Fatal necrotizing fasciitis following two suicide attempts with petroleum oil injection.

PURPOSES: Necrotizing fasciitis is an aggressively progressing complication of the skin and soft tissue infections. It has dramatic course and often leads to patient's death. METHODS: In our research, we present the casuistic case concerning double suicide attempt with petroleum oil injection, complicated by the necrotizing fasciitis, patient was with deliberately withheld mental disorders. RESULTS: During the first suicide attempt, the oil substance was injected into the left cubital fossa and left toes areas, what lead to amputation of the upper left limb above the cubitial fossa and the left toes. Afterward, patient gradually recovered and survived. Two years later, another suicide attempt took place with the same substance: a 27-year-old man injected the petroleum oil into the right supraclavicular area. That affected a necrosis penetrating into the mediastinum and the patient died. CONCLUSIONS: To our knowledge, such case of the necrotizing fasciitis has not been previously reported. The mechanism of derivatives of oil influence on tissues is not investigated yet; therefore, treatment method is uncertain and sometimes ineffective.

The diagnosis and surgical management of diseases of the adrenal glands.

The authors present their own experience in the diagnosis and management of adrenal tumours and cysts. During the years 1980-2000, 74 patients were underwent surgical treatment. Of this group, 23 had Cushing's syndrome, 19 phaeochromocytomas, 4 Conn's syndrome, 2 virilising tumours, 2 adenocarcinomas, 2 ganglioneuromas, 7 adrenal cysts, 8 adenomas, 3 adenocortical carcinomas, 2 nodular hypertrophies, 1 myelolipoma and 1 liposarcoma. Treatment was effective in 73 (98.6%) of patients. We recommend the transperitoneal approach which allows the visual evaluation of both adrenals and extra adrenal tissue. We regard surgical intervention as being the only effective method of treating adrenal tumours.

[Diagnosis and surgical treatment of pancreatic carcinoma]. / Rak trzustki--diagnostyka i leczenie.

The aim of the study was presentation of our experiences in the diagnostics and treatment of pancreatic carcinoma in confrontation with current opinions. Between 1983 and April 1998 308 patients (198 males and 110 females with mean age 61 years) were treated at our department. In 211 cases tumor was primarily localized in the head and in 97 cases (31.5%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigations. Diagnostic accuracy of performed investigations was as following. Ultrasonography-86%, CT-scan-95%, and ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnostics improved detectability of resectionable carcinoma in the last past years. Among 308 patients, 292 underwent surgery. Since 1997 an intraoperative ultrasonography and cholangioscopy of common bile duct and Virsung were performed as a routine. The procedures depended on the localization and the grade of advance of the tumors. UICC classification of pancreatic tumors, pTNM (4th edition 1987) it was used. Only in 25 patients (8%) (tumors pT1a-bN0M0) it was possible to perform radical operation (resection of the pancreas). However in 172 patients (56%) only palliative procedures were done (pT2N1M0). In 95 patients (31%) only laparotomy and biopsy were performed (tumors pT2N1M1). The study shows that although diagnostic methods are improved, the tumors of the pancreas are diagnosed in stages making unable the radical procedures. Only about 10% of carcinomas are resectable. It is caused by with non-characteristic picture of the disease in its early stage.

[Results of surgical treatment for adrenal gland diseases]. / Wyniki chirurgicznego leczenia chorób nadnerczy.

The authors present their own experience in diagnosing and surgical treatment of adrenal tumors. The group consisted of 52 patients with adrenal tumors treated surgically in our Department in 1980-1996. There were 37 women (71%) and 15 men (29%); 22 with Cushing syndrome, 14 with pheochromocytoma, 4 with Conn's syndrome, 1 with virilizing tumor, 1 with adenocarcinoma, 1 with adrenocortical carcinoma, 1 with ganglioneuroblastoma 2 with adenomas, 6 with adrenal cyst. Diagnosis pre- and intraoperative was verified with histological examination. We suggest that the ultrasonography and computed tomography are the most useful methods in determining of tumor localisation. The authors prefer intraperitoneal approach, enabling evaluation of the contralateral adrenal gland and possible localisation of extraadrenal foci. Good results were obtained in 51 patients (98%).

