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Sample records for saltwater nectotizing fasciitis

  1. Saltwater nectotizing fasciitis following coral reef laceration possibly exacerbated by a long-haul flight: a case report.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2009-01-01

    INTRODUCTION: Necrotising fasciits is a rapidly progressive disease characterised by extensive necrosis of the fascia, skin, and subcutaneous tissue, with relative sparing of the underlying muscle. CASE PRESENTATION: We present the case of a 24-year old Irish male student who sustained a laceration to his right shin from contact with a coral reef while swimming in the Phuket region, off the west coast of Thailand. The following day, he returned to Ireland and presented with an aggressive and destructive variant of group A beta-hemolytic streptococcal necrotising fasciitis originating at the site of the coral reef injury, and exacerbated by the long-haul flight. He was successfully treated with aggressive surgical debridement, vacuum-assisted dressings, split skin grafting and broad spectrum antibiotics. CONCLUSION: Necrotising fasciitis can progress rapidly to systemic toxicity and even death without expedient diagnosis and aggressive treatment. Long-haul flights induce significant fluid accumulation in the lower extremity. These physiological fluid shifts may have contributed to the severity of our patient\\'s necrotizing condition following his flight from Thailand.

  2. Plantar fasciitis

    Science.gov (United States)

    ... activities in moderation can also help. Images Plantar fascia Plantar fasciitis References Abu-Laban RB, Rose NGW. Ankle ... Elsevier; 2016:970. Kadakia AR. Heel pain and plantar fasciitis In: Miller MD, ... of tendons and fascia and adolescent and adult pes planus. In: Canale ...

  3. Eosinophilic fasciitis

    Directory of Open Access Journals (Sweden)

    Karolina Niklas

    2015-01-01

    Full Text Available Eosinophilic fasciitis is a rare connective tissue disease with unclear etiology and pathogenesis. It is classified as a scleroderma-like syndrome. The disease is characterized by fibrosis of the skin and subcutaneous tissues with significant thickening of fascia. Visceral involvement is rare. Characteristic feature in laboratory tests is peripheral blood eosinophilia. Differential diagnosis should be performed, including ruling out systemic sclerosis, nephrogenic systemic fibrosis, eosinophilia-myalgia syndrome, scleromyxedema, hypereosinophilic syndrome or Churg-Strauss syndrome. Final diagnosis is confirmed by histopathological examination. In treatment of the disease corticosteroids and/or immunosuppressive drugs are used. Some other drugs showed activity in this disease e.g. dapsone, infiximab or rituximab. Prognosis is rather good but sometimes a long-term treatment is necessary. In this paper we summarized the current knowledge on eosinophilic fasciitis.

  4. NECROTIZING FASCIITIS

    OpenAIRE

    HARJAI, MAN MOHAN

    2000-01-01

    Bacterial resistance to antimicrobial agents increases rapidly outside as well as in hospitals. Antimicrobials may remove sensitive organisms from the bacterial flora, but they also foster the establishment of a resistant strain, not only inducing infection by bacteria which had not previously been considered pathogens, but also preventing spontaneous healing. Although necrotizing fasciitis has been seen in the past 20 years throughout the world, it remains unclear which cases are attributabl...

  5. Saltwater intrusion monitoring in Florida

    Science.gov (United States)

    Prinos, Scott T.

    2016-01-01

    Florida's communities are largely dependent on freshwater from groundwater aquifers. Existing saltwater in the aquifers, or seawater that intrudes parts of the aquifers that were fresh, can make the water unusable without additional processing. The quality of Florida's saltwater intrusion monitoring networks varies. In Miami-Dade and Broward Counties, for example, there is a well-designed network with recently constructed short open-interval monitoring wells that bracket the saltwater interface in the Biscayne aquifer. Geochemical analyses of water samples from the network help scientists evaluate pathways of saltwater intrusion and movement of the saltwater interface. Geophysical measurements, collected in these counties, aid the mapping of the saltwater interface and the design of monitoring networks. In comparison, deficiencies in the Collier County monitoring network include the positioning of monitoring wells, reliance on wells with long open intervals that when sampled might provide questionable results, and the inability of existing analyses to differentiate between multiple pathways of saltwater intrusion. A state-wide saltwater intrusion monitoring network is being planned; the planned network could improve saltwater intrusion monitoring by adopting the applicable strategies of the networks of Miami-Dade and Broward Counties, and by addressing deficiencies such as those described for the Collier County network.

  6. [Necrotizing fasciitis after varicella].

    Science.gov (United States)

    Gonçalves, E; Furtado, F; Estrada, J; Vale, M C; Pinto, M; Santos, M; Moura, G; Vasconcelos, C

    2001-01-01

    Necrotizing fasciitis is a rare and severe infection characterised by extremely rapid progressive involvement of the superficial fascias and deep dermal layers of the skin, with resultant vasculitis and necrosis. The authors present three clinical cases of necrotizing fasciitis; all three patients previously had varicella rash, rapid progressive spreading erythema with severe pain and toxic shock syndrome. Two patients had positive cultures of b-haemolytic streptococcus. Early stage differential diagnosis with celulitis, aggressive antibiotic treatment and pediatric intensive care support are essential. However, the main therapy is early extensive surgical approach involving all indurate areas, down to and including the muscle fascia.

  7. Mortality in necrotizing fasciitis

    International Nuclear Information System (INIS)

    Waseem, A.R.; Samad, A.

    2008-01-01

    The objective of this study was to determine the mortality rate in patients presenting with Necrotizing Fasciitis. This prospective study was conducted at ward 26, JPMC Karachi over a period of two years from March 2001 to Feb 2003. All patients above the age of 12 years diagnosed to be having Necrotizing Fasciitis and admitted through the Accident and emergency department were included in this study. After resuscitation, the patients underwent the emergency exploration and aggressive surgical debridement. Post-operatively, the patients were managed in isolated section of the ward. The patients requiring grafting were referred to plastic surgery unit. The patients were followed up in outpatients department for about two years. Over all, 25 male and 5 female patients fulfilled the inclusion criteria and were included in this study. The common clinical manifestations include redness, swelling, discharging abscess, pain, fever, skin necrosis and foul smelling discharge etc. The most common predisposing factor was Diabetes mellitus whereas the most commonly involved site was perineum. All patients underwent aggressive and extensive surgical debridements. The common additional procedures included Skin grafting, Secondary suturing, Cystostomy and Orchidectomy. Bacteroides and E. coli were the main micro-organisms isolated in this study. Bacteroides was the most common microorganism isolated among the eight patients who died. Necrotizing Fasciitis is a potentially life threatening emergency condition and carries the mortality rate of about 26.6%. The major contributing factors to increase the mortality missed initially diagnosed, old age, diabetes mellitus truncal involvement and late presentation. Anorectal involvement of disease carry worse prognosis. Hyperbaric oxygen therapy and proper use of unprocessed honey reduced the mortality rate. (author)

  8. Talalgia: plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Ricardo Cardenuto Ferreira

    2014-06-01

    Full Text Available Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%. The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor.

  9. Atypical presentations of eosinophilic fasciitis

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    Tulin Ergun

    2016-01-01

    Full Text Available Eosinophilic fasciitis is an uncommon connective tissue disease that may mimic and overlap with other sclerosing disorders such as morphea and lichen sclerosus. Herein, we report four patients (two men and two women, aged 16-64 yeas with eosinophilic fasciitis. There was overlap with both morphea and lichen sclerosus in 2 patients and with morphoea alone in 1 patient. Magnetic resonance imaging (MRI was used for diagnosis in three patients and for assessing treatment response in one patient. Eosinophilic fasciitis may co-exist with morhoea and lichen sclerosus. In view of the overlapping clinical and histopathological features of these disorders, MRI may be helful in delineating the conditions by detecting involvement of fascia.

  10. [Necrotizing fasciitis. 2011 update].

    Science.gov (United States)

    Herr, M; Grabein, B; Palm, H-G; Efinger, K; Riesner, H-J; Friemert, B; Willy, C

    2011-03-01

    Necrotizing fasciitis belongs to a group of complicated soft tissue infections that can be even life threatening. Despite growing knowledge about its etiology, predictors, and the clinical progression, the mortality remains at a high level with 20%. A relevant reduction can be achieved only by an early diagnosis followed by consistent therapy. The clinical findings in about 75% of the cases are pain out of proportion, edema and tenderness, blisters, and erythema. It is elementary to differentiate a necrotizing or a non-necrotizing soft tissue infection early. In uncertain cases it can be necessary to perform a surgical exploration to confirm the diagnosis. The histopathologic characteristics are the fascial necrosis, vasculitis, thrombosis of perforating veins, the presence of the disease-causing bacteria as well as inflammatory cells like macrophages and polymorphonuclear granulocytes. Secondly, both the cutis and the muscle can be affected. In many cases there is a disproportion of the degree of local and systemic symptoms. Depending on the infectious agents there are two main types: type I is a polymicrobial infection and type II is a more invasive, serious, and fulminant monomicrobial infection mostly caused by group A Streptococcus pyogenes.Invasive, severe forms of streptococcal infections seem to occur more often in recent years. Multimodal and interdisciplinary therapy should be based on radical surgical débridement, systemic antibiotic therapy as well as enhanced intensive care therapy, which is sometimes combined with immunoglobulins (in streptococcal or staphylococcal infections) or hyperbaric oxygen therapy (HBOT, in clostridial infections). For wound care of extensive soft tissue defects vacuum-assisted closure has shown its benefit.

  11. Fatal Necrotizing Fasciitis following Episiotomy

    Directory of Open Access Journals (Sweden)

    Faris Almarzouqi

    2015-01-01

    Full Text Available Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.

  12. Sonographic evaluation of plantar fasciitis

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu [Eulji College of Medicine Eulji Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1{+-}1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5{+-}0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0{+-}0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis.

  13. Sonographic evaluation of plantar fasciitis

    International Nuclear Information System (INIS)

    Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu

    1999-01-01

    To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1±1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5±0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0±0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis

  14. Eosinophilic Fasciitis Associated with Myositis

    Directory of Open Access Journals (Sweden)

    Yuko Adachi

    2015-04-01

    Full Text Available Eosinophilic fasciitis is clinically characterized by symmetrical scleroderma-like indurations of the skin with pain. The histological features are fascial inflammation with lymphocytes and eosinophils as well as thickened and fibrotic fascia. Lymphocytic infiltration and degeneration of the underlying muscle are rarely observed. We report a 69-year-old Japanese woman who presented with multiple areas of glossy induration and painful peau d'orange-like lesions on the chest and four extremities. T2-weighted magnetic resonance imaging showed significant hyperintense thickening of the fascia of the lower extremities. Histopathological examination of a biopsy specimen from the induration showed marked fibrinoid degeneration of the fascia and the neighboring muscle with mixed cellular infiltration of lymphocytes and eosinophils. The predominant CD8+ lymphocytic infiltrates were observed by immunohistological study. A diagnosis of eosinophilic fasciitis with myositis was made. Oral administration of prednisolone and discontinuation of exercise significantly improved the lesions and pain.

  15. Infant with MRSA necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Panglao Rajan M

    2014-05-01

    Full Text Available Maria Panglao Rajan,1 Pinkal Patel,1 Lori Cash,1 Anjali Parish,2 Scott Darby,1 Jack Yu,3 Jatinder Bhatia11Department of Pediatrics, Children's Hospital of Georgia, Augusta, GA, USA; 2Medical Center of Central Georgia, Augusta, GA, USA; 3Department of Plastic Surgery, Children's Hospital of Georgia, Augusta, GA, USAAbstract: This is an unusual case of necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus in this premature infant, which highlights severity, rapid progression of this disease and shows outcome if intervention is initiated at an early stage. This case also highlights one of the possible serious complications of percutaneous inserted central catheter (PICC line, which can be life threatening.Keywords: necrotizing fasciitis, methicillin resistant Staphylococcus aureus, PICC, premature infant

  16. Eosinophilic fasciitis after parasite infection

    Directory of Open Access Journals (Sweden)

    Marta Oliveira

    2016-03-01

    Full Text Available Eosinophilic fasciitis is a systemic inflammatory disease characterized by symmetrical swelling and skin induration of the distal portions of the arms and/or legs, evolving into a scleroderma-like appearance, accompanied by peripheral blood eosinophilia. It is a rare disease with a poorly understood etiology. Corticosteroid treatment remains the standard therapy, either taken alone or in association with an immunosuppressive drug. This paper presents a case of a male patient with palpebral edema and marked eosinophilia, diagnosed with intestinal parasitic infection in October 2006. He was treated with an antiparasitic drug, but both the swelling and the analytical changes remained. This was followed by a skin and muscle biopsy, which turned out to be compatible with eosinophilic fasciitis. There was progressive worsening of the clinical state, with stiffness of the abdominal wall and elevated inflammatory parameters, and the patient was referred to the Immunology Department, medicated with corticosteroids and methotrexate. Over the years there were therapeutic adjustments and other causes were excluded. Currently the patient continues to be monitored, and there is no evidence of active disease. The case described in this article is interesting because of the diagnosis of eosinophilic fasciitis probably associated/coexisting with a parasite infection. This case report differs from others in that there is an uncommon cause associated with the onset of the disease, instead of the common causes such as trauma, medication, non-parasitic infections or cancer.

  17. Odontogenic cervical necrotizing fasciitis, etiological aspects ...

    African Journals Online (AJOL)

    Introduction: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft‑tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential.

  18. Multifocal necrotizing fasciitis following Hirshsprung's disease ...

    African Journals Online (AJOL)

    Multifocal necrotizing fasciitis following Hirshsprung's disease surgery away from the surgical wound site. Ahmed A. Haseeb, Shadi Okasha and Atef Elbarawi. Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF.

  19. Necrotizing Fasciitis Associated with Staphylococcus lugdunensis

    Directory of Open Access Journals (Sweden)

    Tony Hung

    2012-01-01

    Full Text Available Necrotizing fasciitis is a life-threatening soft tissue infection that results in rapid local tissue destruction. Type 1 necrotizing fasciitis is characterized by polymicrobial, synergistic infections that are caused by non-Group A streptococci, aerobic and anaerobic organisms. Type 2 necrotizing fasciitis involves Group A Streptococcus (GAS with or without a coexisting staphylococcal infection. Here we provide the first report of necrotizing fasciitis jointly associated with the microbes Group B Streptococcus and Staphylococcus lugdunensis. S. lugdunensis is a commensal human skin bacterium known to cause often painful and prolonged skin and soft tissue infections. To our knowledge, however, this is the first case of Staph. lugdunensis-associated necrotizing fasciitis to be reported in the literature.

  20. Necrotizing fasciitis: an urgent diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Paz Maya, Silvia; Dualde Beltran, Delfina [Hospital Clinico Universitario de Valencia, Valencia (Spain); Lemercier, Pierre; Leiva-Salinas, Carlos [Hospital Politecnico y Universitario La Fe, Valencia (Spain)

    2014-05-15

    Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests - e.g., the ''finger test'' or biopsy - and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging. (orig.)

  1. Plantar pain is not always fasciitis

    Directory of Open Access Journals (Sweden)

    N. Romano

    2017-12-01

    Full Text Available The case is described of a patient with chronic plantar pain, diagnosed as fasciitis, which was not improved by conventional treatment. Magnetic resonance imaging revealed flexor hallucis longus tenosynovitis, which improved after local glucocorticoid injection.

  2. Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric ? ??

    OpenAIRE

    Santos, Leandro Em?lio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brand?o; Soares, Eduardo Augusto Marques

    2014-01-01

    Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.

  3. Scleroderma mimicker – Eosinophilic fasciitis

    Directory of Open Access Journals (Sweden)

    Debanjali Sinha

    2017-01-01

    Full Text Available Eosinophilic fasciitis is an uncommon connective tissue disorder characterized by thickening of the deep fascia and overlying skin and subcutaneous tissue. It may mimic scleroderma and other scleroderma-like conditions. It may be a manifestation of paraneoplastic disorders or may be associated with hematological disorders including lymphomas. Definitive diagnosis is made on histological examination of a deep skin biopsy revealing thickened deep fascia and infiltration by lymphocytes and eosinophils. Enhancement of deep fascia on Gadolinium contrast-enhanced magnetic resonance imaging may be used as a substitute for skin biopsy. Ultrasound imaging is an evolving imaging tool for diagnosing it. Glucocorticoids with or without immunosuppressive agents remains the mainstay of therapy with good response, generally. A younger age of onset, morphea like lesions and dermal fibrosclerosis is more likely to be associated with the refractory disease. Early diagnosis and appropriate treatment may result in better outcomes in terms of morbidity and quality of life of the patients.

  4. CT imaging of necrosive fasciitis

    International Nuclear Information System (INIS)

    Schulze, M.; Overkamp, D.; Joanoviciu, S.; Horger, M.

    2008-01-01

    NF is a rare but dramatic and often fatal infection of the fascii and adjoining soft tissues. Contrary to the Fournier's definition, it is most common in elderly people. Patients with immune problems have a higher risk (e.g. Diabetes mellitus, alcohol or drug abuse, AIDS, leukaemia, chemotherapy and immunosuppressive medication). Predisposition factors are diverticulitis, insect bites, or surgical interventions (Uppot RN, Levy HM, PLatel PH, Radiology 2003; 226; 115; Wysoki MG, Santora TA, Shah RM et al. Necrotizing fasciitis: CT characteristics, Radiology 1997; 203;859). Men are affected more frequently than women. In principle, NF may occur everywhere in the body but incidence in the region of the scrotum, perineum and lower extremities are the most common. (orig.)

  5. Necrotizing fasciitis in nephritic syndrome: a case report

    Science.gov (United States)

    Junaedi, I.; Pasaribu, A. P.

    2018-03-01

    Necrotizing fasciitis is an infection of any layer of tissue compartment; it can be in the dermis, subcutaneous tissue, superficial fascia, deep fascia, or even muscle. Usually, necrotizing fasciitis is associated with necrotizing process caused by the single bacterial organism. The most common pathogen is group A Streptococcus. Delayed in the diagnosis and surgical treatment of necrotizing fasciitis will lead to increased tissue loss and high mortality risk. Here we report a case of necrotizing fasciitis which has a great outcome since the surgical exploration of tissue and debridement was done as soon as the patient is suspected of necrotizing fasciitis.

  6. Cervicofacial necrotizing fasciitis following periodontal abscess.

    Science.gov (United States)

    Medeiros, Rui; Catunda, Ivson de Sousa; Queiroz, Isaac Vieira; de Morais, Hecio Henrique Araujo; Leao, Jair Carneiro; Gueiros, Luiz Alcino Monteiro

    2012-01-01

    Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

  7. Cervical Necrotizing Fasciitis Caused by Dental Extraction

    Directory of Open Access Journals (Sweden)

    José Alcides Arruda

    2016-01-01

    Full Text Available Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

  8. Multifocal necrotizing fasciitis following Hirshsprung's disease ...

    African Journals Online (AJOL)

    Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF. NF typically arises in a single area usually secondary to penetrating injury. NF was only reported as a postoperative complication of Hirshsprung's disease in one report, ...

  9. Necrotizing fasciitis : plain radiographic and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang Dae; Park, Jeong Hee; Jeon, Hae Jeong; Lim, Jong Nam; Heo, Tae Haeng; Park, Dong Rib [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gas shadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer in four cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focal low density lesion suggestive of focal abscess was not visualized. Plain radiography is useful for early diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.

  10. Cervical necrotizing fasciitis in infant: case report

    Directory of Open Access Journals (Sweden)

    Schiavetto, Renata Rennó

    2008-12-01

    Full Text Available Introduction: Necrotizing fasciitis is a bacterial infection characterized by extensive necrosis of tissues, and may include skin and muscles. It's more frequent in adults than in children and generally involves the trunk and extremities. Head and neck area is less commonly affected. The most frequently isolated pathogens are the Streptococcus pyogenes (group A and Staphylococcus aureus. The anatomopathological exam is the best diagnostic method, which early identifies the disease. The clinical support, surgical debridement, and the intravenous antibiotic therapy, are fundamental for the treatment. Objective: To report a case of an infant who suffered from Cervical Necrotizing Fasciitis. Case Report: Infant, male sex, white, 2 months old, previously healthy, with Necrotizing Fasciitis involving the frontal and right lateral cervical regions. After adequate treatment the patient obtained excellent recovery without presenting important aesthetic or functional alterations. Conclusion: The Cervical Necrotizing Fasciitis is uncommon in children. The early surgical debridement is necessary to control the infection, even if it may result in great and deep injuries. The wide spectrum antibiotic therapy and hemodynamic support are also basic for the therapeutic success.

  11. Nekrotiserende fasciitis hos børn

    DEFF Research Database (Denmark)

    Jensen, Karsten Gjessing; Kristensen, Kim

    2009-01-01

    Necrotizing fasciitis (NF) is a serious condition with infection of the muscular fascia causing rapidly spreading necrosis. NF rarely affects children, and we here report two paediatric cases of NF. The first developed NF after a joint puncture, the other after surgical extirpation of a lymph node...

  12. Disseminated mucormycosis and necrotizing fasciitis in immune ...

    African Journals Online (AJOL)

    Laparotomy revealed extensive abdominal wall necrosis, bowel, liver, kidney and subsequent retroperitoneal, posterior diaphragm and inferior vena cava involvement. Second, a 3-year-old on chemotherapy for Burkitt's lymphoma presented with pancytopenia, sepsis, abdominal wall-necrotizing fasciitis and left lower limb ...

  13. Nodular fasciitis: MRI appearance and literature review

    International Nuclear Information System (INIS)

    Leung, L.Y.J.; Shu, S.J.; Chan, M.K.; Chan, C.H.S.; Chan, A.C.L.

    2002-01-01

    Objective: To describe the MRI features of nodular fasciitis and to review the clinical, MRI and histologic aspects of the tumor. Design and patients: Three patients with biopsy-proven nodular fasciitis were selected for a retrospective study. A literature review was also carried out. Results and conclusions: All the lesions appeared slightly hyperintense to skeletal muscle on T1-weighted images, and hyperintense on T2-weighted images with fat saturation [either frequency saturation or Short TI Inversion Recovery (STIR) sequences]. Two enhanced homogeneously after intravenous gadolinium, whereas the third showed heterogeneous enhancement with a nonenhancing area. Despite the difference in enhancing patterns, the histologic appearances of these lesions were similar. Our study shows that the MRI appearance of nodular fasciitis may not be related to the location of lesion. It is thought that the age of nodular fasciitis may reflect its gross morphology, and it is possible that the MRI and histologic appearances could correlate with the age of the lesion, but it would require a larger series to evaluate this concept. (orig.)

  14. Periorbital nodular fasciitis arising during pregnancy

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    Brandon N Phillips

    2014-01-01

    Full Text Available Nodular fasciitis (NF is a benign proliferation of fibroblasts and myofibroblasts that rarely occurs in the periorbital region. We report what we believe to be the first case of periorbital NF associated with pregnancy. A case of intravascular fasciitis, a NF variant, has been reported during pregnancy, but it was not located in the periorbital region. A weak presence of estrogen receptors has been reported in NF. This may make it more susceptible to the hormone-related changes during pregnancy and contribute to the development of the lesion by stimulating fibroblasts and smooth muscle cell types. Although rare, NF should be considered in the differential diagnosis of periorbital soft-tissue masses arising during pregnancy.

  15. AFSC/REFM: Alaska Saltwater Sport Fishing Charter Business Survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The purpose of this project was to collect cost, earning, and employment information from the Alaska saltwater sport fishing charter business sector during the...

  16. Necrotizing Fasciitis: An Emergency Medicine Simulation Scenario

    OpenAIRE

    Galust, Henrik; Oliverio, Matthew H; Giorgio, Daniel J; Espinal, Alexis M; Ahmed, Rami

    2016-01-01

    Necrotizing fasciitis?(NF) is a rare and rapidly progressing life-threatening infectious process. By progressing through a simulation involving a patient with NF and participating in a post-scenario debriefing, learners will gain the necessary skills and knowledge to properly diagnose and manage patients with NF. Learners are taught to initiate appropriate and timely treatment and to advocate on behalf of their patient after inappropriate pushback from consultants to improve outcomes.

  17. Necrotizing Fasciitis: An Emergency Medicine Simulation Scenario.

    Science.gov (United States)

    Galust, Henrik; Oliverio, Matthew H; Giorgio, Daniel J; Espinal, Alexis M; Ahmed, Rami

    2016-08-31

    Necrotizing fasciitis (NF) is a rare and rapidly progressing life-threatening infectious process. By progressing through a simulation involving a patient with NF and participating in a post-scenario debriefing, learners will gain the necessary skills and knowledge to properly diagnose and manage patients with NF. Learners are taught to initiate appropriate and timely treatment and to advocate on behalf of their patient after inappropriate pushback from consultants to improve outcomes.

  18. Nodular Fasciitis of External Auditory Canal

    Directory of Open Access Journals (Sweden)

    Jihyun Ahn

    2016-09-01

    Full Text Available Nodular fasciitis is a pseudosarcomatous reactive process composed of fibroblasts and myofibroblasts, and it is most common in the upper extremities. Nodular fasciitis of the external auditory canal is rare. To the best of our knowledge, less than 20 cases have been reported to date. We present a case of nodular fasciitis arising in the cartilaginous part of the external auditory canal. A 19-year-old man complained of an auricular mass with pruritus. Computed tomography showed a 1.7 cm sized soft tissue mass in the right external auditory canal, and total excision was performed. Histologic examination revealed spindle or stellate cells proliferation in a fascicular and storiform pattern. Lymphoid cells and erythrocytes were intermixed with tumor cells. The stroma was myxoid to hyalinized with a few microcysts. The tumor cells were immunoreactive for smooth muscle actin, but not for desmin, caldesmon, CD34, S-100, anaplastic lymphoma kinase, and cytokeratin. The patient has been doing well during the 1 year follow-up period.

  19. Cervical necrotizing fasciitis: A potentially fatal disease with varied ...

    African Journals Online (AJOL)

    Necrotizing fasciitis was recognized centuries ago by physicians. It is a rapidly progressive and potentially fatal soft‑tissue infection that is typified by soft‑tissue necrosis, especially affecting the subcutaneous tissues and fascia. Cervico‑facial necrotizing fasciitis is said to be uncommon, but when it occurs, it is often of ...

  20. Review of 58 patients with necrotizing fasciitis in the Netherlands

    NARCIS (Netherlands)

    Stigt, S.F. van; Vries, J. de; Bijker, J.B.; Mollen, R.M.; Hekma, E.J.; Lemson, S.M.; Tan, E.C.T.H.

    2016-01-01

    BACKGROUND: Necrotizing fasciitis is a rare, life threatening soft tissue infection, primarily involving the fascia and subcutaneous tissue. In a large cohort of patients presenting with Necrotizing fasciitis in the Netherlands we analysed all available data to determine the causative pathogens and

  1. Necrotizing fasciitis of breast | Salati | East and Central African ...

    African Journals Online (AJOL)

    Necrotizing fasciitis is an uncommon and rapidly progressive, life-threatening soft tissue infection. Necrotizing fasciitis of breast is even rarely encountered. We managed one such 32 years old nondiabetic, obese lady who developed necrotising fascitis of right breast after lumpectomy. Management involved wide ...

  2. Necrotizing fasciitis: strategies for diagnosis and management.

    Science.gov (United States)

    Taviloglu, Korhan; Yanar, Hakan

    2007-08-07

    Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  3. Necrotizing fasciitis caused by group A streptococcus

    Directory of Open Access Journals (Sweden)

    Mikić Dragan

    2002-01-01

    Full Text Available The first case of the confirmed necrotizing fasciitis caused by Group A Streptococcus in Yugoslavia was presented. Male patient, aged 28, in good health, suddenly developed symptoms and signs of severe infective syndrome and intensive pain in the axillary region. Parenteral antibiotic, substitution and supportive therapy was conducted along with the radical surgical excision of the necrotizing tissue. The patient did not develop streptococcal toxic shock syndrome thanks to the early established diagnosis and timely applied aggressive treatment. He was released from the hospital as completely cured two months after the admission.

  4. Necrotizing fasciitis - Report of two unusual cases

    International Nuclear Information System (INIS)

    Kamulegeya, Adriane

    2008-01-01

    Cervico-facial necrotizing fasciitis is a potential complication of odontogenic infection that can lead to mediastinitis and septic shock. A delay or inappropriate treatment of simple infections and immunocompromise increase the risk of developing the disease and in turn increase the morbidity and mortality of the disease. We present two cases one of which we believe developed due to delayed treatment and the other due to immunocompromise. Both cases were successfully treated with surgical debridement and broad spectrum antibiotics. There is need to rethink certain clinical judgments such as treatment during pregnancy and the usefulness of an informative medical history from patients. (author)

  5. Necrotizing fasciitis: strategies for diagnosis and management

    Directory of Open Access Journals (Sweden)

    Yanar Hakan

    2007-08-01

    Full Text Available Abstract Necrotizing fasciitis (NF is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  6. Necrotizing Fasciitis of the Nose Complicated with Cavernous Sinus Thrombosis

    Directory of Open Access Journals (Sweden)

    D. Swaminath

    2014-01-01

    Full Text Available Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative.

  7. Development of Eosinophilic Fasciitis during Infliximab Therapy for Psoriatic Arthritis

    Directory of Open Access Journals (Sweden)

    Richard Hariman

    2016-01-01

    Full Text Available Eosinophilic fasciitis (EF is a rare disorder involving chronic inflammation of the fascia and connective tissue surrounding muscles, nerves, and blood vessels. While its pathogenesis is not entirely understood, this disorder is thought to be autoimmune or allergic in nature. We present here a case of a 59-year-old male who developed peripheral eosinophilia and subsequent eosinophilic fasciitis during treatment with infliximab. To our knowledge, eosinophilic fasciitis has not been previously described in patients during treatment with an inhibitor of tumor necrosis factor α.

  8. Oklahoma’s recent earthquakes and saltwater disposal

    Science.gov (United States)

    Walsh, F. Rall; Zoback, Mark D.

    2015-01-01

    Over the past 5 years, parts of Oklahoma have experienced marked increases in the number of small- to moderate-sized earthquakes. In three study areas that encompass the vast majority of the recent seismicity, we show that the increases in seismicity follow 5- to 10-fold increases in the rates of saltwater disposal. Adjacent areas where there has been relatively little saltwater disposal have had comparatively few recent earthquakes. In the areas of seismic activity, the saltwater disposal principally comes from “produced” water, saline pore water that is coproduced with oil and then injected into deeper sedimentary formations. These formations appear to be in hydraulic communication with potentially active faults in crystalline basement, where nearly all the earthquakes are occurring. Although most of the recent earthquakes have posed little danger to the public, the possibility of triggering damaging earthquakes on potentially active basement faults cannot be discounted. PMID:26601200

  9. The Effects of Saltwater Intrusion to Flood Mitigation Project

    Science.gov (United States)

    Azida Abu Bakar, Azinoor; Khairudin Khalil, Muhammad

    2018-03-01

    The objective of this study is to determine the effects of saltwater intrusion to flood mitigation project located in the flood plains in the district of Muar, Johor. Based on the studies and designs carried out, one of the effective flood mitigation options identified is the Kampung Tanjung Olak bypass and Kampung Belemang bypass at the lower reaches of Sungai Muar. But, the construction of the Kampung Belemang and Tanjung Olak bypass, while speeding up flood discharges, may also increase saltwater intrusion during drought low flows. Establishing the dynamics of flooding, including replicating the existing situation and the performance with prospective flood mitigation interventions, is most effectively accomplished using computer-based modelling tools. The finding of this study shows that to overcome the problem, a barrage should be constructed at Sungai Muar to solve the saltwater intrusion and low yield problem of the river.

  10. Necrotizing Soft Tissue Fasciitis after Intramuscular Injection

    Directory of Open Access Journals (Sweden)

    Angelica Abbate

    2018-01-01

    Full Text Available Necrotizing soft tissue fasciitis (NSTIs or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.

  11. Case Report of Necrotizing Fasciitis Associated with Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Lei Jiao

    2016-01-01

    Full Text Available Necrotizing fasciitis, caused by Streptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated with Streptococcus pneumoniae infection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive for Streptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting from Streptococcus pneumoniae diagnosed at early phase; the patient recovered well without surgical debridement.

  12. Percutaneous planter fasciitis release under local anesthesia: A prospective study

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2017-04-01

    Conclusion: Percutaneous planter fasciitis release under local anesthesia is a minimally invasive procedure that can be performed in the outpatient setting. It is easy, quick, effective and moreover with few complications.

  13. Psychological distress in patients with morphea and eosinophilic fasciitis.

    NARCIS (Netherlands)

    Kroft, Ilse; Jong, E.M.G.J. de; Evers, A.W.M.

    2009-01-01

    OBJECTIVE: To examine the level of psychological distress and factors contributing to distress in patients with morphea or eosinophilic fasciitis. DESIGN: Cross-sectional study. SETTING: Dermatology outpatient clinic of a university hospital. PARTICIPANTS: Of 120 patients with morphea or

  14. Tube Thoracostomy-Related Necrotizing Fasciitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Shun-Pin Hsu

    2006-12-01

    Full Text Available Spontaneous pneumothorax is a serious complication of pulmonary tuberculosis that requires immediate treatment. Necrotizing fasciitis is a serious, rapidly progressive infection of the subcutaneous tissue and fascia, most related to trauma or surgery. Here, we report a case of pulmonary tuberculosis with spontaneous pneumothorax. A standard procedure of tube thoracostomy was performed for lung re-expansion. Two days after the tube was removed, necrotizing fasciitis developed from the puncture site. Computed tomography of the chest showed focal thickness with gas formation and loss of the fat plane over the chest wall, which is compatible with the diagnosis of necrotizing fasciitis. Aggressive treatment was given, including emergency fasciectomy and adequate systemic antibiotic and antituberculous treatment. The necrotizing fasciitis was successfully treated. The patient was discharged and sent home with maintenance antituberculous therapy.

  15. Necrotizing Fasciitis of vulva: A report of two cases

    Directory of Open Access Journals (Sweden)

    Jamal A

    2000-08-01

    Full Text Available Vulvar necrotizing fascitis is an uncommon infectious disorder. Since the first reported cases almost 100 years, ago, necrotizing fasciitis continues to present a diagnostic and therapeutic challenge. What usually begins as a subtle infection can become life-threatening. We report two cases of vulvar necrotizing fasciitis, one after posterior colporrhaphy in a woman with four risk factors and the other in a young woman without any risk factor.

  16. [Functional impairment and radiologic fasciitis under erlotinib therapy].

    Science.gov (United States)

    Osdoit, S; Wierzbicka, E; Guillet, G

    2011-01-01

    Targeted molecules are recent and valuable weapons in the management of certain cancers. Among them, erlotinib is an inhibitor of epidermal growth factor receptor approved in non-small lung cancer and pancreatic cancer after failure of first line treatment. Erlotinib is responsible for many cutaneous side effects. We report a case of acute symptomatic fasciitis that has occurred during erlotinib therapy. To our knowledge it is the first case described. A 56-year-old man was treated with erlotinib for a metastatic non-small lung adenocarcinoma. Shortly after the treatment by erlotinib was introduced, he had a severe acneiform rash resistant to doxycycline treatment. After a year of treatment, he presented intense pain in the legs with functional impairment. Medical imaging confirmed fasciitis. It regressed along with the rash after using strong topical corticosteroids during ten days. Besides bacterial fasciitis, inflammatory and oedematous fasciitis have varied aetiologies. The occurrence of a documented fasciitis during anti EGFR-therapy is original and raises the question of underlying mechanism. We suggest three pathophysiological mechanisms: spreading by contiguity; paraneoplastic fasciitis, or specific lesion of the fascia due to anti-EGFR. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  17. Additional diagnostic value of digital radiology in plantar fasciitis diagnosis

    Directory of Open Access Journals (Sweden)

    Marcel Prasetyo

    2017-08-01

    Full Text Available Background: Ultrasonography (USG is regarded as the gold standard to differentiate normal plantar fascia and plantar fasciitis. Conventional radiography or plain X-ray is typically used to exclude differential diagnosis. Lately, conventional radiography has been digitalized and leads to better visualization of the soft tissue. However, it is not known whether digital radiography evaluation for calcaneus area, both qualitative and quantitative, has a similar diagnostic value as USG findings. Therefore, this study aimed to evaluate whether there is a strong correlation between digital radiographic and USG findings for diagnosing plantar fasciitis.Methods: This is a cross sectional study examining adult patients (>18 years old presenting with inferior heel pain. Plantar aponeurosis thickness was measured by digital radiography and ultrasonography; measurement was performed three times in each modality, and the average value was recorded. Fat stranding, presence of calcaneal enthesophyte, and microfracture were also evaluated in digital radiography. Measurement results were classified into plantar fasciitis diagnosis using the cut-off value 4 mm.Results: There was no significant correlation between plantar aponeurosis thickness measured by digital radiography and by ultrasonography (r=0.069, p=0.688. There was no significant association between plantar fasciitis diagnosis by digital radiography and ultrasonography (p=0.162. However, digital radiography showed good sensitivity to detect plantar fasciitis using a cut-off value of >4 mm plantar fascia thickness.Conclusion: Digital radiography might be used to aid definitive diagnosis for plantar fasciitis.

  18. Climate Change and Saltwater Intrusion along the Eastern ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The Eastern Mediterranean is highly vulnerable to saltwater intrusion into the freshwater aquifers along its coasts. The degradation of these aquifers would result in serious socioeconomic consequence to people living there. This project will investigate how climate change is affecting the salinity of coastal aquifers at several ...

  19. Saltwater Intrusion Appraisal of Shallow Aquifer in Burutu Area of ...

    African Journals Online (AJOL)

    ADOWIE PERE

    is not caused by saltwater intrusion rather by iron which cannot be separately distinguished from groundwater by ... The sand and gravels forms the aquifer in the. Formation and are .... K.S; Soulios, G; Pliakas, F; Tsokas, G ( 2016). Seawater ...

  20. Fatigue crack retardation of high strength steel in saltwater

    International Nuclear Information System (INIS)

    Tokaji, K.; Ando, Z.; Imai, T.; Kojima, T.

    1983-01-01

    A high strength steel was studied in 3 percent saltwater to investigate the effects of a corrosive environment and sheer thickness on fatigue crack propagation behavior following the application of a single tensile overload. Experiments were carried out under sinusoidally varying loads at a load ratio of 0 and frequency of 10 H /SUB z/ . A single tensile overload was found to cause delayed retardation, and the crack propagation rate at first increased, followed by fairly rapid decrease to a minimum value and then increased gradually to its steady-state value, just as it did in air. The overload affected zone size and the retardation cycles increased with decreasing sheet thickness, just as they did in air. However, the zone size and the cycles were larger in 3 percent saltwater than in air. Since the crack propagation rates through the overload affected zone were not affected by the test environment, the longer retardation cycles in 3 percent saltwater were attributed to an enlargement of the overload affected zone size. The crack propagation behavior following the application of a single tensile overload in 3 percent saltwater was well explained by the crack closure concept

  1. PERIORBITAL NECROTIZING FASCIITIS DUE TO CRYPTOCOCCUS NEOFORMANS IN A HEALTHY-YOUNG MAN

    NARCIS (Netherlands)

    DOORENBOSBOT, ACC; HOOYMANS, JMM; BLANKSMA, LJ

    1990-01-01

    A case report is presented of a healthy 25-year-old man who developed a periorbital necrotising fasciitis after a trivial trauma with a wooden splinter. Necrotising fasciitis of the eyelids occurs rarely. Cryptococcus neoformans is not described as a causative factor of necrotizing fasciitis.

  2. [Assessment of plantar fasciitis using shear wave elastography].

    Science.gov (United States)

    Zhang, Lining; Wan, Wenbo; Zhang, Lihai; Xiao, Hongyu; Luo, Yukun; Fei, Xiang; Zheng, Zhixin; Tang, Peifu

    2014-02-01

    To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis. The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion. The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126). SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.

  3. Necrotizing fasciitis: 11-year retrospective case review in South Auckland.

    Science.gov (United States)

    Kulasegaran, Suheelan; Cribb, Benjamin; Vandal, Alain C; McBride, Stephen; Holland, David; MacCormick, Andrew D

    2016-10-01

    The aims of this paper were to review our experience with necrotizing fasciitis at Middlemore Hospital and to define the trends in incidence, inpatient mortality and microbiological profile. A computerized search of the electronic medical records was undertaken to identify adult patients with a diagnosis of necrotizing fasciitis between January 2000 and December 2010. A retrospective review of the clinical records was performed. Of the 138 patients with necrotizing fasciitis identified, 129 had their diagnosis confirmed at operation. The mortality at 30 days was 20.3% (95% confidence interval (CI) 13.9%-28.0%). There was a significant reduction in hospital mortality in each successive year of the study period with an odds ratio of 0.84 (95% CI 0.71-0.98, P = 0.03). A pattern of increasing incidence was noted until February 2004 (95% CI September 2002-July 2005). This was followed by a significant decrease in incidence. The empirical antibiotic regime of clindamycin, gentamicin and penicillin provides satisfactory cover against 95% of the causative pathogens. This represents the largest single-centre published case series in New Zealand. Despite concerns of increasing incidence and mortality associated with necrotizing fasciitis in New Zealand, the experience in South Auckland shows a decrease in incidence of necrotizing fasciitis since 2004 and a statistically significant decreasing trend in hospital mortality. © 2015 Royal Australasian College of Surgeons.

  4. Hospital epidemiology of emergent cervical necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Background : Necrotizing fasciitis (NF is a surgical emergency. It is a rapidly progressing infection of the fascia and subcutaneous tissue and could be fatal if not diagnosed early and treated properly. NF is common in the groin, abdomen, and extremities but rare in the neck and the head. Cervical necrotizing fasciitis (CNF is an aggressive infection of the neck and the head, with devastating complications such as airway obstruction, pneumonia, pulmonary abscess, jugular venous thrombophlebitis, mediastinitis, and septic shock associated with high mortality. Aim : To assess the presentation, comorbidities, type of infection, severity of disease, and intensive care outcome of CNF. Methods : Medical records of the patients treated for NF in the surgical intensive care unit (SICU from January 1995 to February 2005 were reviewed retrospectively. Results : Out of 94 patients with NF, 5 (5.3% had CNF. Four patients were male. The mean age of our patients was 41.2 ± 14.8 years. Sixty percent of patients had an operative procedure as the predisposing factor and 80% of patients received nonsteroidal anti-inflammatory drugs (NSAIDs. The only comorbidity associated was diabetes mellitus (DM in 3 patients (60%. Sixty percent of the cases had type1 NF. Mean sequential organ failure assessment (SOFA score on admission to the ICU was 8.8 ± 3.6. All patients had undergone debridement at least two times. During the initial 24 h our patients received 5.8 ± 3.0 l of fluid, 2.0 ± 1.4 units of packed red blood cells (PRBC, 4.8 ± 3.6 units of fresh frozen plasma (FFP, and 3.0 ± 4.5 units of platelet concentrate. The mean number of days patients were intubated was 5.2 ± 5.1 days and the mean ICU stay was 6.4 ± 5.2 days. Sixty percent of cases had multiorgan dysfunction (MODS and one patient died, resulting in a mortality rate of 20%. Conclusion : According to our study, CNF represents around 5% of NF patients. CNF was higher among male patients and in

  5. Nodular Fasciitis of the Auricle: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Majidi

    2013-03-01

    Full Text Available Introduction: Nodular fasciitis is described as a benign reactive proliferation of myofibroblasts. Due to its rapid-growing nature, a precise clinical diagnosis is difficult and the condition is frequently misdiagnosed as malignant lesions.   Case Report: In this study, we present the case of a young woman with an auricular nodular fasciitis as an example of one of the rarest sites of this tumor. The patient underwent an excision of the lesion under general anesthesia. The literature choices for treatment include complete excision, partial excision, or intralesional injection of steroids. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.   Conclusion:  Auricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.

  6. Nodular Fasciitis of the Breast Mimicking Breast Cancer

    Directory of Open Access Journals (Sweden)

    Shinya Yamamoto

    2014-01-01

    Full Text Available Nodular fasciitis is a benign proliferative lesion that is usually found in the soft tissue of the upper extremity and trunk in young to middle-aged persons. It has rarely been described in the breast. A 35-year-old woman had noticed a mass in her left breast. It was elastic-hard, 13 mm in size, and located mainly in the upper inner quadrant of the left breast. Mammography did not detect the mass. Ultrasonography revealed a hypoechoic lesion with an irregular margin. Neither fine-needle aspiration cytology nor core needle biopsy established a definitive diagnosis. Excisional biopsy was therefore performed. Histologically, the excised tumor tissue results were consistent with a diagnosis of nodular fasciitis of the breast. We report a case of nodular fasciitis of the breast, a rare histological type of breast tumor.

  7. Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

    Science.gov (United States)

    Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

    2016-04-01

    Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory. © The Author(s) 2015.

  8. Necrotizing Fasciitis in Paroxysmal Nocturnal Hemoglobinuria

    Directory of Open Access Journals (Sweden)

    Pusem Patir

    2015-01-01

    Full Text Available Paroxysmal nocturnal hemoglobinuria (PNH is a rare, progressive, and life-threatening hematopoietic stem cell disorder characterized by complement-mediated intravascular hemolysis and a prothrombotic state. Patients with PNH might have slightly increased risk of infections due to complement-associated defects subsequent to CD59 deficiency. Here, we report a rare case of a 65-year-old male patient with necrotic ulcers on both legs, where the recognition of pancytopenia and microthrombi led to the diagnosis of PNH based on FLAER (FLuorescent AERolysin flow cytometric analysis. He was subsequently started on eculizumab therapy, with starting and maintenance doses set as per drug labelling. Progression of the patient’s leg ulcers during follow-up, with fulminant tissue destruction, purulent discharge, and necrotic patches, led to a later diagnosis of necrotizing fasciitis due to Pseudomonas aeruginosa and Klebsiella pneumonia infection. Courses of broad-spectrum antibiotics, surgical debridement, and superficial skin grafting were applied with successful effect during ongoing eculizumab therapy. This case highlights the point that it is important to maintain treatment of underlying disorders such as PNH in the presence of life-threatening infections like NF.

  9. Nekrotiserende fasciitis i hoved-hals-området

    DEFF Research Database (Denmark)

    Wolf, Henning; Ovesen, Therese

    2008-01-01

    OBJECTIVES: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region. MATERIALS AND METHODS: Data were retrieved from patient records with the ICD3...

  10. Fasciitis necroticans efter artroskopi af præpatellar bursitis

    DEFF Research Database (Denmark)

    Schlesinger, NH; Friis-Møller, Alice; Hvolris, Jesper

    2007-01-01

    Necrotizing fasciitis (NF) is a life-threatening soft tissue infection in superficial and deep fascias. NF is most often caused by mixed aerobic and anaerobic bacteria. The treatment is early and aggressive surgical debridement, antibiotics and hyperbaric oxygen. In this case description, a nearly...

  11. Necrotizing Fasciitis: An Unusual Sequela Of Injections In Children ...

    African Journals Online (AJOL)

    Background: Necrotising fasciitis (NF) of the head and the trunk in children is a serious infection that carries high morbidity and mortality. We recently managed two infants with NF from injection mishap of the head and the trunk, respectively. The aim of this report is to highlight ways of effectively treating and/preventing ...

  12. Triple diagnostics for early detection of ambivalent necrotizing fasciitis

    NARCIS (Netherlands)

    Hietbrink, Falco; Bode, Lonneke G.; Riddez, Louis; Leenen, Luke P H; van Dijk, MR

    2016-01-01

    Background: Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity.

  13. Necrotising fasciitis of the submandibular region | Nyako | Ghana ...

    African Journals Online (AJOL)

    Two cases of necrotizing fasciitis (NF) complicating different conditions of the maxillofacial region, treated at the Korle Bu Teaching Hospital are reported. These were managed by an early diagnosis, aggressive surgical exploration, fasciotomies and debridement of necrotic tissue. In addition, frequent irrigation within the ...

  14. Retrospective evaluation of necrotizing fasciitis in university college ...

    African Journals Online (AJOL)

    Context: Cervicofacial necrotizing fasciitis (CNF), although a potentially fatal fulminant infection has been largely under‑reported in the dental literature. Aims: To report our experience with cases seen and treated at the University College Hospital, Ibadan, Nigeria. Settings and Design: A descriptive retrospective clinical ...

  15. Necrotizing Fasciitis In A Preterm, HIV Infected Baby | Olutekunbi ...

    African Journals Online (AJOL)

    Necrotizing fasciitis (NF) is a rapidly progressive life threatening bacterial infection of the soft tissues. It is commoner in the adult population where it is associated with systemic and local disease conditions such as diabetes mellitus, intravenous drug abuse, dental lesions, trauma and immunosuppression. It is rare in ...

  16. Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

    Science.gov (United States)

    Cottom, James M; Baker, Joseph S

    2016-10-01

    When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Cathode Composition in a Saltwater Metal-Air Battery

    Directory of Open Access Journals (Sweden)

    William Shen

    2017-01-01

    Full Text Available Metal-air batteries consist of a solid metal anode and an oxygen cathode of ambient air, typically separated by an aqueous electrolyte. Here, simple saltwater-based models of aluminum-air and zinc-air cells are used to determine the differences between theoretical cell electric potentials and experimental electric potentials. A substantial difference is observed. It is also found that the metal cathode material is crucial to cell electric potential, despite the cathode not participating in the net reaction. Finally, the material composition of the cathode appears to have a more significant impact on cell potential than the submerged surface area of the cathode.

  18. An alternating voltage battery with two salt-water oscillators

    Science.gov (United States)

    Cervellati, Rinaldo; Soldà, Roberto

    2001-05-01

    We built a simple alternating voltage battery that periodically reverses value and sign of its electromotive force (emf). This battery consists of two coupled concentration salt-water oscillators that are phase shifted by initially extracting some drops of salt solution from one of the two oscillators. Although the actual frequency (period: ˜30 s) and emf (˜±55 mV) is low, our battery is suitable to demonstrate a practical application of oscillating systems in the physical, chemical, or biological laboratory for undergraduates. Interpretation of the phenomenon is given.

  19. Origins and delineation of saltwater intrusion in the Biscayne aquifer and changes in the distribution of saltwater in Miami-Dade County, Florida

    Science.gov (United States)

    Prinos, Scott T.; Wacker, Michael A.; Cunningham, Kevin J.; Fitterman, David V.

    2014-01-01

    Intrusion of saltwater into parts of the shallow karst Biscayne aquifer is a major concern for the 2.5 million residents of Miami-Dade County that rely on this aquifer as their primary drinking water supply. Saltwater intrusion of this aquifer began when the Everglades were drained to provide dry land for urban development and agriculture. The reduction in water levels caused by this drainage, combined with periodic droughts, allowed saltwater to flow inland along the base of the aquifer and to seep directly into the aquifer from the canals. The approximate inland extent of saltwater was last mapped in 1995. An examination of the inland extent of saltwater and the sources of saltwater in the aquifer was completed during 2008–2011 by using (1) all available salinity information, (2) time-series electromagnetic induction log datasets from 35 wells, (3) time-domain electromagnetic soundings collected at 79 locations, (4) a helicopter electromagnetic survey done during 2001 that was processed, calibrated, and published during the study, (5) cores and geophysical logs collected from 8 sites for stratigraphic analysis, (6) 8 new water-quality monitoring wells, and (7) analyses of 69 geochemical samples. The results of the study indicate that as of 2011 approximately 1,200 square kilometers (km2) of the mainland part of the Biscayne aquifer were intruded by saltwater. The saltwater front was mapped farther inland than it was in 1995 in eight areas totaling about 24.1 km2. In many of these areas, analyses indicated that saltwater had encroached along the base of the aquifer. The saltwater front was mapped closer to the coast than it was in 1995 in four areas totaling approximately 6.2 km2. The changes in the mapped extent of saltwater resulted from improved spatial information, actual movement of the saltwater front, or a combination of both. Salinity monitoring in some of the canals in Miami-Dade County between 1988 and 2010 indicated influxes of saltwater, with maximum

  20. Necrotizing fasciitis due to Serratia marcescens: case report and review of the literature.

    Science.gov (United States)

    Majumdar, Rohit; Crum-Cianflone, Nancy F

    2016-06-01

    Necrotizing fasciitis is a severe, life-threatening infection.  Serratia marcescens, a Gram-negative bacterium, is an extremely rare cause of necrotizing fasciitis. A case of S. marcescens necrotizing fasciitis is described, and a comprehensive review of the literature (1966-2015) of monomicrobial cases due to this organism performed. We report the first case of S. marcescens necrotizing fasciitis in the setting of calciphylaxis associated with end-stage renal disease.  A comprehensive review of the literature of S. marcescens necrotizing fasciitis is provided to enhance the awareness of this increasingly recognized infection, and to provide a concise summary of risk factors, treatment, and outcome. Our case and review highlight the potential risk factors for S. marcescens necrotizing fasciitis, including underlying renal disease and open wounds, and demonstrate the emergence of this organism as a cause of severe, life-threatening soft tissue infections.

