WorldWideScience

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)

    ... Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 58. Ferri FF. Plantar fasciitis. ... FF ed. Ferri's Clinical Advisor 2016 . Philadelphia, PA: Elsevier; 2016:970. Kadakia AR. Heel pain and plantar ...

  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. Plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Tahririan

    2012-01-01

    Full Text Available Heel pain, mostly caused by plantar fasciitis (PF, is a common complaint of many patients who requiring professional orthopedic care and are mostly suffering from chronic pain beneath their heels. The present article reviews studies done by preeminent practitioners related to the anatomy of plantar fasciitis and their histo-pathological features, factors associated with PF, clinical features, imaging studies, differential diagnoses, and diverse treatment modalities for treatment of PF, with special emphasis on non-surgical treatment. Anti-inflammatory agents, plantar stretching, and orthosis proved to have highest priority; corticosteroid injection, night splints and extracorporeal shock wave therapy were of next priority, in patients with PF. In patients resistant to the mentioned treatments surgical intervention should be considered.

  5. Saltwater icephobicity: Influence of surface chemistry on saltwater icing.

    Science.gov (United States)

    Carpenter, Katherine; Bahadur, Vaibhav

    2015-12-02

    Most studies on icephobicity focus on ice formation with pure water. This manuscript presents studies to understand the influence of surfaces on saltwater ice nucleation and propagation. Experiments are conducted to quantify the influence of surface chemistry on saltwater ice nucleation and to understand the utility of superhydrophobic surfaces for saltwater icephobicity. These experiments are conducted with pure water and two sodium chloride solutions, which represent the salinity of seawater and briny produced water. It is seen that the presence of salt slows down the ice front propagation velocity significantly. Saltwater droplet impact dynamics on superhydrophobic surfaces are also different from pure water. Saltwater droplets retract more and a greater fraction of impacting liquid is repelled from the superhydrophobic surface. It is seen that the greater bounciness of saltwater droplets is a result of slower ice nucleation propagation kinetics. These experiments indicate that superhydrophobic surfaces will have better resistance to impact icing with saltwater than pure water and can remain useful at temperatures as low as -40 °C. Overall, this work is a starting point for further studies on heterogeneous nucleation in saltwater and serves as a bridge between the widely studied freshwater icephobic surfaces and saltwater-related applications.

  6. Plantar fasciitis: a concise review.

    Science.gov (United States)

    Schwartz, Emily N; Su, John

    2014-01-01

    One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis.

  7. Plantar Fasciitis: A Concise Review

    OpenAIRE

    Schwartz, Emily N; Su, John

    2014-01-01

    One of the challenges in the treatment of plantar fasciitis is that there are very few high-quality studies comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines.

  8. [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.

  9. Post-aural Nodular Fasciitis

    Directory of Open Access Journals (Sweden)

    Mohammed Al Rahbi

    2015-01-01

    Full Text Available Nodular fasciitis is a rare benign lesion. Here we report a case of post-auricular nodular fasciitis, which was misdiagnosed by fine-needle aspiration cytology (FNAC as pleomorphic adenoma. An 18-year-old male presented at Al-Nahdha Hospital, physical examination revealed a right post aural firm immobile mass. Radiology suggested the presence of a hypo-dense to iso-dense subcutaneous mass. The swelling was excised and sent for histopathological examination which suggested the diagnosis of nodular fasciitis. FNAC reported pleomorphic adenoma of unusual location should raise the suspicion of nodular fasciitis.

  10. Talalgia: plantar fasciitis ?

    OpenAIRE

    Cardenuto Ferreira, Ricardo

    2014-01-01

    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 s...

  11. Taping for plantar fasciitis.

    Science.gov (United States)

    Podolsky, Roman; Kalichman, Leonid

    2015-01-01

    Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatments have been used to relieve symptoms. Taping is one of the most widespread treatments, with several techniques utilized in clinical practice. To evaluate, based on existing literature, the efficacy of different taping techniques in relieving symptoms and dysfunction caused by plantar fasciitis. PubMed, CINAHL, PEDro, ISIWeb of Science, and Google Scholar databases were searched from inception until December 2012, using a predefined search strategy. Controlled trials of any methodological quality were included, without any language restrictions. The methodological quality of interventional studies was evaluated inter alia by the PEDro score. Five randomized control trials, one cross-over study and two single group repeated measures studies met the inclusion criteria. Two studies were high quality; two were moderate quality and four were of poor methodological quality. All eight studies favored the use of different taping techniques. The most common technique was low dye taping. We found that in the short-term, taping is beneficial in treating plantar fasciitis. The best evidence exists for low dye taping and calcaneal taping. More research is needed to investigate long-term effect and effectiveness of specific taping techniques.

  12. Talalgia: plantar fasciitis.

    Science.gov (United States)

    Cardenuto Ferreira, Ricardo

    2014-01-01

    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.

  13. 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.

  14. Atypical presentations of eosinophilic fasciitis

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. Plantar Fasciitis: Prescribing Effective Treatments.

    Science.gov (United States)

    Shea, Michael; Fields, Karl B.

    2002-01-01

    Plantar fasciitis is an extremely common, painful injury seen among people in running and jumping sports. While prognosis for recovery with conservative care is excellent, prolonged duration of symptoms affects sports participation. Studies on treatment options show mixed results, so finding effective treatments can be challenging. A logical…

  17. 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.

  18. Necrotizing fasciitis of the perineum.

    Science.gov (United States)

    Akın, Yasemin; Celayir, Ayşenur Cerrah; Aköz, Tayfun; Civan, Hasret Ayyıldız; Kurt, Gökmen; Ağzıkuru, Turgut; Sahin, Ceyhan

    2013-05-01

    Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries a high mortality rate and requires prompt diagnosis and urgent treatment with radical debridement and antibiotics; but early diagnosis, which is essential to successful treatment, remains a challenge. Physical examination findings, preoperative and operative findings, histopathological results of the structure, and follow-up results of the patient are discussed with related reports. A 15-month old girl had a history of trivial perineal dermatitis after treatment of anemia and pneumonia. Perineal dermatitis progressed fastly as necrotizing fasciitis which was successfully managed with intensive medical treatment, surgical debridement and reconstructive surgery. Lack of cutaneous findings early in the disease makes the diagnosis challenging, so a high suspicion is essential. Recovery of the patient from this life-threatening condition needs a multi-disciplinary approach involving pediatrics, pediatric surgery, and plastic and reconstructive surgery.

  19. Eosinophilic fasciitis after parasite infection.

    Science.gov (United States)

    Oliveira, Marta; Patinha, Fabia; Marinho, Antonio

    2016-01-01

    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.

  20. 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.

  1. 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.

  2. Diagnosis and treatment of plantar fasciitis.

    Science.gov (United States)

    Goff, James D; Crawford, Robert

    2011-09-15

    Plantar fasciitis, a self-limiting condition, is a common cause of heel pain in adults. It affects more than 1 million persons per year, and two-thirds of patients with plantar fasciitis will seek care from their family physician. Plantar fasciitis affects sedentary and athletic populations. Obesity, excessive foot pronation, excessive running, and prolonged standing are risk factors for developing plantar fasciitis. Diagnosis is primarily based on history and physical examination. Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region. Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion. Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis. Use of ultrasonography and magnetic resonance imaging is reserved for recalcitrant cases or to rule out other heel pathology; findings of increased plantar fascia thickness and abnormal tissue signal the diagnosis of plantar fasciitis. Conservative treatments help with the disabling pain. Initially, patient-directed treatments consisting of rest, activity modification, ice massage, oral analgesics, and stretching techniques can be tried for several weeks. If heel pain persists, then physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections should be considered. Ninety percent of patients will improve with these conservative techniques. Patients with chronic recalcitrant plantar fasciitis lasting six months or longer can consider extracorporeal shock wave therapy or plantar fasciotomy.

  3. 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.)

  4. Diagnosis and management of plantar fasciitis.

    Science.gov (United States)

    Thompson, John V; Saini, Sundeep S; Reb, Christopher W; Daniel, Joseph N

    2014-12-01

    Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary. © 2014 The American Osteopathic Association.

  5. Case report: MRI of decubital ischemic fasciitis

    Directory of Open Access Journals (Sweden)

    Ozden Sila Ulus

    2011-01-01

    Full Text Available The MRI findings in a case of decubital ischemic fasciitis located posterolateral to the right greater trochanter, in a 72-year-old woman, are presented. Decubital ischemic fasciitis is an uncommon entity encountered mostly in debilitated, elderly patients, in the deep subcutaneous tissue, at pressure points or bony prominences. It can simulate soft-tissue sarcomas. Recognition of this lesion radiologically is important to prevent unnecessary interventions.

  6. Primary Care Management of Plantar Fasciitis.

    Science.gov (United States)

    Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

    2015-01-01

    Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed.

  7. Treatment of Plantar Fasciitis With Botulinum Toxin.

    Science.gov (United States)

    Ahmad, Jamal; Ahmad, Stacy H; Jones, Kennis

    2017-01-01

    This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P plantar fasciitis ( P plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. I, Randomized, double-blinded, placebo-controlled study.

  8. Monitoring Coastal Marshes for Persistent Saltwater Intrusion

    Science.gov (United States)

    Kalcic, Maria; Hall, Callie; Fletcher, Rose; Russell, Jeff

    2009-01-01

    Primary goal: Provide resource managers with remote sensing products that support ecosystem forecasting models requiring salinity and inundation data. Work supports the habitat-switching modules in the Coastal Louisiana Ecosystem Assessment and Restoration (CLEAR) model, which provides scientific evaluation for restoration management (Visser et al., 2008). Ongoing work to validate flooding with radar (NWRC/USGS) and enhance persistence estimates through "fusion" of MODIS and Landsat time series (ROSES A.28 Gulf of Mexico). Additional work will also investigate relationship between saltwater dielectric constant and radar returns (Radarsat) (ROSES A.28 Gulf of Mexico).

  9. 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.

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

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

    Climate Change and Saltwater Intrusion along the Eastern Mediterranean: Socioeconomic Vulnerability. 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 ...

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

    African Journals Online (AJOL)

    The area is faced with endemic groundwater quality problems arising from abandoned shallow and deep boreholes. The abandonment of shallow boreholes is presumed to have been caused by saltwater intrusion from the ocean. The objective of this paper is to examine if saltwater is responsible for groundwater ...

  12. Platelet-rich plasma and plantar fasciitis.

    Science.gov (United States)

    Monto, Raymond R

    2013-12-01

    Plantar fasciitis is the most common cause of heel pain and can prove difficult to treat in its most chronic and severe forms. Advanced cases of plantar fasciitis are often associated with ankle stiffness, heel spurs, and other conditions and can lead to extensive physical disability and financial loss. Most available traditional treatments, including orthoses, nonsteroidal anti-inflammatory drugs, and steroid injections have a paucity of supportive clinical evidence. More invasive treatments, ranging from corticosteroid and botulinum-A toxin injections to shockwave therapy and plantar fasciotomy, have demonstrated varying clinical success in severe cases but carry the potential for serious complication and permanent disability. Platelet-rich plasma has recently been demonstrated to be helpful in managing chronic severe tendinopathies when other techniques have failed. This review examines the pathophysiology, diagnostic options, nonoperative treatment modalities, and surgical options currently used for plantar fasciitis. It also focuses on the clinical rationale and available evidence for using autologous platelet-rich plasma to treat severe refractory chronic plantar fasciitis.

  13. 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...

  14. 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.

  15. Plantar fasciitis: what is the diagnosis and treatment?

    Science.gov (United States)

    Johnson, Rachel E; Haas, Kim; Lindow, Kyle; Shields, Robert

    2014-01-01

    Foot pain, specifically plantar heel pain, is a common complaint among patients in a podiatric or orthopaedic office setting but may be seen in primary care offices, urgent care centers, or emergency departments as well. There are numerous causes for heel pain, but plantar fasciitis is the most frequent cause. The diagnosis of plantar fasciitis is generally made clinically, but there are many diagnostic modalities that may be used to confirm the diagnosis. Treatment of plantar fasciitis ranges from conservative measures to surgical interventions, but most cases of plantar fasciitis can be managed conservatively. There is no definitive treatment proven to be the best option for plantar fasciitis. Treatment is patient dependent and commonly requires a combination of different modalities to successfully alleviate the symptoms. In this article, plantar fasciitis from defining the disorder, diagnosis, and treatment are discussed.

  16. Eosinophilic fasciitis occurring under treatment with natalizumab for multiple sclerosis.

    Science.gov (United States)

    Bujold, Janie; Boivin, Catherine; Amin, Mohamed; Bouchard, Jean-Pierre; Soucy, Jacques

    2014-01-01

    Eosinophilic fasciitis is a rare sclerosing syndrome with a poorly understood etiology. We report a case of eosinophilic fasciitis in a 40-year-old man undergoing treatment with natalizumab for multiple sclerosis. Natalizumab is a selective adhesion molecule inhibitor that prevents interaction of leukocytes with endothelial cells. Peripheral blood eosinophilia has been described under treatment with natalizumab, but we herein report the first case to our knowledge of eosinophilic fasciitis as a possible complication of this medication.

  17. Coastal Marsh Monitoring for Persistent Saltwater Intrusion

    Science.gov (United States)

    Hall, Callie M.

    2008-01-01

    This viewgraph presentation reviews NASA's work on the project that supports the Gulf of Mexico Alliance (GOMA) Governors Action Plan to monitor the coastal wetlands for saltwater intrusion. The action items that relate to the task are: (1) Obtain information on projected relative sea level rise, subsidence, and storm vulnerability to help prioritize conservation projects, including restoration, enhancement, and acquisition, and (2) Develop and apply ecosystem models to forecast the habitat structure and succession following hurricane disturbance and changes in ecological functions and services that impact vital socio-economic aspects of coastal systems. The objectives of the program are to provide resource managers with remote sensing products that support ecosystem forecasting models requiring salinity and inundation data. Specifically, the proposed work supports the habitat-switching modules in the Coastal Louisiana Ecosystem Assessment and Restoration (CLEAR) model, which provides scientific evaluation for restoration management.

  18. Necrotizing fasciitis of the neck: case presentation

    Directory of Open Access Journals (Sweden)

    Emil Marginean

    2017-10-01

    Full Text Available Necrotizing fasciitis represents a severe and rare infectious disease, which is accompanied by extended necrosis of subcutaneous tissues and fascia layers, having as a result gangrene of the teguments. To reduce mortality associated with this disease, a rapid diagnosis is necessary as well as aggressive surgical treatment, accompanied by adequate, aggressive antibiotic therapy. As a rule, etiology is teeth related, with the condition more common in immunology-depressed patients. This article presents the experience of the authors regarding a case presentation of necrotizing fasciitis with typical clinical expression and management of the disease in an immunological-depressed patient. Further data on diagnosis, microbiology, clinical manifestations, therapy principles, and prognosis are yet needed for atypical cases.

  19. Life-threatening cervical necrotizing fasciitis.

    Science.gov (United States)

    Helmy, A S; Salah, M A; Nawara, H A; Khatab, H; Khalaf, H A; Abd el-Maguid, N

    1997-12-01

    Eight cases of cervical necrotizing fasciitis are presented. Three were odontogenic, two were pharyngeal in origin and three were primary or idiopathic. Soft tissue gas was recognized in four patients. The bacteriology showed streptococci on the top of the list (50%), while for the idiopathic cases, it was monomicrobial and caused by staphylococci. Third generation cephalosporin and metronidazole represent good initial empirical antibacterial coverage. Histopathologically, all cases showed extensive necrosis of the debrided fascia and vascular thrombosis of the dermal vessels. The mortality rate was 3/8 (37.5%). Early diagnosis of cervical necrotizing fasciitis and initiation of definitive therapy in an intensive care environment is essential to minimize mortality. It is also important to recognize that this devastating infection may occur spontaneously, and it should be suspected in patients with unexplained soft tissue pain and tenderness.

  20. Periorbital nodular fasciitis arising during pregnancy

    Directory of Open Access Journals (Sweden)

    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.

  1. 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...

  2. A saltwater flotation technique to identify unincubated eggs

    Science.gov (United States)

    Devney, C.A.; Kondrad, S.L.; Stebbins, K.R.; Brittingham, K.D.; Hoffman, D.J.; Heinz, G.H.

    2009-01-01

    Field studies on nesting birds sometimes involve questions related to nest initiation dates, length of the incubation period, or changes in parental incubation behavior during various stages of incubation. Some of this information can be best assessed when a nest is discovered before the eggs have undergone any incubation, and this has traditionally been assessed by floating eggs in freshwater. However, because the freshwater method is not particularly accurate in identifying unincubated eggs, we developed a more reliable saltwater flotation method. The saltwater method involves diluting a saturated saltwater solution with freshwater until a salt concentration is reached where unincubated eggs sink to the bottom and incubated eggs float to the surface. For Laughing Gulls (Leucophaeus atricilla), floating eggs in freshwater failed to identify 39.0% (N = 251) of eggs that were subsequently found by candling to have undergone incubation prior to collection. By contrast, in a separate collection of gull eggs, no eggs that passed the saltwater test (N = 225) were found by a later candling to have been incubated prior to collection. For Double-crested Cormorants (Phalacrocorax auritus), floating eggs in freshwater failed to identify 15.6% (N = 250) of eggs that had undergone incubation prior to collection, whereas in a separate collection, none of the eggs that passed the saltwater test (N = 85) were found by a later candling to have been incubated prior to collection. Immersion of eggs in saltwater did not affect embryo survival. Although use of the saltwater method is likely limited to colonial species and requires calibrating a saltwater solution, it is a faster and more accurate method of identifying unincubated eggs than the traditional method of floating eggs in freshwater.

  3. Surgery for Patients With Recalcitrant Plantar Fasciitis

    Science.gov (United States)

    Wheeler, Patrick; Boyd, Kevin; Shipton, Mary

    2014-01-01

    Background: Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. Purpose: To assess the outcome following surgical intervention for patients with plantar fasciitis. Study Design: Case series; Level of evidence, 4. Methods: Seventy-nine patients were identified from operative diaries undergoing plantar fasciotomy surgery between 1993 and 2009. They were contacted to investigate long-term results using self-reported outcome measures. Results: Sixty-eight responses were received (86% response rate), with an average of 7 years (range, 1-15 years) of follow-up. Patients reported an average reduction in pain by visual analog scale of 79%, and 84% of patients were happy with the surgical results. Greater success was achieved in patients with shorter duration of symptoms preoperatively. No deterioration in success was seen over time. Conclusion: Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. The results of current operative techniques need to be fully investigated for longer term success, as do the outcomes of newer nonoperative management strategies. PMID:26535314

  4. Ultrasound guided injection of recalcitrant plantar fasciitis

    Science.gov (United States)

    Kane, D.; Greaney, T.; Bresnihan, B.; Gibney, R.; FitzGerald, O.

    1998-01-01

    OBJECTIVE—To determine the effect of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis.
METHODS—Four patients with a clinical diagnosis of idiopathic plantar fasciitis, who were unresponsive to palpation guided injection with triamcinolone acetonide and local anaesthetic, underwent ultrasonographic examination of the heel.
RESULTS—The following ultrasonographic features were noted:- (a) increased thickness of plantar fascia in symptomatic heels compared with asymptomatic heels, (b) loss of distinction of the distal plantar fascia borders, (c) reduced echogenicity of the plantar fascia. Ultrasound guided injection of the enlarged, hypoechoic plantar fascia resulted in complete relief in four of five heels(mean duration of follow up=24 months) in three cases. One patient developed a recurrence of symptoms after six months.
CONCLUSION—Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure.

 Keywords: ultrasound guided; corticosteroid injection; plantar fasciitis PMID:9771217

  5. Necrotizing fasciitis in association with Ludwig's angina - A case report.

    Science.gov (United States)

    Kavarodi, A M

    2011-07-01

    A 28 year old male diabetic patient developed Ludwig's angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig's angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.

  6. The role of hamstring tightness in plantar fasciitis.

    Science.gov (United States)

    Labovitz, Jonathan M; Yu, Jenny; Kim, Chul

    2011-06-01

    The purpose of this prospective cohort study was to determine if hamstring tightness was an increased risk in plantar fasciitis. It was thought that there is an increased risk of plantar fasciitis when hamstring tightness is present. A total of 105 patients (68 women, 37 men) were included in the study, 79 of whom were diagnosed with plantar fasciitis. Body mass index (BMI) was calculated and the presence of plantar fasciitis, equinus, and calcaneal spurs were assessed. The popliteal angle was measured using standard diagnostic techniques. Without controlling for covariates, BMI, the presence of a calcaneal spur, tightness in the gastrocnemius, gastrocnemius-soleus, and hamstring all had statistically significant association with plantar fasciitis. After controlling for covariates, patients with hamstring tightness were about 8.7 times as likely to experience plantar fasciitis (P 35 were approximately 2.4 times as likely to experience plantar fasciitis compared with those with BMI plantar fasciitis and should be addressed along with equinus and obesity when providing treatment to patients with this diagnosis.

  7. 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 ...

  8. Necrotizing fasciitis developing from a brown recluse spider bite.

    Science.gov (United States)

    Majeski, J

    2001-02-01

    A 20-year retrospective case series was analyzed to identify the brown recluse spider bite as a cause of necrotizing fasciitis. Data from 31 consecutive patients with necrotizing fasciitis were analyzed. Of the 31 patients with necrotizing fasciitis a brown recluse spider bite was found to be the initial cause in two patients. Both patients with spider bites delayed in obtaining medical treatment, and secondary infection of the necrotic tissue occurred. One patient was diagnosed by frozen section tissue biopsy, and the second patient was diagnosed by clinical examination. All patients in this series had immediate aggressive operative debridement. Both patients survived with functional limbs. There were no deaths in this large series. Necrotizing fasciitis can be caused by a secondarily infected brown recluse spider bite. Successful treatment of necrotizing fasciitis from any cause is associated with early diagnosis, immediate surgical debridement, and supplemental enteral or parenteral nutrition.

  9. Plantar fasciitis and its relationship with hallux limitus.

    Science.gov (United States)

    Aranda, Yolanda; Munuera, Pedro V

    2014-05-01

    We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

  10. Necrotizing fasciitis: contribution and limitations of diagnostic imaging.

    Science.gov (United States)

    Malghem, Jacques; Lecouvet, Frédéric E; Omoumi, Patrick; Maldague, Baudouin E; Vande Berg, Bruno C

    2013-03-01

    Necrotizing fasciitis is a rare, rapidly spreading, deep-seated infection causing thrombosis of the blood vessels located in the fascia. Necrotizing fasciitis is a surgical emergency. The diagnosis typically relies on clinical findings of severe sepsis and intense pain, although subacute forms may be difficult to recognize. Imaging studies can help to differentiate necrotizing fasciitis from infections located more superficially (dermohypodermitis). 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, which can be visualized using computed tomography and, above all, magnetic resonance imaging (high signal on contrast-enhanced T1 images and T2 images, best seen with fat saturation). These findings lack specificity, as they can be seen in non-necrotizing fasciitis and even in non-inflammatory conditions. Signs that support a diagnosis of necrotizing fasciitis include extensive involvement of the deep intermuscular fascias (high sensitivity but low specificity), thickening to more than 3mm, and partial or complete absence on post-gadolinium images of signal enhancement of the thickened fasciae (fairly high sensitivity and specificity). Ultrasonography is not recommended in adults, as the infiltration of the hypodermis blocks ultrasound transmission. Thus, imaging studies in patients with necrotizing fasciitis may be challenging to interpret. Although imaging may help to confirm deep tissue involvement and to evaluate lesion spread, it should never delay emergency surgical treatment in patients with established necrotizing fasciitis. Copyright © 2012. Published by Elsevier SAS.

  11. 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.

  12. 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.

  13. 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.

  14. Ultrasound elastography in the early diagnosis of plantar fasciitis.

    Science.gov (United States)

    Lee, So-Yeon; Park, Hee Jin; Kwag, Hyon Joo; Hong, Hyun-Pyo; Park, Hae-Won; Lee, Yong-Rae; Yoon, Kyung Jae; Lee, Yong-Taek

    2014-01-01

    The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis. We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet. Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P=.027, respectively]. US elastography is useful for the early diagnosis of plantar fasciitis. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. 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

  16. 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.

  17. Primary retroperitoneal fasciitis; A rare cause of acute abdominal pain.

    Science.gov (United States)

    Ünal, Emre; Onur, Mehmet Ruhi; Akpinar, Erhan; Karcaaltincaba, Musturay

    2017-07-01

    The retroperitoneal fascial planes can be affected by various clinical disorders. In most of the cases retroperitoneal involvement occurs secondary to spread of a distinct underlying etiology. Herein we report two cases of primary retroperitoneal fasciitis diagnosed with imaging findings. The diagnosis of retroperitoneal fasciitis should be made by exclusion since various and more frequently encountered disorders including acute pancreatitis, duodenitis, pyelonephritis, and appendicitis may present with similar imaging findings. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Hyperemia in plantar fasciitis determined by power Doppler ultrasound.

    Science.gov (United States)

    McMillan, Andrew M; Landorf, Karl B; Gregg, Julie M; De Luca, Jason; Cotchett, Matthew P; Menz, Hylton B

    2013-12-01

    Cross-sectional observational study. To investigate the presence of soft tissue hyperemia in plantar fasciitis with power Doppler ultrasound. Localized hyperemia is an established feature of tendinopathy, suggesting that neurovascular in-growth may contribute to tendon-associated pain in some patients. The presence of abnormal soft tissue vascularity can be assessed with Doppler ultrasound, and a positive finding can assist with targeted treatment plans. However, very little is known regarding the presence of hyperemia in plantar fasciitis and the ability of routine Doppler ultrasound to identify vascular in-growth in the plantar fascia near its proximal insertion. This observational study included 30 participants with plantar fasciitis unrelated to systemic disease and 30 age- and sex-matched controls. Ultrasound examination was performed with a 13- to 5-MHz linear transducer, and power Doppler images were assessed by 2 blinded investigators. Hyperemia of the plantar fascia was present in 8 of 30 participants with plantar fasciitis and in 2 of 30 controls. The between-group difference for hyperemia, using a 4-point scale, was statistically significant, with participants with plantar fasciitis showing increased Doppler ultrasound signal compared to controls (Mann-Whitney U, P = .03). However, the majority of participants with plantar fasciitis with evidence of hyperemia demonstrated very mild color changes, and only 3 were found to have moderate or marked hyperemia. Mild hyperemia can occur with plantar fasciitis, but most individuals will not exhibit greater soft tissue vascularity when assessed with routine Doppler ultrasound. Clinicians treating plantar fasciitis should not consider a positive Doppler signal as essential for diagnosis of the condition but, rather, as a feature that may help to refine the treatment plan for an individual patient.

  19. 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.

  20. Triple diagnostics for early detection of ambivalent necrotizing fasciitis.

    Science.gov (United States)

    Hietbrink, Falco; Bode, Lonneke G; Riddez, Louis; Leenen, Luke P H; van Dijk, Marijke R

    2016-01-01

    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. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct. Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented. In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis. In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.

  1. 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.

  2. Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy.

    Science.gov (United States)

    Yanbin, Xu; Haikun, Chu; Xiaofeng, Ji; Wanshan, Yang; Shuangping, Liu

    2015-01-01

    Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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

    African Journals Online (AJOL)

    ADOWIE PERE

    ABSTRACT: The area is faced with endemic groundwater quality problems arising from abandoned shallow and deep boreholes. The abandonment of shallow boreholes is ... profiling, as well as small loop electromagnetic survey are veritable tools for the delineation of saltwater intrusion in coastal aquifers (Hwang et al.,.

  4. Association between plantar fasciitis and isolated contracture of the gastrocnemius.

    Science.gov (United States)

    Patel, Amar; DiGiovanni, Benedict

    2011-01-01

    Current evidence suggests that limited ankle dorsiflexion is an etiologic factor for plantar fasciitis. This limitation can arise from either an isolated contracture of the gastrocnemius or from a contracture of the gastrocnemius-soleus complex. This study's aim was to determine the proportion of patients with plantar fasciitis that have an associated isolated gastrocnemius contracture. This investigation was a prospective evaluation of patients with either acute or chronic plantar fasciitis. Two hundred fifty-four patients with plantar fasciitis were included. Patients were assessed for the existence of limited ankle dorsiflexion which was further characterized by noting the presence of an isolated gastrocnemius contracture or contracture of the gastrocnemius-soleus complex. The patient's duration of symptoms, type of occupation, and body mass index were also documented. Patients with acute plantar fasciitis were defined as having symptom duration of 9 months or less while those with chronic plantar fasciitis were those with over 9 months of symptoms. The Wilcoxon rank sum and chi square tests were used to compare characteristics between the acute and chronic populations. Eighty-three percent (211 of 254 patients) had limited ankle dorsiflexion. Fifty-seven percent (145 of 254) had an isolated contracture of the gastrocnemius, 26% (66 of 254) had a contracture of the gastrocnemius-soleus complex, and 17% (43 of 254) did not have a dorsiflexion limitation. Patients were further stratified into acute versus chronic symptom duration at the time of presentation. Equinus contracture was noted in 83% (129 of 155) of acute cases, and 82% (82 of 99) of chronic cases. An isolated contracture of the gastrocnemius was found in 60% (93 of 155) of acute, and 52% (52 of 99) of chronic cases. A gastrocnemius-soleus complex contracture was noted in 23% (36 of 155) of acute cases, and 30% (30 of 99) of chronic cases. Patients with chronic plantar fasciitis had a significantly

  5. Current therapeutic approaches for plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Martinelli N

    2014-03-01

    Full Text Available Nicolò Martinelli, Carlo Bonifacini, Giovanni RomeoDepartment of Ankle and Foot Surgery, IRCCS Galeazzi Orthopaedic Institute, Milan, ItalyAbstract: Almost 1 million Americans are affected by plantar fasciitis (PF, which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with good-to-excellent clinical results. Although most cases of chronic PF can be successfully managed with a conservative approach, alternative treatments, including high-energy shock wave therapy and corticosteroid injections, are commonly accepted as second-line treatment when traditional conservative therapy fails. However, surgery is still an important mode of treatment. Recently, new minimally invasive surgical techniques that offer numerous advantages (faster recovery time, early weight-bearing, lower postoperative pain over standard surgical approaches have been proposed, with good results and low complication rates. The purpose of this review is to report new conservative and surgical techniques for the treatment of PF. A literature search for articles about plantar fasciitis was conducted on the PubMed database in order to identify publications addressing the treatments of PF. The literature suggests that, initially, traditional conservative treatments consisting of rest, oral nonsteroidal anti-inflammatory drugs, foot orthotics, and stretching exercises can be tried for several weeks. In patients with chronic recalcitrant PF, extracorporeal shock wave therapy or corticosteroid injection can be considered. Surgery (minimally invasive techniques should be considered only after failure of the conservative treatments.Keywords: heel pain, surgery, plantar fasciosis

  6. [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.

  7. Supercritical Saltwater Spray for Marine Cloud Brightening (MCB)

    Science.gov (United States)

    Neukermans, A.; Cooper, G. F.; Foster, J.; Galbraith, L. K.; Johnston, D.; Ormond, B.; Wang, Q.

    2012-12-01

    Solar Radiation Management (SRM), including both stratospheric sulfur aerosol delivery and MCB, has emerged as the leading contender for geoengineering. Field research in MCB would require a technique capable of producing 1017 salt nuclei/sec from a single source on a seagoing vessel. Spraying supercritical saltwater has emerged as a viable technology, at least for research purposes. Under optimum conditions a single 50-μm nozzle produces 1014 suitable nuclei/sec. Power consumption is high (1-2 MW), but 95% of the required energy is in the form of heat that can probably be obtained from wasted ship-engine heat. While its implementation is conceptually simple, the corrosive nature of supercritical saltwater makes the material requirements very demanding. Progress on this work is detailed.

  8. 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

  9. 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.

