Atypical Kawasaki disease with peripheral gangrene and myocardial infarction: therapeutic implications

We describe a 2-month-old girl with atypical Kawasaki disease (KD) complicated by peripheral gangrene and myocardial infarction. Peripheral ischaemia leading to gangrene is a rare but serious complication of KD in infants younger than 7 months of age. Treatment has been targeted at reducing arterial inflammation, arteriospasm and thrombosis. We report the first patient with incomplete KD and peripheral ischaemia in whom therapy with prostaglandin E1 (PGE1) as vasodilating and antithrombotic agent appeared successful, restoring hand and foot perfusion without significant long-term sequelae. However, PGE1 could have supported development of myocardial infarction by shunting blood away from ischaemic areas distal to a giant coronary artery aneurysm with beginning thrombosis. CONCLUSION. Atypical KD with peripheral gangrene appears to react favourably to treatment with PGE1, but needs careful monitoring to detect early signs of cardiac ischaemia.     

Fournier''s gangrene

We analyzed the ribosomal AT-L30 proteins from 13 type strains of species belonging to the genera Microbispora and Actinomadura. The electrophoretic mobilities of the AT-L30 preparations from Microbispora strains, as determined by two-dimensional polyacrylamide gel electrophoresis, revealed that the members of the genus Microbispora are phylogenetically homogeneous. The results of partial amino acid sequencing of AT-L30 preparations from several representative Microbispora strains supported the separation of the genus Microbispora from other related genera. The amino acid sequences of the AT-L30 proteins from strains of species belonging to the genus Actinomadura sensu stricto displayed a diversity that exemplified the low levels of amino acid sequence homology within the genus. This diversity was considered to be a characteristic typical of the genus Actinomadura.     

Fournier''s gangrene

OBJECTIVE: To evaluate the therapeutic efficacy of decompression of optic nerve canal in the eye with indirect nerve injury in the optic nerve canal. METHODS: 121 patients with indirect injury of optic nerve in the canal were selected and decompression of optic nerve canal was performed on them. Then the outcomes were reviewed and analyzed. RESULTS: Visual acuities of 76 patients (62.81%) were improved. CONCLUSION: It is obvious that decompression of optic nerve canal is associated with significant improvement in cases with good preoperative vision. In cases without light perception, treatment of steroids and dehydrant should be firstly applied, afterwards according to the patient's individual situation, selectively the case is to perform the operation. Thus the therapeutic effectiveness can be greatly elevated. Decompression of optic nerve canal is safe and reliable.     

Symmetrical Brodie's abscess

Chronic recurrent multifocal osteomyelitis is often confused with symmetrical Brodie's abscess as it has a similar pathogenesis. We report an otherwise healthy 17-year-old boy presenting with a true symmetrical Brodie's abscess. We conclude that a symmetrical Brodie's abscess presenting in an otherwise healthy patient is a separate clinical condition with a different management protocol.     

CT in Fournier''s gangrene

BACKGROUND: Few outcome studies directly compare Helicobacter pylori eradication therapy with maintenance H2-antagonist therapy in duodenal ulcer disease. AIM: To examine prospectively the efficacy of H. pylori eradication therapy with ranitidine maintenance therapy over 1 year in patients with confirmed chronic duodenal ulcer. METHODS: One hundred and nineteen patients with active H. pylori infection were randomized to receive ranitidine, 150 mg/day initially (58 patients), or omeprazole, 40 mg/day, amoxycillin 2 g/day and metronidazole 1.2 g/day for 14 days, or omeprazole 40 mg/day and clarithromycin 1.5 g/day, for 14 days (if penicillin-allergic). Symptoms were assessed using the Gastrointestinal System Rating Scale (GSRS) and SF36 quality of life index. RESULTS: 13C urea breath testing confirmed overall treatment success in 100% of patients (58/58) per protocol and 95.1% (58/61) on an intention-to-treat basis. At 4 and 12 months there were no differences in any GSRS symptoms between treatment groups. SF36 analysis showed a perceived health improvement at 4 and 12 months in patients who received H. pylori eradication. However, despite successful H. pylori eradication, one-fifth of patients still required antisecretory therapy. CONCLUSION: Following successful H. pylori eradication, chronic duodenal ulcer patients were at least as well symptomatically as when taking maintenance ranitidine. They perceived that their health had improved, but a subgroup was still acid-suppression dependent.     