  1. Concurrent emphysematous pyelonephritis and thigh necrotizing fasciitis after intramuscular administration of diclofenac

    Directory of Open Access Journals (Sweden)

    Fateme Shamekhi Amiri

    2014-01-01

    Full Text Available Necrotizing fasciitis (NF is a rapidly progressive, life-threatening soft tissue infec-tion. NF may result from any injury to the skin or from hematogenous spread. However, con-current emphysematous pyelonephritis and necrotizing fasciitis of the left thigh has not been reported. We report a case of emphysematous pyelonephritis and necrotizing fasciitis of the left thigh after intramuscular administration of diclofenac that improved with aggressive management including broad-spectrum antibiotics, nephrectomy and surgical intervention.

  2. Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

    Directory of Open Access Journals (Sweden)

    Malkoc Melih

    2015-03-01

    Full Text Available Plantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.

  3. Necrotizing Fasciitis Caused by Hypermucoviscous Klebsiella pneumoniae in a Filipino Female in North America

    Directory of Open Access Journals (Sweden)

    Ng, Daniel

    2014-12-01

    Full Text Available Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America. [West J Emerg Med. 2015;16(1:165–168.

  4. Effects of climate change on saltwater intrusion at Hilton Head Island, SC. U.S.A.

    Science.gov (United States)

    Payne, Dorothy F.

    2010-01-01

    Sea‐level rise and changes in precipitation patterns may contribute to the occurrence and affect the rate of saltwater contamination in the Hilton Head Island, South Carolina area. To address the effects of climate change on saltwater intrusion, a threedimensional, finite‐element, variable‐density, solute‐transport model was developed to simulate different rates of sea‐level rise and variation in onshore freshwater recharge. Model simulation showed that the greatest effect on the existing saltwater plume occurred from reducing recharge, suggesting recharge may be a more important consideration in saltwater intrusion management than estimated rates of sea‐level rise. Saltwater intrusion management would benefit from improved constraints on recharge rates by using model‐independent, local precipitation and evapotranspiration data, and improving estimates of confining unit hydraulic properties.

  5. Morphea and Eosinophilic Fasciitis: An Update.

    Science.gov (United States)

    Mertens, Jorre S; Seyger, Marieke M B; Thurlings, Rogier M; Radstake, Timothy R D J; de Jong, Elke M G J

    2017-08-01

    Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud's phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes

  6. Management of plantar fasciitis in the outpatient setting

    Science.gov (United States)

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-01-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

  7. Giant VAC in a patient with extensive necrotizing fasciitis.

    Science.gov (United States)

    Steinstraesser, Lars; Sand, Michael; Steinau, Hans-Ulrich

    2009-03-01

    The authors present a case of an extensive fulminant necrotizing fasciitis of the left flank, thigh, and lower parts of the leg treated with debridement, split-thickness skin grafting, and a giant negative pressure wound dressing covering 0.53 m( 2) or 18% of the body surface. To the authors' knowledge, this is the largest split-thickness grafted body surface successfully treated with negative pressure wound dressing documented in the literature.

  8. Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Arslan, Arzu E-mail: arzuarslan@netscape.net; Pierre-Jerome, Claude; Borthne, Arne

    2000-12-01

    The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.

  9. Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

    OpenAIRE

    Yamakado, Kotaro

    2013-01-01

    We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent ...

  10. The Effects of Prolotherapy in Recreational Athletes with Plantar Fasciitis

    Directory of Open Access Journals (Sweden)

    Ali Haydar Apaydın

    2018-03-01

    Results: When pre- and post-treatment values were compared; a statistically significant difference was found between the scores of visual pain scale, foot and ankle outcome score and balance coordination test (p<0.01. Conclusion: According to the results of the research, one can conclude that the application of prolotherapy provides symptomatic and functional improvement in recreational athletes with plantar fasciitis. Prolotherapy application seems to be an alternative treatment method in patients who have not been healed by conservative treatment.

  11. Damage control apronectomy for necrotising fasciitis and strangulated umbilical hernia.

    LENUS (Irish Health Repository)

    Coyle, P

    2012-01-31

    We present a case of a 50-year-old morbidly obese woman who presented with a case of necrotizing fasciitis of the anterior abdominal wall due to a strangulated umbilical hernia. The case was managed through damage control surgery (DCS) with an initial surgery to stabilise the patient and a subsequent definitive operation and biological graft hernia repair. We emphasise the relevance of DCS principles in the management of severe abdominal sepsis.

  12. Conjunctive Management of Multi-Aquifer System for Saltwater Intrusion Mitigation

    Science.gov (United States)

    Tsai, F. T. C.; Pham, H. V.

    2015-12-01

    Due to excessive groundwater withdrawals, many water wells in Baton Rouge, Louisiana experience undesirable chloride concentration because of saltwater intrusion. The study goal is to develop a conjunctive management framework that takes advantage of the Baton Rouge multi-aquifer system to mitigate saltwater intrusion. The conjunctive management framework utilizes several hydraulic control techniques to mitigate saltwater encroachment. These hydraulic control approaches include pumping well relocation, freshwater injection, saltwater scavenging, and their combinations. Specific objectives of the study are: (1) constructing scientific geologic architectures of the "800-foot" sand, the "1,000-foot" sand, the "1,200-foot" sand, the "1,500-foot" sand, the "1,700-foot" sand, and the "2,000-foot" sand, (2) developing scientific saltwater intrusion models for these sands. (3) using connector wells to draw native groundwater from one sand and inject to another sand to create hydraulic barriers to halt saltwater intrusion, (4) using scavenger wells or well couples to impede saltwater intrusion progress and reduce chloride concentration in pumping wells, and (5) reducing cones of depression by relocating and dispersing pumping wells to different sands. The study utilizes optimization techniques and newest LSU high performance computing (HPC) facilities to derive solutions. The conjunctive management framework serves as a scientific tool to assist policy makers to solve the urgent saltwater encroachment issue in the Baton Rouge area. The research results will help water companies as well as industries in East Baton Rouge Parish and neighboring parishes by reducing their saltwater intrusion threats, which in turn would sustain Capital Area economic development.

  13. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report

    LENUS (Irish Health Repository)

    Zgraj, Oskar

    2011-12-12

    Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  14. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene: a case report

    Directory of Open Access Journals (Sweden)

    Zgraj Oskar

    2011-12-01

    Full Text Available Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  15. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report.

    Science.gov (United States)

    Zgraj, Oskar; Paran, Sri; O'Sullivan, Maureen; Quinn, Feargal

    2011-12-12

    Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  16. Extended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.

    Science.gov (United States)

    Sugimoto, Motokazu; Matsuura, Kenji; Takayama, Hiroshi; Kayo, Munefumi; Ie, Tomotsugu

    2010-10-01

    Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge. In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully. Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.

  17. Potential for saltwater intrusion into the lower Tamiami aquifer near Bonita Springs, southwestern Florida

    Science.gov (United States)

    Shoemaker, W. Barclay; Edwards, K. Michelle

    2003-01-01

    A study was conducted to examine the potential for saltwater intrusion into the lower Tamiami aquifer beneath Bonita Springs in southwestern Florida. Field data were collected, and constant- and variable-density ground-water flow simulations were performed that: (1) spatially quantified modern and seasonal stresses, (2) identified potential mechanisms of saltwater intrusion, and (3) estimated the potential extent of saltwater intrusion for the area of concern. MODFLOW and the inverse modeling routine UCODE were used to spatially quantify modern and seasonal stresses by calibrating a constant-density ground-water flow model to field data collected in 1996. The model was calibrated by assuming hydraulic conductivity parameters were accurate and by estimating unmonitored ground-water pumpage and potential evapotranspiration with UCODE. Uncertainty in these estimated parameters was quantified with 95-percent confidence intervals. These confidence intervals indicate more uncertainty (or less reliability) in the estimates of unmonitored ground-water pumpage than estimates of pan-evaporation multipliers, because of the nature and distribution of observations used during calibration. Comparison of simulated water levels, streamflows, and net recharge with field data suggests the model is a good representation of field conditions. Potential mechanisms of saltwater intrusion into the lower Tamiami aquifer include: (1) lateral inland movement of the freshwater-saltwater interface from the southwestern coast of Florida; (2) upward leakage from deeper saline water-bearing zones through natural upwelling and upconing, both of which could occur as diffuse upward flow through semiconfining layers, conduit flow through karst features, or pipe flow through leaky artesian wells; (3) downward leakage of saltwater from surface-water channels; and (4) movement of unflushed pockets of relict seawater. Of the many potential mechanisms of saltwater intrusion, field data and variable

  18. Nodular fasciitis: A pseudomalignant clonal neoplasm characterized by USP gene rearrangements and spontaneous regression

    LENUS (Irish Health Repository)

    Hennebry, Jennifer

    2017-01-01

    Introduction: Nodular fasciitis (NF) is a rapidly growing, self-limited, myofibroblastic neoplasm that typically arises in subcutaneous tissues of young adults and regresses spontaneously. Nodular fasciitis mimics sarcoma on clinical, radiological, and histological grounds and is usually, diagnosed following excision.\\r\

  19. Plantar fascia softening in plantar fasciitis with normal B-mode sonography.

    Science.gov (United States)

    Wu, Chueh-Hung; Chen, Wen-Shiang; Wang, Tyng-Guey

    2015-11-01

    To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé's test was used to identify where the differences occurred. Compared to healthy participants (red pixel intensity: 146.9 ± 9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4 ± 7.3, p = 0.01), symptomatic sides of unilateral plantar fasciitis (127.1 ± 7.4, p plantar fasciitis (129.4 ± 7.5, p plantar fascia thickness or green or blue pixel intensity among these groups. Sonoelastography revealed that the plantar fascia is softer in patients with typical clinical manifestations of plantar fasciitis, even if they exhibit no abnormalities on B-mode sonography.

  20. Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report.

    Science.gov (United States)

    Yang, Bo Kyu; Yi, Seung Rim; Lee, Ye Hyun; Kim, Hyun See; Nam, Seok Woo; Ahn, Young Joon; Kim, Seong Wan; Yang, Sung Wook; Im, Se Hyuk

    2014-12-01

    As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

  1. [A patient with muscular torticollis caused by nodular fasciitis in the sternocleidomastoid muscle (SCM)].

    Science.gov (United States)

    Hemmi, Shoji; Murakami, Tatufumi; Shirabe, Teruo; Sunada, Yoshihide

    2002-09-01

    Nodular fasciitis is a benign pseudosarcomatous proliferative lesion which is frequently misdiagnosed as malignant tumor clinically and microscopically. It usually occurs as a rapidly enlarging subcutaneous mass on the upper extremities, especially on the forearm. Here we report a patient showing muscular torticollis caused by nodular fasciitis in the sternocleidomastoid muscle (SCM). A 17-year-old woman was hospitalized because of rapidly progressive torticollis. The right SCM was markedly enlarged and firm on palpation. Muscle biopsy taken from the right SCM revealed massive proliferation of spindle shaped fibroblasts infiltrating into the endomysium. These findings coincided with the intramuscular nodular fasciitis. However, different from typical nodular fasciitis, no apparent nodule formation was found in this patient. Instead, diffuse proliferative lesion extended widely into the neck soft tissue. To our knowledge, this is the first report of muscular torticollis caused by nodular fasciitis involving the SCM.

  2. A genetic linkage map for the saltwater crocodile (Crocodylus porosus

    Directory of Open Access Journals (Sweden)

    Lance Stacey L

    2009-07-01

    Full Text Available Abstract Background Genome elucidation is now in high gear for many organisms, and whilst genetic maps have been developed for a broad array of species, surprisingly, no such maps exist for a crocodilian, or indeed any other non-avian member of the Class Reptilia. Genetic linkage maps are essential tools for the mapping and dissection of complex quantitative trait loci (QTL, and in order to permit systematic genome scans for the identification of genes affecting economically important traits in farmed crocodilians, a comprehensive genetic linage map will be necessary. Results A first-generation genetic linkage map for the saltwater crocodile (Crocodylus porosus was constructed using 203 microsatellite markers amplified across a two-generation pedigree comprising ten full-sib families from a commercial population at Darwin Crocodile Farm, Northern Territory, Australia. Linkage analyses identified fourteen linkage groups comprising a total of 180 loci, with 23 loci remaining unlinked. Markers were ordered within linkage groups employing a heuristic approach using CRIMAP v3.0 software. The estimated female and male recombination map lengths were 1824.1 and 319.0 centimorgans (cM respectively, revealing an uncommonly large disparity in recombination map lengths between sexes (ratio of 5.7:1. Conclusion We have generated the first genetic linkage map for a crocodilian, or indeed any other non-avian reptile. The uncommonly large disparity in recombination map lengths confirms previous preliminary evidence of major differences in sex-specific recombination rates in a species that exhibits temperature-dependent sex determination (TSD. However, at this point the reason for this disparity in saltwater crocodiles remains unclear. This map will be a valuable resource for crocodilian researchers, facilitating the systematic genome scans necessary for identifying genes affecting complex traits of economic importance in the crocodile industry. In addition

  3. Necrotizing fasciitis of the breast: a case managed without mastectomy.

    Science.gov (United States)

    Soliman, M O; Ayyash, E H; Aldahham, A; Asfar, S

    2011-01-01

    To report a rare presentation of necrotizing fasciitis (NF) in the breast and its management. A 61-year-old non-diabetic lady presented with a painful swollen right breast and yellowish discharge associated with fever for the last few days. Based on clinical examination and haematological parameters, a provisional diagnosis of breast abscess was made that later proved to be a case of NF. She was managed conservatively with repeated debridement followed by split-skin grafting with preservation of the breast. This case showed that NF of the breast can present as a simple breast abscess which was managed conservatively. Copyright © 2011 S. Karger AG, Basel.

  4. Fasciitis necroticans efter artroskopi af præpatellar bursitis

    DEFF Research Database (Denmark)

    Schlesinger, NH; Friis-Møller, Alice; Hvolris, Jesper

    2007-01-01

    Necrotizing fasciitis (NF) is a life-threatening soft tissue infection in superficial and deep fascias. NF is most often caused by mixed aerobic and anaerobic bacteria. The treatment is early and aggressive surgical debridement, antibiotics and hyperbaric oxygen. In this case description, a nearly...... 60-year-old man developed NF after arthroscopic synovectomy of an infected prepatellar bursa. We stress the point that the endoscopic technique itself might be responsible for the spreading of bacteria to the fascias. This is a subject for further investigation Udgivelsesdato: 30. april...

  5. Generalized morphea/eosinophilic fasciitis overlap after epoxy exposure

    Directory of Open Access Journals (Sweden)

    Warren H. Chan, MS

    2018-03-01

    Full Text Available Generalized morphea is associated with epoxy resin vapors and is characterized by the development of lesions shortly after exposure. Morphea presenting along with eosinophilic fasciitis (EF, or morphea/EF overlap, is rare and an indicator of poor prognosis and resistance to treatment. Here we present a case of generalized morphea/EF overlap linked to epoxy exposure. Our patient received multiple therapies—ultraviolet A1 phototherapy, prednisone, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, and rituximab—none of which led to a significant response. The refractory nature of this disease warrants vigilance in its association with epoxy exposure.

  6. First Necrotizing Fasciitis Caused by Haemophilus influenza Serotype a

    Science.gov (United States)

    Quach, Giang T.; Frisby, Jared; Kralovich, Kurt; Bohra, Mustafa

    2017-01-01

    Necrotizing fasciitis (NF) is an infrequently encountered skin infection that has high morbidity and mortality, even with prompt medical and surgical intervention. We describe the case of a 67-year-old male presenting with significant NF in his left lower extremity, despite aggressive surgical intervention, and included multiple surgical debridements, ACell Matrix, split-thickness, and negative wound VAC therapy. Ultimately, this patient required a below the knee amputation. This is the first documented case of Haemophilus influenza type a causing NF. PMID:29124073

  7. Fulminant Necrotizing Fasciitis and Toxic Shock Syndrome Caused by Streptococcus agalactiae

    Directory of Open Access Journals (Sweden)

    Emin UYSAL

    2018-03-01

    Full Text Available Necrotizing fasciitis is a rare and life-threatening soft tissue infection that spreads rapidly and involves the skin, subcutaneous tissue, fascia, and muscle layer. The treatment is possible by initiating appropriate antibiotherapy for the clinically suspected cause and by performing surgical intervention quickly and aggressively. However, it should be known that necrotizing fasciitis is a disease that is difficult to manage despite all interventions, effective treatment protocols, and patient care. This article presents the case of a 60-year-old patient with diabetes mellitus who died of toxic shock syndrome with fulminant necrotizing fasciitis caused by Streptococcus agalactiae.

  8. Comparative genome analyses reveal distinct structure in the saltwater crocodile MHC.

    Directory of Open Access Journals (Sweden)

    Weerachai Jaratlerdsiri

    Full Text Available The major histocompatibility complex (MHC is a dynamic genome region with an essential role in the adaptive immunity of vertebrates, especially antigen presentation. The MHC is generally divided into subregions (classes I, II and III containing genes of similar function across species, but with different gene number and organisation. Crocodylia (crocodilians are widely distributed and represent an evolutionary distinct group among higher vertebrates, but the genomic organisation of MHC within this lineage has been largely unexplored. Here, we studied the MHC region of the saltwater crocodile (Crocodylus porosus and compared it with that of other taxa. We characterised genomic clusters encompassing MHC class I and class II genes in the saltwater crocodile based on sequencing of bacterial artificial chromosomes. Six gene clusters spanning ∼452 kb were identified to contain nine MHC class I genes, six MHC class II genes, three TAP genes, and a TRIM gene. These MHC class I and class II genes were in separate scaffold regions and were greater in length (2-6 times longer than their counterparts in well-studied fowl B loci, suggesting that the compaction of avian MHC occurred after the crocodilian-avian split. Comparative analyses between the saltwater crocodile MHC and that from the alligator and gharial showed large syntenic areas (>80% identity with similar gene order. Comparisons with other vertebrates showed that the saltwater crocodile had MHC class I genes located along with TAP, consistent with birds studied. Linkage between MHC class I and TRIM39 observed in the saltwater crocodile resembled MHC in eutherians compared, but absent in avian MHC, suggesting that the saltwater crocodile MHC appears to have gene organisation intermediate between these two lineages. These observations suggest that the structure of the saltwater crocodile MHC, and other crocodilians, can help determine the MHC that was present in the ancestors of archosaurs.

  9. Trace element concentrations of wild saltwater crocodile eggs

    International Nuclear Information System (INIS)

    Manolis, S.C.; Webb, G.J.; Britton, A.R.; Jeffree, R.A.; Markich, S.J.

    2002-01-01

    Saltwater crocodiles (Crocodylus porosus) accumulate trace elements from the environment into their flesh and bones (Jeffree et al., 2001a). Elevated levels of metals (e.g. Hg, Zn, Pb), organochlorines (e.g. DDT) and radionuclides (e.g. radiocesium) have been recorded in blood, tissues and eggs of several crocodilian species (Manolis et al., this volume). In this study the concentrations of various elements (including metals) were measured in the yolk of C. porosus eggs collected from the Finniss River and two other distant nesting sites (Melacca Swamp, a spring-fed freshwater swamp; Adelaide River, a tidal river) during the 2000- 01 nesting season. Infertile eggs from 30 clutches (Adelaide 12, Melacca 8, Finniss 10) were opened and the yolk contents removed (after Webb et al., 1987) and frozen. Samples of yolk were then oven-dried, digested in nitric acid and hydrogen peroxide. The digest solutions were then analysed for 20 elements (see Table 1) using inductively coupled plasma mass spectroscopy. Similarities between the elemental composition of eggs from the three areas suggests that downstream contamination from Rum Jungle Mine is not apparent in C. porosus nesting in the Finniss River. These nesting areas are some 60 km downstream of the mine site, and contaminants are probably greatly diluted during the wet season. C. porosus were also intensively hunted in the Finniss River area during the 1950s and 1960s, until their protection in 1971 (Webb et al. 1984). Some females would have been recruited into the population after the period of mining. Long-term effects of the mine may be apparent in areas with Australian freshwater crocodiles (C. johnstoni), mainly upstream of C. porosus nesting areas and up to the mine. Examination of tissues and eggs of C. johnstoni may provide more information on the historical effects of the mine

  10. Extracorporeal shock wave therapy for treatment of plantar fasciitis

    International Nuclear Information System (INIS)

    Dastgir, N.

    2014-01-01

    Objective: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. Methods: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. Results: At follow-up there was significant decrease in pain on the visual analogue scale (p<0.027), with significant improvement in pain score (p<0.009) and in functional score (p<0.001). The comfortable walking distance had increased significantly and there were no reported side effects. Conclusion: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis. (author)

  11. Orbital compressed air and petroleum injury mimicking necrotizing fasciitis.

    Science.gov (United States)

    Mellington, Faye E; Bacon, Annette S; Abu-Bakra, Mohammed A J; Martinez-Devesa, Pablo; Norris, Jonathan H

    2014-09-01

    Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Necrotizing Fasciitis Secondary to Aeromonas Infection Presenting with Septic Shock

    Directory of Open Access Journals (Sweden)

    Nikhil Bhatia

    2017-01-01

    Full Text Available This report describes a case of necrotizing fasciitis presenting with septic shock due to an Aeromonas infection. The patient cut his foot while mowing the lawn and then spent time in a pool with black mold. He began feeling ill and developed swelling and a quarter-sized black area on his right lower extremity. Despite being hemodynamically unstable with systolic blood pressure in the low 70s, the patient was transferred to our facility from outside hospital 100 miles away. Upon arriving to facility, the patient appeared to be septic and the infected area of skin had grown. Irrigation and debridement were performed and appropriate antibiotic therapy was given; however, the patient subsequently died on hospital day 8. On review of the literature, cases of necrotizing fasciitis due to Aeromonas infection have been treated successfully with the aforementioned therapy; however, there is high mortality associated with these infections, many times related to a delayed diagnosis. Our patient also had multiple poor prognostic factors including hepatic dysfunction and immunosuppression.

  13. Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

    Science.gov (United States)

    Yamakado, Kotaro

    2013-01-01

    We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging. PMID:23875139

  14. Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

    Science.gov (United States)

    Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

    2016-01-01

    We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.  PMID:28083457

  15. Graphite Based Electrode for ECG Monitoring: Evaluation under Freshwater and Saltwater Conditions

    Directory of Open Access Journals (Sweden)

    Tharoeun Thap

    2016-04-01

    Full Text Available We proposed new electrodes that are applicable for electrocardiogram (ECG monitoring under freshwater- and saltwater-immersion conditions. Our proposed electrodes are made of graphite pencil lead (GPL, a general-purpose writing pencil. We have fabricated two types of electrode: a pencil lead solid type (PLS electrode and a pencil lead powder type (PLP electrode. In order to assess the qualities of the PLS and PLP electrodes, we compared their performance with that of a commercial Ag/AgCl electrode, under a total of seven different conditions: dry, freshwater immersion with/without movement, post-freshwater wet condition, saltwater immersion with/without movement, and post-saltwater wet condition. In both dry and post-freshwater wet conditions, all ECG-recorded PQRST waves were clearly discernible, with all types of electrodes, Ag/AgCl, PLS, and PLP. On the other hand, under the freshwater- and saltwater-immersion conditions with/without movement, as well as post-saltwater wet conditions, we found that the proposed PLS and PLP electrodes provided better ECG waveform quality, with significant statistical differences compared with the quality provided by Ag/AgCl electrodes.

  16. A Case of Postsurgical Necrotizing Fasciitis Invading the Rectus Abdominis Muscle and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Francesco Carbonetti

    2014-01-01

    Full Text Available Necrotizing fasciitis is a life-threatening, soft tissue infection and an early diagnosis is needed to permit a prompt surgical and medical intervention. Due to the high fatal potential of the disease complications, the radiologist should distinguish necrotizing fasciitis from the most common soft tissue infections, in order to permit a prompt surgical and medical treatment. We present a case of a wide necrotizing fasciitis who presented at our emergency department and we also provide the basic tools, through a review of the literature, for the general radiologist to distinguish, with computed tomography and magnetic resonance imaging, necrotizing fasciitis from the most common infections that could present during our routine practice.

  17. Fulminant necrotizing fasciitis following the use of herbal concoction: a case report

    Directory of Open Access Journals (Sweden)

    Nasir Abdulrasheed A

    2010-10-01

    Full Text Available Abstract Introduction Necrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer. Case presentation A 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation. Conclusion The herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.

  18. The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation.

    Science.gov (United States)

    Huang, Yu-Chi; Wang, Lin-Yi; Wang, Her-Cherng; Chang, Kai-Lan; Leong, Chau-Peng

    2004-06-01

    The purpose of this study was to investigate the relationship between flexible flatfoot and plantar fasciitis. Twenty-three subjects with flexible flatfoot and 23 subjects with normal arched feet were enrolled. Footprint analysis was used to evaluate the foot conditions in both groups to calculate the individual arch index. We compared the sonographic images of plantar fascia in the flexible flatfoot group with the normal arch group using high-frequency ultrasound. The analysis results indicated that the thickening of the plantar fascia in the flexible flatfoot group was significantly different from the normal arch group. In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis. There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.

  19. Lower extremity necrotizing fasciitis: A unique initial presentation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Anna Weiss

    2015-09-01

    Full Text Available Crohn's disease is a disease of the bowel, typically presenting with diarrhea, weight loss, and abdominal pain. Complications such as abscesses, fistulas, and strictures may require surgical intervention. We would like to report a patient with Crohn's disease who presented for the first time with left lower extremity necrotizing fasciitis. There are very few reports of necrotizing fasciitis in Crohn's disease as the initial presentation.

  20. Necrotizing Fasciitis and Toxic Shock Syndrome from Clostridium septicum following a Term Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    B. H. Rimawi

    2014-01-01

    Full Text Available Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary to Clostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention.

  1. Monomicrobial necrotizing fasciitis in a white male caused by hypermucoviscous Klebsiella pneumoniae

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Brandt, Pernille B; Gad, Dorte

    2009-01-01

    We report a case of monomicrobial necrotizing fasciitis caused by hypermucoviscous Klebsiella pneumoniae in an immunocompromised white male after travel to China. The K. pneumoniae isolate belonged to the K2 serotype, and carried the virulence factors RmpA and aerobactin. To the best of our...... knowledge this is the first report of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae resembling the highly virulent K. pneumoniae isolates associated with liver abscess syndrome in Asia....

  2. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

    OpenAIRE

    Abdulkareem, Abdullateef; D’Souza, Ryan S.; Shogbesan, Oluwaseun; Donato, Anthony

    2017-01-01

    Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrob...

  3. Application of Time-Domain Electromagnetic Method in Investigating Saltwater Intrusion of Santiago Island (Cape Verde)

    Science.gov (United States)

    Gonçalves, Rui; Farzamian, Mohammad; Monteiro Santos, Fernando A.; Represas, Patrícia; Mota Gomes, A.; Lobo de Pina, A. F.; Almeida, Eugénio P.

    2017-11-01

    Santiago Island, the biggest and most populated island of the Cape Verde Republic, is characterised by limited surface waters and strong dependence on groundwater sources as the primary source of natural water supply for extensive agricultural activity and human use. However, as a consequence of the scarce precipitation and high evaporation as well as the intense overexploitation of the groundwater resources, the freshwater management is also in a delicate balance with saltwater at coastal areas. The time-domain electromagnetic (TDEM) method is used to locate the extent of saltwater intrusion in four important agricultural regions in Santiago Island; São Domingos, Santa Cruz, São Miguel, and Tarrafal. The application of this method in Santiago Island proves it to be a successful tool in imaging the fresh/saltwater interface location. Depths to the saline zones and extensions of saline water are mapped along eight TDEM profiles.

  4. Sonographic evaluation of plantar fasciitis and relation to body mass index

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemir, Huseyin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)]. E-mail: ozdemir@firat.edu.tr; Yilmaz, Erhan [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Murat, Ayse [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Karakurt, Lokman [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Poyraz, A. Kursad [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Ogur, Erkin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)

    2005-06-01

    Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m{sup 2} in patients with heel pain and 25 kg/m{sup 2} in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis.

  5. Sonographic evaluation of plantar fasciitis and relation to body mass index

    International Nuclear Information System (INIS)

    Ozdemir, Huseyin; Yilmaz, Erhan; Murat, Ayse; Karakurt, Lokman; Poyraz, A. Kursad; Ogur, Erkin

    2005-01-01

    Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m 2 in patients with heel pain and 25 kg/m 2 in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis

  6. Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

    Science.gov (United States)

    Malone, Terry R.

    2004-01-01

    Objective: Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model. Data Sources: We searched MEDLINE, SPORT Discus, and CINAHL from 1966 to 2003 using the key words plantar fasciitis, windlass mechanism, pronation, heel pain, and heel spur. Data Synthesis: We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments. Conclusions/Recommendations: Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment. PMID:16558682

  7. Modeling Approach for Estimating Co-Produced Water Volumes and Saltwater Disposal Volumes in Oklahoma

    Science.gov (United States)

    Murray, K. E.

    2016-12-01

    Management of produced fluids has become an important issue in Oklahoma because large volumes of saltwater are co-produced with oil and gas, and disposed into saltwater disposal wells at high rates. Petroleum production increased from 2009-2015, especially in central and north-central Oklahoma where the Mississippian and Hunton zones were redeveloped using horizontal wells and dewatering techniques that have led to a disproportional increase in produced water volumes. Improved management of co-produced water, including desalination for beneficial reuse and decreased saltwater disposal volumes, is only possible if spatial and temporal trends can be defined and related to the producing zones. It is challenging to quantify the volumes of co-produced water by region or production zone because co-produced water volumes are generally not reported. Therefore, the goal of this research is to estimate co-produced water volumes for 2008-present with an approach that can be replicated as petroleum production shifts to other regions. Oil and gas production rates from subsurface zones were multiplied by ratios of H2O:oil and H2O:gas for the respective zones. Initial H2O:oil and H2O:gas ratios were adjusted/calibrated, by zone, to maximize correlation of county-scale produced H2O estimates versus saltwater disposal volumes from 2013-2015. These calibrated ratios were then used to compute saltwater disposal volumes from 2008-2012 because of apparent data gaps in reported saltwater disposal volumes during that timeframe. This research can be used to identify regions that have the greatest need for produced water treatment systems. The next step in management of produced fluids is to explore optimal energy-efficient strategies that reduce deleterious effects.

  8. Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography

    International Nuclear Information System (INIS)

    Kawasumi, Yusuke; Sato, Yuki; Sato, Yumi; Ishibashi, Tadashi; Usui, Akihito; Daigaku, Nami; Hosokai, Yoshiyuki; Hayashizaki, Yoshie; Funayama, Masato

    2016-01-01

    To evaluate the difference in sinus fluid volume and density between saltwater and freshwater drowning and diagnose saltwater drowning in distinction from freshwater drowning. Ninety-three drowning cases (22 saltwater and 71 freshwater) were retrospectively investigated; all had undergone post-mortem CT and forensic autopsy. Sinus fluid volume and density were calculated using a 3D-DICOM workstation, and differences were evaluated. Diagnostic performance of these indicators for saltwater drowning was evaluated using a cut-off value calculated by receiver operating characteristic (ROC) analysis. The median sinus fluid volume was 5.68 mL in cases of saltwater drowning (range 0.08 to 37.55) and 5.46 mL in cases of freshwater drowning (0.02 to 27.68), and the average densities were 47.28 (14.26 to 75.98) HU and 32.56 (-14.38 to 77.43) HU, respectively. While sinus volume did not differ significantly (p = 0.6000), sinus density was significantly higher in saltwater than freshwater drowning cases (p = 0.0002). ROC analysis for diagnosis of saltwater drowning determined the cut-off value as 37.77 HU, with a sensitivity of 77 %, specificity of 72 %, PPV of 46 % and NPV of 91 %. The average density of sinus fluid in cases of saltwater drowning was significantly higher than in freshwater drowning cases; there was no significant difference in the sinus fluid volume. (orig.)

  9. Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawasumi, Yusuke; Sato, Yuki; Sato, Yumi; Ishibashi, Tadashi [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, Sendai, Miyagi (Japan); Usui, Akihito; Daigaku, Nami; Hosokai, Yoshiyuki [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, Sendai, Miyagi (Japan); Hayashizaki, Yoshie; Funayama, Masato [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, Sendai, Miyagi (Japan)

    2016-04-15

    To evaluate the difference in sinus fluid volume and density between saltwater and freshwater drowning and diagnose saltwater drowning in distinction from freshwater drowning. Ninety-three drowning cases (22 saltwater and 71 freshwater) were retrospectively investigated; all had undergone post-mortem CT and forensic autopsy. Sinus fluid volume and density were calculated using a 3D-DICOM workstation, and differences were evaluated. Diagnostic performance of these indicators for saltwater drowning was evaluated using a cut-off value calculated by receiver operating characteristic (ROC) analysis. The median sinus fluid volume was 5.68 mL in cases of saltwater drowning (range 0.08 to 37.55) and 5.46 mL in cases of freshwater drowning (0.02 to 27.68), and the average densities were 47.28 (14.26 to 75.98) HU and 32.56 (-14.38 to 77.43) HU, respectively. While sinus volume did not differ significantly (p = 0.6000), sinus density was significantly higher in saltwater than freshwater drowning cases (p = 0.0002). ROC analysis for diagnosis of saltwater drowning determined the cut-off value as 37.77 HU, with a sensitivity of 77 %, specificity of 72 %, PPV of 46 % and NPV of 91 %. The average density of sinus fluid in cases of saltwater drowning was significantly higher than in freshwater drowning cases; there was no significant difference in the sinus fluid volume. (orig.)

  10. Using state-of-the-art technology to evaluate saltwater intrusion in the Biscayne aquifer of Miami-Dade County, Florida

    Science.gov (United States)

    Prinos, Scott T.

    2014-01-01

    The fresh groundwater supplies of many communities have been adversely affected or limited by saltwater intrusion. An insufficient understanding of the origin of intruded saltwater may lead to inefficient or ineffective water-resource management. A 2008–2012 cooperative U.S. Geological Survey (USGS) and Miami-Dade County study of saltwater intrusion describes state-of-the art technology used to evaluate the origin and distribution of this saltwater.

  11. Necrotizing fasciitis secondary to enterocutaneous fistula: three case reports.

    Science.gov (United States)

    Gu, Guo-Li; Wang, Lin; Wei, Xue-Ming; Li, Ming; Zhang, Jie

    2014-06-28

    Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.

  12. Flesh-Eating Disease: A Note on Necrotizing Fasciitis

    Directory of Open Access Journals (Sweden)

    H Dele Davies

    2001-01-01

    Full Text Available There has been much media attention in the past few years to the condition dubbed 'flesh-eating disease', which refers, primarily, to a form of invasive group A beta hemolytic streptococcal (GABHS infection that leads to fascia and muscle necrosis. In 1999, the Canadian Paediatric Society issued a statement on the state of knowledge and management of children, and close contacts of persons with all-invasive GABHS disease (1. The present note is intended to deal specifically with necrotizing fasciitis (NF by providing an update on the limited current state of knowledge, diagnosis and management. Surveillance to establish actual national rates and epidemiology of NF through the Canadian Paediatric Society is proposed.

  13. Diagnosis and management of necrotising fasciitis: a multiparametric approach.

    Science.gov (United States)

    Morgan, M S

    2010-08-01

    Necrotising fasciitis (NF) is situated with myositis and myonecrosis at the severe end of a spectrum of skin and soft tissue infections but is far removed from erisepelas, impetigo and cellulitis. Inexperienced clinicians are easily misled by the protean manifestations of infection, especially exotoxin or superantigen mediated consequences from streptococcal NF. Early clinical suspicion and surgery are key to improving survival, and patients with NF need integrated multidisciplinary management, adjusted to the infecting organism(s), the site of infection, and the effects from any toxins produced. A multiparametric approach, incorporating various clinical and laboratory parameters, can aid aggressive management. This review describes the diagnosis and management of the major types of NF, emphasising important aetiological clues from the history and the appropriate usage of diagnostic investigations. The potential benefits of controversial therapeutic approaches, including hyperbaric oxygen and intravenous immunoglobulin, are discussed. Copyright 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  14. Ultrasound-guided injection for plantar fasciitis: A brief review

    Directory of Open Access Journals (Sweden)

    A S Nair

    2016-01-01

    Full Text Available Plantar fasciitis (PF is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation.

  15. [Fournier gangrene (necrotizing fasciitis) in a woman with diabetes mellitus].

    Science.gov (United States)

    Kamper, Lars; Piroth, W; Haage, P

    2009-08-01

    A 67-year-old woman with insuline-dependent diabetes mellitus and chronic alcohol abuse was admitted with impaired consciousness and fever. Physical examination showed a livid induration of the perineal and vaginal soft tissues with crepitations. Laboratory tests showed greatly elevated infection parameters. Abdominal computed tomography revealed perineal and vaginal subcutaneous gas accumulation extending into the ventral abdominal wall. The combination of an obscure infection and subcutaneous genital gas accumulation suggested the diagnosis of Fournier gangrene, a necrotizing fasciitis. In spite of administration of broad-spectrum antibiotics and repeated surgical removal of necrotic tissue the patient died of multiple organ failure. Successful treatment of Fournier gangrene critically depends on immediate treatment. Administration of broad-spectrum antibiotics and aggressive surgical resection of the necrotic tissue may prevent continuing spreading of the infection. Computed tomography provides an early diagnosis and guides the presurgical evaluation of the subcutaneous spread. Georg Thieme Verlag KG Stuttgart * New York.

  16. Current concepts in the management of necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Evangelos P. Misiakos

    2014-09-01

    Full Text Available Necrotizing fasciitis is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%. Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure and liver cirrhosis. Necrotizing fasciitis is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the LRINEC score or FGSI score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites.Management of the infection begins with broad spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.

  17. Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis.

    Science.gov (United States)

    Fleischer, Adam E; Albright, Rachel H; Crews, Ryan T; Kelil, Tatiana; Wrobel, James S

    2015-10-01

    The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play. © 2015 by the American Institute of Ultrasound in Medicine.

  18. LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

    Directory of Open Access Journals (Sweden)

    Syam Sunder B

    2017-01-01

    Full Text Available BACKGROUND Plantar fasciitis is the most common cause of heel pain for which professional care is sought. Initially thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia and maybe more accurately termed plantar fasciosis. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments include icing, Nonsteroidal Anti-inflammatory Drugs (NSAIDs, rest and activity modification, corticosteroids, botulinum toxin type A, splinting, shoe modifications and orthosis. Other treatment techniques have been directed at resolving the degeneration caused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the goal of restarting the healing process. These techniques include autologous blood injection, Platelet-Rich Plasma (PRP injection, nitroglycerin patches, Extracorporeal Shock Wave Therapy (ESWT and surgical procedures. Recently, research has focused on regenerative therapies with high expectations of success. The use of autologous growth factors is thought to heal through collagen regeneration and the stimulation of a well-ordered angiogenesis. These growth factors are administered in the form of autologous whole blood or Platelet-Rich Plasma (PRP. Platelets can be isolated using simple cell-separating systems. The degranulation of the alpha granules in the platelets releases many different growth factors that play a role in tissue regeneration processes. Platelet-derived growth factor, transforming growth factor-P, vascular-derived endothelial growth factor, epithelial growth factor, hepatocyte growth factor and insulin-like growth factor are examples of such growth factors. Injections with autologous growth factors are becoming common in clinical practice. The present study was an attempt to compare the efficacy of autologous blood injection in plantar fasciitis by comparing it with the local

  19. Halotolerant ability and α-amylase activity of some saltwater fungal isolates

    NARCIS (Netherlands)

    Niknejad, F.; Moshfegh, M.; Najafzadeh, M.J.; Houbraken, J.; Rezaei, S.; Zarrini, G.; Faramarzi, M.A.; Nafissi-Varcheh, N.

    2013-01-01

    Four halotolerant fungal isolates originating from the saltwater Lake Urmia in Iran were selected during a screening program for salt resistance and α-amylase activity. The isolates were identified based on sequencing the ITS region and a part of the β-tubulin gene, as Penicillium chrysogenum

  20. 78 FR 24069 - Safety Zone; 12th Annual Saltwater Classic; Port Canaveral Harbor; Port Canaveral, FL

    Science.gov (United States)

    2013-04-24

    ... under Executive Order 13045, Protection of Children from Environmental Health Risks and Safety Risks. This rule is not an economically significant rule and does not create an environmental risk to health...-AA00 Safety Zone; 12th Annual Saltwater Classic; Port Canaveral Harbor; Port Canaveral, FL AGENCY...

  1. Effective use of surface-water management to control saltwater intrusion

    Science.gov (United States)

    Hughes, J. D.; White, J.

    2012-12-01

    The Biscayne aquifer in southeast Florida is susceptible to saltwater intrusion and inundation from rising sea-level as a result of high groundwater withdrawal rates and low topographic relief. Groundwater levels in the Biscayne aquifer are managed by an extensive canal system that is designed to control flooding, supply recharge to municipal well fields, and control saltwater intrusion. We present results from an integrated surface-water/groundwater model of a portion of the Biscayne aquifer to evaluate the ability of the existing managed surface-water control network to control saltwater intrusion. Surface-water stage and flow are simulated using a hydrodynamic model that solves the diffusive-wave approximation of the depth-integrated shallow surface-water equations. Variable-density groundwater flow and fluid density are solved using the Oberbeck--Boussinesq approximation of the three-dimensional variable-density groundwater flow equation and a sharp interface approximation, respectively. The surface-water and variable-density groundwater domains are implicitly coupled during each Picard iteration. The Biscayne aquifer is discretized into a multi-layer model having a 500-m square horizontal grid spacing. All primary and secondary surface-water features in the active model domain are discretized into segments using the 500-m square horizontal grid. A 15-year period of time is simulated and the model includes 66 operable surface-water control structures, 127 municipal production wells, and spatially-distributed daily internal and external hydrologic stresses. Numerical results indicate that the existing surface-water system can be effectively used in many locations to control saltwater intrusion in the Biscayne aquifer resulting from increases in groundwater withdrawals or sea-level rise expected to occur over the next 25 years. In other locations, numerical results indicate surface-water control structures and/or operations may need to be modified to control

  2. Intra-articular Nodular Fasciitis: An Unexpected Diagnosis for a Joint Lesion: A Case Report

    Directory of Open Access Journals (Sweden)

    MF Michelle Chan

    2014-07-01

    Full Text Available Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

  3. Successful Treatment of Necrotizing Fasciitis and Streptococcal Toxic Shock Syndrome with the Addition of Linezolid

    Directory of Open Access Journals (Sweden)

    Hana Rac

    2017-01-01

    Full Text Available Necrotizing fasciitis is a deep-seated subcutaneous tissue infection that is commonly associated with streptococcal toxic shock syndrome (TSS. Surgical debridement plus penicillin and clindamycin are the current standard of care. We report a case of necrotizing fasciitis and streptococcal TSS where linezolid was added after a failure to improve with standard therapy. Briefly after isolation of Streptococcus pyogenes from tissue cultures, the patient underwent two surgical debridement procedures and was changed to standard of care therapy. While the patient was hemodynamically stable, the patient’s wounds, leukocytosis, and thrombocytopenia all progressively worsened. After initiation of linezolid, the patient slowly improved clinically. The present report is the first to highlight the role of linezolid in streptococcal necrotizing fasciitis and TSS not improving with standard therapy.

  4. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

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    Abdullateef Abdulkareem

    2017-01-01

    Full Text Available Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.

  5. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature.

    Science.gov (United States)

    Abdulkareem, Abdullateef; D'Souza, Ryan S; Shogbesan, Oluwaseun; Donato, Anthony

    2017-01-01

    Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.

  6. Necrotizing fasciitis with toxic shock syndrome in 5 month old baby: A case report

    Directory of Open Access Journals (Sweden)

    Abbas Al-Ramzi

    2017-12-01

    Full Text Available Necrotizing fasciitis is considered to be a severe form of soft-tissue infection that is accompanied with rapidly progressive necrosis to the subcutaneous tissue layer and the superficial fascia. It is also characterized by early development of systemic toxicity. The invasive Streptococcus pyogenes is the most often encountered species as a cause of this disease. The delay in diagnosing is common as the differentiation of the evolving necrotizing fasciitis from cellulitis can be very difficult. Treatments include rapid radical debridement and administration of appropriate antibiotics. However, even with proper treatment, the mortality rate is considered to be high. We reported a 5-month-old girls with fatal necrotizing fasciitis associated with toxic shock–like syndrome due to Streptococcal infection.

  7. Dry cupping for plantar fasciitis: a randomized controlled trial.

    Science.gov (United States)

    Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

    2017-05-01

    [Purpose] The purpose of this study was to determine the effects of dry cupping on pain and function of patients with plantar fasciitis. [Subjects and Methods] Twenty-nine subjects (age 15 to 59 years old, 20 females and 9 males), randomly assigned into the two groups (dry cupping therapy and electrical stimulation therapy groups), participated in this study. The research design was a randomized controlled trial (RCT). Treatments were provided to the subjects twice a week for 4 weeks. Outcome measurements included the Visual Analogue Pain Scale (VAS) (at rest, first in the morning, and with activities), the Foot and Ankle Ability Measure (FAAM), the Lower Extremity Functional Scale (LEFS), as well as the pressure pain threshold. [Results]The data indicated that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function significantly in the population tested, as all the 95% Confidence Intervals (CIs) did not include 0 except for the pressure pain threshold. There was no significant difference between the dry cupping therapy and electrical stimulation groups in all the outcome measurements. [Conclusion] These results support that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function in the population tested.

  8. Atypical presentation of cervical necrotizing fasciitis. Case report.

    Directory of Open Access Journals (Sweden)

    Javier Moraga.

    2017-07-01

    Full Text Available Cervical necrotizing fasciitis (NF is a soft tissue infection with a low incidence, characterized by rapid progression and high morbidity and mortality. The purpose of this report is to communicate the case of a patient diagnosed with cervical NF and its successful management. A 54-year-old male consulted after suffering from the condition for seven days. It was characterized by bilateral submandibular swelling, accompanied by fever, dysphagia, odynophagia, which were severely affecting the patient’s general health. Physical examination revealed a painful, erythematous cervical swelling. A cervical computed tomography scan was performed, revealing a gaseous collection in the left mucosal pharyngeal space, extending to the glottis, associated with significant deep plane soft tissue emphysema onon the left side of the neck and with possible involvement of the danger space; pertinent lab findings include 19,190/uL leukocytes and 219mg/L CRP. Broad-spectrum antibiotic therapy was initiated with ceftriaxone and clindamycin. Exploratory surgery, lavage and drainage of the collected material were performed. Streptococcus anginosus was isolated by culture. The patient recovered appropriately showing improvement in clinical as well as in inflammatory parameters, being discharged on the ninth day. He is currently receiving periodical checkups in the surgery polyclinic.

  9. Necrotizing Fasciitis Complicating Pregnancy: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Marinos Nikolaou

    2014-01-01

    Full Text Available Necrotizing fasciitis is a rare, life-threatening surgical infection in pregnancy with high rates of morbidity and mortality. A 15-year-old primigravid woman, at 28 weeks of gestation with no significant previous medical history, was admitted to our hospital complaining of severe left lower extremity pain and high fever the last 72 hours. During clinical examination, she had a swollen, erythematous and tender to palpation inflamed skin over the medial aspect of the upper thigh without any evidence of injury. Incision drainage was performed immediately and she received broad spectrum antibiotics. During initial laboratory examinations, diabetes mellitus was diagnosed. There was no clinical improvement over the following days. Magnetic resonance imaging (MRI revealed subcutaneous tissue inflammation and edema of infected tissues confirming the disease entity. Multidisciplinary therapy with immediate aggressive surgical debridement of necrotic tissues, multiple antibiotics, and intensive care monitoring was performed successfully. The patient’s postoperative course was uncomplicated and skin defect was closed with split thickness skin grafting. Our case emphasized the potential immunosuppressive role of pregnancy state in conjunction with diabetes mellitus in the development of severe necrotizing soft tissue infections.

  10. Necrotizing fasciitis of the lower extremity: a case report and current concept of diagnosis and management.

    LENUS (Irish Health Repository)

    Naqvi, G A

    2012-02-01

    Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.

  11. Necrotizing Fasciitis of the Chest in a Neonate in Southern Nigeria

    Directory of Open Access Journals (Sweden)

    Oluwafemi Olasupo Awe

    2014-01-01

    Full Text Available We discuss the successful saving of a male neonate with necrotizing fasciitis of the chest following a hot fomentation of the umbilicus with exposure of the ribs and the pleural space on the right side. He recovered 5 weeks after admission. We stressed the need to recognize necrotizing fasciitis extending from the upper anterior abdominal wall to the chest following hot fomentation of the umbilicus. The need for multidisciplinary cooperation for excellent outcome is very important, that is, neonatologist, medical microbiologist, and plastic and chest surgeons.

  12. Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan

    Directory of Open Access Journals (Sweden)

    Yao-Hung Tsai

    2017-10-01

    Conclusions: Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000 cells/mm3 and ≥80% of segmented leukocyte forms. Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.

  13. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola

    Directory of Open Access Journals (Sweden)

    Kim Si-Hyun

    2012-03-01

    Full Text Available Abstract Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

  14. A rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Carmen E. Flores

    2017-11-01

    Conclusions: Necrotizing fasciitis of the head and neck demands a high index of suspicion involving a multidisciplinary team, rapid diagnostic measures and aggressive surgical and antibiotic management as the mainstay of treatment in reversing this potentially fulminant and lethal disease process. In this rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis, the infection spread across cervical fascial planes onto the anterior chest wall rather than dissecting as usual to the parapharyngeal, retropharyngeal spaces or mediastinum. Extensive and potentially disfiguring debridements may be necessary to obtain negative margins with frequent reoperations until the patient is ready for reconstruction.

  15. Stratigraphic controls on saltwater intrusion in the Dominguez Gap area of coastal Los Angeles

    Science.gov (United States)

    Edwards, B.D.; Ehman, K.D.; Ponti, D.J.; Reichard, E.G.; Tinsley, J.C.; Rosenbauer, R.J.; Land, M.

    2009-01-01

    The Los Angeles Basin is a densely populated coastal area that significantly depends on groundwater. A part of this groundwater supply is at risk from saltwater intrusion-the impetus for this study. High-resolution seismic-reflection data collected from the Los Angeles-Long Beach Harbor Complex have been combined with borehole geophysical and descriptive geological data from four nearby ??400-m-deep continuously cored wells and with borehole geophysical data from adjacent water and oil wells to characterize the Pliocene to Holocene stratigraphy of the Dominguez Gap coastal aquifer system. The new data are shown as a north-south, two- dimensional, sequence-stratigraphic model that is compared to existing lithostratigraphic models of the Los Angeles Basin in an attempt to better understand pathways of saltwater intrusion into coastal aquifers. Intrusion of saltwater into the coastal aquifer system generally is attributed to over-pumping that caused the hydraulic gradient to reverse during the mid-1920s. Local water managers have used the existing lithostratigraphic model to site closely spaced injection wells of freshwater (barrier projects) attempting to hydraulically control the saltwater intrusion. Improved understanding of the stratigraphic relationships can guide modifications to barrier design that will allow more efficient operation. Allostratigraphic nomenclature is used to define a new sequence-stratigraphic model for the area because the existing lithostratigraphic correlations that have been used to define aquifer systems are shown not to be time-correlative. The youngest sequence, the Holocene Dominguez sequence, contains the Gaspur aquifer at its base. The Gaspur aquifer is intruded with saltwater and consists of essentially flat-lying gravelly sands deposited by the ancestral Los Angeles River as broad channels that occupied a paleovalley incised into the coastal plain during the last glacio-eustatic highstand. The underlying sequences are deformed into

  16. Mapping saltwater intrusion in the Biscayne Aquifer, Miami-Dade County, Florida using transient electromagnetic sounding

    Science.gov (United States)

    Fitterman, David V.

    2014-01-01

    Saltwater intrusion in southern Florida poses a potential threat to the public drinking-water supply that is typically monitored using water samples and electromagnetic induction logs collected from a network of wells. Transient electromagnetic (TEM) soundings are a complementary addition to the monitoring program because of their ease of use, low cost, and ability to fill in data gaps between wells. TEM soundings have been used to map saltwater intrusion in the Biscayne aquifer over a large part of south Florida including eastern Miami-Dade County and the Everglades. These two areas are very different with one being urban and the other undeveloped. Each poses different conditions that affect data collection and data quality. In the developed areas, finding sites large enough to make soundings is difficult. The presence of underground pipes further restricts useable locations. Electromagnetic noise, which reduces data quality, is also an issue. In the Everglades, access to field sites is difficult and working in water-covered terrain is challenging. Nonetheless, TEM soundings are an effective tool for mapping saltwater intrusion. Direct estimates of water quality can be obtained from the inverted TEM data using a formation factor determined for the Biscayne aquifer. This formation factor is remarkably constant over Miami-Dade County owing to the uniformity of the aquifer and the absence of clay. Thirty-six TEM soundings were collected in the Model Land area of southeast Miami-Dade County to aid in calibration of a helicopter electromagnetic (HEM) survey. The soundings and HEM survey revealed an area of saltwater intrusion aligned with canals and drainage ditches along U.S. Highway 1 and the Card Sound Road. These canals and ditches likely reduced freshwater levels through unregulated drainage and provided pathways for seawater to flow at least 12.4 km inland.

  17. [Influence of saltwater irrigation on the yield and quality of Cynodon dactylon under desert conditions].

