, with an estimated incidence of about 0.24-0.40 per 100 000 in the UK. Necrotising fasciitis can be classified based on its microbiology or the anatomy or body region affected. Initial signs of necrotising fasciitis can be minimal and non-specific but a patient often presents with pain out of proportion to clinical signs on examination, as well as erythema and oedema, in addition to systemic symptoms associated with sepsis. Diagnosis is often based on high clinical suspicion with biochemical and clinical imaging used as adjuncts. To aid with early diagnosis of necrotising fasciitis, a scoring system known as the Laboratory Risk Indicator for necrotising fasciitis was developed which has a positive predictive value of 92%. Once diagnosed, appropriate resuscitation and antibiotics, along with prompt and aggressive surgical debridement, is the mainstay of treatment.
Subject(s)
Fasciitis, Necrotizing , Soft Tissue Infections , Anti-Bacterial Agents/therapeutic use , Debridement , Early Diagnosis , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/therapy , Humans , Risk FactorsSubject(s)
Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/microbiology , Liver Diseases/epidemiology , Liver Diseases/microbiology , Streptococcal Infections/epidemiology , Streptococcus bovis/isolation & purification , Colorectal Neoplasms/physiopathology , Comorbidity , Female , Humans , Liver Diseases/physiopathology , Male , Prevalence , Prognosis , Risk Assessment , Streptococcal Infections/diagnosis , Survival Rate , United Kingdom/epidemiologyABSTRACT
Colorectal carcinoma is one of the most common cancers encountered in the western world and increasingly in the developing world as well. This conditions results in considerable morbidity and mortality. As a result of the impact colorectal carcinoma has on society, a considerable amount of research has gone into elucidating the molecular mechanisms of this disease. This has led to a proliferation in the understanding of the molecular aetiology of the disease. Such research has revealed the underlying mechanisms to be complex and diverse, with no single molecular cause for the development of colorectal cancer. In this review, we look at the basic underlying molecular mechanisms of colorectal cancer and also briefly explore its implications with regards to clinical applications. We look at how this information relates to the prognosis and also its potential use in screening. A medline and pubmed search was conducted using the keywords colorectal carcinoma, molecular biology of colorectal carcinoma, mutations, and the relevant articles were used for this review. Bibliographies of these articles were also searched for relevant articles. There is considerable information available on the pathogenesis of colorectal carcinoma and such knowledge is beginning to impact on clinical practice.
Subject(s)
Biomarkers/analysis , Colorectal Neoplasms , Molecular Biology/methods , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/metabolism , Humans , Mass Screening/methods , Morbidity/trends , United Kingdom/epidemiologyABSTRACT
Acute appendicitis is a common surgical problem however the diagnosis is often overlooked when it presents as a small bowel obstruction. In this report we present two cases of elderly patients who presented with small bowel obstruction and raised inflammatory markers. Both patients were successfully treated with a laparotomy, adhesiolysis and appendicectomy and went on to make a good recovery.
