RESUMEN
Bites from the adder, Vipera berus, are well known for causing local and general toxicity. We report a case of a 63-year-old female who was bitten in one of her lower extremities. She was seen twice in the emergency department with symptoms and signs consistent with severe envenomation. Despite treatment with antihistamines and corticosteroids the oedema persisted. A lymphoscintigraphy was performed showing dermal backflow in the right leg, confirming the diagnosis of lymphoedema. Based on the present case report and review of the literature antivenom therapy should be considered more actively.
Asunto(s)
Linfedema/inducido químicamente , Venenos de Víboras/efectos adversos , Animales , Antivenenos/administración & dosificación , Antivenenos/uso terapéutico , Femenino , Humanos , Linfedema/diagnóstico por imagen , Linfocintigrafia , Persona de Mediana Edad , Mordeduras de Serpientes/complicaciones , Mordeduras de Serpientes/terapia , Medias de Compresión , ViperidaeRESUMEN
INTRODUCTION: To describe the lessons learned from treatment of war casualties at a public hospital in Denmark. METHODS: A retrospective review of soldiers who underwent free flap reconstruction at Rigshospitalet, Denmark, between January 2006 and December 2010. RESULTS: Nine patients were treated using free flaps. The age distribution was 21-34 years. Extremity fractures associated with considerable soft tissue loss were seen in all cases. The mean time from injury to reconstruction was 13.2 days. A total of 11 free flaps were used, the majority of which were latissimus dorsi flaps (seven out of 11). Flap-loss occurred in one patient, presumably due to leakage at the anastomotic site, which necessitated another free flap procedure. All patients received rehabilitation services following discharge from the inpatient unit, including prosthetic fitting. The mean follow-up time was 26 months. CONCLUSIONS: This report is the first to detail the reconstructive procedures in soldiers treated at a public hospital in Denmark. The treatment of war casualties has not only been a challenge to the surgeons tasked with managing these devastating injuries, but also to Danish healthcare in general. The outcome of multidisciplinary treatment, combining the expertise of various specialties, is highly encouraging. The rate of complications was low, and the aesthetic appearance of the reconstructed limbs and the functional recovery were satisfactory. We therefore recommend the use of free flaps to reconstruct defects resulting from battlefield trauma. FUNDING: none. TRIAL REGISTRATION: not relevant.
Asunto(s)
Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Trasplante de Tejidos , Guerra , Heridas y Lesiones , Adulto , Campaña Afgana 2001- , Dinamarca , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/rehabilitación , Recuperación de la Función , Reoperación/métodos , Estudios Retrospectivos , Trasplante de Tejidos/efectos adversos , Trasplante de Tejidos/métodos , Trasplante de Tejidos/rehabilitación , Resultado del Tratamiento , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/etiología , Heridas y Lesiones/cirugíaRESUMEN
A clinical case of the rare disorder steatocystoma multiplex is described in a 39-year-old female. The patient was diagnosed with generalized intradermal lesions that started presenting in early adulthood. There was no family history of similar lesions.Skin examination showed multiple, skin-coloured cystic lesions on the chest, abdomen, axillae and back. The patient's clinical presentations and history were compatible with steatocystoma multiplex. Various treatment options for steatocystoma multiplex and steatocystoma multiplex suppurativum have been published and include oral antibiotics, isotretinoin, excision and incision techniques.