    Science.gov (United States)

    Zhou, Ruilian; Dov, Paternak; Zhao, Halin

    2002-08-01

    Responses of six varieties (Suwannee, Coast cross, Tifton44, Tifton68, Tifton78 and Tifton85) of Cynodon dactylon to irrigation-water salinity were investigated in field by means of a double line source experimental design. The digestibility of the grass by goat was analyzed using the rumen gastric justice digestion method. The results showed that the six varieties grew well, and had a high yield of fresh grass when eletro-conductivity (Eci) Cynodon dactylon were not effected by saltwater irrigation.

  18. Wetting and evaporation of salt-water nanodroplets: A molecular dynamics investigation.

    Science.gov (United States)

    Zhang, Jun; Borg, Matthew K; Sefiane, Khellil; Reese, Jason M

    2015-11-01

    We employ molecular dynamics simulations to study the wetting and evaporation of salt-water nanodroplets on platinum surfaces. Our results show that the contact angle of the droplets increases with the salt concentration. To verify this, a second simulation system of a thin salt-water film on a platinum surface is used to calculate the various surface tensions. We find that both the solid-liquid and liquid-vapor surface tensions increase with salt concentration and as a result these cause an increase in the contact angle. However, the evaporation rate of salt-water droplets decreases as the salt concentration increases, due to the hydration of salt ions. When the water molecules have all evaporated from the droplet, two forms of salt crystals are deposited, clump and ringlike, depending on the solid-liquid interaction strength and the evaporation rate. To form salt crystals in a ring, it is crucial that there is a pinned stage in the evaporation process, during which salt ions can move from the center to the rim of the droplets. With a stronger solid-liquid interaction strength, a slower evaporation rate, and a higher salt concentration, a complete salt crystal ring can be deposited on the surface.

  19. Coastal ground water at risk - Saltwater contamination at Brunswick, Georgia and Hilton Head Island, South Carolina

    Science.gov (United States)

    Krause, Richard E.; Clarke, John S.

    2001-01-01

    IntroductionSaltwater contamination is restricting the development of ground-water supply in coastal Georgia and adjacent parts of South Carolina and Florida. The principal source of water in the coastal area is the Upper Floridan aquifer—an extremely permeable and high-yielding aquifer—which was first developed in the late 1800s. Pumping from the aquifer has resulted in substantial ground-water-level decline and subsequent saltwater intrusion of the aquifer from underlying strata containing highly saline water at Brunswick, Georgia, and with encroachment of sea-water into the aquifer at the northern end of Hilton Head Island, South Carolina. The saltwater contamination at these locations has constrained further development of the Upper Floridan aquifer in the coastal area and has created competing demands for the limited supply of freshwater. The Georgia Department of Natural Resources, Georgia Environmental Protection Division (GaEPD) has restricted permitted withdrawal of water from the Upper Floridan aquifer in parts of the coastal area (including the Savannah and Brunswick areas) to 1997 rates, and also has restricted additional permitted pumpage in all 24 coastal area counties to 36 million gallons per day above 1997 rates. These actions have prompted interest in alternative management of the aquifer and in the development of supplemental sources of water supply including those from the shallower surficial and upper and lower Brunswick aquifers and from the deeper Lower Floridan aquifer.

  20. Simulation of saltwater movement in the Floridan aquifer system, Hilton Head Island, South Carolina

    Science.gov (United States)

    Bush, Peter W.

    1988-01-01

    Freshwater to supply Hilton Head Island, S.C., is obtained from the upper permeable zone of the Upper Floridan aquifer. Long-term pumping at Savannah, Ga., and the steadily increasing pumping on Hilton Head Island, have lowered Upper Floridan heads near the center of the island from about 10 feet above sea level to about 6 to 7 feet below sea level. The seaward hydraulic gradient that existed before pumping began has been reversed, thus increasing the potential for saltwater intrusion. Simulations of predevelopment, recent, and future ground-water flow in the Floridan aquifer system beneath the north end of Hilton Head Island and Port Royal Sound are presented. A finite-element model for fluid-density-dependent ground-water flow and solute transport was used in cross section. The general configuration of the simulated predevelopment flowfield is typical of a coastal aquifer having a seaward gradient in the freshwater. The freshwater flows toward Port Royal Sound over an intruding wedge of saltwater. The simulated flowfield at the end of 1983 shows that ground water in the Floridan aquifer system beneath most of Hilton Head Island has reversed its predevelopment direction and is moving toward Savannah. The distribution of chloride concentrations, based on simulation at the end of 1983, is about the same as the predevelopment distribution of chloride concentrations obtained from simulation. Results of two 50-year simulations from 1983 to 2034 suggest that there will be no significant threat of saltwater intrusion into the upper permeable zone of the Upper Floridan aquifer if heads on Hilton Head Island remain at current levels for the next 45 to 50 years. However, if head decline continues at the historical rate, any flow that presently occurs from the north end of the island toward Port Royal Sound will cease, allowing lateral intrusion of saltwater to proceed. Even under these conditions, chloride concentrations in the upper permeable zone of the Upper Floridan

  1. Impact of the bottom drag coefficient on saltwater intrusion in the extremely shallow estuary

    Science.gov (United States)

    Lyu, Hanghang; Zhu, Jianrong

    2018-02-01

    The interactions between the extremely shallow, funnel-shaped topography and dynamic processes in the North Branch (NB) of the Changjiang Estuary produce a particular type of saltwater intrusion, saltwater spillover (SSO), from the NB into the South Branch (SB). This dominant type of saltwater intrusion threatens the winter water supplies of reservoirs located in the estuary. Simulated SSO was weaker than actual SSO in previous studies, and this problem has not been solved until now. The improved ECOM-si model with the advection scheme HSIMT-TVD was applied in this study. Logarithmic and Chézy-Manning formulas of the bottom drag coefficient (BDC) were established in the model to investigate the associated effect on saltwater intrusion in the NB. Modeled data and data collected at eight measurement stations located in the NB from February 19 to March 1, 2017, were compared, and three skill assessment indicators, the correlation coefficient (CC), root-mean-square error (RMSE), and skill score (SS), of water velocity and salinity were used to quantitatively validate the model. The results indicated that the water velocities modeled using the Chézy-Manning formula of BDC were slightly more accurate than those based on the logarithmic BDC formula, but the salinities produced by the latter formula were more accurate than those of the former. The results showed that the BDC increases when water depth decreases during ebb tide, and the results based on the Chézy-Manning formula were smaller than those based on the logarithmic formula. Additionally, the landward net water flux in the upper reaches of the NB during spring tide increases based on the Chézy-Manning formula, and saltwater intrusion in the NB was enhanced, especially in the upper reaches of the NB. At a transect in the upper reaches of the NB, the net transect water flux (NTWF) is upstream in spring tide and downstream in neap tide, and the values produced by the Chézy-Manning formula are much larger than

  2. Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Seok, Jee Hyun; Jee, Won Hee; Chun, Kyung Ah; Kim, Ji Young; Jung, Chan Kwon; Kim, Yang Ree; Kim, Yang Soo; Chung, Yang Guk [The Catholic University of Korea, Seoul (Korea, Republic of); Eo, Wan Kyu [KyungHee University, Seoul (Korea, Republic of)

    2009-04-15

    We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2- weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2- weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. MR imaging is helpful for differentiating between NF and PM.

  3. Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

    International Nuclear Information System (INIS)

    Seok, Jee Hyun; Jee, Won Hee; Chun, Kyung Ah; Kim, Ji Young; Jung, Chan Kwon; Kim, Yang Ree; Kim, Yang Soo; Chung, Yang Guk; Eo, Wan Kyu

    2009-01-01

    We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2- weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2- weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. MR imaging is helpful for differentiating between NF and PM

  4. Facial paralysis as a result of severe cervico-facial necrotizing fasciitis

    African Journals Online (AJOL)

    Necrotizing fasciitis (NF) is a progressive, rapidly spreading, inflammatory infection characterized by necrosis of the deep fascia, with secondary effect on the subcutaneous tissue and differing degrees of toxicity. It is a fairly rare entity in the cervico-facial region where it usually originates from odontogenic infection; gingivitis ...

  5. Necrotizing fasciitis in a plastic surgery unit: a report of ten patients ...

    African Journals Online (AJOL)

    Background: Diffuse necrotizing fasciitis is the most treacherous soft tissue infection particularly because it may masquerade as simple cellulitis, thereby delaying diagnosis and treatment. Necrotizing fascitis correspond to deeper burns and require resuscitation, early debridement and skin coverage. It runs a rapid clinical ...

  6. Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report

    Directory of Open Access Journals (Sweden)

    Islam Asad

    2008-12-01

    Full Text Available Abstract Introduction Cervical necrotizing fasciitis is an aggressive infection with high morbidity and mortality. We present a case of cervical necrotizing fasciitis and descending mediastinitis in a healthy young man, caused by unilateral tonsillitis with a successful outcome without aggressive debridement. Case presentation A 41-year-old man was admitted to our unit with a diagnosis of severe acute unilateral tonsillitis. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. Computed tomography scan of his neck and chest showed evidence of cervical necrotizing fasciitis and descending mediastinitis secondary to underlying pharyngeal disease. He was treated with broad-spectrum intravenous antibiotics. His condition improved over the next 3 days but a tender and fluctuant swelling appeared in the suprasternal region. A repeat scan showed the appearance of an abscess extending from the pretracheal region to the upper mediastinum which was drained through a small transverse anterior neck incision. After surgery, the patient's condition quickly improved and he was discharged on the 18th day of admission. Conclusion Less invasive surgical techniques may replace conventional aggressive debridement as the treatment of choice for cervical necrotizing fasciitis and descending necrotizing mediastinitis.

  7. Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture

    Directory of Open Access Journals (Sweden)

    Al-Reshaid Reshaid

    2010-01-01

    Full Text Available Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture.

  8. Life-threatening necrotizing fasciitis of the neck: an unusual consequence of a sore throat

    NARCIS (Netherlands)

    Persaud, R.; Krahé, D.; Georgalas, C.; Kaniyur, S.; Das, S.; Alusi, G.

    2004-01-01

    BACKGROUND: Necrotizing fasciitis is life-threatening bacterial infection which spreads with frightening speed along the fascial planes resulting in extensive tissue necrosis and often death. The infection is caused by either Group A streptococci or a combination of aerobic and anaerobic bacteria.

  9. Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens

    Directory of Open Access Journals (Sweden)

    Hsu Wei-Hsiu

    2011-01-01

    Full Text Available Abstract Background Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen. Methods Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1 and 35 patients with a gram-negative pathogen (Group 2. Results Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors. Conclusions Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.

  10. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis.

    Science.gov (United States)

    Fox, Thomas Peter; Oliver, Govind; Wek, Caesar; Hester, Thomas

    2013-08-16

    We report the case of a 72-year-old woman suffering with severe plantar fasciitis who received a therapeutic corticosteroid injection. Two-and-a-half years after the injection she developed a small calcified lump under the skin which subsequently caused ulceration and infection. She went on to develop a diabetic foot infection requiring an extended course of intravenous antibiotics.

  11. Long-term outcome of eosinophilic fasciitis : A cross-sectional evaluation of 35 patients

    NARCIS (Netherlands)

    Mertens, JS; Thurlings, Rogier M; Kievit, Wietske; Seyger, Marieke M B; Radstake, Timothy R D; de Jong, Elke M G J

    BACKGROUND: Eosinophilic fasciitis (EF) is a connective tissue disease with an unknown long-term course. OBJECTIVE: To evaluate presence and determinants of residual disease damage in patients with EF after long-term follow-up. METHODS: Patients with biopsy-proven EF were included for this

  12. Long-term outcome of eosinophilic fasciitis: A cross-sectional evaluation of 35 patients

    NARCIS (Netherlands)

    Mertens, J.S.; Thurlings, R.M.; Kievit, W.; Seyger, M.M.B.; Radstake, T.R.D.J.; Jong, E.M.G.J. de

    2017-01-01

    BACKGROUND: Eosinophilic fasciitis (EF) is a connective tissue disease with an unknown long-term course. OBJECTIVE: To evaluate presence and determinants of residual disease damage in patients with EF after long-term follow-up. METHODS: Patients with biopsy-proven EF were included for this

  13. Cervical nodular fasciitis in a 10-year-old girl: a case report of a rare ...

    African Journals Online (AJOL)

    Thus, as clinical and morphologic characteristics are similar to those of malignant tumours, this entity is often misdiagnosed, with a few cases described in the literature. We present a case of nodular fasciitis involving the retropharynx and hypopharynx of a 10-year-old girl and discuss the importance of considering this rare ...

  14. The Rare Benign Lesion That Mimics a Malignant Tumor in Breast Parenchyma: Nodular Fasciitis of the Breast

    Directory of Open Access Journals (Sweden)

    Hilal Erinanc

    2018-01-01

    Full Text Available We herein report the clinical and pathological findings of a rare case of nodular fasciitis in the breast parenchyma of a 48-year-old female. Because of potentially malignant findings on ultrasonography and during clinical examination, the patient underwent an excisional biopsy. Histologically, the lesion was composed of spindle to round shaped cells arranged in short bundles in a storiform pattern. Immunohistochemically, the cells were positive for vimentin and SMA and negative for desmin, S100, and CD34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. We emphasize that nodular fasciitis of the breast may show clinical features and imaging findings similar to those of breast cancer. The histopathologic diagnosis of nodular fasciitis can also be challenging. The purpose of this case report is to highlight the characteristics and the differential diagnosis of this rare neoplasm.

  15. The effectiveness of combined prescription of ankle–foot orthosis and stretching program for the treatment of recalcitrant plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Rehab A.E. Sallam

    2016-01-01

    Combined prescription of night-stretch ankle–foot orthosis and stretching exercises for plantar flexors and fascia had greater therapeutic effects compared with each treatment alone. Stretching exercises alone are not beneficial in the treatment of recalcitrant plantar fasciitis.

  16. Evaluation of the Impact of Groundwater Pumping on Freshwater-Saltwater Interface Fluctuations in a Coastal Aquifer of South Korea

    Science.gov (United States)

    Yoon, H.; Kim, Y.; Lee, S. H.; Ha, K.

    2017-12-01

    It is necessary to monitor the variation of freshwater-saltwater interface for the sustainable use of groundwater resources in coastal areas. In the present study, we developed a device to measure the location of the freshwater-saltwater interface based on the concept of the neutral buoyancy and installed it in a coastal aquifer of the western sea, South Korea. To evaluate the impact of pumping on the groundwater and saltwater-freshwater interface level, we designed nine different pumping scenarios and monitored the groundwater and saltwater-freshwater interface levels of pumping well and two observation wells. The result of monitoring groundwater level shows that the response of observation wells to the pumping is relatively fast and high, however, the response of freshwater-saltwater interface occurred when the pumping rate and duration are over 25m3/day and 48hours, respectively. For the prediction and simulation of the groundwater level fluctuation under groundwater pumping events, we designed a artificial neural network based time series model considering rainfall, tide, and pumping rate as input components. The result of the prediction shows that the correlation coefficient between observed and estimated groundwater levels is as high as 0.7. It is expected that the result of this research can provide useful information for the effective management of groundwater resources in the study area.

  17. Nodular fasciitis: correlation of MRI findings and histopathology

    International Nuclear Information System (INIS)

    Wang, X.L.; De Schepper, A.M.A.; Vanhoenacker, F.; Gielen, J.; De Raeve, H.; Aparisi, F.; Rausin, L.; Somville, J.

    2002-01-01

    Objective: To compare the histopathology of nodular fasciitis (NF) with the magnetic resonance imaging (MRI) findings in order to evaluate the basis of the MR signal characteristics. Design and patients: Ten patients with NF, nine females and 1 male, with an age ranging from 13 to 58 years (mean 26.8 years) were studied. MRI findings, available in all 10 patients, were compared with the histopathology in nine patients, and an area-to-area comparative study of the whole specimen section histopathology and MRI was performed in two patients. Results: On the basis of an excisional biopsy or resection specimen, the nine lesions were classified into myxoid (n=4), cellular (n=3) and fibrous (n=2) subtypes. Four myxoid lesions with a subcutaneous location showed a homogeneous SI comparable with muscle on T1-weighted images, high SI on T2-weighted images, and had homogeneous enhancement. One cellular lesion presented with homogeneous, slightly higher SI than muscle on T1-weighted images and inhomogeneous, high SI on T2-weighted images. Alcian blue stain of the whole specimen section revealed the lesion had two parts corresponding to different enhancement patterns on MRI. The blue-stained myxoid part showed markedly diffuse enhancement, while the non-stained cystic space had only peripheral enhancement. Two other cellular lesions had the same appearance on both T1- and T2-weighted images and showed inhomogeneous, diffuse enhancement. One fibrous subtype lesion presented with inhomogeneous, overall slightly higher SI than muscle on T1-weighted images, lower SI at the periphery and high SI in the center on STIR images and only peripheral enhancement. Microscopy and CD-31 staining of the lesion showed more extracellular matrix, with poor vascularity in the center and more collagenous matrix with higher vascularity at the periphery. Conclusion: Although similar findings were found in some lesions, the large histologic variability of NF hampers the definition of a prototype of NF

  18. Electrolytes imbalance in saltwater near-drowning victims in the Gulf of Thailand.

    Science.gov (United States)

    Yongsiri, Somchai; Dinchuthai, Pakapan; Thammakumpee, Jiranuch; Prongnamchai, Suriya; Chueansuwan, Rachaneeporn; Tangjaturonrasme, Siriporn; Chaivanit, Pechngam

    2013-10-01

    Near-drowning victims in saltwater are expected to have multiple electrolytes imbalance that affected treatment outcome. There are limited data about these parameters in Thailand to guide the treatment plan. To study the characteristic of electrolytes imbalance in saltwater near-drowning victims in the Gulf of Thailand. Retrospective analytic study of 39 medical records of near-drowning patients admitted to Burapha University Hospital between 2000 and 2010. Characteristics of the patients and serum electrolytes were analyzed by SPSS version 19 for windows. The study included 23 male, 16 female patients. Average age was 14.46 +/- 11.15 years and 19/39 (48.72%) patients were aged 10 or less. The following electrolytes imbalance were identified, hypokalemia 8/39 (20.51%), hypernatremia 12/39 (30.77%), hyperchloremia 15/39 (38.46%), high anion gap 23/39 (58.97%), and hypobicarbonatemia 28/39 (71.79%). Seven out of eight patients in the hypokalemia group were in the high anion gap group. Mean SpO2 in the patients who had high anion gap was significantly lower than those who had normal anion gap (87.06 +/- 17.68% vs. 95.8 +/- 5.94% p = 0.031) without difference in systolic blood pressure (112.59 +/- 14.63 vs. 105.67 +/- 13.98 p = 0.159). Those who were hypotensive significantly had lower bicarbonate (17.00 +/- 3.51 vs. 20.59 +/- 3.81 p = 0.038) and higher anion gap (19.29 +/- 1.799 vs. 16.25 +/- 6.25 p = 0.025) than normotensive patients. Hypobicarbonatemia, high anion gap, hypernatremia, and hypokalemia were common in saltwater near-drowning patients in the Gulf of Thailand. The cause of high anion gap was probably due to hypoxia and hypotension.

  19. A modeling study of saltwater intrusion in the Andarax delta area using multiple data sources

    DEFF Research Database (Denmark)

    Antonsson, Arni Valur; Engesgaard, Peter Knudegaard; Jorreto, Sara

    context. The validity of a conceptual model is determined by different factors, where both data quantity and quality is of crucial importance. Often, when dealing with saltwater intrusion, data is limited. Therefore, using different sources (and types) of data can be beneficial and increase......In groundwater model development, construction of the conceptual model is one of the (initial and) critical aspects that determines the model reliability and applicability in terms of e.g. system (hydrogeological) understanding, groundwater quality predictions, and general use in water resources...

  20. Analysis of potential saltwater intrusion at NEP I and II power station

    Energy Technology Data Exchange (ETDEWEB)

    Lee, D.W.

    1980-06-01

    The potential of adverse environmental impacts to groundwater availability and groundwater quality from construction dewatering of the coastal aquifer at a proposed New England Power site was examined with an analytical model. The drawdown zone and the extent of saltwater intrusion were predicted with and without the use of a slurry-wall barrier. The use of a slurry wall to mitigate any adverse impacts is feasible but the limited understanding of the coastal aquifer demands that monitoring requirements be included in the construction plan.

  1. Analysis of potential saltwater intrusion at NEP I and II power station

    International Nuclear Information System (INIS)

    Lee, D.W.

    1980-06-01

    The potential of adverse environmental impacts to groundwater availability and groundwater quality from construction dewatering of the coastal aquifer at a proposed New England Power site was examined with an analytical model. The drawdown zone and the extent of saltwater intrusion were predicted with and without the use of a slurry-wall barrier. The use of a slurry wall to mitigate any adverse impacts is feasible but the limited understanding of the coastal aquifer demands that monitoring requirements be included in the construction plan

  2. Theory and application of an approximate model of saltwater upconing in aquifers

    Science.gov (United States)

    McElwee, C.; Kemblowski, M.

    1990-01-01

    Motion and mixing of salt water and fresh water are vitally important for water-resource development throughout the world. An approximate model of saltwater upconing in aquifers is developed, which results in three non-linear coupled equations for the freshwater zone, the saltwater zone, and the transition zone. The description of the transition zone uses the concept of a boundary layer. This model invokes some assumptions to give a reasonably tractable model, considerably better than the sharp interface approximation but considerably simpler than a fully three-dimensional model with variable density. We assume the validity of the Dupuit-Forchheimer approximation of horizontal flow in each layer. Vertical hydrodynamic dispersion into the base of the transition zone is assumed and concentration of the saltwater zone is assumed constant. Solute in the transition zone is assumed to be moved by advection only. Velocity and concentration are allowed to vary vertically in the transition zone by using shape functions. Several numerical techniques can be used to solve the model equations, and simple analytical solutions can be useful in validating the numerical solution procedures. We find that the model equations can be solved with adequate accuracy using the procedures presented. The approximate model is applied to the Smoky Hill River valley in central Kansas. This model can reproduce earlier sharp interface results as well as evaluate the importance of hydrodynamic dispersion for feeding salt water to the river. We use a wide range of dispersivity values and find that unstable upconing always occurs. Therefore, in this case, hydrodynamic dispersion is not the only mechanism feeding salt water to the river. Calculations imply that unstable upconing and hydrodynamic dispersion could be equally important in transporting salt water. For example, if groundwater flux to the Smoky Hill River were only about 40% of its expected value, stable upconing could exist where

  3. Saltwater intrusion in the surficial aquifer system of the Big Cypress Basin, southwest Florida, and a proposed plan for improved salinity monitoring

    Science.gov (United States)

    Prinos, Scott T.

    2013-01-01

    The installation of drainage canals, poorly cased wells, and water-supply withdrawals have led to saltwater intrusion in the primary water-use aquifers in southwest Florida. Increasing population and water use have exacerbated this problem. Installation of water-control structures, well-plugging projects, and regulation of water use have slowed saltwater intrusion, but the chloride concentration of samples from some of the monitoring wells in this area indicates that saltwater intrusion continues to occur. In addition, rising sea level could increase the rate and extent of saltwater intrusion. The existing saltwater intrusion monitoring network was examined and found to lack the necessary organization, spatial distribution, and design to properly evaluate saltwater intrusion. The most recent hydrogeologic framework of southwest Florida indicates that some wells may be open to multiple aquifers or have an incorrect aquifer designation. Some of the sampling methods being used could result in poor-quality data. Some older wells are badly corroded, obstructed, or damaged and may not yield useable samples. Saltwater in some of the canals is in close proximity to coastal well fields. In some instances, saltwater occasionally occurs upstream from coastal salinity control structures. These factors lead to an incomplete understanding of the extent and threat of saltwater intrusion in southwest Florida. A proposed plan to improve the saltwater intrusion monitoring network in the South Florida Water Management District’s Big Cypress Basin describes improvements in (1) network management, (2) quality assurance, (3) documentation, (4) training, and (5) data accessibility. The plan describes improvements to hydrostratigraphic and geospatial network coverage that can be accomplished using additional monitoring, surface geophysical surveys, and borehole geophysical logging. Sampling methods and improvements to monitoring well design are described in detail. Geochemical analyses

  4. Geophysical characterization of saltwater intrusion in a coastal aquifer: The case of Martil-Alila plain (North Morocco)

    Science.gov (United States)

    Himi, Mahjoub; Tapias, Josefiina; Benabdelouahab, Sara; Salhi, Adil; Rivero, Luis; Elgettafi, Mohamed; El Mandour, Abdenabi; Stitou, Jamal; Casas, Albert

    2017-02-01

    Several factors can affect the quantity and the quality of groundwater resources, but in coastal aquifers seawater intrusion is often the most significant issue regarding freshwater supply. Further, saltwater intrusion is a worldwide issue because about seventy percent of the world's population lives in coastal regions. Generally, fresh groundwater not affected by saltwater intrusion is characterized by low salinity and therefore low electrical conductivity (EC) values. Consequently, high values of EC in groundwater along the coastline are usually associated to seawater intrusion. This effect is amplified if the coastal aquifer is overexploited with a subsequent gradual displacement of the freshwater-saltwater interface towards the continent. Delineation of marine intrusion in coastal aquifers has traditionally relied upon observation wells and collection of water samples. This approach may miss important hydrologic features related to saltwater intrusion in areas where access is difficult and where wells are widely spaced. Consequently, the scarcity of sampling points and sometimes their total absence makes the number of data available limited and most of the time not representative for mapping the spatial and temporal variability of groundwater salinity. In this study, we use a series of geophysical methods for characterizing the aquifer geometry and the extension of saltwater intrusion in the Martil-Alila coastal region (Morocco) as a complement to geological and hydrogeochemical data. For this reason, we carried out three geophysical surveys: Gravity, Electrical Resistivity and Frequency Domain Electromagnetic. The geometry of the basin has been determined from the interpretation of a detailed gravity survey. Electrical resistivity models derived from vertical electrical soundings allowed to characterize the vertical and the lateral extensions of aquifer formations. Finally, frequency domain electromagnetic methods allowed delineating the extension of the

  5. Notes on saltwater intrusion and trace element distribution in Metro Manila groundwaters

    International Nuclear Information System (INIS)

    Santos, G. Jr.; Ramos, A.F.; Fernandez, L.G.; Almoneda, R.V.; Garcia, T.Y.; Cruz, C.C.; Petrache, C.A.; Andal, T.T.; Alcantara, E.

    1989-01-01

    Preliminary analyses of waters for uranium and other trace elements from deepwells operated by the Metropolitan Waterworks and Sewerage System (MWSS) in Metro Manila were performed. Uranium, which ranged from 0.2 ppb to 6 ppb, was correlated with saltwater intrusion. Values >=0.8 ppb for uranium were considered indicative of saline water intrusion in the aquifers. Saline water intrusions in Malabon, Navotas, Paranaque, Las Pinas, Bacoor, Imus, Kawit, Pasig, Antipolo, San Mateo, Taguig, Cainta, Taytay, Alabang and Muntinlupa were noted. Most of these areas were also identified by MWSS as being affected by saltwater intrusion. Tritium values ranged from 0 (below detection limits) to 44 tritium units. Except for one well in Muntinlupa, all the values obtained were below the lower limit of detection of 30.83 T.U. Mercury contents in six well locations had values above the maximum limit set by the National Standards for Drinking Water. Four wells exceeded the permissible level for manganese while two wells had iron concentrations greater than the National Standards. Other trace element concentrations such as Cr, Pb, Zn, Co and Ni either did not exceed their permissible levels or were not included in the National Standards. (Auth.). 6 refs.; 1 tab.; 3 figs

  6. Synergy of climate change and local pressures on saltwater intrusion in heterogeneous coastal aquifers

    Science.gov (United States)

    Abou Najm, M.; Safi, A.; El-Fadel, M.; Doummar, J.; Alameddine, I.

    2016-12-01

    The relative importance of climate change induced sea level rise on the salinization of a highly urbanized karstified coastal aquifers were compared with non-sustainable pumping. A 3D variable-density groundwater flow and solute transport model was used to predict the displacement of the saltwater-freshwater interface in a pilot aquifer located along the Eastern Mediterranean. The results showed that the influence of sea level rise was marginal when compared with the encroachment of salinity associated with anthropogenic abstraction. Model predictions of salinity mass and volumetric displacement of the interface corresponding to a long-term monthly transient model showed that the saltwater intrusion dynamic is highly sensitive to change in the abstraction rates which were estimated based on combinations of water consumption rates and population growth rates. Salinity encroachment, however, appeared to be more sensitive to water consumption rates in comparison to population growth rates, where a 50% increase in the rate of former led to four times more intrusion as compared to an equivalent increase in population growth rate over 20 years. Coupling both increase in population growth and increased consumption rates had a synergistic effect that aggravated the intrusion beyond the sum of the individual impacts. Adaptation strategies targeting a decrease in groundwater exploitation proved to be effective in retarding the intrusion.

  7. Map of the approximate inland extent of saltwater at the base of the Biscayne aquifer in the Model Land Area of Miami-Dade County, Florida, 2016

    Science.gov (United States)

    Prinos, Scott T.

    2017-07-11

    The inland extent of saltwater at the base of the Biscayne aquifer in the Model Land Area of Miami-Dade County, Florida, was mapped in 2011. Since that time, the saltwater interface has continued to move inland. The interface is near several active well fields; therefore, an updated approximation of the inland extent of saltwater and an improved understanding of the rate of movement of the saltwater interface are necessary. A geographic information system was used to create a map using the data collected by the organizations that monitor water salinity in this area. An average rate of saltwater interface movement of 140 meters per year was estimated by dividing the distance between two monitoring wells (TPGW-7L and Sec34-MW-02-FS) by the travel time. The travel time was determined by estimating the dates of arrival of the saltwater interface at the wells and computing the difference. This estimate assumes that the interface is traveling east to west between the two monitoring wells. Although monitoring is spatially limited in this area and some of the wells are not ideally designed for salinity monitoring, the monitoring network in this area is improving in spatial distribution and most of the new wells are well designed for salinity monitoring. The approximation of the inland extent of the saltwater interface and the estimated rate of movement of the interface are dependent on existing data. Improved estimates could be obtained by installing uniformly designed monitoring wells in systematic transects extending landward of the advancing saltwater interface.

  8. Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report

    OpenAIRE

    Chauhan, Deepender; Arora, Ritu; Das, Sima; Shroff, Daraius; Narula, Ritesh

    2007-01-01

    Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be...

  9. Necrotizing Fasciitis Caused by Inconspicuous Infection of Aeromonas hydrophila in an Immunocompromised Host

    Directory of Open Access Journals (Sweden)

    Kuo-Chun Liao

    2010-09-01

    Full Text Available We present a case of serious necrotizing fasciitis due to Aeromonas hydrophila without a suggestive history of routes of pathogen invasion in a 60-year-old male. Despite prompt broad-spectrum antibiotic and extensive surgical therapies, the patient died within 72 hours following initial presentation. Our experience suggests clinicians be highly alert to the disease when an immunocompromised patient featured fulminant soft-tissue infection in the endemic area.

  10. Fungal necrotizing fasciitis, an emerging infectious disease caused by Apophysomyces (Mucorales).

    Science.gov (United States)

    Chander, Jagdish; Stchigel, Alberto Miguel; Alastruey-Izquierdo, Ana; Jayant, Mayank; Bala, Kiran; Rani, Hena; Handa, Uma; Punia, Rajpal Singh; Dalal, Usha; Attri, Ashok Kumar; Monzon, Araceli; Cano-Lira, José Francisco; Guarro, Josep

    2015-01-01

    The mucoralean fungi are emerging causative agents of primary cutaneous infections presenting in the form of necrotizing fasciitis. The aim of this study was to investigate a series of suspected necrotizing fasciitis cases by Apophysomyces species over one-year period in a northern Indian hospital. The clinical details of those patients suspected to suffer from fungal necrotizing fasciitis were recorded. Skin biopsies from local wounds were microscopically examined and fungal culturing was carried out on standard media. The histopathology was evaluated using conventional methods and special stains. Apophysomyces isolates were identified by their morphology and by molecular sequencing of the internal transcribed spacer (ITS) region of the ribosomal genes. Antifungal susceptibility testing was carried out following EUCAST guidelines and treatment progress was monitored. Seven patients were found to be suffering from necrotizing fasciitis caused by Apophysomyces spp. Six isolates were identified as Apophysomyces variabilis and one as Apophysomyces elegans. Five patients had previously received intramuscular injections in the affected area. Three patients recovered, two died and the other two left treatment against medical advice and are presumed to have died due to their terminal illnesses. Posaconazole and terbinafine were found to be the most active compounds against A. variabilis, while the isolate of A. elegans was resistant to all antifungals tested. Apophysomyces is confirmed as an aggressive fungus able to cause fatal infections. All clinicians, microbiologists and pathologists need to be aware of these emerging mycoses as well as of the risks involved in medical practices, which may provoke serious fungal infections such as those produced by Apophysomyces. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  11. EFFECTIVENESS OF INSTUMENTAL ASSISTED SOFT TISSUE MOBILIZATION TECHNIQUE WITH STATIC STRETCHING IN SUBJECTS WITH PLANTAR FASCIITIS

    Directory of Open Access Journals (Sweden)

    Vinod Babu. K

    2014-08-01

    Full Text Available Background: Instrumental assisted soft tissue mobilization and static stretching found to be effective in plantar fasciitis, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Instrumental assisted soft tissue mobilization technique for plantar fascia combined with static stretching of triceps surae for subjects with chronic stage of Plantar Fasciitis on pain intensity, ankle dorsiflexion range of motion and functional disability. Methods: An experimental study design, selected subjects with chronic Plantar Fasciitis randomized subjects into each Study and Control group. Total of 40 subject’s data who completed study, 20 in each group, was used for analysis. Control group received conventional exercise while Study group received conventional exercises with Instrumental assisted soft tissue mobilization combined with static stretching of triceps surae muscle. Outcome measurements such as Intensity of pain using Numerical Pain Rating Scale-101 (NPRS-101, function disability using Foot Function Index Pain Subscale (FFI and ankle dorsiflexion active range of motion using Goniometer was measured before and after 2 weeks of intervention. Results: There is statistically significant improvement in means of NRS-101, ankle dorsiflexion active range of motion and Foot Function Index Pain Subscale after intervention in both groups. When the post-intervention means were compared between Study and Control group after 2 weeks of treatment there is statistically significant difference in means between the groups whereas study group showed greater percentage of improvement than control group. Conclusion: It is concluded that Instrumental assisted soft tissue mobilization technique combined with static stretching of triceps surae muscle is significantly effective than conventional exercises on reducing pain, improving ankle dorsiflexion range of motion and functional disability for subjects

  12. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Zonghuan Li

    Full Text Available It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis.Databases (MEDLINE, Cochrane library and EMBASE and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS, tenderness threshold (TT, heel tenderness index (HTI, response rate, plantar fascia thickness (PFT, hypoechogenicity and heel pad thickness (HPT. The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE system was used to assess the quality of evidence.Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI.Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research.

  13. Ultrasound- versus Palpation-Guided Injection of Corticosteroid for Plantar Fasciitis: A Meta-Analysis

    Science.gov (United States)

    Yu, Aixi; Qi, Baiwen

    2014-01-01

    Background It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis. Methods Databases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Results Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI. Conclusion Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research. PMID:24658102

  14. Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

    Science.gov (United States)

    Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

    2015-01-01

    Summary Background although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. Methods this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. Results increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (pplantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. Conclusion US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis. PMID:26958538

  15. Groundwater Modeling in Coastal Arid Regions Under the Influence of Marine Saltwater Intrusion

    Science.gov (United States)

    Walther, Marc; Kolditz, Olaf; Grundmann, Jens; Liedl, Rudolf

    2010-05-01

    The optimization of an aquifer's "safe yield", especially within agriculturally used regions, is one of the fundamental tasks for nowaday's groundwater management. Due to the limited water ressources in arid regions, conflict of interests arise that need to be evaluated using scenario analysis and multicriterial optimization approaches. In the context of the government-financed research project "International Water Research Alliance Saxony" (IWAS), the groundwater quality for near-coastal, agriculturally used areas is investigated under the influence of marine saltwater intrusion. Within the near-coastal areas of the study region, i.e. the Batinah plains of Northern Oman, an increasing agricultural development could be observed during the recent decades. Simultaneously, a constant lowering of the groundwater table was registered, which is primarily due to the uncontrolled and unsupervised mining of the aquifers for the local agricultural irrigation. Intensively decreased groundwater levels, however, cause an inversion of the hydraulic gradient which is naturally aligned towards the coast. This, in turn,leads to an intrusion of marine saltwater flowing inland, endangering the productivity of farms near the coast. Utilizing the modeling software package OpenGeoSys, which has been developed and constantly enhanced by the Department of Environmental Informatics at the Helmholtz Centre for Environmental Research Leipzig (UFZ; Kolditz et al., 2008), a three-dimensional, density-dependent model including groundwater flow and mass transport is currently being built up. The model, comprehending three selected coastal wadis of interest, shall be used to investigate different management scenarios. The main focus of the groundwater modelling are the optimization of well positions and pumping schemes as well as the coupling with a surface runoff model, which is also used for the determination of the groundwater recharge due to wadi runoff downstream of retention dams. Based on

  16. Saltwater Upconing and Decay Beneath a Well Pumping Above an Interface Zone

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Quanlin; Bear, Jacob; Bensabat, Jacob

    2004-04-20

    Saltwater, or brine, underlies fresh water in many aquifers, with a transition zone separating them. Pumping fresh water by wells located above the transition zone produces upconing of the latter, eventually salinizing the pumped water, forcing shut-off. The salinity of the pumped water depends on the pumping rate, on the location of the well's screen, on the fresh water flow regime, and on the difference in density between fresh and salt water, expressed as a dimensionless factor called density difference factor (DDF). Following the well's shut-off, the upconed saltwater mound undergoes decay, tending to return to the pre-pumping regime. In this paper, the upconing-decay processes in an axially symmetrical system are investigated to discover how they are affected by the DDF and by the dispersivities. The code FEAS-Brine, developed for the simulation of coupled density-dependent flow and salt transport, is used. In this code, the flow equation is solved by the Galer:wqkin finite element method (FEM), while the advective-dispersive salt transport equation is solved in the Eulerian-Lagrangian framework. This code does not suffer from the instability constraint on the Peclet number in the vicinity of the pumping well, where advection dominates the salt transport. Simulation results show that upconing is very sensitive to the DDF, which, in our work, is in the range from 0 (for ideal tracer) to 0.2 (for brine). It is shown that for the DDF of 0.025 (for seawater), local upconing occurs only for low iso-salinity surfaces, while those of high salt concentration, practically, do not shift toward the pumping well. For an ideal tracer, all iso-salinity surfaces rise toward the pumping well. For brine, however, only iso-salinity surfaces of very low salinity upcone towards the pumping well. The decay process is lengthy; it takes a long time for the upconed saltwater to migrate back to the original horizontal transition zone prior to pumping. However, the wider

  17. The Development of Sustainable Saltwater-Based Food Production Systems: A Review of Established and Novel Concepts

    Directory of Open Access Journals (Sweden)

    Daryl Gunning

    2016-12-01

    Full Text Available The demand for seafood products on the global market is rising, particularly in Asia, as affluence and appreciation of the health benefits of seafood increase. This is coupled with a capture fishery that, at best, is set for stagnation and, at worst, significant collapse. Global aquaculture is the fastest growing sector of the food industry and currently accounts for approximately 45.6% of the world’s fish consumption. However, the rapid development of extensive and semi-extensive systems, particularly intensive marine-fed aquaculture, has resulted in worldwide concern about the potential environmental, economic, and social impacts of such systems. In recent years, there has been a significant amount of research conducted on the development of sustainable saltwater-based food production systems through mechanical (e.g., recirculatory aquaculture (RAS systems methods and ecosystem-based approaches (e.g., integrated multi-trophic aquaculture (IMTA. This review article will examine the potential negative impacts of monocultural saltwater aquaculture operations and review established (RAS and novel (IMTA; constructed wetlands; saltwater aquaponics saltwater-based food production systems and discuss their (potential contribution to the development of sustainable and environmentally-friendly systems.

  18. Deep saltwater in Chalk of North-West Europe: origin, interface characteristics and development over geological time

    DEFF Research Database (Denmark)

    Bonnesen, Ellen Prip; Larsen, F.; Sonnenborg, T.O.

    2009-01-01

    High-concentration saltwaters occur in many places in the regional Chalk aquifers of North-West Europe; to investigate deep occurrences, profiles of interstitial porewater chemistry have been studied from three 250-450m deep cores drilled in the eastern parts of Zealand, Denmark. At the studied...

  19. Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis.

    Science.gov (United States)

    Chen, Hongying; Ho, Hok-Ming; Ying, Michael; Fu, Siu Ngor

    2013-10-01

    Single-cohort laboratory-based study. To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis. Background Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis. Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. There were significantly higher VI (mean ± SD, 2.4% ± 1.4%) and fascia thickness (5.0 ± 1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4% ± 0.5%; fascia thickness, 3.3 ± 0.7 mm) and with the dominant side of the controls (VI, 1.6% ± 0.4%; fascia thickness, 2.9 ± 0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia

  20. A STUDY ON SPECTRUM OF NECROTISING FASCIITIS IN A TERTIARY CARE CENTRE

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    V. Jeyaraman

    2016-12-01

    Full Text Available BACKGROUND Necrotising Fasciitis (NF is a serious infection involving the fascia and subcutaneous tissues. Distinguishing necrotising fasciitis from a less severe infection is difficult, but crucial, since necrotising fasciitis is a surgical emergency. The treatment of choice for NF is rapid surgical debridement/fasciotomy and broad-spectrum antibiotic therapy. Since, NF occurs rarely, reports on its epidemiology, clinical features, resource utilisation and outcomes are commonly based on relatively small case series and cohorts limiting generalisation of reported findings. The aim of the study is to examine the epidemiological features and explore clinical characteristics of patients diagnosed with necrotising fasciitis. The findings may be applied in clinical evaluation, raise awareness and help in the prevention of disease complications. MATERIALS AND METHODS This was a retrospective study of 35 patients with necrotising fasciitis between 2011 to April 2015. This study was done through the periods between 2011 to April 2015. Following history taking and physical examination, patients were subjected to routine laboratory investigations, plain chest x-ray and cardiological evaluation was done when indicated. After a diagnosis of NF was made, the patient was started empirically on broad-spectrum antibiotics and underwent serial wound debridement/fasciotomy and tissue samples were sent for culture and sensitivity. Based on the quantitative growth of organism and its antibiotic sensitivity, they were started on appropriate antibiotics. Serial dressings were done at the time of admission. Data was collected in a retrospective manner and were analysed and compared with other studies. Data charting was done using MS Excel 2010. RESULTS A total of 35 patients were diagnosed to have necrotising fasciitis. Majority of these patients fell within middle age groups with most of them presenting with NF involving the lower limb extremity. Almost, all patients

  1. The Henry-Saltwater Intrusion Benchmark – Alternatives in Multiphysics Formulations and Solution Strategies

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    E Holzbecher

    2016-03-01

    Full Text Available In a classical paper Henry set up a conceptual model for simulating saltwater intrusion into coastal aquifers. Up to now the problem has been taken up by software developers and modellers as a benchmark for codes simulating coupled flow and transport in porous media. The Henry test case has been treated using different numerical methods based on various formulations of differential equations. We compare several of these approaches using multiphysics software. We model the problem using Finite Elements, utilizing the primitive variables and the streamfunction approach, both with and without using the Oberbeck-Boussinesq assumption. We compare directly coupled solvers with segregated solver strategies. Changing finite element orders and mesh refinement, we find that models based on the streamfunction converge 2-4 times faster than runs based on primitive variables. Concerning the solution strategy, we find an advantage of Picard iterations compared to monolithic Newton iterations.

  2. Methods for culturing saltwater rotifers (Brachionus plicatilis) for rearing larval zebrafish.

    Science.gov (United States)

    Lawrence, Christian; Sanders, Erik; Henry, Eric

    2012-09-01

    The saltwater rotifer, Brachionus plicatilis, is widely used in the aquaculture industry as a prey item for first-feeding fishes due to its ease of culture, small size, rapid reproductive rate, and amenability to enrichment with nutrients. Despite the distinct advantages of this approach, rotifers have only been sporadically utilized for rearing larval zebrafish, primarily because of the common misconception that maintaining cultures of rotifers is difficult and excessively time-consuming. Here we present simple methods for maintaining continuous cultures of rotifers capable of supporting even the very largest zebrafish aquaculture facility, with minimal investments in materials, time, labor, and space. Examples of the methods' application in one large, existing facility is provided, and troubleshooting of common problems is discussed.

  3. Standard Test Method for Saltwater Pressure Immersion and Temperature Testing of Photovoltaic Modules for Marine Environments

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This test method provides a procedure for determining the ability of photovoltaic modules to withstand repeated immersion or splash exposure by seawater as might be encountered when installed in a marine environment, such as a floating aid-to-navigation. A combined environmental cycling exposure with modules repeatedly submerged in simulated saltwater at varying temperatures and under repetitive pressurization provides an accelerated basis for evaluation of aging effects of a marine environment on module materials and construction. 1.2 This test method defines photovoltaic module test specimens and requirements for positioning modules for test, references suitable methods for determining changes in electrical performance and characteristics, and specifies parameters which must be recorded and reported. 1.3 This test method does not establish pass or fail levels. The determination of acceptable or unacceptable results is beyond the scope of this test method. 1.4 The values stated in SI units are to be ...

  4. Geochemical and sedimentological signature of catastrophic saltwater inundations (tsunami), New Zealand

    International Nuclear Information System (INIS)

    Chague-Goff, C.; Goff, J.R.

    1999-01-01

    Three tidal marshes in Able Tasman National Par, New Zealand, were studied using geochemical, sedimentological and radiometric dating techniques. Charcoal and plant material samples were taken from one core in each inlet for 14 C analysis. radiocarbon ages were converted to dendrocalibrated years . All samples produced a terrestrial 13 C signal. Near surface samples were date d by measuring 137 Cs. A 1700 year record of catastrophic saltwater inundations (CSI) events (Tsunami) was produced. Up to four such events were identified, with ruptures of one or more of the Wellington, Wairarapa and Alpine Faults being the most likely tsunamigenic source. CSI signatures include: peaks in Fe and/or S, a peak in fines and contemporaneous or delayed peaks in organic content and/or loss on ignition (LOI). Geochemical data in association with grain size analyses proved to be a valuable tool in the interpretation of these events

  5. Cationic surfactants for control of fresh- and saltwater mollusks in nuclear cooling systems

    International Nuclear Information System (INIS)

    Post, R.M.; Mallen, E.; Lehmann, F.

    1991-01-01

    One result of the release of the US Nuclear Regulatory Commission's Generic Letter 89-13, Service Water Problems Affecting Safety-Related Equipment, was the heightened awareness of the nuclear industry to the problems of macrofouling in heat exchange systems. The principal mollusk species that contribute to freshwater macrofouling problems are Asiatic Clam (southern United States) and Zebra Mussel (Great Lakes). The predominant saltwater fouling mollusks are the Blue Mussel (Pacific, northern Atlantic), Ribbed Mussel (southern Atlantic, Gulf Coast), and American Oyster (Atlantic, Gulf Coast). The nuclear community's awareness of macrofouling problems and the ineffectiveness of intermittent chlorination programs have led to the development of several chemical control technologies for eliminating macrofouling organism infestation. One technology that has proven effective for the control of macrofouling organisms is the periodic addition of a combination of two cationic charged surfactants, specifically, alkyldimethylbenzylammonium chloride (QUAT) and dodecyl guanidine hydrochloride (DGH). Experience with the cationic surfactants at several nuclear power plants is reported

  6. Imaging Saltwater Intrusion Along the Coast of Monterey Bay Using Long-Offset Electrical Resistivity Tomography

    Science.gov (United States)

    Goebel, M.; Knight, R. J.; Pidlisecky, A.

    2016-12-01

    Coastal regions represent a complex dynamic interface where saltwater intrusion moves seawater landward and groundwater discharge moves freshwater seaward. These processes can have a dramatic impact on water quality, affecting both humans and coastal ecosystems. The ability to map the subsurface distribution of fresh and salt water is a critical step in predicting and managing water quality in coastal regions. This is commonly accomplished using wells, which are expensive and provide point information, which may fail to capture the spatial complexity in subsurface conditions. We present an alternate method for acquiring data, long-offset Electrical Resistivity Tomography (ERT), which is non-invasive, cost effective, and can address the problem of poor spatial sampling. This geophysical method can produce continuous profiles of subsurface electrical resistivity to a depth of 300 m, with spatial resolution on the order of tens of meters. Our research focuses on the Monterey Bay region, where sustained groundwater extraction over the past century has led to significant saltwater intrusion. ERT was acquired along 40 kilometers of the coast using the roll along method, allowing for continuous overlap in data acquisition. Electrodes were spaced every 22.2 m, with a total of 81 electrodes along the 1.8 km active cable length. The data show a complex distribution of fresh and salt water, influenced by geology, groundwater pumping, recharge, and land-use. While the inverted ERT resistivity profiles correspond well with existing data sets and geologic interpretations in the region, the spatial complexity revealed through the ERT data goes beyond what is known from traditional data sources alone. This leads us to conclude that this form of data can be extremely useful in informing and calibrating groundwater flow models, making targeted management decisions, and monitoring changes in subsurface salinities over time.

  7. Managing saltwater intrusion in coastal arid regions and its societal implications for agriculture

    Directory of Open Access Journals (Sweden)

    J. Grundmann

    2016-05-01

    Full Text Available Coastal aquifers in arid and semiarid regions are particularly at risk due to intrusion of salty marine water. Since groundwater is predominantly used in irrigated agriculture, its excessive pumping – above the natural rate of replenishment – strengthen the intrusion process. Using this increasingly saline water for irrigation, leads to a destruction of valuable agricultural resources and the economic basis of farmers and their communities. The limitation of resources (water and soil in these regions requires a societal adaptation and change in behaviour as well as the development of appropriate management strategies for a transition towards stable and sustainable future hydrosystem states. Besides a description of the system dynamics and the spatial consequences of adaptation on the resources availability, the contribution combines results of an empirical survey with stakeholders and physically based modelling of the groundwater-agriculture hydrosystem interactions. This includes an analysis of stakeholders' (farmers and decision makers behaviour and opinions regarding several management interventions aiming on water demand and water resources management as well as the thinking of decision makers how farmers will behave. In this context, the technical counter measures to manage the saltwater intrusion by simulating different groundwater pumping strategies and scenarios are evaluated from the economic and social point of view and if the spatial variability of the aquifer's hydrogeology is taken into consideration. The study is exemplarily investigated for the south Batinah region in the Sultanate of Oman, which is affected by saltwater intrusion into a coastal aquifer system due to excessive groundwater withdrawal for irrigated agriculture.

  8. Modification of saltwater stress response in Cyprinus carpio (Linnaeus, 1758) pre-exposed to pesticide indoxacarb.

    Science.gov (United States)

    Ghelichpour, Melika; Taheri Mirghaed, Ali; Mirzargar, Seyed Saeed; Joshaghani, Hamidreza; Ebrahimzadeh Mousavi, Hoseinali

    2018-01-01

    To evaluate the effects of indoxacarb on saltwater stress response in Cyprinus carpio, the fish were pre-exposed to indoxacarb (0, 0.75, 1.5 and 3mg/L denoted as CP, 0.75IT, 1.5IT and 3IT, respectively) for 21 days and then released to saltwater. A negative control (CN) group was included (the fish were held in indoxacarb-free water for the entire experiment). The fish were sampled immediately (0h) and 24, 48 and 72h after the salinity exposure for the analysis of plasma cortisol, glucose and sodium, chloride, potassium and calcium levels. All fish pre-exposed to 3mg/L indoxacarb, died after the first day of salinity challenge. CP showed typical cortisol response after the salinity challenge, but, cortisol response of the fish pre-exposed to indoxacarb (0.75IT and 1.5IT) was blocked. Plasma glucose increased significantly in all groups compared to the CN; however, this elevation had no consistent trend in 0.75IT and 1.5IT which indicated interference in glucose response due to indoxacarb exposure. Plasma sodium increased (compared to CN) in all groups after the salinity challenge. However, elevation in plasma chloride and potassium was significantly different among the groups and the indoxacarb-treated fish showed slightly sooner ionic disturbance. The results clearly indicate that indoxacarb impairs stress response of C. carpio and the fish may not be able to respond normally to additional stressors, which threatens their survival. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Necrotizing Fasciitis Secondary to a Primary Suture for Anoperineal Trauma by Motorcycle Accident in a Healthy Adult

    Directory of Open Access Journals (Sweden)

    Susumu Saigusa

    2015-01-01

    Full Text Available A 41-year-old man experienced a swollen scrotum three days after a motorcycle accident and presented to our hospital. He had had a primary suture repair for anoperineal trauma in an outside hospital at the time of the injury. He presented to us with general fatigue, low grade fevers, and perineal pain. Abdominal computed tomography showed subcutaneous emphysema from the scrotum to the left chest. The sutured wound had foul-smelling discharge and white exudate. We made the diagnosis of necrotizing fasciitis and immediately opened the sutured wound and performed initial debridement and lavage with copious irrigation. We continued antibiotics and lavage of the wound until the infection was controlled. Fortunately, the necrotizing fasciitis did not worsen and he was discharged after 15 days. Our experience indicates that anoperineal injuries should not be closed without careful and intensive follow-up due to the potential of developing necrotizing fasciitis.