Evaluation of the results of endotoxic shock (ES) treatment with dopamine (DA) and hydrocortisone (H).

The aim of this report is to present complex evaluation of the applied treatment with dopamine (DA) and hydrocortisone (H) in experimental endotoxic shock (ES). An evaluation is based on long-term experiences of the author's Clinic. The studies were performed in dogs. ES was evoked by intravenous E. coli endotoxin administration in a dose of 2 mg/kg. An appearance and progress of ES was evaluated by determination of many hemodynamic and biochemical parameters. In the treatment DA and H were used. Besides of mentioned above parameters also morphological, histochemical and ultrastructural investigations of the lung and liver were done. DA and H applied together were the most effective treatment in the course of ES. It could be a theoretical ground for combined ES treatment in people.

[Effect of hydrocortisone and dopamine on activity of beta-glucuronidase in lung parenchyma during experimental septic shock]. / Wplyw hydrokortyzonu i dopaminy na aktywnosc beta-glukuronidazy miazszu plucnego w doswiadczalnym wstrzasie endotoksycznym.

An effect of hydrocortisone and dopamine on beta-glucuronidase activity in the lung tissue in experimental septic shock was analysed. The study involved 30 mongrel dogs. Septic shock was induced with i.v. E. coli endotoxin. Total and free activity of beta-glucuronidase was determined with Talalay et al. technique in pulmonary parenchyma homogenate, mitochondrial-lysosomal fraction and supernatant. It was found, that hydrocortisone and dopamine given together increase the stability of the pulmonary lysosomes indicating a value of such management of the septic shock in man.

[The effect of hydrocortisone and dopamine on the activity of some lysosomal liver enzymes in experimental endotoxic shock]. / Einfluss des Hydrokortisons und Dopamins auf die Aktivität einiger lysosomaler Leberenzyme im experimentellen Endotoxinschock.

The influence of hydrocortisone and dopamine to the course of the organic functional changes and the activity of same lysosomal hepatic enzymes were tested in 30 dogs in endotoxic shock. A continuous lowering of the blood pressure and the central venous pressure were observed in the non-treated group. The hemodynamic impairments turned out in the treated groups in a less acute course. The coupled treatment with hydrocortisone and dopamine in the experimental endotoxic shock seems to reduce the activity of the lysosomal enzymes in the liver and in the peripheral blood.

[Effect of hydrocortisone on the behavior of mediators of the adrenergic system (dopamine, noradrenaline and homovanillic acid) in the liver during experimental endotoxic shock]. / Einfluss des Hydrokortisons auf das Verhalten der Mediatoren des adrenergischen Systems (Dopamin, Noradrenalin und Homovanillinsäure) in der Leber im Verlauf des experimentellen Endotoxinschocks.

The influence of hydrocortisone on the behaviour of the concentration of dopamine (DA), noradrenaline (NA), and homovanillic acid (HVA) were estimated in liver homogenates in the course of the experimental endotoxic shock. The concentration of DA and NA decrease in untreated animals in the 2nd and 4th hour in order to increase significantly in the 6th hour. The concentration of the HVA also increased in the 6th hour after a transitory significant decrease. - The values in the treated animals were in case of DA increased in the 2nd and 4th hour and decreased significantly in the 6th hour. In case of NA they decreased in the 2nd and 4th and increased significantly in the 6th hour and the values for HVA increased significantly in the whole time. The favourable effect of the hydrocortisone in the treated group can be traced back to the increased DA concentration, the decreased NA concentration and the better utilization of the DA by the tissue. This increased HVA could be evidence for them.