ABSTRACT
Necrotizing fasciitis is a rapidly progressive infection of the fascia and subcutaneous tissues accompanied by a high mortality rate approaching 80% to 100%. Factors that predispose patients to this life-threatening complication include obesity, malnutrition, malignancy, chronic alcoholism, drug abuse, peripheral vascular disease, diabetes mellitus, and immunosuppressive therapy. The pathomechanisms for the development of this rare disease still remain unclear. We report a case of necrotizing fasciitis with Clostridium perfringens after laparoscopic cholecystectomy. The patient left the hospital 5 months after admission. Early recognition based on clinical signs (pain, asymmetric abdominal thickening, crepitus) and computed tomography scanning (gas dissection along fascial planes), in conjunction with prompt, aggressive surgical therapy and debridement of all devitalized tissue, high-dose antibiotic therapy, and therapy at the intensive care unit, appears to afford patients the best chance of survival.
Subject(s)
Cholecystectomy, Laparoscopic/adverse effects , Clostridium Infections/etiology , Clostridium perfringens/isolation & purification , Fasciitis, Necrotizing/etiology , Surgical Wound Infection/etiology , Cholecystectomy, Laparoscopic/methods , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Clostridium perfringens/drug effects , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Humans , Male , Middle Aged , Risk Factors , Surgical Wound Infection/diagnosis , Surgical Wound Infection/drug therapyABSTRACT
BACKGROUND: Cardiac surgery in the elderly is performed with increasing frequency. Beside low mortality an evident gain in quality of life is the most important aim of therapy. To investigate the medium term outcome of cardiac surgery, we evaluated patients over 75 years of age who were operated on within a 1.5-year period. METHODS: Between 01/98 and 06/99, 124 patients (76 male, 48 female), mean age of 76.6 (range 75-86) years were operated on. Eighty-four per cent had isolated coronary or valve procedures and 16% had combined procedures. Pre- and postoperative NYHA classification, follow-up period, perioperative mortality and the subjective satisfaction were recorded. RESULTS: Total perioperative mortality was 6.4%. After a mean follow-up time of 15.2 (range 6-24) months, patient satisfaction with the operative results was excellent in 73%, good in 26% and low (unsatisfied) in 1%. CONCLUSIONS: Cardiac surgery in the elderly can be performed with an acceptable morbidity and mortality. The fact that 99.1% of the patients are satisfied with their operation and the dramatic improvement in functional status (96.5% NYHA I and II) justify cardiac surgery in this age.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Diseases/surgery , Quality of Life , Age Factors , Aged , Aged, 80 and over , Cardiac Surgical Procedures/mortality , Critical Care , Female , Follow-Up Studies , Heart Diseases/mortality , Heart Diseases/physiopathology , Humans , Length of Stay , Male , Patient Satisfaction , Recovery of Function/physiology , Treatment OutcomeABSTRACT
HISTORY AND CLINICAL FINDINGS: A 39 year old female patient presented with nausea and crampy abdominal pain in the right lower quadrant. INVESTIGATIONS: Physical examination showed a markedly distended abdomen with a diffuse pain, punctum maximum in the right lower part of the abdomen and reduced peristalsis. Plain abdominal x-rays revealed slightly dilated loops of small bowel with air-fluid levels. Abdominal ultrasound revealed thickening of the bowel wall of the distal ileum and some free fluid. To exclude Crohn's disease, Sellink-computer tomography was performed, which also showed thickening of the wall of the terminal ileum and dilated bowel loops proximal to the underlying stenosis. DIAGNOSIS, TREATMENT AND COURSE: Intraoperatively, the terminal ileum was thickened by scar tissue and subtotally invaginated. Histologic investigation of the resected specimen showed submucosal endometriosis. CONCLUSION: Endometriosis of the small bowel should be considered carefully in the differential diagnosis of female patients of reproductive age who suffer from symptoms of ileus, dysmenorrhea and sterility.