  10. Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

    Science.gov (United States)

    Grieve, Rob; Palmer, Shea

    2017-06-01

    To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. Online questionnaire survey. Practising physiotherapists across the UK who treat patients with plantar fasciitis. Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  11. Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination.

    Science.gov (United States)

    Ahn, Jae Hoon; Lee, Choong Woo; Park, ChanJoo; Kim, Yoon-Chung

    2016-01-01

    Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid. We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone. The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified. Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position. The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.

  12. Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis

    DEFF Research Database (Denmark)

    Broholm, Rikke; Pingel, Jessica; Simonsen, Lene

    2017-01-01

    -mode ultrasound (US) in patients with plantar fasciitis (PF). 20 patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5) and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat...... pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter...

  13. Eosinophilic fasciitis in a military recruit: MRI evaluation with clinical correlation

    International Nuclear Information System (INIS)

    Liou, Chang-Hsien; Juan, Chun-Jung; Chen, Cheng-Yu.; Huang, Guo-Shu; Taylor, John A.M.; Gao, Hong-Wei

    2003-01-01

    Eosinophilic fasciitis (EF) is an uncommon connective tissue disease. We report a patient with EF who presented with episodic swelling and stiffness of his legs and forearms in combination with peripheral eosinophilia. Imaging studies of the legs and forearms, including computed tomography (CT) and magnetic resonance imaging (MRI), clearly demonstrated the characteristic finding of fascial thickening. The complete clinical imaging and pathological findings are described in this report. Cross-sectional imaging is useful in diagnosing EF and in the appropriate clinical scenario may be helpful in differentiating EF from other connective tissue diseases. (orig.)

  14. Eosinophilic fasciitis associated with hypereosinophilia, abnormal bone-marrow karyotype and inversion of chromosome 5.

    Science.gov (United States)

    Ferguson, J S; Bosworth, J; Min, T; Mercieca, J; Holden, C A

    2014-03-01

    We report the case of a male patient presenting with eosinophilia, pulmonary oedema and eosinophilic fasciitis (EF). He had the classic clinical appearance and magnetic resonance imaging of EF. Cytogenetic analysis of the bone marrow revealed a previously undescribed pericentric inversion of chromosome 5. Overall, the presentation was consistent with a diagnosis of chronic eosinophilic leukaemia, not otherwise specified (CEL-NOS). Dermatologists should consult a haematologist in cases of EF, in order to rule out possible haematological malignancies. © 2013 British Association of Dermatologists.

  15. Nodular fasciitis of the face diagnosed by US-guided core needle biopsy: a case report

    International Nuclear Information System (INIS)

    Lee, Sang Kwon; Kwon, Sun Young

    2006-01-01

    We report here on a case of nodular fasciitis (NF) that was diagnosed by ultrasonography (US)-guided core needle biopsy in a 31-year-old man, and we include the US and computed tomographic (CT) findings and the histopathologic findings at US-guided core needle biopsy (CNB). We suggest that high-resolution US is useful for the detailed evaluation of NF in the superficial regions, such as the face, and US-guided CNB is useful for the definitive histologic diagnosis of NF without causing scarring

  16. Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman

    Directory of Open Access Journals (Sweden)

    Monié M

    2014-07-01

    Full Text Available Marguerite Monié,1 Laurence Drieux,2–4 Bernadette Nzili,1 Michèle Dicko,5 Catherine Goursot,1 Sandrine Greffard,6 Dominique Decré,3,4,7 Anthony Mézière1 1Assistance Publique-Hôpitaux de Paris (AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, 2Assistance Publique-Hôpitaux de Paris, Hôpital Charles-Foix, Bactériologie-Hygiène, Paris, 3Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology, Paris, 4INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology, Paris, 5AP-HP, GHU Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, 6AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Pitié Salpêtrière, Service de Médecine Gériatrique, Paris, 7AP-HP, Hôpital Saint-Antoine, Bactériologie-Hygiène, Paris, France Abstract: Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain

  17. Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report.

    Science.gov (United States)

    Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

    We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  18. Analysis of impact of temperature and saltwater on Nannochloropsis salina bio-oil production by ultra high resolution APCI FT-ICR MS

    KAUST Repository

    Sanguineti, Michael Mario; Hourani, Nadim; Witt, Matthí as; Sarathy, Mani; Thomsen, Laurenz A.; Kuhnert, Nikolai

    2015-01-01

    Concentrated Nannochloropsis salina paste was reconstituted in distilled water and synthetic saltwater and processed at 250°C and 300°C via hydrothermal liquefaction. The resulting bio-oils yielded a diverse distribution of product classes

  19. Effects of climate variability on saltwater intrusions in coastal aquifers in Southern Denmark

    Science.gov (United States)

    Meyer, Rena; Sonnenborg, Torben; Engesgaard, Peter; Høyer, Anne-Sophie; Jørgensen, Flemming; Hisnby, Klaus; Hansen, Birgitte; Jensen, Jørn Bo; Piotrowski, Jan A.

    2016-04-01

    As in many other regions of the world fresh water supply in Denmark is based on groundwater resources. Aquifers in the low-lying areas in the south-west of Jutland are particularly vulnerable to saltwater intrusions which are likely to intensify due to relative sea level rise. To understand the dynamics and development of this complex flow system, the initial hydrodynamic conditions imposed by the last Scandinavian Ice Sheet (SIS) must be taken into account. The whole region has undergone changes in climatic and hydraulic conditions within the last 15000 years that may show influence on the present flow conditions. It is likely that the groundwater-flow dynamics, driven by the postglacial hydraulic head drop and the relative sea level rise are not yet equilibrated. Enhanced by the potential future sea level rise due to climate change, contamination of fresh-water aquifers will continue. The 2800-km2 - large coast-to-coast study area located in the southern part of Jutland was partly overridden by the Weichselian ice sheet. Geophysical and geological mapping shows salt water intrusions up to 20 km inland from the present coast. Based on a geological voxel model spanning Miocene through Quaternary deposits a large-scale 3D numerical groundwater flow and salt water transport model has been developed. It includes density-driven flow and simulates the distribution of the current saltwater intrusions and their evolution during the last 15000 years. Particle tracking and direct age simulations are performed to identify recharge areas and constrain groundwater ages. The simulated ages are compared to ages derived from isotope analysis of groundwater samples both from Miocene and Quaternary aquifers. The origin of the groundwater is determined based on isotopic and chemical composition. Additionally, heavy noble gas analysis is carried out to estimate recharge temperatures and mechanisms at locations where groundwater recharge during the last glaciation is indicated. This

  20. Evaluation of the effects of sea-level change and coastal canal management on saltwater intrusion in the Biscayne aquifer of south Florida, USA

    Science.gov (United States)

    Hughes, J. D.; Sifuentes, D. F.; White, J.

    2015-12-01

    Sea-level increases are expected to have an effect on the position of the freshwater-saltwater interface in the Biscayne aquifer in south Florida as a result of the low topographic relief of the area and high rates of groundwater withdrawal from the aquifer. To study the effects that future sea-level increases will have on saltwater intrusion in the Biscayne aquifer in Broward County, Florida, a three-dimensional, variable-density, groundwater-flow and transport model was developed. The model was calibrated to observed groundwater heads and chloride concentrations for a 62-year period that includes historic increases in sea level, development of a surface-water management system to control flooding, and increases in groundwater withdrawals as the area transitioned from agricultural to urban land uses. Sensitivity analyses indicate that downward leakage of saltwater from coastal canals and creeks was the primary source of saltwater to the Biscayne aquifer during the last 62-years in areas where the surface-water system is not actively managed and is tidally influenced. In areas removed from the coastal canals and creeks or under active surface-water management, historic groundwater withdrawals were the primary cause of saltwater intrusion into the aquifer. Simulation of future conditions suggests that possible increases in sea level will result in additional saltwater intrusion. Model scenarios suggest that additional saltwater intrusion will be greatest in areas where coastal canals and creeks were historically the primary source of seawater. Future saltwater intrusion in those areas, however, may be reduced by relocation of salinity-control structures.

  1. Development and evaluation of a regression-based model to predict cesium-137 concentration ratios for saltwater fish

    International Nuclear Information System (INIS)

    Pinder, John E.; Rowan, David J.; Smith, Jim T.

    2016-01-01

    Data from published studies and World Wide Web sources were combined to develop a regression model to predict "1"3"7Cs concentration ratios for saltwater fish. Predictions were developed from 1) numeric trophic levels computed primarily from random resampling of known food items and 2) K concentrations in the saltwater for 65 samplings from 41 different species from both the Atlantic and Pacific Oceans. A number of different models were initially developed and evaluated for accuracy which was assessed as the ratios of independently measured concentration ratios to those predicted by the model. In contrast to freshwater systems, were K concentrations are highly variable and are an important factor in affecting fish concentration ratios, the less variable K concentrations in saltwater were relatively unimportant in affecting concentration ratios. As a result, the simplest model, which used only trophic level as a predictor, had comparable accuracies to more complex models that also included K concentrations. A test of model accuracy involving comparisons of 56 published concentration ratios from 51 species of marine fish to those predicted by the model indicated that 52 of the predicted concentration ratios were within a factor of 2 of the observed concentration ratios. - Highlights: • We developed a model to predict concentration ratios (C_r) for saltwater fish. • The model requires only a single input variable to predict C_r. • That variable is a mean numeric trophic level available at (fishbase.org). • The K concentrations in seawater were not an important predictor variable. • The median-to observed ratio for 56 independently measured C_r was 0.83.

  2. Monitoring and Assessment of Saltwater Intrusion using Geographic Information Systems (GIS), Remote Sensing and Geophysical measurements of Guimaras Island, Philippines

    Science.gov (United States)

    Hernandez, B. C. B.

    2015-12-01

    Degrading groundwater quality due to saltwater intrusion is one of the key challenges affecting many island aquifers. These islands hold limited capacity for groundwater storage and highly dependent on recharge due to precipitation. But its ease of use, natural storage and accessibility make it more vulnerable to exploitation and more susceptible to encroachment from its surrounding oceanic waters. Estimating the extent of saltwater intrusion and the state of groundwater resources are important in predicting and managing water supply options for the community. In Guimaras island, central Philippines, increasing settlements, agriculture and tourism are causing stresses on its groundwater resource. Indications of saltwater intrusion have already been found at various coastal areas in the island. A Geographic Information Systems (GIS)-based approach using the GALDIT index was carried out. This includes six parameters assessing the seawater intrusion vulnerability of each hydrogeologic setting: Groundwater occurrence, Aquifer hydraulic conductivity, Groundwater Level above sea, Distance to shore, Impact of existing intrusion and Thickness of Aquifer. To further determine the extent of intrusion, Landsat images of various thematic layers were stacked and processed for unsupervised classification and electrical resistivity tomography using a 28-electrode system with array lengths of 150 and 300 meters was conducted. The GIS index showed where the vulnerable areas are located, while the geophysical measurements and images revealed extent of seawater encroachment along the monitoring wells. These results are further confirmed by the measurements collected from the monitoring wells. This study presents baseline information on the state of groundwater resources and increase understanding of saltwater intrusion dynamics in island ecosystems by providing a guideline for better water resource management in the Philippines.

  3. A conceptual framework and monitoring strategy for movement of saltwater in the coastal plain aquifer system of Virginia

    Science.gov (United States)

    Mcfarland, E. Randolph

    2015-09-04

    A conceptual framework synthesizes previous studies to provide an understanding of conditions, processes, and relations of saltwater to groundwater withdrawal in the Virginia Coastal Plain aquifer system. A strategy for monitoring saltwater movement is based on spatial relations between the saltwater-transition zone and 612 groundwater-production wells that were regulated during 2013 by the Virginia Department of Environmental Quality. The vertical position and lateral distance and direction of the bottom of each production well’s screened interval was calculated relative to previously published groundwater chloride iso-concentration surfaces. Spatial analysis identified 81 production wells completed in the Yorktown-Eastover and Potomac aquifers that are positioned in closest proximity to the 250-milligrams-per-liter chloride surface, and from which chloride concentrations are most likely to increase above the U.S. Environmental Protection Agency’s 250-milligrams-per-liter secondary maximum-contaminant level. Observation wells are specified to distinguish vertical upconing from lateral intrusion among individual production wells. To monitor upconing, an observation well is to be collocated with each production well and completed at about the altitude of the 250-milligrams-per-liter chloride iso-concentration surface. To monitor lateral intrusion, a potential location of an observation well is projected from the bottom of each production well’s screened interval, in the lateral direction to the underlying chloride surface to a distance of 1 mile.

  4. Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen

    Directory of Open Access Journals (Sweden)

    D. Yahav

    2014-11-01

    Conclusions: In our center, 42% of monomicrobial necrotizing fasciitis cases were found to be caused by Gram-negative organisms, mostly E. coli. These infections usually appeared in immunocompromised or postoperative patients, often presented with normal CPK levels, and were associated with high mortality rates.

  5. Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report

    Directory of Open Access Journals (Sweden)

    Giri Smith

    2012-02-01

    Full Text Available Abstract Introduction Retroperitoneal necrotizing fasciitis is a rare, fulminant, and potentially lethal complication of intra-abdominal suppuration. A retroperitoneal origin is very rare and very few cases have been reported in the literature. To the best of our knowledge, this case is only the fourth case reported of successful management following retroperitoneal necrotizing fasciitis. Case presentation A 33-year-old Tamang man presented to our facility with a history of five days of fever and vomiting and eight days of severe left loin pain. On examination, he had features of peritonism. A laparotomy was performed, revealing extensive necrotizing fasciitis of the retroperitoneum extending to the anterior abdominal wall. Our patient survived following extensive debridement of the necrotic tissues and supportive care. Conclusions Retroperitoneal necrotizing fasciitis can rarely present with features of peritonism, and hence should be included as a possible differential diagnosis for anyone presenting with peritonism. Although a fatal condition, early intervention and aggressive management can save the life of a patient.

  6. Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.

    Science.gov (United States)

    Gamba, Carlo; Sala-Pujals, Aleix; Perez-Prieto, Daniel; Ares-Vidal, Jesus; Solano-Lopez, Alberto; Gonzalez-Lucena, Gemma; Ginés-Caspedosa, Alberto

    2018-04-01

    The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition. Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients. In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36. The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning. Level IV, case series.

  7. Necrotizing Fasciitis in a Pediatric Patient Caused by Lancefield Group G Streptococcus: Case Report and Brief Review of the Literature

    Directory of Open Access Journals (Sweden)

    John Rausch

    2011-01-01

    Full Text Available We report a case of necrotizing fasciitis with an accompanying toxic shock syndrome caused by Group G Streptococcus in a pediatric patient with a lymphatic malformation. Pediatricians need to be aware of the possibility of such infections, especially in those with vascular/lymphatic malformations, as early treatment is critical for survival.

  8. Successful treatment of a necrotizing fasciitis patient caused by Mucor indicus with amphotericin B and skin grafting.

    Science.gov (United States)

    Luo, Yijin; Zeng, Fanqin; Huang, Xiaowen; Li, Qun; Tan, Guozhen; Xi, Liyan; Lu, Changming; Guo, Qing

    2014-04-01

    Cutaneous mucormycosis, an uncommon disease caused by Mucorales, predominantly occurs in immunocompromised host. The present case is a primary cutaneous mucormycosis due to Mucor indicus in an immunocompetent individual. It is with the features of necrotizing fasciitis over the right pretibial area. We are presenting this case owing to its rarity and the successful treatment with amphotericin B and skin grafting.

  9. Integrating Desalination and Energy Storage using a Saltwater-based Hybrid Sodium-ion Supercapacitor.

    Science.gov (United States)

    Guo, Zhaowei; Ma, Yuanyuan; Dong, Xiaoli; Hou, Mengyan; Wang, Yonggang; Xia, Yongyao

    2018-06-11

    Ever-increasing freshwater scarcity and energy crisis problems require efficient seawater desalination and energy storage technologies; however, each target is generally considered separately. Herein, a hybrid sodium-ion supercapacitor, involving a carbon-coated nano-NaTi 2 (PO 4 ) 3 -based battery anode and an activated-carbon-based capacitive cathode, is developed to combine desalination and energy storage in one device. On charge, the supercapacitor removes salt in a flowing saltwater electrolyte through Cl - electrochemical adsorption at the cathode and Na + intercalation at the anode. Discharge delivers useful electric energy and regenerates the electrodes. This supercapacitor can be used not only for energy storage with promising electrochemical performance (i.e., high power, high efficiency, and long cycle life), but also as a desalination device with desalination capacity of 146.8 mg g -1 , much higher than most reported capacitive and battery desalination devices. Finally, we demonstrate renewables to usable electric energy and desalted water through combining commercial photovoltaics and this hybrid supercapacitor. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  10. A direct biocombinatorial strategy toward next generation, mussel-glue inspired saltwater adhesives.

    Science.gov (United States)

    Wilke, Patrick; Helfricht, Nicolas; Mark, Andreas; Papastavrou, Georg; Faivre, Damien; Börner, Hans G

    2014-09-10

    Biological materials exhibit remarkable, purpose-adapted properties that provide a source of inspiration for designing new materials to meet the requirements of future applications. For instance, marine mussels are able to attach to a broad spectrum of hard surfaces under hostile conditions. Controlling wet-adhesion of synthetic macromolecules by analogue processes promises to strongly impact materials sciences by offering advanced coatings, adhesives, and glues. The de novo design of macromolecules to mimic complex aspects of mussel adhesion still constitutes a challenge. Phage display allows material scientists to design specifically interacting molecules with tailored affinity to material surfaces. Here, we report on the integration of enzymatic processing steps into phage display biopanning to expand the biocombinatorial procedure and enable the direct selection of enzymatically activable peptide adhesion domains. Adsorption isotherms and single molecule force spectroscopy show that those de novo peptides mimic complex aspects of bioadhesion, such as enzymatic activation (by tyrosinase), the switchability from weak to strong binders, and adsorption under hostile saltwater conditions. Furthermore, peptide-poly(ethylene oxide) conjugates are synthesized to generate protective coatings, which possess anti-fouling properties and suppress irreversible interactions with blood-plasma protein cocktails. The extended phage display procedure provides a generic way to non-natural peptide adhesion domains, which not only mimic nature but also improve biological sequence sections extractable from mussel-glue proteins. The de novo peptides manage to combine several tasks in a minimal 12-mer sequence and thus pave the way to overcome major challenges of technical wet glues.

  11. Simulation of saltwater intrusion in a poorly karstified coastal aquifer in Lebanon (Eastern Mediterranean)

    Science.gov (United States)

    Khadra, Wisam M.; Stuyfzand, Pieter J.

    2018-03-01

    To date, there has been no agreement on the best way to simulate saltwater intrusion (SWI) in karst aquifers. An equivalent porous medium (EPM) is usually assumed without justification of its applicability. In this paper, SWI in a poorly karstified aquifer in Lebanon is simulated in various ways and compared to measurements. Time series analysis of rainfall and aquifer response is recommended to decide whether quickflow through conduits can be safely ignored. This aids in justifying the selection of the exemplified EPM model. To examine the improvement of SWI representation when discrete features (DFs) are embedded in the model domain, the results of a coupled discrete-continuum (CDC) approach (a hybrid EPM-DF approach) are compared to the EPM model. The two approaches yielded reasonable patterns of hydraulic head and groundwater salinity, which seem trustworthy enough for management purposes. The CDC model also reproduced some local anomalous chloride patterns, being more adaptable with respect to the measurements. It improved the overall accuracy of salinity predictions at wells and better represented the fresh-brackish water interface. Therefore, the CDC approach can be beneficial in modeling SWI in poorly karstified aquifers, and should be compared with the results of the EPM method to decide whether the differences in the outcome at local scale warrant its (more complicated) application. The simulation utilized the SEAWAT code since it is density dependent and public domain, and it enjoys widespread application. Including DFs necessitated manual handling because the selected code has no built-in option for such features.

  12. Influence of the Three Gorges Project on saltwater intrusion in the Yangtze River Estuary

    Science.gov (United States)

    An, Qiang; Wu, Yanqing; Taylor, Shauna; Zhao, Bin

    2009-02-01

    The Three Gorges Project (TGP) is a transcentury project that has aroused world attention. It is expected that the flow velocity and runoff of the Yangtze River will be changed after the project has been accomplished. Consequently, however, the ecological environment in the Yangtze River Basin, particularly in the estuary region, will be affected. Salinity intrusion into the Yangtze River estuary, in general, is mostly affected by the Yangtze River discharge and its external tidal level. This paper focuses on examining the influence of changes in runoff on salinity value. The question, to which should be paid attention is: how is the interaction between changes in runoff of the Yangtze River and salinity distribution in the Yangtze River estuary, China? In this research, a three-dimensional model has been used to identify the effects of runoff change on salinity distribution. The drawn conclusion is that the change of salinity is influenced by discharge variation. Positive and negative impacts of TGP would both turn up but in different period. In sum, TGP is in favor of restraining saltwater intrusion. Nevertheless a suitable method should be found to resolve its negative influences.

  13. Forecasting Induced Seismicity Using Saltwater Disposal Data and a Hydromechanical Earthquake Nucleation Model

    Science.gov (United States)

    Norbeck, J. H.; Rubinstein, J. L.

    2017-12-01

    The earthquake activity in Oklahoma and Kansas that began in 2008 reflects the most widespread instance of induced seismicity observed to date. In this work, we demonstrate that the basement fault stressing conditions that drive seismicity rate evolution are related directly to the operational history of 958 saltwater disposal wells completed in the Arbuckle aquifer. We developed a fluid pressurization model based on the assumption that pressure changes are dominated by reservoir compressibility effects. Using injection well data, we established a detailed description of the temporal and spatial variability in stressing conditions over the 21.5-year period from January 1995 through June 2017. With this stressing history, we applied a numerical model based on rate-and-state friction theory to generate seismicity rate forecasts across a broad range of spatial scales. The model replicated the onset of seismicity, the timing of the peak seismicity rate, and the reduction in seismicity following decreased disposal activity. The behavior of the induced earthquake sequence was consistent with the prediction from rate-and-state theory that the system evolves toward a steady seismicity rate depending on the ratio between the current and background stressing rates. Seismicity rate transients occurred over characteristic timescales inversely proportional to stressing rate. We found that our hydromechanical earthquake rate model outperformed observational and empirical forecast models for one-year forecast durations over the period 2008 through 2016.

  14. Biogeochemical cycling of carbon, nitrogen, and phosphorus in saltwater marshes of Lavaca Bay, Texas. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Armstrong, N.E.; Hinson, M.O. Jr.; Collins, J.H.; Fruh, E.G.

    1975-01-24

    Both laboratory and field tests were conducted. Special sediment slurry uptake studies were performed for the purpose of developing Freundlich-like isotherms relating sediment concentrations of C, N, P to the equilibrium concentrations in water and to show the effects of sediment composition, salinity, and temperature on uptake. The flux of N and P into and out of sediment were studied in fixed-bed systems by continuously adding various amounts of N and P to these systems and following uptake in the sediments until equilibrium conditions were established, then stopping the additions and following the release of nutrients from the sediments. Mass balances were made for C, N, and P added in spiked and non-spiked Bay water, and productivity measurements were taken to determine the stimulatory effects of these nutrient additions. The field studies involved the collection of hydraulic and nutrient data at several stations in a bayou off Swan Lake in Lavaca Bay to determine net nutrient transport and exchange from and in the saltwater marshes. Mathematical models describing the sediment uptake of C, N, and P as a function of the mass transfer coefficient and the difference between equilibrium and ambient nutrient concentrations were developed.

  15. Quantitative analysis of production traits in saltwater crocodiles (Crocodylus porosus): II. age at slaughter.

    Science.gov (United States)

    Isberg, S R; Thomson, P C; Nicholas, F W; Barker, S G; Moran, C

    2005-12-01

    Crocodile morphometric (head, snout-vent and total length) measurements were recorded at three stages during the production chain: hatching, inventory [average age (+/-SE) is 265.1 +/- 0.4 days] and slaughter (average age is 1037.8 +/- 0.4 days). Crocodile skins are used for the manufacture of exclusive leather products, with the most common-sized skin sold having 35-45 cm in belly width. One of the breeding objectives for inclusion into a multitrait genetic improvement programme for saltwater crocodiles is the time taken for a juvenile to reach this size or age at slaughter. A multivariate restricted maximum likelihood analysis provided (co)variance components for estimating the first published genetic parameter estimates for these traits. Heritability (+/-SE) estimates for the traits hatchling snout-vent length, inventory head length and age at slaughter were 0.60 (0.15), 0.59 (0.12) and 0.40 (0.10) respectively. There were strong negative genetic (-0.81 +/- 0.08) and phenotypic (-0.82 +/- 0.02) correlations between age at slaughter and inventory head length.

  16. Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

    Directory of Open Access Journals (Sweden)

    Tuite Helen

    2010-11-01

    Full Text Available Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

  17. Streptococcal necrotizing fasciitis with toxic shock syndrome and rapid fatal outcome

    Directory of Open Access Journals (Sweden)

    Kojić Miroslav

    2015-01-01

    Full Text Available Introduction. Streptococcal necrotizing fasciitis (NF is a serious soft tissue infection with rapid progression of inflammatory process among superficial or deep fascia, systemic host response to infection leading to toxic shock syndrome (TSS, and multiple organ failure. Lethality is high. Case Outline. A 46-year-old male without co-morbidities was admitted to the Emergency Department with redness, swelling and pain on his right lower leg. He became sick two day s ea rlier with m alaise, chills and shivering. On admission he was hypotensive, anuric, with erythematous rash on his face, neck and chest, with acute ren al failure and elevated creatine phosphokinase level. During the next several hours, the changes on his right lower leg rapidly spread to the whole leg, followed by skin destruction and subcutaneo us bleeding, indicating NF. Aggressive antimicrobial, supportive and symptom atic therapy was initiated immediately and on the same evening surgical intervention was performed. Despite these measures, a rapid development of severe TSS, with lethal outcome, occurred in less than 40 hours after the admission. Stre ptococcus pyogenes (group A β-hemolytic Streptococcus was isolated from the throat, skin and tissue obtained duri ng the surgery. Conclusion. Necrotizing fasciitis is a very serious disease with unpre dictable course. For that reason doctors must devote a great deal of a ttention to early, i.e. timely diagnosis of this disease, whose treatment with a multid isciplinary approach is very important.

  18. Clinical parameters and challenges of managing cervicofacial necrotizing fasciitis in a Sub-Saharan tertiary hospital

    Directory of Open Access Journals (Sweden)

    Adeola A Olusanya

    2015-01-01

    Full Text Available Introduction: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF in the University College Hospital, Ibadan. Materials and Methods: Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. Results: Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844 cm. The mean hospital stay was 27.8 (±23.1 days, and scar formation was the most common complication encountered. Conclusion: Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.

  19. Fascitis necrosante bilateral: a propósito de un caso Bilateral necrotizing fasciitis: case report

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    F. Fernández Gómez

    2011-06-01

    Full Text Available La fascitis necrosante es una enfermedad de origen infeccioso que afecta a la fascia muscular y progresa rápidamente. Para el manejo de este tipo de pacientes es clave un diagnóstico precoz y un tratamiento adecuado que combine antibioticoterapia y cirugía. Presentamos el caso de una paciente de 77 años de edad con diagnóstico de fascitis necrosante de presentación atípica por la bilateralidad de las lesiones, la ausencia de factores predisponentes y la presencia de un único germen causal.Necrotizing fasciitis is an infectious disease that involves muscular fascia and has a quickly progress. Early diagnosis and proper treatment that consists on antibiotic therapy and surgery are the key of patient management. We report the case of a 77 years old oman with necrotizing fasciitis diagnosis with atypical presentation due to bilateral skin lesions, lack of risk factors and only one germ as causal pathogen.

  20. Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

    LENUS (Irish Health Repository)

    Smyth, Andrew

    2010-11-17

    Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

  1. Idiopathic neonatal necrotising fasciitis caused by community-acquired MSSA encoding Panton Valentine Leukocidin genes.

    LENUS (Irish Health Repository)

    Dunlop, Rebecca L E

    2012-02-01

    Neonatal necrotising fasciitis is very rare in comparison to the adult presentation of the disease and a Plastic Surgeon may only encounter one such case during his or her career. Often this is initially misdiagnosed and managed as simple cellulitis. It generally affects previously healthy babies, the site is often the lower back area and a history of minor skin trauma may be elicited. The causative organism is usually Streptococcus or polymicrobial, as is the case in the adult population. We present the case of a previously healthy 11-day-old infant with idiopathic, rapidly progressive necrotising fasciitis of the back, cause by Methicillin sensitive Staphylococcus aureus (MSSA) infection. The strain was isolated and found to encode the Panton-Valentine Leukocidin genes, which have been associated with particularly severe necrotising infections in other sites, with high mortality. These strains are the subject of specific treatment and eradication guidance in the UK but awareness of this and the importance of obtaining detailed culture typing is likely to be low amongst Plastic Surgeons.

  2. Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

    Science.gov (United States)

    Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

    2013-01-01

    Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

  3. Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis.

    Science.gov (United States)

    Miyamoto, Wataru; Yasui, Youichi; Miki, Shinya; Kawano, Hirotaka; Takao, Masato

    2017-10-14

    To evaluate the medium-term clinical results of endoscopic plantar fascia release (EPFR) using a suprafascial approach for recalcitrant plantar fasciitis. Twenty-four feet of twenty-three patients who underwent EPFR using a suprafascial approach were followed up for more than 2 years using the American Orthopedic Foot and Ankle Society (AOFAS) score. The AOFAS score at final follow-up was compared between patients who participated in athletic activity (group A) and those who were sedentary (group S) and between those with and those without calcaneal spur (group with CS and group without CS, respectively). The ability of patients to return to athletic activity, and if so, the time interval between surgery and return to athletic activity, were investigated in group A. Complications were recorded. The median follow-up duration was 48 months. The mean AOFAS score in all patients increased significantly between before surgery and final follow-up (P plantar nerve occurred in three feet. EPFR using a suprafascial approach was effective for recalcitrant plantar fasciitis. However, the prognosis of sedentary patients was inferior to that of patients engaged in athletic activity. IV.

  4. The correlation between plantar fascia thickness and symptoms of plantar fasciitis.

    Science.gov (United States)

    Mahowald, Sarah; Legge, Bradford S; Grady, John F

    2011-01-01

    The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ± 1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols.

  5. Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis.

    Science.gov (United States)

    Broholm, R; Pingel, J; Simonsen, L; Bülow, J; Johannsen, F

    2017-12-01

    Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    Science.gov (United States)

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  7. [Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident].

    Science.gov (United States)

    Mayayo, Emilio; Stchigel, Alberto M; Cano, José F; Bernal-Escoté, Xana; Guarro, Josep

    2013-01-03

    Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.

  8. Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse.

    Science.gov (United States)

    Pushkar, Dmitry Y; Vasilchenko, Mikhail I; Kasyan, George R

    2013-10-01

    Necrotising fasciitis is a severe form of soft tissue infection. Herein, we present an unreported complication of the transvaginal repair of a pelvic organ prolapse (POP) with trocar-guided polypropylene mesh and a concomitant hysterectomy. A 61-year-old Caucasian female who had been using an intrauterine device (IUD) for 30 years presented with a stage 3 pelvic organ prolapse. A genital ultrasound examination confirmed the presence of an IUD, but found no endometrial abnormalities. The surgical management was limited to a transvaginal hysterectomy and simultaneous anterior vaginal wall repair augmented with trocar-guided mesh. A morphological examination of the removed uterus confirmed the presence of the intrauterine device and additionally found endometrial cancer (T1N0M0), which was not revealed during the preoperative ultrasound. Within 6 days of the surgery, she developed anaerobic bilateral necrotising fasciitis on both thighs. Non-clostridial streptococci were identified in the wound. After 18 days of intensive care, the patient died of fatal coagulopathy.

  9. Beneficial effects of platelet-rich plasma on improvement of pain severity and physical disability in patients with plantar fasciitis: A randomized trial

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2016-01-01

    Conclusion: Administration of PRP leads to significant improvement in pain severity and physical limitation in patients with plantar fasciitis. This healing effect may be begun at least 3 months after injection.

  10. Assessment of Heavy Metal in Self-caught Saltwater Fish from Port Dickson Coastal Water (Malaysia)

    International Nuclear Information System (INIS)

    Praveena, S.M.; Lin, C.L.S.

    2015-01-01

    Freshwater fish has been studied and reported numerously. However, little attention has been made and limited studies available on local marine fish in Malaysia. Thus, in this study, concentrations of heavy metals (Cd, Cr, Pb and Cu) were studied in four major local marine fish Megalaspis cordyla (hardtail scad), Rastrelliger kanagurta (Indian mackerel), Selaroides leptolepis (yellow stripe scad) and Sardinella fimbriata (fringescale sardinella). The study was also intended to estimate potential health risk assessment from these heavy metals to the consumption of fish and assess maximum allowable fish consumption rate. The range of heavy metal concentrations were 0.053-0.096 mg/ kg for Cd, 1.16-2.34 mg/ kg for Cr, 8.34-12.44 mg/ kg for Pb and 1.40-3.21 mg/ kg for Cu in four major self-caught saltwater fish. Heavy metal levels of Cd and Cu in the local marine fish from Port Dickson are below the limit enforced by Food Regulations (1985) while the levels of Cr and Pb have exceeded the limit. Potential health risks associated with Cd, Cr, Cu and Pb were assessed based on target hazard quotients. HQ values calculated for Cd, Cr and Cu were less than 1, thus indicate that no adverse effects while HQ values for Pb exceeded 1 for all the fish species assessed with the exception of Megalaspis spp and Sardinella sppa. Cr was the highest while Pb concentrations were the lowest in all the studied fish samples for maximum allowable fish consumption rate. A long term monitoring program is crucial to be done in coastal areas with high consumption of local marine fish along Port Dickson to obtain real consumption rates and other cofounders factors in local population. (author)

  11. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia

    International Nuclear Information System (INIS)

    O'Regan, Kevin; Maher, Michael M.; O'Mahony, Edward; MacEneaney, Peter; Fitzgerald, Edward

    2009-01-01

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management. (orig.)

  12. Epinephrine auto-injection radically increases risk for clostridial infection and necrotizing fasciitis

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    Kenneth Larson

    2017-04-01

    Full Text Available Clostridial perfringens is a bacteria commonly found on skin flora. Due to the optimal growth environment intramuscular epinephrine injections predispose patients to the rapid development of clostridial myonecrosis. There have been only four cases, including this one, reported in the last 60 years of pediatric Clostridium perfringens infections post-epinephrine injection. We detail the successful management of a 16 year old, immunocompetent female who developed gas gangrene and necrotizing fasciitis on her thigh secondary to clostridial infection after utilization of an Epinephrine Auto-Injector and review the pediatric literature of patients with Clostridial perfringens secondary to epinephrine injection. We define common clinical signs and symptoms of clostridial infection from the review of the literature. The relevance of our findings is to raise awareness among emergency physicians when patients present following an injection in order to reduce diagnostic delay that could result in amputation or death.

  13. CT imaging of necrosive fasciitis; CT-Bildgebung der nekrotisierenden Fasziitis

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, M.; Overkamp, D.; Joanoviciu, S.; Horger, M.

    2008-07-15

    NF is a rare but dramatic and often fatal infection of the fascii and adjoining soft tissues. Contrary to the Fournier's definition, it is most common in elderly people. Patients with immune problems have a higher risk (e.g. Diabetes mellitus, alcohol or drug abuse, AIDS, leukaemia, chemotherapy and immunosuppressive medication). Predisposition factors are diverticulitis, insect bites, or surgical interventions (Uppot RN, Levy HM, PLatel PH, Radiology 2003; 226; 115; Wysoki MG, Santora TA, Shah RM et al. Necrotizing fasciitis: CT characteristics, Radiology 1997; 203;859). Men are affected more frequently than women. In principle, NF may occur everywhere in the body but incidence in the region of the scrotum, perineum and lower extremities are the most common. (orig.)

  14. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia

    Energy Technology Data Exchange (ETDEWEB)

    O' Regan, Kevin; Maher, Michael M. [Mercy University Hospital, Department of Radiology, Cork (Ireland); Cork University Hospital, Department of Radiology, Cork (Ireland); O' Mahony, Edward; MacEneaney, Peter; Fitzgerald, Edward [Mercy University Hospital, Department of Radiology, Cork (Ireland)

    2009-10-15

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management. (orig.)

  15. Pyoderma Gangrenosum Masquerading as Necrotizing Fasciitis: Stepping Away from Cognitive Shortcuts

    Directory of Open Access Journals (Sweden)

    Rachael Hilton

    2017-09-01

    Full Text Available A patient with post-Cesarean wound complication was treated for necrotizing fasciitis (NF with sharp debridement and broad-spectrum antibiotics. Several operations and three weeks later, her abdominal skin, subcutaneous fat, right-sided rectus abdominus, and underlying fascia had been removed without any improvement in granulation tissue. Original pathology samples demonstrated sheets of necrosis consistent with NF, but were re-reviewed by a dermatopathologist who diagnosed the patient with pyoderma gangrenosum (PG. She was started on high-dose steroids and dapsone, and her wound quickly showed signs of improvement. Anchor bias delayed the initiation of steroids and diagnosis of PG as the surgical, medical, and consulting teams were hesitant to stray from the diagnosis of NF.

  16. Necrotizing Fasciitis: Diagnostic Challenges in a Mute Bedridden Patient with Atypical Laboratory Parameters

    Directory of Open Access Journals (Sweden)

    Ghan-Shyam Lohiya

    2012-01-01

    Full Text Available A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient’s right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C, and leukocytosis (count: 13×109/L; was 6.5×109/L ten days earlier. Necrotizing fasciitis (NF was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.

  17. Necrotizing fasciitis: diagnostic challenges in a mute bedridden patient with atypical laboratory parameters.

    Science.gov (United States)

    Lohiya, Ghan-Shyam; Tan-Figueroa, Lilia; Krishna, Vijay; Lohiya, Sunita

    2012-01-01

    A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient's right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C), and leukocytosis (count: 13 × 10(9)/L; was 6.5 × 10(9)/L ten days earlier). Necrotizing fasciitis (NF) was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.

  18. Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report

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    Chauhan Deepender

    2007-01-01

    Full Text Available Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

  19. Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: a case report.

    Science.gov (United States)

    Chauhan, Deepender; Arora, Ritu; Das, Sima; Shroff, Daraius; Narula, Ritesh

    2007-01-01

    Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

  20. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia.

    LENUS (Irish Health Repository)

    O'Regan, Kevin

    2009-10-01

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management.

  1. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia.

    LENUS (Irish Health Repository)

    O'Regan, Kevin

    2012-01-31

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management.

  2. Human-crocodile conflict and conservation implications of Saltwater Crocodiles Crocodylus porosus (Reptilia: Crocodylia: Crocodylidae in Sri Lanka

    Directory of Open Access Journals (Sweden)

    A.A. Thasun Amarasinghe

    2015-04-01

    Full Text Available Human-wildlife conflict occurs when human requirements encroach on those of wildlife populations, with potential costs to both humans and wild animals.  As top predators in most inland waters, crocodilians are involved in human-wildlife conflicts in many countries.  Here we present findings of a 5-year survey on human-crocodile conflict on the island of Sri Lanka and relate the results to improving management practices. We aimed to quantify and understand the causes of human-crocodile conflict in Sri Lanka, and propose solutions to mitigate it.  Visual encounter surveys were carried out to estimate the population size of Saltwater Crocodiles. We recorded 778 sightings of Saltwater Crocodiles at 262 of 400 locations surveyed, and estimate the total population to comprise more than 2000 non-hatchlings and to have increased at an average rate of 5% p.a. since 1978. We propose four crocodile vigilance zones within the wet zone and one crocodile vigilance zone within the dry zone of the country. Specific threats to Saltwater Crocodiles identified in crocodile vigilance zones were: habitat destruction and loss; illegal killing and harvesting (17 killings out of fear, ~200 incidents of killing for meat and skins, ~800 eggs annually for consumption; unplanned translocations; and, interaction with urbanization (10 incidents of crocodiles being run over by trains/vehicles and electrocution. Additionally, 33 cases of crocodile attacks on humans were recorded [8 fatal, 25 non-fatal (minor to grievous injuries] and more than 50 incidents of attacks on farm and pet animals. 

  3. Consequences and mitigation of saltwater intrusion induced by short-circuiting during aquifer storage and recovery in a coastal subsurface

    Science.gov (United States)

    Gerardus Zuurbier, Koen; Stuyfzand, Pieter Jan

    2017-02-01

    Coastal aquifers and the deeper subsurface are increasingly exploited. The accompanying perforation of the subsurface for those purposes has increased the risk of short-circuiting of originally separated aquifers. This study shows how this short-circuiting negatively impacts the freshwater recovery efficiency (RE) during aquifer storage and recovery (ASR) in coastal aquifers. ASR was applied in a shallow saltwater aquifer overlying a deeper, confined saltwater aquifer, which was targeted for seasonal aquifer thermal energy storage (ATES). Although both aquifers were considered properly separated (i.e., a continuous clay layer prevented rapid groundwater flow between both aquifers), intrusion of deeper saltwater into the shallower aquifer quickly terminated the freshwater recovery. The presumable pathway was a nearby ATES borehole. This finding was supported by field measurements, hydrochemical analyses, and variable-density solute transport modeling (SEAWAT version 4; Langevin et al., 2007). The potentially rapid short-circuiting during storage and recovery can reduce the RE of ASR to null. When limited mixing with ambient groundwater is allowed, a linear RE decrease by short-circuiting with increasing distance from the ASR well within the radius of the injected ASR bubble was observed. Interception of deep short-circuiting water can mitigate the observed RE decrease, although complete compensation of the RE decrease will generally be unattainable. Brackish water upconing from the underlying aquitard towards the shallow recovery wells of the ASR system with multiple partially penetrating wells (MPPW-ASR) was observed. This leakage may lead to a lower recovery efficiency than based on current ASR performance estimations.

  4. Saltwater contamination in the managed low-lying farmland of the Venice coast, Italy: An assessment of vulnerability

    Energy Technology Data Exchange (ETDEWEB)

    Da Lio, Cristina, E-mail: cristina.dalio@ve.ismar.cnr.it [Institute of Marine Sciences, National Research Council, Arsenale — Tesa 104, Castello 2737/F, 30122 Venezia (Italy); Carol, Eleonora, E-mail: eleocarol@fcnym.unlp.edu.ar [Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Cátedra de Hidrología General, Facultad de Ciencias Naturales y Museo, Universidad Nacional de La Plata 64 n" o3 La Plata (Argentina); Kruse, Eduardo, E-mail: kruse@fcnym.unlp.edu.ar [Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Cátedra de Hidrología General, Facultad de Ciencias Naturales y Museo, Universidad Nacional de La Plata 64 n" o3 La Plata (Argentina); Teatini, Pietro, E-mail: pietro.teatini@unipd.it [Institute of Marine Sciences, National Research Council, Arsenale — Tesa 104, Castello 2737/F, 30122 Venezia (Italy); Dept. of Civil, Architectural and Environmental Engineering, University of Padova, Via Trieste 63, 35121 Padova (Italy); Tosi, Luigi, E-mail: luigi.tosi@ismar.cnr.it [Institute of Marine Sciences, National Research Council, Arsenale — Tesa 104, Castello 2737/F, 30122 Venezia (Italy)

    2015-11-15

    The original morphology and hydrogeology of many low-lying coastlands worldwide have been significantly modified over the last century through river diversion, embankment built-up, and large-scale land reclamation projects. This led to a progressive shifting of the groundwater–surficial water exchanges from naturally to anthropogenically driven. In this human-influenced hydrologic landscape, the saltwater contamination usually jeopardizes the soil productivity. In the coastland south of Venice (Italy), several well log measurements, chemical and isotope analyses have been performed over the last decade to characterize the occurrence of the salt contamination. The processing of this huge dataset highlights a permanent variously-shaped saline contamination up to 20 km inland, with different conditions in relation with the various geomorphological features of the area. The results point out the important role of the land reclamation in shaping the present-day salt contamination and reveal the contribution of precipitation, river discharge, lagoon and sea water to the shallow groundwater in the various coastal sectors. Moreover, an original vulnerability map to salt contamination in relation to the farmland productivity has been developed taking into account the electrical conductivity of the upper aquifer in the worst condition, the ground elevation, and the distance from salt and fresh surface water sources. Finally, the study allows highlighting the limit of traditional investigations in monitoring saltwater contamination at the regional scale in managed Holocene coastal environments. Possible improvements are outlined. - Highlights: • Land reclamation shapes the present saltwater contamination in the Venice coastland. • Natural and anthropogenic forcings drive the seawater flow in shallow aquifers. • Hydro-geophysical–geochemical investigations highlight the groundwater origin. • The vulnerability of the farmland to salt contamination extents up to 20

  5. Saltwater contamination in the managed low-lying farmland of the Venice coast, Italy: An assessment of vulnerability

    International Nuclear Information System (INIS)

    Da Lio, Cristina; o3 La Plata (Argentina))" data-affiliation=" (Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Cátedra de Hidrología General, Facultad de Ciencias Naturales y Museo, Universidad Nacional de La Plata 64 no3 La Plata (Argentina))" >Carol, Eleonora; o3 La Plata (Argentina))" data-affiliation=" (Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Cátedra de Hidrología General, Facultad de Ciencias Naturales y Museo, Universidad Nacional de La Plata 64 no3 La Plata (Argentina))" >Kruse, Eduardo; Teatini, Pietro; Tosi, Luigi

    2015-01-01

    The original morphology and hydrogeology of many low-lying coastlands worldwide have been significantly modified over the last century through river diversion, embankment built-up, and large-scale land reclamation projects. This led to a progressive shifting of the groundwater–surficial water exchanges from naturally to anthropogenically driven. In this human-influenced hydrologic landscape, the saltwater contamination usually jeopardizes the soil productivity. In the coastland south of Venice (Italy), several well log measurements, chemical and isotope analyses have been performed over the last decade to characterize the occurrence of the salt contamination. The processing of this huge dataset highlights a permanent variously-shaped saline contamination up to 20 km inland, with different conditions in relation with the various geomorphological features of the area. The results point out the important role of the land reclamation in shaping the present-day salt contamination and reveal the contribution of precipitation, river discharge, lagoon and sea water to the shallow groundwater in the various coastal sectors. Moreover, an original vulnerability map to salt contamination in relation to the farmland productivity has been developed taking into account the electrical conductivity of the upper aquifer in the worst condition, the ground elevation, and the distance from salt and fresh surface water sources. Finally, the study allows highlighting the limit of traditional investigations in monitoring saltwater contamination at the regional scale in managed Holocene coastal environments. Possible improvements are outlined. - Highlights: • Land reclamation shapes the present saltwater contamination in the Venice coastland. • Natural and anthropogenic forcings drive the seawater flow in shallow aquifers. • Hydro-geophysical–geochemical investigations highlight the groundwater origin. • The vulnerability of the farmland to salt contamination extents up to 20

  6. Electrochemical behavior of Q235 steel in saltwater saturated with carbon dioxide based on new imidazoline derivative inhibitor

    International Nuclear Information System (INIS)

    Liu, F.G.; Du, M.; Zhang, J.; Qiu, M.

    2009-01-01

    The electrochemical behavior of carbon steel in saltwater saturated with CO 2 with/without an new synthesized imidazoline inhibitor was studied using polarization and electrochemical impedance spectrum (EIS), and the inhibitive ability of the inhibitor was evaluated by weight-loss method in 298-328 K temperature range. Results showed that the inhibition efficiency is up to above 80%, and imidazoline is a kind of mixed-type inhibitor. It was seen that the adsorption of imidazoline on Q235 steel can be fitted to Frumkin isotherm equation. Quantum chemistry calculation results show that the imidazoline ring and heteroatoms are the active sites of the inhibitors

  7. Continuous Infraclavicular Block for Forearm Amputation After Being Bitten by a Saltwater Crocodile (Crocodylus Porosus: A Case Report

    Directory of Open Access Journals (Sweden)

    Chin-Hsi Chiu

    2009-08-01

    Full Text Available Two important issues after a complete right forearm amputation are replantation and ongoing pain management. There are no reports of successful forearm replantation as a consequence of a crocodile bite. Here, we discuss our pain management in a case of complete forearm amputation after a bite from a saltwater crocodile (Crocodylus porosus, which necessitated six further operations to achieve successful replantation. Continuous infraclavicular brachial plexus block was effective for acute pain control in this case. We strongly recommend performing the block with an indwelling catheter under ultrasound guidance for higher accuracy and safety.

  8. Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal

    Directory of Open Access Journals (Sweden)

    Fahri Yetışır

    2015-01-01

    Full Text Available Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS (ConvaTec and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT. Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

  9. Ultrasound guided injection of dexamethasone versus placebo for treatment of plantar fasciitis: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Gilheany Mark F

    2010-07-01

    Full Text Available Abstract Background Plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel. Management of this condition commonly involves the use of corticosteroid injection in cases where less invasive treatments have failed. However, despite widespread use, only two randomised trials have tested the effect of this treatment in comparison to placebo. These trials currently offer the best available evidence by which to guide clinical practice, though both were limited by methodological issues such as insufficient statistical power. Therefore, the aim of this randomised trial is to compare the effect of ultrasound-guided corticosteroid injection versus placebo for treatment of plantar fasciitis. Methods The trial will be conducted at the La Trobe University Podiatry Clinic and will recruit 80 community-dwelling participants. Diagnostic ultrasound will be used to diagnose plantar fasciitis and participants will be required to meet a range of selection criteria. Participants will be randomly allocated to one of two treatment arms: (i ultrasound-guided injection of the plantar fascia with 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group, or (ii ultrasound-guided injection of the plantar fascia with 1 mL normal saline (control group. Blinding will be applied to participants and the investigator performing procedures, measuring outcomes and analysing data. Primary outcomes will be pain measured by the Foot Health Status Questionnaire and plantar fascia thickness measured by ultrasound at 4, 8 and 12 weeks. All data analyses will be conducted on an intention-to-treat basis. Conclusion This will be a randomised trial investigating the effect of dexamethasone injection on pre-specified treatment outcomes in people with plantar fasciitis. Within the parameters of this protocol, the trial findings will be used to make evidence-based recommendations regarding the use of corticosteroid injection for treatment of this

  10. Plantar fasciitis (fasciosis) treatment outcome study: plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement.

    Science.gov (United States)

    Fabrikant, Jerry M; Park, Tae Soon

    2011-06-01

    Ultrasound, well recognized as an effective diagnostic tool, reveals a thickening of the plantar fascia in patients with plantar fasciitis/fasciosis disease. The authors hypothesized that ultrasound would also reveal a decrease in the plantar fascia thickness for patients undergoing treatment for the disease, a hypothesis that, heretofore, had been only tested on a limited number of subjects. They conducted a more statistically significant study that found that clinical treatment with injection and biomechanical correction does indeed diminish plantar fascia thickness as shown on ultrasound. The study also revealed that patients experience the most heightened plantar fascia tenderness toward the end of the day, and improvement in their symptomatic complaints were associated with a reduction in plantar fascia thickness. As a result, the authors conclude that office-based ultrasound can help diagnose and confirm plantar fasciitis/fasciosis through the measurement of the plantar fascia thickness. Because of the advantages of ultrasound--that it is non-invasive with greater patient acceptance, cost effective and radiation-free--the imaging tool should be considered and implemented early in the diagnosis and treatment of plantar fasciitis/fasciosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peerbooms Joost C

    2010-04-01

    Full Text Available Abstract Background If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. GPS® gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate. Methods and design A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure. The main outcome measures of this study are pain and function measured with questionnaires. Conclusion Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available. Trial Registration Trial registration number: http://www.clinicaltrials.gov NCT00758641.

  12. Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis.

    Science.gov (United States)

    Engkananuwat, Phoomchai; Kanlayanaphotporn, Rotsalai; Purepong, Nithima

    2018-01-01

    Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale-foot and ankle score, and range of motion in ankle dorsiflexion ( P plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon-only group (n = 7; 28%). II, lesser quality RCT or prospective comparative study.

  13. Growth factor-enriched autologous plasma improves wound healing after surgical debridement in odontogenic necrotizing fasciitis: a case report

    Directory of Open Access Journals (Sweden)

    Martinez-Fong Daniel

    2011-03-01

    Full Text Available Abstract Background Odontogenic necrotizing fasciitis of the neck is a fulminant infection of odontogenic origin that quickly spreads along the fascial planes and results in necrosis of the affected tissues. It is usually polymicrobial, occurs frequently in immunocompromised patients, and has a high mortality rate. Case presentation A 69-year old Mexican male had a pain in the maxillar right-canine region and a swelling of the submental and submandibular regions. Our examination revealed local pain, tachycardia, hyperthermia (39°C, and the swelling of bilateral submental and submandibular regions, which also were erythematous, hyperthermic, crepitant, and with a positive Godet sign. Mobility and third-degree caries were seen in the right mandibular canine. Bacteriological cultures isolated streptococcus pyogenes and staphylococcus aureus. The histopathological diagnosis was odontogenic necrotizing fasciitis of the submental and submandibular regions. The initial treatment was surgical debridement and the administration of antibiotics. After cultures were negative, the surgical wound was treated with a growth factor-enriched autologous plasma eight times every third day until complete healing occurred. Conclusions The treatment with a growth factor-enriched autologous plasma caused a rapid healing of an extensive surgical wound in a patient with odontogenic necrotizing fasciitis. The benefits were rapid tissue regeneration, an aesthetic and a functional scar, and the avoidance of further surgery and possible complications.