  10. Plantar Fasciitis: Will Physical Therapy Help My Foot Pain?

    Science.gov (United States)

    2017-02-01

    One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In 2014, the Orthopaedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy. The results of this study support prior studies that show faster recovery time for those who receive evidence-based physical therapy for their foot pain. J Orthop Sports Phys Ther 2017;47(2):56. doi:10.2519/jospt.2017.0501.

  11. Heel lipoma mimicking plantar fasciitis in a ballroom dancer.

    Science.gov (United States)

    Taweel, Nicholas R; Raikin, Steven M

    2015-01-01

    The present case illustrates a lipoma as an unusual cause of heel pain. A 64-year-old female ballroom dancer presented with 8 months of pain that was unresponsive to previous treatment of plantar fasciitis. Magnetic resonance imaging revealed a heel lipoma. Her pain was fully resolved after surgical excision. Soft tissue tumors should be included in the differential diagnosis of heel pain, especially when symptoms and treatment response do not follow the typical course of plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis

    Directory of Open Access Journals (Sweden)

    Kalyana C. Janga

    2017-01-01

    Full Text Available A 43-year-old male patient with past medical history of diabetes mellitus (DM, end stage renal disease (ESRD on hemodialysis (HD, congestive heart failure (CHF, obstructive sleep apnea (OSA, and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT of the thigh revealed evidence of edema with no evidence of a focal collection or gas formation noted. The patient’s clinical symptoms persisted and he underwent magnetic resonance imaging (MRI of his thigh which was reported to show small areas of muscle necrosis with fluid collection. These findings in the acute setting concerned necrotizing fasciitis. After careful discussion following a multidisciplinary approach, a decision was made to perform a fasciotomy with tissue debridement. The patient was treated with IV antibiotics and discharged with a vacuum assisted wound drain. The surgical pathology revealed evidence of muscle edema with necrosis. Seven weeks later the patient presented with similar complaints on the other thigh (right thigh. MRI of the thighs revealed worsening edema with features suggestive of myositis and possible muscle infarction. A CT guided biopsy of the right quadriceps muscle revealed fibrotic interstitial connective tissue and no evidence of necrosis. This favored a diagnosis of diabetic muscle infarction. The disease was managed with pain control, strict diabetes management, and aggressive dialysis.

  13. 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.

  14. Eosinophilic Fasciitis associated with Mycoplasma arginini infection.

    Science.gov (United States)

    Silló, Pálma; Pintér, Dóra; Ostorházi, Eszter; Mazán, Mercedes; Wikonkál, Norbert; Pónyai, Katinka; Volokhov, Dmitriy V; Chizhikov, Vladimir E; Szathmary, Susan; Stipkovits, Laszlo; Kárpáti, Sarolta

    2012-03-01

    Eosinophilic fasciitis (EF) with generalized sclerodermiform skin lesions developed over a 19-month period in a previously healthy 23-year-old man. Although we confirmed EF by skin histology and laboratory tests, the recurrent fevers and the clinical observation of sclerotic prepuce with urethritis indicated further bacteriological analysis by conventional microbiological and DNA-based tests. Urethra cultures were positive for an arginine-hydrolyzing mycoplasma and Ureaplasma urealyticum. The patient also had serum IgM antibodies to Mycoplasma pneumoniae using enzyme-linked immunosorbent assay (ELISA)-based qualitative detection. Mycoplasma arginini was isolated from two independent venous blood serum samples and was identified by conventional microbiological tests and sequencing of the 16S rRNA and rpoB genes (GenBank sequence accession numbers HM179555 and HM179556, respectively). M. arginini genomic DNA also was detected by species-specific PCR in the skin lesion biopsy sample. Treatment with corticosteroids and long-term courses of selected antibiotics led to remission of skin symptoms and normalization of laboratory values. This report provides the first evidence of EF associated with mycoplasma infection and the second report of human infection with M. arginini and therefore suggests that this mycoplasma infection might have contributed to the pathogenesis of the disease.

  15. Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Alireza Moghtaderi

    2014-01-01

    Conclusion: The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

  16. Enzyme activities and glyphosate biodegradation in a riparian soil affected by simulated saltwater incursion

    OpenAIRE

    Changming Yang; Mengmeng Wang

    2011-01-01

    Soil salinization due to saltwater incursion, is a major threat to biochemical activities and thus strongly alters biogeochemical processes in a freshwater riparian of coastal estuary region. A pot incubation experiment was conducted to investigate the effects of simulated saltwater incursion on some key enzymatic activities and biodegradation dynamics of herbicide glyphosate in a riparian soil in Chongming Island located in the Yangtze River estuary, China. The results showed that saltwater ...

  17. 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 ...

  18. Perforated diverticulitis presenting as necrotising fasciitis of the leg

    Directory of Open Access Journals (Sweden)

    Talbot Robert

    2008-02-01

    Full Text Available Abstract Diverticulosis of the colon is a common condition of increasing age. Complications of diverticulitis including stricture, perforation and fistula formation often require surgery. Perforated diverticulitis may rarely present with spreading superficial sepsis. We describe for the first time, to our knowledge, a case of retroperitoneal diverticula perforation presenting as necrotising fasciitis of the leg necessitating hind-quarter amputation.

  19. 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 nearl...

  20. Cervico-facial necrotising fasciitis occurring with facial paralysis ...

    African Journals Online (AJOL)

    It frequently involves the groin, abdomen and extremities, but rarely involves the cemco-facial region. A case is presented of a 70-year old man who, following a futile attempt to extract a lower left first molar, developed a cervico-facial necrotising fasciitis with facial nerve paralysis. Bacteriological investigations revealed the ...

  1. Case Report: Extremity Necrotizing Fasciitis: Four-year Experience ...

    African Journals Online (AJOL)

    Patients and Method: This is a retrospective observational study. The medical records of patients diagnosed with Necrotizing fasciitis of the extremities and managed solely or jointly with the Plastic/Reconstructive surgeons, by the orthopaedic surgical service of Ahmadu Bello University Teaching Hospital, Zaria between ...

  2. Unusual presentation of necrotizing fasciitis in an HIV exposed infant

    African Journals Online (AJOL)

    Necrotizing fasciitis(NF) is a potentially life threatening soft tissue infection characterized by rapidly spreading inflammation with necrosis of fascia, subcutaneous tissues and overlying skin and is associated with signs of systemic toxicity. We present a case report of an uncommon presentation of NF in an HIV exposed infant.

  3. How We Manage Plantar Fasciitis (With Memory Jogger).

    Science.gov (United States)

    Tanner, Suzanne M.; Harvey, Jack S.

    1988-01-01

    Common among runners and athletes who participate in jumping sports, plantar fasciitis is an overuse injury that is potentially incapacitating, causes heel and arch pain, and usually occurs after sudden increases in running mileage, frequency, or speed. Therapy is described. (Author/CB)

  4. 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.

  5. Complications of extracorporeal shockwave therapy in plantar fasciitis : Systematic review

    NARCIS (Netherlands)

    Roerdink, R. L.; Dietvorst, M.; van der Zwaard, B.; van der Worp, H.; Zwerver, J.

    2017-01-01

    Background: Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is

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

    African Journals Online (AJOL)

    2011-11-12

    Nov 12, 2011 ... under-reported in the dental literature. Aims: To report our experience with cases seen and treated .... Retrospective evaluation of necrotizing fasciitis extremities. Reports of CNF in the literature were mostly .... Surgical Memoirs of the war of rebellion. New York: Reverside. Press; 1871. p. 146-70. 3. Meleny ...

  7. Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis.

    Science.gov (United States)

    Zhou, Binghua; Zhou, You; Tao, Xu; Yuan, Chengsong; Tang, Kanglai

    2015-01-01

    Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis. Copyright © 2015 American College of

  8. 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.

  9. 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

  10. Disposal of saltwater during well construction--Problems and solutions

    Science.gov (United States)

    Pitt, William A.; Meyer, Frederick W.; Hull, John E.

    1977-01-01

    The recent interest in the disposal of treated sewage effluent by deep-well injection into salt-water-filled aquifers has increased the need for proper disposal of salt water as more wells are drilled and tested each year.The effects on an unconfined aquifer of the improper disposal of salt water associated with the construction of three wells in southeastern Florida emphasize this need. In two of the wells provisions to prevent and detect salt-water contamination of the unconfined aquifer were practically nonexistent, and in one well extensive provisions were made. Of the three drilling sites the one with proper provision for detection presented no serious problem, as the ground water contaminated by the salt water was easily located and removed. The provisions consisted of drilling a brine-injection well to dispose of salt water discharged in drilling and testing operations, using a closed drilling circulation system to reduce spillage, installing shallow observation wells to map the extent and depth of any salt-water contamination of the shallow aquifer, and installing a dewatering system to remove contaminated ground water.

  11. Sensitivity and Uncertainty analysis of saltwater intrusion in coastal aquifers

    Science.gov (United States)

    Zhao, Z.; Jin, G.; Zhao, J.; Li, L.; Chen, X.; Tao, X.

    2012-12-01

    Aquifer heterogeneity has been a focus in uncertainty analysis of saltwater intrusion in coastal aquifers, especially the spatial variance of hydraulic conductivities. In this study, we investigated how inland and seaward boundary conditions may also contribute to the uncertainty in predicting saltwater intrusion in addition to the aquifer properties. Based on numerical simulations, the analysis focused on the salt-freshwater mixing zoon characterized by its location given by the contour line of 50% salt concentration of seawater and width of an area between the contour lines of 10% and 90% seawater concentrations. Sensitivity analysis was conducted first to identify the most influential factors on the location and width of the mixing zoon among tidal amplitude, freshwater influx rate, aquifer permeability, fluid viscosity and longitudinal dispersivity. Based on the results of the sensitivity analysis, an efficient sampling strategy was form to determine the parameter space for uncertainty analysis. The results showed that (1) both freshwater influx across the inland boundary and tidal oscillations on the seaward boundary imposed a retardation effect on the mixing zoon; and (2) seasonal variations of freshwater influx rate combined with tidal fluctuations of sea level led to great uncertainty with the simulated mixing zoon.

  12. 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.

  13. Numerical simulation and analysis of saltwater intrusion lengths in the Pearl River Delta, China

    NARCIS (Netherlands)

    Zhang, W.; Feng, H.; Zheng, J.; Hoitink, A.J.F.; Vegt, van der M.; Zhu, Y.; Cai, H.

    2013-01-01

    In recent years, large-scale saltwater intrusion has been threatening the freshwater supply in the metropolitan cities surrounding the Pearl River delta (PRD). Therefore, a better understanding of the saltwater intrusion process in this region is necessary for local water resource management. In

  14. Necrotizing Fasciitis of the Lower Extremity Caused by Serratia marcescens A Case Report.

    Science.gov (United States)

    Heigh, Evelyn G; Maletta-Bailey, April; Haight, John; Landis, Gregg S

    2016-03-01

    Necrotizing fasciitis is a rare and potentially fatal infection, with mortality of up to 30%. This case report describes a patient recovering from a laryngectomy for laryngeal squamous cell cancer who developed nosocomial necrotizing fasciitis of the lower extremity due to Serratia marcescens . Only eight cases of necrotizing fasciitis exclusive to the lower extremity due to S marcescens have been previously reported. Patients with S marcescens necrotizing fasciitis of the lower extremity often have multiple comorbidities, are frequently immunosuppressed, and have a strikingly high mortality rate.

  15. Management of plantar fasciitis in the outpatient setting.

    Science.gov (United States)

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

    2016-04-01

    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. Copyright: © Singapore Medical Association.

  16. [Metastatic cervical fasciitis revealing invasive lobular breast carcinoma].

    Science.gov (United States)

    Munoz, J; Garcia, C; Joujoux, J-M; Dandurand, M; Meunier, L; Stoebner, P-E

    2015-02-01

    We describe the case of a 71-year-old woman presenting cervical metastatic fasciitis with invasive lobular carcinoma (ILC) of the breast. The patient consulted for a deep and painless skin infiltration of the neck associated with dysphagia and restricted cervical mobility. Skin and muscle biopsies were normal. Muscle fascia biopsy showed a linear infiltration of metastatic cells in "single file", revealing ILC of the right breast. ILCs have a particular metastatic pattern. They can permeate through tissue planes, infiltrate solid organs and spread on serous membranes in an insidious fashion. Our case shows that ILC can metastasise into muscular fascia, causing "fasciitis-like" symptoms. Dermatologists should be aware of this particular pattern of dissemination. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  17. Necrotizing fasciitis following drainage of Streptococcus milleri empyema.

    Science.gov (United States)

    Tcherveniakov, Peter; Svennevik, Eirik; Tzafetta, Kallirroi; Milton, Richard

    2010-03-01

    Streptococcus milleri (SM) is a heterogeneous group of Streptococci, which is a recognized cause of purulent infections of the mediastinal and pleural spaces. These infections are notoriously resistant and require aggressive surgical management. We present our experience with a 60-year-old patient, who developed necrotizing fasciitis of the chest wall after initial bedside drainage of a SM empyema. He required extensive debridement with significant soft tissue loss and subsequent latissimus dorsi flap reconstruction to cover the defect.

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

    OpenAIRE

    Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

    2017-01-01

    [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...

  19. 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.

  20. Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature.

    Science.gov (United States)

    Marchesi, Andrea; Marcelli, Stefano; Parodi, Pier C; Perrotta, Rosario E; Riccio, Michele; Vaienti, Luca

    2017-04-01

    Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  1. 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.

  2. Necrotizing fasciitis of the perineum associated with a bartholin abscess.

    Science.gov (United States)

    Morris, Michael W; Aru, Marco; Gaugler, Andrew; Morris, Rachael F; Vanderlan, Wesley B

    2014-04-01

    Perineal gangrene was first described in healthy, young males more than two and one-half centuries ago. This disease, referred to commonly as Fournier gangrene, was marked by rapid progression, high mortality, and unknown etiology. In the last century the pathologic processes were described and accounts of perineal gangrene were reported in females. This disease still demonstrates a male predominance, but mortality does not demonstrate a gender predilection. We present a case of a Bartholin abscess progressing to necrotizing fasciitis of the perineum in a 53-year-old female following drainage and marsupialization. Perineal gangrene was treated successfully with serial debridements and a targeted antimicrobial regimen, with wound closure by secondary intention. Following retrospective case review, the exact pathophysiologic cause of progression to necrotizing fasciitis of the perineum is unclear though antibiotic resistance was a likely contributor. Clinical studies are necessary to investigate the differential incidence of this disease, which may result from diagnostic unawareness of necrotizing fasciitis of the perineum in females due to adherence to Fournier's original description or coding bias. Future clinical studies may define risk factors for disease better, and allow for standardized management and improved outcomes regardless of gender.

  3. Plantar fasciitis and the calcaneal spur: Fact or fiction?

    Science.gov (United States)

    Johal, K S; Milner, S A

    2012-03-01

    Plantar fasciitis is a common diagnosis in patients presenting with heel pain. The presence of co-existing calcaneal spurs has often been reported but confusion exists as to whether it is a casual or significant association. The lateral heel radiographs of nineteen patients with a diagnosis of plantar fasciitis and nineteen comparison subjects with a lateral ankle ligament sprain matched for age and sex, were reviewed independently by two observers. Objective measurements of calcaneal spur length and a subjective grading of spur size were recorded. There was a significantly higher prevalence of calcaneal spurs in the cases than the comparison group (89% versus 32%; McNemar chi-square=9.09, df=2, p=0.00257). There was good inter- and intra-observer agreement. The current study has demonstrated a significant association between plantar fasciitis and calcaneal spur formation. Further research is warranted to assess whether the association is causal. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  4. Necrotizing fasciitis in association with Ludwig’s angina – A case report

    Science.gov (United States)

    Kavarodi, A.M.

    2011-01-01

    A 28 year old male diabetic patient developed Ludwig’s angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig’s angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented. PMID:24151421

  5. Necrotizing fasciitis in association with Ludwig’s angina – A case report

    OpenAIRE

    Kavarodi, A.M.

    2011-01-01

    A 28 year old male diabetic patient developed Ludwig’s angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig’s angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.

  6. 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\

  7. Fatal Necrotizing Fasciitis in a Child following a Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Yohel Ocaña

    2013-01-01

    Full Text Available Necrotizing fasciitis is a serious soft tissue infection rarely occurring in children after blunt trauma. Due to its high morbidity and mortality rates, a high index of suspicion is necessary for prompt diagnosis and treatment. We describe a 6-year-old Costa Rican girl who died secondary to multiple complications following a posttraumatic necrotizing fasciitis.

  8. Fatal Necrotizing Fasciitis in a Child following a Blunt Chest Trauma

    OpenAIRE

    Yohel Ocaña; Rolando Ulloa-Gutierrez; Adriana Yock-Corrales

    2013-01-01

    Necrotizing fasciitis is a serious soft tissue infection rarely occurring in children after blunt trauma. Due to its high morbidity and mortality rates, a high index of suspicion is necessary for prompt diagnosis and treatment. We describe a 6-year-old Costa Rican girl who died secondary to multiple complications following a posttraumatic necrotizing fasciitis.

  9. 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

  10. [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.

  11. Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis.

    Science.gov (United States)

    Cheung, R T H; Sze, L K Y; Mok, N W; Ng, G Y F

    2016-09-01

    Plantar fasciitis, a common injury in runners, has been speculated to be associated with weakness of the intrinsic foot muscles. A recent study reported that atrophy of the intrinsic forefoot muscles might contribute to plantar fasciitis by destabilizing the medial longitudinal arch. However, intrinsic foot muscle volume difference between individuals with plantar fasciitis and healthy counterparts remains unknown. This study examined the relationship of intrinsic foot muscle volume and incidence of plantar fasciitis. Case-control study. 20 experienced (≥5 years) runners were recruited. Ten of them had bilateral chronic (≥2 years) plantar fasciitis while the others were healthy characteristics-matched runners. Intrinsic muscle volumes of the participants' right foot were scanned with a 1.5T magnetic resonance system and segmented using established methods. Body-mass normalized intrinsic foot muscle volumes were compared between runners with and without chronic plantar fasciitis. There was significant greater rearfoot intrinsic muscle volume in healthy runners than runners with chronic plantar fasciitis (Cohen's d=1.13; p=0.023). A similar trend was also observed in the total intrinsic foot muscle volume but it did not reach a statistical significance (Cohen's d=0.92; p=0.056). Forefoot volume was similar between runners with and without plantar fasciitis. These results suggest that atrophy of intrinsic foot muscles may be associated with symptoms of plantar fasciitis in runners. These findings may provide useful information in rehabilitation strategies of chronic plantar fasciitis. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  12. Numerical and physical modeling of cutoff walls against saltwater intrusion

    Science.gov (United States)

    Crestani, Elena; Camporese, Matteo; Salandin, Paolo

    2017-04-01

    Seawater intrusion is a relevant problem for many communities living in small islands, where the amount of fresh water available for human consumption depends on the delicate equilibrium between the natural groundwater recharge from rainfall and the surrounding sea. However, it can represent a significant issue also for coastal regions where groundwater is extracted for water supply: an excessive extraction to meet growing demands for drinking water and irrigation purposes leads to a decrease of seaward flows of fresh water and consequently to an increase of seawater intrusion into coastal aquifers. Cutoff walls represent one of the possible strategies that can be adopted to reduce seawater intrusion into coastal aquifers and to limit the inland progression of the saltwater wedge. In this study, on the basis of several preliminary simulations developed by the SUTRA code, a cutoff wall occluding 70% of the aquifer depth is designed for a physical experiment, whose setup details are reported as follows. The physical model represents the terminal part of a coastal aquifer and consists of a flume 500 cm long, 30 cm wide and 60 cm high, filled for an height of 49 cm with glass beads with a d50 of 0.6 mm and a uniformity coefficient d60/d10 1.5. The resulting porous medium is homogeneous, with porosity of about 0.37 and hydraulic conductivity of about 1.3 10-3 m/s. Upstream from the sandbox, a tank filled by freshwater provides recharge for the aquifer. The downstream tank simulates the sea and red food dye is added to the saltwater to easily visualize the salt wedge. The volume of the downstream tank is about five times the upstream one, and, due to the small filtration discharge, minimizing salt concentration variations due to the incoming freshwater flow. The hydraulic gradient during the tests is constant, due to the fixed water level in the tanks. Water levels and discharged flow rate are continuously monitored. The cutoff wall was realized with sodium bentonite

  13. Influences of saltwater immersion on properties of wood-cellulosic paper.

    Science.gov (United States)

    Bunyaphiphat, Tunchira; Nakagawa-Izumi, Akiko; Enomae, Toshiharu

    2015-02-13

    The saltwater immersion method was developed to inhibit mould growth on flood- or tsunami-damaged paper. Commercially available fine paper used for printing and writing showed decreased tensile indices after saltwater immersion. The salt remaining in the paper tended to increase the moisture content because of the salt deliquescence and moisture in the air. The tensile index was restored by removing salt from the paper. Crystallization and distribution of salt in interfibre pores were also considered to influence interfibre rebonding. The difference in the fibre responses to saltwater depended on the relationship between nano-scaled pores in the fibre walls, osmotic pressure, and the degree of sizing, which resulted in low water retention values. More of the starch applied as a surface sizing agent was dissolved or dispersed during distilled water immersion than saltwater immersion. This loosened the fibre network, which was a factor that decreased the sizing degree of the paper. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. 78 FR 24069 - Safety Zone; 12th Annual Saltwater Classic; Port Canaveral Harbor; Port Canaveral, FL

    Science.gov (United States)

    2013-04-24

    ....regulations.gov , type the docket number in the ``SEARCH'' box and click ``SEARCH.'' Click on Open Docket... Saltwater Classic. On April 27, 2013, the Cox Events Group and K92.3-FM will host a fishing tournament...

  15. 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

  16. Assessing the risk of saltwater intrusion in coastal aquifers

    Science.gov (United States)

    Klassen, J.; Allen, D. M.

    2017-08-01

    In coastal regions, the quality of groundwater can be compromised due to saltwater intrusion (SWI) caused by natural (sea level rise (SLR) and storm surge) and anthropogenic (pumping) hazards. The goal of this research was to develop and test an approach for assessing the risk of SWI in coastal aquifers. The Gulf Islands in British Columbia (BC) was the case study area. The vulnerability of the bedrock aquifers to SWI was assessed spatially by mapping hazards in combination with the aquifer susceptibility. Climate change related hazards, including SLR and storm surge overwash, were integrated into floodplain maps for each island using projected SLR data for 2100 in combination with estimated storm surge levels based on data collected over a forty year period. When combined with maps showing the density of pumping wells, coastal zones that may be at higher risk of SWI were identified for this particular coastal area of BC. Hazards due to pumping have the greatest influence on the vulnerability. Risk was evaluated spatially using an economic valuation of loss - here replacement of a water supply. The combination of chemical indicators of SWI and risk assessment maps are potentially useful tools for identifying areas vulnerable to SWI, and these tools can be used to improve decision-making related to monitoring and community development for coastal areas, thereby increasing resilience.

  17. 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 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.

  18. Necrotizing fasciitis: eight-year experience and literature review

    Directory of Open Access Journals (Sweden)

    Jinn-Ming Wang

    Full Text Available OBJECTIVES: To describe clinical, laboratory, microbiological features, and outcomes of necrotizing fasciitis. METHODS: From January 1, 2004 to December 31, 2011, 115 patients (79 males, 36 females diagnosed with necrotizing fasciitis were admitted to Mackay Memorial Hospital in Taitung. Demographic data, clinical features, location of infection, type of comorbidities, microbiology and laboratory results, and outcomes of patients were retrospectively analyzed. RESULTS: Among 115 cases, 91 survived (79.1% and 24 died (20.9%. There were 67 males (73.6% and 24 females (26.4% with a median age of 54 years (inter-quartile ranges, 44.0-68.0 years in the survival group; and 12 males (50% and 12 females (50% with a median age of 61 years (inter-quartile ranges, 55.5-71.5 years in the non-surviving group. The most common symptoms were local swelling/erythema, fever, pain/tenderness in 92 (80%, 87 (76% and 84 (73% patients, respectively. The most common comorbidies were liver cirrhosis in 54 patients (47% and diabetes mellitus in 45 patients (39%. A single organism was identified in 70 patients (61%, multiple pathogens were isolated in 20 patients (17%, and no microorganism was identified in 30 patients (26%. The significant risk factors were gender, hospital length of stay, and albumin level. DISCUSSION: Necrotizing fasciitis, although not common, can cause notable rates of morbidity and mortality. It is important to have a high index of suspicion and increase awareness in view of the paucity of specific cutaneous findings early in the course of the disease. Prompt diagnosis and early operative debridement with adequate antibiotics are vital.

  19. Variable Ki67 proliferative index in 65 cases of nodular fasciitis, compared with fibrosarcoma and fibromatosis

    Science.gov (United States)

    2013-01-01

    Abstract Nodular fasciitis is the most common pseudosarcomatous lesion of soft tissue. Ki67 was considered as a useful marker for distinguishing some benign and malignant lesions. To study the usefulness of Ki67 in diagnosis of nodular fasciitis, the expression of Ki67 was examined by using immunostaining in 65 nodular fasciitis specimens, 15 desmoid fibromatosis specimens and 20 fibrosarcoma specimens. The results showed that there was a variable Ki67 index in all 65 cases of nodular fasciitis, and the mean labeling index was 23.71±15.01%. In majority (70.77%) of all cases,the index was ranged from 10% to 50%, in 6.15% (4/65) of cases the higher Ki67 index (over 50%) could be seen. The Ki67 proliferative index was closely related to duration of lesion, but not to age distribution, lesion size, sites of lesions and gender. Moreover, the mean proliferative index in desmoid fibromatosis and fibrosarcoma was 3.20±1.26% and 26.15±3.30% respectively. The mean Ki67 index of nodular fasciitis was not significantly lower than fibrosarcoma, but higher than desmoid fibromatosis. The variable and high Ki67 index in nodular fasciitis may pose a diagnostic challenge. We should not misdiagnose nodular fasciitis as a sarcoma because of its high Ki67 index. The recurrence of nodular fasciitis is rare; and the utility of Ki67 immunostaining may be not suitable for recurrence assessment in nodular fasciitis. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4782335818876666 PMID:23531088

  20. 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...

  1. 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 nearl...... 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...

  2. Tension-free treatment of large perianal necrotizing fasciitis using quartet rotationplasty.

    Science.gov (United States)

    Ulkür, Ersin; Karagöz, Hüseyin; Celiköz, Bahattin

    2006-03-01

    In the present study, the authors report their experience with quartet rotationplasty that were performed to cover large perianal defects caused by necrotizing fasciitis with no tension to the anus. From April of 2000 to August of 2004, four patients with large perianal necrotizing fasciitis were treated with quartet rotationplasty. The average follow-up period was 10 months. All operations were successful. All large perianal defects were closed with quartet rotationplasty, and there was no tension on the suture lines between the flap and the anus. Quartet rotationplasty is a logical and easy means of covering large perianal defects caused by necrotizing fasciitis.

  3. Groundwater salinity in a floodplain forest impacted by saltwater intrusion

    Science.gov (United States)

    Kaplan, David A.; Muñoz-Carpena, Rafael

    2014-11-01

    Coastal wetlands occupy a delicate position at the intersection of fresh and saline waters. Changing climate and watershed hydrology can lead to saltwater intrusion into historically freshwater systems, causing plant mortality and loss of freshwater habitat. Understanding the hydrological functioning of tidally influenced floodplain forests is essential for advancing ecosystem protection and restoration goals, however finding direct relationships between hydrological inputs and floodplain hydrology is complicated by interactions between surface water, groundwater, and atmospheric fluxes in variably saturated soils with heterogeneous vegetation and topography. Thus, an alternative method for identifying common trends and causal factors is required. Dynamic factor analysis (DFA), a time series dimension reduction technique, models temporal variation in observed data as linear combinations of common trends, which represent unexplained common variability, and explanatory variables. DFA was applied to model shallow groundwater salinity in the forested floodplain wetlands of the Loxahatchee River (Florida, USA), where altered watershed hydrology has led to changing hydroperiod and salinity regimes and undesired vegetative changes. Long-term, high-resolution groundwater salinity datasets revealed dynamics over seasonal and yearly time periods as well as over tidal cycles and storm events. DFA identified shared trends among salinity time series and a full dynamic factor model simulated observed series well (overall coefficient of efficiency, Ceff = 0.85; 0.52 ≤ Ceff ≤ 0.99). A reduced multilinear model based solely on explanatory variables identified in the DFA had fair to good results (Ceff = 0.58; 0.38 ≤ Ceff ≤ 0.75) and may be used to assess the effects of restoration and management scenarios on shallow groundwater salinity in the Loxahatchee River floodplain.

  4. Groundwater salinity in a floodplain forest impacted by saltwater intrusion.

    Science.gov (United States)

    Kaplan, David A; Muñoz-Carpena, Rafael

    2014-11-15

    Coastal wetlands occupy a delicate position at the intersection of fresh and saline waters. Changing climate and watershed hydrology can lead to saltwater intrusion into historically freshwater systems, causing plant mortality and loss of freshwater habitat. Understanding the hydrological functioning of tidally influenced floodplain forests is essential for advancing ecosystem protection and restoration goals, however finding direct relationships between hydrological inputs and floodplain hydrology is complicated by interactions between surface water, groundwater, and atmospheric fluxes in variably saturated soils with heterogeneous vegetation and topography. Thus, an alternative method for identifying common trends and causal factors is required. Dynamic factor analysis (DFA), a time series dimension reduction technique, models temporal variation in observed data as linear combinations of common trends, which represent unexplained common variability, and explanatory variables. DFA was applied to model shallow groundwater salinity in the forested floodplain wetlands of the Loxahatchee River (Florida, USA), where altered watershed hydrology has led to changing hydroperiod and salinity regimes and undesired vegetative changes. Long-term, high-resolution groundwater salinity datasets revealed dynamics over seasonal and yearly time periods as well as over tidal cycles and storm events. DFA identified shared trends among salinity time series and a full dynamic factor model simulated observed series well (overall coefficient of efficiency, Ceff=0.85; 0.52≤Ceff≤0.99). A reduced multilinear model based solely on explanatory variables identified in the DFA had fair to good results (Ceff=0.58; 0.38≤Ceff≤0.75) and may be used to assess the effects of restoration and management scenarios on shallow groundwater salinity in the Loxahatchee River floodplain. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. 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.

  6. 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.

  7. [Percutaneous surgery for plantar fasciitis due to a calcaneal spur].

    Science.gov (United States)

    Apóstol-González, Saúl; Herrera, Jesús

    2009-01-01

    Determine the efficacy of percutaneous surgical treatment for talalgia due to a calcaneal spur. This is an observational, descriptive, clinical series analyzing the outcomes of 10 patients with a diagnosis of talalgia due to plantar fasciitis with a calcaneal spur treated with percutaneous foot surgery. The end result was assessed with a visual analog scale (VAS) to measure pain, the patients' opinion and their return to activities of daily living. Central tendency and scatter measurements were calculated. The inferential analysis was done with the non-parametric chi square (chi2) test. Most patients were females (90%) and mean age was 40.5 years. Follow-up was 12 months. One patient had bleeding of the approached area. Pain was reduced from 8 to 1.5 in the VAS. Nine patients returned to their activities. Two patients had occasional mild pain upon prolonged bipedestation. Ninety percent of results were satisfactory. Percutaneous foot surgery in talalgias caused by plantar fasciitis due to a calcaneal spur is a simple and effective method. It reduces the operative time and allows for an early return of patients to their activities of daily living.

  8. 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

  9. 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

  10. 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.

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

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    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.

  12. Klebsiella pneumoniae Causing Necrotizing Fasciitis in a Patient With Thalassaemia Major

    OpenAIRE

    Kwan, Kenny; Fung, Boris; Wing-Yuk, Ip

    2011-01-01

    We present a case of Klebsiella pneumoniae necrotizing fasciitis in a patient with thalassaemia major. Klebsiella sp. is known to cause severe infections in patients with thalassaemia, with high mortality rates.

