Necrotising fasciitis of the upper limb: a review of the literature.

Necrotising fasciitis is an uncommon life-threatening surgical emergency. While most commonly seen in the lower limb it can also affect the upper limb. This article reviews and summarises the current literature on necrotising fasciitis in the upper limb, covering common predisposing factors, clinical presentations, scoring systems, common organism types and the timing of surgical treatment. The key to managing this condition continues to be early clinical diagnosis and aggressive surgical debridement to attempt to reduce the morbidity and mortality of this condition.

The medium-term results of the Stanmore non-invasive extendible endoprosthesis in the treatment of paediatric bone tumours.

In skeletally immature patients, resection of bone tumours and reconstruction of the lower limb often results in leg-length discrepancy. The Stanmore non-invasive extendible endoprosthesis, which uses electromagnetic induction, allows post-operative lengthening without anaesthesia. Between 2002 and 2009, 55 children with a mean age of 11.4 years (5 to 16) underwent reconstruction with this prosthesis; ten patients (18.2%) died of disseminated disease and one child underwent amputation due to infection. We reviewed 44 patients after a mean follow-up of 41.2 months (22 to 104). The mean Musculoskeletal Tumor Society score was 24.7 (8 to 30) and the Toronto Extremity Salvage score was 92.3% (55.2% to 99.0%). There was no local recurrence of tumour. Complications developed in 16 patients (29.1%) and ten (18.2%) underwent revision. The mean length gained per patient was 38.6 mm (3.5 to 161.5), requiring a mean of 11.3 extensions (1 to 40), and ten component exchanges were performed in nine patients (16.4%) after attaining the maximum lengthening capacity of the implant. There were 11 patients (20%) who were skeletally mature at follow-up, ten of whom had equal leg lengths and nine had a full range of movement of the hip and knee. This is the largest reported series using non-invasive extendible endoprostheses after excision of primary bone tumours in skeletally immature patients. The technique produces a good functional outcome, with prevention of limb-length discrepancy at skeletal maturity.

Familial adenomatous polyposis complicated with an invasive colo-rectal adenocarcinoma in a 26-year-old Nigerian male - a rare finding.

Familial adenomatous polyposis is very rare in our environment. This condition occurring with a complication of a colorectal cancer has never been reported to the best of our knowledge. We present a case of a 26-year-old Nigerian man who came to us in February this year with a 10-year history of watery stool, which is also mucoid with tenesmus. There was also associated weight loss and colicky abdominal pains. He had also previously had a previous proctoscopy and rectal biopsy that showed numerous adenomatous polyps with dysplastic changes confirmed by histology. Barium enema revealed multiple polyps up to the right side of the transverse colon. Repeat histology after panproctocolectomy confirmed foci of invasive adenocarcinoma of the colon up to the muscle coat. The patient post-operatively is alive and well.

Comparison of three immunological tests for seroepidemiological purposes in human echinococcosis.

The comparative sensitivity and specificity of three immunodiagnostic tests for hydatid disease--the latex agglutination (LA) test, the indirect haemagglutination (IHA) test and the counterimmunoelectrophoresis (CIEP) test--were studied. The results of the IHA test were evaluated using three positivity criteria. Antigen from the same source--hydatid cyst fluid pool of ovine origin--was utilized for the three tests. A total of 123 sera were studied; 30 preoperative sera from patients with other parasitic and infectious diseases, 30 sera from patients with non-parasitic diseases and 30 sera from normal blood donors. The results of the three tests were correlated to the immunoelectrophoresis (IEP) test based on the presence of arc 5. The same sensitivity (86.7%) and specificity (99%) was obtained in LA, CIEP and IHA tests when the minimum cross-reactivity titre criterion was employed for the latter. Non-specificity was relatively high (13%) in the IHA test when only serological reactivity was considered. The sensitivity of the IHA test decreased (83.3%) using the diagnostic titre criterion and non-specific reactions were eliminated. All three tests correlated well with the IEP test.

[Correlative urinary excretion of sodium-uric acid in hyperuricemia (author's transl)]. / Eliminación urinaria correlativa de sodio-ácido úrico en hiperuricemias.

Since uricosuria is an essential compensative factor in hyperuricemia, multiple factors exist which can influence on the uric acid excretion in the tubules. Normally, 90% of the uric acid filtered by the glomerulus is reabsorbed, and its active tubular secretion forms the greater part of the uric acid present in the urine. One of the factors observed as leading to urinary excretion of uric acid, is saline overload, although this effect cannot always be achieved. This study is an attempt to assess the importance of hyperuricemia as a determinant of the action of sodium upon the urinary excretion of uric acid. The series were grouped according to the plasma and urinary values of uric acid. In cases studied, the percentage of sodium was similar independent of the excretion percentages obtained for uric acid. Nevertheless, in the groups with increased plasma levels of uric acid, a direct and significant correlation was found between the excretion percentage of sodium and that of uric acid. These data cannot be obtained in groups with normal plasma levels of uric acid. Since saline overload does not always lead to hyperuricosuria, other factors must condition the secondary effect. The obtained results suggest that hyperuricemia can be one of those factors, offering a great amount of uric acid to the renal tubule, a condition in which the sodium may act as a dragging factor which may not be possible with a lesser degree of uric acid.

[A new technical variation of the latex agglutination test for the diagnosis of human hydatidosis]. / Una nueva variante técnica de la prueba de aglutinación del látex para el diagnóstico de la hidatidosis humana.

A new variant of the latex agglutination test using latex particles of 0,81 mu diameter is described. Hidatid cyst fluid antigen standardized by immunoelectrophoretic analysis was used. Fifty-one human sera from surgically confirmed hydatidosis and ninety control sera from non-hydatid diseases and healthy donors were studied. The method showed a sensibility of 86,2% and a global inespecificity of 1,1%. A human case of teniasis by Taenia saginata was positive. General considerations about the interpretation of results in human hydatid disease serology are made.

[Diagnostic usefulness of the LUNDH test in the functional examination of the exocrine pancreas]. / Utilidad del "LUNDH test" en la exploración funcional del páncreas exocrino

We have revised the diagnostic utility of the "LUNDH TEST" in chronic exocrine pancreatic disease. The results obtained by the different authors consulted suggest, that it is likely to be more useful in clinical practice because of its practical advantages.