  14. Application and evaluation of electromagnetic methods for imaging saltwater intrusion in coastal aquifers: Seaside Groundwater Basin, California

    Science.gov (United States)

    Nenna, Vanessa; Herckenrather, Daan; Knight, Rosemary; Odlum, Nick; McPhee, Darcy

    2013-01-01

    Developing effective resource management strategies to limit or prevent saltwater intrusion as a result of increasing demands on coastal groundwater resources requires reliable information about the geologic structure and hydrologic state of an aquifer system. A common strategy for acquiring such information is to drill sentinel wells near the coast to monitor changes in water salinity with time. However, installation and operation of sentinel wells is costly and provides limited spatial coverage. We studied the use of noninvasive electromagnetic (EM) geophysical methods as an alternative to installation of monitoring wells for characterizing coastal aquifers. We tested the feasibility of using EM methods at a field site in northern California to identify the potential for and/or presence of hydraulic communication between an unconfined saline aquifer and a confined freshwater aquifer. One-dimensional soundings were acquired using the time-domain electromagnetic (TDEM) and audiomagnetotelluric (AMT) methods. We compared inverted resistivity models of TDEM and AMT data obtained from several inversion algorithms. We found that multiple interpretations of inverted models can be supported by the same data set, but that there were consistencies between all data sets and inversion algorithms. Results from all collected data sets suggested that EM methods are capable of reliably identifying a saltwater-saturated zone in the unconfined aquifer. Geophysical data indicated that the impermeable clay between aquifers may be more continuous than is supported by current models.

  15. Saltwater contamination in the managed low-lying farmland of the Venice coast, Italy: An assessment of vulnerability.

    Science.gov (United States)

    Da Lio, Cristina; Carol, Eleonora; Kruse, Eduardo; Teatini, Pietro; Tosi, Luigi

    2015-11-15

    The original morphology and hydrogeology of many low-lying coastlands worldwide have been significantly modified over the last century through river diversion, embankment built-up, and large-scale land reclamation projects. This led to a progressive shifting of the groundwater-surficial water exchanges from naturally to anthropogenically driven. In this human-influenced hydrologic landscape, the saltwater contamination usually jeopardizes the soil productivity. In the coastland south of Venice (Italy), several well log measurements, chemical and isotope analyses have been performed over the last decade to characterize the occurrence of the salt contamination. The processing of this huge dataset highlights a permanent variously-shaped saline contamination up to 20km inland, with different conditions in relation with the various geomorphological features of the area. The results point out the important role of the land reclamation in shaping the present-day salt contamination and reveal the contribution of precipitation, river discharge, lagoon and sea water to the shallow groundwater in the various coastal sectors. Moreover, an original vulnerability map to salt contamination in relation to the farmland productivity has been developed taking into account the electrical conductivity of the upper aquifer in the worst condition, the ground elevation, and the distance from salt and fresh surface water sources. Finally, the study allows highlighting the limit of traditional investigations in monitoring saltwater contamination at the regional scale in managed Holocene coastal environments. Possible improvements are outlined. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Effects of sea-level rise and pumpage elimination on saltwater intrusion in the Hilton Head Island area, South Carolina, 2004-2104

    Science.gov (United States)

    Payne, Dorothy F.

    2010-01-01

    Saltwater intrusion of the Upper Floridan aquifer has been observed in the Hilton Head area, South Carolina since the late 1970s and currently affects freshwater supply. Rising sea level in the Hilton Head Island area may contribute to the occurrence of and affect the rate of saltwater intrusion into the Upper Floridan aquifer by increasing the hydraulic gradient and by inundating an increasing area with saltwater, which may then migrate downward into geologic units that presently contain freshwater. Rising sea level may offset any beneficial results from reductions in groundwater pumpage, and thus needs to be considered in groundwater-management decisions. A variable-density groundwater flow and transport model was modified from a previously existing model to simulate the effects of sea-level rise in the Hilton Head Island area. Specifically, the model was used to (1) simulate trends of saltwater intrusion from predevelopment to the present day (1885-2004) and evaluate the conceptual model, (2) project these trends from the present day into the future based on different potential rates of sea-level change, and (3) evaluate the relative influences of pumpage and sea-level rise on saltwater intrusion. Four scenarios were simulated for 2004-2104: (1) continuation of the estimated sea-level rise rate over the last century, (2) a doubling of the sea-level rise, (3) a cessation of sea-level rise, and (4) continuation of the rate over the last century coupled with an elimination of all pumpage. Results show that, if present-day (year 2004) pumping conditions are maintained, the extent of saltwater in the Upper Floridan aquifer will increase, whether or not sea level continues to rise. Furthermore, if all pumpage is eliminated and sea level continues to rise, the simulated saltwater extent in the Upper Floridan aquifer is reduced. These results indicate that pumpage is a strong driving force for simulated saltwater intrusion, more so than sea-level rise at current rates

  17. Eosinophilic Fasciitis

    Science.gov (United States)

    ... MD, Assistant Professor, Division of Rheumatology and Clinical Immunology , Robert Larner, MD, College of Medicine, The University ... pneumonia in immunocompromised people ). Drugs Mentioned In This Article Generic Name Select Brand Names azathioprine IMURAN cyclosporine ...

  18. Plantar Fasciitis

    Science.gov (United States)

    ... the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should ... Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care ...

  19. EFFECT OF KINESIO TAPING IN ADJUNCT TO CONVENTIONAL THERAPY IN REDUCING PAIN AND IMPROVING FUNCTIONAL ABILITY IN INDIVIDUALS WITH PLANTAR FASCIITIS A RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    S.Tulasi Ratna

    2015-08-01

    Full Text Available Background: Plantar fasciitis is one of the most common musculoskeletal disorders of foot. The pain and discomfort associated with this condition has a dramatic impact on physical mobility and function. Treatment of this condition is usually conservative; however, review of literature revealed no clinical studies demonstrating the efficacy of any targeted treatment for this condition. Methods: This was a prospective study which included 60 subjects with plantar fasciitis, who were randomly divided into two groups. Subjects in group I received ultrasound and exercise therapy while subjects in group II received kinesio tape in addition to ultrasound and exercise therapy. Patients were evaluated at the beginning of the study and at the end of three weeks using VAS (visual analogue scale for pain intensity, PFPS (plantar fasciitis pain / disability scale for functional ability and ultra sonography for any change in the caliber of plantar fascia. Results: A statistically significant difference in improvement was noted within the groups and between the groups in terms of visual analogue scale and plantar fasciitis pain /disability scale score (p0.05. Conclusion: Kinesio taping can be used as an adjunct to conventional therapy in clinical application for greater improvement in pain levels and functional ability in patients with plantar fasciitis.

  20. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Michael M. Neeki

    2017-05-01

    Full Text Available Introduction: Necrotizing fasciitis (NF is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. Methods: This was a 10-year retrospective chart-review study that included emergency department (ED patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0–13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8, moderate risk (LRINEC score 6–7, and low risk (LRINEC score ≤5. All cases missing laboratory values were due to the absence of a C-reactive protein (CRP value. Since the score for a negative or positive CRP value for the LRINEC score was 0 or 4 respectively, a LRINEC score of 0 or 1 without a CRP value would have placed the patient in the “low risk” group and a LRINEC score of 8 or greater without CRP value would have placed the patient in the “high risk” group. These patients missing CRP values were added to these respective groups. Results: Among the 948 ED patients with cellulitis, more than one-tenth (10.7%, n=102 of 948 were moderate or high risk for NF based on LRINEC score. Of the 135 ED patients with a diagnosis of NF, 22 patients had valid CRP laboratory values and LRINEC scores were calculated. Among the other 113 patients without CRP values, six patients had a LRINEC score ≥ 8, and 19 patients had a LRINEC score ≤ 1. Thus, a total of 47 patients were further classified based on LRINEC score without a CRP value

  1. Bubble-size distributions produced by wall injection of air into flowing freshwater, saltwater and surfactant solutions

    Science.gov (United States)

    Winkel, Eric S.; Ceccio, Steven L.; Dowling, David R.; Perlin, Marc

    2004-12-01

    As air is injected into a flowing liquid, the resultant bubble characteristics depend on the properties of the injector, near-wall flow, and flowing liquid. Previous research has shown that near-wall bubbles can significantly reduce skin-friction drag. Air was injected into the turbulent boundary layer on a test section wall of a water tunnel containing various concentrations of salt and surfactant (Triton-X-100, Union Carbide). Photographic records show that the mean bubble diameter decreased monotonically with increasing salt and surfactant concentrations. Here, 33 ppt saltwater bubbles had one quarter, and 20 ppm Triton-X-100 bubbles had one half of the mean diameter of freshwater bubbles.

  2. Potential effects of deepening the St. Johns River navigation channel on saltwater intrusion in the surficial aquifer system, Jacksonville, Florida

    Science.gov (United States)

    Bellino, Jason C.; Spechler, Rick M.

    2013-01-01

    The U.S. Army Corps of Engineers (USACE) has proposed dredging a 13-mile reach of the St. Johns River navigation channel in Jacksonville, Florida, deepening it to depths between 50 and 54 feet below North American Vertical Datum of 1988. The dredging operation will remove about 10 feet of sediments from the surficial aquifer system, including limestone in some locations. The limestone unit, which is in the lowermost part of the surficial aquifer system, supplies water to domestic wells in the Jacksonville area. Because of density-driven hydrodynamics of the St. Johns River, saline water from the Atlantic Ocean travels upstream as a saltwater “wedge” along the bottom of the channel, where the limestone is most likely to be exposed by the proposed dredging. A study was conducted to determine the potential effects of navigation channel deepening in the St. Johns River on salinity in the adjacent surficial aquifer system. Simulations were performed with each of four cross-sectional, variable-density groundwater-flow models, developed using SEAWAT, to simulate hypothetical changes in salinity in the surficial aquifer system as a result of dredging. The cross-sectional models were designed to incorporate a range of hydrogeologic conceptualizations to estimate the effect of uncertainty in hydrogeologic properties. The cross-sectional models developed in this study do not necessarily simulate actual projected conditions; instead, the models were used to examine the potential effects of deepening the navigation channel on saltwater intrusion in the surficial aquifer system under a range of plausible hypothetical conditions. Simulated results for modeled conditions indicate that dredging will have little to no effect on salinity variations in areas upstream of currently proposed dredging activities. Results also indicate little to no effect in any part of the surficial aquifer system along the cross section near River Mile 11 or in the water-table unit along the cross

  3. Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis.

    Science.gov (United States)

    Chang, Ryan; Rodrigues, Pedro A; Van Emmerik, Richard E A; Hamill, Joseph

    2014-08-22

    Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF). We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms(-1). Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (pfoot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Bilateral Necrotizing Fasciitis of the Foot Associated with Group B Streptococcus

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    Keitaro Fukuda

    2016-09-01

    Full Text Available Necrotizing fasciitis (NF is a severe bacterial infection involving fascia and subcutaneous tissue. It generally affects upper or lower extremities unilaterally, and there are few reports of bilateral-extremity NF. Here, we report a case of a 43-year-old male with type 1 diabetes who had NF on the left foot and subsequently developed NF on the other foot 1 week later. The patient survived with antimicrobial therapy and bilateral below-knee amputation. As group B streptococcus (GBS was isolated by blood culture and culture of excised tissues of both feet, bilateral GBS NF of the foot was diagnosed. GBS is a rare causative pathogen in NF; however, there have been two case reports of bilateral GBS NF of an extremity in which NF appeared on the opposite extremity 1 week after the primary site infection, as in our case. GBS was isolated from cultures of blood and excised tissues of both extremities in both cases. Together, these observations suggest that GBS has a potential to cause secondary NF at remote sites by hematogenous dissemination with approximately 1 week delay and thereby lead to bilateral NF.

  5. Antibacterial Derivatives of Ciprofloxacin to Inhibit Growth of Necrotizing Fasciitis Associated Penicillin Resistant Escherichia coli

    Directory of Open Access Journals (Sweden)

    Ronald Bartzatt

    2013-01-01

    Full Text Available Escherichia coli (E. coli is associated with necrotizing fasciitis (type I and can induce enough damage to tissue causing hypoxia. Three ester derivatives of the broad-spectrum antibiotic ciprofloxacin were placed into bacteria culture simultaneously with the parent ciprofloxacin (drug 1 to ascertain the level of antibacterial activity. The n-propyl (drug 2, n-pentyl (drug 3, and n-octyl (drug 4 esters of ciprofloxacin were synthesized under mixed phase conditions and by microwave excitation. The formation of ester derivatives of ciprofloxacin modified important molecular properties such as Log P and polar surface area which improves tissue penetration, yet preserved strong antibacterial activity. The Log P values for drugs 1, 2, 3, and 4 became −0.701, 0.437, 1.50, and 3.02, respectively. The polar surface areas for drugs 1, 2, 3, and 4 were determined to be 74.6 Angstroms2, 63.6 Angstroms2, 63.6 Angstroms2, and 63.6 Angstroms2, respectively. These values of Log P and polar surface area improved tissue penetration, as indicated by the determination of dermal permeability coefficient (Kp and subsequently into the superficial fascial layer. All drugs induced greater than 60% bacterial cell death at concentrations less than 1.0 micrograms/milliliter. The ester derivatives of ciprofloxacin showed strong antibacterial activity toward penicillin resistant E. coli.

  6. Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Samuel B. Weimer

    2017-01-01

    Full Text Available Introduction. Necrotizing fasciitis (NF is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV infection. Case Report. A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Conclusion. NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.

  7. Effectiveness of Plantar Fascia-Specific Stretching Exercises in Plantar Fasciitis

    Directory of Open Access Journals (Sweden)

    Devrim Özer

    2015-12-01

    Full Text Available Aim: Plantar fasciitis (PF is a painful and disabling disease that affects the quality of life and daily activities of patients and it is the most common cause of heel pain in adults. In primary treatment, conservative treatment is suggested and different conservative options are described in the literature. In our study, we evaluated the efficacy of plantar fascia-specific stretching exercises in the treatment of PF. Methods: Twenty-nine feet - 21 patients with the mean age of 49.3 years were included in the study. The mean length of follow-up was 19.8 months and the mean length of exercise period was 4.94 months. Non-weight bearing plantar fascia-specific stretching exercise was done twice daily, for 10 times at each session. In addition to exercises, silicone heel pad and nonsteroidal anti-inflammatory drugs (NSAID were added. Visual analog scale (VAS was used for pain evaluation. Results: Full recovery detected in 15 feet in 10 patients (52% and a decrease in pain was seen in 10 feet in 8 patients (34%. There was no response in 4 feet in 3 patients (14%. There was statistically significant difference between pre-treatment and post-treatment visual analog scale scores (p=0.0001. Conclusion: Plantar fascia-specific stretching exercise is an effective treatment option in PF.

  8. Static, dynamic balance and functional performance in subjects with and without plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Geiseane Aguiar Gonçalves

    Full Text Available Abstract Introduction: Plantar fasciitis (PF is characterized by non-inflammatory degeneration and pain under the heel, and is one of the most common foot complaints. The compensations and adjustments made to decrease the discomfort caused by the disease are clinical findings and can be a factor that contributes to impaired balance and decreased functional performance. Objective: To compare functional performance as well as static and dynamic balance among subjects with and without PF. Methods: The sample consisted of 124 subjects of both sexes aged 20-60 years. Participants were divided into two groups: a bilateral PF group (PFG; n = 62 and a control group (CG, n = 62. The following outcomes were analyzed: static and dynamic balance (using functional tests and functional performance (using a questionnaire. We used Student’s t test for independent samples to compare variables between the groups. The alpha error was set at 0.05. Results: Subjects with PF showed greater impairment in their overall dynamic balance performance (p < 0.001 than the control group, except for left posteromedial movement (p = 0.19. The CG showed showed better functional performance (p < 0.001 than the PF group. There was no difference between groups for the variable static balance on stable (p = 0.160 and unstable surfaces (p = 0.085. Conclusion: Subjects with PF displayed smaller reach distances in the overall Star Excursion Balance Test (SEBT, demonstrating a deficit in dynamic balance and functional performance when compared with healthy subjects.

  9. Necrotizing fasciitis after scrotum skin injury in an infant: A case report.

    Science.gov (United States)

    Ren, Z X; Liu, C L; Zhang, Q; Xu, F; Zheng, Y N; Li, X J; Yang, J

    2018-03-01

    Necrotizing fasciitis (NF) is a life-threatening situation that is rare in children, especially infants, and early diagnosis is challenging. Timely identification and broad-spectrum antibiotic and supportive treatment before surgical debridement are very important for survival and may reduce scar formation. A previously healthy 4-month-old infant was admitted to our pediatric intensive care unit (PICU) with a history of fever and cough for 5 days and extreme swelling of the scrotum for one day. Necrotic-like tissue without margins appeared on his scrotum and perineum in 24 hours. NF was suspected, and the patient soon developed shock. The patient underwent surgical debridement after his condition stabilized. Pathological analysis confirmed the diagnosis of NF. Broad-spectrum antibiotic, immediate fluid resuscitation, assistant ventilation, and vasoactive drugs were administered. Surgical debridement and autologous split-thickness skin grafting were performed. The wound recovered well after 2 months. Ultrasound revealed normal testicles, and no anorectal injury was found. Close clinical monitoring and timely treatment of skin injuries in sick children are very important. Sufficient antibiotic administration and supportive treatment before surgical debridement are crucial for survival from NF.

  10. Simulation of groundwater flow pathlines and freshwater/saltwater transition zone movement, Manhasset Neck, Nassau County, New York

    Science.gov (United States)

    Misut, Paul; Aphale, Omkar

    2014-01-01

    A density-dependent groundwater flow and solute transport model of Manhasset Neck, Long Island, New York, was used to analyze (1) the effects of seasonal stress on the position of the freshwater/saltwater transition zone and (2) groundwater flowpaths. The following were used in the simulation: 182 transient stress periods, representing the historical record from 1920 to 2011, and 44 transient stress periods, representing future hypothetical conditions from 2011 to 2030. Simulated water-level and salinity (chloride concentration) values are compared with values from a previously developed two-stress-period (1905–1944 and 1945–2005) model. The 182-stress-period model produced salinity (chloride concentration) values that more accurately matched the observed salinity (chloride concentration) values in response to hydrologic stress than did the two-stress-period model, and salinity ranged from zero to about 3 parts per thousand (equivalent to zero to 1,660 milligrams per liter chloride). The 182-stress-period model produced improved calibration statistics of water-level measurements made throughout the study area than did the two-stress-period model, reducing the Lloyd aquifer root mean square error from 7.0 to 5.2 feet. Decreasing horizontal and vertical hydraulic conductivities (fixed anisotropy ratio) of the Lloyd and North Shore aquifers by 20 percent resulted in nearly doubling the simulated salinity(chloride concentration) increase at Port Washington observation well N12508. Groundwater flowpath analysis was completed for 24 production wells to delineate water source areas. The freshwater/saltwater transition zone moved toward and(or) away from wells during future hypothetical scenarios.

  11. Dissolved carbon dynamics in the freshwater-saltwater mixing zone of a coastal river entering the Northern Gulf of Mexico

    Science.gov (United States)

    He, S.; Xu, Y. J.

    2017-12-01

    Estuaries play an important role in the dynamics of dissolved carbon from freshwater to marine systems. This study aims to determine how dissolved inorganic carbon (DIC) and dissolved organic carbon (DOC) concentrations change along an 88-km long estuarine river with salinity ranging from 0.02 to 29.50. The study is expected to elucidate which processes most likely control carbon dynamics in a freshwater-saltwater mixing system, and to evaluate the net metabolism of this estuary using mixing curves and stable isotope analyses. From November 2014 to February 2016, water samples were collected and in-situ measurements on ambient water conditions were performed during eighteen field trips at six sites from upstream to downstream of the Calcasieu River, which enters the Northern Gulf of Mexico in the southern United States. δ13CDIC and δ13CDOC were measured from May 2015 to February 2017 during five of the field trips. The DIC concentration and δ13CDIC increased rapidly with increasing salinity in the mixing zone. The DIC concentrations appeared to be largely influenced by conservative mixing. The δ13CDIC values were close to those suggested by the conservative mixing model for May 2015, June 2015 and November 2015, but lower than those for July 2015 and February 2016, suggesting that an estuarine river can fluctuate from a balanced to a heterotrophic system (i.e., production/respiration aquatic photosynthesis from carbon produced by terrestrial photosynthesis in a river-ocean continuum. These findings suggest that riverine dissolved carbon undergoes a rapid change in freshwater-saltwater mixing, and that these dynamics should be taken into account in carbon processing and budgeting in the world's estuarine systems.

  12. Linking river, floodplain, and vadose zone hydrology to improve restoration of a coastal river affected by saltwater intrusion.

    Science.gov (United States)

    Kaplan, D; Muñoz-Carpena, R; Wan, Y; Hedgepeth, M; Zheng, F; Roberts, R; Rossmanith, R

    2010-01-01

    Floodplain forests provide unique ecological structure and function, which are often degraded or lost when watershed hydrology is modified. Restoration of damaged ecosystems requires an understanding of surface water, groundwater, and vadose (unsaturated) zone hydrology in the floodplain. Soil moisture and porewater salinity are of particular importance for seed germination and seedling survival in systems affected by saltwater intrusion but are difficult to monitor and often overlooked. This study contributes to the understanding of floodplain hydrology in one of the last bald cypress [Taxodium distichum (L.) Rich.] floodplain swamps in southeast Florida. We investigated soil moisture and porewater salinity dynamics in the floodplain of the Loxahatchee River, where reduced freshwater flow has led to saltwater intrusion and a transition to salt-tolerant, mangrove-dominated communities. Twenty-four dielectric probes measuring soil moisture and porewater salinity every 30 min were installed along two transects-one in an upstream, freshwater location and one in a downstream tidal area. Complemented by surface water, groundwater, and meteorological data, these unique 4-yr datasets quantified the spatial variability and temporal dynamics of vadose zone hydrology. Results showed that soil moisture can be closely predicted based on river stage and topographic elevation (overall Nash-Sutcliffe coefficient of efficiency = 0.83). Porewater salinity rarely exceeded tolerance thresholds (0.3125 S m(-1)) for bald cypress upstream but did so in some downstream areas. This provided an explanation for observed vegetation changes that both surface water and groundwater salinity failed to explain. The results offer a methodological and analytical framework for floodplain monitoring in locations where restoration success depends on vadose zone hydrology and provide relationships for evaluating proposed restoration and management scenarios for the Loxahatchee River.

  13. Salt-water encroachment in southern Nassau and southeastern Queens Counties, Long Island, New York

    Science.gov (United States)

    Lusczynski, N.J.; Swarzenski, Wolfgang V.

    1966-01-01

    deposits. It extends from the seaward areas inland about 2 miles into Island Park. The deep wedge extends into southeastern Queens County and southern Nassau County principally in the deeper parts of the Magothy (?) Formation and in the underlying clay member of the Raritan Formation. The leading edge of the deep wedge is at the base of the Magothy (?) Formation. This edge is apparently at the shoreline east of Lido Beach and extends inland about 4 miles to Woodmere and about 7 miles to South Ozone Park. Zones of diffusion as much as 6 miles wide and about 500 feet thick were delineated in the frontal part of the salty-water wedges. These thick and broad zones of diffusion were probably formed during the past 1,000 or more years in heterogeneous unconsolidated deposits by long- and short-term changes in sea level and in fresh-water outflow to the sea and by dispersion caused by the movements of the water and its salt mass. Changes in sea level and fresh-water outflow together produced appreciable advances and recessions of the salt-water front. The chemical compositions of the diffused water in all wedges are modified to some extent by base exchange and other physical and chemical processes and also by diffusion. The intermediate wedge of salty water is moving landward at a rate of less than 20 feet a year in the vicinity of Island Park and, thus, has moved less than 1,000 feet since 1900. The leading edge of the deep wedge has advanced landward at about 300 feet a :ear in Woodmere in southwestern Nassau County and about 160 feet a year at South Ozone Park in southeastern Queens County, principally under the influence of local withdrawals near the toe of the wedge. Between Hewlett and Lido Beach, the deep wedge is moving inland at the rate of about 10 feet a year under the influence of regional withdrawals in inland areas. Regional encroachment of the deep wedge is apparently retarded appreciably by cyclic flow, that is, by the return seaward in the upper

  14. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    International Nuclear Information System (INIS)

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-01-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment

  15. Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis.

    Science.gov (United States)

    Gurcay, Eda; Kara, Murat; Karaahmet, Ozgur Zeliha; Ata, Ayşe Merve; Onat, Şule Şahin; Özçakar, Levent

    We compared the effectiveness of ultrasound (US)-guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p plantar fascia thickness had decreased significantly in both groups at the sixth week (p  .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US-guided corticosteroid injections are safe and effective in the short-term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot-related quality of life. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    Energy Technology Data Exchange (ETDEWEB)

    Canyilmaz, Emine, E-mail: dremocan@ktu.edu.tr [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Canyilmaz, Fatih [Department of Orthopaedics and Traumatology, Yavuz Selim Bone Disease and Rehabilitation Hospital, Trabzon (Turkey); Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Uslu, Gonca Hanedan [Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon (Turkey); Aynaci, Osman [Department of Orthopaedics and Traumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Yoney, Adnan [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey)

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  17. Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Joo; Kim, Ju Dong; Ryu, Hye In; Cho, Yeon Hee; Kong, Jun Ha; Ohe, Joo Young; Kwon, Yong Dae; Choi, Byung Joon; Kim, Gyu Tae [School of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)

    2011-12-15

    The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.

  18. New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

    Science.gov (United States)

    Yin, Mengchen; Chen, Ni; Huang, Quan; Marla, Anastasia Sulindro; Ma, Junming; Ye, Jie; Mo, Wen

    2017-12-01

    To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. Randomized, controlled, prospective study. Outpatient of local medical center settings. Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm 2 , respectively (a rate of 8 impulses per second), were applied. The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e [.011+42.807×heel spur+.109×edema+5.395×VAS score] ) -1 .The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The

  19. [Necrotizing fasciitis: results of a survey on management practices in French-speaking intensive care units].

    Science.gov (United States)

    de Prost, N; Bosc, R; Brun-Buisson, C; Chosidow, O; Decousser, J-W; Dhonneur, G; Lepeule, R; Rahmouni, A; Sbidian, E; Amathieu, R

    2014-12-01

    Necrotizing fasciitis (NF) are rare and severe soft tissue infections associated with a high mortality rate. In order to assess the management of NF in French-speaking intensive care units (ICUs), we conducted a survey endorsed by the French Society of Anesthesia and Intensive Care (SFAR). Online self-administered survey. A link to an online survey was sent by email to 4620 anesthesiologists and/or intensivists and was available online from January to February 2014. One hundred and seventy-five physicians (3.8%) who worked in 135 ICUs filled out the online survey. Among respondents, 42% reported having managed up to two patients with NF during the previous year; 59% and 72% of respondents reported not having a surgical and a medical specialist consultant, respectively. A delayed access to the operating room (OR) of more than 6hours was reported in 31% of cases and access to the OR was reported not to be routinely considered as a priority in 13% of cases. Only 17% of respondents reported that time to transfer to the OR was never a cause for delayed surgery. The main causes for delayed surgery were: delayed diagnosis (45%), delayed validation of surgical intervention (37%), and difficulty of access to the OR (8%). Finally, 83% of respondents estimated that creating dedicated multidisciplinary teams for managing NFs could lead to improving outcomes. This survey illustrates the heterogeneous management of NF in French-speaking ICUs and points out several logistical aspects that should be improved to reduce the time to the first surgical debridement. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  20. Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review.

    Science.gov (United States)

    Fraser, John J; Corbett, Revay; Donner, Chris; Hertel, Jay

    2018-05-01

    To assess if manual therapy (MT) in the treatment of plantar fasciitis (PF) patients improves pain and function more effectively than other interventions. A systematic review of all randomized control trials (RCTs) investigating the effects of MT in the treatment of human patients with PF, plantar fasciosis, and heel pain published in English on PubMed, CINAHL, Cochrane, and Web of Science databases was conducted. Research quality was appraised utilizing the PEDro scale. Cohen's d effect sizes (ES) and associated 95% confidence intervals (CI) were calculated between treatment groups. Seven RCTs were selected that employed MT as a primary independent variable and pain and function as dependent variables. Inclusion of MT in treatment yielded greater improvement in function (6 of 7 studies, CI that did not cross zero in 14 of 25 variables, ES = 0.5-21.5) and algometry (3 of 3 studies, CI that did not cross zero in 9 of 10 variables, ES = 0.7-3.0) from 4 weeks to 6 months when compared to interventions such as stretching, strengthening, or modalities. Though pain improved with the inclusion of MT, ES calculations favored MT in only 2 of 6 studies (3 of 13 variables) and was otherwise equivalent in effectiveness to comparison interventions. MT is clearly associated with improved function and may be associated with pain reduction in PF patients. It is recommended that clinicians consider use of both joint and soft tissue mobilization techniques in conjunction with stretching and strengthening when treating patients with PF. Treatment, level 1a.

  1. Foot mobility and plantar fascia elasticity in patients with plantar fasciitis.

    Science.gov (United States)

    Sahin, Namık; Oztürk, Alpaslan; Atıcı, Teoman

    2010-01-01

    In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (pplantar fascia elasticity, which may lead to posterior heel pain syndrome.

  2. ULTRASONOGRAPHY, AN EFFECTIVE TOOL IN DIAGNOSING PLANTAR FASCIITIS: A SYSTEMATIC REVIEW OF DIAGNOSTIC TRIALS

    Science.gov (United States)

    Wyland, Matthew; Applequist, Lee; Bolowsky, Erin; Klingensmith, Heather; Virag, Isaac

    2016-01-01

    Background Plantar fasciitis (PF) is the most common cause of heel pain that affects 10% of the general population, whether living an athletic or sedentary lifestyle. The most frequent mechanism of injury is an inflammatory response that is caused by repetitive micro trauma. Many techniques are available to diagnose PF, including the use of ultrasonography (US). Purpose The purpose of this study is to systematically review and appraise previously published articles published between the years 2000 and 2015 that evaluated the effectiveness of using US in the process of diagnosing PF, as compared to alternative diagnostic methods. Methods A total of eight databases were searched to systematically review scholarly (peer reviewed) diagnostic and intervention articles pertaining to the ability of US to diagnose PF. Results Using specific key words the preliminary search yielded 264 articles, 10 of which were deemed relevant for inclusion in the study. Two raters independently scored each article using the 15 point modified QUADAS scale. Discussion Six studies compared the diagnostic efficacy of US to another diagnostic technique to diagnose PF, and four studies focused on comparing baseline assessment of plantar fascia before subsequent intervention. The most notable US outcomes measured were plantar fascia thickness, enthesopathy, and hypoechogenicity. Conclusion US was found to be accurate and reliable compared to alternative reference standards like MRI in the diagnosis of PF. The general advantages of US (e.g. cost efficient, ease of administration, non-invasive, limited contraindications) make it a superior diagnostic modality in the diagnosis of PF. US should be considered in rehabilitation clinics to effectively diagnose PF and to accurately monitor improvement in the disease process following rehabilitation interventions. Level of Evidence 1A PMID:27757279

  3. Functional genomic characterization of virulence factors from necrotizing fasciitis-causing strains of Aeromonas hydrophila.

    Science.gov (United States)

    Grim, Christopher J; Kozlova, Elena V; Ponnusamy, Duraisamy; Fitts, Eric C; Sha, Jian; Kirtley, Michelle L; van Lier, Christina J; Tiner, Bethany L; Erova, Tatiana E; Joseph, Sandeep J; Read, Timothy D; Shak, Joshua R; Joseph, Sam W; Singletary, Ed; Felland, Tracy; Baze, Wallace B; Horneman, Amy J; Chopra, Ashok K

    2014-07-01

    The genomes of 10 Aeromonas isolates identified and designated Aeromonas hydrophila WI, Riv3, and NF1 to NF4; A. dhakensis SSU; A. jandaei Riv2; and A. caviae NM22 and NM33 were sequenced and annotated. Isolates NF1 to NF4 were from a patient with necrotizing fasciitis (NF). Two environmental isolates (Riv2 and -3) were from the river water from which the NF patient acquired the infection. While isolates NF2 to NF4 were clonal, NF1 was genetically distinct. Outside the conserved core genomes of these 10 isolates, several unique genomic features were identified. The most virulent strains possessed one of the following four virulence factors or a combination of them: cytotoxic enterotoxin, exotoxin A, and type 3 and 6 secretion system effectors AexU and Hcp. In a septicemic-mouse model, SSU, NF1, and Riv2 were the most virulent, while NF2 was moderately virulent. These data correlated with high motility and biofilm formation by the former three isolates. Conversely, in a mouse model of intramuscular infection, NF2 was much more virulent than NF1. Isolates NF2, SSU, and Riv2 disseminated in high numbers from the muscular tissue to the visceral organs of mice, while NF1 reached the liver and spleen in relatively lower numbers on the basis of colony counting and tracking of bioluminescent strains in real time by in vivo imaging. Histopathologically, degeneration of myofibers with significant infiltration of polymorphonuclear cells due to the highly virulent strains was noted. Functional genomic analysis provided data that allowed us to correlate the highly infectious nature of Aeromonas pathotypes belonging to several different species with virulence signatures and their potential ability to cause NF. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  4. Whole-Genome Sequencing of a Human Clinical Isolate of emm28 Streptococcus pyogenes Causing Necrotizing Fasciitis Acquired Contemporaneously with Hurricane Harvey

    OpenAIRE

    Long, S. Wesley; Kachroo, Priyanka; Musser, James M.; Olsen, Randall J.

    2017-01-01

    ABSTRACT We discovered an emm28 Streptococcus pyogenes isolate causing necrotizing fasciitis in a patient exposed to the floodwaters of Hurricane Harvey in the Houston, TX, metropolitan area in August 2017. The Oxford Nanopore MinION instrument provided sufficient genome sequence data within 1 h of beginning sequencing to close the genome.

  5. Necrotising fasciitis as atypical presentation of infection with emerging Neisseria meningitidis serogroup W (MenW) clonal complex 11, the Netherlands, March 2017

    NARCIS (Netherlands)

    Russcher, Anne; Fanoy, Ewout; van Olden, Ger D. J.; Graafland, Antonie D.; van der Ende, Arie; Knol, Mirjam J.

    2017-01-01

    In March 2017, a patient with necrotising fasciitis caused by Neisseria meningitidis serogroup W (MenW) clonal complex 11 was diagnosed in the Netherlands. Unusual and severe presentations of MenW infections are common in the current European epidemic. In the Netherlands, the incidence of MenW

  6. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.

    Science.gov (United States)

    Mohseni-Bandpei, Mohammad Ali; Nakhaee, Masoomeh; Mousavi, Mohammad Ebrahim; Shakourirad, Ali; Safari, Mohammad Reza; Vahab Kashani, Reza

    2014-08-01

    Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  7. Two Paraneoplastic Autoimmune Syndromes: Limbic Encephalitis and Palmar Fasciitis in a Patient with Small Cell Lung Cancer.

    Science.gov (United States)

    Lazarev, Irina; Shelef, Ilan; Refaely, Yael; Ariad, Samuel; Ifergane, Gal

    2015-09-07

    Small cell lung cancer (SCLC) is characterized by a relatively high rate of autoimmune phenomena. Paraneoplastic limbic encephalitis (PLE) is an autoimmune syndrome in which a non-neural tumor containing an antigen normally present in the nervous system precipitates an antibody attack on neural tissues. Patients with PLE usually present with rapidly progressive short-term memory deficits, confusion or even dementia. Palmar fasciitis and polyarthritis syndrome (PFPAS) is another autoimmune syndrome characterized by rheumatologic manifestations, especially involving the palms of the hands. We report a case of a 59-year old woman who presented with worsening neurological symptoms of two-week duration, and later coma. The combined clinical, serological, and imaging studies suggested a diagnosis of PLE. A chest computed tomographic scan showed a 1.2 cm-diameter mass in the upper lobe of the left lung that was surgically removed and showed SCLC. Following surgery, neurological symptoms rapidly improved, allowing the patient to receive adjuvant chemotherapy. While in remission for both SCLC and PLE, the patient developed pain, soft-tissue swelling, and stiffness in both palms, suggesting the diagnosis of PFPAS. Five months following the diagnosis of palmar fasciitis, SCLC relapsed with mediastinal and cervical lymphadenopathy. This case report underlines the continuous interaction of SCLC with the immune system, expressed by coexistence of two rare paraneoplastic diseases, PLE, and PFPAS, in a patient with SCLC. While symptoms related to PLE preceded the initial diagnosis of SCLC, other symptoms related to PFPAS preceded relapse.

  8. Two paraneoplastic autoimmune syndromes: limbic encephalitis and palmar fasciitis in a patient with small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Irina Lazarev

    2015-09-01

    Full Text Available Small cell lung cancer (SCLC is characterized by a relatively high rate of autoimmune phenomena. Paraneoplastic limbic encephalitis (PLE is an autoimmune syndrome in which a non-neural tumor containing an antigen normally present in the nervous system precipitates an antibody attack on neural tissues. Patients with PLE usually present with rapidly progressive short-term memory deficits, confusion or even dementia. Palmar fasciitis and polyarthritis syndrome (PFPAS is another autoimmune syndrome characterized by rheumatologic manifestations, especially involving the palms of the hands. We report a case of a 59-year old woman who presented with worsening neurological symptoms of two-week duration, and later coma. The combined clinical, serological, and imaging studies suggested a diagnosis of PLE. A chest computed tomographic scan showed a 1.2 cm-diameter mass in the upper lobe of the left lung that was surgically removed and showed SCLC. Following surgery, neurological symptoms rapidly improved, allowing the patient to receive adjuvant chemotherapy. While in remission for both SCLC and PLE, the patient developed pain, soft-tissue swelling, and stiffness in both palms, suggesting the diagnosis of PFPAS. Five months following the diagnosis of palmar fasciitis, SCLC relapsed with mediastinal and cervical lymphadenopathy. This case report underlines the continuous interaction of SCLC with the immune system, expressed by coexistence of two rare paraneoplastic diseases, PLE, and PFPAS, in a patient with SCLC. While symptoms related to PLE preceded the initial diagnosis of SCLC, other symptoms related to PFPAS preceded relapse.

  9. Hydrogeology, water quality, and saltwater intrusion in the Upper Floridan Aquifer in the offshore area near Hilton Head Island, South Carolina, and Tybee Island, Georgia, 1999-2002

    Science.gov (United States)

    Falls, W. Fred; Ransom, Camille; Landmeyer, James E.; Reuber, Eric J.; Edwards, Lucy E.

    2005-01-01

    To assess the hydrogeology, water quality, and the potential for saltwater intrusion in the offshore Upper Floridan aquifer, a scientific investigation was conducted near Tybee Island, Georgia, and Hilton Head Island, South Carolina. Four temporary wells were drilled at 7, 8, 10, and 15 miles to the northeast of Tybee Island, and one temporary well was drilled in Calibogue Sound west of Hilton Head Island. The Upper Floridan aquifer at the offshore and Calibogue sites includes the unconsolidated calcareous quartz sand, calcareous quartz sandstone, and sandy limestone of the Oligocene Lazaretto Creek and Tiger Leap Formations, and the limestone of the late Eocene Ocala Limestone and middle Avon Park Formation. At the 7-, 10-, and 15-mile sites, the upper confining unit between the Upper Floridan and surficial aquifers correlates to the Miocene Marks Head Formation. Paleochannel incisions have completely removed the upper confining unit at the Calibogue site and all but a 0.8-foot-thick interval of the confining unit at the 8-mile site, raising concern about the potential for saltwater intrusion through the paleochannel-fill sediments at these two sites. The paleochannel incisions at the Calibogue and 8-mile sites are filled with fine- and coarse-grained sediments, respectively. The hydrogeologic setting and the vertical hydraulic gradients at the 7- and 10-mile sites favored the absence of saltwater intrusion during predevelopment. After decades of onshore water use in Georgia and South Carolina, the 0-foot contour in the regional cone of depression of the Upper Floridan aquifer is estimated to have been at the general location of the 7- and 10-mile sites by the mid-1950s and at or past the 15-mile site by the 1980s. The upward vertical hydraulic gradient reversed, but the presence of more than 17 feet of upper confining unit impeded the downward movement of saltwater from the surficial aquifer to the Upper Floridan aquifer at the 7- and 10-mile sites. At the 10

  10. Evaluation of Dicentrarchus labrax meats and the vegetable quality of Beta vulgaris var. Cicla farmed in freshwater and saltwater aquaponic systems

    OpenAIRE

    Nozzi, Valentina; Parisi, Giuliana; Di Crescenzo, Davide; Giordano, Mario; Carnevali, Oliana

    2016-01-01

    The purpose of this study is to exploit the euryhaline nature of commercially attractive species for their cultivation in freshwater aquaponic systems. This approach may increase the profitability of aquaponic production in coastal countries where the consumption of marine fish is traditional and of commercial relevance. For this purpose, juvenile European sea bass (Dicentrarchus labrax) were reared in an aquaponic freshwater (AFW) system and an aquaponic saltwater (ASW) system (salinity 20 p...

  11. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2012-01-01

    Full Text Available Background and Aim: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations. Materials and Methods: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm 2 in 3 sessions at weekly intervals or sham therapy (n = 20 in each group. Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients′ pain scores, performed at baseline and 12 weeks after completion of the therapy. Results : The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001, but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03. Both groups showed significant pain improvement over the course of the study (P < 0.001, though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049. Conclusions: Extracorporeal shock wave therapy contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.

  12. Analysis of impact of temperature and saltwater on Nannochloropsis salina bio-oil production by ultra high resolution APCI FT-ICR MS

    KAUST Repository

    Sanguineti, Michael Mario

    2015-05-01

    Concentrated Nannochloropsis salina paste was reconstituted in distilled water and synthetic saltwater and processed at 250°C and 300°C via hydrothermal liquefaction. The resulting bio-oils yielded a diverse distribution of product classes, as analyzed by ultra high resolution APCI FT-ICR MS. The organic fractions were analyzed and both higher temperatures and distilled water significantly increase the number of total compounds present and the number of product classes. Major bio-oil products consisted of N1O1, hydrocarbon, and O2 classes, while O1, O4, S1, N1O2, and N2O2 classes represented the more significant minor classes. Both chlorine and sulfur containing compounds were detected in both distilled and saltwater reactions, while fewer numbers of chlorine and sulfur containing products were present in the organic fraction of the saltwater reactions. Further refinement to remove the chlorine and sulfur contents appears necessary with marine microalgal bio-oils produced via hydrothermal liquefaction. The higher heating value (MJ/kg) as calculated by the Boie equation of classes of interest in the bio-oil reveals a significant potential of algal hydrothermal liquefaction products as a sustainable and renewable fuel feedstock. © 2015.

  13. Application of the top specified boundary layer (TSBL) approximation to initial characterization of an inland aquifer mineralization 1. Direct contact between fresh and saltwater

    Science.gov (United States)

    Rubin, H.; Buddemeier, R.W.

    1998-01-01

    This paper presents a basic study in generalized terms that originates from two needs: (1) to understand the major mechanisms involved in the mineralization of groundwater of the Great Bend Prairie aquifer of Kansas by saltwater originating from a deeper Permian bedrock formation, and (2) to develop simple, robust tools that can readily be used for local assessment and management activities in the salt-affected region. A simplified basic conceptual model is adopted, incorporating two horizontal layers of porous medium which come into contact at a specific location within the model domain. The top layer is saturated with freshwater, and the bottom layer is saturated with saltwater. The paper considers various stages of approximation which can be useful for simplified simulation of the build-up of the transition zone (TZ) between the freshwater and the saltwater. The hierarchy of approximate approaches leads to the development of the top specified boundary layer (TSBL) method, which is the major tool used in this study for initial characterization of the development of the TZ. It is shown that the thickness of the TZ is mainly determined by the characteristic dispersivity. The build-up of the TZ is completed after a time period equal to the time needed to advect a fluid particle along the whole extent of the TZ. Potential applications and the effects of natural recharge and pumpage on salinity transport in the domain are discussed and evaluated in the context of demonstrating the practicality of the TSBL approach.

  14. A novel method for rearing first-feeding larval zebrafish: polyculture with Type L saltwater rotifers (Brachionus plicatilis).

    Science.gov (United States)

    Best, Jason; Adatto, Isaac; Cockington, Jason; James, Althea; Lawrence, Christian

    2010-09-01

    Promoting high rates of growth and survival can be a major challenge in zebrafish culture, especially during the first-feeding stage. Here we describe a new rearing technique in which zebrafish larvae are polycultured in static tanks with Type "L" saltwater rotifers (Brachionus plicatilis) for the first 5 days of feeding (days 5-9 postfertilization). To demonstrate the effectiveness of this technique, we conducted rearing trials using fish from two different strains: AB and nacre. Growth, survival, water quality, and rotifer density were assayed daily through the polyculture phase (days 5-9), and during the transition to standard rearing conditions (days 10-12). After that point, once the fish were fully integrated onto recirculating systems, parameters were measured once per week out to day 30. In all trials, the fish displayed high rates of growth and survival throughout the three phases (polyculture, transition, and recirculating flow), indicating that this method may be employed during the critical first-feeding stage to help improve rearing performance in zebrafish facilities. Additionally, water quality parameters observed during the polyculture phase of the trials reveal that early zebrafish larvae are much more tolerant of elevated levels of ammonia and salinity than previously believed.

  15. Inferring spatial and temporal behavioral patterns of free-ranging manatees using saltwater sensors of telemetry tags

    Science.gov (United States)

    Castelblanco-Martínez, Delma Nataly; Morales-Vela, Benjamin; Slone, Daniel H.; Padilla-Saldívar, Janneth Adriana; Reid, James P.; Hernández-Arana, Héctor Abuid

    2015-01-01

    Diving or respiratory behavior in aquatic mammals can be used as an indicator of physiological activity and consequently, to infer behavioral patterns. Five Antillean manatees, Trichechus manatus manatus, were captured in Chetumal Bay and tagged with GPS tracking devices. The radios were equipped with a micropower saltwater sensor (SWS), which records the times when the tag assembly was submerged. The information was analyzed to establish individual fine-scale behaviors. For each fix, we established the following variables: distance (D), sampling interval (T), movement rate (D/T), number of dives (N), and total diving duration (TDD). We used logic criteria and simple scatterplots to distinguish between behavioral categories: ‘Travelling’ (D/T ≥ 3 km/h), ‘Surface’ (↓TDD, ↓N), ‘Bottom feeding’ (↑TDD, ↑N) and ‘Bottom resting’ (↑TDD, ↓N). Habitat categories were qualitatively assigned: Lagoon, Channels, Caye shore, City shore, Channel edge, and Open areas. The instrumented individuals displayed a daily rhythm of bottom activities, with surfacing activities more frequent during the night and early in the morning. More investigation into those cycles and other individual fine-scale behaviors related to their proximity to concentrations of human activity would be informative

  16. Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

    Directory of Open Access Journals (Sweden)

    Orestis Ioannidis

    2017-07-01

    Full Text Available BackgroundFournier’s gangrene (FG is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4% and 4 females (16.6%. In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%. All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and

  17. Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study.

    Science.gov (United States)

    Oud, Lavi; Watkins, Phillip

    2014-12-01

    Necrotizing fasciitis (NF) is a rare complication in pregnant women. There have been no population-level data reported to date on its epidemiology, clinical features, resource utilization, and outcomes. This was a retrospective, population-based cohort study, using the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations for the years 2001-2010. Hospitalizations with a diagnosis of NF were then identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 728.86. Denominator data for incidence estimates were derived from the Texas Center for Health Statistics reports of live births, abortions and fetal deaths, and previously reported population-based, age-specific linkage data on miscarriage, and were used to estimate the annual total number of pregnancies (TEP). The incidence of pregnancy-associated NF (PANF), hospitalization type, clinical features, resource utilization and outcomes were examined. There were 4,060,201 pregnancy-associated hospitalizations and 148 PANF hospitalizations during study period. Postpartum hospitalizations accounted for 82.4% of all PANF events, and intensive care unit care was required in 61.5%. The key trends noted between 2001-2002 and 2009-2010 included rising incidence of PANF from 1.1 vs. 3.8 per 100,000 TEP-years (P = 0.0001), chronic comorbidities 0% vs. 31.7% (P = 0.0777), and development of organ failure in 9.1% vs. 31.7% (P = 0.0302). There was no significant change in total hospital charges or hospital length of stay. Three patients (2%) died in the hospital and 55% of survivors had routine home discharge. The present cohort of PANF is the largest reported to date. The incidence of PANF rose nearly 3.5-fold over the past decade, with most events developing following delivery hospitalization. Chronic illness has been increasingly present, along with rising severity of illness. The majority of patients required ICU care. Hospital mortality was

  18. Determinants of Home Discharge Among Survivors of Necrotizing Fasciitis: A Population-Level Analysis.

    Science.gov (United States)

    Oud, Lavi

    2016-07-01

    The majority of patients with necrotizing fasciitis (NF) in the United Sates survive their illness, and there is increasing interest in addressing the ability of survivors to return to their community following hospitalization. However, there are no data on the factors affecting home discharge among survivors of NF. We used the Texas Inpatient Public Use Data File to conduct a retrospective population-based examination of hospitalizations with NF aged 15 years or older between 2001 and 2010. Multivariate logistic regression modeling was used to explore predictors of home discharge among hospital survivors. There were 10,724 NF hospitalizations surviving to discharge during study period, of which 62.5% were discharged home. The following key predictors have adversely affected odds of home discharge (odds ratio and 95% confidence intervals): age ≥ 75 years (0.349 (0.292 - 0.417)), Medicare insurance (0.582 (0.510 - 0.663)), congestive heart failure (0.836 (0.719 - 0.972)), chronic liver disease (0.684 (0.522 - 0.895)), respiratory failure (0.464 (0.386 - 0.558)), neurological failure (0.573 (0.418 - 0.787)), and need for mechanical ventilation (0.339 (0.199 - 0.578)). Increased odds of home discharge were found among males (1.116 (1.058 - 1.285)), Hispanics (1.193 (1.056 - 1.349)), those lacking health insurance (2.161 (1.183 - 2.521)) or managed at a teaching hospital (1.264 (1.127 - 1.418)). In this first population-level examination of the determinants of home discharge among survivors of NF, older age, Medicare insurance, selected comorbidities, and development of organ failure decreased patients' odds of home discharge. Unexpectedly, male gender, Hispanic ethnicity, lack of health insurance, and being managed at a teaching hospital were associated with favorable impact on patients' discharge disposition. Further studies are warranted in other populations and healthcare environments to corroborate the present findings and to refine our understanding of the

  19. Cervical necrotizing fasciitis due to bacterial tonsillitis Fasceite necrotizante cervical secundária a amigdalite bacteriana

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2005-04-01

    Full Text Available Necrotizing fasciitis is a severe and potentially fatal soft tissue infection, but involvement of the head and neck is rare. We report on 4 cases of cervical necrotizing fasciitis arising from tonsillitis. One patient was diabetic and one had received steroids before disease development. One patient developed acute respiratory failure and died of septic shock. Three patients recovered, helped by early recognition, aggressive surgical intervention, appropriate broad-spectrum antibiotics, and supportive therapy. The common bacteria found in all abscess samples were Streptococcus sp., but mixed flora with anaerobic organisms was seen in all but 1 case. Tonsillitis and peritonsillar abscess must be suspected as a cause of cervical necrotizing fasciitis and a successful result can be achieved with immediate aggressive treatment.A fasceite necrotizante cervical é uma infecção grave de partes moles do pescoço. Trata-se de entidade rara, porém quando presente tem como principal origem um foco infeccioso odontogênico. São descritos 4 casos de fasceite necrotizante cervical a partir de tonsilites e abscesso peritonsilar, os quais, foram admitidos e tratados na unidade de terapia intensiva. Um dos pacientes era portador de Diabetes Melittus não insulino- dependente e outro paciente havia recebido corticoterapia antes do desenvolvimento da infecção. Em um dos casos ocorreu mediastinite, insuficiência respiratória e o paciente evolui para o óbito em decorrência de choque séptico. Durante o tratamento, 3 pacientes evoluíram satisfatoriamente devido ao diagnostico precoce, tratamento cirúrgico agressivo e utilização de antibiótico terapia de largo espectro. A bactéria mais comumente encontrada foi o Streptococcus sp, mas flora mista com germes anaeróbios foi encontrada em 3 dos casos descritos. CONCLUSÕES: Deve-se suspeitar de tonsilite e abscesso peritonsilar como causa de fasceite necrotizante cervical para que tratamento agressivo e

  20. Presentations and treatment of childhood scleroderma: localized scleroderma, eosinophilic fasciitis, systemic sclerosis, and graft-versus-host disease.

