3181/4137. myositis and fasciitis associated with group A beta hemolytic streptococcal infections: development of a rabbit model. Group A streptococci produce a variety of clinical symptoms ranging from minor pharyngeal infections to life-threatening soft-tissue disease. A rabbit model is described for induction of myonecrosis and fasciitis with group A beta-hemolytic streptococci. Group A streptococcal infections have shown remarkable virulence in recent years, resulting in severe local tissue destruction and life-threatening toxicity. After subcutaneous injection into the thigh of 20 ml broth containing 10(5) to 10(9) cfu/ml, initial soft tissue infection rapidly progressed to rhabdomyolysis. The response of the rabbits to the infection was consistent with the human response. ( info) |
3182/4137. Colonic (splenic flexure) necrosis due to thrombosis of the middle colic artery following blunt abdominal trauma. We report an unusual case of a 28-year-old man who developed a colonic necrosis due to thrombosis of the middle colic artery 18 hours following blunt abdominal trauma. Although rare, this condition can occur in those patients whom non surgical treatment was initially performed. ( info) |
| We report two patients treated with ciprofloxacin who presented with acute renal failure. On renal biopsy, a necrotizing vasculitis was identified in addition to acute interstitial nephritis. Improvement in renal function resulted with the discontinuation of the antibiotic and the institution of immunosuppressive therapy. ( info) |
| Radiation necrosis is a delayed complication of cranial irradiation, typically presenting as a single intracerebral mass that is radiographically indistinguishable from recurrent tumor. We describe 6 patients with a distinct radiographic syndrome of multifocal enhancing lesions on magnetic resonance images, and their variable clinical courses: some fluctuating, some spontaneously resolving, and some demonstrating fulminant progression to frank necrosis. ( info) |
3185/4137. Dissecting thoracic aorta and fusiform aneurysm of the abdominal aorta. A 59-year-old woman with dissection of the thoracic aorta and a fusiform aneurysm of the abdominal aorta without evidence of Marfan's syndrome underwent aneurysmorrhaphy with a bifurcated expanded polytetrafluoroethylene graft. Histological specimens of the aneurysmal wall revealed the presence of idiopathic cystic medial necrosis. As typical findings of idiopathic cystic medial necrosis in the aortic wall are very rare except in cases of Marfan's syndrome, the present case is reported and the implications of this condition are discussed. ( info) |
| Cutaneous, noninfectious, granulomatous lesions have been reported occasionally in different types of immunodeficiencies, including common variable immunodeficiency (CVD). We present a child with CVID and cutaneous granulomas with a strikingly prominent caseating necrosis. We think that such granulomatous lesions constitute a distinctive manifestation of immunodeficiency, and may reflect a altered immune response. Corticosteroids have been of benefit to our patient, as well as in similar cases. ( info) |
| We describe a case of necrotizing arteritis of the brain in a 26-year-old man who presented as organic brain syndrome. The lesion has been confused clinically with acute encephalitis. At necropsy, no other abnormalities suggestive of systemic arteritis were found. Such CNS-restricted necrotizing arteritis of medium and small arteries in the absence of granuloma is extremely uncommon. ( info) |
3188/4137. Rectal necrosis following anterior resection of the rectum. Acute ischaemic colitis is a well recognized complication following abdominal surgery. It may occur spontaneously in older patients and is probably due to diffuse or localized obliterative arterial disease. In contrast, acute ischaemic proctitis is a rare clinical problem. It is caused by an acute surgical or thromboembolic interruption of the major blood supply and or collateral circulation of the rectum. Minor ischaemia may result in superficial mucosal ulceration whereas a major ischaemic episode will result in rectal necrosis with perforation. Acute rectal necrosis has not been reported as a complication following anterior resection of the rectum. This paper details a patient who developed necrosis of the rectum and the anal canal following anterior resection of the rectum for cancer of the recto-sigmoid junction. ( info) |
3189/4137. Colonic lesions in pancreatitis. Lesions of the colon are generally considered to be uncommon sequelae of pancreatitis. They include: localized paralytic ileus (colon cut-off sign), necrosis, fistulae, stenosis and varices. On the basis of an extensive review of the literature (432 cases), it is suggested indeed that the real incidence is significant. The anatomic relationship of the large bowel to the pancreas is an important factor in the genesis and localization of the lesions. Enzymatic-inflammatory and ischemic processes are involved in the most highly supported theories. colon cut-off sign is almost always spontaneously reversible and may represent an "alarm" for more serious complications. Massive necrosis develops during the early stage of severe pancreatitis and its mortality rate has been reported to be high. Fistulae are late complications of the disease, associated with a protracted course and probably a consequence of pancreatic suppuration or pseudocysts. Stenoses are the most interesting colonic complications following pancreatitis and caused by either acute obstruction of the colon due to an inflammatory mass or progressive obstruction due to pericolic fibrosis. In this case, the clinical picture may mimic carcinoma. ( info) |
| We report a patient suffering from necrotizing fasciitis. The principal pathogen was streptococcus pneumoniae. As far as we are aware, this is the first reported case of necrotizing fasciitis (NF) attributable to this organism. We discuss the pathogenesis of NF, and review the literature relating to this disorder. ( info) |