ABSTRACT
Necrotizing fasciitis is a rare, often fatal soft tissue infection. It still remains a confusing entity because of the nomenclature and multiple subtypes described in the past. An interesting case study of a patient with necrotizing fasciitis secondary to nonclostridial gas gangrene is presented. A comprehensive review of necrotizing fasciitis, its disease process and treatment modalities will be discussed.
Subject(s)
Bacterial Infections/classification , Fasciitis/microbiology , Foot Diseases/microbiology , Necrosis/microbiology , Streptococcal Infections/surgery , Bacteria, Anaerobic/isolation & purification , Bacterial Infections/surgery , Bacteroides/isolation & purification , Clavulanic Acids/therapeutic use , Drug Therapy, Combination/therapeutic use , Fasciitis/surgery , Fasciitis/therapy , Foot Diseases/surgery , Foot Ulcer/microbiology , Gangrene/classification , Gangrene/microbiology , Humans , Hyperbaric Oxygenation , Male , Middle Aged , Necrosis/classification , Skin Transplantation , Staphylococcus aureus/isolation & purification , Streptococcus pyogenes/isolation & purification , Ticarcillin/therapeutic useABSTRACT
We evaluated the effects of a large (920 cal) liquid carbohydrate (CHO) load on the maximum exercise capacity of 18 patients with chronic airflow obstruction [forced expiratory volume at at 1 s (FEV1) = 1.27 +/- 0.48 liters; FEV1/forced vital capacity = 0.41 +/- 0.11]. Patients underwent duplicate incremental cycle ergometer exercise tests to a symptom-limited maximum following CHO and a liquid placebo in single-blind fashion. Expired gas measurements were obtained during each power output. In 12 patients arterial blood gases were measured, and in six patients venous blood was obtained for measurement of glucose, electrolytes, and osmolality. With CHO, the maximum power output decreased from 86 +/- 30 to 76 +/- 31 W (P less than 0.001), whereas the ventilation at exhaustion was nearly identical (47.6 +/- 13.2 and 46.8 +/- 12.5 l/min). Arterial partial pressure of CO2 (PaCO2) at exhaustion decreased (P less than 0.025), arterial partial pressure of O2 (PaO2) increased (P less than 0.01), and the ventilatory equivalent for CO2 (VE/VCO2) increased (P less than 0.005) with CHO. At equivalent power outputs, CHO resulted in significant increases in VE (P less than 0.001) and VCO2 (P less than 0.001); PaCO2 was unchanged, whereas PaO2 increased (P less than 0.01). CHO increased the serum glucose at rest and during exercise. No changes in serum osmolality or electrolytes occurred during exercise following CHO. After CHO loading, the majority of patients appeared to reach their limiting level of ventilation at a lower power output. In contrast, there was no significant difference in the mean maximum power output with CHO in six normal control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