  13. Infantile nodular fasciitis of the hand: A case report and literature review

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    I Weng Lao

    2016-09-01

    Full Text Available Pediatric nodular fasciitis is uncommon and has a preference for the head and neck region. Occurrence in other anatomic locations is uncommon. We describe here a case of nodular fasciitis that arose in the hand of a newborn infant who presented with a rapidly growing mass. On MRI, it was heterogeneous isointense on T1-weighted and hyperintense on T2-weighted images. Histological examination showed short intersecting fascicles of uniform spindled myofibroblasts embedded in a myxoid to collagenous stroma, consistent with a nodular fasciitis. However, the lesion was initially diagnosed as an infantile fibrosarcoma due to the rapid growth, brisk mitotic activity and focally infiltrative architecture. This study illustrates that unusual presentation of nodular fasciitis may cause diagnostic confusion.

  14. 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

    Necrotising fasciitis (NF), commonly known as flesh eating disease is a fast progressing, potentially lethal infection of the subcutaneous tissue/fascia. Treatment includes high doses of intravenous antibiotics and aggressive surgical debridement. Accurate identification of the microbial community...

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

    OpenAIRE

    Vinod Babu. K; Lisa Michael Pereira; Sai Kumar. N; Ayyappan. V.R

    2014-01-01

    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 disab...

  16. Plantar fasciitis – to jab or to support? A systematic review of the current best evidence

    Directory of Open Access Journals (Sweden)

    Uden H

    2011-05-01

    Full Text Available Hayley Uden1, Eva Boesch1, Saravana Kumar1,21Division of Health Sciences, 2International Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, South Australia, AustraliaBackground: Plantar fasciitis is a common condition routinely managed by podiatrists in the community and is widely treated conservatively. Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and corticosteroid injections. While common to clinical practice, the evidence base underpinning these treatment strategies is unknown. Therefore, the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis.Methods: A systematic literature search was conducted. Experimental studies, in English, from 1998 to 2010 were accepted for inclusion in this review. The PEDro quality assessment tool and the National Health and Medical Research Council's hierarchy of evidence were used to assess the quality of the included studies.Results: Six randomized controlled trials which met the selection criteria were included in this review. Four reported on customized functional foot orthoses and 2 on corticosteroid injections. Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis. Additionally, customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis. Corticosteroid injections may have side effects, especially pain (from the injection.Conclusion: Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis. While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis

  17. Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States.

    Science.gov (United States)

    Fraser, John J; Glaviano, Neal R; Hertel, Jay

    2017-02-01

    Study Design Retrospective observational study. Background Plantar fasciitis is responsible for 1 million ambulatory patient care visits annually in the United States. Few studies have investigated practice patterns in the treatment of patients with plantar fasciitis. Objective To assess physical therapist utilization and employment of manual therapy and supervised rehabilitation in the treatment of patients with plantar fasciitis. Methods A retrospective review of the PearlDiver patient record database was used to evaluate physical therapist utilization and use of manual therapy and supervised rehabilitation in patients with plantar fasciitis between 2007 and 2011. An International Classification of Diseases code (728.71) was used to identify plantar fasciitis, and Current Procedural Terminology codes were used to identify evaluations (97001), manual therapy (97140), and rehabilitation services (97110, 97530, 97112). Results A total of 819 963 unique patients diagnosed with plantar fasciitis accounted for 5 739 737 visits from 2007 to 2011, comprising 2.7% of all patients in the database. Only 7.1% (95% confidence interval: 7.0%, 7.1%) of patients received a physical therapist evaluation. Of the 57 800 patients evaluated by a physical therapist (59.8% female), 50 382 (87.2% ± 0.4%) received manual therapy, with significant increases in utilization per annum. A large proportion (89.5% ± 0.4%) received rehabilitation following physical therapist evaluation. Conclusion Despite plantar fasciitis being a frequently occurring musculoskeletal condition, a small proportion of patients with plantar fasciitis were seen by physical therapists. Most patients who were evaluated by a physical therapist received manual therapy and a course of supervised rehabilitation as part of their plan of care. Level of Evidence Treatment, level 2a. J Orthop Sports Phys Ther 2017;47(2):49-55. doi:10.2519/jospt.2017.6999.

  18. Flat Feet and a Diagnosis of Plantar Fasciitis in a Marine Corps Recruit.

    Science.gov (United States)

    Lurati, Ann R

    2015-04-01

    A 22-year-old man sought care at an orthopedic clinic for acute plantar fasciitis. He reported that he had begun an intensive exercise program to prepare himself for Marine Corps Officer Candidate School. Pes Planus, or flat feet, was noted on physical examination. This article reviews the diagnoses of pes planus and plantar fasciitis as well as current intervention strategies. © 2015 The Author(s).

  19. Cervical necrotizing fasciitis and myositis in a western lowland gorilla (Gorilla gorilla gorilla).

    Science.gov (United States)

    Allender, M C; McCain, S L; Ramsay, E C; Schumacher, J; Ilha, M R S

    2009-06-01

    A 39-yr-old wild-caught, female western lowland gorilla (Gorilla gorilla gorilla) died during an immobilization to assess swelling and apparent pain of the cervical region. Necropsy revealed a fistulous tract containing plant material in the oropharynx, above the soft palate, communicating with a left-sided cervical necrotizing fasciitis and myositis. Alpha-hemolytic Streptococcus and Prevotella sp. were isolated from the cervical lesion. This is a report of cervical necrotizing fasciitis in a western lowland gorilla.

  20. 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.

  1. How effective is acupuncture for reducing pain due to plantar fasciitis?

    Science.gov (United States)

    Thiagarajah, Anandan Gerard

    2017-02-01

    Plantar fasciitis is a commonly seen outpatient condition that has numerous treatment modalities of varying degrees of efficacy. This systematic review aimed to determine the effectiveness of acupuncture in reducing pain caused by plantar fasciitis. Online literature searches were performed on the PubMed and Cochrane Library databases for studies on the use of acupuncture for pain caused by plantar fasciitis. Studies designed as randomised controlled trials and that compared acupuncture with standard treatments or had real versus sham acupuncture arms were selected. The Delphi list was used to assess the methodological quality of the studies retrieved. Three studies that compared acupuncture with standard treatment and one study on real versus sham acupuncture were found. These showed that acupuncture significantly reduced pain levels in patients with plantar fasciitis, as measured on the visual analogue scale and the Plantar Fasciitis Pain/Disability Scale. These benefits were noted between four and eight weeks of treatment, with no further significant reduction in pain beyond this duration. Side effects were found to be minimal. Although acupuncture may reduce plantar fasciitis pain in the short term, there is insufficient evidence for a definitive conclusion regarding its effectiveness in the longer term. Further research is required to strengthen the acceptance of acupuncture among healthcare providers.

  2. 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.

  3. A fatal case of multidrug resistant acinetobacter necrotizing fasciitis: the changing scary face of nosocomial infection.

    Science.gov (United States)

    Sinha, Nupur; Niazi, Masooma; Lvovsky, Dmitry

    2014-01-01

    Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.

  4. A Fatal Case of Multidrug Resistant Acinetobacter Necrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection

    Directory of Open Access Journals (Sweden)

    Nupur Sinha

    2014-01-01

    Full Text Available Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.

  5. Stochastic Optimization for an Analytical Model of Saltwater Intrusion in Coastal Aquifers

    Science.gov (United States)

    Stratis, Paris N.; Karatzas, George P.; Papadopoulou, Elena P.; Zakynthinaki, Maria S.; Saridakis, Yiannis G.

    2016-01-01

    The present study implements a stochastic optimization technique to optimally manage freshwater pumping from coastal aquifers. Our simulations utilize the well-known sharp interface model for saltwater intrusion in coastal aquifers together with its known analytical solution. The objective is to maximize the total volume of freshwater pumped by the wells from the aquifer while, at the same time, protecting the aquifer from saltwater intrusion. In the direction of dealing with this problem in real time, the ALOPEX stochastic optimization method is used, to optimize the pumping rates of the wells, coupled with a penalty-based strategy that keeps the saltwater front at a safe distance from the wells. Several numerical optimization results, that simulate a known real aquifer case, are presented. The results explore the computational performance of the chosen stochastic optimization method as well as its abilities to manage freshwater pumping in real aquifer environments. PMID:27689362

  6. 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.

    2017-08-01

    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.

  7. Stochastic Optimization for an Analytical Model of Saltwater Intrusion in Coastal Aquifers.

    Science.gov (United States)

    Stratis, Paris N; Karatzas, George P; Papadopoulou, Elena P; Zakynthinaki, Maria S; Saridakis, Yiannis G

    The present study implements a stochastic optimization technique to optimally manage freshwater pumping from coastal aquifers. Our simulations utilize the well-known sharp interface model for saltwater intrusion in coastal aquifers together with its known analytical solution. The objective is to maximize the total volume of freshwater pumped by the wells from the aquifer while, at the same time, protecting the aquifer from saltwater intrusion. In the direction of dealing with this problem in real time, the ALOPEX stochastic optimization method is used, to optimize the pumping rates of the wells, coupled with a penalty-based strategy that keeps the saltwater front at a safe distance from the wells. Several numerical optimization results, that simulate a known real aquifer case, are presented. The results explore the computational performance of the chosen stochastic optimization method as well as its abilities to manage freshwater pumping in real aquifer environments.

  8. 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.

  9. 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...... reaching saltwater intrusion in the area. Furthermore, the geological information obtained from these boreholes laid a foundation for a new hydrogeological conceptual model of the area, which we aim to assess in this simulation study.Appraisal of the conceptual model of the Andarax delta area is conducted...... using different types of data that have been gathered and analyzed; these include measurements of hydraulic head, salinity (EC), geochemistry and electrical resistivity. The approach here has been to construct a saltwater intrusion model of the area with the aim of obtaining a model that is reasonably...

  10. 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.

  11. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial.

    Science.gov (United States)

    McMillan, Andrew M; Landorf, Karl B; Gilheany, Mark F; Bird, Adam R; Morrow, Adam D; Menz, Hylton B

    2012-05-22

    To investigate the effectiveness of ultrasound guided corticosteroid injection in the treatment of plantar fasciitis. Randomised, investigator and participant blinded, placebo controlled trial. University clinic in Melbourne, Australia. 82 people with a clinical and ultrasound diagnosis of plantar fasciitis unrelated to systemic inflammatory disease. Participants were randomly allocated to ultrasound guided injection of the plantar fascia with either 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group) or 1 mL normal saline (placebo). Before injection the participants were given an ultrasound guided posterior tibial nerve block with 2% lidocaine (lignocaine). Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasound at 4, 8, and 12 weeks. Reduction in pain at four weeks favoured the dexamethasone group by 10.9 points (95% confidence interval 1.4 to 20.4, P=0.03). Between group differences for pain scores at eight and 12 weeks were not statistically significant. Plantar fascia thickness measured at four weeks favoured the dexamethasone group by -0.35 mm (95% confidence interval -0.67 to -0.03, P=0.03). At eight and 12 weeks, between group differences for plantar fascia thickness also favoured dexamethasone, at -0.39 mm (-0.73 to -0.05, P=0.02) and -0.43 mm (-0.85 to -0.01, P=0.04), respectively. The number needed to treat with dexamethasone for one successful outcome for pain at four weeks was 2.93 (95% confidence interval 2.76 to 3.12). There were no reported adverse events associated with the intervention. A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not

  12. 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.)

  13. 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.

  14. 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.

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

    Science.gov (United States)

    Nair, AS; Sahoo, RK

    2016-01-01

    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. PMID:27833490

  16. 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.

  17. 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.

  18. 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.

  19. LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

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    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

  20. Resistivity imaging reveals complex pattern of saltwater intrusion along Monterey coast

    Science.gov (United States)

    Goebel, Meredith; Pidlisecky, Adam; Knight, Rosemary

    2017-08-01

    Electrical Resistivity Tomography data were acquired along 40 km of the Monterey Bay coast in central California. These data resulted in electrical resistivity images to depths of approximately 280 m.b.s.l., which were used to understand the distribution of freshwater and saltwater in the subsurface, and factors controlling this distribution. The resulting resistivity sections were interpreted in conjunction with existing data sets, including well logs, seismic reflection data, geologic reports, hydrologic reports, and land use maps from the region. Interpretation of these data shows a complex pattern of saltwater intrusion resulting from geology, pumping, and recharge. The resistivity profiles were used to identify geological flow conduits and barriers such as palaeo-channels and faults, localized saltwater intrusion from individual pumping wells, infiltration zones of surface fresh and brackish water, and regions showing improvements in water quality due to management actions. The use of ERT data for characterizing the subsurface in this region has led to an understanding of the spatial distribution of freshwater and saltwater at a level of detail unattainable with the previously deployed traditional well based salinity mapping and monitoring techniques alone. Significant spatial variability in the extent and geometry of intrusion observed in the acquired data highlights the importance of adopting continuous subsurface characterization methods such as this one.

  1. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.

    Science.gov (United States)

    Bolívar, Yolanda Aranda; Munuera, Pedro V; Padillo, Juan Polo

    2013-01-01

    The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity was associated with plantar fasciitis. A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited. Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves, sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive powers. Differences between the 2 groups for the tests used to assess muscular shortening were significant (P muscles of the lower limb was present in the plantar fasciitis patients, but not in the unaffected participants. The results of this study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from an adequate tissue-specific plantar fascia-stretching protocol. Level III, case control study.

  2. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis.

    Science.gov (United States)

    Lewis, Rebecca D; Wright, Paul; McCarthy, Laine H

    2015-12-01

    In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer: A Search Terms: Plantar fasciitis, heel pain, treatment, orthotics, Limits: Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted: January 16, 2014; updated January 20, 2015 INCLUSION CRITERIA: Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis.

  3. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review.

    Science.gov (United States)

    Huffer, Dean; Hing, Wayne; Newton, Richard; Clair, Mike

    2017-03-01

    The aim was to critically evaluate the literature investigating strength training interventions in the treatment of plantar fasciitis and improving intrinsic foot musculature strength. A search of PubMed, CINHAL, Web of Science, SPORTSDiscus, EBSCO Academic Search Complete and PEDRO using the search terms plantar fasciitis, strength, strengthening, resistance training, intrinsic flexor foot, resistance training. Seven articles met the eligibility criteria. Methodological quality was assessed using the modified Downs and Black checklist. All articles showed moderate to high quality, however external validity was low. A comparison of the interventions highlights significant differences in strength training approaches to treating plantar fasciitis and improving intrinsic strength. It was not possible to identify the extent to which strengthening interventions for intrinsic musculature may benefit symptomatic or at risk populations to plantar fasciitis. There is limited external validity that foot exercises, toe flexion against resistance and minimalist running shoes may contribute to improved intrinsic foot musculature function. Despite no plantar fascia thickness changes being observed through high-load plantar fascia resistance training there are indications that it may aid in a reduction of pain and improvements in function. Further research should use standardised outcome measures to assess intrinsic foot musculature strength and plantar fasciitis symptoms. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis.

    Science.gov (United States)

    Ahmad, Jamal; Karim, Ammar; Daniel, Joseph N

    2016-09-01

    This study classified plantar heel spurs and their relationship to plantar fasciitis. Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis. The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs. Level III, comparative series. © The Author(s) 2016.

  5. First study on oyster-shell-based phosphorous removal in saltwater - A proxy to effluent bioremediation of marine aquaculture.

    Science.gov (United States)

    Martins, Marta C; Santos, Eduarda B H; Marques, Catarina R

    2017-01-01

    The efficiency of oyster-shell waste for the removal of phosphorous (P) in saltwater was herein evaluated. For that, different factors were tested, being attained >56% and >98% P removal by natural oyster shell (NOS)-fraction model and followed both the Elovich and Intraparticle Difusion kinetic models. COS followed only Pseudo-Second Order and, mainly, the Elovich model. Overall, optimal conditions for P removal from saltwater were established for NOS and COS, which will unquestionably allow to comply with regulated P levels for the discharge of wastewater from saltwater RAS. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. 'Potato peel dressing': a novel adjunctive in the management of necrotizing fasciitis.

    Science.gov (United States)

    Manjunath, K S; Bhandage, Supriya; Kamat, Shishir

    2015-03-01

    Management of necrotizing fasciitis, a rare and potentially fatal, polymicrobial disease comprises of aggressive debridement, intravenous antibiotics and application of various adjunctives. So far adjunctives like hyperbaric oxygen therapy, intravenous immunoglobulins, vacuum assisted or foam dressing, and guided tissue regeneration with amniotic dressing have been put to use. Each of these adjunctives has faced criticism for their shortcomings. Potato peel has been used as a dressing for chronic wounds but there is no literature available on its application over wounds afflicted with necrotizing fasciitis. Owing to various medicinal properties of potato peel and its use as a dressing in other medical conditions, same was used as an adjunctive in the present case. Here we present a case of cervical necrotizing fasciitis of dentogenous origin, treated by mainstay surgical treatment with debridement, drainage in combination with broad spectrum antibiotics and a novel adjunctive, 'potato peel dressing', which has shown promising results.

  7. Anatomical factors associated with predicting plantar fasciitis in long-distance runners.

    Science.gov (United States)

    Warren, B L

    1984-01-01

    The purpose of this study was to identify anatomical variables associated with plantar-fasciitis sufferers. Selected anatomical variables which were chosen for measurement were leg length, pronation of the subtalar joint, plantar and dorsiflexion ability, and arch height of the foot, as well as the variables height, weight, age, and miles run per week. The means and standard deviations revealed that leg-length inequality, pronation of the subtalar joint, and arch height were not good indicators of plantar-fasciitis sufferers. According to the discriminant-function analysis in which 64% of the subjects were assigned to the appropriate group, plantar flexion, dorsiflexion, and height were good predictors of the recovered and non-recovered sufferers, but could predict no more than 50% of the present sufferers. Therefore, a set of predictor variables was not found for the prediction of plantar-fasciitis sufferers.

  8. 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.

  9. Periorbital Nodular Fasciitis in Pregnancy: Case Report and Review of the Literature.

    Science.gov (United States)

    Skippen, Brent; Tomlinson, Jeanne; Tumuluri, Krishna

    2016-01-01

    Nodular fasciitis is a comparatively common benign soft tissue tumor, which may rarely occur in the periorbital and orbital regions. It can be confused with a malignant sarcoma both in its clinical behavior and histologic appearance. Trauma is a suspected risk factor for nodular fasciitis and pregnancy may also be a risk factor. This may be due to the hormone-related changes occurring in pregnancy, which are suspected to be responsible for the growth of some orbital masses in pregnancy. However, there are other cases of orbital masses, which have grown in pregnancy and were not proven positive for estrogen or progesterone receptors, suggesting another mechanism for tumor growth. In any case, awareness of nodular fasciitis in the differential diagnosis of a rapidly growing, soft tissue mass in the periorbital and orbital regions is important to avoid misdiagnosis of a malignancy and unnecessary treatment.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. Lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis.

    Science.gov (United States)

    Sadek, Ahmed Fathy; Fouly, Ezzat Hassan; Elian, Mostafa Mohammed

    2015-08-01

    To compare the outcome following lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis. 30 women and 3 men aged 30 to 60 (mean, 45) years with resistant plantar fasciitis were randomised to undergo release of the first branch of the lateral plantar nerve with (group 1, n=18) or without (group 2, n=15) calcaneal drilling. Patients were followed up for a mean of 27 months. According to the modified Mayo scoring system for plantar fasciotomy, group 1 was superior to group 2 in terms of score (93.9±6.97 vs. 83±8.2, pplantar nerve achieves better outcome than release alone in patients with resistant plantar fasciitis.

  13. [Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis].

    Science.gov (United States)

    Yan, Wenguang; Sun, Shaodan; Li, Xuhong

    2014-12-01

    To observe the therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis. A total of 153 plantar with plantar fasciitis were randomly divided into a combined group (n=51), an extracorporeal shock wave group (n=53) and an orthopaedic group (n=49). The combined group received treatment of both extracorporeal shock wave and orthopaedic insole while the extracorporeal shock wave or the orthopaedic group only received the treatment of extracorporeal shock wave or orthopaedic insole. The therapeutic parameters such as visual analogue scale (VAS) scores, continued walking time and thickness of the plantar fascia were monitored before and aft er the treatment for 2 weeks, 1 month and 3 months, respectively. The VAS scores in the 3 groups were all reduced after the treatment compared with the corresponding scores before the therapy (Pplantar fascia was improved after the treatment (Pplantar fasciitis. It is recommended to spread in clinic.

  14. Autologous blood injection and botulinum toxin for resistant plantar fasciitis accompanied by spasticity.

    Science.gov (United States)

    Logan, Lynne Romeiser; Klamar, Karl; Leon, Jerry; Fedoriw, Wladislaw

    2006-08-01

    An originally ambulatory 18-yr-old woman with spastic left hemiplegic cerebral palsy developed left plantar fasciitis with a gradual loss of function requiring use of a wheelchair. Her symptoms were resistant to physical therapy. Two hundred units of botulinum toxin A was diluted in 4 mL of saline and injected into the gastrocnemius. Three milliliters of autologous blood was injected into the plantar fascia. She reported decreased pain at 3 days postinjection. At 10 days, she had no pain on walking. Dorsiflexion increased and Ashworth and Tardieu improved. A stretching program was taught and a better-fitting night splint was obtained. At 21 days, she exhibited no pain and increased dorsiflexion. Autologous blood injection combined with botulinum toxin A may be an alternative treatment for resistant plantar fasciitis accompanied by spasticity. Our hypothesis is that chronic plantar fasciitis is a degenerative condition and thus is relieved when a mild inflammatory process is created that leads to healing.

  15. [Necrotizing fasciitis: study of 17 cases presenting a low mortality rate].

    Science.gov (United States)

    Kibadi, K; Forli, A; Martin Des Pallieres, T; Debus, G; Moutet, F; Corcella, D

    2013-04-01

    Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. The originality of this study is to present a series of necrotizing fasciitis treated and followed these last five years, and to compare the therapeutic results with those of the literature. We led a retrospective study on the patients treated for necrotizing fasciitis between 2005 and 2009 by bringing together the demographic and clinical data, the bacteriological examinations and the results of management. Follow-up data from these patients during period of study (five years) were notified. Seventeen patients were treated (11 men and six women). The average age of the patients was 52 years (ranging from 28 to 82 years). Risk factors of necrotizing fasciitis for our patients were: nonsteroidal anti-inflammatory drugs (82.2%), cutaneous wound (76.4%), obesity (29.4%), oto-rhino-laryngologic diseases (23.5%), alcoholic and drug addicts (23.5%), and diabetis (11.7%). The most isolated and responsible germ was Streptococcus pyogenes in 75.5% of cases. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensible to the antibiotics being administered (clindamycin in 70.5% of cases). The surgical management was early done with an average delay of 2.7 days (ranging from 1 to 15 days). We observed a low mortality rate (11.7%). One patient died during the period of follow-up after one year (average follow-up of 2.0 years; 1-3 years). Contrary to the data from the literature, this study presents a decrease of the mortality in necrotizing fasciitis with an early treatment and an adequate management. The precocity and the quality of surgical procedures as well as the presence of an underlying disease are determining factors for successful management of necrotizing fasciitis. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  16. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners.

    Science.gov (United States)

    Ribeiro, Ana Paula; Trombini-Souza, Francis; Tessutti, Vitor D; Lima, Fernanda R; João, Sílvia M A; Sacco, Isabel C N

    2011-02-01

    Plantar fasciitis is the third most frequent injury in runners. Despite its high prevalence, its pathogenesis remains inconclusive. The literature reports overload as the basic mechanism for its development. However, the way that these plantar loads are distributed on the foot surface of runners with plantar fasciitis and the effects of pain on this mechanical factor has not yet been investigated. Therefore, the aim of this study was to evaluate and compare the plantar pressure distributions during running in runners with symptom or history of plantar fasciitis and runners without the disease. Forty-five recreational runners with plantar fasciitis (30 symptomatic and 15 with previous history of the disease) and 60 runners without plantar fasciitis (control group) were evaluated. Pain was assessed by a visual analogue scale. All runners were evaluated by means of the Pedar system insoles during running forty meters at a speed of 12(5%) km/h, using standard sport footwear. Two-way ANOVAS were employed to investigate the main and interaction effects between groups and plantar areas. No interaction effects were found for any of the investigated variables: peak pressure (P = 0.61), contact area (P = 0.38), contact time (P = 0.91), and the pressure-time integral (P = 0.50). These findings indicated that the patterns of plantar pressure distribution were not affected in recreational runners with plantar fasciitis when compared to control runners. Pain also did not interfere with the dynamic patterns of the plantar pressure distributions. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

    Science.gov (United States)

    Nazerani, Shahram; Maghari, Ahmad; Kalantar Motamedi, Mohammad Hosein; Vahedian Ardakani, Jalal; Rashidian, Nikdokht; Nazerani, Tina

    2012-01-01

    ABSTRACT Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition. PMID:24350113

  18. Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site

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    Soo Chung Hong

    2014-01-01

    Full Text Available In this article, we present two cases of femoral pseudoaneurysm (PA at the femoral arterial puncture site followed by necrotizing fasciitis, which is rare but can be fatal when not managed appropriately. PA was revealed by lower-extremity angiography and color-flow Doppler ultrasonography. Hematoma removal, thrombolysis, and bleeder ligation with Gelfoam were repeatedly performed by a vascular surgeon. When necrotizing fasciitis developed, aggressive surgical drainage and creation of a viable wound bed for reconstruction were mandatory. We adopted a vacuum-assisted closure device (Kinetics Concepts International as the standard treatment for complicated, serious, infected PA of the puncture site. Excellent clinical outcomes were obtained.

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

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    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.

  20. Nodular fasciitis in the masticator space eroding into the mandible: a case report

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    Haider AboSharkh, BSc, DMD

    2015-03-01

    Full Text Available Nodular fasciitis is a benign soft tissue neoplasm of mesenchymal origin. It is usually characterized by rapid growth, infiltrative behavior, and heterogeneous histopathology, which can make diagnosis difficult and lead to delayed management. It has a 15%-20% occurrence rate in the head and neck and occurs rarely intraorally. In this report, we discuss an unusual case of nodular fasciitis originating in the masticator space and destroying the ascending ramus of the mandible. The treatment involved complete resection of the lesion and reconstruction with a temporomandibular joint prosthesis. At 24 months after surgery, the patient showed a return to normal function with no signs of recurrence.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Ascending necrotizing fasciitis of the face following odontogenic infection.

    Science.gov (United States)

    Park, Eugene; Hirsch, Elliot M; Steinberg, Jordan P; Olsson, Alexis B

    2012-05-01

    Necrotizing fasciitis (NF) of the face is a rare but extremely dangerous complication of dental infection associated with a nearly 30% mortality rate. This infection spreads rapidly along the superficial fascial planes of the head and neck and can lead to severe disfigurement. Reports in the literature of cases of NF of the face caused by dental infection are few. We report such a case in a 36-year-old woman and review the current standards of diagnosis and management. The patient initially presented with pain and severe swelling in the left side of her face subsequent to a dental infection. The symptoms had progressed quickly and had not improved with administration of oral antibiotics in the outpatient setting. The patient had no palpable crepitus despite its classic association with NF. The infection also took a rare, ascending route of spread with involvement of the temporalis muscle. Cultures taken during debridement grew Streptococcus anginosus and Bacteroides. Biopsies of involved muscle showed histologic evidence of necrosis. Through early surgical intervention including aggressive debridement, and the adjunctive use of appropriate antibiotics, the patient recovered with minimal loss of facial mass and no skin loss. Although NF of the face is rare, the surgeon must maintain a high index of suspicion with any patient presenting after a dental infection with rapid progression of swelling and a disproportionate amount of pain that is unresponsive to antibiotics.

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

    Science.gov (United States)

    Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

    2017-01-01

    [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. PMID:28603360

  7. 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

  8. Experimental Investigation on Flash Evaporation of Saltwater Droplets Released into Vacuum

    Science.gov (United States)

    Liu, Lu; Bi, Qin-cheng; Li, Hui-xiong

    2009-08-01

    In this paper, the flash evaporation process of saltwater droplets released into vacuum is experimentally investigated. During the experiment, a saltwater (NaCl) droplet was suspended on a thermocouple junction, which was used to measure the temperature evolution. The droplet surface temperature was captured by an infrared thermal imager, and the shape variation was recorded by a high speed camera. According to the experimental results, the component and solution concentration has great influence on the evaporation process. With a rise of salt concentration in water, the evaporation rate decreases. The shape of temperature transition curve also depends on the salt concentration in solution, no matter whether it is higher or lower than the eutectic point (22.4%). The effects of environmental pressure, initial droplet temperature and initial droplet diameter on the temperature transition of droplets were also summarized based on the experimental data.

  9. Effects of subfornical organ extracts on salt-water balance in the rat

    Science.gov (United States)

    Summy-Long, J. Y.; Crawford, I. L.; Severs, W. B.

    1976-01-01

    The subfornical organ (SFO) is a circumventricular structure located at the junction of the lamina terminalis and the tela choroidea of the third cerebral ventricle. SFO is histologically regarded as a neurosecretory structure, although the physiological effects or biochemical nature of such secretions are not yet ascertained. Results are presented for an experimental study designed to determine whether SFO extracts alter parameters associated with salt-water balance in the rat. The data obtained support the conclusion that SFO contains some water-soluble substance(s), easily released by incubation, dialyzable and heat stable, which influences the salt-water balance after injection into ventricular cerebrospinal fluid. Whether other brain tissues or plasma contains the same or similar material is not yet convincingly established. The observation that one or more active constituents are easily released from SFO upon incubation in potassium-enriched medium may be of value.

  10. Subsoil architecture and morphological setting shaping the saltwater intrusion in the coastal plain south of the Venice lagoon, Italy

    OpenAIRE

    Tosi, Luigi; Carol, Eleonora; Da Lio, Cristina; Donnici, Sandra; Kruse, Eduardo; Bassan, Valentina; Mazzuccato, Andrea; Fornaro, Elena; Teatini, Pietro

    2014-01-01

    The southern catchment of the Venice watershed (Italy) is threatened by shallow aquifer and soil salinization. The saltwater may extend inland up to 20 km from the Adriatic coastline and deepen down to some tens of meters. Here, saltwater contamination is driven by other forcing factors than excessive pumping, such as ground elevation, buried geological structures, tide encroachment along watercourses, climate and tide conditions, and drainage practices implemented in reclaimed areas. This wo...

  11. Saltwater wedge variation in a non-anthropogenic coastal karst aquifer influenced by a strong tidal range (Burren, Ireland)

    Science.gov (United States)

    Perriquet, Marie; Leonardi, Véronique; Henry, Tiernan; Jourde, Hervé

    2014-11-01

    Spatial and temporal changes in saltwater wedges in coastal karst aquifers are still poorly understood, largely due to complex mixing processes in these heterogeneous environments, but also due to anthropogenic forcing such as pumping, which commonly affect natural variations in wedges. The purpose of this study was first to characterize the hydrodynamic functioning of a karst aquifer in an oceanic temperate climate with little anthropogenic pressure but strongly influenced by a high tidal range and second, to evaluate the extent and movements of a saltwater wedge influenced by both the tide and the natural recharge of the aquifer. Variations in specific conductivity combined with water chemistry results from six boreholes and two lakes located in the Bell Harbour catchment (western Ireland) enabled us to assess the extent of the intrusion of the saltwater wedge into the aquifer as a function of both karst recharge and tidal movements at high/low and neap/spring tidal cycles. The marked spatial disparity of the saltwater wedge was analysed as a function of both the hydrodynamic and the structural properties of the karst aquifer. Results showed that the extent of the saltwater wedge depended not only on the intrinsic properties of the aquifer but also on the relative influence of the recharge and the tide on groundwater levels, which have opposite effects. Recharge in the Burren area throughout the year is large enough to prevent saltwater intruding more than about one kilometre from the shore. A strong tidal amplitude seems to be the motor of sudden saltwater intrusion observed in the aquifer near the shore while the position of the groundwater level seems to influence the intensity of the salinity increase. Competition between recharge and the tide thus controls the seawater inputs, hence explaining temporal and spatial changes in the saltwater wedge in this coastal karst aquifer.