    Science.gov (United States)

    Hedrich, Christian Michael; Fiebig, Barbara; Hahn, Gabriele; Suttorp, Meinolf; Gahr, Manfred

    2011-07-01

    Juvenile scleroderma is a rare connective tissue disease that involves the skin and subcutaneous tissue. Among all presentations of juvenile scleroderma, localized scleroderma (JLSc) is the most frequent, followed by systemic disease (JSSc) and eosinophilic fasciitis (EF). In posttransplantation chronic graft-versus-host disease (GvHD), scleroderma-like skin involvement can occur. Systemic forms of juvenile scleroderma and GvHD can affect the internal organs, such as the lungs, the gastrointestinal tract, the heart, and kidneys and cause disability and severe, sometimes lethal, complications. Here, the authors give an overview of different presentations of juvenile scleroderma. They report their experience with the different forms and presentations of scleroderma, diagnostic workups, treatment, and outcome of all forms of childhood scleroderma in the context of the existing literature.

  1. Fournier gangrene: a rare case of necrotizing fasciitis of the entire right hemi-pelvis in a diabetic female.

    Science.gov (United States)

    Taylor, Gregory M; Hess, David V

    2018-02-01

    Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death. We present the case of a 58-year-old diabetic female presenting febrile, hypoxic, with severe respiratory distress and evidence of septic shock, found to have necrotizing fasciitis of the entire right hemi-pelvis. Despite rapid recognition, IV antibiotics and operative management, the patient went to the intensive-care unit on multiple pressors and died 24 h later.

  2. Dead or Alive? Factors Affecting the Survival of Victims during Attacks by Saltwater Crocodiles (Crocodylus porosus in Australia.

    Directory of Open Access Journals (Sweden)

    Yusuke Fukuda

    Full Text Available Conflicts between humans and crocodilians are a widespread conservation challenge and the number of crocodile attacks is increasing worldwide. We identified the factors that most effectively decide whether a victim is injured or killed in a crocodile attack by fitting generalized linear models to a 42-year dataset of 87 attacks (27 fatal and 60 non-fatal by saltwater crocodiles (Crocodylus porosus in Australia. The models showed that the most influential factors were the difference in body mass between crocodile and victim, and the position of victim in relation to the water at the time of an attack. In-water position (for diving, swimming, and wading had a higher risk than on-water (boating or on-land (fishing, and hunting near the water's edge positions. In the in-water position a 75 kg person would have a relatively high probability of survival (0.81 if attacked by a 300 cm crocodile, but the probability becomes much lower (0.17 with a 400 cm crocodile. If attacked by a crocodile larger than 450 cm, the survival probability would be extremely low (<0.05 regardless of the victim's size. These results indicate that the main cause of death during a crocodile attack is drowning and larger crocodiles can drag a victim more easily into deeper water. A higher risk associated with a larger crocodile in relation to victim's size is highlighted by children's vulnerability to fatal attacks. Since the first recently recorded fatal attack involving a child in 2006, six out of nine fatal attacks (66.7% involved children, and the average body size of crocodiles responsible for these fatal attacks was considerably smaller (384 cm, 223 kg than that of crocodiles that killed adults (450 cm, 324 kg during the same period (2006-2014. These results suggest that culling programs targeting larger crocodiles may not be an effective management option to improve safety for children.

  3. Measuring behavioral responses of sea turtles, saltwater crocodiles, and crested terns to drone disturbance to define ethical operating thresholds.

    Science.gov (United States)

    Bevan, Elizabeth; Whiting, Scott; Tucker, Tony; Guinea, Michael; Raith, Andrew; Douglas, Ryan

    2018-01-01

    Drones are being increasingly used in innovative ways to enhance environmental research and conservation. Despite their widespread use for wildlife studies, there are few scientifically justified guidelines that provide minimum distances at which wildlife can be approached to minimize visual and auditory disturbance. These distances are essential to ensure that behavioral and survey data have no observer bias and form the basis of requirements for animal ethics and scientific permit approvals. In the present study, we documented the behaviors of three species of sea turtle (green turtles, Chelonia mydas, flatback turtles, Natator depressus, hawksbill turtles, Eretmochelys imbricata), saltwater crocodiles (Crocodylus porosus), and crested terns (Thalasseus bergii) in response to a small commercially available (1.4 kg) multirotor drone flown in Northern Territory and Western Australia. Sea turtles in nearshore waters off nesting beaches or in foraging habitats exhibited no evasive behaviors (e.g. rapid diving) in response to the drone at or above 20-30 m altitude, and at or above 10 m altitude for juvenile green and hawksbill turtles foraging on shallow, algae-covered reefs. Adult female flatback sea turtles were not deterred by drones flying forward or stationary at 10 m altitude when crawling up the beach to nest or digging a body pit or egg chamber. In contrast, flyovers elicited a range of behaviors from crocodiles, including minor, lateral head movements, fleeing, or complete submergence when a drone was present below 50 m altitude. Similarly, a colony of crested terns resting on a sand-bank displayed disturbance behaviors (e.g. flight response) when a drone was flown below 60 m altitude. The current study demonstrates a variety of behavioral disturbance thresholds for diverse species and should be considered when establishing operating conditions for drones in behavioral and conservation studies.

  4. Measuring behavioral responses of sea turtles, saltwater crocodiles, and crested terns to drone disturbance to define ethical operating thresholds

    Science.gov (United States)

    Whiting, Scott; Tucker, Tony; Guinea, Michael; Raith, Andrew; Douglas, Ryan

    2018-01-01

    Drones are being increasingly used in innovative ways to enhance environmental research and conservation. Despite their widespread use for wildlife studies, there are few scientifically justified guidelines that provide minimum distances at which wildlife can be approached to minimize visual and auditory disturbance. These distances are essential to ensure that behavioral and survey data have no observer bias and form the basis of requirements for animal ethics and scientific permit approvals. In the present study, we documented the behaviors of three species of sea turtle (green turtles, Chelonia mydas, flatback turtles, Natator depressus, hawksbill turtles, Eretmochelys imbricata), saltwater crocodiles (Crocodylus porosus), and crested terns (Thalasseus bergii) in response to a small commercially available (1.4 kg) multirotor drone flown in Northern Territory and Western Australia. Sea turtles in nearshore waters off nesting beaches or in foraging habitats exhibited no evasive behaviors (e.g. rapid diving) in response to the drone at or above 20–30 m altitude, and at or above 10 m altitude for juvenile green and hawksbill turtles foraging on shallow, algae-covered reefs. Adult female flatback sea turtles were not deterred by drones flying forward or stationary at 10 m altitude when crawling up the beach to nest or digging a body pit or egg chamber. In contrast, flyovers elicited a range of behaviors from crocodiles, including minor, lateral head movements, fleeing, or complete submergence when a drone was present below 50 m altitude. Similarly, a colony of crested terns resting on a sand-bank displayed disturbance behaviors (e.g. flight response) when a drone was flown below 60 m altitude. The current study demonstrates a variety of behavioral disturbance thresholds for diverse species and should be considered when establishing operating conditions for drones in behavioral and conservation studies. PMID:29561901

  5. Dead or Alive? Factors Affecting the Survival of Victims during Attacks by Saltwater Crocodiles (Crocodylus porosus) in Australia.

    Science.gov (United States)

    Fukuda, Yusuke; Manolis, Charlie; Saalfeld, Keith; Zuur, Alain

    2015-01-01

    Conflicts between humans and crocodilians are a widespread conservation challenge and the number of crocodile attacks is increasing worldwide. We identified the factors that most effectively decide whether a victim is injured or killed in a crocodile attack by fitting generalized linear models to a 42-year dataset of 87 attacks (27 fatal and 60 non-fatal) by saltwater crocodiles (Crocodylus porosus) in Australia. The models showed that the most influential factors were the difference in body mass between crocodile and victim, and the position of victim in relation to the water at the time of an attack. In-water position (for diving, swimming, and wading) had a higher risk than on-water (boating) or on-land (fishing, and hunting near the water's edge) positions. In the in-water position a 75 kg person would have a relatively high probability of survival (0.81) if attacked by a 300 cm crocodile, but the probability becomes much lower (0.17) with a 400 cm crocodile. If attacked by a crocodile larger than 450 cm, the survival probability would be extremely low (drag a victim more easily into deeper water. A higher risk associated with a larger crocodile in relation to victim's size is highlighted by children's vulnerability to fatal attacks. Since the first recently recorded fatal attack involving a child in 2006, six out of nine fatal attacks (66.7%) involved children, and the average body size of crocodiles responsible for these fatal attacks was considerably smaller (384 cm, 223 kg) than that of crocodiles that killed adults (450 cm, 324 kg) during the same period (2006-2014). These results suggest that culling programs targeting larger crocodiles may not be an effective management option to improve safety for children.

  6. Improvement of a Clinical Score for Necrotizing Fasciitis: 'Pain Out of Proportion' and High CRP Levels Aid the Diagnosis.

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    Borschitz, Thomas; Schlicht, Svenja; Siegel, Ekkehard; Hanke, Eric; von Stebut, Esther

    2015-01-01

    Necrotizing fasciitis (NF) is a rare mono-/polymicrobial skin infection that spreads to underlying tissues. NF is quickly progressing and leads to life threatening situations. Immediate surgical debridement together with i.v. antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. We now compared the initial clinical and laboratory presentation of NF and cellulitis in detail to assess if a typical pattern can be identified that aids timely diagnosis of NF and avoidance of fatal outcome. 138 different clinical and laboratory features of 29 NF patients were compared to those of 59 age- and gender matched patients with severe erysipelas requiring a subsequent hospitalization time of ≥10 days. Differences in clinical presentation were not obvious; however, NF patients suffered significantly more often from strong pain. NF patients exhibited dramatically elevated CRP levels (5-fold, p>0.001). The overall laboratory risk indicator for necrotizing fasciitis (LRINEC) score was significantly higher in NF patients as compared to cellulitis. However, a modification of the score (alteration of laboratory parameters, addition of clinical parameters) led to a clear improvement of the score with a higher positive predictive value without losing specificity. In summary, clinical differentiation of NF from cellulitis appears to be hard. 'Pain out of proportion' may be an early sign for NF. An improvement of the LRINEC score emphasizing only relevant laboratory and clinical findings as suggested may aid the early diagnosis of NF in the future leading to improvement of disease outcome by enabling rapid adequate therapy.

  7. Treatment of chronic plantar fasciitis with extra corporeal shock wave therapy: ultrasonographic morphological aspect and functional evaluation

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    Roberto Androson

    2013-12-01

    Full Text Available Objective: This paper has the purpose to analyze prospectively the treatment results in patients with chronic plantar fasciitis resistant to conservative treatment who underwent extracorporeal shock wave therapy (ESWT. Methods: We evaluated 30 patients (36 feet; 16 (53.3% patients were male and 14 (47.7% female with mean age of 48.7 y.o., varying from 33 to 78 y.o.; 16 (53.3% present the problem on the left side, 14 (46.7% on the right ones and 6 (20% bilateral; the symptomatology varied from 6 to 60 months, with the average of 13.58 months. These patients were submitted to a weekly ESWT session for 4 consecutive weeks. We measured the plantar fascia thickness millimeters with ultrasound and we applied American Orthopaedic Foot and Ankle Society (AOFAS scale for ankle and hindfoot, and Roles & Maudsley scales in pre ESWT, after one, three and six months after and decrease in the plantar fascia thickness by the ultrasound (p = 0.011 along the different moments studied. Results: We observed improvement of the evaluated criteria (p < 0.001 and plantar fascia thickness by ultrasound (p = 0.011 at different time points studied. Conclusion: The ESWT can be considered an important tool in the primary or adjuvant treatment of the chronic plantar fasciitis when associated with conventional therapies. This methodology is safe, non-invasive and provides precocious rehabilitation and return to regular activities considering the results of the statistical analysis. This resource provides decrease in the thickness of the plantar fascia.

  8. A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

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    Kiralj Aleksandar I

    2015-01-01

    Full Text Available Background/Aim. Necrotizing fasciitis (NF is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012 were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81% were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%. The majority of our patients were male (164 - 75.92%. Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%, followed by obesity (38 - 17.59% and diabetes mellitus (31 - 14.35%. Trauma was most common etiological factor (22 - 10.8% in infected wounds, followed by abdominal (15 - 6.94% and orthopedic (11 - 5.09% surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18% patients and more than one etiological factor were diagnosed in 20 (9.25% patients. The majority of our patients had type I acute NF

  9. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial

    Science.gov (United States)

    Lai, Ta-Wei; Ma, Hsiao-Li; Lee, Meng-Shiunn; Chen, Po-Ming; Ku, Ming-Chou

    2018-01-01

    Objectives: Extracorporeal shockwave therapy (ESWT) and corticosteroid injection (CSI) are treatment options for plantar fasciitis. Their clinical outcome comparison remains a debate. Also, the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive. Methods: A total of 97 patients with chronic plantar fasciitis were enrolled in the randomized prospective trial. Forty-seven patients received extracorporeal shock wave therapy (ESWT), and fifty patients received corticosteroid injection (CSI). The thickness of the plantar fascia was evaluated respectively before ESWT and CSI, and at the 4th and 12th week after ESWT and CSI by ultrasonography. Pain level and clinical outcomes were recorded using visual analogue scale (VAS) and 100-points scoring systems. Correlation analysis was performed between the thickness change and clinical outcome. Results: Under ultrasonography, we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4th week (p=0.048). VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection (0.001 and pplantar fascia thickness at 4th week was positively correlated with the decrease of VAS score at 12th week follow-up (R=0.302, P=0.039). Conclusions: At 4th week after treatment, the thickness of plantar fascia increased. Then it decreased gradually, but not to the baseline at 12th week. On the pain level outcome at 12th week, extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis. The more change of plantar fascia after ESWT, the more efficient on clinical outcome. PMID:29504578

  10. Modeling the Effects of Storm Surge from Hurricane Jeanne on Saltwater Intrusion into the Surficial Aquifer, East-Central Florida (USA)

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    Xiao, H.; Wang, D.; Hagen, S. C.; Medeiros, S. C.; Hall, C. R.

    2017-12-01

    Saltwater intrusion (SWI) that has been widely recognized as a detrimental issue causing the deterioration of coastal aquifer water quality and degradation of coastal ecosystems. While it is widely recognized that SWI is exacerbated worldwide due to global sea-level rise, we show that increased SWI from tropical cyclones under climate change is also a concern. In the Cape Canaveral Barrier Island Complex (CCBIC) located in east-central Florida, the salinity level of the surficial aquifer is of great importance to maintain a bio-diverse ecosystem and to support the survival of various vegetation species. Climate change induced SWI into the surficial aquifer can lead to reduction of freshwater storage and alteration of the distribution and productivity of vegetation communities. In this study, a three-dimensional variable-density SEAWAT model is developed and calibrated to investigate the spatial and temporal variation of salinity level in the surficial aquifer of CCBIC. We link the SEAWAT model to surge model data to examine the effects of storm surge from Hurricane Jeanne. Simulation results indicate that the surficial aquifer salinity level increases significantly right after the occurrence of storm surge because of high aquifer permeability and rapid infiltration and diffusion of the overtopping saltwater, while the surficial aquifer salinity level begins to decrease after the fresh groundwater recharge from the storm's rainfall. The tropical storm precipitation generates an effective hydraulic barrier further impeding SWI and providing seaward freshwater discharge for saltwater dilution and flushing. To counteract the catastrophic effects of storm surge, this natural remediation process may take at least 15-20 years or even several decades. These simulation results contribute to ongoing research focusing on forecasting regional vegetation community responses to climate change, and are expected to provide a useful reference for climate change adaptation planning

  11. Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature.

    Science.gov (United States)

    Cortese, Antonio; Pantaleo, Giuseppe; Borri, Antonio; Amato, Massimo; Claudio, Pier Paolo

    2017-02-01

    Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin. In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need. Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

  12. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

    Science.gov (United States)

    Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

    2018-01-01

    Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis. PMID:29862211

  13. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

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    Babak Vahdatpour

    2018-01-01

    Full Text Available Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40 received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS and modified Roles and Maudsley score (RMS at baseline and 1 month and 3 months after intervention. Plantar fascia (PF thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006 and RMS showed better improvement in intervention group (P = 0.026. There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292. Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

  14. The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients' activity level and pain localization

    Science.gov (United States)

    Hanada, M.; Takahashi, M.; Matsuyama, Y.

    2017-12-01

    In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (Pplantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.

  15. Combined use of frequency‐domain electromagnetic and electrical resistivity surveys to delineate the freshwater/saltwater interface near saline lakes in the Nebraska Sand Hills, Nebraska, USA

    Science.gov (United States)

    Ong, John T.; White, Eric A.; Lane, John W.; Halihan, Todd; Zlotnik, Vitaly A; Butler, Dwain K.

    2009-01-01

    We investigate the use of frequency‐domain electromagnetic (FDEM) and electrical resistivity (ER) surveys for rapid and detailed characterization of the direction of lake‐aquifer fluxes and the configuration of salt plumes generated from saline lakes. This methodology was developed and applied at several lakes in the Nebraska Sand Hills, Nebraska, in an area with both freshwater and saline lakes hydraulically connected to the freshwater surficial aquifer. The FDEM survey was conducted by mounting the instrument on a fiberglass cart towed by an all‐terrain vehicle. The towed FDEM surveys covered about 25 km per day and served as a reconnaissance method for choosing locations for the more quantitative and detailed ER surveys. Around the saline lakes, areas with high electrical conductivity are consistent with the regional direction of ground‐water flow. Lower electrical conductivity was measured around the freshwater lakes with anomalies correlating to a paleovalley axis inferred from previous studies. The efficacy of this geophysical approach is attributed to: (1) significant contrast in electrical conductivity between freshwater and saltwater, (2) near‐surface location of the freshwater/saltwater interface, (3) minimal cultural interference, and (4) relative homogeneity of the aquifer materials.

  16. Molecular cloning and 3D model of first cytochrome P450 from CYP3A subfamily in saltwater crocodile (Crocodylus porosus).

    Science.gov (United States)

    Tabassum, Rabia

    2017-10-18

    Cytochrome P450s (CYPs) play critical role in oxidative metabolism of numerous xenobiotics and endogenous compounds. The first CYP3A subfamily member in saltwater crocodile has been cloned and modelled for three-dimensional (3D) structure. The full-length cDNA was obtained employing reverse transcription polymerase chain reaction (RT-PCR) strategy and rapid amplification of cDNA ends (RACE). The cDNA sequence of 1659 nucleotides includes 132 nucleotides from 5' untranslated region (UTR), an open reading frame of 1527 nucleotides encoding 509 amino acids designated as CYP3A163. The alignment of CYP3A163 sequence with CYP3A subfamily across the lineages exhibit the loss of 1 residue in birds and 7 residues in mammals in comparison to reptiles suggesting the adaptation processes during evolution. The amino acid identity of CYP3A163 with Alligator mississippiensis CYP3A77 and Homo sapiens CYP3A4 is 91% and 62% respectively. The 3D structure of CYP3A163 modelled using human CYP3A4 structure as a template with Phyre 2 software, represents high similarity with its functionally important motifs and catalytic domain. Both sequence and structure of CYP3A163 display the common and conserved features of CYP3A subfamily. Overall, this study provides primary molecular and structural data of CYP3A163 required to investigate the xenobiotic metabolism in saltwater crocodiles. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Diel use of a saltwater creek by white-tip reef sharks Triaenodon obesus (Carcharhiniformes: Carcharhinidae) in Academy Bay, Galapagos Islands.

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    Peñiaherrera, César; Hearn, Alex R; Kuhn, Angela

    2012-06-01

    White-tip reef sharks are common inhabitants of the shallow waters surrounding the Galapagos Islands, where several known aggregation sites have become touristic attractions. With the aim to describe site fidelity and residency patterns of the white-tip reef sharks in a saltwater creek, we used the ultrasonic telemetry method. The study was undertaken in a saltwater channel South of Academy Bay, Santa Cruz Island, from May 2008-September 2009. A total of nine transmitters were attached to sharks and ultrasonic receivers were deployed at the inner and outside areas of the creek. From the total of fitted sharks, four lost their transmitters. The results obtained with the remaining sharks showed an elevated use of the inner area of the channel during the day, with more use of the external area during the night. However, none of the sharks were detected at the site every day, suggesting that they may have a number of preferred sites within their home range. More studies are needed to detail the home range and habitat use of this species, and to guide its protection level in the Academy Bay area.

  18. Diel use of a saltwater creek by white-tip reef sharks Triaenodon obesus (Carcharhiniformes: Carcharhinidae in Academy Bay, Galapagos Islands

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    César Peñaherrera

    2012-06-01

    Full Text Available White-tip reef sharks are common inhabitants of the shallow waters surrounding the Galapagos Islands, where several known aggregation sites have become touristic attractions. With the aim to describe site fidelity and residency patterns of the white-tip reef sharks in a saltwater creek, we used the ultrasonic telemetry method. The study was undertaken in a saltwater channel South of Academy Bay, Santa Cruz Island, from May 2008-September 2009. A total of nine transmitters were attached to sharks and ultrasonic receivers were deployed at the inner and outside areas of the creek. From the total of fitted sharks, four lost their transmitters. The results obtained with the remaining sharks showed an elevated use of the inner area of the channel during the day, with more use of the external area during the night. However, none of the sharks were detected at the site every day, suggesting that they may have a number of preferred sites within their home range. More studies are needed to detail the home range and habitat use of this species, and to guide its protection level in the AcademyBay area. Rev. Biol. Trop. 60 (2: 735-743. Epub 2012 June 01.

  19. Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand

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    Khamnuan P

    2015-07-01

    Full Text Available Patcharin Khamnuan,1,2 Wilaiwan Chongruksut,3 Kijja Jearwattanakanok,4 Jayanton Patumanond,5 Apichat Tantraworasin,3 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Nursing, Phayao Hospital, Phayao, Thailand; 3Department of Surgery, Faculty of Medicine, Chiang Mai University, 4Department of Surgery, Nakornping Hospital, Chiang Mai, Thailand; 5Clinical Epidemiology Unit, Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand Background: Necrotizing fasciitis (NF is a life-threatening infection of skin and fascia. Its progress is extremely fast, with extensive necrosis. Delay in treatment, with subsequent huge soft tissue loss and associated severe sepsis, remains a major cause of death in the management of NF. Objective: The aim of this study was to explore clinical characteristics that may be used to predict severe sepsis in patients with NF, in the context of routine clinical practice in northern Thailand. Methods: A retrospective observational cohort study was conducted. The patient cohort in this study consisted of all patients who were diagnosed with NF by surgical or pathological confirmation. The follow-up period started with the admission date and ended with the discharge date. The clinical variables were collected from patients registered at three provincial hospitals in northern Thailand from 2009 to 2012. The clinical predictors for severe sepsis were analyzed using multivariable risk regression. Results: A total of 1,452 patients were diagnosed with NF, either with severe sepsis (n=237 [16.3%] or without severe sepsis (n=1,215 [83.7%]. From the multivariable analysis, female sex (relative risk [RR] =1.51; 95% confidence interval [CI] =1.04–2.20, diabetes mellitus (RR =1.40; 95% CI =1.25–1.58, chronic heart disease (RR =1.31; 95% CI =1.15–1.49, hemorrhagic bleb (RR =1.47; 95% CI =1.32–1.63, skin necrosis (RR =1.45; 95% CI =1

  20. Extravasation injury of balanced electrolyte solution simulates the clinical condition of necrotizing fasciitis: A case report

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    Carmine D'Acunto

    2015-10-01

    Full Text Available Extravasation injury (EI is an iatrogenic condition that occurs preferentially in neonatal and pediatric patients when the injection of fluid substances by intravenous access is required and it accidentally leaks into the adjacent tissues or in spaces outside of vascular compartment. Different types and amount of substances once undergoing extravasation can affect the EI differently [1]. In some instances immediate measures such as saline washout, local antidotes, enzymatic debridement and surgical interventions can be required in order to prevent the occurrence of a growing injury avoiding the progression of the EI to a medical emergency [6]. Here we report an unusual case of a preterm 2-month-old male patient in which the extravasation of balanced electrolyte solution on the upper right arm resulted in the development of full-thickness skin necrosis appearing as the clinical condition of necrotizing fasciitis. The management of necrotic tissue was performed using escharectomy as well as autograft skin under conditions of general anesthesia.

  1. Fasceíte necrotizante da mama: relato de caso Necrotizing fasciitis of the breast: case report

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    Marco Aurélio da Costa Silva

    1998-05-01

    Full Text Available É apresentado um caso de fasceíte necrotizante, na mama, em uma paciente de 68 anos que foi submetida à excisão de um volumoso lipoma mamário e evoluiu com infecção local agressiva, apresentando necrose extensa do parênquima da mama e de suas fáscias, além da pele, quadro este que caracteriza as fasceítes. O trabalho chama a atenção para a gravidade da entidade e a dificuldade diagnóstica, em razão do comprometimento cutâneo mais tardio e menos extenso; enfatiza-se a necessidade de afastar tal diagnóstico na vigência de infecções mamárias, assim como ter uma abordagem precoce e agressiva na presença de um quadro de fasceíte necrotizante mamária.A case of postsurgical necrotizing fasciitis is presented. A 68-year-old female patient was submitted to a lumpectomy for a big breast lipoma. After surgen there was an aggressive local infection, with extensive necrosis of the breast tissue, including the superficial and deep fasciae and also the skin over the breast. The gravity of the disease and the difficulties in its diagnosis due to the late skin necrosis are emphasized. Under such circunstances an early and aggressive approach is necessary.

  2. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges.

    Science.gov (United States)

    Fais, Paolo; Viero, Alessia; Viel, Guido; Giordano, Renzo; Raniero, Dario; Kusstatscher, Stefano; Giraudo, Chiara; Cecchetto, Giovanni; Montisci, Massimo

    2018-04-07

    Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.

  3. Effeciency of extracorporeal shock wave therapy in patients with plantar fasciitis and the relationship with subcalcaneal spur length

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    Serpil Tuna

    2014-06-01

    Full Text Available Objective: ESWT is widely used in the treatment of plantar fascitis. In this study, we aimed to investigate the effect of ESWT on heel pain and symptoms in the short and medium term. We also compared the subcalcaneal spur length and the heel pain severity and examined the effect of the subcalcaneal spur length on the efficiency of ESWT therapy. Methods: The efficiency of ESWT applied to 59 heel of 48 patients compared retrospectively . We used Visual Analog Scale (VAS and Wolgin scale to evaluate the treatment outcomes. We measure the subcalcaneal spurs length of the patients with foot x-ray . Correlation between the VAS scores and the length of subcalcaneal spur were also evaluated. Results: Improvement in VAS in the first week and 3 months after ESWT treatment was statistically significant. There was no correlation between subcalcaneal spur length and the severity of pain. The number of patients in the'' medium, bad'' group decreased while the number of patients in the '' good'' group incresed according to WDS after ESWT treatment. Conclusion: As a result of this study we concluded that ESWT is effective in the treatment of plantar fasciitis in the short and medium term.

  4. Severe form of streptococcal necrotizing fasciitis of the upper limb - diagnostic and therapeutic challenge: A case report

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    Mikić Dragan

    2015-01-01

    Full Text Available Introduction. Since delay in recognition and effective treatment of necrotizing fasciitis (NF caused by invasive group A streptococcus increases the mortality and disability, the early diagnosis and management of this disease are essential for a better outcome. We presented a patient with a severe form of streptococcal NF of the left upper limb in whom amputation was performed as a life saving procedure. Case report. A 65-year-old man, previously healthy, suffered an injury to his left hand by sting on a fish bone. Two days after that the patient got fever, redness, swelling and pain in his left hand. Clinical examination of the patient after admission indicated NF that spread quickly to the entire left upper limb, left armpit, and the left side of the chest and abdomen. Despite the use of aggressive antibiotic and surgical therapy severe destruction of the skin and subcutaneous tissues developed with the development of gangrene of the left upper limb. In this situation, the team of specialists decided that the patient must be operated on submited to amputation of the left arm, at the shoulder. After amputation and aggressive debridement of soft tissue on the left side of the trunk, the patient completely recovered. β-hemolytic streptococcus group A was isolated from the skin and tissue obtained during the surgery. Conclusion. In the most severe forms of streptococcal NF of the extremities, adequate multidisciplinary treatment, including limb amputation, can save the life of a patient.

  5. Expression Profiles of Branchial FXYD Proteins in the Brackish Medaka Oryzias dancena: A Potential Saltwater Fish Model for Studies of Osmoregulation

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    Yang, Wen-Kai; Kang, Chao-Kai; Chang, Chia-Hao; Hsu, An-Di; Lee, Tsung-Han; Hwang, Pung-Pung

    2013-01-01

    FXYD proteins are novel regulators of Na+-K+-ATPase (NKA). In fish subjected to salinity challenges, NKA activity in osmoregulatory organs (e.g., gills) is a primary driving force for the many ion transport systems that act in concert to maintain a stable internal environment. Although teleostean FXYD proteins have been identified and investigated, previous studies focused on only a limited group of species. The purposes of the present study were to establish the brackish medaka (Oryzias dancena) as a potential saltwater fish model for osmoregulatory studies and to investigate the diversity of teleostean FXYD expression profiles by comparing two closely related euryhaline model teleosts, brackish medaka and Japanese medaka (O. latipes), upon exposure to salinity changes. Seven members of the FXYD protein family were identified in each medaka species, and the expression of most branchial fxyd genes was salinity-dependent. Among the cloned genes, fxyd11 was expressed specifically in the gills and at a significantly higher level than the other fxyd genes. In the brackish medaka, branchial fxyd11 expression was localized to the NKA-immunoreactive cells in gill epithelia. Furthermore, the FXYD11 protein interacted with the NKA α-subunit and was expressed at a higher level in freshwater-acclimated individuals relative to fish in other salinity groups. The protein sequences and tissue distributions of the FXYD proteins were very similar between the two medaka species, but different expression profiles were observed upon salinity challenge for most branchial fxyd genes. Salinity changes produced different effects on the FXYD11 and NKA α-subunit expression patterns in the gills of the brackish medaka. To our knowledge, this report is the first to focus on FXYD expression in the gills of closely related euryhaline teleosts. Given the advantages conferred by the well-developed Japanese medaka system, we propose the brackish medaka as a saltwater fish model for

  6. [Necrotizing fasciitis of the hand and forearm : Acute surgical treatment and defect reconstruction with MatriDerm® and split-thickness skin graft].

    Science.gov (United States)

    Niedermueller, B; Singer, G; Pickl, P; Jesacher, M

    2018-03-01

    This case report describes a 55-year-old male patient with type II necrotizing fasciitis (NF) of the hand and forearm. The rapid progression of the tissue infection could be successfully stopped with radical surgical débridement and antibiotic therapy. For the reconstruction of the extensive loss of soft tissue a combination of split-thickness skin graft (STSG) and the synthetic dermal substitute MatriDerm® was used. In cases of NF, MatriDerm® and STSG provide a rapidly available and simple alternative to other reconstruction techniques.

  7. Effectiveness and relevant factors of platelet-rich plasma treatment in managing plantar fasciitis:A systematic review

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    Seet Khing Chiew

    2016-01-01

    Full Text Available Background: Plantar fasciitis (PF is a common foot complaint, affects both active sportsmen and physically inactive middle age group. It is believed that PF results from degenerative changes rather than inflammation. Platelet-rich plasma (PRP therapy has been introduced as an alternative therapy for PF. This study is aimed to systematically review to the effectiveness and relevant factors of PRP treatment in managing PF. Materials and Methods: A search was conducted in electronic databases, including PubMed, Scopus, and Google Scholar using different keywords. Publications in English-language from 2010 to 2015 were included. Two reviewers extracted data from selected articles after the quality assessment was done. Results: A total of 1126 articles were retrieved, but only 12 articles met inclusion and exclusion criteria. With a total of 455 patients, a number of potentially influencing factors on the effectiveness of PRP for PF was identified. In all these studies, PRP had been injected directly into the plantar fascia, with or without ultrasound guidance. Steps from preparation to injection were found equally crucial. Amount of collected blood, types of blood anti-coagulant, methods in preparing PRP, speed, and numbers of time the blood samples were centrifuged, activating agent added to the PRP and techniques of injection, were varied between different studies. Regardless of these variations, superiority of PRP treatment compared to steroid was reported in all studies. Conclusion: In conclusion, PRP therapy might provide an effective alternative to conservative management of PF with no obvious side effect or complication. The onset of action after PRP injection also greatly depended on the degree of degeneration.

  8. Case of Paecilomyces lilacinus infection occurring in necrotizing fasciitis-associated skin ulcers on the face and surrounding a tracheotomy stoma.

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    Nagamoto, Eiko; Fujisawa, Akihiko; Yoshino, Yuichiro; Yoshitsugu, Kanako; Odo, Masashi; Watanabe, Hidetaka; Igata, Toshikatsu; Noguchi, Hiromitsu

    2014-01-01

    A 28-year-old man undergoing treatment for hemophagocytic syndrome developed Paecilomyces lilacinus infection in skin ulcers on the face and in the tracheotomy stoma. While his bone marrow was suppressed by chemotherapy with dexamethasone, cyclosporin and etoposide for hemophagocytic syndrome, dental infection led to subacute necrotizing fasciitis caused by Pseudomonas aeruginosa on the right side of the face, resulting in a large area of soft tissue defects. Etoposide was discontinued, and prophylactic treatment with itraconazole was initiated. The ulcers resulting from necrotizing fasciitis were treated conservatively using trafermin and alprostadil alfadex ointment 0.003 %, and near-complete re-epithelialization occurred, except on the right lower eyelid, right buccal mucosa and perioral area. However, 6 weeks later, pustules/crusts started to form and break down repeatedly, leading to expansion of tissue defects on the face. Direct microscopic examination revealed fungal elements, and fungal culture identified Paecilomyces lilacinus suspicious twice some other day. Based on DNA extraction from the isolated fungus, this fungal strain was identified as Paecilomyces lilacinus. Cyclosporin and itraconazole were discontinued, and treatment with liposomal amphotericin B and a tapering dose of steroids was initiated. Cure was achieved in approximately 2.5 months after treatment initiation, and no relapse has been observed. The most important factor that ultimately contributed to the resolution of fungal infection might have been release of immunosuppression by discontinuing cyclosporin and tapering steroids.

  9. Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

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    Sutera, R; Iovane, A; Sorrentino, F; Candela, F; Mularo, V; La Tona, G; Midiri, M

    2010-03-01

    This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients' history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (pplantar fascia, which could be overlooked in the supine position.

  10. The role of dunes in contrasting saltwater intrusion in coastal areas; a case study in the southern Po Plain Adriatic coast (Ravenna, Northern Italy)

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    Marconi, V.; Antonellini, M.; Balugani, E.; Minchio, A.; Gabbianelli, G.

    2009-04-01

    Due to climate changes and to anthropogenic interventions, saltwater intrusion is affecting the aquifers and the surface water of the Po plain along the Adriatic coast. During the last decade, we recognized in this area a pattern of climate change: precipitations are less frequent and the yearly amount of rain is concentrated in a few strong storm events. This pattern results in an increase of gales strength during the winter, which causes shoreline retreat and an erosion of the coastal dunes. The coastal part of the Po plain consists of a low-lying and mechanically-drained farmland further from the sea and of a narrow belt of dunes and pine forests in the backshore area. The wide sandy beaches are now retreating and the dune system (only a few meters in height) is almoust destroyed, because of tourism development and of disaggregated rivers and shorelines management. A still active dune system is preserved in our study area, a coastal plain included between the Fiumi Uniti and Bevano rivers near the city of Ravenna. As a result of an intensive exploitation of coastal aquifers for agricultural, industrial, and civil uses, both the phreatic aquifer and the surface waters have been contaminated by seawater. Despite its value for the natural ecosystem and the agricultural soil, the phreatic aquifer is not considered of interest by the regional authorities responsible for water management. A detailed hydrogeological survey was performed by our research group during the Summer 2008 within the framework of the CIRCLE-ERANET project WATERKNOW on the effects of climate change on the mediterranean catchments. In this survey 29 auger holes with an average spacing of 350 m where drilled with the objective of determining the top groundwater quality in the coastal aquifer. At the same time, we measured the chemical and physical parameters of the surface waters. The data collected in the field show that a fresh groundwater lens is still present in the aquifer of the backshore

  11. A Comprehensive evaluation of groundwater vulnerability to saltwater up-coning and sea water intrusion in a coastal aquifer (case study: Ghaemshahr-juybar aquifer)

    Science.gov (United States)

    Motevalli, Alireza; Moradi, Hamid Reza; Javadi, Saman

    2018-02-01

    Aquifer salinization has recently increased significantly due to human activity and has caused irreparable environmental and economic effects. In this research, a new method is proposed for modeling the vulnerability to salinity for the Ghaemshahr-juybar aquifer. Specifically, the GALDIT (Sea water intrusion) and TAWLBIC (Saltwater up-coning) indices were combined to produce a map of vulnerability (Comprehensive Salinity Index or CSI) to seawater intrusion of a region near the coast and saltwater up-coning away from the coast, respectively. Single parameter and removal layer sensitivity analysis were performed in order to identify the sensitive parameters and achieve optimal weights (through the single-parameter method) of contributing factors in all three methods. The three optimized methods produced were GALDIT-Opt, TAWLBIC-Opt and CSI-Opt. To assess the accuracy of the original maps and optimal ones, the Pearson correlation was used. Results indicated that the Pearson correlation of the optimized GALDIT, TAWLBIC and CSI model was better than GALDIT, TAWLBIC and CSI. The results show that the increase in correlation between EC (Electrical Conductivity), TDS (Total Dissolved Solids) and SAR (Sodium Adsorption Ratio) from the GALDIT model to the CSI-Opt model from values of 0.64, 0.56 and 0.68 has improved to values of 0.81, 0.88 and 0.91, respectively. The highest concentration of EC, with a value of 7050 μs/cm, is sampled in the areas of the east and northwest of the Ghaemshahr-juybar aquifer, which are classified in the CSI-Opt model as high and very high vulnerability levels. The highest concentration of TDS and SAR has been found in the east, northwest and northeast of the Ghaemshahr-juybar aquifer with a value of 4724 ppm for TDS and 14 mg/l for SAR that have been modeled in the CSI-Opt index as highly vulnerable areas. Eventually, CSI mapping can be used as an efficient tool in prioritizing in terms of the vulnerability to aquifer salinity, carrying out

  12. Diel use of a saltwater creek by white-tip reef sharks Triaenodon obesus (Carcharhiniformes: Carcharhinidae in Academy Bay, Galapagos Islands

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    César Peñaherrera

    2012-06-01

    Full Text Available White-tip reef sharks are common inhabitants of the shallow waters surrounding the Galapagos Islands, where several known aggregation sites have become touristic attractions. With the aim to describe site fidelity and residency patterns of the white-tip reef sharks in a saltwater creek, we used the ultrasonic telemetry method. The study was undertaken in a saltwater channel South of Academy Bay, Santa Cruz Island, from May 2008-September 2009. A total of nine transmitters were attached to sharks and ultrasonic receivers were deployed at the inner and outside areas of the creek. From the total of fitted sharks, four lost their transmitters. The results obtained with the remaining sharks showed an elevated use of the inner area of the channel during the day, with more use of the external area during the night. However, none of the sharks were detected at the site every day, suggesting that they may have a number of preferred sites within their home range. More studies are needed to detail the home range and habitat use of this species, and to guide its protection level in the AcademyBay area. Rev. Biol. Trop. 60 (2: 735-743. Epub 2012 June 01.Los tiburones punta blanca de arrecife son habitantes comunes de las aguas que rodean las Islas Galápagos, por lo que muchos de sus sitios de agregación se han convertido en atractivos turísticos. Con el objetivo de describir la fidelidad del sitio y los patrones de residencia de nueve tiburones desde mayo 2008-septiembre 2009, se utilizó telemetría ultrasónica en un canal de agua salada en el sur de Bahía Academia, Isla Santa Cruz. A pesar de que cuatro tiburones perdieron sus transmisores, los restantes tiburones monitoreados mostraron un uso elevado del interior del canal durante el día y del exterior durante la noche. Sin embargo, ninguno de los tiburones fue detectado en el sitio diariamente, lo cual sugiere que deben tener un número mayor de sitios preferidos dentro de su área de vida.

  13. Characteristics of Phytoplankton Biomass, Primary Production and Community Structure in the Modaomen Channel, Pearl River Estuary, with Special Reference to the Influence of Saltwater Intrusion during Neap and Spring Tides.

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    Zhou, Weihua; Gao, Jie; Liao, Jianzu; Shi, Ronggui; Li, Tao; Guo, Yajuan; Long, Aimin

    2016-01-01

    In recent decades, increasing frequency and intensity of saltwater intrusion in the Modaomen Channel has threatened the freshwater supply in the surrounding cities of the Pearl River Estuary, and ulteriorly changed the environmental conditions of the estuarine waters. Phytoplankton biomass, primary production (PP) and species composition, as well as hydrological and chemical parameters were examined along a downstream transect in the Modaomen Channel during neap tide (NT) and spring tide (ST), when a strong saltwater intrusion event occurred in late September, 2011. A total of 46 species phytoplankton were identified, including Bacillariophyta (25 species), Dinoflagellate (14 species), Chlorophyta (4 species), Cyanophyta (2 species) and Euglenozoa (1 species). The dominant species were shifted from freshwater diatoms (e.g., Melosira granulata and Melosira granulata var. angustissima) in the upper reaches to saline water diatoms (e.g., Skeletonema costatum and Coscinodiscus sp.) in the river mouth. Generally, phytoplankton density, biomass (chl-a) and PP decreased from the upper to lower reaches along the channel, and were significantly higher in NT than those of ST. There was a shift from large-sized phytoplankton (>20 μm) in the upper reaches to relative small-sized cells (5-20 μm) in the lower reaches. Compared to NT, low discharge and flow velocity, coupled with strong easterly winds during ST specially aggravated saltwater intrusion further to the upstream (~50 km from the estuary). The intruded saltwater diluted nutrients, N/P ratios, chl-a, and phytoplankton abundances, and thereby led to a decline in PP during ST.

  14. Necrotizing Fasciitis Among Patients With Liver Cirrhosis in Texas, 2001 - 2010: A Population-Based Cohort Study.

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    Oud, Lavi; Watkins, Phillip

    2016-02-01

    Liver cirrhosis is a risk factor for necrotizing fasciitis (NF), and is associated with markedly worse outcomes than for NF among non-cirrhosis patients. Only limited, mostly single-center, data were reported to date on the epidemiology, clinical features, resource utilization and outcomes of NF among patients with cirrhosis. We studied a population-based cohort of adult hospitalizations associated with cirrhosis, who had a diagnosis of NF during the years 2001 - 2010, using the Texas Inpatient Public Use Data File. The annual volume of NF hospitalizations was benchmarked against all annual hospitalizations with a diagnosis of cirrhosis. The patterns of demographics, chronic comorbidities, evolving organ failure, resource utilization and outcomes were examined. There were 371,745 hospitalizations associated with liver cirrhosis, with 381 NF hospitalizations during study period. The annual volume of NF hospitalizations rose 7.9%/year (P = 0.0287), while its incidence among cirrhosis-associated hospitalizations remained unchanged (P = 0.2955). Non-cirrhosis comorbidities were reported in 69.6% and ICU care was required in 67.2% of NF hospitalization. The key changes noted between 2001 - 2003 and 2008 - 2010 among NF hospitalizations included rising mean (SD) Deyo-Charlson index 2.4 (1.5) vs. 3.9 (2.4) (P < 0.0001), development of ≥ 3 organ failures in 9.1% vs. 39.8% (P < 0.0001), and discharge to long-term care facilities 7.8% vs. 21.1% (P = 0.0204). Hospital mortality was unchanged (26% vs. 33.1%; P = 0.3659). Inflation-adjusted total hospital charges did not change (P = 0.1025) during study period. The present cohort of NF associated with liver cirrhosis is the largest reported to date. A rising annual volume of NF events matched a corresponding increase in cirrhosis-associated hospitalizations. There was increasing burden of chronic comorbidity and rising severity of illness, with a majority of patients requiring ICU care. Case fatality was high and there has

  15. Retrospective study of necrotizing fasciitis and characterization of its associated Methicillin-resistant Staphylococcus aureus in Taiwan

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    Changchien Chih-Hsuan

    2011-10-01

    Full Text Available Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA has emerged as a prevalent pathogen of necrotizing fasciitis (NF in Taiwan. A four-year NF cases and clinical and genetic differences between hospital acquired (HA- and community-acquired (CA-MRSA infection and isolates were investigated. Methods A retrospective study of 247 NF cases in 2004-2008 and antimicrobial susceptibilities, staphylococcal chromosomal cassette mec (SCCmec types, pulsed field gel electrophoresis (PFGE patterns, virulence factors, and multilocus sequence typing (MLST of 16 NF-associated MRSA in 2008 were also evaluated. Results In 247 cases, 42 microbial species were identified. S. aureus was the major prevalent pathogen and MRSA accounted for 19.8% of NF cases. Most patients had many coexisting medical conditions, including diabetes mellitus, followed by hypertension, chronic azotemia and chronic hepatic disease in order of decreasing prevalence. Patients with MRSA infection tended to have more severe clinical outcomes in terms of amputation rate (p S. aureus or non-S. aureus infection. NF patients infected by HA-MRSA had a significantly higher amputation rate, comorbidity, C-reactive protein level, and involvement of lower extremity than those infected by CA-MRSA. In addition to over 90% of MRSA resistant to erythromycin and clindamycin, HA-MRSA was more resistant than CA-MRSA to trimethoprim-sulfamethoxazole (45.8% vs. 4%. ST59/pulsotype C/SCCmec IV and ST239/pulsotype A/SCCmec III isolates were the most prevalent CA- and HA-MRSA, respectively in 16 isolates obtained in 2008. In contrast to the gene for γ-hemolysin found in all MRSA, the gene for Panton-Valentine leukocidin was only identified in ST59 MRSA isolates. Other three virulence factors TSST-1, ETA, and ETB were occasionally identified in MRSA isolates tested. Conclusion NF patients with MRSA infection, especially HA-MRSA infection, had more severe clinical outcomes than those infected by

  16. EFFECT OF LOW ENERGY VERSUS MEDIUM ENERGY RADIAL SHOCK WAVE THERAPY IN THE TREATMENT OF CHRONIC PLANTER FASCIITIS

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    Khaled Z. Fouda

    2016-02-01

    Full Text Available Background: Plantar fasciitis (PF is the most common cause of heel pain and it can often be a challenge for clinicians to treat successfully. Radial shock wave therapy (RSWT has been introduced recently for treatment of musculoskeletal disorders. Different energy levels of shock wave therapy have been used in the literatures for treatment of PF with no clear settled parameters. Therefore, the purpose of this study was intended to investigate and compare the efficacy of two different energy levels of RSWT on PF patients. Methods: Forty patients having unilateral chronic PF were recruited for the study from orthopedic outpatient clinics of Cairo University hospitals and National Institute of Neuromotor System Cairo Egypt, with a mean age of (47.15±4.57 years. Patients were randomly assigned into two equal groups. Group (A treated with low intensity level of 1.6 bars (0.16 mJ/mm2 RSWT and group (B treated with medium intensity level of 4 bars (0.38 mJ/mm2 RSWT. Functional assessment of the foot based on Foot Function Index (FFI and Present pain intensity was measured during rest by Visual Analogue Scale (VAS. Results: There was as significant decreased in the total FFI scores from (118.42 ±6.51 to (81.37 ±3.46 for group (A and from (118.93 ±6.85 to (58.50 ±3.22 for group (B. Also regarding VAS Scores there was as significant decreased in the pain intensity from (5.11 ±0.41 to (2.85 ±0.31 for group (A and from (4.95 ±0.39 to (2.05 ±0.22 for group (B. Conclusion: Radial shock wave therapy is an effective modality that should be considered in the treatment of chronic PF, while the medium energy level RSWT is better than the low energy level RSWT in regarding to the measured treatment outcomes.

  17. Evaluation of Dicentrarchus labrax Meats and the Vegetable Quality of Beta vulgaris var. cicla Farmed in Freshwater and Saltwater Aquaponic Systems

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    Valentina Nozzi

    2016-09-01

    Full Text Available The purpose of this study is to exploit the euryhaline nature of commercially attractive species for their cultivation in freshwater aquaponic systems. This approach may increase the profitability of aquaponic production in coastal countries where the consumption of marine fish is traditional and of commercial relevance. For this purpose, juvenile European sea bass (Dicentrarchus labrax were reared in an aquaponic freshwater (AFW system and an aquaponic saltwater (ASW system (salinity 20 ppt, in combination with chard (Beta vulgaris var. cicla seedlings, a salt tolerant plant. At the end of the trial, nitrate and phosphate concentration in water significantly increased in the ASW system, suggesting that the ability of B. vulgaris to absorb these substances was limited by salinity. Total reflection X-ray fluorescence spectrometry revealed that the concentration of some oligoelements such as Fe remained lower with respect to the concentration in the freshwater hydroponic solution, in both AFW and ASW. FTIR-Fourier transform infrared spectroscopy on plants showed that growth at high salinity affected their lipid content. In the case of fish, freshwater had no effects on mono- and poly-unsaturated fatty acid profiles, although saturated fatty acids were significantly decreased in D. labrax reared in AFW. Our results demonstrates that it is possible to increase aquaponic profitability by farming D. labrax juveniles in an aquaponic freshwater system together with Beta vulgaris, obtaining good quality products.

  18. Adaption of the microbial community to continuous exposures of multiple residual antibiotics in sediments from a salt-water aquacultural farm.

    Science.gov (United States)

    Xi, Xiuping; Wang, Min; Chen, Yongshan; Yu, Shen; Hong, Youwei; Ma, Jun; Wu, Qian; Lin, Qiaoyin; Xu, Xiangrong

    2015-06-15

    Residual antibiotics from aquacultural farming may alter microbial community structure in aquatic environments in ways that may adversely or positively impact microbially-mediated ecological functions. This study investigated 26 ponds (26 composited samples) used to produce fish, razor clam and shrimp (farming and drying) and 2 channels (10 samples) in a saltwater aquacultural farm in southern China to characterize microbial community structure (represented by phospholipid fatty acids) in surface sediments (0-10 cm) with long-term exposure to residual antibiotics. 11 out of 14 widely-used antibiotics were quantifiable at μg kg(-1) levels in sediments but their concentrations did not statistically differ among ponds and channels, except norfloxacin in drying shrimp ponds and thiamphenicol in razor clam ponds. Concentrations of protozoan PLFAs were significantly increased in sediments from razor clam ponds while other microbial groups were similar among ponds and channels. Both canonical-correlation and stepwise-multiple-regression analyses on microbial community and residual antibiotics suggested that roxithromycin residuals were significantly related to shifts in microbial community structure in sediments. This study provided field evidence that multiple residual antibiotics at low environmental levels from aquacultural farming do not produce fundamental shifts in microbial community structure. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Corrosion Fatigue Crack Propagation Rate Characteristics for Weldable Ship and Offshore Steels with Regard to the Influence of Loading Frequency and Saltwater Temperature

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    Jakubowski Marek

    2017-03-01

    Full Text Available After Vosikovsky (1975, the corrosion fatigue crack growth rate (CFCGR characteristics have been divided into three regions. The region-III rates are very close to mechanical fatigue crack growth rates. CFCGR formulae, including the long-crack length effect (in region I only, the loading frequency effect (in region II only, and the saltwater temperature effect, have been proposed. It has been assumed that CFCGR is proportional to f-k, where f is the loading frequency and k is a constant. The averaged k-value for all steels of yield stress (YS below 500 MPa, usually with ferrite-pearlite microstructures, is higher than that for YS > 500 MPa, usually with quenched and tempered microstructures. The temperature effect does not appear in region I below room temperature. In the remaining cases, that is, in region I for elevated temperatures and in region II for both low and elevated temperatures, the CFCGR increases with increasing temperature. Under a potential of -0.8 V, a long-crack-length effect, qualitatively similar to analogous effect for free corrosion conditions, appears.

  20. Application of the top specified boundary layer (TSBL) approximation to initial characterization of an inland aquifer mineralization: 2. Seepage of saltwater through semi-confining layers

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    Rubin, H.; Buddemeier, R.W.

    1998-01-01

    This paper presents a generalized basic study that addresses practical needs for an understanding of the major mechanisms involved in the mineralization of groundwater in the Great Bend Prairie aquifer in south- central Kansas. This Quaternary alluvial aquifer and associated surface waters are subject to contamination by saltwater, which in some areas seeps from the deeper Permian bedrock formation into the overlying freshwater aquifer through semiconfining layers. A simplified conceptual model is adopted. It incorporates the freshwater aquifer whose bottom is comprised of a semiconfining layer through which a hydrologically minor but geochemically important saline water discharge seeps into the aquifer. A hierarchy of approximate approaches is considered to analyze the mineralization processes taking place in the aquifer. The recently developed top specified boundary layer (TSBL) approach is very convenient to use for the initial characterization of these processes, and is further adapted to characterization of head-driven seepage through semi-confining layers. TSBL calculations indicate that the seeping saline water may create two distinct new zones in the aquifer: (1) a completely saline zone (CSZ) adjacent to the semiconfining bottom of the aquifer, and (2) a transition zone (TZ) which develops between the CSZ and the freshwater zone. Some possible scenarios associated with the various mineralization patterns are analyzed and discussed.

  1. Assessing sea-level rise impact on saltwater intrusion into the root zone of a geo-typical area in coastal east-central Florida.

