Acute cholecystitis is a common cause of emergency room admissions in elderly patients, and may have an atypical course with serious complications and high mortality. The authors present 131 elderly patients (aged 70 and older) who were treated for acute cholecystitis. The most common complaint was right upper abdominal pain (73%), followed by fever (55%), vomiting (48%), palpable mass (22%) and jaundice (13%). Twelve per cent of the patients were in septic shock on admission. Most patients (74%) had severe concomitant disease, increasing their operative risk significantly. Patients were prepared for surgery by hydration, nasogastric drainage, and antibiotics, while imaging was performed. They were all operated on within 48 hours. The operation of choice was cholecystectomy, which was performed in 86 patients. In 45 older and high risk patients, cholecystostomy was performed. The decision to perform cholecystostomy was taken prior to the operation, and was based on the estimated operative risk. Five patients (3.8%) died postoperatively. The major cause of death was cardiovascular disorders. Major complications occurred in 14.5 per cent and minor in 23 per cent of the patients. The complication rate correlated with severe concomitant diseases and older age groups. Patients with fever and leukocytosis had a better outcome, possibly reflecting a better immunologic status. The authors conclude that aggressive preoperative preparation and judicious use of cholecystostomy as a life-saving drainage procedure can lower the mortality from acute cholecystitis in the elderly population.
Mohs surgery and other surgical techniques are used for the removal of squamous cell carcinoma of the lower lip and may leave a large defect in the vermilion and underlying tissue. When nearly the entire lower lip is excised, reconstruction of this defect is a challenge. Repair requires the matching of vermilion color, maintenance of oral sphincter function and mouth opening size, and retention of sensation. Several techniques have been suggested. We present a modification of the Webster flap for total lower lip reconstruction using innervated muscle-bearing flaps.To present a surgical technique for the reconstruction of total lower lip defects after excision of squamous cell carcinoma.Innervated muscle-bearing flaps are used and demonstrated in one case. The surgical technique is discussed in detail.The reconstructive results were excellent. There were no postoperative complications.The use of innervated muscle-bearing flaps is a useful and effective option for the reconstruction of total lower lip defects.
Traumatic injury resulting in isolated dysfunction of the hypoglossal nerve is relatively rare and described in few case reports. We present a patient with isolated unilateral palsy of the twelfth cranial nerve (CN XII) resulting from recurrent airway intervention following extensive burn injuries. The differential diagnosis for paralysis of the CN XII is also discussed herein. This case illustrates the significance of comprehensive diagnostic evaluation and the need for refined airway manipulation in patients that require multiple endotracheal intubations. Une blessure traumatique résultant en un dysfonctionnement isolé du nerf hypoglosse est relativement rare et décrit dans quelques rapports de cas. Nous présentons un patient atteint de paralysie hypoglossal unilatérale isolée à la suite de l’intervention des voies respiratoires récurrentes après de brûlures extensives. Le diagnostic différentiel de la paralysie du nerf crânien (NC XII) est également discuté ici. Ce cas illustre l’importance de l’évaluation diagnostique complète et la nécessité pour la manipulation délicate des voies respiratoires chez les patients qui nécessitent de multiples intubations trachéales.
The assessment of deuteroporphyrin-hemin complex as an agent for the treatment of burn wounds infected with a multiple-drug resistant strain of Staphylococcus aureus was performed. The effect of the porphyrin on the survival of the infectious bacteria was first assayed in culture, and later tested as well in a burned infected animal model. The addition of deuteroporphyrin and hemin, separately or together (as a complex) to a growing culture of S. aureus was monitored during 8 hours. It was found that deuteroporphyrin alone was strongly bactericidal only after photosensitization. On the other hand, hemin alone was moderately bactericidal but light independent. A combination of both deuterophyrin and hemin was extremely potent even in the dark and did not require illumination to eradicate the bacteria. The in vivo experiments by application of the above porphyrins in combination to infected burn wounds in guinea pigs was an effective way to reduce dramatically the contaminating S. aureus. Reduction of more than 99% of the viable bacteria was noted after the porphyrin mixture was dropped on the eschar or injected into the eschar, an effect that lasted for up to 24 hours. The deuteroporphyrin-hemin complex may be suggested as a new bactericidal treatment of S. aureus infected burns since it was found to be a potent and promising anti-Staphylococcal agent.
Bio-Alcamid (BA) (polyalkylimide) was introduced in Europe in 2001. It is a nonresorbable injectable filler for soft tissue augmentation, indicated for a wide variety of clinical applications in reconstructive and cosmetic surgery in conditions where subcutaneous volumetric compensation is required. Although BA biocompatibility was approved by a European Union Certificate (CE), the substance is not a natural component of biologic tissues, and thus inflammation and infection are still potential risks. The authors present a case of BA infection after minor trauma 3 years after bilateral injections to the malar regions in a 43-year-old woman, causing an abscess that required surgical drainage and parenteral antibiotics.