  12. 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.

  13. Physical and sensory quality of tilapia (Oreochromis niloticus reared in freshwater and saltwater environments

    Directory of Open Access Journals (Sweden)

    L. O. S. Rebouças

    2017-07-01

    Full Text Available The objective of this study was to evaluate the physical and sensory characteristics of tilapia (Oreochromis niloticus reared in freshwater and saltwater environments. The microbiological quality of the samples was evaluated by determination of the most probable number of coliform bacteria at 35°C and 45°C and by the detection of Staphylococcus spp. and Salmonella sp. For physical evaluation, the pH, color, texture, cooking loss, and water-retention capacity (WRC were determined. Sensory analysis was performed by 30 trained tasters of both sexes and the following attributes were evaluated: color, flavor, odor, texture, and juiciness. There was a significant difference in pH between the two treatments (P>0.05, as well as in WRC and texture. The findings were uniform in terms of color (L*, a* and b*. The results of microbiological analysis were lower than those established by the current legislation, with the samples being adequate for consumption. No significant differences were observed in the sensory parameters, except for color. Rearing tilapia in a saltwater environment resulted in greater pH and WRC, better texture, and less cooking losses than freshwater-reared tilapia. The sensory characteristics flavor, odor, texture and juiciness are similar, but tasters prefer saltwater-reared tilapia (paired comparison.

  14. QTL mapping for two commercial traits in farmed saltwater crocodiles (Crocodylus porosus).

    Science.gov (United States)

    Miles, L G; Isberg, S R; Thomson, P C; Glenn, T C; Lance, S L; Dalzell, P; Moran, C

    2010-04-01

    The recent generation of a genetic linkage map for the saltwater crocodile (Crocodylus porosus) has now made it possible to carry out the systematic searches necessary for the identification of quantitative trait loci (QTL) affecting traits of economic, as well as evolutionary, importance in crocodilians. In this study, we conducted genome-wide scans for two commercially important traits, inventory head length (which is highly correlated with growth rate) and number of scale rows (SR, a skin quality trait), for the existence of QTL in a commercial population of saltwater crocodiles at Darwin Crocodile Farm, Northern Territory, Australia. To account for the uncommonly large difference in sex-specific recombination rates apparent in the saltwater crocodile, a duel mapping strategy was employed. This strategy employed a sib-pair analysis to take advantage of our full-sib pedigree structure, together with a half-sib analysis to account for, and take advantage of, the large difference in sex-specific recombination frequencies. Using these approaches, two putative QTL regions were identified for SR on linkage group 1 (LG1) at 36 cM, and on LG12 at 0 cM. The QTL identified in this investigation represent the first for a crocodilian and indeed for any non-avian member of the Class Reptilia. Mapping of QTL is an important first step towards the identification of genes and causal mutations for commercially important traits and the development of selection tools for implementation in crocodile breeding programmes for the industry.

  15. Extent and source of saltwater intrusion into the alluvial aquifer near Brinkley, Arkansas, 1984

    Science.gov (United States)

    Morris, E.E.; Bush, W.V.

    1986-01-01

    An approximate area of 56 sq mi of the alluvial aquifer just north of Brinkley, Arkansas, has been contaminated by saltwater (chloride concentration > or = 50 mg/L) intruded from underlying aquifers. The contamination was mapped from water quality data for 217 wells. Saltwater problems appear to have spread rapidly in the alluvial aquifer since the late 1940's. Chemical comparisons indicate that the alluvial aquifer was contaminated by water from the Sparta aquifer which in turn was contaminated by the underlying Nacatoch aquifer. The possibility of intrusion into the alluvial aquifer through abandoned oil and gas test wells was investigated but no evidence could be found to support this possibility. Upward movement into the alluvial aquifer from the underlying Sparta aquifer through the thinned or absent Jackson confining unit appears to be the principal reason for saltwater in the alluvial aquifer. Increased withdrawals of water from the alluvial aquifer for irrigation and public supply appear to have contributed to this upward movement. (Author 's abstract)

  16. An Unusual Presentation of Ludwig's Angina Complicated by Cervical Necrotizing Fasciitis: A Case Report and Review of the Literature.

    Science.gov (United States)

    Chueng, Kristelle; Clinkard, David J; Enepekides, Danny; Peerbaye, Yousef; Lin, Vincent Y W

    2012-01-01

    Ludwig's angina can seldom be complicated by necrotizing fasciitis. Due to the rapidly progressing nature of this infection and the potential for airway compromise and death, it is important to be aware of different ways in which this disease process can present in order to recognize and treat it emergently. We report here an unusual presentation of a case of Ludwig's angina complicated by necrotizing fasciitis in an elderly patient. The clinical features, diagnosis, and treatment are discussed in detail as well as a brief literature review on craniocervical necrotizing fasciitis.

  17. 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.

  18. A successfully treated case of necrotizing fasciitis with complicated sepsis due to intramuscular steroid injection

    Directory of Open Access Journals (Sweden)

    Ahmet Karakas

    2016-12-01

    Full Text Available Necrotising fasciitis is a devastating soft tissue infection which characterised by rapidly progressing necrosis involving mainly fascia and subcutaneous tissues. A 66-year old male patient with chronic obstructive pulmonary disease admitted to our hospital with fever, pain and swelling in the right thigh and right leg, difficulty in walking, dry mouth and weakness. There was a single dose intramuscular steroid injection story in his anamnesis. Physical examination revealed swelling, hyperemia and pain in the right gluteal region spreading through the right femur and popliteal fossa. He was diagnosed necrotizing fasciitis complicated with sepsis. We administered the supportive therapy and broad-spectrum antibiotic therapy in addition to the surgical debridement, vacuum assisted closure and hyperbaric oxygen therapy. The patient was discharged after six months of the follow-up period in hospital. In conclusion, Health-care personnel should be careful when the intramuscular injections planned for patients at the risk of development of necrotizing fasciitis reason of their chronic illnesses or immunosuppressive conditions. In patients who developed necrotizing fasciitis despite everything, we want to strongly emphasise the advantageous hyperbaric oxygen therapy as an additional therapy to the broad spectrum antibiotherapy and surgical debridement [Cukurova Med J 2016; 41(4.000: 787-791

  19. The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis.

    Science.gov (United States)

    Gross, Michael T; Byers, James M; Krafft, Jeffrey L; Lackey, Eric J; Melton, Kathy M

    2002-04-01

    Single-group, pre-, and postintervention repeated measures design. To determine the impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. Few studies have examined the efficacy of foot orthotics for plantar fasciitis, and no single study has yet examined the effects of semirigid foot orthotics on an established quality-of-life instrument. Eight men and 7 women (mean ages 44.7 +/- 9.0 years) who reported having plantar fasciitis symptoms for an average of 21.3 +/- 23.7 months participated in the study. Subjects were timed for a 100-m walk at a self-selected speed, then they rated the pain they experienced during the walk using a 10-cm visual analog scale. Subjects also completed the pain and disability subsections of the Foot Function Index questionnaire. All measures were acquired before the fabrication of custom semirigid foot orthotics and 12 to 17 days following onset of foot orthotic use. Postorthotic 100-m walk times were not significantly different (t = 0.39, P = 0.70) than preorthotic values. Postorthotic pain ratings (mean = 0.7 +/- 0.7) for the 100-m walk were significantly less than (Wilcoxon t = 1, P disability subsection ratings (Wilcoxon t = 0, P disability ratings. Custom semirigid foot orthotics may significantly reduce pain experienced during walking and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis.

  20. Pseudomembranous colitis due to Clostridium difficile as a cause of perineal necrotising fasciitis.

    Science.gov (United States)

    Duburcq, Thibault; Parmentier-Decrucq, Erika; Poissy, Julien; Mathieu, Daniel

    2013-01-22

    Although rare, pseudomembranous colitis may be a cause of perineal necrotising fasciitis in a context of immunosuppression, as in the case we report. This origin must be quickly identified because the therapeutic management, especially surgery, is unlikely to be the same as usual. Similarly, antibiotic treatment is also a matter of discussion due to the potential deleterious role of antibiotics in pseudomembranous colitis.

  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...

  2. 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.

  3. 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 ...

  4. Pulsed radiofrequency electromagnetic field therapy: a potential novel treatment of plantar fasciitis.

    Science.gov (United States)

    Brook, Joel; Dauphinee, Damien M; Korpinen, Jaryl; Rawe, Ian M

    2012-01-01

    Plantar fasciitis is a common cause of heel pain, and although treatments are usually conservative, they can take up to 2 years to achieve resolution. A double-blind, multicenter, randomized, placebo-controlled study was used to evaluate a small, wearable, extended-use pulsed radiofrequency electromagnetic field (PRFE) device as a treatment of plantar fasciitis. A total of 70 subjects diagnosed with plantar fasciitis were enrolled in the present study. The subjects were randomly assigned a placebo or active PRFE device. The subjects were instructed to wear the PRFE device overnight, record their morning and evening pain using a 0- to 10-point visual analog scale (VAS), and log any medication use. The primary outcome measure for the present study was morning pain, a hallmark of plantar fasciitis. The study group using the active PRFE device showed progressive decline in morning pain. The day 7 AM-VAS score was 40% lower than the day 1 AM-VAS score. The control group, in comparison, showed a 7% decline. A significantly different decline was demonstrated between the 2 groups (p = .03). The PM-VAS scores declined by 30% in the study group and 19% in the control group, although the difference was not significant. Medication use in the study group also showed a trend downward, but the use in the control group remained consistent with the day 1 levels. PRFE therapy worn on a nightly basis appears to offer a simple, drug-free, noninvasive therapy to reduce the pain associated with plantar fasciitis. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.

    Science.gov (United States)

    Monto, Raymond Rocco

    2014-04-01

    Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat. In this study, autologous platelet-rich plasma (PRP), a concentrated bioactive blood component rich in cytokines and growth factors, was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection (pretreatment = time 0) and at 3, 6, 12, and 24 months following injection treatment. Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis. The cortisone group had a pretreatment average AOFAS score of 52, which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months, then dropped to near baseline levels of 58 at 12 months, and continued to decline to a final score of 56 at 24 months. In contrast, the PRP group started with an average pretreatment AOFAS score of 37, which increased to 95 at 3 months, remained elevated at 94 at 6 and 12 months, and had a final score of 92 at 24 months. PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis. Level I, prospective randomized comparative series.

  6. A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management

    Directory of Open Access Journals (Sweden)

    Kimberley Fayman

    2017-01-01

    Conclusion: This is the youngest patient with primary necrotising fasciitis of the breast described in the literature. Prompt resuscitation and an aggressive surgical approach are critical to the successful management of this life threatening pathology.

  7. Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series.

    Science.gov (United States)

    van Egmond, Jeroen C; Breugem, Stefan J M; Driessen, Marcel; Bruijn, Daniel J

    2015-06-01

    Plantar fasciitis is the most common cause of heel pain. Diverse non-operative treatment options are available. The purpose of this study was to determine if a single platelet-rich-plasma injection at the origin of the plantar fascia in patients with plantar fasciitis gives a functional improvement. Patients with plantar fasciitis and failed conservative treatment were included in this retrospective study. Included patients were sent four questionnaires after platelet-rich-plasma injection. Primary outcome is functional improvement, determined by foot function index in which lower scores correlates with a better foot function. A total of 61 feet in 58 patients were included. The median foot function index before treatment was 69.4 and after treatment 31.8, which is a significant decrease. In 80.3% of the patients the foot function index decreased. Therefore platelet-rich-plasma injection seems to be effective in treatment of patients with plantar fasciitis when conservative treatment failed.

  8. 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.

  9. Necrotising fasciitis causing compartment syndrome of the forearm and septic shock due to Vibrio vulnificus: a case report.

    Science.gov (United States)

    Leechavengvongs, Somsak; Jidpugdeebodin, Suwanee; Milindankura, Samaniya

    2006-01-01

    Compartment syndrome caused by necrotising fasciitis has rarely been described. We report a case of systemic Vibrio vulnificus necrotising fasciitis presented with compartmental syndrome of the forearm and septic shock. The patient was treated with systemic antibiotic treatment and urgent surgical decompression followed by multiple necrotic tissue debridements. The patient recovered with some limited motion of the hand function. Prompt recognition and immediate treatment with antibiotics and surgical intervention are essential.

  10. 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.

  11. Platelet-rich plasma as a treatment for plantar fasciitis

    Science.gov (United States)

    Yang, Wei-yi; Han, Yan-hong; Cao, Xue-wei; Pan, Jian-ke; Zeng, Ling-feng; Lin, Jiong-tong; Liu, Jun

    2017-01-01

    Abstract Background: Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF compared with the efficacy and safety of steroid treatments. Methods: Databases (PubMed, EMBASE, and The Cochrane Library) were searched from their establishment to January 30, 2017, for randomized controlled trials (RCTs) comparing PRP with steroid injections as treatments for PF. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were the visual analogue scale (VAS), Foot and Ankle Disability Index (FADI), American Orthopedic Foot and Ankle Society (AOFAS) scale, and the Roles and Maudsley score (RMS). The statistical analysis was performed with RevMan 5.3.5 software. Results: Nine RCTs (n = 430) were included in this meta-analysis. Significant differences in the VAS were not observed between the 2 groups after 4 [weighted mean difference (WMD) = 0.56, 95% confidence interval (95% CI): −1.10 to 2.23, P = .51, I2 = 89%] or 12 weeks of treatment (WMD = −0.49, 95% CI: −1.42 to 0.44, P = .30, I2 = 89%). However, PRP exhibited better efficacy than the steroid treatment after 24 weeks (WMD = −0.95, 95% CI: −1.80 to −0.11, P = .03, I2 = 85%). Moreover, no significant differences in the FADI, AOFAS, and RMS were observed between the 2 therapies (P > .05). Conclusion: Limited evidence supports the conclusion that PRP is superior to steroid treatments for long-term pain relief; however, significant differences were not observed between short and intermediate effects. Because of the small sample size and the limited number of high-quality RCTs, additional high-quality RCTs with larger sample sizes are required to validate this result. PMID:29095303

  12. Electrochemical corrosion behavior of X52 and X60 steels in carbon dioxide containing saltwater solution

    OpenAIRE

    Rihan Omar Rihan

    2012-01-01

    X52 and X60 high strength low alloy (HSLA) steels are widely used in the construction of petroleum pipelines. This paper discusses the corrosion resistance of X52 and X60 steels in CO2 containing saltwater at pH 4.4 and 50 ºC. A circulating flow loop system inside an autoclave was used for conducting the experimental work. The rotating impeller speed was 2000 rpm. The corrosion rate was monitored using in situ electrochemical methods such as potentiodynamic sweep, linear polarization resistan...

  13. Geophysical and geochemical investigation of the saltwater intrusion into the coastal carbonate aquifer of Mallorca, Spain

    Science.gov (United States)

    Garing, C.; Luquot, L.; Pezard, P.; Gouze, P.

    2012-12-01

    Coastal aquifers often display seawater intrusions resulting in the formation of a salty water wedge progressing inland. The mixing zone water has a chemical composition in disequilibrium with the rock forming carbonate minerals inducing significant mass transfers that may modify porosity and permeability irreversibly. Yet, these changes in the aquifer properties and the controlling mechanisms are poorly described due to the large variability of the (bio)chemical and hydrodynamic environment and the difficulty of monitoring both the fluid and the rock changes over pertinent durations. In this study we first characterize a saltwater intrusion into a coastal carbonate aquifer of Mallorca Island (Spain) and monitor its evolution with time, from 2003 to 2011, using repeated electrical conductivity logs of the formation and the saturating fluid, as well as regular pore-water sampling and permanent downhole multi-parameters monitoring of the water. Secondly, we investigate the geochemical processes occurring within the mixing zone by a coupled analysis of the sampled water composition and the characteristics of the rock, which are investigates with borehole images, thin sections and X-Ray tomography. The results show that the mixing zone groundwater is undersaturated with respect to calcite. The maximum calcite undersaturation is observed at the saltwater side of the mixing zone, which is not consistent with the prediction of the theoretical conservative mixing of the freshwater and seawater end-members. The observation of calcite dissolution features suggests that the undersaturated water in the mixing zone might lead to noticeable porosity development at these depths. Also, the localization of the dissolution features slightly deeper to the maximum undersaturation suggests an upward motion of the mixing zone. The data also highlight a pH anomaly (acidification) localized at the center of the freshwater-saltwater, which cannot be explained by conservative mixing, but

  14. Offshore Stratigraphic Controls on Salt-Water Intrusion in Los Angeles Area Coastal Aquifers

    Science.gov (United States)

    Edwards, B. D.; Ponti, D. J.; Ehman, K. D.; Tinsley, J. C.; Reichard, E. G.

    2002-12-01

    Ground water is a major component of the water supply for the ~10 million residents of Los Angeles County. Ground water pumping, linked to population growth since the early 1900's, caused water levels to decline, reversed seaward hydraulic gradients in some coastal aquifers, and resulted in salt water intrusion. United States Geological Survey geologists and hydrologists are working cooperatively with local water agencies to (1) understand and model the process of salt-water intrusion in this siliciclastic, structurally complex basin, and (2) identify potential pathways for the salt-water intrusion. We collected over 2000 trackline-km of single- and multi-channel intermediate- and high-resolution seismic-reflection profiles (60 to 5000 Hz) from the Los Angeles/Long Beach Harbor complex and the adjacent San Pedro shelf to develop a 3-dimensional stratigraphic model of the coastal aquifer system. These data define stratal geometries, paleo-channels, and fault traces in the offshore that are potential pathways of salt-water intrusion. The offshore seismic-reflection profiles correlate with onshore geophysical and borehole data collected from four nearby drill sites that were cored continuously to depths ranging to 400 meters. These core holes provide detailed 1-dimensional reference sections that furnish stratigraphic, age, and facies control for the seismic-reflection profiles. The coastal aquifer system is described using sequence stratigraphic concepts as units deposited during eustatic sea level fluctuations during the Pleistocene to Recent. Seismic-reflection profiles identify sequence boundaries, and hence aquifer and aquitard units, by the truncation and onlap of reflectors. If and where the sequences crop out on the sea floor provides a potential pathway for intrusion. The youngest unit, the Gaspur aquifer, is intruded with salt water and consists of at least two flat-lying sequences, each marked by basal gravelly sands deposited by the ancestral Los Angeles

  15. 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

  16. Necrotizing fasciitis following saphenofemoral junction ligation with long saphenous vein stripping: a case report

    Directory of Open Access Journals (Sweden)

    Ferguson Graeme

    2010-05-01

    Full Text Available Abstract Introduction Necrotizing fasciitis is a rare condition with a mortality rate of around 34%. It can be mono- or polymicrobial in origin. Monomicrobial infections are usually due to group A streptococcus and their incidence is on the rise. They normally occur in healthy individuals with a history of trauma, surgery or intravenous drug use. Post-operative necrotizing fasciitis is rare but accounts for 9 to 28% of all necrotizing fasciitis. The incidence of wound infection following saphenofemoral junction ligation and vein stripping is said to be less than 3%, although this complication is probably under-reported. We describe a case of group A streptococcus necrotizing fasciitis following saphenofemoral junction ligation and vein stripping. Case Presentation A 39-year-old woman presented three days following a left sided saphenofemoral junction ligation with long saphenous vein stripping at another institution. She had a three day history of fever, rigors and swelling of the left leg. She was pyrexial and shocked. She had a very tender, swollen left groin and thigh, with a small blister anteriorly and was in acute renal failure. She was prescribed intravenous penicillin and diagnosed with necrotizing fasciitis. She underwent extensive debridement of her left thigh and was commenced on clindamycin and imipenem. Post-operatively, she required ventilatory and inotropic support with continuous veno-venous haemofiltration. An examination 12 hours after surgery showed no requirement for further debridement. A group A streptococcus, sensitive to penicillin, was isolated from the debrided tissue. A vacuum assisted closure device was fitted to the clean thigh wound on day four and split-skin-grafting was performed on day eight. On day 13, a wound inspection revealed that more than 90% of the graft had taken. Antibiotics were stopped on day 20 and she was discharged on day 22. Conclusion Necrotizing fasciitis is a very serious complication for a

  17. Geoelectrical Surveys for Characterization of the Coastal Saltwater Intrusion in Metapontum Forest Reserve (Southern Italy

    Directory of Open Access Journals (Sweden)

    Antonio Satriani

    2012-01-01

    Full Text Available A geoelectrical survey was carried out in the Metapontum Forest Reserve located along the Ionian coast of the Basilicata region (Southern Italy. In this work we used the method of two-dimensional electrical resistivity tomography for obtaining high-resolution electrical images in the investigated site. In particular, three electrical resistivity tomography, all orthogonal to the coastline, in the investigated area were carried out. To complete and integrate the geophysical data, soil and groundwater samplings, seventeen and five, respectively, were analyzed using chemical physical techniques. Geoelectrical survey, supported by laboratory analysis of soil and water samples have revealed the presence of a process of saltwater in coastal Forest Reserve of Metapontum, which have caused the decline of the existing pine forest with the consequent erosion and desertification problems. The results have disclosed the way to identify and discriminate large areas affected by intensive soil salinization and high resolution electrical images of the subsurface electrical resistivity plays a key role in delineating the saltwater intrusion front in coastal areas. Furthermore, our integrated study represents a contribution to the future programs for the protection, planning, and management of the terrestrial and marine resources in this coastal area.

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

    Science.gov (United States)

    Grundmann, Jens; Al-Khatri, Ayisha; Schütze, Niels

    2016-05-01

    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.

  19. 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.

  20. [Postvaccinal fatal Streptococcus zooepidemicus necrotizing fasciitis in a young dog: a case report].

    Science.gov (United States)

    Greijdanus-Van Der Putten, S W M; Vos, J H; Duvekot, J R V; Paillot, R; McLean, R; Brokers, H J; Heuvelink, A E; Meertens, N M; Waller, A S

    2014-09-01

    A 2.5-years-old female mongrel dog was routinely subcutaneously vaccinated. A few hours later mental dullness was noticed by the owner progressing into stupor the next day and resulting in a comatose state and death within 48 hours after vaccination. At post mortem examination, which was extended with histology and bacteriology, a necrotizing fasciitis and bacteremia caused by Streptococcus equi subsp. zooepidemicus were established. In the isolated Streptococcus strain four different superantigens were demonstrated that appeared to be able to produce exotoxins in vitro. Therefore, it is concluded that the minor skin trauma caused by vaccination enabled this strain to gain access to the subcutaneous tissue and to induce a necrotizing fasciitis. This process was complicated with a bacterial septicemia leading to death of the dog within 48 hours.

  1. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

    Science.gov (United States)

    Cottom, James M; Maker, Jared M

    2016-01-01

    Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. A Report of Peritonitis from Aeromonas sobria in a Peritoneal Dialysis (PD) Patient with Necrotizing Fasciitis.

    Science.gov (United States)

    Janma, Jirayut; Linasmita, Patcharasarn; Changsirikulchai, Siribha

    2015-11-01

    A 70-years of age, male patient with underlying type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease had undergone continuous ambulatory peritoneal dialysis (CAPD)for 3 years without any episodes of peritonitis. He was diagnosed with necrotizing fasciitis and later developed peritonitis after receiving a laceration from an aquatic injury suffered during the flood disaster of 2011. The blood culture, necrotic tissue and the clear dialysate collected upon admission had shown Aeromonas sobria. The route of peritonitis may be from the hematogenous spread of A. sobria resulting in necrotizing fasciitis. A. sobria should be considered as the pathogen of peritonitis in PD patients who have history of wounds from contaminated water. We suggest that the PD patients who present with septicemia and did not meet the criteria for peritonitis, the initial dialysate effluent should be sent for culture. The benefit of this is to allow early recognition and treatment of peritonitis.

  3. 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.

  4. Primary leiomyosarcoma of the abdominal wall mimicking nodular fasciitis in a child

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    Yuhki Koike

    2015-06-01

    Full Text Available We report the case of an 8-year-old boy with a 30-mm solid mass in the right lower quadrant of the abdominal wall. Computed tomography revealed that the tumor was on the lateral border of the rectus abdominis, and surgical resection was performed. Despite difficulty in differentiating this mass from nodular fasciitis, pathologic analysis and immunohistochemical staining led to the diagnosis of leiomyosarcoma.

  5. 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...

  6. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

    Science.gov (United States)

    Mahindra, Pankaj; Yamin, Mohammad; Selhi, Harpal S; Singla, Sonia; Soni, Ashwani

    2016-01-01

    Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis. Copyright 2016, SLACK Incorporated.

  7. Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

    OpenAIRE

    Camino Junior, Rubens; Naclerio-Homem,Maria G.; Cabral, Lecy Marcondes; Luz, João Gualberto C.

    2014-01-01

    Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridem...

  8. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study.

    Science.gov (United States)

    Jain, Kowshik; Murphy, Philip N; Clough, Timothy M

    2015-12-01

    Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection. 60 heels with intractable plantar fasciitis who had failed conservative treatment were randomised to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared. Pre-injection, the two groups were well matched with no statistically significant difference. At 3 months, all three outcome scores had significantly improved from their pretreatment level in both groups. The scores in the Steroid arm were marginally better than in the PRP arm, but this difference was not statistically significant. At 6 months, there was no statistically significant difference between the two groups, though there was a trend for the PRP scores to become better than the Steroid scores. At 12 months, the RM, VAS and AOFAS scores in the PRP arm (1.9, 3.3 and 88.5) were significantly better than the Steroid arm (2.6, 5.3 and 75) with P values of .013, .028 and .033, respectively. PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

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    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

  10. Group A Streptococci-Associated Necrotizing Fasciitis following Cat Bite in an Immunocompromised Patient

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    Sudheer Nambiar

    2017-01-01

    Full Text Available Necrotizing soft tissue infections are characterized clinically by fulminant tissue destruction, systemic signs of toxicity, and high mortality. Accurate diagnosis and appropriate treatment must include early surgical intervention and antibiotic therapy. Mortality rate is very high and could be even higher in an immunocompromised host. We present a 57-year-old female with history of rheumatoid arthritis on oral corticosteroid and methotrexate therapy with painful swelling of the left hand following a cat bite that was diagnosed as having group A streptococcus pyogenes-associated necrotizing fasciitis. Treatment with ampicillin-sulbactam, Clindamycin, and surgical debridement was performed. In spite of all the adequate therapy she succumbed to death from streptococcal toxic shock and related complications after thirty-two days of treatment in intensive care unit. Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. Tissue infections in cat bite wounds are commonly caused by pathogenic bacterium known as Pasteurella multocida. Group A streptococcal infections are not reported following cat bites. A high index of suspicion must be maintained to suspect group A streptococcal associated necrotizing fasciitis following cat bites and an early medical and surgical intervention should be made for any best possible outcome.

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

    Science.gov (United States)

    Monié, Marguerite; Drieux, Laurence; Nzili, Bernadette; Dicko, Michèle; Goursot, Catherine; Greffard, Sandrine; Decré, Dominique; Mézière, Anthony

    2014-01-01

    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 of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis.

  12. Combination of Hip Strengthening and Manipulative Therapy for the Treatment of Plantar Fasciitis: A Case Report.

    Science.gov (United States)

    Santos, Bruno Dos; Corrêa, Leticia Amaral; Teixeira Santos, Luciano; Filho, Ney Armando Meziat; Lemos, Thiago; Nogueira, Leandro Alberto Calazans

    2016-12-01

    The purpose of this case report is to describe the management of using a combination of hip strengthening and manipulative therapy (MT) for a patient with plantar fasciitis. A 44-year-old patient reported heel pain for approximately 1 year before treatment. The patient reported plantar heel pain and tenderness at the calcaneal tuberosity. The pain was most noticeable in the morning but was reduced after a 30-minute walk. A diagnosis of plantar fasciitis was made at the initial assessment. Initially, a clinical evaluation was performed to measure pain intensity (Numeric Pain Rating Scale), pressure-pain threshold (algometry), and perceived exertion (OMNI Resistance Exercise Scale). The patient then underwent 10 sessions of hip strengthening and MT over a period of 3 months. After the treatment, the intensity of pain and the pressure-pain threshold was reevaluated. The patient reported an improvement in pain intensity (baseline score = 6 vs final score = 1) and an increase in the pressure-pain threshold (initial score = 2.6 vs final score = 7.1). Perceived exertion was also improved after hip muscle strength training (initial score = 10 vs final score = 8). The combination of hip strengthening and MT improved foot pain in a patient with a clinical diagnosis of plantar fasciitis.

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

    Directory of Open Access Journals (Sweden)

    Zonghuan Li

    Full Text Available 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.

  14. Low dose radiotherapy for plantar fasciitis. Treatment outcome of 171 patients.

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    Badakhshi, Harun; Buadch, Volker

    2014-12-01

    Although the effectiveness of low-dose radiotherapy for chronic degenerative and inflammatory diseases has been documented in previous studies, patient-reported clinical outcomes are rarely available. This study aimed to determine the effect of low-dose radiotherapy on patients with painful plantar fasciitis. From 2002 to 2008, 200 patients older than 65 years of age with painful plantar fasciitis were treated in our hospital. Records from 171 of these patients were available for analysis. All patients were treated with an identical dose of 3Gy using identical equipment and techniques. Response was evaluated with patient-reported questionnaires and clinical visits. Minimum-term follow-up was 18 months, with mean follow-up at 54 months. Three months after receiving low-dose radiotherapy, 67.3% of patients had no or mild pain, and 57.9% had no or discrete mobility restriction. At a mean of 54 months, 61.4% of patients had no or mild pain and 64.9% of patients had no or discrete mobility restriction; 60.8% of patients reported improved quality of life. Low-dose radiotherapy is effective in most patients with painful plantar fasciitis. Due to minimal side effects and low costs, it represents an excellent treatment option compared to conventional therapies or surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

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    Marcus Vinicius Grecco

    2013-01-01

    Full Text Available OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6 ±11.8 years (range: 25-68 years, 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment.

  16. Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Júlia Maria D'Andréa Greve

    2009-02-01

    Full Text Available OBJECTIVE: To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS: Thirty-two patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 was composed of 16 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 was composed of 16 patients who underwent three applications of radial shockwaves (once a week and received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 47.3 ± 10.3 years (range 25-68; 81% were female, 87% were overweight, 56% had bilateral impairment, and 75% used analgesics regularly. RESULTS: Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment. CONCLUSION: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment.