    Science.gov (United States)

    Xiao, Han; Wang, Dingbao; Medeiros, Stephen C; Hagen, Scott C; Hall, Carlton R

    2018-07-15

    Saltwater intrusion (SWI) into root zone in low-lying coastal areas can affect the survival and spatial distribution of various vegetation species by altering plant communities and the wildlife habitats they support. In this study, a baseline model was developed based on FEMWATER to simulate the monthly variation of root zone salinity of a geo-typical area located at the Cape Canaveral Barrier Island Complex (CCBIC) of coastal east-central Florida (USA) in 2010. Based on the developed and calibrated baseline model, three diagnostic FEMWATER models were developed to predict the extent of SWI into root zone by modifying the boundary values representing the rising sea level based on various sea-level rise (SLR) scenarios projected for 2080. The simulation results indicated that the extent of SWI would be insignificant if SLR is either low (23.4cm) or intermediate (59.0cm), but would be significant if SLR is high (119.5cm) in that infiltration/diffusion of overtopping seawater in coastal low-lying areas can greatly increase root zone salinity level, since the sand dunes may fail to prevent the landward migration of seawater because the waves of the rising sea level can reach and pass over the crest under high (119.5cm) SLR scenario. Copyright © 2018 Elsevier B.V. All rights reserved.

  2. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial.

    Science.gov (United States)

    Malay, D Scot; Pressman, Martin M; Assili, Amir; Kline, Jason T; York, Shane; Buren, Ben; Heyman, Eugene R; Borowsky, Pam; LeMay, Carley

    2006-01-01

    Extracorporeal shockwave therapy (ESWT) has demonstrated efficacy in the treatment of recalcitrant proximal plantar fasciitis. The objective of this investigation was to compare the outcomes of participants treated with a new ESWT device with those treated with placebo. A total of 172 volunteer participants were randomized in a 2:1 active-to-placebo ratio in this prospective, double-blind, multicenter trial conducted between October 2003 and December 2004. ESWT (n=115) or placebo control (n=57) was administered on a single occasion without local or systemic anesthesia or sedation, after which follow-up was undertaken. The primary outcomes were the blind assessor's objective, and the participant's subjective assessments of heel pain during the first 3 months of follow-up. Participants were also followed up to 1 year to identify any adverse outcomes that may have been related to the shockwave device. On the visual analog scale, the blind assessor's objective assessment of heel pain displayed a mean reduction of 2.51 in the shockwave group and 1.57 in the placebo group; this difference was statistically significant (P=.045). On the visual analog scale, the participant's self-assessment of heel pain displayed a mean reduction of 3.39 in the shockwave group and 1.78 in the placebo group; this difference was statistically significant (P<.001). No serious adverse events were observed at any time. It was concluded that ESWT was both efficacious and safe for participants with chronic proximal plantar fasciitis that had been unresponsive to exhaustive conservative treatment.

  3. High genetic diversity and demographic history of captive Siamese and Saltwater crocodiles suggest the first step toward the establishment of a breeding and reintroduction program in Thailand.

    Directory of Open Access Journals (Sweden)

    Sorravis Lapbenjakul

    Full Text Available The Siamese crocodile (Crocodylus siamensis and Saltwater crocodile (C. porosus are two of the most endangered animals in Thailand. Their numbers have been reduced severely by hunting and habitat fragmentation. A reintroduction plan involving captive-bred populations that are used commercially is important and necessary as a conservation strategy to aid in the recovery of wild populations. Here, the genetic diversity and population structure of 69 individual crocodiles, mostly members of captive populations, were analyzed using both mitochondrial D-loop DNA and microsatellite markers. The overall haplotype diversity was 0.924-0.971 and the mean expected heterozygosity across 22 microsatellite loci was 0.578-0.701 for the two species. This agreed with the star-like shaped topology of the haplotype network, which suggests a high level of genetic diversity. The mean ratio of the number of alleles to the allelic range (M ratio for the populations of both species was considerably lower than the threshold of 0.68, which was interpreted as indicative of a historical genetic bottleneck. Microsatellite markers provided evidence of introgression for three individual crocodiles, which suggest that hybridization might have occurred between C. siamensis and C. porosus. D-loop sequence analysis detected bi-directional hybridization between male and female individuals of the parent species. Therefore, identification of genetically non-hybrid and hybrid individuals is important for long-term conservation management. Relatedness values were low within the captive populations, which supported their genetic integrity and the viability of a breeding and reintroduction management plan. This work constitutes the first step in establishing an appropriate source population from a scientifically managed perspective for an in situ/ex situ conservation program and reintroduction of crocodile individuals to the wild in Thailand.

  4. Selenium and mercury molar ratios in saltwater fish from New Jersey: Individual and species variability complicate use in human health fish consumption advisories☆

    Science.gov (United States)

    Burger, Joanna; Gochfeld, Michael

    2014-01-01

    Balancing risk versus benefits to humans and other organisms from consuming fish is a national concern in the USA, as well as in many other parts of the world. Protecting public health is both a federal and state responsibility, and states respond by issuing fish consumption advisories, particularly for mercury. Recently it has been emphasized that the protective role of selenium against mercury toxicity depends on their molar ratios, which should be evaluated as an indication of selenium’s protective capacity, and incorporated in risk assessments for fish consumption. However, there is no single “protective” ratio agreed upon. In this paper we examine the selenium:mercury (Se:Hg) molar ratios in a wide range of saltwater fish caught and eaten by recreational fishers along the New Jersey coast. We were particularly interested in interspecific and intraspecific variability, and whether the molar ratios were consistent within a species, allowing for its use in managing risk. The selenium–mercury molar ratio showed significant variation among and within fish species. The molar ratio decreased with the size of the fish species, decreased with the mercury levels, and within a fish species, the selenium:mercury ratio decreased with fish size. As an essential element, selenium undergoes some homeostatic regulation, but it is also highly toxic. Within species, mercury level tends to increase with size, accounting for the negative relationship between size and ratio. This variability may make it difficult to use the selenium:mercury molar ratio in risk assessment, risk management, and risk communication at this time, and more information is needed on how mercury and selenium actually interact and on the relationship between the molar ratios and health outcomes. PMID:22405995

  5. Interspecific and intraspecific variation in selenium:mercury molar ratios in saltwater fish from the Aleutians: Potential protection on mercury toxicity by selenium

    Science.gov (United States)

    Burger, Joanna; Gochfeld, Michael; Jeitner, Christian; Donio, Mark; Pittfield, Taryn

    2014-01-01

    A number of factors affect the consumption risk from mercury in fish, including mercury levels, seasonal patterns of mercury concentrations, human consumption patterns, and sensitive populations (e.g. pregnant women, fetuses, young children, and yet unknown genetic factors). Recently the protective effects of selenium on methylmercury toxicity have been publicized, particularly for saltwater fish. We examine levels of mercury and selenium in several species of fish and seabirds from the Aleutians (Alaska), determine selenium:mercury molar ratios, and examine species-specific and individual variation in the ratios as a means of exploring the use of the ratio in risk assessment and risk management. Variation among species was similar for mercury and selenium. There was significant inter-specific and intraspecific variation in selenium:mercury molar ratios for fish, and for birds. The mean selenium:mercury molar ratios for all fish and bird species were above 1, meaning there was an excess of selenium relative to mercury. It has been suggested that an excess of selenium confers some protective advantage for salt water fish, although the degree of excess necessary is unclear. The selenium:mercury molar ratio was significantly correlated negatively with total length for most fish species, but not for dolly varden. Some individuals of Pacific cod, yellow irish lord, rock greenling, Pacific halibut, dolly varden, and to a lesser extent, flathead sole, had selenium:mercury ratios below 1. No bird muscle had an excess of mercury (ratio below 1), and only glaucous-winged gull and pigeon guillemot had ratios between 1 and 5. There was a great deal of variation in selenium:mercury molar ratios within fish species, and within bird species, making it difficult and impractical to use these ratios in risk assessment or management, for fish advisories, or for consumers, particularly given the difficulty of interpreting the ratios. PMID:22664537

  6. Mercury and selenium levels in 19 species of saltwater fish from New Jersey as a function of species, size, and season

    Science.gov (United States)

    Burger, Joanna; Gochfeld, Michael

    2014-01-01

    There are few data on risks to biota and humans from mercury levels in saltwater fish. This paper examines mercury and selenium levels in muscle of 19 species of fish caught by recreational fisherfolk off the New Jersey shore, as a function of species of fish, size, and season, and risk of mercury to consumers. Average mercury levels ranged from 0.01 ppm (wet weight) (Menhaden Brevoortia tyrannus) to 1.83 ppm (Mako Shark Isurus oxyrinchus). There were four categories of mercury levels: very high (only Mako), high (averaging 0.3–0.5 ppm, 3 species), medium (0.14–0.20 ppm, 10 species), and low (below 0.13 ppm, 5 species). Average selenium levels for the fish species ranged from 0.18 ppm to 0.58 ppm, and had lower variability than mercury (coefficient of variation=38.3 vs 69.1%), consistent with homeostatic regulation of this essential element. The correlation between mercury and selenium was significantly positive for five and negative for two species. Mercury levels showed significant positive correlations with fish size for ten species. Size was the best predictor of mercury levels. Selenium showed no consistent relationship to fish length. Over half of the fish species had some individual fish with mercury levels over 0.3 ppm, and a third had fish with levels over 0.5 ppm, levels that pose a human health risk for high end consumers. Conversely several fish species had no individuals above 0.5 ppm, and few above 0.3 ppm, suggesting that people who eat fish frequently, can reduce their risk from mercury by selecting which species (and which size) to consume. Overall, with the exception of shark, Bluefin Tuna (Thunnus thynnus), Bluefish (Pomatomus saltatrix) and Striped Bass (Morone saxatilis), the species sampled are generally medium to low in mercury concentration. Selenium:mercury molar ratios were generally above 1:1, except for the Mako shark. PMID:21292311

  7. Randomized multicenter follow-up trial on the effect of radiotherapy for plantar fasciitis (painful heels spur) depending on dose and fractionation – a study protocol

    International Nuclear Information System (INIS)

    Holtmann, Henrik; Niewald, Marcus; Prokein, Benjamin; Graeber, Stefan; Ruebe, Christian

    2015-01-01

    An actual clinical trial showed the effect of low dose radiotherapy in painful heel spur (plantar fasciitis) with single doses of 1.0 Gy and total doses of 6.0 Gy applied twice weekly. Furthermore, a lot of animal experimental and in vitro data reveals the effect of lower single doses of 0.5 Gy which may be superior in order to ease pain and reduce inflammation in patients with painful heel spur. Our goal is therefore to transfer this experimentally found effect into a randomized multicenter trial. This was a controlled, prospective, two-arm phase III-multicenter trial. The standard arm consisted of single fractions of 1.0 Gy applied two times a week, for a total dose of 6.0 Gy (total therapy time: 3 weeks). The experimental arm consisted of single fractions of 0.5 Gy applied 3 times a week, for a total dose of 6.0 Gy (total therapy time: 4 weeks). Following a statistical power calculation, there were 120 patients for each investigation arm. The main inclusion criteria were: age > = 40 years, clinical and radiologically diagnosed painful heel spur (plantar fasciitis), and current symptoms for at least 6 months. The main exclusion criteria were: former local trauma, surgery or radiotherapy of the heel; pregnant or breastfeeding women; and a pre-existing severe psychiatric or psychosomatic disorder. After approving a written informed consent the patients are randomized by a statistician into one of the trial arms. After radiotherapy, the patients are seen after six weeks, after twelve weeks and then every twelve weeks up to 48 weeks. Additionally, they receive a questionnaire every six weeks after the follow-up examinations up to 48 weeks. The effect is measured using the visual analogue scale of pain (VAS), the calcaneodynia score according to Rowe and the SF-12 score. The primary endpoint is the pain relief three months after therapy. Patients of both therapy arms with an insufficient result are offered a second radiotherapy series applying the standard dose

  8. Impact of plantar fasciitis on the quality of life of male and female patients according to the Foot Health Status Questionnaire

    Directory of Open Access Journals (Sweden)

    Palomo-López P

    2018-04-01

    Full Text Available Patricia Palomo-López,1 Ricardo Becerro-de-Bengoa-Vallejo,2 Marta Elena Losa-Iglesias,3 David Rodríguez-Sanz,4 César Calvo-Lobo,5 Daniel López-López6 1Department of Nursing, University Center of Plasencia, Universidad de Extremadura, Spain; 2School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain; 3Faculty of Health Sciences, Universidad Rey Juan Carlos, Spain; 4Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain; 5Nursing and Physical Therapy Department, Faculty of Health Sciences, University of León, Ponferrada, León, Spain; 6Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain Background and purpose: Plantar fasciitis (PF is a foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma. We evaluated and compared the impact on quality of life (QoL related to foot health and general health between males and females with PF. Methods: In this cross-sectional descriptive study, patients with PF were recruited from a podiatry clinic. Physical examination, sociodemographic data, and the self-reported Foot Health Status Questionnaire (FHSQ were recorded. The FHSQ has three sections and provides two composite scores from 0 to 100. Higher scores (close to 100 reflect better QoL related to foot health and health in general; lower scores (close to 0 denote a worse QoL related to these health items. Results: One hundred patients (49 males [42.38 ± 14.065 years old] and 51 females [43.90 ± 14.305 years old] were recruited. Section one of the FHSQ evaluates four foot domains, and significant differences (P<0.05 were shown for foot pain and footwear, with males having higher scores than females, but not for foot function and general foot health (P>0.05. Section two assesses four domains of general wellbeing, and significant

  9. Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?

    Energy Technology Data Exchange (ETDEWEB)

    Hermann, Robert Michael, E-mail: hermann@strahlentherapie-westerstede.com [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Meyer, Andreas [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Gemeinschaftspraxis für Strahlentherapie Hildesheim/Goslar (Germany); Becker, Alexandra [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Schneider, Michael [Orthopaedic Centre for Musculoskeletal Research, University of Würzburg (Germany); Reible, Michael; Carl, Ulrich Martin [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Christiansen, Hans [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Nitsche, Mirko [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel (Germany)

    2013-12-01

    Purpose: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials: A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results: Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion: Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.

  10. Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?

    International Nuclear Information System (INIS)

    Hermann, Robert Michael; Meyer, Andreas; Becker, Alexandra; Schneider, Michael; Reible, Michael; Carl, Ulrich Martin; Christiansen, Hans; Nitsche, Mirko

    2013-01-01

    Purpose: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials: A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results: Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion: Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice

  11. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

    Science.gov (United States)

    Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

    2016-01-01

    BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

  12. Contemporary trends of the epidemiology, clinical characteristics, and resource utilization of necrotizing fasciitis in Texas: a population-based cohort study.

    Science.gov (United States)

    Oud, Lavi; Watkins, Phillip

    2015-01-01

    Introduction. There are limited population-level reports on the contemporary trends of the epidemiology, clinical features, resource utilization, and outcomes of necrotizing fasciitis (NF). Methods. We conducted a cohort study of Texas inpatient population, identifying hospitalizations with a diagnosis of NF during the years 2001-2010. The incidence, clinical features, resource utilization, and outcomes of NF hospitalizations were examined. Results. There were 12,172 NF hospitalizations during study period, with ICU admission in 50.3%. The incidence of NF rose 2.7%/year (P = 0.0001). Key changes between 2001-2002 and 2009-2010 included rising incidence of NF (5.9 versus 7.6 per 100,000 [P < 0.0001]), chronic comorbidities (69.4% versus 76.7% [P < 0.0001]), and development of ≥1 organ failure (28.5% versus 51.7% [P < 0.0001]). Inflation-adjusted hospital charges rose 37% (P < 0.0001). Hospital mortality (9.3%) remained unchanged during study period. Discharges to long-term care facilities rose from 12.2 to 30% (P < 0.0001). Conclusions. The present cohort of NF is the largest reported to date. There has been increasing incidence, chronic illness, and severity of illness of NF over the past decade, with half of NF hospitalizations admitted to ICU. Hospital mortality remained unchanged, while need for long-term care rose nearly 2.5-fold among survivors, suggesting increasing residual morbidity. The sources of the observed findings require further study.

  13. Contemporary Trends of the Epidemiology, Clinical Characteristics, and Resource Utilization of Necrotizing Fasciitis in Texas: A Population-Based Cohort Study

    Directory of Open Access Journals (Sweden)

    Lavi Oud

    2015-01-01

    Full Text Available Introduction. There are limited population-level reports on the contemporary trends of the epidemiology, clinical features, resource utilization, and outcomes of necrotizing fasciitis (NF. Methods. We conducted a cohort study of Texas inpatient population, identifying hospitalizations with a diagnosis of NF during the years 2001–2010. The incidence, clinical features, resource utilization, and outcomes of NF hospitalizations were examined. Results. There were 12,172 NF hospitalizations during study period, with ICU admission in 50.3%. The incidence of NF rose 2.7%/year (P=0.0001. Key changes between 2001-2002 and 2009-2010 included rising incidence of NF (5.9 versus 7.6 per 100,000 [P<0.0001], chronic comorbidities (69.4% versus 76.7% [P<0.0001], and development of ≥1 organ failure (28.5% versus 51.7% [P<0.0001]. Inflation-adjusted hospital charges rose 37% (P<0.0001. Hospital mortality (9.3% remained unchanged during study period. Discharges to long-term care facilities rose from 12.2 to 30% (P<0.0001. Conclusions. The present cohort of NF is the largest reported to date. There has been increasing incidence, chronic illness, and severity of illness of NF over the past decade, with half of NF hospitalizations admitted to ICU. Hospital mortality remained unchanged, while need for long-term care rose nearly 2.5-fold among survivors, suggesting increasing residual morbidity. The sources of the observed findings require further study.

  14. Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

    Science.gov (United States)

    Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon

    2014-01-01

    Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

  15. Simulation of saltwater movement in the Upper Floridan aquifer in the Savannah, Georgia-Hilton Head Island, South Carolina, area, predevelopment-2004, and projected movement for 2000 pumping conditions

    Science.gov (United States)

    Provost, Alden M.; Payne, Dorothy F.; Voss, Clifford I.

    2006-01-01

    A digital model was developed to simulate ground-water flow and solute transport for the Upper Floridan aquifer in the Savannah, Georgia-Hilton Head Island, South Carolina, area. The model was used to (1) simulate trends of saltwater intrusion from predevelopment to the present day (1885-2004), (2) project these trends from the present day into the future, and (3) evaluate the relative influence of different assumptions regarding initial and boundary conditions and physical properties. The model is based on a regional, single-density ground-water flow model of coastal Georgia and adjacent parts of South Carolina and Florida. Variable-density ground-water flow and solute transport were simulated using the U.S. Geological Survey finite-element, variable-density solute-transport simulator SUTRA, 1885-2004. The model comprises seven layers: the surficial aquifer system, the Brunswick aquifer system, the Upper Floridan aquifer, the Lower Floridan aquifer, and the intervening confining units. The model was calibrated to September 1998 water levels, for single-density freshwater conditions, then refined using variable density and chloride concentration to give a reasonable match to the trend in the chloride distribution in the Upper Floridan aquifer inferred from field measurements of specific conductance made during 2000, 2002, 2003, and 2004. The model was modified to simulate solute transport by allowing saltwater to enter the system through localized areas near the northern end of Hilton Head Island, at Pinckney Island, and near the Colleton River, and was calibrated to match chloride concentrations inferred from field measurements of specific conductance. This simulation is called the 'Base Case.'

  16. Necrotizing fasciitis of soft tissues. Diagnostic imaging findings and literature review; Le fascite necrotizzante dei tessuti molli. Ruolo della diagnostica per immagini e revisione della letteratura

    Energy Technology Data Exchange (ETDEWEB)

    Parenti, G.C.; Marri, C. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Servizio di Radiodiagnostica; Calandra, G. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Unita' operativa di Pronto Soccorso; Morisi, C. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Servizio di Anatomia Patologica; Zabberoni, W. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Div. di Malattie Infettive, Gruppo di rilevamento dati sulle INPS-ASL

    2000-05-01

    It retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of the cases of necrotizing fasciitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. 130 patients with progressive necrotizing soft tissue infections were examined from May 1991 to February 1998. In 32 of them (22-84 years old) the retrospective pathologic diagnosis was necrotizing fasciitis. Involved sites were the limbs (26/32), the cervical region (5/32) and the perineal region (1/32). Nineteen patients were submitted to conventional radiography, also for soft tissue studies. US was performed in an emergency setting in all the 32 cases, by a selected group of US operators particularly skilled in this kind of soft tissue condition. Contrast enhanced CT was performed in 9 cases. B-mode and Doppler US yielded useful and reliable information for prompt and correct diagnosis. Particularly these techniques showed changes as shown at US and histologic findings, but US missed changes in subcutaneous soft tissue and muscle in 11 cases (3/32 and 8/32, respectively) with subsequent histologic confirmation. Contrast enhanced CT better defined the extent of disease and possible complications, especially in sites that are difficult to study with US. Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fasciitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment. [Italian] Scopo di questo lavoro e' di valutare retrospettivamente i casi di fascite necrotizzante giunti all'esame diagnostico con particolare riguardo ai segni radiologici, ecografici e TC che possono essere utili per l'inquadramento diagnostico precoce e corretto. Da

  17. Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur) using very low doses – a study protocol

    International Nuclear Information System (INIS)

    Niewald, Marcus; Seegenschmiedt, M Heinrich; Micke, Oliver; Gräber, Stefan

    2008-01-01

    A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis) is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases) of the DEGRO (German Society for Radiation Oncology) decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0 Gy in single fractions of 1.0 Gy applied twice a week experimental arm: total dose 0.6 Gy in single fractions of 0.1 Gy applied twice a week (acting as a placebo) Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores): Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms). This trial protocol has been approved by the expert panel of the DEGRO as well as

  18. Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur using very low doses – a study protocol

    Directory of Open Access Journals (Sweden)

    Micke Oliver

    2008-09-01

    Full Text Available Abstract Background A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases of the DEGRO (German Society for Radiation Oncology decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. Methods/Design In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0 Gy in single fractions of 1.0 Gy applied twice a week experimental arm: total dose 0.6 Gy in single fractions of 0.1 Gy applied twice a week (acting as a placebo Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores: Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms. This trial protocol has been

  19. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

    Directory of Open Access Journals (Sweden)

    Roje Zdravko

    2011-12-01

    Full Text Available Abstract Necrotizing fasciitis (NF is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS, he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia. On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was

  20. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination

    Science.gov (United States)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell; Bolvig, Lars; Fredberg, Ulrich

    2018-01-01

    Background: Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown. Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study Design: Cohort study; Level of evidence, 3. Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model. Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women (P Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups (P Fascia thickness (P = .49) and presence of a heel spur (P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been

  1. Fasciíte necrosante: revisão com enfoque nos aspectos dermatológicos Necrotizing fasciitis: new insights with a focus on dermatological aspects

    Directory of Open Access Journals (Sweden)

    Izelda Maria Carvalho Costa

    2004-04-01

    Full Text Available Fasciíte necrosante é infecção bacteriana destrutiva e rapidamente progressiva do tecido subcutâneo e fáscia superficial, associada a altos índices de morbimortalidade, se não tiver tratamento precoce. Recentemente, inúmeros casos publicados têm demonstrado aumento na freqüência e gravidade dessa infecção, particularmente causada pelo Streptococcus do grupo A (GAS e que acomete até mesmo pessoas jovens e saudáveis. Classifica-se em tipo I, quando causada por flora mista de anaeróbios e outras bactérias, e tipo II, quando causada pelo GAS isolado ou associado ao Staphylococcus aureus. Os fatores predisponentes incluem: doenças crônicas e malignas, abuso de álcool, uso de drogas endovenosas, lesões da pele como varicela, úlceras crônicas, psoríase, cirurgia, traumas abertos e fechados, entre outros. Clinicamente destacam-se: a dor intensa, o edema grave, a rápida progressão e a resposta pobre à antibioticoterapia. É necessário um alto índice de suspeição para o diagnóstico clínico, que é confirmado à intervenção cirúrgica, com a evidência de necrose da fáscia superficial. Os exames radiológicos são úteis, e o diagnóstico diferencial deve ser feito principalmente com celulite em seu estágio inicial. O tratamento, que deve ser precoce, é feito com antibióticos de amplo espectro, debridamento cirúrgico agressivo e medidas de suporte clínico e nutricional.Necrotizing fasciitis is a destructive and quickly progressing bacterial infection of the subcutaneous layer and superficial fascia. It is associated with high levels of unhealthiness and mortality if not treated early. Recently, countless published cases demonstrated an increasing frequency and severity of these infections, especially those caused by Group A Streptococcus (GAS, which afflicts even young and healthy persons. It is classified as type I when caused by a mixed anaerobic flora and other bacteria, and type II when caused by GAS alone or

  2. Fascitis nodular cervical en paciente gestante: revisión de la literatura y presentación de un caso Cervical nodular fasciitis in a pregnant woman: Review of the literature and presentation of a new case

    Directory of Open Access Journals (Sweden)

    Manuel Acosta-Feria

    2010-09-01

    Full Text Available La fascitis nodular es una lesión benigna rara, de crecimiento rápido, cuya patogenia es aún desconocida. Si bien a nivel de cabeza y cuello aparece en un 20% de los casos, su aparición en pacientes gestantes es extremadamente rara. Presentamos el segundo caso descrito en la literatura en el cual está presente dicha asociación. Mujer de 25 años y gestante de 13 semanas, con una tumoración retroauricular derecha de 3 cm de diámetro, 3 meses de evolución y rápido crecimiento. No presentaba parálisis facial ni dolor en la exploración inicial. Tras la exéresis quirúrgica de la lesión, el diagnóstico anatomopatológico definitivo de ésta, fue de fascitis nodular. Tras 2 años desde la intervención quirúrgica no se ha evidenciado recidiva de la tumoración, llevándose el embarazo a término sin presentar complicaciones ni para la madre ni para el feto.The nodular fasciitis is a rare benign lesion of rapid growth, whose pathogenesis is still unknown. While at the head and neck appeared in 20% of cases, its occurrence in pregnant patients is extremely rare. We report the second case described in the literature in which this association is present. Woman of 25 years and 13 weeks pregnant, who had a right auricular tumour 3 cm in diameter, 3 months of development and rapid growth. No facial paralysis or pain in the initial exploration. After surgical resection of the lesion, the final pathological diagnosis of the same was nodular fasciitis. After two years since the surgery, there was no evidence of recurrence of the tumour, taking ad términun pregnancy without complications or the mother or the fetus.

  3. Fascitis necrosante bilateral de diseminación hematógena por Staphylococcus Aureus: Caso pediátrico Necrotizing bilateral fasciitis of hematogenous dissemination, caused by Staphylococcus Aureus: Pediatric case

    Directory of Open Access Journals (Sweden)

    J.R. Manzani Baldi

    2011-06-01

    Full Text Available Presentamos un caso clínico muy poco frecuente de fascitis con miositis y necrosis cutánea en tronco y muslos, de presentación bilateral y simétrica y de mecanismo hematógeno, en una niña de 4 años durante el desarrollo de un cuadro séptico de foco primario orofaringeo, que requirió internamiento en centro de terapia intensiva pediátrica (CTP. Optamos por una conducta quirúrgica agresiva y precoz, apoyada por medidas médicas de soporte vital y antibioticoterapia empírica hasta el momento del diagnóstico. El agente etiológico fue Staphylococcus aureus. El resultado tras varias intervenciones, fue a costa de secuelas estéticas importantes. El seguimiento de la paciente tras 6 años de evolución, no ha mostrado ningún otro episodio similar.We present a not very frequent clinical case of fasciitis with miositis and cutaneous necrosis in trunk and thighs, with bilateral and symmetrical presentation and haematogenous dissemination mechanism in a 4 years old girl during the development of sepsis with primary oropharingeal focus, that required to be interned in paediatric intensive care unit. It was necessary and aggressive an precocious surgical treatment, supported by vital life measures and empiric antibiotics, until the final germen diagnosis. The etiologic agent was Staphylococcus aureus. As a result, there were very important aesthetic sequels after several surgical procedures. After 6 years evolution, there wasn't any other similar episode.

  4. Tratamiento de la fascitis necrosante por E. Coli mediante desbridamiento quirúrgico y terapia Vac®, a propósito de un caso Treatment of necrotizing fasciitis caused by E.Coli with surgical debridement and vacuum assisted therapy (Vac®, case report

    Directory of Open Access Journals (Sweden)

    M. Silva Bueno

    2011-12-01

    Full Text Available La fascitis necrosante es una rara infección de tejidos blandos con una alta tasa de morbi-mortalidad. Presentamos el caso de una paciente de 44 años diagnosticada de fascitis necrosante por E. coli en el contexto clínico de inmunosupresión por trasplante renal. Logramos un tratamiento exitoso mediante la asociación de desbridamiento quirúrgico, antibioticoterapia intravenosa y curas con terapia de presión negativa (VAC®, seguido de injertos autólogos de piel parcial. Remarcamos las ventajas clínicas de la terapia de presión negativa en el manejo y curación de heridas complejas.Necrotizing fasciitis is a rare soft tissue infection which presents a high rate of morbi-mortality. We describe the case of a 44 years old patient diagnosed with necrotizing fasciitis caused by E. coli, in the context of immunosuppression due to renal transplantation. Successful treatment was achieved by combining surgical debridement, intravenous antibiotic treatment and vacuum assisted closure therapy (VAC® completed by autologous split skin grafts. We stress the clinical benefits of subatmospheric pressure therapy in the management and healing of complex wounds.

  5. Tratamiento de la fascitis necrosante por E. Coli mediante desbridamiento quirúrgico y terapia Vac®: a propósito de un caso Treatment of necrotizing fasciitis caused by E.Coli with surgical debridement and vacuum assisted therapy (Vac®: case report

    Directory of Open Access Journals (Sweden)

    M. Silva Bueno

    2011-06-01

    Full Text Available La fascitis necrosante es una rara infección de tejidos blandos con una alta tasa de morbi-mortalidad. Presentamos el caso de una paciente de 44 años diagnosticada de fascitis necrosante por E. coli en el contexto clínico de inmunosupresión por trasplante renal. Logramos un tratamiento exitoso mediante la asociación de desbridamiento quirúrgico, antibioticoterapia intravenosa y curas con terapia de presión negativa (VAC®, seguido de injertos autólogos de piel parcial. Remarcamos las ventajas clínicas de la terapia de presión negativa en el manejo y curación de heridas complejas.Necrotizing fasciitis is a rare soft tissue infection which presents a high rate of morbi-mortality. We describe the case of a 44 years old patient diagnosed with necrotizing fasciitis caused by E. coli, in the context of immunosuppression due to renal transplantation. Successful treatment was achieved by combining surgical debridement, intravenous antibiotic treatment and vacuum assisted closure therapy (VAC® completed by autologous split skin grafts. We stress the clinical benefits of subatmospheric pressure therapy in the management and healing of complex wounds.

  6. Separating NaCl and AlCl3·6H2O Crystals from Acidic Solution Assisted by the Non-Equilibrium Phase Diagram of AlCl3-NaCl-H2O(-HCl Salt-Water System at 353.15 K

    Directory of Open Access Journals (Sweden)

    Huaigang Cheng

    2017-08-01

    Full Text Available Extracting AlCl3·6H2O from acid leaching solution through crystallization is one of the key processes to extracting aluminum from fly ash, coal gangue and other industrial solid wastes. However, the obtained products usually have low purity and a key problem is the lack of accurate data for phase equilibrium. This paper presented the non-equilibrium phase diagrams of AlCl3-NaCl-H2O (HCl salt-water systems under continuous heating and evaporation conditions, which were the main components of the acid leaching solution obtained through a sodium-assisted activation hydrochloric acid leaching process. The ternary system was of a simple eutonic type under different acidities. There were three crystalline regions; the crystalline regions of AlCl3·6H2O, NaCl and the mixture AlCl3·6H2O/NaCl, respectively. The phase diagram was used to optimize the crystallization process of AlCl3·6H2O and NaCl. A process was designed to evaporate and remove NaCl at the first stage of the evaporation process, and then continue to evaporate and crystallize AlCl3·6H2O after solid-liquid separation. The purities of the final salt products were 99.12% for NaCl and up to 97.35% for AlCl3·6H2O, respectively.

  7. Long-Term Prognosis of Plantar Fasciitis

    DEFF Research Database (Denmark)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell

    2018-01-01

    , exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study....... The risk was significantly greater for women (P heel...... regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us...

  8. Disseminated mucormycosis and necrotizing fasciitis in immune ...

    African Journals Online (AJOL)

    of the coagulopathy and anaemia with blood product administration ... disintegration of the terminal ileum, the caecum and the .... combined with effective antifungal therapy and reversal ... precluded by its toxicity and, in some situations, cost.

  9. Morphea and Eosinophilic Fasciitis: An Update

    NARCIS (Netherlands)

    Mertens, J.S.; Seyger, M.M.B.; Thurlings, R.M.; Radstake, T.R.D.J.; Jong, E.M.G.J. de

    2017-01-01

    Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint

  10. Odontogenic cervical necrotizing fasciitis, etiological aspects

    African Journals Online (AJOL)

    2015-06-26

    Jun 26, 2015 ... Results: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-. 72.69]) ... immune deficiencies, chronic alcoholism, or hepatic ... of these reports regarding the etiology of the development ..... periodontal lesions, where the Streptococcus strains are.

  11. Almost remediation of saltwater spills at E and P sites

    International Nuclear Information System (INIS)

    Carty, D.J.

    1995-01-01

    At exploration and production (E and P) sites crude spills restricted to topsoil are often self-remediating, but salt spills rarely are. Most soils naturally biodegrade crude. Without appropriate human intervention, brine spills can result in decades of barren land and seriously degrade surface water and aquifers. Servicing the E and P industry are remediation practitioners with a limited array of often expensive remediation concepts and materials which they hope will work, and sometimes do. Unfortunately, many remediation practitioners are unfamiliar with, or disregard, the natural physical, chemical, and biotic complexity of the soil and aquatic media. All too often this results in exacerbating injury to an already damaged ecosystem. Likewise, important cultural factors such as public relations, environmental regulations, property rights, and water rights are also overlooked until after implementation of an ill-advised or illegal remediation design has been initiated. A major issue is determining what constitutes ''successful'' remediation of a brine spill. Environmental managers have long sought one or two universally applicable fast and cheap amendment/treatment protocols for all their diverse multi-state salt affected spill scenarios. This presentation describes aspects of common spill-affected ecosystems which must be considered to achieve ''successful'' remediation

  12. Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg

    Directory of Open Access Journals (Sweden)

    Yu-Xiong Ye

    2009-03-01

    Full Text Available We report a 50-year-old man with poorly controlled diabetes mellitus who presented with a painful, swollen right leg. He had also experienced right flank pain for 1 week prior to admission. Physical examination was notable for tenderness over the right flank. The right leg was diffusely swollen and exquisitely tender to touch, with palpable crepitance. Laboratory tests revealed leukocytosis and pyuria. Computed tomography showed a right ureteral stone with hydronephrosis and characteristic findings of emphysematous pyelonephritis. Furthermore, a right perirenal gas-forming abscess with extension to the right leg was noted. The patient was successfully treated with antibiotic therapy, aggressive control of blood sugar, percutaneous drainage of the hydronephrosis and perirenal abscess, and aggressive debridement of the leg.

  13. Challenges in the management of cervicofacial necrotizing fasciitis ...

    African Journals Online (AJOL)

    Background: Necrotizing fascitis is uncommon but a life threatening cervico-facial infection, which is characterized by aggressive spread of inflammation and necrosis of the tissues. In our environment clinical presentation is often late and patient's management at this stage is very challenging. We present the challenges in ...

  14. Necrotizing fasciitis: A deadly disease | Cree | East and Central ...

    African Journals Online (AJOL)

    Background: Knowledge of the diagnosis, cause, course and required treatment of this deadly disease among physicians and surgeons around the world is limited. Methods: A study was undertaken at University Teaching Hospital (UTH), Lusaka Zambia to review the incidence, associated pathology, management given, ...

  15. Cervical Necrotizing Fasciitis: A Potentially Fatal Disease with ...

    African Journals Online (AJOL)

    management of this disease.[11] We report two ... aggressive and serial debridement were the bedrock of management in these cases. Keywords: ..... because of its relatively poor blood supply. .... soft tissue infections: Obstacles in diagnosis.

  16. Eosinophilic fasciitis in a child mimicking a myopathy.

    NARCIS (Netherlands)

    Pillen, S.; Engelen, B.G.M. van; Hoogen, F.H.J. van den; Fiselier, T.J.W.; Vossen, P. van der; Drost, G.

    2006-01-01

    A 14-year-old boy was suspected of having a myopathy with joint contractures. He presented with progressive painless joint contractures of his right wrist and fingers, and reduced muscle strength of his right arm, without obvious skin changes. Laboratory investigation showed a normal CK,

  17. Necrotizing fasciitis caused by Apophysomyces variabilis in an immunocompetent patient

    Directory of Open Access Journals (Sweden)

    José Y. Rodríguez

    2018-06-01

    Full Text Available Mucormycosis caused by Apophysomyces variabilis is rarely reported in humans. A case of A. variabilis infection in an immunocompetent men after friction burns in a car accident is described. The infection presented as a rapidly progressive necrotizing infection of the skin and soft tissue, which required extensive surgical debridement and total colonic defunctioning colostomy associated with prolonged antifungal therapy. A. variabilis infection should be considered as a differential diagnosis of rapidly progressive necrotizing skin and soft tissue infections in immunocompetent individuals. Keywords: Mucormycosis, Zygomycetes, Apophysomyces variabilis, Amphotericin B

  18. Unusual presentation of necrotizing fasciitis in an HIV exposed infant

    African Journals Online (AJOL)

    ... presentation of NF, in this instance, it presented on the scalp, in an HIV exposed neonate. It also stressed the importance prompt diagnosis of all skin lesions in HIV exposed neonates, and the role of early diagnosis and aggressive multi disciplinary team management in salvaging NF which is a potentially fatal condition.

  19. Red Flags For Necrotizing Fasciitis: A Case Control Study

    Directory of Open Access Journals (Sweden)

    Khalid Al Alayed

    2015-07-01

    Conclusions: When considered together, the traditional ‘red flags’ for NF may be sufficient to rule in or rule out the diagnosis. If future prospective studies validate these findings, there will be a potential opportunity to expedite NF diagnosis and improve patient outcomes.

  20. Retrospective evaluation of necrotizing fasciitis in university college ...

    African Journals Online (AJOL)

    2011-11-12

    Nov 12, 2011 ... Aims: To report our experience with cases seen and treated at the University College ... conditions included three cases each of diabetes mellitus and chronic ... the etiology of CNF in all cases with periodontal infection.

  1. The relationship between early growth and survival of hatchling saltwater crocodiles (Crocodylus porosus in captivity.

    Directory of Open Access Journals (Sweden)

    Matthew L Brien

    Full Text Available Hatchling fitness in crocodilians is affected by "runtism" or failure to thrive syndrome (FTT in captivity. In this study, 300 hatchling C. porosus, artificially incubated at 32°C for most of their embryonic development, were raised in semi-controlled conditions, with growth criteria derived for the early detection of FTT (within 24 days. Body mass, four days after hatching (BM4d, was correlated with egg size and was highly clutch specific, while snout-vent length (SVL4d was much more variable within and between clutches. For the majority of hatchlings growth trajectories within the first 24 days continued to 90 days and could be used to predict FTT affliction up to 300 days, highlighting the importance of early growth. Growth and survival of hatchling C. porosus in captivity was not influenced by initial size (BM4d, with a slight tendency for smaller hatchlings to grow faster in the immediate post-hatching period. Strong clutch effects (12 clutches on affliction with FTT were apparent, but could not be explained by measured clutch variables or other factors. Among individuals not afflicted by FTT (N = 245, mean growth was highly clutch specific, and the variation could be explained by an interaction between clutch and season. FTT affliction was 2.5 times higher among clutches (N = 7 that hatched later in the year when mean minimum air temperatures were lower, compared with those clutches (N = 5 that hatched early in the year. The results of this study highlight the importance of early growth in hatchling C. porosus, which has implications for the captive management of this species.

  2. Predictive uncertainty analysis of a saltwater intrusion model using null-space Monte Carlo

    DEFF Research Database (Denmark)

    Herckenrath, Daan; Langevin, Christian D.; Doherty, John

    2011-01-01

    variability did not make a noticeable difference to the uncertainty of the prediction. With this higher level of heterogeneity, however, the computational burden of generating calibration-constrained parameter fields approximately doubled. Predictive uncertainty variance computed through the NSMC method...

  3. Fertilizer legacies meet saltwater incursion: challenges and constraints for coastal plain wetland restoration

    Directory of Open Access Journals (Sweden)

    Marcelo Ardón

    2017-07-01

    Full Text Available Coastal wetland restoration is an important tool for climate change adaptation and excess nutrient runoff mitigation. However, the capacity of restored coastal wetlands to provide multiple ecosystem services is limited by stressors, such as excess nutrients from upstream agricultural fields, high nutrient legacies on-site, and rising salinities downstream. The effects of these stressors are exacerbated by an accelerating hydrologic cycle, expected to cause longer droughts punctuated by more severe storms. We used seven years of surface water and six years of soil solution water chemistry from a large (440 ha restored wetland to examine how fertilizer legacy, changes in hydrology, and drought-induced salinization affect dissolved nutrient and carbon concentrations. To better understand the recovery trajectory of the restored wetland, we also sampled an active agricultural field and two mature forested wetlands. Our results show that nitrogen (N and phosphorus (P concentrations in soil solution were 2–10 times higher in the restored wetland compared to two mature forested wetlands, presumably due to legacy fertilizer mobilized by reflooding. Despite elevated nutrient concentrations relative to reference wetlands, the restored wetland consistently attenuated N and P pulses delivered from an upstream farm. Even with continued loading, N and P concentrations in surface water throughout the restored wetland have decreased since the initial flooding. Our results suggest that high nutrient concentrations and export from wetlands restored on agricultural lands may be a severe but temporary problem. If field to wetland conversion is to become a more widespread method for ameliorating nutrient runoff and adapting coastal plain ecosystems to climate change, we should adopt new methods for minimizing the initial export phase of wetland restoration efforts.

  4. The use of isotope techniques to investigate saltwater intruded aquifers in the Philippines

    International Nuclear Information System (INIS)

    Peralta, G.L.

    1988-01-01

    Studies in Metro Manila area have identified inland bodies of saline water which have been called ''connate water''. It has been refered to in literature as saline water occurring inland at a range of depths, in close association with freshwater. The relationships between these various bodies of saline water are not clear and for groundwater development planning it would be useful to determine whether the inland cases are a series of small isolated residual bodies from the last marine transgression or parts of a large continuous saline body. Furthermore the origin and mechanism of natural groundwater recharges are often not clear from the chemical and hydrogeological data as in the island of Cebu. In these circumstances it was recommended that useful planning data be obtained from a study of the concentrations of natural isotopes in the groundwater, particularly in the areas of Manila, Cebu and Bulacan-Pampanga. (author)

  5. Identification of sources and mechanisms of salt-water pollution ground-water quality

    International Nuclear Information System (INIS)

    Richter, B.C.; Dutton, A.R.; Kreitler, C.W.

    1990-01-01

    This book reports on salinization of soils and ground water that is widespread in the Concho River watershed and other semiarid areas in Texas and the United States. Using more than 1,200 chemical analyses of water samples, the authors were able to differentiate various salinization mechanisms by mapping salinity patterns and hydrochemical facies and by analyzing isotopic compositions and ionic ratios. Results revealed that in Runnels County evaporation of irrigation water and ground water is a major salinization mechanism, whereas to the west, in Irion and Tom Green Counties, saline water appears to be a natural mixture of subsurface brine and shallowly circulating meteoric water recharged in the Concho River watershed. The authors concluded that the occurrence of poor-quality ground water is not a recent or single-source phenomenon; it has been affected by terracing of farmland, by disposal of oil-field brines into surface pits, and by upward flow of brine from the Coleman Junction Formation via insufficiently plugged abandoned boreholes

  6. 76 FR 32142 - Proposed Information Collection; Comment Request; Alaska Saltwater Sportfishing Economic Survey

    Science.gov (United States)

    2011-06-03

    ... marine sport species in Alaska (e.g., lingcod and rockfish). The data collected from the survey will be... a survey to collect data for conducting economic analyses of marine sport fishing in Alaska. This... management of the Pacific halibut sport fishery off Alaska, while the State of Alaska manages the salmon...

  7. 77 FR 5751 - Marine Recreational Fisheries of the United States; National Saltwater Angler Registry and State...

    Science.gov (United States)

    2012-02-06

    ... Fisheries, Fishing, Fishing vessels, Statistics. Dated: February 1, 2012. Alan D. Risenhoover, Acting Deputy.... 600.1416: a. Revise paragraphs (a), (b)(1), (c), introductory text (d) and (d)(1); and b. Add...

  8. Study of the saltwater-freshwater interface with EM-31 and direct measurements

    DEFF Research Database (Denmark)

    Calvache, Carlos Duque; Kinnear, Johnathan; Engesgaard, Peter Knudegaard

    Ringkøbing Fjord, a brackish coastal lagoon system, in the western part of Denmark is an EU ecological habitat, where the salinity and water stage is controlled primarily by the natural inflow from the Skjern River and by the management of a sluice between the fjord and the open sea. So far nobod...

  9. Spatial distributions of biogeochemical reactions in freshwater-saltwater mixing zones of sandy beach aquifers

    Science.gov (United States)

    Kim, K. H.; Michael, H. A.; Ullman, W. J.; Cai, W. J.

    2017-12-01

    Beach aquifers host biogeochemically dynamic mixing zones between fresh and saline groundwaters of contrasting origins, histories, and compositions. Seawater, driven up the beachface by waves and tides, infiltrates into the sand and meets the seaward-discharging fresh groundwater, creating and maintaining a highly reactive intertidal circulation cell well-defined by salinity. Seawater supplies oxygen and reactive carbon to the circulation cell, supporting biogeochemical reactions within the cell that transform and attenuate dissolved nutrient fluxes from terrestrial sources. We investigated the spatial distribution of chemical reaction zones within the intertidal circulation cell at Cape Shores, Lewes, Delaware. Porewater samples were collected from multi-level wells along a beach-perpendicular transect. Samples were analyzed for particulate carbon and reactive solutes, and incubated to obtain rates of oxic respiration and denitrification. High rates of oxic respiration were observed higher on the beach, in the landward freshwater-saline water mixing zone, where dissolved oxygen availability was high. Denitrification was dominant in lower areas of the beach, below the intertidal discharge point. High respiration rates did not correlate with particulate carbon concentrations entrained within porewater, suggesting that dissolved organic carbon or immobile particulate carbon trapped within the sediment can contribute to and alter bulk reactivity. A better understanding of the sources and sinks of carbon within the beach will improve our ability to predict nutrient fluxes to estuaries and oceans, aiding the management of coastal environments and ecosystems.

  10. Salt-water imbalance and fluid overload in hemodialysis patients: a pivotal role of corin.

    Science.gov (United States)

    Ricciardi, Carlo Alberto; Lacquaniti, Antonio; Cernaro, Valeria; Bruzzese, Annamaria; Visconti, Luca; Loddo, Saverio; Santoro, Domenico; Buemi, Michele

    2016-08-01

    Natriuretic peptides (NP) play a key role in regulation of salt and water balance. Corin, a serine protease which activates NP, plays a key role in regulation of blood pressure and cardiac function. The aim of the study was to evaluate the involvement of corin in renal physiopathology, analyze its levels in dialyzed patients and evaluate its relation with fluid overload and comorbidities such as heart failure and blood hypertension. We studied serum corin in uremic patients (n = 20) undergoing hemodialysis therapy (HD) and in healthy subjects (HS). Corin levels in uremic patients were higher than in HS (p role of corin in kidney diseases and to define its diagnostic and prognostic role.

  11. Influence of Saltwater Barrage on Tides, Salinity, and Chlorophyll a in Cochin Estuary, India

    Digital Repository Service at National Institute of Oceanography (India)

    Shivaprasad, A.; Vinita, J.; Revichandran, C.; Manoj, N.T.; Srinivas, K.; Reny, P.D.; Ashwini, R.; Muraleedharan, K.R.

    . The analysis showed that the closure of the barrage caused amplification of tides in the immediate vicinity and up to 10 km farther downstream. When the barrage was closed, the northern region of the TB transformed from an ebb-dominant system into a flood...

  12. Saltwater intrusion and water management in the unconfined coastal aquifer of Ravenna (Italy): a numerical model

    NARCIS (Netherlands)

    Giambastiani, Beatrice Maria Sole; Antonellini, Marco; Oude Essink, Gualbert; Stuurman, Roelof J.

    2007-01-01

    The Ravenna pine forests represent an historical landmark in the Po River Plain. They have great environmental, historical and tourist value. The San Vitale pine for- est is located 10 km north of the town. It is surrounded by an urban area, the city indus- trial infrastructure and the waterworks of

  13. Geochemical records of salt-water inflows into the deep basins of the Baltic Sea

    DEFF Research Database (Denmark)

    Neumann, T.; Christiansen, C.; Clasen, S.

    1997-01-01

    The estuarine circulation system of the Baltic Sea promotes stable stratification and bottom water anoxia in sedimentary basins of the Baltic proper. Ingressions of saline, oxygen-rich waters from the North Sea replace the oxygen depleted deep water. Timing and extent of the ingressions vary...... on time-scales of years to decades, and are largely determined by wind-strength and storm frequency over the North Atlantic Ocean and Europe. Mn/Fe-ratios in sediments from a dated sediment core of the Gotland Deep (250 m water depth) record variations in redox conditions that can be linked to historical......-pressure areas over the North Atlantic in more recent times. The last three events have also been observed by hydrographic measurements. During the long time stagnation periods, Fe and Mn will be segregated into a particulate phase (iron sulfide) which accumulates at the seafloor and a dissolved phase (Mn2...

  14. Carbon dynamics in a Late Quaternary-age coastal limestone aquifer system undergoing saltwater intrusion.

    Science.gov (United States)

    Bryan, Eliza; Meredith, Karina T; Baker, Andy; Andersen, Martin S; Post, Vincent E A

    2017-12-31

    This study investigates the inorganic and organic aspects of the carbon cycle in groundwaters throughout the freshwater lens and transition zone of a carbonate island aquifer and identifies the transformation of carbon throughout the system. We determined 14 C and 13 C carbon isotope values for both DIC and DOC in groundwaters, and investigated the composition of DOC throughout the aquifer. In combination with hydrochemical and 3 H measurements, the chemical evolution of groundwaters was then traced from the unsaturated zone to the deeper saline zone. The data revealed three distinct water types: Fresh (F), Transition zone 1 (T1) and Transition zone 2 (T2) groundwaters. The 3 H values in F and T1 samples indicate that these groundwaters are mostly modern. 14 C DOC values are higher than 14 C DIC values and are well correlated with 3 H values. F and T1 groundwater geochemistry is dominated by carbonate mineral recrystallisation reactions that add dead carbon to the groundwater. T2 groundwaters are deeper, saline and characterised by an absence of 3 H, lower 14 C DOC values and a different DOC composition, namely a higher proportion of Humic Substances relative to total DOC. The T2 groundwaters are suggested to result from either the slow circulation of water within the seawater wedge, or from old remnant seawater caused by past sea level highstands. While further investigations are required to identify the origin of the T2 groundwaters, this study has identified their occurrence and shown that they did not evolve along the same pathway as fresh groundwaters. This study has also shown that a combined approach using 14 C and 13 C carbon isotope values for both DIC and DOC and the composition of DOC, as well as hydrochemical and 3 H measurements, can provide invaluable information regarding the transformation of carbon in a groundwater system and the evolution of fresh groundwater recharge. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Stakeholder Participation in Research Design and Decisions: Scientists, Fishers, and Mercury in Saltwater Fish

    Science.gov (United States)

    Burger, Joanna; Gochfeld, Michael; Fote, Tom

    2015-01-01

    Individuals who fish and eat self-caught fish make decisions about where to fish, the type to eat, and the quantity to eat. Federal and state agencies often issue consumption advisories for some fish with high mercury (Hg) concentrations, but seldom provide either the actual metal levels to the general public, or identify the fish that have low contaminant levels. Community participatory research is of growing importance in defining, studying, and resolving complex exposure and risk issues, and this paper is at the intersection of traditional stakeholder approaches and community-based participatory research. The objective of this paper is to describe the process whereby stakeholders (fishers), were involved in directing and refining research questions to address their particular informational needs about mercury levels in fish, potential risks, and methods to maintain health, by balancing the risks and benefits of fish consumption. A range of stakeholders, mainly individual fishers, fishing organizations, and other scientists, were involved at nearly every stage. Community participants influenced many aspects of the design and implementation of the research, in the determination of which fish species to sample, in the collection of the samples, and in the final analyses and synthesis, as well as the communication of results and implications of the research through their fishing club publications, talks and gatherings. By involving the most interested and affected communities, the data and conclusions are relevant to their needs because the fish examined were those they ate and wanted information about, and directly address concerns about the risk from consuming self-caught fish. Although mercury levels in fish presumed to be high in mercury are known, little information was available to the fishermen on mercury levels in fish that were low and thus provided little risk to their families. While community participatory research is more time-consuming and expensive than traditional scientific research, both the process and results are better scientifically I in terms of community relevance. PMID:23413085

  16. Computational benefits using artificial intelligent methodologies for the solution of an environmental design problem: saltwater intrusion.

