M H Dang | PubMed Health

PubMed1977

Necrotizing fasciitis: a persistent surgical problem.

Necrotizing fasciitis is a rare but specific clinical entity which, if not diagnosed early and treated aggressively, is rapidly fatal. The disease was first described during the Civil War and continues to be associated with a 50% mortality. The infectious process is diagnosed by the presence of a widespread fascial necrosis with extensive undermining of the adjacent tissues. The initial mechanism of injury as well as the location and etiologic agent of the suppurative fasciitis may vary. A review of 41 cases of necrotizing fasciitis occurring over a 22-year period disclosed an overall mortality of 39%. Most often, the mortality was related to the severity of the associated diseases and a failure to recognize the disease process promptly. The rate may be lowered by early recognition and prompt surgical intervention coupled with intensive supportive therapy.

Adolescent↗

PubMed1975

Complete occlusion of the infrarenal abdominal aorta: management and results in 64 patients.

Sixty-four patients with complete occlusion of the infrarenal abdominal aorta were reviewed. The clinical findings, diagnostic procedures, and surgical management are described. Sixty-one patients underwent thromboendarterectomy and bypass grafts from the infrarenal abdominal aorta to the iliac or common femoral arteries. Because purulent material was found in the retroperitoneum of two patients, the proximal anastomosis was performed to the descending thoracic aorta in one patient and to the upper abdominal aorta in the other. One patient underwent thromboendarterectomy and patch graft angioplasty. The hospital mortality rate was 4.6 percent. Sixty-one patients discharged from the hospital were followed (average length of follow-up was 37 months). There were three late deaths (4.9 percent). Two patients have had occlusion of one limb of their bypass grafts and, along with four others, have developed recurrent symptoms of vascular insufficiency of the lower extremities. These symptoms were due to progressive atherosclerotic occlusive disease of the distal arterial tree for which additional distal procedures were required.

Adult↗