  17. The treatment of intractable plantar fasciitis with platelet-rich plasma injection.

    Science.gov (United States)

    Kumar, Vishwajeet; Millar, Tim; Murphy, Philip N; Clough, Tim

    2013-01-01

    Whilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems. Evaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis. Patients with plantar fasciitis not responded to a minimum of 1 year standard conservative management were offered PRP therapy. Injections were performed in theatre as a day case. Roles-Maudsley (RM) scores, Visual Analogue Scores (VAS), AOFAS scores and 'would have injection again' were collated pre-operatively, three and six months. Prospective data was collected of 50 heels (44 patients). At six month review, RM score improved from mean 4 to 2 (p<0.001), VAS improved from 7.7 to 4.2 (p<0.001) and AOFAS improved from 60.6 to 81.9 (p<0.001). 28 patients (64%) were very satisfied and would have the injection again. No complications were reported. In these chronic cases, PRP produce an efficacy rate, approaching 2 out of every 3. The procedure was safe with no reported complications. The authors feel PRP may have some role in treatment, and merits further study with a prospective randomised trial. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  18. One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

    Science.gov (United States)

    Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea

    2013-01-01

    OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

  19. Plantar fasciitis: A randomized comparative study of platelet rich plasma and low dose radiation in sportspersons.

    Science.gov (United States)

    Gogna, Paritosh; Gaba, Sahil; Mukhopadhyay, Reetadyuti; Gupta, Rakesh; Rohilla, Rajesh; Yadav, Lakhpat

    2016-08-01

    Plantar Fasciitis makes up about 15% of patients requiring professional care due to foot symptoms. The treatment methods are numerous with none proving to be clearly superior to others. We aimed to compare two common treatment methods in search of the best treatment. All consecutive sportspersons presenting to our OPD with clinical diagnosis of plantar fasciitis underwent treatment consisting of stretching exercises, activity modification, and NSAID's for 6 months. First 40 patients who did not respond to the treatment were divided randomly into two groups of 20 patients each, Group A (Platelet rich plasma - PRP) and Group B (low dose radiation - LDR). At the time of final follow-up (6 months) the mean improvement in the pain score (Visual-Analogue-Scale), American Orthopaedic Foot and Ankle Score (AOFAS) and Plantar fascia thickness on ultrasound were compared. Significant improvement in all 3 parameters was noted at the time of final follow up within both groups. When compared to each other, the difference in outcome of both these Groups on the given 3 parameters came out to be insignificant (p>0.05). PRP is as good as LDR in patients with chronic recalcitrant plantar fasciitis not responding to physical therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Effectiveness of device-assisted ultrasound-guided steroid injection for treating plantar fasciitis.

    Science.gov (United States)

    Chen, Chien-Min; Chen, Jenq-Shyong; Tsai, Wen-Chung; Hsu, Hung-Chih; Chen, Kai-Hua; Lin, Chu-Hsu

    2013-07-01

    The aim of this study was to investigate the effectiveness of device-assisted ultrasound-guided steroid injection for treating plantar fasciitis. An ultrasound-guided injection device designed with space for securing a transducer and syringe was used to guide steroid injection. Patients with unilateral plantar fasciitis were enrolled and randomly divided into device-assisted ultrasound-guided and palpation-guided groups. Pain intensity was measured using a visual analog scale and tenderness threshold. Ultrasound and pain intensity evaluations were performed before injection and at 3 wks and at 3 mos postinjection. Betamethasone (7 mg) and 1% lidocaine (0.5 ml) were injected into the inflamed plantar fascia. Thirty-three patients who received either device-assisted ultrasound-guided or palpation-guided injection had significantly lower visual analog scale scores (P plantar fascia (3/16 vs. 9/16; P = 0.033) than the palpation-guided group did at 3 mos postinjection. The heel pad was significantly thin (P = 0.004) in the palpation-guided group postinjection. Device-assisted ultrasound-guided injection for treating plantar fasciitis results in better therapeutic outcomes than palpation-guided injection does.

  1. 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

    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. 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. 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. 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.

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

    Science.gov (United States)

    Li, Zonghuan; Xia, Chengyan; Yu, Aixi; Qi, Baiwen

    2014-01-01

    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.

  3. Brief Report: Power Doppler Ultrasonography for Detection of Increased Vascularity in the Fascia: A Potential Early Diagnostic Tool in Fasciitis of Dermatomyositis.

    Science.gov (United States)

    Yoshida, Ken; Nishioka, Makiko; Matsushima, Satoshi; Joh, Kensuke; Oto, Yosuke; Yoshiga, Masayuki; Otani, Kazuhiro; Ito, Haruyasu; Hirai, Kenichiro; Furuya, Kazuhiro; Ukichi, Taro; Noda, Kentaro; Kingetsu, Isamu; Kurosaka, Daitaro

    2016-12-01

    We previously demonstrated that fasciitis is a common lesion of dermatomyositis (DM) that is detectable early after disease onset by en bloc muscle biopsy combined with magnetic resonance imaging (MRI). Power Doppler ultrasonography (PDUS) is a useful method for detection of inflammation and vascularity in rheumatic diseases. We undertook this study to determine whether fasciitis was detectable by PDUS in patients with DM. We prospectively evaluated 7 patients with DM and 7 patients with polymyositis (PM) for the detection of fasciitis with PDUS. MRI and PDUS were both performed in all patients. Fasciitis was histologically confirmed by en bloc biopsy. Among all patients with DM, 4 showed signs of fasciitis on MRI, while increased blood flow signals were observed along the fascia by PDUS in 6 DM patients, including 4 patients with early disease (fascia. Immunohistochemical staining for CD31 indicated abnormal neovascular proliferation in the fascia in patients with DM. None of the PM patients showed signs of fasciitis or increased vascularity by MRI, PDUS, or en bloc biopsy. In our limited population, PDUS was useful for the detection of fasciitis associated with DM, especially in the early stage of disease. The increased blood flow signal as detected by PDUS is involved in angiogenesis accompanying fasciitis in patients with DM. © 2016, American College of Rheumatology.

  4. Predictive uncertainty analysis of a saltwater intrusion model using null-space Monte Carlo

    Science.gov (United States)

    Herckenrath, Daan; Langevin, Christian D.; Doherty, John

    2011-01-01

    Because of the extensive computational burden and perhaps a lack of awareness of existing methods, rigorous uncertainty analyses are rarely conducted for variable-density flow and transport models. For this reason, a recently developed null-space Monte Carlo (NSMC) method for quantifying prediction uncertainty was tested for a synthetic saltwater intrusion model patterned after the Henry problem. Saltwater intrusion caused by a reduction in fresh groundwater discharge was simulated for 1000 randomly generated hydraulic conductivity distributions, representing a mildly heterogeneous aquifer. From these 1000 simulations, the hydraulic conductivity distribution giving rise to the most extreme case of saltwater intrusion was selected and was assumed to represent the "true" system. Head and salinity values from this true model were then extracted and used as observations for subsequent model calibration. Random noise was added to the observations to approximate realistic field conditions. The NSMC method was used to calculate 1000 calibration-constrained parameter fields. If the dimensionality of the solution space was set appropriately, the estimated uncertainty range from the NSMC analysis encompassed the truth. Several variants of the method were implemented to investigate their effect on the efficiency of the NSMC method. Reducing the dimensionality of the null-space for the processing of the random parameter sets did not result in any significant gains in efficiency and compromised the ability of the NSMC method to encompass the true prediction value. The addition of intrapilot point heterogeneity to the NSMC process was also tested. According to a variogram comparison, this provided the same scale of heterogeneity that was used to generate the truth. However, incorporation of intrapilot point variability did not make a noticeable difference to the uncertainty of the prediction. With this higher level of heterogeneity, however, the computational burden of

  5. 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

  6. Secondary aneurysmal bone cyst in the distal humerus after resection of intra-articular nodular fasciitis of the elbow.

    Science.gov (United States)

    Yamamoto, Michiro; Urakawa, Hiroshi; Nishida, Yoshihiro; Hirata, Hitoshi

    2015-07-22

    Nodular fasciitis most often occurs within subcutaneous tissues, but may also arise within skeletal muscle, dermis, vessels, peripheral nerves and, although rarely, within joints. Knowledge regarding the cause of aneurysmal bone cysts, its natural history, and the results of treatment is limited. Secondary aneurysmal bone cysts are associated with other neoplastic processes. Intra-articular nodular fasciitis in the elbow joint has not been reported previously, nor has the development of aneurysmal bone cyst secondary to intra-articular nodular fasciitis in the elbow joint. We report an unusual case of a Japanese 13-year-old boy who presented with a 1-year history of right elbow pain. The onset of pain was insidious, without antecedent trauma. On physical examination, the range of motion of the elbow was limited. Grip strength was reduced in the affected extremity. Incisional biopsy was performed and histologic findings revealed nodular fasciitis in the elbow joint. After tumor excision, a secondary aneurysmal bone cyst in the distal humerus developed. Endoscopy-assisted curettage and artificial bone grafting were performed. One year after surgery, a plain radiography showed no recurrence, and the patient returned to his daily activities without any symptoms. An aneurysmal bone cyst in the distal humerus developed after excision of intra-articular nodular fasciitis arising in the elbow. The secondary aneurysmal bone cyst successfully healed after endoscopy-assisted curettage and artificial bone grafting. The findings of this case suggest that these two tumors reside in the same biologic spectrum defined as USP6-induced tumors.

  7. Treatment of Plantar Fasciitis With Radial Soundwave "Early" Is Better Than After 6 Months: A Pilot Study.

    Science.gov (United States)

    Saxena, Amol; Hong, Brian K; Yun, Andrew S; Maffulli, Nicola; Gerdesmeyer, Ludger

    Extracorporeal shock wave therapy/radial soundwave therapy has been predominantly used for chronic or recalcitrant plantar fasciitis with strong scientific evidence of reliable outcomes. Most of the studies included patients with plantar fasciitis with symptoms >6 months in duration. Only 2 known studies have investigated acute plantar fasciitis, which is plantar fasciitis. Data were prospectively collected from 28 eligible patients who underwent radial soundwave therapy (RSWT) during a 9-month period in 2014. Of the 28 subjects, 14 were enrolled in the "early group" with a symptom duration of 6 months. The pretreatment and posttreatment visual analog scale scores, Roles-Maudlsey scores, and activity level were recorded and compared. The early implementation of RSWT yielded comparable outcomes when compared with the standard group. RSWT is a valid treatment modality that can be implemented soon after the initial treatment options or first-phase treatment options have failed. Early treatment is more likely to allow for maintenance of patients' activity level. Also, waiting 6 months to treat plantar fasciitis with RSWT results in delays and inferior results. Early treatment is better for active and athletic patients. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Autologous whole blood versus corticosteroid local injection in treatment of plantar fasciitis: A randomized, controlled multicenter clinical trial.

    Science.gov (United States)

    Karimzadeh, Afshin; Raeissadat, Seyed Ahmad; Erfani Fam, Saleh; Sedighipour, Leyla; Babaei-Ghazani, Arash

    2017-03-01

    Plantar fasciitis is the most common cause of heel pain. Local injection modalities are among treatment options in patients with resistant pain. The aim of the present study was to evaluate the effect of local autologous whole blood compared with corticosteroid local injection in treatment of plantar fasciitis. In this randomized controlled multicenter study, 36 patients with chronic plantar fasciitis were recruited. Patients were allocated randomly into three treatment groups: local autologous blood, local corticosteroid injection, and control groups receiving no injection. Patients were assessed with visual analog scale (VAS), pressure pain threshold (PPT), and plantar fasciitis pain/disability scale (PFPS) before treatment, as well as 4 and 12 weeks post therapy. Variables of pain and function improved significantly in both corticosteroid and autologous blood groups compared to control group. At 4 weeks following treatment, patients in corticosteroid group had significantly lower levels of pain than patients in autologous blood and control groups (higher PPT level, lower PFPS, and VAS). After 12 weeks of treatment, both corticosteroid and autologous blood groups had lower average levels of pain than control group. The corticosteroid group showed an early sharp and then more gradual improvement in pain scores, but autologous blood group had a steady gradual drop in pain. Autologous whole blood and corticosteroid local injection can both be considered as effective methods in the treatment of chronic plantar fasciitis. These treatments decrease pain and significantly improve function compared to no treatment.

  9. Administration of an Herbal Complex, Jakyak-Gamcho-Tang (JGT), for Plantar Fasciitis in Military Medical Service: A Case Report.

    Science.gov (United States)

    Kwon, Seungwon; Jung, Woo-Sang; Moon, Sang-Kwan; Cho, Ki-Ho; Shin, Kyoung-Ho

    Plantar fasciitis is a common disease affecting the heel and plantar side of the foot. This condition can be improved within 6 months with conservative treatments such as stretching, nonsteroidal anti-inflammatory drugs (NSAIDs), extracorporeal shockwave therapy, and corticosteroid injection. However, soldiers need a faster and safer therapy for symptomatic relief to meet the requirements of their occupation. In this report, we reveal that Jakyak-Gamcho-Tang (JGT), an herbal complex, had a positive effect in a case series of 10 military patients with plantar fasciitis. We treated 10 patients with chronic and acute plantar fasciitis with the JGT herbal complex for 21.00 ± 5.72 days. During JGT administration, the patients continued to perform calf-strengthening exercises. After JGT administration, the average foot function index (FFI) score was reduced from 41.11 ± 7.86 to 1.65 ± 3.60 and the average facial rating scale (FRS) was reduced from 5.65 ± 0.88 to 0.40 ± 0.70. A statistically significant difference was observed between the average FFI and FRS measured before and after treatment (paired t test, P plantar fasciitis. In 7 out of the 10 patients (70%), no pain was experienced after the treatment. In this case series, we show the clinical effects of JGT on pain control in patients with plantar fasciitis. Further clinical studies investigating the effects of JGT are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot.

    Science.gov (United States)

    Chundru, Usha; Liebeskind, Amy; Seidelmann, Frank; Fogel, Joshua; Franklin, Peter; Beltran, Javier

    2008-06-01

    To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter's neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10-92 years. Pearson chi-square analyses and Fisher's exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, pcalcaneal edema (15.0% vs 3.0%, P=0.005), calcaneal spur (48.0% vs 7.0%, Pcalcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter's neuropathy.

  11. 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.

  12. Using transportation networks to inform valuation of water quality changes for saltwater recreation on Cape Cod, MA

    Science.gov (United States)

    Estimating the non-market value of beaches for saltwater recreation is complex. An individual’s preference for a beach depends on beach characteristics and perception. When choosing one beach over another, an individual balances these personal preferences with any additiona...

  13. Effect of volcanic dykes on coastal groundwater flow and saltwater intrusion: A field-scale multiphysics approach and parameter evaluation

    Science.gov (United States)

    Comte, J.-C.; Wilson, C.; Ofterdinger, U.; González-Quirós, A.

    2017-03-01

    Volcanic dykes are common discrete heterogeneities in aquifers; however, there is a lack of field examples of, and methodologies for, comprehensive in situ characterization of their properties with respect to groundwater flow and solute transport. We have applied an integrated multiphysics approach to quantify the effect of dolerite dykes on saltwater intrusion in a coastal sandstone aquifer. The approach involved ground geophysical imaging (passive magnetics and electrical resistivity tomography), well hydraulic testing, and tidal propagation analysis, which provided constraints on the geometry of the dyke network, the subsurface saltwater distribution, and the sandstone hydrodynamic properties and connectivity. A three-dimensional variable-density groundwater model coupled with a resistivity model was further calibrated using groundwater and geophysical observations. A good agreement of model simulations with tide-induced head fluctuations, geophysically derived pore water salinities, and measured apparent resistivities was obtained when dykes' hydraulic conductivity, storativity, and effective porosity are respectively about 3, 1, and 1 orders of magnitude lower than the host aquifer. The presence of the dykes results in barrier-like alterations of groundwater flow and saltwater intrusion. Preferential flow paths occur parallel to observed dyke orientations. Freshwater inflows from upland recharge areas concentrate on the land-facing side of the dykes and saltwater penetration is higher on their sea-facing side. This has major implications for managing groundwater resources in dyke-intruded aquifers, including in coastal and island regions and provides wider insights on preferential pathways of groundwater flow and transport in highly heterogeneous aquifer systems.

  14. THE EFFECTS OF INTERFERENTIAL THERAPY FOR INDUSTRIAL WORKERS IN CASE OF PLANTAR FASCIITIS

    Directory of Open Access Journals (Sweden)

    Himashree Das

    2015-10-01

    Full Text Available Background: In the recent industrial set up, plantar fasciitis is one of the commonest problems faced by workers. It occurs mainly in the prolonged standing workers. There are some studies where some authors mentioned about interferential therapy as a treatment modality in plantar fasciitis but there is no such evidence supporting the use of IFT. Here comes the need of the study to find out the effects of the interferential therapy and also to find out whether the conventional therapy and interferential therapy are effective in plantar fasciitis for industrial workers. The aim of the study is to find out the benefit of the interferential therapy with the conventional therapy and also use conventional therapy alone for industrial worker in case of planter fasciitis. Methods: A sample of 30 subjects were distributing randomly in two groups. These subjects were referred by the consultant physician and orthopedic surgeon. All the subjects were signed a consent form prior to participation in the study. Before receiving any intervention, on day zero outcome measures assessment were carried out for both groups subjects by VAS (Visual analog scale for pain measurement, FFI (Foot Function index scale for activity limitation scores and goniometric measurement of active dorsi-flexion of ankle joint. Range of Motion (ROM measurement for both group A and B were taken usual in slandered goniometry according Martin and White. On day 15th, all outcome measures re-assessment will be carried out for the result. Results: In comparison of both interventions group B (IFT with conventional therapy is more effective in decreasing pain (p = 0.00 improving functional ability (p = 0.00 than group A (only conventional therapy. For ROM, t = -0.642 the difference is not significant (p = 0.526. It has been inferred that conventional therapy and IFT with conventional therapy are equally effective for improving ROM. Conclusion: In conclusion, this study indicating that there

  15. 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

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

    Directory of Open Access Journals (Sweden)

    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

  17. How will induced seismicity in Oklahoma respond to decreased saltwater injection rates?

    Science.gov (United States)

    Langenbruch, Cornelius; Zoback, Mark D

    2016-11-01

    In response to the marked number of injection-induced earthquakes in north-central Oklahoma, regulators recently called for a 40% reduction in the volume of saltwater being injected in the seismically active areas. We present a calibrated statistical model that predicts that widely felt M ≥ 3 earthquakes in the affected areas, as well as the probability of potentially damaging larger events, should significantly decrease by the end of 2016 and approach historic levels within a few years. Aftershock sequences associated with relatively large magnitude earthquakes that occurred in the Fairview, Cherokee, and Pawnee areas in north-central Oklahoma in late 2015 and 2016 will delay the rate of seismicity decrease in those areas.

  18. 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 ...

  19. 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.

  20. LOCATIONAL DIFFERENCES IN MERCURY AND SELENIUM LEVELS IN 19 SPECIES OF SALTWATER FISH FROM NEW JERSEY

    Science.gov (United States)

    Burger, Joanna; Jeitner, Christian; Gochfeld, Michael

    2014-01-01

    Individuals who fish, and their families that ingest self-caught fish, make decisions about where to fish, what type of fish to eat, and the quantity of fish to eat. While federal and state agencies often issue consumption advisories for some fish with high mercury (Hg) concentrations, advisories seldom provide the actual metal levels to the general public. There are few data for most saltwater fish, and even less information on variations in Hg levels in fish within a state or geographical region. The objective of this study was to provide Hg concentrations from 19 species of fish caught in different locations in New Jersey to (1) test the hypothesis that mean metal levels vary geographically, (2) provide this information to individuals who fish these coastal waters, and (3) provide a range of values for risk assessors who deal with saltwater fish exposure in the Northeastern United States. Selenium (Se) was also examined because of its purported moderating effect on the toxicity of Hg. Hg levels showed significant geographical variation for 10 of 14 species that were caught in more than one region of New Jersey, but there were significant locational differences for Se in only 5 of the fish. Mercury levels were significantly lower in fish collected from northern New Jersey (except for ling, Molva molva), compared to other regions. As might be expected, locational differences in Hg levels were greatest for fish species with the highest Hg concentrations (shark, Isurus oxyrinchus; tuna, Thunnus thynnus and T. albacares; striped bass, Morone saxatilis; bluefish, Pomatomus saltatrix). Fishers and their families might reduce their risk from Hg exposure not only by selecting fish generally lower in Hg, but by fishing predominantly in some regions over others, further lowering the potential risk. Health professionals might use these data to advise patients on which fish are safest to consume (in terms of Hg exposure) from particular geographical regions. PMID:21598171

  1. 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.

  2. 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.

  3. 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.

  4. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

    Energy Technology Data Exchange (ETDEWEB)

    Chundru, Usha [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Liebeskind, Amy; Beltran, Javier [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Seidelmann, Frank; Franklin, Peter [Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Fogel, Joshua [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Brooklyn College, Department of Economics, Brooklyn, NY (United States)

    2008-06-15

    To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter's neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10-92 years. Pearson chi-square analyses and Fisher's exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p < 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P<0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P < 0.001), plantar fasciitis (52.5% vs 11.0%, P<0.001), and PTTD (32.0% vs 11.0%, P<0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter's neuropathy. (orig.)

  5. Expression of HuR and Cyclooxygenase-2 in Nodular Fasciitis and Low-Grade Sarcoma: An Immunohistochemical Study

    OpenAIRE

    Son, Hyun-Jin; Baek, Tae-Hwa; Lee, Seung Yun; Kim, Joo-Heon; Kang, Dong-Wook; Lee, Hye-Kyung; Park, Mee-Ja

    2014-01-01

    Background Nodular fasciitis is the most common reactive mesenchymal lesion to be misidentified as a type of sarcoma. HuR is an mRNA-binding protein that can stabilize cyclooxygenase-2 (COX-2) mRNA leading to COX-2 overexpression. The aim of this study is a comparison of the expressions of COX-2 and HuR and the relationships between their expressions and the clinicopathological parameters in nodular fasciitis and low-grade sarcoma. Methods We measured the expression of HuR and COX-2 in 21 cas...

  6. Successful treatment of perineal necrotising fasciitis and associated pubic bone osteomyelitis with the vacuum assisted closure system

    Science.gov (United States)

    Kumar, Susim; O'Donnell, Mark E; Khan, Khalid; Dunne, Gillian; Carey, P Declan; Lee, Jack

    2008-01-01

    Background Acute necrotising fasciitis is a life-threatening condition, which requires urgent surgical intervention. Surgical debridement is invariably associated with large areas of tissue loss. Case presentation We present a 58-year old woman with a past history of cervical carcinoma who presented with necrotising fasciitis of the perineum and upper thighs with associated pubic bone osteomyelitis. Following extensive debridement, a Vacuum Assisted Closure (VAC) system was applied to the large residual defect to facilitate skin graft application and optimise wound healing. Conclusion This case demonstrates the successful management of a complex and potentially lethal wound of the perineum with debridement, skin grafting and the VAC system. PMID:18577204

  7. Successful treatment of perineal necrotising fasciitis and associated pubic bone osteomyelitis with the vacuum assisted closure system

    Directory of Open Access Journals (Sweden)

    Dunne Gillian

    2008-06-01

    Full Text Available Abstract Background Acute necrotising fasciitis is a life-threatening condition, which requires urgent surgical intervention. Surgical debridement is invariably associated with large areas of tissue loss. Case presentation We present a 58-year old woman with a past history of cervical carcinoma who presented with necrotising fasciitis of the perineum and upper thighs with associated pubic bone osteomyelitis. Following extensive debridement, a Vacuum Assisted Closure (VAC system was applied to the large residual defect to facilitate skin graft application and optimise wound healing. Conclusion This case demonstrates the successful management of a complex and potentially lethal wound of the perineum with debridement, skin grafting and the VAC system.

  8. Treatment of Chronic Plantar Fasciitis with Noninvasive Interactive Neurostimulation: A Prospective Randomized Controlled Study.

    Science.gov (United States)

    Razzano, Cristina; Carbone, Stefano; Mangone, Massimiliano; Iannotta, M Raffaella; Battaglia, Alessandro; Santilli, Valter

    The initial treatment of plantar fasciitis should be conservative, with most cases responding to standard physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), heel pads, and stretching. In cases of chronic refractory symptoms, more invasive treatment could be necessary. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of the present prospective randomized controlled study was to evaluate whether the use of NIN for chronic plantar fasciitis could result in greater improvement in a foot functional score, lower levels of reported pain, reduced patient consumption of NSAIDs, and greater patient satisfaction compared with electric shockwave therapy in patients without a response to standard conservative treatment. The patients were randomized using random blocks to the NIN program (group 1) or electric shockwave therapy (group 2). The outcome measurements were the pain subscale of the validated Foot Function Index (PS-FFI), patient-reported subjective assessment of the level of pain using a standard visual analog scale, and daily intake of NSAID tablets (etoricoxib 60 mg). The study group was evaluated at baseline (time 0), week 4 (time 1), and week 12 (final follow-up point). Group 1 (55 patients) experienced significantly better results compared with group 2 (49 patients) in term of the PS-FFI score, visual analog scale score, and daily intake of etoricoxib 60 mg. NIN was an effective treatment of chronic resistant plantar fasciitis, with full patient satisfaction in >90% of cases. The present prospective randomized controlled study showed superior results for noninvasive neurostimulation compared with electric shockwave therapy, in terms of the functional score, pain improvement, and use of NSAIDs. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. Cryopreserved human amniotic membrane injection for plantar fasciitis: a randomized, controlled, double-blind pilot study.

    Science.gov (United States)

    Hanselman, Andrew E; Tidwell, John E; Santrock, Robert D

    2015-02-01

    Treatment options for plantar fasciitis have resulted in varied patient outcomes. The aim of this study was to compare a novel treatment, cryopreserved human amniotic membrane (c-hAM), to a traditional treatment, corticosteroid. Our hypothesis was that c-hAM would be safe and comparable to corticosteroids for plantar fasciitis in regard to patient outcomes. A randomized, controlled, double-blind, single-center pilot study was completed. Patients were randomized into one of 2 treatment groups: c-hAM or corticosteroid. Patients received an injection at their initial baseline visit with an option for a second injection at their first 6-week follow-up. Total follow-up was obtained for 12 weeks after the most recent injection. The primary outcome measurement was the Foot Health Status Questionnaire (FHSQ). The secondary outcome measurements were the Visual Analog Scale (VAS) and verbally reported percentage improvement. Data were analyzed between groups for the 2 different cohorts (1 injection versus 2 injections). Twenty-three patients had complete follow-up. Fourteen were randomized to receive corticosteroid and 9 were randomized to receive c-hAM. Three patients in each group received second injections. With the numbers available, the majority of outcome measurements showed no statistical difference between groups. The corticosteroid did, however, have greater FHSQ shoe fit improvement (P = .0244) at 6 weeks, FHSQ general health improvement (P = .0132) at 6 weeks, and verbally reported improvement (P = .041) at 12 weeks in the one-injection cohort. Cryopreserved hAM had greater FHSQ foot pain improvement (P = .0113) at 18 weeks in the 2-injection cohort. Cryopreserved hAM injection may be safe and comparable to corticosteroid injection for treatment of plantar fasciitis. This is a pilot study and requires further investigation. Level I, prospective randomized trial. © The Author(s) 2014.

  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. Comparative study for the treatment of plantar fasciitis by corticosteroids versus platelet rich plasma

    Directory of Open Access Journals (Sweden)

    Tarun Kukreja

    2017-01-01

    Full Text Available Purpose: The purpose of this study to compare the efficiency of corticosteroid and platelet rich plasma (PRP for the treatment of chronic plantar fasciitis. Materials and Methods: The present study was conducted in Department of Orthopaedics at Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune from June 2013 to September 2015. In this series, forty patients having chronic plantar fasciitis were treated with PRP and corticosteroid injection. The results were evaluated prospectively to compare the efficacy of both the procedures. One group of twenty patients received an injection of corticosteroid and the second group of twenty patients received an injection of PRP. Patients were selected if they fit into the inclusion criteria of the study after random selection. Results: Both groups initially performed well. The patients were followed up at 3, 6, and 12 months interval and were analyzed with the scoring systems (American Orthopedic Foot and Ankle Society [AOFAS], visual analog scale and Roles and Maudsley system. The average pretreatment AOFAS score at 3 months after treatment in the steroid group was 45 and improved to 82 and in the PRP group was 44 and improved to 90. However, the steroid group scores degraded with a sharp drop in the AOFAS rating to 74 at 6 months and 62 at 12 months after treatment. In stark contrast, the PRP group scores remained high with AOFAS scores of 87 at 6 month and 85 at 12 months after treatment. Conclusion: This study confirms the long-term superiority of PRP over corticosteroid injection for chronic planter fasciitis.

  13. Botulinum toxin type A in chronic plantar fasciitis: clinical effects one year after injection.

    Science.gov (United States)

    Díaz-Llopis, Ismael V; Gómez-Gallego, Diego; Mondéjar-Gómez, Francisco J; López-García, Alfredo; Climent-Barberá, Jose M; Rodríguez-Ruiz, Carmen M

    2013-08-01

    To determine whether the efficacy of botulinum toxin type A in chronic plantar fasciitis was maintained for more than six months after treatment. Observational follow-up study. Twenty-four patients who received botulinum toxin type A injection in a previous randomized study of chronic plantar fasciitis (active treatment group) and who presented a benefit one month after treatment. A visual analogue scale for pain and the Foot Health Status Questionnaire were used to re-evaluate results 12 months after the botulinum toxin injection. No further injections of botulinum toxin had been administered during the follow-up period. Patients were also asked to give a subjective assessment of treatment outcome. At 12 months, compared with the six-month evaluation, there was a further improvement in foot pain measured using the visual analogue scale, though this did not reach significance (1.78 at 6 months versus 1.22 at 12 months; P = 0.142). However, there were significant improvements in two domains of Foot Health Status Questionnaire: foot pain (91.11 at 6 months versus 80.00 at 12 months; P = 0.001) and foot function (96.19 at 6 months versus 89.38 at 12 months; P = 0.047). There was a small, non-significant deterioration in the shoe and foot health domains. Satisfaction with the outcome was good or very good in the large majority of patients. In patients with chronic plantar fasciitis, the positive effect detected six months after treatment with botulinum toxin type A was maintained at 12 months and there was a further improvement in pain and foot function.

  14. Prospective study of percutaneous radiofrequency nerve ablation for chronic plantar fasciitis.

    Science.gov (United States)

    Erken, H Yener; Ayanoglu, Semih; Akmaz, Ibrahim; Erler, Kaan; Kiral, Ahmet

    2014-02-01

    Chronic plantar heel pain is one of the most painful foot conditions and is generally associated with plantar fasciitis. This study reports 2-year follow-up results of radiofrequency nerve ablation (RFNA) of the calcaneal branches of the inferior calcaneal nerve in patients with chronic heel pain associated with plantar fasciitis. After receiving approval from the institutional review board, we prospectively evaluated the results of the RFNA of the calcaneal branches of the inferior calcaneal nerve on 35 feet in 29 patients with plantar heel pain between 2008 and 2011. All of the patients who were treated had been complaining of heel pain for more than 6 months and had failed conservative treatment. All of the patients were evaluated (quantitatively) using the average 10-point Visual Analog Scale (VAS) before treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. We also evaluated 26 feet in 20 patients with American Orthopaedic Foot and Ankle Society scale (AOFAS) scores before the treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. The average VAS score of the feet was 9.2 ± 1.9 before treatment, 0.5 ± 1.3 at 1 month after the procedure, 1.5 ± 2.1 at 1-year follow-up, and 1.3 ± 1.8 at 2-year follow-up (P plantar fasciitis that did not respond to other conservative treatment options. Level IV, retrospective case series.

  15. Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-Up

    Directory of Open Access Journals (Sweden)

    Shi Ping Zhang

    2011-01-01

    Full Text Available Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28 or control group (n = 25. The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4, which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM, overall pain (20.3 ± 3.7 versus 9.5 ± 3.6 and pressure pain threshold (145.5 ± 32.9 versus −15.5 ± 39.4. No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain.

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

    Energy Technology Data Exchange (ETDEWEB)

    Liou, Chang-Hsien; Juan, Chun-Jung; Chen, Cheng-Yu. [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (Taiwan); Huang, Guo-Shu [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (Taiwan); Department of Radiology, Tri-Service General Hospital, 325, Sec. 2, Neihu 114, Cheng-Kung Road, Taipei, Taiwan (Taiwan); Taylor, John A.M. [Department of Diagnosis, New York Chiropractic College, Seneca Falls, New York (United States); Gao, Hong-Wei [Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (Taiwan)

    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.)