Fournier gangrene: our experience

OBJECTIVE: Fournier's gangrene is a necrotizing fasciitis involving the genitoperineal region caused by the synergistic action of aerobic and anaerobic pathogens. It is a rapidly progressing disease and carries a high mortality. Our experience with Fournier's gangrene is presented. METHODS: Herein we describe 11 cases of Fournier's gangrene that were diagnosed and treated from 1991 to 1996. The most important predisposing factor was diabetes mellitus and the most common triggering factor was a perianal condition. RESULTS/CONCLUSIONS: The survival rate was high (81%) and can be ascribed to early diagnosis, aggressive and rapid surgical treatment with debridement, resection of the necrotic areas, drainage, simultaneous broad spectrum antibiotic therapy and frequent local treatment.     

Symmetrical cyanosis circumscripta e lipomate

In order to assess the Se status in individuals living in the Veneto region, a series of related measurements was performed. These included plasma selenium by PIXE and glutathione-peroxidase (GSH-Px) activities in plasma, red blood cells and platelets. Individuals were either normals or people suffering from various liver diseases. Moreover, an oral supplement of sodium selenite was given to 13 patients suffering from stable chronic renal failure (CRF) in parallel to 26 normals: data on plasma GSH-Px and on serum creatinine and creatinine clearance were collected either before or after supplementation. Results were in support of a relatively low selenium status: mean +/- SD plasma Se values of normals (0.82 +/- 0.17mumol/L, n = 82) were comparable to data observed in European regions where Se deficiency was already known. Even lower values were observed in those with liver diseases. Among enzyme activities, the distribution of the data of platelet GSH-Px was in further support of low Se status in the evaluated individuals. After Se supplementation, both normals and CRF patients showed a significant increase in the creatinine clearance, reflecting an improvement of the glomerular filtration rate. We suggest that more extensive surveys of the Se status should be carried out in Italy; moreover, Se supplementation may be advisable in individuals affected with moderate impairment of renal function.     

Gas gangrene mediastinitis after Boerhaave syndrome

Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the esophagus are both life threatening conditions. The combination of these two entities led to septic multiorgan failure in a 38-year-old woman. The patient was treated successfully by esophagectomy and postoperative lavage through a partially open abdomen. The lack of information regarding emesis, the leading symptom of Boerhaave's syndrome, caused delayed diagnosis: the triad of emesis, severe epigastric pain and emphysema of the skin was not established until 30 h after the onset of symptoms.     

轴对称功能梯度材料设计模型

采用弹性力学、复合材料力学以及计算数学的有关理论,建立起了轴对称功能梯度材料分析模型,结合这类材料实际应用背景,给出了理论模型求解的边界条件。在求解梯度层层间热应力的过程中,引入了三角级数来描述功能梯度材料层间热应力,从而得到了层间热应力的精确解,以此优化这类材料的设计与实现该类材料的成功制备。     

Limb gangrene and two types of vasculitis

Single strand conformation polymorphism (SSCP) analysis using ethidium bromide can be improved by adding formamide as the denaturant. This gives higher resolution than previous SSCP methods; it had 100% sensitivity in the discrimination of 14 PCR samples from two different genes, even for a long fragment close to the upper limit of 250 base pairs. This modified procedure is a rapid, simple, safe, and yet highly sensitive method for detecting structural differences in DNA fragments.     

Gas gangrene: potential for hyperbaric oxygen therapy

Clostridial myonecrosis (gas gangrene) is an uncommon sequela of traumatic injury. Infection with Clostridium perfringens in devitalized tissue is the most common cause. Wide surgical debridement and appropriate antibiotic therapy remain the standard of care. However, the addition of hyperbaric oxygen therapy to standard management has been shown to have a synergistic effect in reducing morbidity and mortality in both canine and murine models. Although no prospective human data are available, retrospective data indicate that concomitant hyperbaric oxygen therapy has resulted in a twofold reduction in mortality. Where feasible, hyperbaric oxygen therapy should routinely be incorporated into the treatment plan for gas gangrene. Primary care physicians are in a unique position not only to make an early diagnosis but also to have a central role in coordinating multidisciplinary care often needed for this potentially fatal infection.