    Science.gov (United States)

    Papadopoulou, Maria P; Nikolos, Ioannis K; Karatzas, George P

    2010-01-01

    Artificial Neural Networks (ANNs) comprise a powerful tool to approximate the complicated behavior and response of physical systems allowing considerable reduction in computation time during time-consuming optimization runs. In this work, a Radial Basis Function Artificial Neural Network (RBFN) is combined with a Differential Evolution (DE) algorithm to solve a water resources management problem, using an optimization procedure. The objective of the optimization scheme is to cover the daily water demand on the coastal aquifer east of the city of Heraklion, Crete, without reducing the subsurface water quality due to seawater intrusion. The RBFN is utilized as an on-line surrogate model to approximate the behavior of the aquifer and to replace some of the costly evaluations of an accurate numerical simulation model which solves the subsurface water flow differential equations. The RBFN is used as a local approximation model in such a way as to maintain the robustness of the DE algorithm. The results of this procedure are compared to the corresponding results obtained by using the Simplex method and by using the DE procedure without the surrogate model. As it is demonstrated, the use of the surrogate model accelerates the convergence of the DE optimization procedure and additionally provides a better solution at the same number of exact evaluations, compared to the original DE algorithm.

  17. 77 FR 42189 - Marine Recreational Fisheries of the United States; National Saltwater Angler Registry and State...

    Science.gov (United States)

    2012-07-18

    ... Exempted State designation; allow the U.S. Virgin Islands to be designated as an Exempted State under the... or registration requirements to be eligible for Exempted State designation; (3) allow the U.S. Virgin... so small that exclusion of this group from a sample will not bias survey results. Comment: One state...

  18. Identity and quantity of microorganisms in necrotising fasciitis determined by culture and molecular methods

    DEFF Research Database (Denmark)

    Rudkjøbing, Vibeke Børsholt; Thomsen, Trine Rolighed; Nielsen, Per Halkjær

    communities were more common by molecular methods than culture. Correspondence between findings by culture and molecular methods indicates that the latter may be an appropriate method. The advantages of using molecular methods are: 1) identification of the pathogen(s) even when antibiotics have been...... involved in the disease may add to the knowledge of NF pathogenesis and influence the administration of antibiotics, thereby potentially improving the outcome for the patients. In this study the aim was to investigate the applicability of different molecular methods as compared to standard culture......-based methods. We investigated the microbial communities in 21 samples obtained during debridement of NF patients (n=8). Samples were examined by standard bacteriological examination (culture and microscopy) at Rigshospitalet (Copenhagen, Denmark) and a range of molecular methods. The best DNA extraction...

  19. A rare late complication after concomitant chemoradiation of an oropharyngeal tumor: cervical necrotizing fasciitis

    NARCIS (Netherlands)

    Karakullukçu, Barış; van der Vlies, Dalith; Hoebers, Frank J. P.

    2012-01-01

    Chemoradiation is increasingly being used to treat locally advanced head and neck carcinomas. Possible rare complications of this treatment modality have begun to appear, as the number of treated patients increase. In this report, we present a case who underwent chemoradiation due to T3N3M0 tonsil

  20. Fatal necrotizing fasciitis due to necrotic toxin-producing Escherichia coli strain

    Directory of Open Access Journals (Sweden)

    C. Gallois

    2015-11-01

    Full Text Available We report a fatal case of necrotizing soft tissues infection caused by an Escherichia coli strain belonging to phylogenetic group C and harbouring numerous virulence factors reported to be part of a pathogenicity island (PAI such as PAI IIJ96 and conserved virulence plasmidic region.

  1. Potential use of reverse osmosis in managing saltwater waste collected at road-salt storage facilites [sic].

    Science.gov (United States)

    2006-01-01

    The implementation of its anti-icing program comprises a large part of the Virginia Department of Transportation's (VDOT) maintenance effort. Earlier research confirmed that VDOT captures a large volume of salt-laden stormwater runoff at its 300+ sal...

  2. Wastewater and Saltwater: Studying the Biogeochemistry and Microbial Activity Associated with Wastewater Inputs to San Francisco Bay

    Science.gov (United States)

    Challenor, T.; Menendez, A. D.; Damashek, J.; Francis, C. A.; Casciotti, K. L.

    2014-12-01

    Nitrification is the process of converting ammonium (NH­­4+) into nitrate (NO3-), and is a crucial step in removing nitrogen (N) from aquatic ecosystems. This process is governed by ammonia-oxidizing bacteria (AOB) and archaea (AOA) that utilize the ammonia monooxygenase gene (amoA). Studying the rates of nitrification and the abundances of ammonia-oxidizing microorganisms in south San Francisco Bay's Artesian Slough, which receives treated effluent from the massive San Jose-Santa Clara Regional Wastewater Facility, are important for understanding the cycling of nutrients in this small but complex estuary. Wastewater inputs can have negative environmental impacts, such as the release of nitrous oxide, a byproduct of nitrification and a powerful greenhouse gas. Nutrient inputs can also increase productivity and sometimes lead to oxygen depletion. Assessing the relative abundance and diversity of AOA and AOB, along with measuring nitrification rates gives vital information about the biology and biogeochemistry of this important N-cycling process. To calculate nitrification rates, water samples were spiked with 15N-labeled ammonium and incubated in triplicate for 24 hours. Four time-points were extracted across the incubation and the "denitrifier" method was used to measure the isotopic ratio of nitrate in the samples over time. In order to determine relative ratios of AOB to AOA, DNA was extracted from water samples and used in clade-specific amoA PCR assays. Nitrification rates were detectable in all locations sampled and were higher than in other regions of the bay, as were concentrations of nitrate and ammonium. Rates were highest in the regions of Artesian Slough most directly affected by wastewater effluent. AOB vastly outnumbered AOA, which is consistent with other studies showing that AOB prefer high nutrient environments. AOB diversity includes clades of Nitrosospira and Nitrosomonas prevalent in estuarine settings. Many of the sequenced genes are related to estuarine sediment found at other sites in the San Francisco Bay as well as the Chesapeake Bay, China East Sea, and Pearl River Estuary. Our data provide evidence for the path that N takes once entering the estuary and also further characterize the behavior of nitrifying microorganisms in extremely high-nutrient aquatic environments.

  3. A synthetic study on constaining a 2D density-dependent saltwater intrusion model using electrical imaging data

    DEFF Research Database (Denmark)

    Antonsson, Arni Valur; Nguyen, Frederic; Engesgaard, Peter Knudegaard

    of the synthetic model, basically a salinity distribution in the coastal aquifer, was converted to resistivity distribution by assuming a certain petrophysical relation between water salinity and electrical conductivity. The obtained resistivity distribution was then used when electrical data acquisition...... was simulated. By applying an advanced inversion approach, electrical images of resistivity were obtained and based on the assumed petrophysical model the salinity distribution was derived. A number of different intrusion simulations were conducted with the aim of assessing the applicability of the method under....... Compared to conventional methods, which only give (few) point information, electrical images can give data over large spatial distances but that can be of great value for groundwater modeling purposes. The aim of this study is to investigate in a synthetic way, the applicability of using electrical images...

  4. Salt-water encroachment into aquifers of the Raritan Formation in the Sayreville Area, Middlesex County, New Jersey

    Science.gov (United States)

    Appel, Charles A.

    1962-01-01

    The principal sources of ground water in the Sayreville area are the Old Bridge Sand and Farrington Sand Members of the Raritan Formation of Late Cretaceous age. These aquifers yielded about 32.3 mgd (million gallons per day) for public and industrial water supplies in 1958; about 24.5 mgd was withdrawn from the Old Bridge Sand Member.

  5. Spatial and temporal patterns across an ecological boundary: Allochthonous effects of a young saltwater lake on a desert ecosystem

    Science.gov (United States)

    Brehme, C.S.; Boarman, W.I.; Hathaway, S.A.; Herring, A.; Lyren, L.; Mendelsohn, M.; Pease, K.; Rahn, M.; Rochester, C.; Stokes, D.; Turschak, G.; Fisher, R.N.

    2009-01-01

    We documented changes in the abundance and composition of terrestrial flora and fauna with respect to distance from the sea edge and timing of large allochthonous inputs from the Salton Sea, California. We found significant effects that were most pronounced within 300 m of the shore, but extended 3 km inland via coyote scat deposition. The zone within 300 m of the sea had a higher density of vegetation with a distinctly different plant composition. The denser vegetation supported higher abundances of birds and reptiles. Coyotes exhibited spatial and temporal responses to marine subsidies of fish, while birds were likely subsidized by aquatic aerial insects. Top-down control, as well as dietary and habitat preferences, may have resulted in reduced number of ants, beetles, and small mammals near the sea. Species responses to the habitat edge appeared to be associated with life history, as the near shore habitat favored habitat generalists and shore specialists, while inland desert habitat favored many sand and open desert specialists. Ecosystem responses support current theories of allochthonous spatial subsidies and consumer-resource dynamics but were limited in scope, magnitude, and distance.

  6. Sapflow and water use of freshwater wetland trees exposed to saltwater incursion in a tidally influenced South Carolina watershed

    Science.gov (United States)

    Krauss, K.W.; Duberstein, J.A.

    2010-01-01

    Sea-level rise and anthropogenic activity promote salinity incursion into many tidal freshwater forested wetlands. Interestingly, individual trees can persist for decades after salt impact. To understand why, we documented sapflow (Js), reduction in Js with sapwood depth, and water use (F) of baldcypress (Taxodium distichum (L.) Rich.) trees undergoing exposure to salinity. The mean Js of individual trees was reduced by 2.8 g H2O??m-2??s-1 (or by 18%) in the outer sapwood on a saline site versus a freshwater site; however, the smallest trees, present only on the saline site, also registered the lowest Js. Hence, tree size significantly influenced the overall site effect on Js. Trees undergoing perennial exposure to salt used greater relative amounts of water in outer sapwood than in inner sapwood depths, which identifies a potentially different strategy for baldcypress trees coping with saline site conditions over decades. Overall, individual trees used 100 kg H2O??day-1 on a site that remained relatively fresh versus 23.9 kg H2O??day-1 on the saline site. We surmise that perennial salinization of coastal freshwater forests forces shifts in individual-tree osmotic balance and water-use strategy to extend survival time on suboptimal sites, which further influences growth and morphology.

  7. Estimating movement and survival rates of a small saltwater fish using autonomous antenna receiver arrays and passive integrated transponder tags

    Science.gov (United States)

    Rudershausen, Paul J.; Buckel, Jeffery A.; Dubreuil, Todd; O'Donnell, Matthew J.; Hightower, Joseph E.; Poland, Steven J.; Letcher, Benjamin H.

    2014-01-01

    We evaluated the performance of small (12.5 mm long) passive integrated transponder (PIT) tags and custom detection antennas for obtaining fine-scale movement and demographic data of mummichog Fundulus heteroclitus in a salt marsh creek. Apparent survival and detection probability were estimated using a Cormack Jolly Seber (CJS) model fitted to detection data collected by an array of 3 vertical antennas from November 2010 to March 2011 and by a single horizontal antenna from April to August 2011. Movement of mummichogs was monitored during the period when the array of vertical antennas was used. Antenna performance was examined in situ using tags placed in wooden dowels (drones) and in live mummichogs. Of the 44 tagged fish, 42 were resighted over the 9 mo monitoring period. The in situ detection probabilities of the drone and live mummichogs were high (~80-100%) when the ambient water depth was less than ~0.8 m. Upstream and downstream movement of mummichogs was related to hourly water depth and direction of tidal current in a way that maximized time periods over which mummichogs utilized the intertidal vegetated marsh. Apparent survival was lower during periods of colder water temperatures in December 2010 and early January 2011 (median estimate of daily apparent survival = 0.979) than during other periods of the study (median estimate of daily apparent survival = 0.992). During late fall and winter, temperature had a positive effect on the CJS detection probability of a tagged mummichog, likely due to greater fish activity over warmer periods. During the spring and summer, this pattern reversed possibly due to mummichogs having reduced activity during the hottest periods. This study demonstrates the utility of PIT tags and continuously operating autonomous detection systems for tracking fish at fine temporal scales, and improving estimates of demographic parameters in salt marsh creeks that are difficult or impractical to sample with active fishing gear.

  8. Activity and conformation of lysozyme in molecular solvents, protic ionic liquids (PILs) and salt-water systems.

    Science.gov (United States)

    Wijaya, Emmy C; Separovic, Frances; Drummond, Calum J; Greaves, Tamar L

    2016-09-21

    Improving protein stabilisation is important for the further development of many applications in the pharmaceutical, specialty chemical, consumer product and agricultural sectors. However, protein stabilization is highly dependent on the solvent environment and, hence, it is very complex to tailor protein-solvent combinations for stable protein maintenance. Understanding solvent features that govern protein stabilization will enable selection or design of suitable media with favourable solution environments to retain protein native conformation. In this work the structural conformation and activity of lysozyme in 29 solvent systems were investigated to determine the role of various solvent features on the stability of the enzyme. The solvent systems consisted of 19 low molecular weight polar solvents and 4 protic ionic liquids (PILs), both at different water content levels, and 6 aqueous salt solutions. Small angle X-ray scattering, Fourier transform infrared spectroscopy and UV-vis spectroscopy were used to investigate the tertiary and secondary structure of lysozyme along with the corresponding activity in various solvation systems. At low non-aqueous solvent concentrations (high water content), the presence of solvents and salts generally maintained lysozyme in its native structure and enhanced its activity. Due to the presence of a net surface charge on lysozyme, electrostatic interactions in PIL-water systems and salt solutions enhanced lysozyme activity more than the specific hydrogen-bond interactions present in non-ionic molecular solvents. At higher solvent concentrations (lower water content), solvents with a propensity to exhibit the solvophobic effect, analogous to the hydrophobic effect in water, retained lysozyme native conformation and activity. This solvophobic effect was observed particularly for solvents which contained hydroxyl moieties. Preferential solvophobic effects along with bulky chemical structures were postulated to result in less competition with water at the specific hydration layer around the protein, thus reducing protein-solvent interactions and retaining lysozyme's native conformation. The structure-property links established in this study are considered to be applicable to other proteins.

  9. Analysis of steady-state salt-water upconing with application at Truro well field, Cape Cod, Massachusetts

    Science.gov (United States)

    Reilly, T.E.; Frimpter, M.H.; LeBlanc, D.R.; Goodman, A.S.

    1987-01-01

    Sharp interface methods have been used successfully to describe the physics of upconing. A finite-element model is developed to simulate a sharp interface for determination of the steady-state position of the interface and maximum permissible well discharges. The model developed is compared to previous published electric-analog model results of Bennett and others (1968). -from Authors

  10. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2016-01-01

    Conclusions: Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term.

  11. Platelet-rich plasma versus dry needling of myofascial meridian trigger points in the treatment of plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Reem El Mallah

    2017-01-01

    Conclusion PRP injection is a promising line of treatment for chronic PF with documented ultrasonographic healing effect. Dry needling is a simple and safe technique for treating pain associated with PF, yet it is more invasive and less effective compared with PRP injection.

  12. Physiotherapeutic methods in the treatment of heel spurs and inflammation of plantar fasciitis - a review of the literature

    Directory of Open Access Journals (Sweden)

    Mariola Monika Uczciwek

    2017-06-01

    Full Text Available For aim of this paper and analysis of the treatment methods in question articles from Pumbed basis were used. Pumbed basis, which works under the auspices of US National Library of  Medicine and National Institute of  Health, helped to analyze the treatment methods for chronic condition of heel spur and plantar fascia. The analytical process was based on  bibliographical descript. Results of 1204 numbers were summarized because of specialist criterion.  Heel spurs are bony growths growing out of the plantar fascia and other soft tissues lining nearby which conduct to the plantar fascia ignition. The occurrence of these is connected with burdensome feeling of pain that can be felt when making first steps after getting up in the morning. It is a serious condition that applies to more and more people. Being overweight, training sports straining feet are the reasons contributing to this condition. Yet, it is not a general rule for the risk group. Treating methods in this sphere give many opportunities for physical therapist and doctors. The best sustainable method is physical therapy supported by medical aids. However, not every case gives intended results. If the sustainable methods are not enough, the surgical treatment should be introduced. There is no doubt that any method of treatment is individually reclaimed by every patient.

  13. Effect of load ratio and saltwater corrosive environment on the initiation life of fatigue of 10Ni5CrMoV steel

    Science.gov (United States)

    Xie, Xing; Yi, Hong; Xu, Jian; Gen, Liming; Chen, Luyun

    2017-09-01

    Fatigue initiation life has been studied with 10CrNi5MoV steel for use in ocean engineering at different load ratios and in different environmental media. The microstructure and micro-topography have been observed and analyzed by means of SEM, EDS and EBSD. Our findings indicate that, the initiation life of 10Ni5CrMoV steel in seawater is shorter than that in air, and the difference in longevity is larger with the increasing of load ratio. Corrosion pits had a great influence on initial corrosion fatigue life.

  14. Magnetic resonance imaging of lesions to the superficial plantar aponevrosis

    International Nuclear Information System (INIS)

    Helie, O.; Dubayle, P.; Boyer, B.; Pharaboz, C.

    1995-01-01

    MRI is an efficient imaging modality to establish the diagnosis of plantar fascia tear and planta fasciitis. MRI allows to differentiate recent rupture from scar and fasciitis. (authors). 13 refs., 6 figs

  15. Magnetic resonance imaging of lesions to the superficial plantar aponevrosis; Imagerie par resonance magnetique des lesions de l`aponevrose plantaire superficielle

    Energy Technology Data Exchange (ETDEWEB)

    Helie, O.; Dubayle, P.; Boyer, B.; Pharaboz, C. [Hopital des Armees Begin, 94 - Saint-Mande (France)

    1995-01-01

    MRI is an efficient imaging modality to establish the diagnosis of plantar fascia tear and planta fasciitis. MRI allows to differentiate recent rupture from scar and fasciitis. (authors). 13 refs., 6 figs.

  16. A COMPARITIVE STUDY ON EFFECTIVENESS OF TAPING WITH IONTOPHORESIS AND TAPING ALONE IN CHRONIC PLANTAR FASCITIS

    OpenAIRE

    Biju Chetri, U.T. Ifthikar Ali, Madhusmita Koch, Abhijit Dutta

    2016-01-01

    Background: Plantar fasciitis is a painful condition caused by microtrauma to plantar fascia due to overuse. It is a most common cause of heel pain in runners. Various studies proved taping and Iontophoresis as effective in the treating plantar fasciitis. But there are no studies comparing the combined effect of iontophoresis with taping and taping alone in the treatment of plantar fasciitis. Methods: 50 patients suffering from plantar fasciitis who met the inclusion criteria were selected...

  17. Massachusetts Recreational Fishing Demand Survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Stated preference choice experiment data were collected in 2012 from Massachuestts saltwater recreational fishermen. Saltwater anglers fishing in Massachusetts (MA)...

  18. Atypical proliferative myositis: original MR description with pathologic correlation: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Jarraya, Mohamed; Guermazi, Ali [Boston University School of Medicine, Department of Radiology, Musculoskeletal Section, Boston, MA (United States); Parva, Pedram [VA Boston Healthcare System, Boston, MA (United States); Stone, Michael [Stamford Hospital, Department of Surgery, Stamford, CT (United States); Klein, Michael J. [Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, NY (United States)

    2014-08-15

    Proliferative myositis (PM) along with proliferative fasciitis and nodular fasciitis are a group of pseudosarcomatous myofibroblastic proliferations. Although the histologic presentation of each is almost identical, the magnetic resonance imaging (MRI) appearance of proliferative myositis is closer to that of inflammatory myopathies. We report a case of PM in which the imaging and histologic features combine typical findings of PM with unusual imaging features, suggesting of reactive (or nodular) fasciitis. (orig.)

  19. Atypical proliferative myositis: original MR description with pathologic correlation: Case report

    International Nuclear Information System (INIS)

    Jarraya, Mohamed; Guermazi, Ali; Parva, Pedram; Stone, Michael; Klein, Michael J.

    2014-01-01

    Proliferative myositis (PM) along with proliferative fasciitis and nodular fasciitis are a group of pseudosarcomatous myofibroblastic proliferations. Although the histologic presentation of each is almost identical, the magnetic resonance imaging (MRI) appearance of proliferative myositis is closer to that of inflammatory myopathies. We report a case of PM in which the imaging and histologic features combine typical findings of PM with unusual imaging features, suggesting of reactive (or nodular) fasciitis. (orig.)

  20. The Infectious and Noninfectious Dermatological Consequences of Flooding: A Field Manual for the Responding Provider.

    Science.gov (United States)

    Bandino, Justin P; Hang, Anna; Norton, Scott A

    2015-10-01

    Meteorological data show that disastrous floods are increasingly frequent and more severe in recent years, perhaps due to climatic changes such as global warming. During and after a flood disaster, traumatic injuries, communicable diseases, chemical exposures, malnutrition, decreased access to care, and even mental health disorders dramatically increase, and many of these have dermatological manifestations. Numerous case reports document typical and atypical cutaneous infections, percutaneous trauma, immersion injuries, noninfectious contact exposures, exposure to wildlife, and exacerbation of underlying skin diseases after such disasters as the 2004 Asian tsunami, Hurricane Katrina in 2005, and the 2010 Pakistan floods. This review attempts to provide a basic field manual of sorts to providers who are engaged in care after a flooding event, with particular focus on the infectious consequences. Bacterial pathogens such as Staphylococcus and Streptococcus are still common causes of skin infections after floods, with atypical bacteria also greatly increased. Vibrio vulnificus is classically associated with exposure to saltwater or brackish water. It may present as necrotizing fasciitis with hemorrhagic bullae, and treatment consists of doxycycline or a quinolone, plus a third-generation cephalosporin and surgical debridement. Atypical mycobacterial infections typically produce indolent cutaneous infections, possibly showing sporotrichoid spread. A unique nontuberculous infection called spam has recently been identified in Satowan Pacific Islanders; combination antibiotic therapy is recommended. Aeromonas infection is typically associated with freshwater exposure and, like Vibrio infections, immunocompromised or cirrhotic patients are at highest risk for severe disease, such as necrotizing fasciitis and sepsis. Various antibiotics can be used to treat Aeromonas infections. Melioidosis is seen mainly in Southeast Asia and Australia, particularly in rice farmers, and

  1. Enhanced Gravitational Drainage of Crude Oil Through Alabama Beach Sand Caused by the Dispersant Corexit 9500A

    Science.gov (United States)

    Steffy, D. A.; Nichols, A.; Hobbs, K.

    2017-12-01

    Oil spill material released by the 2010 Deepwater Horizon accident contaminated a majority of the 60 miles of Alabama coastline. In response to the oil spill, BP sprayed a dispersant, Corexit 9500A, as an initial remediation effort. An unforeseen impact of the saltwater-dispersant mixture includes the mobilization of oil-spilled material into the underlying beach sand. This study investigated the effect of the dispersant to promote gravitational drainage by measuring the physical characteristics of the sand, saltwater, crude oil, and the dispersant solution. The saltwater-dispersant mixture promoted the downward movement of oil mass 20 times greater extent than just saltwater. These tests are meant to simulate spill material on the beach being exposed to a low-energy, 1-meter mixed tide occurring along the Alabama coastline. A separate test simulated oilwet sand exposed to saltwater and a saltwater-dispersant mixture. The oil-wet sand impeded the vertical movement of saltwater, but allowed a saltwater-dispersant solution to mobilize the oil to migrate downward. The mobilization of oil in this three phase system of saltwater, oil, and air is controlled by: the pressure-saturation profile of the sand; interfacial tension with saltwater; and its surface tension with air.

  2. Case report

    African Journals Online (AJOL)

    raoul

    25 sept. 2011 ... Robin A, Méry G, George JL, Maalouf T, Angioi K. Facial necrotizing fasciitis after mild trauma of the eyelid: role of nonsteroidal anti- inflammatory treatment. J Fr Ophtalmol. 2010 Oct;33(8):568-72. This article on PubMed. 6. Cornelia Poitelea, Michael J. Wearne. Periocular necrotising fasciitis--a case report.

  3. Browse Title Index

    African Journals Online (AJOL)

    Items 451 - 500 of 823 ... Vol 17, No 2 (2012), Necrotizing fasciitis of breast, Abstract PDF. SA Salati, AA Rather. Vol 10, No 2 (2005), Necrotizing fasciitis: A deadly disease, Abstract PDF. IC Cree, PS Phiri. Vol 11, No 2 (2006), Needle in the chest: A case presentation, Abstract PDF. D D Mugala, D Datta, E P Musonda, Chomba ...

  4. 75 FR 22070 - Pacific Halibut Fisheries; Guided Sport Charter Vessel Fishery for Halibut; Recordkeeping and...

    Science.gov (United States)

    2010-04-27

    ... period for submission of Alaska Department of Fish and Game Saltwater Sport Fishing Charter Trip Logbook... of Alaska Department of Fish and Game (ADF&G) Saltwater Sport Fishing Charter Trip Logbook (charter... fishery. To avoid duplicative surveys of, and reporting by, industry, NMFS depends on data gathered by the...

  5. Field and model investigations of freshwater lenses in coastal aquifers

    NARCIS (Netherlands)

    Pauw, P.S.

    2015-01-01

    A major problem of sustaining freshwater supply from freshwater lens is the invasion of saline groundwater into a fresh groundwater body. In many coastal areas saltwater intrusion has led to well closure and reduced freshwater supply. Furthermore, in the future saltwater intrusion is expected to

  6. 78 FR 38297 - Proposed Information Collection; Comment Request; California Recreational Groundfish Survey

    Science.gov (United States)

    2013-06-26

    ... California saltwater angler preferences relative to Pacific groundfish. Pacific groundfish caught in...' recreational saltwater fishing activities in California (including groundfish); their attitudes and preferences... collected will provide NMFS, as well as state agency partners such as the California Department of Fish and...

  7. Development of a coastal drought index using salinity data

    Science.gov (United States)

    Paul Conrads; Lisa Darby

    2016-01-01

    The location of the freshwater-saltwater interface in surface-water bodies is an important factor in the ecological and socio-economic dynamics of coastal communities. It influences community composition in freshwater and saltwater ecosystems, determines fisheries spawning habitat, and controls freshwater availability for municipal and industrial water intakes. These...

  8. Field manual for reclamation of salt contaminated soils

    International Nuclear Information System (INIS)

    Burley, M.J.; Lesky, M.; Warren, R.J.

    1988-01-01

    Saltwater is often produced with crude oil and must be separated from it at a processing facility prior to deep-well injection. Increasing volumes of saltwater have led to pipeline corrosion and an increasing frequency of saltwater spills. A field manual for treating saltwater-contaminated soil was prepared by the Production Research Department of Esso Resources Canada Limited and Husky Oil Operations Limited. The purpose of the manual is to provide field and plant operations with a practical guide for reclaiming brine spills on mineral (agricultural) soil. The manual covers background scientific theory about how saltwater affects the soil, initial steps for treating new spills, site assessment, and reclamation program design, implementation and monitoring. A sample spill site assessment form is included. 8 refs

  9. Ultrasound guided local steroid injection versus extracorporeal ...

    African Journals Online (AJOL)

    Nayera Saber

    2011-12-17

    Dec 17, 2011 ... inflammatory drugs; PF, plantar fasciitis; Mayo CSS, Mayo clinical scoring system. .... and the recruitment of appropriate stem cells ;leading to an enhancement .... Paired sample Student's t-test was done to compare between.

  10. The Pattern of Penile Gangrene in Sokoto, Nigeria | Ntia | African ...

    African Journals Online (AJOL)

    Early presentation, aggressive antibiotic therapy and urinary diversion can prevent or minimize penile loss. Some patients with partial penile loss require surgical reconstruction of the urethra and penis. Keywords: Penile gangrene, Fournier's gangrene, necrotizing fasciitis, phalloplasty, urethroplasty, neomeatoplasty

  11. Inflammatory focal myositis of the sternomastoid muscle: is there an absolute indication for biopsy? A case report and review of the literature

    NARCIS (Netherlands)

    Georgalas, Christos; Kapoor, Lekha; Chau, Ha; Bhattacharyya, Abir

    2006-01-01

    Focal myositis is a localised inflammatory process affecting skeletal muscles belonging to the pathological group of inflammatory pseudo tumours of soft tissue that includes myositis ossificans, proliferative myositis and nodular pseudosarcomatous fasciitis. Very rarely, it may affect one of the

  12. Glossary of Foot and Ankle Terms

    Science.gov (United States)

    ... long bones of the fingers or toes. Plantar fascia - Plantar fascia is a thin layer of tough tissue supporting ... the foot. Plantar fasciitis - An inflammation of the plantar fascia. Symptoms are usually pain at the bottom of ...

  13. Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances

    Energy Technology Data Exchange (ETDEWEB)

    Yu, J.S. [Ohio State Univ., Columbus (United States). Dept. of Radiology

    2000-09-01

    Magnetic resonance (MR) imaging has emerged as an important noninvasive diagnostic imaging technique for assessment of foot pathology. This modality, owing to its multiplanar imaging capability and inherent superiority in contrast, has been shown to be more accurate and sensitive for detection of plantar fascia pathology than any other imaging method. One of the most important and recognizable causes of heel pain is plantar fasciitis. With the exception of plantar fasciitis, there has been little emphasis on imaging other conditions that affect this important structure. The objective of this review is to demonstrate, from a perspective of MR imaging, the many different pathologic conditions that affect the plantar fascia. Included in this review will be a discussion of normal anatomy as well as entities such as acute plantar fasciitis, chronic plantar fasciitis, traumatic rupture, normal post-surgical changes, pathologic post-fasciotomy conditions, infection, and fibromatosis. (orig.)

  14. Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances

    International Nuclear Information System (INIS)

    Yu, J.S.

    2000-01-01

    Magnetic resonance (MR) imaging has emerged as an important noninvasive diagnostic imaging technique for assessment of foot pathology. This modality, owing to its multiplanar imaging capability and inherent superiority in contrast, has been shown to be more accurate and sensitive for detection of plantar fascia pathology than any other imaging method. One of the most important and recognizable causes of heel pain is plantar fasciitis. With the exception of plantar fasciitis, there has been little emphasis on imaging other conditions that affect this important structure. The objective of this review is to demonstrate, from a perspective of MR imaging, the many different pathologic conditions that affect the plantar fascia. Included in this review will be a discussion of normal anatomy as well as entities such as acute plantar fasciitis, chronic plantar fasciitis, traumatic rupture, normal post-surgical changes, pathologic post-fasciotomy conditions, infection, and fibromatosis. (orig.)

  15. Monitoring cardiac output during hyperbaric oxygen treatment of haemodynamically unstable patients

    DEFF Research Database (Denmark)

    Hansen, Marco Bo; Treschow, Frederik; Skielboe, Martin

    2013-01-01

    Patients suffering from necrotizing fasciitis (NF) are often haemodynamically unstable and require extended monitoring of cardiovascular parameters; yet this is limited during hyperbaric oxygen treatment (HBOT). We aimed to evaluate the use and safety of transoesophageal Doppler (TED) monitoring ...

  16. Case series

    African Journals Online (AJOL)

    abp

    15 mai 2014 ... 1Service de Chirurgie Maxillo Faciale Hôpital Militaire Avicenne, Marrakech, Maroc, 2Service de .... cependant ses contre-indications et sa disponibilité limitent son .... cervical necrotizing fasciitis with hyperbaric oxygen.

  17. Heel Pain

    Science.gov (United States)

    ... of the foot, by stretching of the long band of tissue that connects the heel and the ... associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the ...

  18. Presentation and Diagnosis of Fournier Gangrene.

    Science.gov (United States)

    Voelzke, Bryan B; Hagedorn, Judith C

    2018-04-01

    Necrotizing fasciitis is a severe type of necrotizing soft tissue infection involving the superficial fascia and subcutaneous tissues. Fournier gangrene, a type of necrotizing fasciitis, affects the genitalia or perineum. Although a rare health condition, Fournier gangrene can result in significant morbidity and unnecessary mortality following delay in diagnosis and management. We provide a review of relevant presenting features to aid diagnosis and allow timely surgical management of this serious infectious condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Skin diseases of the vulva

    DEFF Research Database (Denmark)

    Sand, Freja Lærke; Thomsen, Simon Francis

    2017-01-01

    A multitude of infectious diseases of viral (genital herpes, herpes zoster, genital warts and molluscum contagiosum), bacterial (syphilis, chancroid, lymphogranuloma venereum, donovanosis, erysipelas, cellulitis and necrotising fasciitis, folliculitis, impetigo, bartholin gland abscess, trichomyc......A multitude of infectious diseases of viral (genital herpes, herpes zoster, genital warts and molluscum contagiosum), bacterial (syphilis, chancroid, lymphogranuloma venereum, donovanosis, erysipelas, cellulitis and necrotising fasciitis, folliculitis, impetigo, bartholin gland abscess...

  20. Component Analysis and Identification of Black Tahitian Cultured Pearls From the Oyster Pinctada margaritifera Using Spectroscopic Techniques

    Science.gov (United States)

    Shi, L.; Wang, Y.; Liu, X.; Mao, J.

    2018-03-01

    Raman spectroscopy, ultraviolet, visible, and near infrared (UV-Vis-NIR) reflectance spectroscopy, and X-ray fluorescence (XRF) spectroscopy were used to characterize black Tahitian cultured pearls and imitations of these saltwater cultured pearls produced by γ-irradiation, and by coloring of cultured pearls with silver nitrate or organic dyes. Raman spectra indicated that aragonite was the major constituent of these four types of pearl. Using Raman spectroscopy at an excitation wavelength of 514 nm, black Tahitian cultured pearls exhibited characteristic 1100-1700 cm-1 bands. These bands were attributed to various organic components, including conchiolin and other black biological pigments. The peaks shown by saltwater cultured pearls colored with organic dyes varied with the type of dye used. Tahitian cultured and organic-dye-treated saltwater cultured pearls were easily identified by Raman spectroscopy. UV-Vis-NIR reflectance spectra showed bands at 408, 497, and 700 nm derived from porphyrin pigment and other black pigments. The spectra of dye-treated black saltwater pearls showed absorption peaks at 216, 261, 300, and 578 nm. The 261-nm absorption band disappeared from the spectra of γ-irradiated saltwater cultured pearls. This suggests the degradation of conchiolin in the γ-irradiated saltwater cultured pearls. XRF analysis revealed the presence of Ag on the surface of silver nitrate-dyed saltwater cultured pearls.

  1. Organophosphate inhibition of avian salt gland Na, K-ATPase activity

    Science.gov (United States)

    Eastin, W.C.; Fleming, W.J.; Murray, H.C.

    1982-01-01

    1. Adult black ducks (Anas rubripes) were given freshwater or saltwater (1.5% NaCl) for 11 days and half of each group was also given an organophosphate (17 p.p.m. fenthion) in the diet on days 6–11.2. After 11 days, ducks drinking saltrwater had lost more weight and had higher plasma Na and uric acid concentration and osmolalities than birds drinking freshwater.3. Saltwater treatment stimulated the salt gland to increased weight and Na, K-ATPase activity.4. Fenthion generally reduced plasma and brain cholinesterase activity and depressed cholinesterase and Na, K-ATPase activities in salt glands of birds drinking saltwater.

  2. Artificial Intelligence-Based Models for the Optimal and Sustainable Use of Groundwater in Coastal Aquifers

    Science.gov (United States)

    Sreekanth, J.; Datta, Bithin

    2011-07-01

    Overexploitation of the coastal aquifers results in saltwater intrusion. Once saltwater intrusion occurs, it involves huge cost and long-term remediation measures to remediate these contaminated aquifers. Hence, it is important to have strategies for the sustainable use of coastal aquifers. This study develops a methodology for the optimal management of saltwater intrusion prone aquifers. A linked simulation-optimization-based management strategy is developed. The methodology uses genetic-programming-based models for simulating the aquifer processes, which is then linked to a multi-objective genetic algorithm to obtain optimal management strategies in terms of groundwater extraction from potential well locations in the aquifer.

  3. Coastal estuaries and lagoons: The delicate balance at the edge of the sea

    Science.gov (United States)

    Conrads, Paul A.; Rodgers, Kirk D.; Passeri, Davina L.; Prinos, Scott T.; Smith, Christopher; Swarzenski, Christopher M.; Middleton, Beth A.

    2018-04-19

    Coastal communities are increasingly concerned about the dynamic balance between freshwater and saltwater because of its implications for societal, economic, and ecological resources. While the mixing of freshwater and saltwater sources defines coastal estuaries and lagoons, sudden changes in this balance can have a large effect on critical ecosystems and infrastructure. Any change to the delivery of water from either source has the potential to affect the health of both humans and natural biota and also to damage coastal infrastructure. This fact sheet discusses the potential of major shifts in the dynamic freshwater-saltwater balance to alter the environment and coastal stability.

  4. Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness.

    Science.gov (United States)

    Granado, Michael J; Lohman, Everett B; Gordon, Keith E; Daher, Noha S

    2018-01-01

    Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis. The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible. The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group ( p  plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p plantar fascia thickness between the two sides was less than 0.1 mm ( p  plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended, then the toes should be extended maximally and then noted to ensure subsequent ultrasound procedures are repeated. Standardizing the position of the MTP joints is not only important for attaining the most accurate thickness measurement of the plantar fascia, but is also

  5. Sex pheromone of the baldcypress leafroller (Lepidoptera: Tortricidae)

    Science.gov (United States)

    Brian T. Sullivan; Jeremy D. Allison; Richard A. Goyer; William P. Shepherd

    2015-01-01

    The baldcypress leafroller, Archips goyerana Kruse (Lepidoptera: Tortricidae), is a specialist on Taxodium distichum (L.) Richard and has caused serious defoliation in swamps of southeastern Louisiana, accelerating decline of baldcypress forests concurrently suffering from nutrient depletion, prolonged flooding, and saltwater...

  6. OIL BOND®

    Science.gov (United States)

    Technical product bulletin: this miscellaneous oil spill control agent is a solidifier used in cleanups. It absorbs and solidifies hydrocarbon spills on freshwater and saltwater or land applications. Ring spill with booms or pillows before treatment.

  7. Recreational Angler Attitudes

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA Fisheries implemented a national survey of saltwater recreational anglers beginning in February 2013. The survey was implemented in six regions including the...

  8. 77 FR 37387 - Proposed Information Collection; Comment Request; Understanding Recreational Angler Attitudes and...

    Science.gov (United States)

    2012-06-21

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Proposed Information Collection; Comment Request; Understanding Recreational Angler Attitudes and Preferences for Saltwater... survey will be to understand the range of attitudes, preferences, and concerns that recreational anglers...

  9. Puget Sound Recreational Shellfish Harvesting Survey - Model Intended Angler Behavior

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collect and analyze survey data from recreational saltwater fishermen in Oregon and Washington. Model trip demand using stated frequency / contingent behavior data....

  10. Special Issue: Response of Microbial Communities to Environmental Changes

    Directory of Open Access Journals (Sweden)

    Ulrich Stingl

    2018-03-01

    Full Text Available Environmental issues such as eutrophication, ocean acidification, sea level rise, saltwater intrusion, increase in carbon dioxide levels, or rise of average global temperatures, among many others, are impacting and changing whole ecosystems [...

  11. Download

    African Journals Online (AJOL)

    GB

    hemolysis, hyperkalemia, hyponatremia and an elevated circulating volume, whereas seawater drowning producesheme concentration, hypernatremia and lower circulating blood volume. These presentations partially depend on the amount of water aspirated. Important concern in aspiration of fresh and saltwater are.

  12. Ask a Scientist: What is Color Blindness?

    Medline Plus

    Full Text Available ... t you see colors well in the dark? Do fish have eyelids? Why does saltwater sting your ... treated, and how people become color blind. What do my eyes do when I’m sleeping? Click ...

  13. Fact Sheet: Notice of Ambient Water Quality Criteria Document for Tributyltin (TBT) - Final

    Science.gov (United States)

    Information pertaining to 2004 Final Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Tributyltin (TBT) for freshwater and saltwater. This fact sheet includes the safe levels of TBT that should protect the majority of species.

  14. Aquatic Life Criteria - Tributyltin (TBT)

    Science.gov (United States)

    Documents pertaining to 2004 Final Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Tributyltin (TBT) for freshwater and saltwater. These documents include the safe levels of TBT that should protect the majority of species.

  15. 2D and 3D Subsurface Geo-electrical Resistivity Imaging of ...

    African Journals Online (AJOL)

    PROF HORSFALL

    2018-04-12

    Apr 12, 2018 ... water supplies and impact food chains. Heavy metals ... sites, salt brines, acid spills and natural salt-water intrusions. .... Cooper, DF; Grey, S; Raymond, D; Walker, P. (2005). ... ponds at the Western Treatment Plant, Victoria.

  16. License Address List

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Address list generated from National Saltwater Angler Registry. Used in conjunction with an address-based sample as per survey design.

  17. Ask a Scientist: What is Color Blindness?

    Medline Plus

    Full Text Available ... you see colors well in the dark? Do fish have eyelids? Why does saltwater sting your eyes? ... be nearsighted or farsighted? Click to Watch Do fish have eyelids? Click to Watch Why don’t ...

  18. 40 CFR 408.321 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... AND STANDARDS CANNED AND PRESERVED SEAFOOD PROCESSING POINT SOURCE CATEGORY Non-Alaskan Herring Fillet... freshwater and saltwater fish and shellfish, to be processed, in the form in which it is received at the...

  19. 40 CFR 408.311 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... AND STANDARDS CANNED AND PRESERVED SEAFOOD PROCESSING POINT SOURCE CATEGORY Alaskan Herring Fillet... freshwater and saltwater fish and shellfish, to be processed, in the form in which it is received at the...

  20. 2009 S. Atlantic SPCE angler pilot survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This survey collected information to assess the economic value from an anglers perspective of saltwater charter and private boat fishing for selected species in...

  1. Juvenile Pacific Salmon in Puget Sound

    National Research Council Canada - National Science Library

    Fresh, Kurt L

    2006-01-01

    Puget sound salmon (genus Oncorhynchus) spawn in freshwater and feed, grow and mature in marine waters, During their transition from freshwater to saltwater, juvenile salmon occupy nearshore ecosystems in Puget Sound...

  2. Special Issue: Response of Microbial Communities to Environmental Changes.

    Science.gov (United States)

    Stingl, Ulrich

    2018-03-30

    Environmental issues such as eutrophication, ocean acidification, sea level rise, saltwater intrusion, increase in carbon dioxide levels, or rise of average global temperatures, among many others, are impacting and changing whole ecosystems [...].

  3. Geophysical Research Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Geophysical Research Facility (GRF) is a 60 ft long × 22 ft wide × 7 ft deep concrete basin at CRREL for fresh or saltwater investigations and can be temperature...

  4. Effluent salinity of pipe drains and tube-wells : a case study from the Indus plain

    NARCIS (Netherlands)

    Kelleners, T.J.

    2001-01-01

    Keywords: anisotropy, aquifer, desalinization, effluent salinity, groundwater, irrigation, salt-water upconing, soil salinity, stream-function, subsurface drainage

    Irrigated agriculture in arid and semi-arid zones often suffers from waterlogging and salinity problems.

  5. Arsenic mobilization and attenuation by mineral–water interactions: implications for managed aquifer recharge

    Science.gov (United States)

    Managed aquifer recharge (MAR) has a potential for addressing deficits in water supplies worldwide. It is also widely used for preventing saltwater intrusion, maintaining the groundwater table, and augmenting ecological stream flows among many beneficial environmental application...

  6. Ultrasound diagnosis and evaluation of plantar heel pain.

    Science.gov (United States)

    Argerakis, Nicholas G; Positano, Rock G; Positano, Rock C J; Boccio, Ashley K; Adler, Ronald S; Saboeiro, Gregory R; Dines, Joshua S

    2015-03-01

    One of the most common causes of heel pain is plantar fasciitis; however, there are other pathologic disorders that can mimic the symptoms and clinical presentation of this disorder. The purpose of this study was to retrospectively review the prevalence of various pathologic disorders on ultrasound in patients with proximal plantar heel pain. The medical records and diagnostic ultrasound reports of patients presenting with plantar heel pain between March 1, 2006, and March 31, 2007, were reviewed retrospectively, and the prevalence of various etiologies was collected. The inclusion criteria were based on their clinical presentation of plantar fasciitis or previous diagnosis of plantar fasciitis from an unknown source. Ultrasound evaluation was then performed to confirm the clinical diagnosis. We examined 175 feet of 143 patients (62 males and 81 females; age range, 16-79 years). Plantar fibromas were present in 90 feet (51%). Plantar fasciitis was diagnosed in 128 feet (73%). Coexistent plantar fibroma and plantar fascial thickening was found in 63 feet (36%). Of the 47 feet that were negative for plantar fasciitis on ultrasound, 27 (57%) revealed the presence of plantar fibroma. Diagnostic ultrasound can effectively and safely identify the prevalence of various etiologies of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed for confirmation of diagnosis.

  7. A COMPARITIVE STUDY ON EFFECTIVENESS OF TAPING WITH IONTOPHORESIS AND TAPING ALONE IN CHRONIC PLANTAR FASCITIS

    Directory of Open Access Journals (Sweden)

    Biju Chetri

    2016-04-01

    Full Text Available Background: Plantar fasciitis is a painful condition caused by microtrauma to plantar fascia due to overuse. It is a most common cause of heel pain in runners. Various studies proved taping and Iontophoresis as effective in the treating plantar fasciitis. But there are no studies comparing the combined effect of iontophoresis with taping and taping alone in the treatment of plantar fasciitis. Methods: 50 patients suffering from plantar fasciitis who met the inclusion criteria were selected. The subjects were randomly divided into two groups i.e. Group A and Group B. Group A received taping, iontophoresis with plantar fascia stretching. Group B received taping and plantar fascia stretching. A total of 6 treatment sessions were given on alternate days over a period of two weeks for both the groups. Results: VAS and FFI scores across baseline and post intervention showed a significant improvement statistically in their mean scores between Groups A and B (P<0.05. Between group comparison of VAS and FFI scores, it showed that subject treated with Iontophoresis in combination with taping and plantar fascia stretch (Group A had significant improvement in VAS and functional ability when compared to subjects treated with taping and plantar fascia stretching alone (Group B. Conclusion: Iontophoresis along with Taping and plantar fascia stretching gave an additional benefit when compared with Taping and plantar fascia stretching alone in reducing pain and improving function in plantar fasciitis.

  8. Fine needle aspiration cytology of pseudosarcomatous reactive lesions of soft tissues: A report of two cases

    Directory of Open Access Journals (Sweden)

    Suchitha Satish

    2012-01-01

    Full Text Available Pseudosarcomatous lesions are reactive proliferative lesions of the soft tissue, that are likely to be misdiagnosed as malignant, based on clinical and histological features. The most common lesions are nodular fasciitis, proliferative fasciitis, proliferative myositis and myositis ossificans. These rapidly growing soft-tissue lesions can represent a variety of diagnoses involving radically different treatment modalities. Accurate diagnosis is important to avoid unnecessary and often mutilating surgery. We report two cases to illustrate the importance of correct identification of these lesions by fine needle aspiration cytology.

  9. Spontaneous distal rupture of the plantar fascia.

    Science.gov (United States)

    Gitto, Salvatore; Draghi, Ferdinando

    2018-07-01

    Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a 48-year-old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections. © 2017 Wiley Periodicals, Inc.

  10. Delineation of Salt Water Intrusion through Use of Electromagnetic-Induction Logging: A Case Study in Southern Manhattan Island, New York

    Directory of Open Access Journals (Sweden)

    Frederick Stumm

    2017-08-01

    Full Text Available Groundwater with chloride concentrations up to 15,000 mg/L has intruded the freshwater aquifer underlying southern Manhattan Island, New York. Historical (1940–1950 chloride concentration data of glacial aquifer wells in the study area indicate the presence of four wedges of saltwater intrusion that may have been caused by industrial pumpage. The limited recharge capability of the aquifer, due to impervious surfaces and the 22.7 million liters per day (mld of reported industrial pumpage early in the 20th Century was probably the cause for the saltwater intrusion and the persistence of the historical saltwater intrusion wedges over time. Recent drilling of wells provided new information on the hydrogeology and extent of saltwater intrusion of the glacial aquifer overlying bedrock. The new observation wells provided ground-water level, chloride concentration, hydraulic conductivity, and borehole geophysical data of the glacial aquifer. The glacial sediments range in thickness from less than 0.3 m to more than 76.2 m within the study area. A linear relation between Electromagnetic-induction (EM conductivity log response and measured chloride concentration was determined. Using this relation, chloride concentration was estimated in parts of the glacial aquifer where sampling was not possible. EM logging is an effective tool to monitor changes in saltwater intrusion wedges.

  11. A 2D fluid motion model of the estuarine water circulation: Physical analysis of the salinity stratification in the Sebou estuary

    Science.gov (United States)

    Haddout, Soufiane; Maslouhi, Abdellatif; Magrane, Bouchaib

    2018-02-01

    Estuaries, which are coastal bodies of water connecting the riverine and marine environment, are among the most important ecosystems in the world. Saltwater intrusion is the movement of coastal saline water into an estuary, which makes up-estuary water, that becomes salty due to the mixing of freshwater with saltwater. It has become a serious environmental problem in the Sebou estuary (Morocco) during wet and dry seasons, which have a considerable impact on residential water supply, agricultural water supply as well as urban industrial production. The variations of salt intrusion, and the vertical stratification under different river flow conditions in the Sebou estuary were investigated in this paper using a two-dimensional numerical model. The model was calibrated and verified against water level variation, and salinity variation during 2016, respectively. Additionally, the model validation process showed that the model results fit the observed data fairly well ( R2 > 0.85, NSC > 0.89 and RMSE = 0.26 m). Model results show that freshwater is a dominant influencing factor to the saltwater intrusion and controlled salinity structure, vertical stratification and length of the saltwater intrusion. Additionally, the extent of salinity intrusion depends on the balance between fresh water discharges and saltwater flow from the sea. This phenomenon can be reasonably predicted recurring to mathematical models supported by monitored data. These tools can be used to quantify how much fresh water is required to counterbalance salinity intrusion at the upstream water intakes.

  12. Stepwise minimal debridement in Fournier's gangrene: a technical ...

    African Journals Online (AJOL)

    Fournier's gangrene, so called after the French physician who first described this condition in 1883, is a necrotizing fasciitis of the perineum and the genitalia. It is a fulminant gangrene of the genitalia. It is a polymicrobial infection caused by gram-positive, gram-negative anaerobic bacteria.1-4 The infection is said to spread ...

  13. Biofilm in group A streptococcal necrotizing soft tissue infections

    DEFF Research Database (Denmark)

    Siemens, Nikolai; Chakrakodi, Bhavya; Shambat, Srikanth Mairpady

    2016-01-01

    Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with forei...

  14. Fasciite nodulaire de la cavite buccale | Maamouri | Journal ...

    African Journals Online (AJOL)

    Introduction: Nodular fasciitis is a benign tumour-like lesion characterized by fibroblastic proliferation. It is common in subcutaneous fascia, usually of the upper extremity but it's very rare in the oral cavity. Frequently misdiagnosed as sarcoma due to its rapid growth, rich cellularity and mitotic activity. Patients and Methods: ...

  15. Browse Title Index

    African Journals Online (AJOL)

    Items 101 - 150 of 813 ... Vol 25, No 4 (2016), Challenges in the management of cervicofacial necrotizing fasciitis in a developing economy: our experience, Abstract. T Obiora Umeanuka, C Uchenna Okechi, N Felix Chukwuneke. Vol 24, No 4 (2015), Challenges in the management of glaucoma in a developing country; ...

  16. Unusual foreign bodies in the orofacial soft tissue spaces: A report of ...

    African Journals Online (AJOL)

    Surgical explorations of the left buccal, left submasseteric and the right buccal spaces led to the retrieval of the foreign bodies. Prompt diagnosis and surgical removal of such foreign bodies will greatly minimize the associated complications which may include; cellulitis, facial abscess, allergic reactions, necrotizing fasciitis ...

  17. Clinical Parameters and Challenges of Managing Cervicofacial ...

    African Journals Online (AJOL)

    Introduction: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial ...

  18. Author Details

    African Journals Online (AJOL)

    Haseeb, Ahmed A. Vol 11, No 2 (2015) - Articles Multifocal necrotizing fasciitis following Hirshsprung's disease surgery away from the surgical wound site. Abstract PDF. ISSN: 1687-4137. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's ...

  19. Author Details

    African Journals Online (AJOL)

    Disu, EA. Vol 6, No 1 (2014) - Articles Necrotizing Fasciitis In A Preterm, HIV Infected Baby Abstract. ISSN: 2141-1123. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL · News. OTHER ...

  20. Facteurs predictifs de gravite des cellulites cervico-faciales diffuses ...

    African Journals Online (AJOL)

    Objective : Cervicofacial cellulitis is a dermohypodermitis which originates at the hypodermic fat from a burglary of a focus dental, Its gravity lies partly in its diffuse form with a risk of airway obstruction and mediastinitis and secondly in its venture with necrotizing fasciitis and necrotizing gangrene. In the absence of ...