  17. Cranial fasciitis of childhood (CFC): an unusual clinical case of a rare disease.

    Science.gov (United States)

    Zavras, Niki; Poddighe, Dimitri

    2017-09-13

    Cranial fasciitis of childhood (CFC) is a very uncommon tumour of the scalp, which is almost exclusively observed in the first years of life. It is a benign proliferation of fibroblasts, but its rapid growth rate may resemble a malignant disease. This disease may be suspected from clinical and radiological features, but a definitive diagnosis may be achieved only by pathological examination. We report a case whose onset was in late childhood and whose clinical and radiological characteristics were atypical. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. 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

  19. Complete remission of plantar fasciitis with a gluten-free diet: relationship or just coincidence?

    Science.gov (United States)

    Paoloni, Marco; Tavernese, Emanuela; Ioppolo, Francesco; Fini, Massimo; Santilli, Valter

    2014-09-01

    We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To the best of our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. 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.

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

    Science.gov (United States)

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

    2016-12-29

    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.

  2. An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy.

    Science.gov (United States)

    Singam, Narayanasarma V; Rusia, Deepam; Prakash, Rajan

    2017-04-01

    BACKGROUND Necrotizing fasciitis (NF) of the orbit is a rare and deadly condition that requires prompt surgical and medical management to decrease morbidity and mortality.  CASE REPORT Here we present an interesting case of an individual who developed fulminant NF of the left orbit requiring emergent surgical intervention, antibiotics, and subsequent hyperbaric oxygen therapy in an attempt to save the eye.  CONCLUSIONS With an early and aggressive multifaceted approach using antibiotics, surgery, and hyperbaric oxygen it may be possible to preserve eye structure and function. Without treatment NF is a rapidly progressive condition and can result in significant morbidity.

  3. Saltwater movement in the upper Floridan aquifer beneath Port Royal Sound, South Carolina

    Science.gov (United States)

    Smith, Barry S.

    1994-01-01

    Freshwater for Hilton Head Island, South Carolina, is supplied by withdrawals from the Upper Floridan aquifer. Freshwater for the nearby city of Savannah, Georgia, and for the industry that has grown adjacent to the city, has also been supplied, in part, by withdrawal from the Upper Floridan aquifer since 1885. The withdrawal of ground water has caused water levels in the Upper Floridan aquifer to decline over a broad area, forming a cone of depression in the potentiometric surface of the aquifer centered near Savannah. In 1984, the cone of depression extended beneath Hilton Head Island as far as Port Royal Sound. Flow in the aquifer, which had previously been toward Port Royal Sound, has been reversed, and, as a result, saltwater in the aquifer beneath Port Royal Sound has begun to move toward Hilton Head Island. The Saturated-Unsaturated Transport (SUTRA) model of the U.S. Geological Survey was used for the simulation of density-dependent ground-water flow and solute transport for a vertical section of the Upper Floridan aquifer and upper confining unit beneath Hilton Head Island and Port Royal Sound. The model simulated a dynamic equilibrium between the flow of seawater and freshwater in the aquifer near the Gyben-Herzberg position estimated for the period before withdrawals began in 1885; it simulated reasonable movements of brackish water and saltwater from that position to the position determined by chemical analyses of samples withdrawn from the aquifer in 1984, and it approximated hydraulic heads measured in the aquifer in 1976 and 1984. The solute-transport simulations indicate that the transition zone would continue to move toward Hilton Head Island even if pumping ceased on the island. Increases in existing withdrawals or additional withdrawals on or near Hilton Head Island would accelerate movement of the transition zone toward the island, but reduction in withdrawals or the injection of freshwater would slow movement toward the island, according to the

  4. Saltwater intrusion in the Floridan aquifer system near downtown Brunswick, Georgia, 1957–2015

    Science.gov (United States)

    Cherry, Gregory S.; Peck, Michael

    2017-02-16

    IntroductionThe Floridan aquifer system (FAS) consists of the Upper Floridan aquifer (UFA), an intervening confining unit of highly variable properties, and the Lower Floridan aquifer (LFA). The UFA and LFA are primarily composed of Paleocene- to Oligocene-age carbonate rocks that include, locally, Upper Cretaceous rocks. The FAS extends from coastal areas in southeastern South Carolina and continues southward and westward across the coastal plain of Georgia and Alabama, and underlies all of Florida. The thickness of the FAS varies from less than 100 feet (ft) in aquifer outcrop areas of South Carolina to about 1,700 ft near the city of Brunswick, Georgia.Locally, in southeastern Georgia and the Brunswick– Glynn County area, the UFA consists of an upper water-bearing zone (UWBZ) and a lower water-bearing zone (LWBZ), as identified by Wait and Gregg (1973), with aquifer test data indicating the upper zone has higher productivity than the lower zone. Near the city of Brunswick, the LFA is composed of two permeable zones: an early middle Eocene-age upper permeable zone (UPZ) and a highly permeable lower zone of limestone (LPZ) of Paleocene and Late Cretaceous age that includes a deeply buried, cavernous, saline water-bearing unit known as the Fernandina permeable zone. Maslia and Prowell (1990) inferred the presence of major northeast–southwest trending faults through the downtown Brunswick area based on structural analysis of geophysical data, northeastward elongation of the potentiometric surface of the UFA, and breaches in the local confining unit that influence the area of chloride contamination. Pronounced horizontal and vertical hydraulic head gradients, caused by pumping in the UFA, allow saline water from the FPZ to migrate upward into the UFA through this system of faults and conduits.Saltwater was first detected in the FAS in wells completed in the UFA near the southern part of the city of Brunswick in late 1957. By the 1970s, a plume of groundwater

  5. Evaluation of Flow Paths and Confluences for Saltwater Intrusion and Its Influence on Fish Species Diversity in a Deltaic River Network

    Science.gov (United States)

    Shao, X.; Cui, B.; Zhang, Z.; Fang, Y.; Jawitz, J. W.

    2016-12-01

    Freshwater in a delta is often at risk of saltwater intrusion, which has been a serious issue in estuarine deltas all over the world. Salinity gradients and hydrologic connectivity in the deltas can be disturbed by saltwater intrusion, which can fluctuate frequently and locally in time and space to affect biotic processes and then to affect the distribution patterns of the riverine fishes throughout the river network. Therefore, identifying the major flow paths or locations at risk of saltwater intrusion in estuarine ecosystems is necessary for saltwater intrusion mitigation and fish species diversity conservation. In this study, we use the betweenness centrality (BC) as the weighted attribute of the river network to identify the critical confluences and detect the preferential flow paths for saltwater intrusion through the least-cost-path algorithm from graph theory approach. Moreover, we analyse the responses of the salinity and fish species diversity to the BC values of confluences calculated in the river network. Our results show that the most likely location of saltwater intrusion is not a simple gradient change from sea to land, but closely dependent on the river segments' characteristics. In addition, a significant positive correlation between the salinity and the BC values of confluences is determined in the Pearl River Delta. Changes in the BC values of confluences can produce significant variation in the fish species diversity. Therefore, the dynamics of saltwater intrusion are a growing consideration for understanding the patterns and subsequent processes driving fish community structure. Freshwater can be diverted into these major flow paths and critical confluences to improve river network management and conservation of fish species diversity under saltwater intrusion.

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

    OpenAIRE

    César Peñaherrera; Alex R Hearn; Angela Kuhn

    2012-01-01

    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 sha...

  7. 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.

  8. Assessing impacts of climate change, sea level rise, and drainage canals on saltwater intrusion to coastal aquifer

    OpenAIRE

    Rasmussen, P.; Sonnenborg, T.O.; G. Goncear; Hinsby, K.

    2012-01-01

    Groundwater abstraction from coastal aquifers is vulnerable to climate change and sea level rise because both may potentially impact saltwater intrusion and hence groundwater quality depending on the hydrogeological setting. In the present study the impacts of sea level rise and changes in groundwater recharge are quantified for an island located in the Western Baltic Sea. Agricultural land dominates the western and central parts of the island, which geologically are developed as push ...

  9. Necrotizing fasciitis in a pediatric patient caused by lancefield group g streptococcus: case report and brief review of the literature.

    Science.gov (United States)

    Rausch, John; Foca, Marc

    2011-01-01

    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.

  10. 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.

  11. 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.

  12. Use of Vacuum-assisted Wound Closure to Manage Limb Wounds in Patients Suffering from Acute Necrotizing Fasciitis

    Directory of Open Access Journals (Sweden)

    Wen-Shyan Huang

    2006-07-01

    Conclusion: The VAC technique of wound closure was found to be effective in managing non-healing limb wounds consequential to surgical treatment for patients suffering from acute necrotizing fasciitis. Although the cost of the VAC device was high, morbidity was much lower when compared to the CWD technique.

  13. Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up

    Directory of Open Access Journals (Sweden)

    Shuming Li

    2014-01-01

    Full Text Available Plantar fasciitis is the most common cause of heel pain in adults. A novel alternative medical instrument, the miniscalpel-needle (MSN, which is based on an acupuncture needle, has been recently developed in China. The objective of this study was to evaluate the effectiveness of the MSN release treatment versus that of traditional steroid injection for plantar fasciitis. Patients with plantar fasciitis were randomly assigned to 2 groups and followed up for 12 months, with 29 receiving MSN treatment and 25 receiving steroid injection treatment. The results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Our data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection.

  14. Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial.

    Science.gov (United States)

    Rastegar, Shirvan; Baradaran Mahdavi, Sadegh; Hoseinzadeh, Babak; Badiei, Sajad

    2017-11-08

    Plantar fasciitis is a common cause of heel pain. Considering different interventions which are applied for patients with plantar fasciitis, dry needling is proposed as a new modality of treatment recently. The aim of this study is to evaluate the effectiveness of dry needling versus steroid injection for plantar fasciitis. Sixty-six patients were recruited to this single-blind clinical trial study. Participants were randomly allocated to receive 1 ml (40 mg) of Depo-Medrol (methylprednisolone acetate) or dry needling. They were followed up for 12 months and monitored for total perception of pain using the visual analogue scale (VAS), with data obtained in baseline and at three weeks, six weeks, three months, six months and one year after treatment. Mean VAS score before treatment was 6.96 ± 0.87 for the steroid group and 6.41 ± 0.83 for the dry-needling group (P value = 0.54). Steroid injection reduced VAS scores rapidly until three weeks after treatment compared with dry needling (0.32 ± 0.71 and 3.47 ± 1.32, respectively; P value plantar heel pain rapidly but dry needling can provide more satisfactory results for patients with plantar fasciitis in the long term.

  15. Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up

    Science.gov (United States)

    Li, Shuming; Shen, Tong; Liang, Yongshan; Zhang, Ying; Bai, Bo

    2014-01-01

    Plantar fasciitis is the most common cause of heel pain in adults. A novel alternative medical instrument, the miniscalpel-needle (MSN), which is based on an acupuncture needle, has been recently developed in China. The objective of this study was to evaluate the effectiveness of the MSN release treatment versus that of traditional steroid injection for plantar fasciitis. Patients with plantar fasciitis were randomly assigned to 2 groups and followed up for 12 months, with 29 receiving MSN treatment and 25 receiving steroid injection treatment. The results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Our data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection. PMID:25114704

  16. 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.

  17. Effects of using synthetic sea salts when measuring and modeling copper toxicity in saltwater toxicity tests.

    Science.gov (United States)

    Arnold, W Ray; Cotsifas, Jeffrey S; Winter, Anna R; Klinck, Joel S; Smith, D Scott; Playle, Richard C

    2007-05-01

    Synthetic sea salts are often used to adjust the salinity of effluent, ambient, and laboratory water samples to perform toxicity tests with marine and estuarine species. The U.S. Environmental Protection Agency (U.S. EPA) provides guidance on salinity adjustment in its saltwater test guidelines. The U.S. EPA suggests using commercial sea salt brands, such as Forty Fathoms (now named Crystal Sea Marinemix, Bioassay Grade), HW Marinemix, or equivalent salts to adjust sample salinity. Toxicity testing laboratories in Canada and the United States were surveyed to determine synthetic sea salt brand preference. The laboratories (n = 27) reported using four brands: Crystal Sea Marinemix (56%), HW Marinemix (22%), Instant Ocean (11%), and Tropic Marin (11%). Saline solutions (30 g/L) of seven synthetic sea salts were analyzed for dissolved copper and dissolved organic carbon (DOC) content. Brands included those listed above plus modified general-purpose salt (modified GP2), Kent Marine, and Red Sea Salt. The synthetic sea salts added from analysis of variance, Tukey, alpha = 0.05, p copper toxicity. However, the measured dissolved copper effective concentration 50% (EC50) for Crystal Sea Marinemix was 9.7 microg Cu/L, similar to other tested sea salts. Analysis indicates that the organic matter in Crystal Sea Marinemix differs considerably from that of natural organic matter. On the basis of consistently adding little DOC and little dissolved copper, GP2 and Kent Marine are the best salts to use.

  18. Development of the sediment and water quality management strategies for the Salt-water River, Taiwan.

    Science.gov (United States)

    Lin, C E; Chen, C T; Kao, C M; Hong, A; Wu, C Y

    2011-01-01

    The Salt-water River watershed is one of the major river watersheds in the Kaohsiung City, Taiwan. Water quality and sediment investigation results show that the river water contained high concentrations of organics and ammonia-nitrogen, and sediments contained high concentrations of heavy metals and organic contaminants. The main pollution sources were municipal and industrial wastewaters. Results from the enrichment factor (EF) and geo-accumulation index (Igeo) analyses imply that the sediments can be characterized as heavily polluted in regard to Cd, Cr, Pb, Zn, and Cu. The water quality analysis simulation program (WASP) model was applied for water quality evaluation and carrying capacity calculation. Modeling results show that the daily pollutant inputs were much higher than the calculated carrying capacity (1050 kg day(-1) for biochemical oxygen demand and 420 kg day(-1) for ammonia-nitrogen). The proposed watershed management strategies included river water dilution, intercepting sewer system construction and sediment dredging. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Autologous creatinine clearance in a case of necrotizing fasciitis and anuria.

    Science.gov (United States)

    Eadon, Michael T; Koyner, Jay L

    2012-01-01

    Necrotizing fasciitis can present with concomitant acute kidney injury. The etiology of acute kidney injury is often multifactorial; potential sources include volume depletion, abdominal compartment syndrome, rhabdomyolysis, and acute tubular necrosis (which may be related to hemodynamic instability, medications, or sepsis/infection). Kidney injury, defined via changes in serum creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine output portions of the Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage (RIFLE) criteria in assessing the severity of kidney injury. It further reinforces the imperfection in using serum creatinine as a primary measure of glomerular filtration rate. Copyright © 2012 S. Karger AG, Basel.

  20. The use of dry needling and myofascial meridians in a case of plantar fasciitis.

    Science.gov (United States)

    Akhbari, Behnam; Salavati, Mahyar; Ezzati, Kamran; Mohammadi Rad, Shahrzad

    2014-03-01

    The purpose of this case report is to describe the use of dry needling based on myofascial meridians for management of plantar fasciitis. A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity. Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient. Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis.

  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. 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.

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

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    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.

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

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    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.

  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

    2017-02-27

    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. 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

  7. Application of electrophoresis of chlorine in the treatment of plantar fasciitis (prominent heel.

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    Filatova E.V.

    2014-12-01

    Full Text Available Aim: to determine the effectiveness of electrophoresis of chlorine in the treatment of patients with plantar fasciitis. Material and methods. Survey and treatment of 40 patients in out-patient treatment at a private medical clinic OOO «ЛЭЙТОНС» ("LEYTONS, LLC" of 45-65 years with "heel spur" (4 men and 36 women. Age of the disease varied from 6 months to several years. All patients' diagnosis was confirmed radiographically. Before and after the treatment there were tests: Visual analogue scale (VAS (scale from 0 to 100 points and dynamic test WAM, defines psychological component of pathology. Results: patients were divided into 3 groups according to type of therapy. In 1-St group was held on the heels of hydrocortisone phonophoresis, in the 2nd group of shock wave therapy; in 3rd group held electrophoresis 5% solution of calcium chloride on the heel with the cathode. In the 1st group pain after the treatment group stopped at 80% of the patients; in the group 2, with 83%; in the group 377% of the patients. Conclusion. Our study showed that the chlorine electrophoresis in patients with plantar fasciitis can be a choice in complex rehabilitation. Identification of adverse effects of therapy confirms the need for an integrated approach to treating patients with this pathology.

  8. Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

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    Ana Paula Ribeiro

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF. INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.

  9. The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial.

    Science.gov (United States)

    Shashua, Anat; Flechter, Shlomo; Avidan, Liat; Ofir, Dani; Melayev, Alex; Kalichman, Leonid

    2015-04-01

    A single-blind randomized controlled trial. To evaluate the efficacy of ankle and midfoot mobilization on pain and function of patients with plantar fasciitis (PF). Plantar fasciitis is a degenerative process of the plantar fascia, with a lifetime prevalence of approximately 10%. Limited ankle dorsiflexion is a common finding and apparently acts as a contributing factor to the development of PF. Fifty patients with PF, aged 23 to 73 years, were randomly assigned to either the intervention or control group. Both groups received 8 treatments, twice a week, consisting of stretching exercises and ultrasound. In addition, the intervention group received mobilization of the ankle and midfoot joints. Dorsiflexion range of motion was measured at the beginning and at the end of treatment. The results were evaluated by 3 outcomes: the numeric pain-rating scale, Lower Extremity Functional Scale, and algometry. No significant difference was found between groups in any of the outcomes. Both groups showed a significant difference in the numeric pain-rating scale and Lower Extremity Functional Scale. Both groups significantly improved in dorsiflexion range of motion, with no difference between groups. The addition of ankle and foot joint mobilization aimed at improving dorsiflexion range of motion is not more effective than stretching and ultrasound alone in treating PF. The association between limited ankle dorsiflexion and PF is most probably due to soft tissue limitations, not the joints. Trial registered at ClinicalTrials.gov (registration number NCT01439932). Therapy, level 1b.

  10. Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

    Science.gov (United States)

    Ribeiro, Ana Paula; Trombini-Souza, Francis; Tessutti, Vitor; Lima, Fernanda Rodrigues; de Camargo Neves Sacco, Isabel; João, Sílvia Maria Amado

    2011-01-01

    OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms. PMID:21808870

  11. Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis.

    Science.gov (United States)

    Chou, Andrew Chia Chen; Ng, Sean Yung Chuan; Su, David Hsien Ching; Singh, Inderjeet Rikhraj; Koo, Kevin

    2016-12-01

    Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF. Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations. There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations. RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  12. Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection.

    Science.gov (United States)

    Kim, Minchul; Choi, Yun Sun; You, Myung-Won; Kim, Jin Su; Young, Ki Won

    2016-12-01

    The aim of this study was to investigate whether ultrasound elastography can demonstrate the outcome of the treatment in comparison with gray-scale imaging. Sixteen patients (mean age, 46.9 years) with plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment. Individuals graded their heel pain on a 100-mm visual analogue scale (VAS) and underwent gray-scale ultrasonography and sonoelastography. Collagen was injected in the heels. Fascial thickness and hypoechogenicity, perifascial edema, and plantar fascial elasticity were evaluated. Follow-up sonoelastography and VAS grading were done 3 months after the injection. Statistical analyses were performed by the paired t test and the Fisher exact test. A P plantar fascial thickness showed insignificant decrease on follow-up (from 4.30 [1.37] to 4.23 [1.15] mm, P = 0.662). Fascial hypoechogenicity and perifascial edema did not change significantly after treatment. The mean strain ratio of the plantar fascia was significantly increased (from 0.71 [0.24] to 1.66 [0.72], P = 0.001). Softening of the plantar fascia decreased significantly after injection (from 12 to 3 ft, P = 0.004). Twelve (75%) of 16 patients showed significant VAS improvement at the follow-up. Sonoelastography revealed a hardening of the plantar fascia after collagen injection treatment and could aid in monitoring the improvement of the symptoms of plantar fasciitis, in cases where gray-scale imaging is inconclusive.

  13. 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

  14. 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.

  15. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis.

    Science.gov (United States)

    Ang, Teck Wee Andrew

    2015-08-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

  16. Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study.

    Science.gov (United States)

    Costantino, C; Vulpiani, M C; Romiti, D; Vetrano, M; Saraceni, V M

    2014-02-01

    Plantar fasciitis is one of the most common causes of pain in the inferior heel and is very frequent in some running sports. It affects up to 10% of general population and accounts for 11% to 15% of all foot pain symptomatology. Several treatments have been suggested, but there is no evidence supporting a specific conservative management strategy. Evaluation of the efficacy of combined cryoultrasound therapy on chronic plantar fasciitis with heel spurs resistant to pharmacological and instrumental therapies. Single-blind randomized clinical trial. 102 consecutive patients affected by chronic plantar fasciitis with painful symptomatology for at least 6 months, intensity of pain higher than 5 on the VAS score, presence of heel spurs, use of plantar orthoses and ineffectiveness of previous therapies. The patients were randomized into two groups: Group A treated with cryoultrasound therapy and Group B with cryotherapy. Our protocol was based on 10 daily treatments, lasting 20 minutes. Each participant was evaluated using VAS score before (T0) the treatment and 3 months (T1), 12 months (T2) and 18 months (T3) after. Effectiveness index was calculated from T1 to T3. Both treatments have been found effective. The difference in pain intensity on the VAS scale between the two groups at T2 was 4.35 points in favor of Group A (IC 95% 3.75; 4.95; Pplantar fasciitis. Cryoultrasound therapy promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis, granted its high therapeutic efficiency, patients' satisfaction, its limited cost and its short and repeatable protocol of use.

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

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    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.

  18. An Unusual Presentation of Ludwig’s Angina Complicated by Cervical Necrotizing Fasciitis: A Case Report and Review of the Literature

    OpenAIRE

    Kristelle Chueng; David J. Clinkard; Danny Enepekides; Yousef Peerbaye; Vincent Y. W. Lin

    2012-01-01

    Ludwig's angina can seldom be complicated by necrotizing fasciitis. Due to the rapidly progressing nature of this infection and the potential for airway compromise and death, it is important to be aware of different ways in which this disease process can present in order to recognize and treat it emergently. We report here an unusual presentation of a case of Ludwig's angina complicated by necrotizing fasciitis in an elderly patient. The clinical features, diagnosis, and treatment are discuss...

  19. Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial.

    Science.gov (United States)

    Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz

    2014-01-01

    Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

  20. Ghost Forest Rising: A Hyperspectral Approach to Assessing Vegetation Health and Tree Die-Off in Response to Saltwater Intrusion in a Coastal Environment

    Science.gov (United States)

    Lightning, L.; Jass, T. L.; McGirt, A.; Emanuel, R. E.

    2016-12-01

    In coastal areas, saltwater intrusion is a natural occurrence that can affect the quality of groundwater and surface water. Saltwater intrusion can also affect the health of vegetation that depends on fresh water. We studied the effects of saltwater on vegetation with particular focus on loblolly pine trees (Pinus taeda). Our study took place on the Albemarle-Pamlico Peninsula (APP), a 6,000 km2 region of North Carolina's Outer Coastal Plain surrounded on three sides by estuarine coastline. Years of local, anecdotal observations suggest that stands of dead pine trees known as "Ghost Forest," are spreading along coastal waterways. We investigated the health of pine trees in this region to explore potential links between saltwater intrusion and die-off, particularly where artificial ditches and canals allow saltwater to flow deep into the interior of the peninsula. Using a handheld spectroradiometer, we collected hyperspectral reflectance data in visible and near infrared wavebands (350-1000 nm) from more than 100 individual canopy and leaf samples across the APP. We accompanied these measurements with GPS coordinates, measurements of tree height and circumference, distances from nearby waterways, and specific conductance measurements (as a salinity proxy) of these waters. We used reflectance spectra to calculate the Normalized Difference Vegetation Index (NDVI), the Red-Green Index (RGI), and site-specific indices to determine the health of particular trees and canopies. Using this information in conjunction with ancillary data, we explored the correlations between the health of vegetation and the salinity of nearby water sources.

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

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    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

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

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    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. 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.

  4. 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.

  5. 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.

  6. Thigh abscess and necrotizing fasciitis following an inside-out transobturator tape intervention: a case report.

    Science.gov (United States)

    Kerbaj, Jad; Aubry, Camille; Prost, Caroline; Brouqui, Philippe

    2016-06-02

    Tension-free vaginal transobturator tapes are used worldwide in the treatment of urinary incontinence in women. Very few severe complications have been described following this procedure, with no standard treatment yet established. We present the case of a 36-year-old French white woman with no remarkable medical history, presenting with an abscess and necrotizing fasciitis 48 hours after an inside-out tension-free transobturator procedure. Samples were collected by guided puncture from the abscess, retrieving Staphylococcus aureus and Citrobacter koseri. Severe complications following this procedure are rare, although it can have the potential for significant morbidity and even mortality, which is worth highlighting. We recommend early surgical treatment in combination with broad-spectrum antibiotics and coverage for Staphylococcus aureus, which may be a causative agent.

  7. 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.)

  8. A case of necrotising fasciitis caused by Serratia marsescens: extreme age as functional immunosuppression?

    Science.gov (United States)

    Cope, Thomas Edmund; Cope, Wei; Beaumont, David Martin

    2013-03-01

    We report the case of a 97-year-old woman who had a prolonged hospital admission for the treatment of right-sided heart failure. During her stay she experienced a rapid deterioration, characterised by shortness of breath, cardiovascular compromise and a hot, red, swollen calf. Post-mortem examination demonstrated that this was caused by necrotising fasciitis due to Serratia marcescens as a single pathogen. This is only the second reported case of this condition in the absence of diabetes or immunosuppression, and clinical deterioration was much more rapid. The case underlines the importance of circumspection and regular review in the diagnosis of the elderly patient. It reminds us that these patients should be viewed as functionally immunosuppressed, and that some or all of the haematological markers of infection can be absent even in severe disease.

  9. 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.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series.

    Science.gov (United States)

    MacLean, Alexandra A; Miller, George; Bamboat, Zubin M; Hiotis, Karen

    2004-09-01

    We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance.

  13. Chronic Plantar Fasciitis is Mediated by Local Hemodynamics: Implications for Emerging Therapies

    Science.gov (United States)

    Miller, Larry E.; Latt, Daniel L.

    2015-01-01

    Plantar fasciitis (PF) is a common, disabling condition affecting millions of patients each year. With early diagnosis and timely application of traditional nonsurgical treatments, symptoms generally resolve over time. However, despite adequate treatment, 20% of patients will experience persistent symptoms. In these patients, minimally invasive therapies that augment local hemodynamics to initiate a regenerative tissue-healing cascade have the greatest potential to resolve long-standing symptoms. We performed a narrative review based on a best evidence evaluation of manuscripts published in Medline-indexed journals to determine the mechanisms involved in soft tissue injury and healing. This evaluation also highlights emerging minimally invasive therapies that exploit these mechanisms in recalcitrant PF. PMID:25709971

  14. Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results.

    Science.gov (United States)

    Wu, P T; Lee, J S; Wu, K C; Wu, T T; Shao, C J; Liang, F W; Chern, T C; Su, F C; Jou, I M

    2016-02-01

    We evaluated the effects of ultrasound (US)-guided percutaneous radiofrequency thermal lesioning (RTL) and the impact of obesity when treating patients with recalcitrant plantar fasciitis. 30 consecutive patients were enrolled. The visual analog scale (VAS), American Orthopedic Foot-Ankle Society (AOFAS) Ankle-Hindfoot Score, and plantar fascia thickness measured using US were recorded at baseline and at follow-up 1, 3, 6, and 12 months after surgery under local anesthesia. 12 patients in the obese (BMI ≥ 30 kg/m(2)) group and 18 patients in the non-obese group. There were significant postoperative decreases in VAS scores and in fascial thickness, and an increase in the AOFAS scores (all p Plantar fascial thickness was correlated with VAS and AOFAS scores. © Georg Thieme Verlag KG Stuttgart · New York.

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

    DEFF Research Database (Denmark)

    Broholm, Rikke; Pingel, Jessica; Simonsen, Lene

    2017-01-01

    Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularisation 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). 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...

  16. Endoscopic Plantar Fasciotomy vs Open Radiofrequency Microtenotomy for Recalcitrant Plantar Fasciitis.

    Science.gov (United States)

    Wang, Weining; Rikhraj, Inderjeet Singh; Chia, Andrew Chen Chou; Chong, Hwei Chi; Koo, Kevin Oon Thien

    2017-11-01

    Although usually self-limiting, around 10% of patients develop recalcitrant plantar fasciitis despite conservative treatment. In such cases, operative intervention can be offered. Traditionally, plantar fasciotomy has been the treatment of choice, but recently, there has been a push for more minimally invasive approaches. Radiofrequency microtenotomy has also been increasingly used as a treatment option. In this study, we compare the outcomes of endoscopic plantar fasciotomy and open radiofrequency microtenotomy. Patients treated in our institution with either procedure between 2007 and 2015 were included and interviewed at baseline and 3 months, 6 months, and 12 months postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) and 36-item Medical Outcomes Short Form (SF-36) questionnaires. They were asked questions to evaluate their expectation and satisfaction postoperatively. Demographic and clinicopathological data were prospectively collected from clinical charts and electronic records. There was no difference in either treatment arms preoperatively and an overall improvement in all functional outcomes postoperatively. However, patients who had endoscopic plantar fasciotomy fared better at 3 months compared to patients who underwent open microtenotomy with the visual analog score component of the AOFAS hindfoot score (HINDVAS) and the social functioning and role-functioning-emotional reaching statistical significance ( P = .027, P = .03, and P = .03, respectively). There was no difference in functional outcomes at 6 or 12 months postoperatively. Endoscopic plantar fasciotomy was associated with an earlier improvement in functional outcome in our study. However, both treatments had equivalent outcomes at 1-year follow-up, suggesting that either method is reasonable in the treatment of chronic plantar fasciitis. Level III, comparative study.

  17. The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis.

    Science.gov (United States)

    Kuyucu, Ersin; Koçyiğit, Figen; Erdil, Mehmet

    2015-09-01

    Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Corticosteroid versus placebo injection for plantar fasciitis: A meta-analysis of randomized controlled trials

    Science.gov (United States)

    LI, ZONGHUAN; YU, AIXI; QI, BAIWEN; ZHAO, YONG; WANG, WEIYANG; LI, PING; DING, JUNHUI

    2015-01-01

    The aim of this meta-analysis was to determine the efficacy of corticosteroid versus placebo injection for the treatment of plantar fasciitis. Databases (Medline, Embase, the Cochrane Library and Google Scholar) and study references were searched for randomized controlled trials comparing corticosteroid with placebo injection for plantar fasciitis. Studies that met the inclusion criteria were selected for the analysis. The risk of bias tool was used for the methodological assessment. Outcomes including visual analogue score (VAS) and plantar fascia thickness (PFT) were extracted and pooled. Egger's test was used to detect publication bias. The evidence quality was assessed by the Grading of Recommendations Assessment, Development and Evaluation system. Statistical analysis was performed using RevMan 5.2. A total of four studies with 289 patients were included in the analysis. Compared with the placebo, corticosteroid injection provided better pain relief after one month [standardized mean difference (SMD), −0.32; 95% confidence interval (CI), −0.59--0.06); P=0.02). No difference was detected with respect to the VAS after two months (SMD, −0.04; 95% CI, −0.35–0.27; P=0.79) or three months (SMD, −0.42; 95% CI, −1.00–0.16; P=0.15) or to the PFT (MD, 0.70; 95% CI, −1.77–0.38; P=0.20), although a tendency of favoring corticosteroid injection was observed. No obvious publication bias was detected. In conclusion, corticosteroid injection may provide pain relief for a short period of time, but the efficacy may disappear with the progression of time. PMID:26136971

  19. Necrotizing fasciitis in oro-maxillo-facial area after radiotherapy for squamous cell carcinoma of the soft palate.

    Science.gov (United States)

    Ormenişan, Alina; Morariu, Silviu Horia; Cotoi, Ovidiu Simion; Vartolomei, Mihai Dorin; Grigoraş, Radu Ionuţ; Mocan, Simona Liliana; Suciu, Mircea

    2015-01-01

    The fascia's and subcutaneous adipose tissue's impairment by mono or polymicrobial infection, which also can involve the skin and the muscles, is rarely seen in oro-maxillo-facial area. The present case report is presenting a case of necrotizing fasciitis in a patient who had a history of an invasive squamous cell carcinoma of the soft palate, with surgical treatment and with radiotherapy. He was admitted in our Clinic with malaise and subsequently developed a toxico-septic shock. Clinical symptoms, serological and bacteriological analysis and histopathological examination confirmed the diagnosis of necrotizing fasciitis (NF). The patient subsequently underwent a series of surgical reconstruction and aesthetic treatments because of the complications that had arised in the meantime. Postoperative evolution was favorable towards complete closure of the defect. The prognosis of this disease is generally reserved, the favorable evolution depending on the possibility of wound sterilization and the surgery is required despite its mutilating effect.

