Atraumatic acute compartment syndrome - case report.

INTRODUCTION: The publishing of our case report on an idiopathic compartment syndrome of both upper limbs after icing a contusion trauma was motivated by another article on the acute spontaneous compartment syndrome of upper limb published in Rozhledy v chirurgii 8/2021. CASE REPORT: We present the case of a 43-year-old man admitted in the evening for painful massive swelling of both upper extremities. The swelling developed immediately after icing his bruises suffered due to a probable fall on the previous day in a state of inebriety. Compartment syndrome of the left hand and right forearm was diagnosed; subsequently, adequate dermatofasciectomy resulted in normalization of the condition in both upper limbs. The patients condition was cured to a full extent without any disorders of perfusion, mobility or sensation in both upper extremities. CONCLUSION: Only few reports on the atraumatic compartment syndrome of upper extremity can be found in the literature and it is an acute condition encountered quite rarely at outpatient offices of surgery. Nevertheless, we need to be able to recognize this nosological unit and provide proper treatment in time, otherwise the patient may suffer serious permanent damage.

[Steroids: The physiologic and pharmacologic effects of glucocorticoids]. / Szteroidok: A glükokortikoidok élettani és gyógyszertani hatásai.

Glucocorticoids are widely used in medical practice mainly for suppression of the immune system. According to Selye - who named them - the endogenous molecules are very important for the adaptation to challenges, stress. They were synthesized in the 1940s. Since then numerous data have been published about their production (also locally in several organs), transportation (primarily cortisol-binding globulin) and receptors (nuclear and non-genomic effects). Although glucocorticoids are primarily under the control of the hypothalamo-pituitary-adrenocortical axis, several other molecules (especially catecholamines) may also increase their secretion. Their permissive influences are dominant, thereby they are indispensable for the effect of numerous other molecules. Thus, glucocorticoids have very diverse influence from metabolism through cardiovascular effect to bone-metabolism, affecting even the central nervous system. They are also important in metabolic syndrome. Their extensive therapeutic usage are limited by side-effects, which could be diminished - among others - with concomitant usage of the anabolic dehydroepiandrosterone.