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

    Science.gov (United States)

    Yetışır, Fahri; Şarer, Akgün Ebru; Acar, H. Zafer

    2015-01-01

    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. PMID:26448894

  1. 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.

  2. Saltwater Intrusion and its Long-Term Consequences in a Coastal Alluvial Aquifer of Northern Oman

    Science.gov (United States)

    Weyhenmeyer, C. E.; Waber, H. N.

    2002-12-01

    The alluvial aquifer of the Eastern Batinah coastal plain supplies water for the most densely populated, cultivated and industrialized areas in the Sultanate of Oman. In recent years, overexploitation of these groundwater resources has resulted in a drastic lowering of the groundwater table and consequent seawater intrusion into the coastal aquifer sections. During recent drilling operations near the coast (~3 km) groundwater samples were taken at depths intervals of 2-5 m. The front of the saline intrusion wedge was encountered at a depth of 70-80 mbs as suggested by sudden changes in groundwater chemistry and isotope values. Groundwater near the saline intrusion front is characterized by lower Na/Cl and higher Ca/Mg ratios compared to ion ratios expected from groundwater mixing calculations between fresh- and saltwater. The observed changes in ion ratios suggest that Na is removed from the groundwater and replaced by Ca from cation exchange surfaces in the aquifer (e.g., clay particles), which is an indication that the saline front is still migrating inland. To date, a deterioration of overall groundwater quality can be recognized as far inland as 15 km and Cl and Na concentrations in these areas are well above the general quality standards for drinking water. Estimates of infiltration rates based on isotope ratios (Sr, O, H) suggest that less than 10% of the total groundwater recharge occurs on the coastal plain itself, with the remaining 90% originating in the adjacent Oman Mountains. Groundwater residence times on the coastal plain are in the order of a few hundred to several thousand years as suggested by a number of radioactive isotopes (3H, 85Kr, 39Ar, 14C). Therefore, these groundwater resources essentially have to be considered non-renewable and there is a pressing requirement for the development of sustainable groundwater management strategies. Attempts to artificially increase infiltration on the coastal plain by the construction of large recharge dams

  3. Necrotizing fasciitis caused by Haemophilus influenzae type b in a patient with rectal cancer treated with combined bevacizumab and chemotherapy: a case report.

    Science.gov (United States)

    Ugai, Tomotaka; Norizuki, Masataro; Mikawa, Takahiro; Ohji, Goh; Yaegashi, Makito

    2014-04-12

    Recently, necrotizing fasciitis has been reported in patients treated with bevacizumab, usually secondary to wound healing complications, gastrointestinal perforations, or fistula formation. The risk of invasive Haemophilus influenzae type b infection is significantly increased in immunocompromised hosts. However, necrotizing fasciitis due to Haemophilus influenzae type b in a patient treated with combined bevacizumab and chemotherapy has not been previously reported. A 59-year-old woman was admitted to the intensive care unit after sudden onset of fever, chills, and right thigh pain. She received chemotherapy with fluorouracil, irinotecan, and bevacizumab for colon cancer 10 days prior to admission. The advancing erythematous margin and her worsening clinical condition prompted us to suspect necrotizing fasciitis and consult the orthopedics department for a fascia biopsy and debridement. Surgical exploration revealed a murky dishwater-colored pus exudate from the incision site and the lack of a shiny appearance of the fascia that also suggested necrotizing fasciitis. After 2 days, the final results of the blood and exudate cultures confirmed the presence of Haemophilus influenzae type b. A diagnosis of necrotizing fasciitis due to Haemophilus influenzae type b was made. The patient required recurrent surgical debridement and drainage, but she recovered from the septic shock. We report a case of necrotizing fasciitis due to Haemophilus influenzae type b in a patient without injury and with rectal cancer treated with combined bevacizumab and chemotherapy. Physicians should consider invasive Haemophilus influenzae type b disease in the presence of necrotizing fasciitis in patients treated with this combined treatment modality.

  4. Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs.

    Science.gov (United States)

    Chang, Ryan; Kent-Braun, Jane A; Hamill, Joseph

    2012-06-01

    Due to complexity of the plantar intrinsic foot muscles, little is known about their muscle architecture in vivo. Chronic plantar fasciitis may be accompanied by muscle atrophy of plantar intrinsic foot muscles and tibialis posterior compromising the dynamic support of the foot prolonging the injury. Magnetic resonance images of the foot may be digitized to quantify muscle architecture. The first purpose of this study was to estimate in vivo the volume and distribution of healthy plantar intrinsic foot muscles. The second purpose was to determine whether chronic plantar fasciitis is accompanied by atrophy of plantar intrinsic foot muscles and tibialis posterior. Magnetic resonance images were taken bilaterally in eight subjects with unilateral plantar fasciitis. Muscle perimeters were digitally outlined and muscle signal intensity thresholds were determined for each image for volume computation. The mean volume of contractile tissue in healthy plantar intrinsic foot muscles was 113.3 cm(3). Forefoot volumes of plantar fasciitis plantar intrinsic foot muscles were 5.2% smaller than healthy feet (P=0.03, ES=0.26), but rearfoot (P=0.26, ES=0.08) and total foot volumes (P=0.07) were similar. No differences were observed in tibialis posterior size. While the total volume of plantar intrinsic foot muscles was similar in healthy and plantar fasciitis feet, atrophy of the forefoot plantar intrinsic foot muscles may contribute to plantar fasciitis by destabilizing the medial longitudinal arch. These results suggest that magnetic resonance imaging measures may be useful in understanding the etiology and rehabilitation of chronic plantar fasciitis. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    OpenAIRE

    Fahri Yetışır; Akgün Ebru Şarer; H. Zafer Acar

    2015-01-01

    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...

  6. Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis.

    Science.gov (United States)

    Fong, Daniel Tik-Pui; Pang, Kai-Yip; Chung, Mandy Man-Ling; Hung, Aaron See-Long; Chan, Kai-Ming

    2012-12-01

    It is a routine practice to prescribe a combination of rocker shoes and custom-made foot orthoses for patients with plantar fasciitis. Recently, there has been a debate on this practice, and studies have shown that the individual prescription of rocker shoes or custom-made foot orthoses is effective in treating plantar fasciitis. The aim of this study was to evaluate and compare the immediate therapeutic effects of individually prescribed rocker sole shoes and custom-made foot orthoses, and a combined prescription of them on plantar fasciitis. This was a cross-over study. Fifteen patients with unilateral plantar fasciitis were recruited; they were from both genders and aged between 40 and 65. Subjects performed walking trials which consisted of one 'unshod' condition and four 'shod' conditions while wearing baseline shoes, rocker shoes, baseline shoes with foot orthotics, and rocker shoes with foot orthotics. The study outcome measures were the immediate heel pain intensity levels as reflected by visual analog scale pain ratings and the corresponding dynamic plantar pressure redistribution patterns as evaluated by a pressure insole system. The results showed that a combination of rocker shoes and foot orthoses produced a significantly lower visual analog scale pain score (9.7 mm) than rocker shoes (30.9 mm) and foot orthoses (29.5 mm). With regard to baseline shoes, it also significantly reduced the greatest amount of medial heel peak pressure (-33.58%) without overloading other plantar regions when compared to rocker shoes (-7.99%) and foot orthoses (-28.82%). The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    2010-01-01

    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 condition. Trial Registration

  8. 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

  9. Ecosystem Productivity Responses to Saltwater Intrusion and P Loading As a Result of Future Sea Level Rise in the Coastal Everglades

    Science.gov (United States)

    Wilson, B.; Troxler, T.; Gaiser, E.; Kominoski, J. S.; Richards, J.; Servais, S.; Stachelek, J.; Kelly, S.; Sklar, F.; Coronado-Molina, C.; Madden, C.; Davis, S. E., III; Mazzi, V.; Schulte, N.; Bauman, L.

    2014-12-01

    Coastal wetlands, which have immense potential to store carbon (C) in vegetation and sediments, are a vital part of the global C cycle. How C storage in coastal wetlands will be affected by accelerated sea level rise as a result of a warming climate, however, is uncertain. In oligotrophic wetlands such as the Everglades in the southeastern USA, saltwater intrusion will bring ions (Cl-, SO42-) and phosphorus (P), a limiting nutrient for ecosystem productivity. It is hypothesized that shifts in stressors and subsidies can shift the soil carbon balance from a net C sink to a source, stimulating peat collapse, which will, in turn, accelerate the effects of sea level rise. The objective of this study is to investigate how simulated saltwater intrusion into freshwater and oligohaline wetlands will change net ecosystem productivity and affect the soil C balance. Using coupled field and mesocosm experiments beginning in August 2014, we are examining how plant gross primary production, plant respiration, ecosystem respiration, and net ecosystem exchange in freshwater and oligohaline wetlands will change when exposed to saltwater and an increase in P loading. We predict that a higher saltwater load will increase ecosystem respiration while decreasing ecosystem productivity, possibly shifting the C balance of these marshes from a net sink to a source. In contrast, increased P loading has been shown to increase ecosystem productivity in oligotrophic wetlands; sawgrass, the dominant macrophyte in Everglades marshes, increases productivity with increased P, but periphyton decreases productivity. Therefore, it is still unknown how the interaction of an increased P subsidy coupled with saltwater intrusion will affect overall net ecosystem productivity and the C balance. Results from this study will reveal how the soil C balance in freshwater and oligohaline wetlands changes with saltwater intrusion due to sea level rise.

  10. Are there any reasons to change our behavior in necrotizing fasciitis with the advent of new antibiotics?

    Science.gov (United States)

    Menichetti, Francesco; Giuliano, Simone; Fortunato, Simona

    2017-04-01

    The treatment of necrotizing fasciitis requires a multifaceted approach, consisting of surgical source control with immediate surgical debridement along with life support, clinical monitoring, and antimicrobial therapy. Many drugs are now available for the treatment of this life-threatening infectious disease, and the purpose of this review is to provide the reader with an updated overview of the newest therapeutic options. Because most necrotizing soft tissue infections are polymicrobial, broad-spectrum coverage is advisable. Acceptable monotherapy regimens include piperacillin-tazobactam or a carbapenem. However, drugs such as ceftolozane-tazobactam, ceftazidime-avibactam in association with an antianaerobic agent (metronidazole or clindamycin) are currently available as valuable alternatives. The new cephalosporins active against methicillin-resistant Staphylococcus aureus (MRSA), ceftaroline, and ceftobiprole share similar antibacterial activity against Gram-positive cocci, and they might be considered as an alternative to nonbetalactam anti-MRSA agents for necrotizing fasciitis management. Two new long-acting lypoglycopeptides - oritavancin and dalbavancin - share the indications for acute bacterial skin and skin structure infections and had similar activity against Gram-positive cocci including MRSA and streptococci. Carbapenem-sparing agents are particularly suitable for antimicrobial stewardship strategy. The new long-acting lypoglycopeptides are very effective in treating necrotizing fasciitis and are uttermost attractive for patients requiring short hospital stays and early discharge.

  11. Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis.

    Science.gov (United States)

    Scheuer, R; Friedrich, M; Hahne, J; Holzapfel, J; Machacek, P; Ogon, M; Pallamar, M

    2016-03-01

    Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis. 284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19-77 weeks after the first application of ESWT. 76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors. Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions. In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-07-01

    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. 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. 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, Pplantar fasciitis for at least 6 months after treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. 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

    2017-10-01

    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.

  14. 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.

  15. Investigation of the acute plantar fasciitis with contrast-enhanced ultrasound and shear wave elastography - first results.

    Science.gov (United States)

    Putz, Franz Josef; Hautmann, Matthias G; Banas, Miriam; Jung, Ernst Michael

    2017-09-04

    The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain. In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis. 23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding tissue. All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p = 0.0005) and peak (p = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue. CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy.

  16. Comparison of formation mechanism of fresh-water and salt-water lacustrine organic-rich shale

    Science.gov (United States)

    Lin, Senhu

    2017-04-01

    Based on the core and thin section observation, major, trace and rare earth elements test, carbon and oxygen isotopes content analysis and other geochemical methods, a detailed study was performed on formation mechanism of lacustrine organic-rich shale by taking the middle Permian salt-water shale in Zhungaer Basin and upper Triassic fresh-water shale in Ordos Basin as the research target. The results show that, the middle Permian salt-water shale was overall deposited in hot and dry climate. Long-term reductive environment and high biological abundance due to elevated temperature provides favorable conditions for formation and preservation of organic-rich shale. Within certain limits, the hotter climate, the organic-richer shale formed. These organic-rich shale was typically distributed in the area where palaeosalinity is relatively high. However, during the upper Triassic at Ordos Basin, organic-rich shale was formed in warm and moist environment. What's more, if the temperature, salinity or water depth rises, the TOC in shale decreases. In other words, relatively low temperature and salinity, stable lake level and strong reducing conditions benefits organic-rich shale deposits in fresh water. In this sense, looking for high-TOC shale in lacustrine basin needs to follow different rules depends on the palaeoclimate and palaeoenvironment during sedimentary period. There is reason to believe that the some other factors can also have significant impact on formation mechanism of organic-rich shale, which increases the complexity of shale oil and gas prediction.

  17. 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.

  18. 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.

  19. Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: a randomized clinical trial.

    Science.gov (United States)

    Yucel, Ufuk; Kucuksen, Sami; Cingoz, Havva T; Anliacik, Emel; Ozbek, Orhan; Salli, Ali; Ugurlu, Hatice

    2013-12-01

    Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Randomized clinical trial. Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

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

    Science.gov (United States)

    Vahdatpour, Babak; Sajadieh, Sepideh; Bateni, Vahid; Karami, Mehdi; Sajjadieh, Hamidreza

    2012-01-01

    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/mm2) 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 plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy. PMID:23826009

  1. Eosinophilic Fasciitis

    Science.gov (United States)

    ... Summer Camp Tips for Kids With Asthma, Allergies Antioxidants: The Good Health Helpers As Stroke 'Liquefies' Brain ... Mouth and Dental Disorders Older People’s Health Issues Skin Disorders Special Subjects Women's Health Issues Symptoms ALL ...

  2. Plantar Fasciitis

    Science.gov (United States)

    ... Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family HealthInfants and Toddlers Kids and Teens Pregnancy and ... Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family HealthInfants and Toddlers Kids and Teens Pregnancy and ...

  3. Assessing impacts of climate change, sea level rise, and drainage canals on saltwater intrusion to coastal aquifer

    Directory of Open Access Journals (Sweden)

    P. Rasmussen

    2013-01-01

    Full Text Available Groundwater abstraction from coastal aquifers is vulnerable to climate change and sea level rise because both may potentially impact saltwater intrusion and hence groundwater quality depending on the hydrogeological setting. In the present study the impacts of sea level rise and changes in groundwater recharge are quantified for an island located in the Western Baltic Sea. The low-lying central area of the investigated part of the island was extensively drained and reclaimed during the second half of the 19th century by a system of artificial drainage canals that significantly affects the flow dynamics of the area. The drinking water, mainly for summer cottages, is abstracted from 11 wells drilled to a depth of around 20 m into the upper 5–10 m of a confined chalk aquifer, and the total pumping is only 5–6% of the drainage pumping. Increasing chloride concentrations have been observed in several abstraction wells and in some cases the WHO drinking water standard has been exceeded. Using the modeling package MODFLOW/MT3D/SEAWAT the historical, present and future freshwater-sea water distribution is simulated. The model is calibrated against hydraulic head observations and validated against geochemical and geophysical data from new investigation wells, including borehole logs, and from an airborne transient electromagnetic survey. The impact of climate changes on saltwater intrusion is found to be sensitive to the boundary conditions of the investigated system. For the flux-controlled aquifer to the west of the drained area only changes in groundwater recharge impacts the freshwater–sea water interface whereas sea level rise does not result in increasing sea water intrusion. However, on the barrier islands to the east of the reclaimed area, below which the sea is hydraulically connected to the drainage canals, and the boundary of the flow system therefore controlled, the projected changes in sea level, groundwater recharge and stage of the

  4. Evaluation of Well Records and Geophysical Logs for Determining the Presence of Freshwater, Saltwater, and Gas Above the Marcellus Shale, South-Central New York

    Science.gov (United States)

    Records of water wells in NWIS and records and geophysical logs of gas wells in ESOGIS were evaluated to provide a preliminary determination of the presence of freshwater, saltwater, and gas above the Marcellus Shale in south-central New York.

  5. Toward Integrated Disaster Risk Management in Vietnam : Recommendations Based on the Drought and Saltwater Intrusion Crisis and the Case for Investing in Longer-Term Resilience

    OpenAIRE

    Global Facility for Disaster Reduction and Recovery

    2017-01-01

    Vietnam is one of the most hazard-prone countries in the East Asia and Pacific region, with droughts, severe storms, and flooding causing substantial economic and human losses. Climate change is projected to increase the impact of disasters, especially the timing, frequency, severity, and intensity of hydro-meteorological events. Vietnam’s 2015–2016 drought and associated saltwater intrus...

  6. Comparison of the analgesic effect of ultrasound and low-level laser therapy in patients suffering from plantar fasciitis (calcar calcanei)

    Science.gov (United States)

    Navratil, Leos; Skopek, Jiri; Hronkova, Hana; Kymplova, Jaroslava; Knizek, Jiri

    2001-10-01

    To compare the effectiveness of the two therapeutic approaches, ultrasound and low level laser (LLLT) used in 181 patients suffering from calcar calcanei-plantar fasciitis. The effectiveness of the treatment was determined according to the evaluation of the patient using certain criteria described in the table. The complete disappearance of pain was seen in 50% of 60 patients treated with US and partial improvement in 16.6% and 69 patients were treated with LLLT from which 67% described complete pain relief, and 20% partial improvement. The results show that the LLLT is a good therapeutic approach in the treatment of pain in patients suffering from calcar calcanei-plantar fasciitis. The treatment with laser was significantly more successful then the ultrasound therapy, which is currently the most common therapy used for plantar fasciitis.

  7. 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

  8. Postzygotic Isolation Evolves before Prezygotic Isolation between Fresh and Saltwater Populations of the Rainwater Killifish, Lucania parva

    Directory of Open Access Journals (Sweden)

    Genevieve M. Kozak

    2012-01-01

    Full Text Available Divergent natural selection has the potential to drive the evolution of reproductive isolation. The euryhaline killifish Lucania parva has stable populations in both fresh water and salt water. Lucania parva and its sister species, the freshwater L. goodei, are isolated by both prezygotic and postzygotic barriers. To further test whether adaptation to salinity has led to the evolution of these isolating barriers, we tested for incipient reproductive isolation within L. parva by crossing freshwater and saltwater populations. We found no evidence for prezygotic isolation, but reduced hybrid survival indicated that postzygotic isolation existed between L. parva populations. Therefore, postzygotic isolation evolved before prezygotic isolation in these ecologically divergent populations. Previous work on these species raised eggs with methylene blue, which acts as a fungicide. We found this fungicide distorts the pattern of postzygotic isolation by increasing fresh water survival in L. parva, masking species/population differences, and underestimating hybrid inviability.

  9. Re-plumbing the coast: Untangling the effects of climate change and water management on vulnerability of coastal landscapes to saltwater incursion

    Science.gov (United States)

    Bhattachan, A.; BenDor, T.; Ardón, M.; Bernhardt, E. S.; Wright, J. P.; Emanuel, R. E.

    2016-12-01

    The Atlantic Coastal Plain of the United States has been altered drastically in the past century to support agriculture, real estate, and recreational activities. In a landscape with minimal hydraulic gradients and potentially large fluctuations in sea level, the effects of introducing artificial drainages (e.g., ditches and canals) on hydrological properties are often drastic and sometimes unpredictable. In this study, we focus on a portion of the outer coastal plain of North Carolina that ranges in elevation between 6 to -5 meters a.m.s.l. To this end, we use a high-resolution, Lidar-derived digital elevation model to study the effects of artificial drainages on landscape elevation, flow accumulation, and drainage density within an 800-km2 study area. Specifically, we use image-processing techniques to filter artificial drainages from the region and compare hydrologically relevant landscape metrics with and without these features. In general, artificial drainages lower land elevation, short-circuit otherwise natural flow paths and lead to increased ( 3 times) drainage density across the landscape. We also calculate a saltwater intrusion vulnerability index (SIVI), with and without canals and ditches, to investigate the contribution of this infrastructure to saltwater intrusion vulnerability in this low-lying coastal region. The SIVI represents the ability of the freshwater to impede the inland migration of saltwater during drought periods or as sea level rises. Our results show that the construction of artificial drainages would in fact lead to an increase in vulnerability to saltwater intrusion and this pattern is consistent across all four major land-cover (wetlands, agriculture, shrub and forest) in our study area. Thus, combined with extant saltwater impacts on freshwater-dependent landscapes across our study area, our findings are immediately relevant to this region and to similar coastal regions worldwide.

  10. 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.

  11. 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.

  12. 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.

  13. Fournier's gangrene (necrotising fasciitis) complicated by renal and respiratory insufficiency: a case report.

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    Frisman, E; Rácz, O; Beck, J; Firment, J; Bodnárová, L

    2016-01-01

    A case report of a 68-year-old male obese diabetic patient with an abscess of left femoral region, and diffuse inflammation of abdominal wall and genital region developing sepsis, respiratory and renal failure. At admission in the regional hospital a diagnosis of polymicrobial necrotising fasciitis with suspected sepsis was declared. The patient was transferred to the special intensive care unit (SICU) of Burns and reconstructive surgery at the Kosice-Saca. The patient was treated surgically, with hyperbaric oxygen and pharmacologically to control his diabetes. The main aetiological agent of the condition was identified as Stenotrophomonas maltophilia. In addition to respiratory and metabolic acidosis and gastric bleeding occurred. Due to acute renal failure (day 38) the patient was transferred to clinic of anaesthesiology and the intensive care medicine at the University Hospital in Kosice. The patient was treated by continuous veno-venous haemodialysis, mechanical ventilation and nasogastric nutritional support. On day 48 the conscious sub-febrile patient with healed wounds was transferred back to the regional hospital with ventilation support and continuous renal replacement therapy. His diabetes was uncontrolled, and only kidney parameters remained pathological. The survival of this patient with an extremely poor prognosis was achieved through prompt transfer to a specialised centre, early identification of the aetiological agent and immediate appropriate antibiotic treatment as a result of good cooperation between surgeons and laboratory specialists.

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

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    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.

  15. A surgeon's nightmare: pyoderma gangrenosum with pathergy effect mimicking necrotising fasciitis.

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    Slocum, Amanda Mun Yee

    2017-12-20

    A 53-year-old woman was admitted for vulval swelling and fever. She was initially diagnosed with vulval cellulitis and given parenteral antibiotics. Within 1 week, she developed necrotic-looking skin lesions extending from her vulva to her buttock. Emergency surgical debridement with diversion colostomy was performed in view of suspected necrotising fasciitis. Shortly after the surgery, she developed necrotic-looking skin lesions at the peripheral venous cannula insertion site, central line insertion site, and around her surgical wounds and stoma. A second surgical debridement was performed and shortly afterwards, similar skin lesions appeared around her surgical wounds. Her clinical progression was suggestive of pyoderma gangrenosum with pathergy effect. Hence, she was started on topical steroid, systemic steroid and immunosuppressant. The skin lesions responded well to medical therapy. Further systemic workup for conditions associated with this disease revealed findings suspicious for myelodysplastic syndrome. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

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    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.

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

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    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.

  18. Correlation between the outcome of extracorporeal shockwave therapy and pretreatment MRI findings for chronic plantar fasciitis.

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    Maki, Masahiro; Ikoma, Kazuya; Imai, Kan; Kido, Masamitsu; Hara, Yusuke; Arai, Yuji; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2015-05-01

    The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) findings before extracorporeal shockwave therapy (ESWT) and the treatment outcome of ESWT. This study examined 50 feet with chronic plantar fasciitis. The scores before ESWT and after a six-month follow-up were investigated using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale and the Visual Analog Scale (VAS). MRI before ESWT was used for image evaluation. MRI revealed thickening of the plantar fascia (PF), and an investigation was conducted regarding the findings of a high-signal-intensity area (HSIA) inside the PF, edema near the PF, and bone marrow edema (BME) of the calcaneus. The average JSSF score and VAS score improved significantly at follow-up. In total, 44 feet were noted in the improved group. MRI revealed that the average amounts of PF thickening did not significantly differ between the improved group and the non-improved group. HSIA, edema near the PF, and BME were observed in 36, 41, and 11 feet in the improved group, respectively; and 2, 4, and 2 feet in the non-improved group, respectively. An HSIA in the PF predicted symptom improvement more easily than other MRI findings. IV.

  19. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis.

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    Alkhamaali, Zaied K; Crocombe, Andrew D; Solan, Matthew C; Cirovic, Srdjan

    2016-01-01

    Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.

  20. Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities caused by Plantar Fasciitis

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    Alotaibi, Abdullah K.; Petrofsky, Jerrold S.; Daher, Noha S.; Lohman, Everett; Laymon, Michael; Syed, Hasan M.

    2015-01-01

    Background Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material/Methods Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. Conclusions This trial showed that MPC is useful in treating inferior heel symptoms caused by PF. PMID:25791231

  1. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review

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    Petraglia, Federica; Ramazzina, Ileana; Costantino, Cosimo

    2017-01-01

    Summary Background: Plantar fasciitis (PF) is reported in different sports mainly in running and soccer athletes. Purpose of this study is to conduct a systematic review of published literature concerning the diagnosis and treatment of PF in both recreational and élite athletes. The review was conducted and reported in accordance with the PRISMA statement. Methods: The following electronic databases were searched: PubMed, Cochrane Library and Scopus. As far as PF diagnosis, we investigated the electronic databases from January 2006 to June 2016, whereas in considering treatments all data in literature were investigated. Results: For both diagnosis and treatment, 17 studies matched inclusion criteria. The results have highlighted that the most frequently used diagnostic techniques were Ultrasonography and Magnetic Resonance Imaging. Conventional, complementary, and alternative treatment approaches were assessed. Conclusions: In reviewing literature, we were unable to find any specific diagnostic algorithm for PF in athletes, due to the fact that no different diagnostic strategies were used for athletes and non-athletes. As for treatment, a few literature data are available and it makes difficult to suggest practice guidelines. Specific studies are necessary to define the best treatment algorithm for both recreational and élite athletes. Level of evidence: Ib. PMID:28717618

  2. Cervical necrotizing fasciitis and diabetic ketoacidosis: literature review and case report.

    Science.gov (United States)

    Leyva, P; Herrero, M; Eslava, J M; Acero, J

    2013-12-01

    Necrotizing fasciitis (NF) is a rare polymicrobial infection that can be life-threatening. It is a rapidly progressive inflammatory process affecting the deep fascia, with secondary necrosis of the subcutaneous tissue. It is characterized by its fulminant course and its high mortality rate. Most cases of NF affect the abdomen, groin, and extremities. NF in the neck is reported to be rare and most cases are odontogenic in origin. Misdiagnosis and delayed treatment can result in death from sepsis, mediastinitis, carotid artery erosion, jugular vein thrombophlebitis, or aspiration pneumonia. The diagnosis is based on a combination of clinical history and predisposing factors, Gram staining and culture, imaging, and surgical exploration. Early and aggressive surgical treatment and intensive medical care are essential. The aim of this article is to report a case of severe and extensive cervical NF worsened by a diabetic ketoacidosis as a first appearance of diabetes mellitus. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Autoimmune fasciitis triggered by the anti-programmed cell death-1 monoclonal antibody nivolumab.

    Science.gov (United States)

    Parker, Matthew Js; Roberts, Mark E; Lorigan, Paul C; du Plessis, Daniel G; Chinoy, Hector

    2018-02-08

    A 43-year-old woman with a history of recently diagnosed metastatic melanoma was commenced on systemic therapy with nivolumab, an anti-programmed cell death-1 monoclonal antibody and one of an increasing group of the so-called 'immune checkpoint inhibitors'. She experienced a dramatic complete response within 6 months of initiation. However, in addition to developing incident autoimmune hypothyroidism, she also developed progressive fatigue, proximal weakness, myalgia and dysphagia. Initial investigations with blood tests, electrophysiology and a muscle biopsy were non-specific or normal. Subsequent examination revealed 'woody' thickening of the subcutaneous tissues of the forearms, thighs and calves consistent with fasciitis. MRI and a full-thickness skin-muscle biopsy were ultimately diagnostic of a likely iatrogenic autoimmune myofasciitis. The clinical manifestations only responded partly to prednisolone 30 mg orally and treatment was escalated to include intravenous immunoglobulin. At 3 months, this has only resulted in a modest incremental improvement. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

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    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.

  5. Effectiveness of polydeoxyribonucleotide injection versus normal saline injection for treatment of chronic plantar fasciitis: a prospective randomised clinical trial.

    Science.gov (United States)

    Kim, Jae Kwang; Chung, Jae Yoon

    2015-07-01

    Polydeoxyribonucleotide (PDRN) has been used for the treatment of chronic tendinosis. This prospective randomised study was conducted to evaluate the efficacy and complications of PDRN injection for treatment of plantar fasciitis. Forty patients with a clinical diagnosis of plantar fasciitis were randomly allocated to PDRN injection (PDRN group, n = 20) or normal saline injection (placebo group, n = 20). Injections were performed weekly for three weeks. Clinical evaluations were done at baseline and four and 12 weeks after treatment began using the visual analogue scale (VAS) for foot pain and Manchester-Oxford Foot Questionnaire (MOXFQ). We also monitored the complications in both groups at one, two, four and 12 weeks after initial treatment. The PDRN group achieved a significant improvement in VAS and MOXFQ scores at four weeks after treatment, and this improvement continued until 12 weeks after treatment. On the other hand, the placebo group did not achieve a significant improvement in the VAS or MOXFQ scores at four or 12 weeks. The initial VAS and MOXFQ scores of the PDRN group were not significantly different from those of the placebo group. At four weeks after treatment, the VAS and MOXFQ scores of the PDRN group were better than those of the placebo group, but the difference was not statistically significant. At 12 weeks after treatment, the VAS and MOXFQ scores of the PDRN group were significantly better than those of the placebo group. We noticed no injection-related complications, such as itching, urticaria, redness or infection signs around the injection site in either group. PDRN injection is an effective and safe treatment option and may be considered for plantar fasciitis.

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

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    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.

  7. Static progressive stretch brace as a treatment of pain and functional limitations associated with plantar fasciitis: a pilot study.

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    Sharma, Neena K; Loudon, Janice K

    2010-06-01

    Plantar fasciitis is a common and hard-to-treat disorder of the foot. Numerous studies have compared various stretching exercises, but the use of a day-wear static progressive stretch brace has not been studied. A randomized, single-blinded trial was conducted to compare the effectiveness of a static progressive stretch brace to standard care of active stretching exercises. Thirteen subjects (12 women and 1 man; mean age, 42 +/- 9.0 years) with plantar fasciitis participated in this study between January 2004 and March 2007. Subjects were randomized to either an exercise group (static stretch group, n = 8) or a brace group (static progressive stretch group, n = 9) for an 8-week treatment period and 1-month follow up. Both groups received basic off-the-shelf foot orthoses. Data were available for 7 subjects in the exercise group and 6 in the brace group. Pain and functional limitations were evaluated with the Foot Functional Index pain subscale, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and great toe extension motion. Overall pain and morning pain improved in both groups as compared with baseline measures (repeated-measures analysis of variance, P = .04 and P = .02, respectively). Functional rating also improved in both groups (repeated-measures analysis of variance, P = .005). No changes were found in either group with great toe extension range of motion. In addition, there was no significant group difference or interaction with time and group with any measures. Both interventions (static, exercise, and brace stretching) were beneficial for treating pain and functional limitations, suggesting that static progressive stretch brace is an effective alternative option to static stretching exercises for people with plantar fasciitis.

  8. 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/mm2, 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×VASscore])-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 Youden

  9. Description of a Rare Case of Nodular Fasciitis of the Apical Aspect of the Upper Buccal Sulcus

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    Ana Amélia Souza

    2016-01-01

    Full Text Available This report describes a rare case of nodular fasciitis (NF of the oral cavity, discussing the clinical, histological, and immunohistochemical characteristics. Histopathologic diagnosis of this type of lesion can be challenging due to its differential diagnosis, which principally includes sarcoma. The patient presented with a painless, well-defined nodule, reported as increasing in size, located at the apical aspect of the upper left buccal sulcus. Histologically, the lesion revealed spindle cell proliferation arranged in fascicles, while immunohistochemistry demonstrated positivity for smooth muscle actin. Eight months after complete surgical excision, no signs of local recurrence have been observed.

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

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    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.

  11. Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study.

    Science.gov (United States)

    Macias, David M; Coughlin, Michael J; Zang, Kerry; Stevens, Faustin R; Jastifer, James R; Doty, Jesse F

    2015-01-01

    Plantar fasciitis affects nearly 1 million persons in the United States at any one time. Conservative therapies have been reported to successfully treat 90% of plantar fasciitis cases; however, for the remaining cases, only invasive therapeutic solutions remain. This investigation studied newly emerging technology, low-level laser therapy. From September 2011 to June 2013, 69 subjects were enrolled in a placebo-controlled, randomized, double-blind, multicenter study that evaluated the clinical utility of low-level laser therapy for the treatment of unilateral chronic fasciitis. The volunteer participants were treated twice a week for 3 weeks for a total of 6 treatments and were evaluated at 5 separate time points: before the procedure and at weeks 1, 2, 3, 6, and 8. The pain rating was recorded using a visual analog scale, with 0 representing "no pain" and 100 representing "worst pain." Additionally, Doppler ultrasonography was performed on the plantar fascia to measure the fascial thickness before and after treatment. Study participants also completed the Foot Function Index. At the final follow-up visit, the group participants demonstrated a mean improvement in heel pain with a visual analog scale score of 29.6 ± 24.9 compared with the placebo subjects, who reported a mean improvement of 5.4 ± 16.0, a statistically significant difference (p plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial.

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    Eslamian, Fariba; Shakouri, Seyed Kazem; Jahanjoo, Fatemeh; Hajialiloo, Mehrzad; Notghi, Faraz

    2016-09-01

    Plantar fasciitis is a self-limiting condition, but can be painful and disabling. Among the different treatments which exist, corticosteroid injections are effective and popular. Extracorporeal shock wave therapy (ESWT) is another treatment modality used for resistant conditions. In this study, the authors evaluated the efficacy of radial ESWT versus corticosteroid injections in the treatment of chronic plantar fasciitis. Randomized clinical trial. Physical medicine and rehabilitation research center in a university hospital. Forty patients with plantar fasciitis who did not respond to conservative treatment. Patients were allocated to radial ESWT with 2000 shock waves/session of 0.2 mJ/mm(2) (n = 20) or local methylprednisolone injections (n = 20). Pain in the morning and during the day based on a visual analog scale (VAS), functional abilities using the foot function index (FFI), and satisfaction were evaluated before treatment and at 4 and 8 weeks after treatment. Patients (average age: 42.1± 8.20) received five sessions of ESWT or single steroid injection. Changes in the VAS in morning and during the day and the FFI throughout the study period were significant in both groups (P plantar fasciitis. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis--a feasibility study.

    Science.gov (United States)

    Zelen, Charles M; Poka, Attila; Andrews, James

    2013-10-01

    Specialized treatment of plantar fasciitis that can reduce inflammation and promote healing may be a possible alternative prior to surgical intervention. We report the results of a randomized clinical trial examining the efficacy of micronized dehydrated human amniotic/chorionic membrane (mDHACM) injection as a treatment for chronic refractory plantar fasciitis. An institutional review board-approved, prospective, randomized, single-center clinical trial was performed. Forty-five patients were randomized to receive injection of 2 cc 0.5% Marcaine plain, then either 1.25 cc saline (controls), 0.5 cc mDHACM, or 1.25 cc mDHACM. Follow-up visits occurred over 8 weeks to measure function, pain, and functional health and well-being. Significant improvement in plantar fasciitis symptoms was observed in patients receiving 0.5 cc or 1.25 cc mDHACM versus controls within 1 week of treatment and throughout the study period. At 1 week, American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scores increased by a mean of 2.2 ± 17.4 points for controls versus 38.7 ± 11.4 points for those receiving 0.5 cc mDHACM (P plantar fasciitis, mDHACM is a viable treatment option. Larger studies are needed to confirm our findings. Level I, prospective randomized study.

  14. A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial.

    Science.gov (United States)

    Konjen, Nipaporn; Napnark, Tapakorn; Janchai, Siriporn

    2015-01-01

    To compare the effectiveness ofradial extracorporeal shock wave therapy (rSWET) and ultrasound therapy (US) in the treatment of chronic plantar fasciitis. Randomized controlled trial. Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. Thirty patients who were diagnosed with plantar fasciitis for at least 3 months and who had not responded to other forms of conservative treatment were recruited for this study. They were randomly divided into two groups of 15 patients. The rESWT group was treated with 1 session per week and the US group with 3 sessions per week, with both groups undergoing a total of 6 consecutive weeks of treatment. Visual analog scale (VAS) assessments were performed before and after treatment at 1, 3, 6, 12, and 24 weeks. The mobility subscale of the plantar fasciitis pain and disability scale (PFPS) was measured before and after treatment. Patient satisfaction was evaluated at the conclusion of the 6-week treatment protocol. VAS pain intensity scores were significantly decreased in both groups (p plantar fasciitis treatment, both rESWT and US were found to be effective in reducing pain and increasing mobility; however, statistical analysis showed that rESWT is significantly more effective than US.

  15. Canine Streptococcal Toxic Shock Syndrome associated with Necrotizing Fasciitis: An Overview

    Directory of Open Access Journals (Sweden)

    Barkha Sharma

    2012-10-01

    Full Text Available Canine Toxic Shock Syndrome (CSTSS is a serious often fatal disease syndrome seen in dogs caused as a result of an infection caused by gram positive cocci of the family Streptococci. The main bacterium involved in the etiology of Canine Streptococcal Toxic Shock Syndrome is Streptoccoccus canis, which was discovered by Deveriese in 1986 and implicated as a cause of this disease syndrome in 1996 by Miller and Prescott. The clinical findings in this syndrome are very much similar to those seen in the infamous 'Toxic Shock 'caused by staphylococcal toxins in humans, especially females. Like in humans, the reason for emergence/reemergence of Canine Streptococcal Toxic Shock Syndrome (CSTSS is unclear and very little is known about its transmission and prevention. The disease is characterized by multi systemic organ failure and a shock like condition in seemingly healthy dog often following an injury. In absence of proper and prompt diagnosis and subsequent treatment by injectable antibiotics and aggressive shock therapy, dog often succumbs to the disease within a few hours. The dog may have some rigidity and muscle spasms or convulsions and a deep unproductive cough followed by haemorrhage from nasal and mouth along with melena. On necropsy, these dogs show severe edema of the gastrointestinal tract, congestion of multiple organs, severe pulmonary congestion and evidence of thrombo embolism. Necrotizing fasciitis is a localized form of streptococcal infection seen as extensive soft tissue sloughing and necrosis along the fascial planes. No vaccination is available so avoidance of the probable causal factors mainly participation in community events, estrus, change of environment and shipping is the only way to keep pet dogs away from this disease. [Vet. World 2012; 5(5.000: 311-319

  16. 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

  17. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis

    Science.gov (United States)

    Sun, Jiale; Gao, Fuqiang; Wang, Yanhua; Sun, Wei; Jiang, Baoguo; Li, Zirong

    2017-01-01

    Abstract Background: Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF. Methods: The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3. Results: Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97–3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI −0.01 to 2.03, P = .05, I2 = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49–3.16, P < .0001; OR 4.63, 95% CI 1.30–16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I2 = 81%, P = .005). Conclusion: This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions. PMID:28403111

  18. 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.

  19. 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.

  20. Fulminant Necrotizing Fasciitis of the Thigh, Following an Infection of the Sacro-iliac Joint in an Immunosuppressed, Young Woman.

    Science.gov (United States)

    Gothner, Martin; Dudda, Marcel; Kruppa, Christiane; Schildhauer, Thomas A; Swol, Justyna

    2015-09-28

    Necrotizing soft tissue infection of an extremity is a rare but life-threatening disease. The disease is an infection that involves the soft tissue layer and is characterized by rapidly spreading inflammation (especially of the fascial planes and the surrounding tissues) with a high mortality. Early diagnosis is essential for the outcome of the patients. Radical surgical debridement is the treatment of choice. The predisposing factors are immunosuppression, diabetes mellitus and drug abuse. This report presents a case of necrotizing fasciitis in the thigh, following an abscess of the sacro-iliac joint, as a rare complication in a young, immunosuppressed woman. The patient's history revealed intravenous drug abuse and hepatitis C. After immediate diagnosis by magnetic resonance imaging, radical surgical debridement was required and performed. Prior to soft tissue coverage with a split skin graft, five additional sequential debridements were necessary. During her hospital stay, the patient experienced further cerebral and pulmonary septic embolisms and an infection of the elbow. Six months after admission, the patient was discharged in good condition to a rehabilitation center. Necrotizing fasciitis is a life-threatening complication following an abscess of the sacro-iliac joint. Physicians must be vigilant to inflammatory signs and pain in immunosuppressed patients. An abscess of the sacro-iliac joint is rare, but complications of an untreated abscess can be fatal in these patients.

  1. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial.

    Science.gov (United States)

    Eftekharsadat, Bina; Babaei-Ghazani, Arash; Zeinolabedinzadeh, Vahideh

    2016-01-01

    This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis. During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients' plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension[ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis. The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (pdry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.

  2. An assessment of the application factor used to derive the saltwater acute ambient water quality copper criterion.

    Science.gov (United States)

    Arnold, W Ray; Cotsifas, Jeffrey S

    2008-04-01

    The basis for all US Environmental Protection Agency (USEPA) acute ambient water quality criteria is the chemical specific final acute value (FAV; an estimate of the concentration of the chemical corresponding to a cumulative probability of 0.05 of acute toxicity values for all genera with which acceptable acute tests have been conducted). The acute criterion for all chemicals is equal to the chemical's FAV divided by an application factor of 2. The intention of dividing the FAV by a factor of 2 is to convert the acute toxicity value to an incipient acute toxicity value, resulting in an acute criterion concentration that will protect against toxic effects to aquatic organisms. In the case of copper (Cu) in saltwater, the FAV is reduced from the normal 0.05 probability to equal to the genus mean acute value (GMAV; the geometric mean of copper effect concentration 50% [EC50] values) of the economically important marine bivalves of the genus Mytilus. Analyses to determine an application factor specific to Mytilus and copper were performed to assess the adequacy of the application factor of 2. An estimate of a dissolved copper application factor that is specific to and protective of Mytilus was determined using the results of sixty-four 48-h embryo survival and shell development copper toxicity tests of natural water samples collected from sites around the United States. A variety of point-estimate effects concentrations (EC1, EC5, EC10, EC20, and chronic values [ChV]) and statistical toxic-effect endpoints (no observed effect concentration [NOEC] and lowest observed effect concentration [LOEC]) were derived from the test results and compared. The most similar toxic effect endpoint estimates were EC1 approximately equal to NOEC, EC10 approximately equal to ChV, and EC20 approximately equal to LOEC. Probabilistic methods were used to determine a specific application factor with a high probability of providing protection. This analysis suggests that an application factor

  3. Variations of niacin content in saltwater fish and their relation with dietary RDA in Polish subjects grouped by age.

    Science.gov (United States)

    Majewski, Michał; Lebiedzińska, Anna

    2014-01-01

    A rich and natural source of readily assimilated dietary protein together with invaluable vitamins and minerals are fish, particularly the saltwater species. The quality of any given foodstuff is determined by its nutritional value, which in turn depends on the food type and methods used for manufacture, processing and storage. Many fish products contain fewer water soluble vitamins than the source foodstuff as a result of using various technologies during food processing, such as smoking or deep freezing, where vitamins are often either degraded or leached out. In the case of niacin it is relatively easy to make good such losses by eating niacin-rich foods or by taking dietary supplements e.g. the essential amino acid L-tryptophan. To determine niacin content in sea fish that are commonly available on the Polish market and to assess whether this dietary source is sufficient to satisfy the RDA requirements for various age groups of selected subjects living in Poland. Niacin levels were measured firstly in 10 saltwater fish species together with butterfish and Norwegian salmon that formed a separate group. Altogether, 15 types of fish products were analysed in all. They consisted of smoked fish: whitefish, butterfish, sprat, trout, herring (kippers) and mackerel, and frozen fish: butterfish, Norwegian salmon, sole, grenadier and panga. Each product was measured as ten replicates, thus in total 150 analyses were performed. A microbiologically-based method was used for the niacin determination, with enzyme hydrolysis by 40 mg papain and diastase on a 2 g sample (according to the AOAC procedure) to release the free form from the bioavailable form that is bound to NAD and NADP. The most plentiful sources of niacin were found in smoked fish with the highest amounts in butterfish, after warm temperature smoking, and in mackerel; respectively 9.03 and 8.90 mg/100 g. Such 100 g portions of smoked fish are a good dietary source of niacin, in that for men and women above 19

  4. 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.

  5. 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, Hillel; Buddemeier, Robert W.

    1998-08-01

    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.

  6. 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.

  7. 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.

  8. Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages.

    Science.gov (United States)

    Alameddine, Ibrahim; Jawhari, Gheeda; El-Fadel, Mutasem

    2017-04-01

    Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

  9. Effects of saltwater intrusion on pinewood vegetation using satellite ASTER data: the case study of Ravenna (Italy).

    Science.gov (United States)

    Barbarella, M; De Giglio, M; Greggio, N

    2015-04-01

    The San Vitale pinewood (Ravenna, Italy) is part of the remaining wooded areas within the southeastern Po Valley. Several studies demonstrated a widespread saltwater intrusion in the phreatic aquifer caused by natural and human factors in this area as the whole complex coastal system. Groundwater salinization affects soils and vegetation, which takes up water from the shallow aquifer. Changes in groundwater salinity induce variations of the leaf properties and vegetation cover, recognizable by satellite sensors as a response to different spectral bands. A procedure to identify stressed areas from satellite remote sensing data, reducing the expensive and time-consuming ground monitoring campaign, was developed. Multispectral Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) data, acquired between May 2005 and August 2005, were used to calculate Normalized Difference Vegetation Index (NDVI). Within the same vegetation type (thermophilic deciduous forest), the areas with the higher vegetation index were taken as reference to identify the most stressed areas using a statistical approach. To confirm the findings, a comparison was conducted using contemporary groundwater salinity data. The results were coherent in the areas with highest and lowest average NDVI values. Instead, to better understand the behavior of the intermediate areas, other parameters influencing vegetation (meteorological data, water table depth, and tree density) were added for the interpretation of the results.

  10. Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages

    Science.gov (United States)

    Alameddine, Ibrahim; Jawhari, Gheeda; El-Fadel, Mutasem

    2017-04-01

    Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

  11. Analysis of Tidal DC Resistivity Time Series for Periodic Saltwater Mixing Patterns and Determination of Hydraulic Ground Properties

    Science.gov (United States)

    Sutter, E. M.; Ingham, M.

    2016-12-01

    Saline intrusion research using geoelectrical time-lapse monitoring, is often directed towards imaging the saltwater-freshwater boundary and the amount of seawater mixing within a coastal aquifer. However, these time series can contain additional information about subsurface hydrologic properties like hydraulic conductivity and permeability which are crucial elements in coastal groundwater management. In this study, DC resistivity time series from tidal time-lapse monitoring surveys of a shallow coastal sand and gravel aquifer in New Zealand have been analysed for recurring patterns of percentage seawater mixing in different portions of the aquifer. The results show a distinctly different behaviour of percentage seawater change with time for several horizontal locations along two profile lines with varying depth. In addition, the geoelectric time series have been cross-correlated with tidal stage data approximated near the survey location in order to find portions of the aquifer that exhibit different time lags with respect to a diurnal tidal cycle. First results yield a remarkably similar picture to resistivity ratios obtained between high and low tide inversion models of the DC resistivity time series both at different locations and for different seasons. The two methods indicate a correlation between rising and falling tides and the resistivity changes observed from geoelectrical monitoring studies .This may be used to distinguish between more or less hydraulically conductive portions of a coastal aquifer.

  12. 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

  13. Negative pressure wound therapy in preseptal orbital cellulitis complicated with necrotizing fasciitis and preseptal abscess.

    Science.gov (United States)

    Contreras-Ruiz, José; Ramos-Cadena, Angeles; Solis-Arias, Patricia; Lozano-Platonoff, Adriana; Lopez-García, Lirio A; Contreras-Barrera, Martha E; Saenz-Corral, Claudia; de-la-Cruz-Garcia, Isabel; Cárdenas-Mejía, Alexander; Lopez-Oliver, Rubén

    2015-01-01

    Preseptal cellulitis (PC) may be locally complicated with abscess formation and necrotizing fasciitis. If not treated promptly and adequately, it may result in further complications. The authors report a series of patients where negative pressure wound therapy (NPWT) proved a safe and valuable adjunct therapy in avoiding complications of PC and in accelerating wound healing. A 4 patient case series. Four male patients (11 months to 58 years old) with unilateral complicated PC. Patients were admitted with PC and treated initially with specific intravenous antibiotic therapy. These patients did not respond adequately; therefore, surgical drainage and/or debridement were performed. After surgery, persistent edema and purulent discharge was observed prompting the need for adjunct NPWT every 48 to 72 hours. NPWT is the use of vacuum through a wound filler material covered with an airtight drape connected to a pump. Complete ophthalmologic examination was performed after each 48-hour cycle. Length of hospital stay, days from surgery to discharge, days from start of NPWT to discharge, clinical improvement, and safety. Four patients were diagnosed with PC between 2 and 5 days of evolution. Two diabetic adults developed the condition secondary to trauma, the adolescent as a result of a cosmetic piercing, and the infant associated to sinusitis. NPWT reached -125 mm·Hg, except for the infant who received -75 mm·Hg. The average number of days necessary for improvement with NPWT was 6.7 days. Only 2 patients required surgical reconstruction. Time from debridement to discharge was in average 13.5 days. No ocular complications were observed, and follow up was satisfactory with normal eyelid function and aesthetics and preserved visual acuity. NPWT proved to be safe and effective for treating locally complicated PC as an adjuvant therapy to antibiotic and surgical treatment that decreased the length of hospital stay, and the time for recovery in patients that were slow

  14. Consensus for dry needling for plantar heel pain (plantar fasciitis): a modified Delphi study.

    Science.gov (United States)

    Cotchett, Matthew P; Landorf, Karl B; Munteanu, Shannon E; Raspovic, Anita M

    2011-09-01

    Plantar heel pain (plantar fasciitis) is a common and disabling condition. A variety of treatment options are available to patients with plantar heel, however the evidence for these treatments is generally weak and the best way to manage plantar heel pain remains unclear. Trigger point dry needling is increasingly used as an adjunct therapy for musculoskeletal pain. In patients with plantar heel pain this technique is thought to improve muscle activation patterns, increase joint range of motion and alleviate pain. However, there have been no randomised controlled trials that have evaluated the effectiveness of dry needling for plantar heel pain. In order to develop a treatment protocol to evaluate the effectiveness of dry needling for plantar heel pain we conducted a three stage modified Delphi process using a web-based survey technique. Over a series of three iterations, 30 experts (participants) worldwide indicated their level of agreement on specific issues relating to the use of dry needling for plantar heel pain including their treatment rationale, needling details and treatment regimen. Consensus for a dry needling protocol for plantar heel pain was achieved when >60% of participants (IQR ≤ 1.0 category on 5-point Likert scale) agreed the protocol was adequate. The response rate was 75% (n=30), 100% (n=30) and 93% (n=28) in the first, second and third rounds respectively. Round 1 helped generate a list of 10 items that were deemed important for developing a dry needling protocol for plantar heel pain. These 10 items were subsequently presented in Round 2. Of these, 5 of the 10 items met the criteria to be included in a dry needling protocol for plantar heel pain that was presented in the final round, Round 3. Items that did not meet the criteria were either removed or amended and then presented in Round 3. In the final round, 93% of participants (IQR range = 1) agreed the proposed dry needling protocol for plantar heel pain was adequate. The protocol can

  15. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial.

    Science.gov (United States)

    Chew, Kelvin Tai Loon; Leong, Darren; Lin, Cindy Y; Lim, Kay Kiat; Tan, Benedict

    2013-12-01

    To evaluate the efficacy of autologous conditioned plasma (ACP) compared with extracorporeal shockwave (ESWT) and conventional treatments for plantar fasciitis. Randomized trial. Sports medicine center in a tertiary care hospital. Fifty-four subjects (age range, 29-71 years) with unilateral chronic plantar fasciitis with more than 4 months of symptoms. Subjects randomized to 3 groups: 19 to ACP and conventional treatment (ACP group), 19 to ESWT and conventional treatment (ESWT group), and 16 to conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated. Outcomes were pain-Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasound plantar fascia thickness assessed at baseline before treatment and at 1 month, 3 months, and 6 months after treatment. VAS, AOFAS ankle-hindfoot scale, and plantar fascia thickness improved in all groups. Significant VAS pain score improvements in the ACP group compared with conventional treatment at month 1 (P = .037) and for the ESWT group compared with conventional treatment at months 1, 3, and 6 (P = .017, P = .022, and P = .042). The AOFAS ankle-hindfoot scale score improved in the ACP group at months 3 and 6 (P = .004 and P = .013) and, for the ESWT group, at months 1 and 3 (P = .011 and P = .003) compared with conventional treatment. Significant improvements in plantar fascia thickness were seen in the ACP group at months 1 and 3 compared with conventional treatments (P = .015 and P = .014) and at months 3 and 6 compared with the ESWT group (P = .019 and P = .027). No adverse events reported. Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in improved pain and functional outcomes compared with conventional treatment alone. There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements, although the ACP group demonstrated greater

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

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    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

  17. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

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    Vincent Delliere

    2014-01-01

    Full Text Available We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.

  18. High Prevalence of Obesity and Female Gender Among Patients With Concomitant Tibialis Posterior Tendonitis and Plantar Fasciitis.

    Science.gov (United States)

    Reb, Christopher W; Schick, Faith A; Karanjia, Homyar N; Daniel, Joseph N

    2015-10-01

    The link between increased body weight and hindfoot complaints is largely based on correlation to single foot pathology. We retrospectively reviewed 6879 patients with tibialis posterior tendonitis (TPT), plantar fasciitis (PF), or both. Among patients with either TPT or PF, 1 in 11 (9%) had both. We then compared age, gender, and body mass index among these groups. Patients with both diagnoses were neither statistically older nor more obese than patients with single diagnoses. However, they were statistically more female. Given the overall high prevalence of obesity in the study population, we feel these data support the link between obesity and multiple foot pathology. Prognostic, Level IV: Case series. © 2015 The Author(s).

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

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    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.

  20. 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 (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.

  1. 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.

  2. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients.

    Science.gov (United States)

    Cottom, James M; Maker, Jared M; Richardson, Phillip; Baker, Joseph S

    2016-01-01

    Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Locally advanced adenocarcinoma of the rectum presenting with necrotising fasciitis of the perineum: successful management with early aggressive surgery and multimodal therapy.

    Science.gov (United States)

    Ferreira, Luís; Alexandrino, Henrique; Soares Leite, Júlio; Castro Sousa, Francisco

    2015-12-16

    Colorectal cancer is a common malignant neoplasm and its treatment usually involves surgery associated, in some cases, depending on the staging, with chemoradiotherapy. Necrotising fasciitis of the perineum is a highly lethal infection of the perineum, perirectal tissues and genitals, requiring emergency surgical debridement, broad-spectrum antibiotics and control of sepsis. We present the case of a 59-year-old man with necrotising fasciitis of the perineum as the first clinical manifestation of locally advanced adenocarcinoma of the rectum, in which successful management consisted of early and aggressive surgical debridement, followed by multimodal therapy with curative intent. 2 years and 6 months after surgery the patient is well, with no evidence of local or systemic relapse. 2015 BMJ Publishing Group Ltd.

  4. 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 (Psports 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.

  5. IMMEDIATE EFFECT OF THREE SOFT TISSUE MANIPULATION TECHNIQUES ON PAIN RESPONSE AND FLEXIBILITY IN CHRONIC PLANTAR FASCIITIS: A RANDOMIZED CLINICAL TRIAL

    OpenAIRE

    Pattanshetty, Renu B.; Amit S.Raikar

    2015-01-01

    Background and Objectives: Plantar fasciitis is a common foot disorder in which patients have pain and tenderness at the sole of the foot. Rest, exercises, orthotics, taping, cryotherapy, therapeutic ultrasound, electrical stimulation, whirlpool bath, and iontophoresis have been widely used to relieve plantar pain. Long term use of manual therapy techniques like myofascial release technique, positional release therapy and passive stretching have been used in the past to reduce pain and imp...

  6. A rare case of primary necrotising fasciitis of the breast: combined use of hyperbaric oxygen and negative pressure wound therapy to conserve the breast. Review of literature.

    Science.gov (United States)

    Marongiu, Francesco; Buggi, Federico; Mingozzi, Matteo; Curcio, Annalisa; Folli, Secondo

    2017-04-01

    Necrotising fasciitis is a rare but potentially fatal disease. It is even more unusual as a primary disease of the breast. Surgical treatment is required in order to gain control over the spreading infection and mastectomy is reported to be the most common procedure. We report the first case of an otherwise healthy woman exhibiting a primary necrotising fasciitis of the breast, which was treated combining conservative surgery with hyperbaric oxygen (HO) and negative pressure wound therapy (NPWT). A 39-year-old woman presented to the emergency room with fever and swelling of her right breast. The physical examination showed oedema and erythema of the breast, with bluish blisters on the lower quadrant. Ultrasound and CT scans showed diffuse oedema of the entire right breast, with subdermal gas bubbles extending to the fascial planes. Few hours later the necrotic area extended regardless an IV antibiotic therapy; a selective debridement of all breast necrotic tissue was performed and repeated 7 days later. The HO was started immediately after the first surgery and repeated daily (2·8 Bar, 120 min) for 18 days and then a NPWT (120-135 mmHg) was applied. Forty-five days after the last debridement, the breast wound was covered with a full-thickness skin graft. Several months later, an excellent cosmetic result was observed. This is the first case of primary necrotising fasciitis of the breast treated associating HO and NPWT to surgical debridement only; this combination resulted in a complete recovery with the additional benefit of breast conservation. Such result is discussed in light of the available literature on the treatment of primary necrotising fasciitis of the breast. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  7. Pulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study.

    Science.gov (United States)

    Osman, Ayman M; El-Hammady, Dina H; Kotb, Mohamed M

    2016-01-01

    Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations. To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency (TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantar fasciitis pain. Prospective comparative study. Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut University Hospital. Twenty patients with refractory chronic bilateral plantar fasciitis received PRF to the medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the other heel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking up from bed and after prolonged walking, and satisfaction score were used for assessment of studied patients at one, 3, 6, 12, and 24 weeks from the intervention. All studied patients showed significant improvement in their pain scale after the intervention that lasted for 24 weeks; however, the PRF heels had significantly better pain scale and satisfaction scores at the first and third weeks assessments when compared to the TRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3 weeks for the TRF (P plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial calcaneal nerve, plantar fasciitis, plantar aponeurosis, visual analogue scale.

  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. Necrotizing fasciitis with group A Streptococci and Eggerthella lenta as a complication of Varicella in a child – case presentation –

    Directory of Open Access Journals (Sweden)

    Claudia Cambrea Simona

    2014-02-01

    Full Text Available Necrotizing fasciitis is a life threatening condition that can be quickly spread through the flesh surrounding the muscle. The disease can be polymicrobial, or caused by group A beta hemolytic Streptococci, or by Clostridium spp. We present a case of a 7 years old girl, which was hospitalized in Children Infectious Diseases Department in a 7th day of chickenpox (hematic crusts all over the body, high fever, asthenia, vomiting, oligoanuria, and tumefaction, pain and functio lessa in the right thigh. In a very short time in the right thigh swelling, edema and congestion have increased gradually, and in the third highest middle thigh the ecchymotic areas appeared evolving towards bubbles and blisters which included the right thigh and calf. After excluding the diagnosis of thrombophlebitis was raised suspicion of necrotizing fasciitis. CT pelvic scan evidenced pelvic asymmetry by maximus and medium right gluteal muscles swelling with important inflammatory infiltrate extended laterally in the subcutaneous adipose tissue. In blood culture was isolated Eggerthella lenta, and from throat swab was isolated group A Streptococci. Treatment consists of a combination of antibiotics associated with intravenous immunoglobulin administration. Despite medical treatment evolution worsened and required transfer in a pediatric surgery department where emergent surgical debridement associated with intensive antibiotic therapy was done. After this intervention evolution was slowly favorable without major limb dysfunction. Polymicrobial necrotizing fasciitis is a severe disease, which if recognized early can have a

  10. Increased range of motion and function in an individual with breast cancer and necrotizing fasciitis-manual therapy and pulsed short-wave diathermy treatment.

    Science.gov (United States)

    Johnson, Wayne; Draper, David O

    2010-01-01

    Necrotizing fasciitis is a severe soft tissue infection of the subcutaneous tissue and fascia affecting those predisposed to immune system compromise. It is a life threatening condition; mortality can be reduced by rapid diagnosis, adequate early surgical debridement and antibiotic ointment. In this case report we present the use of manual therapy (MT) techniques, joint and soft tissue mobilization, following a regimen of pulsed short wave diathermy (PSWD) in the treatment of a woman 3 years post necrotizing fasciitis developed during chemotherapy treatment for breast cancer. During her course of chemotherapy, she developed necrotizing fasciitis which was treated with extensive surgical debridement (8 linear feet of incisions) followed by debridement to both hips and the pelvis area. When we started working with her, we put her on a course of PSWD/MT. After six weeks of following this regimen, she gained 25 degrees of external rotation in both her left and right hips, 15 degrees of left hip flexion and 17 degrees of right hip flexion. The patient gained 10 degrees of right hip extension, yet there was no improvement in left hip extension. The treatments led to a dramatic reduction in pain and scarring from previous surgeries. The patient also returned to running.

  11. Correlation between computerised findings and Newman's scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis

    Science.gov (United States)

    Chen, H; Ho, H M; Ying, M; Fu, S N

    2012-01-01

    Objectives The purpose of this study was to correlate findings on small vessel vascularity between computerised findings and Newman's scaling using power Doppler ultrasonography (PDU) imaging and its predictive value in patients with plantar fasciitis. Methods PDU was performed on 44 patients (age range 30–66 years; mean age 48 years) with plantar fasciitis and 46 healthy subjects (age range 18–61 years; mean age 36 years). The vascularity was quantified using ultrasound images by a customised software program and graded by Newman's grading scale. Vascular index (VI) was calculated from the software program as the ratio of the number of colour pixels to the total number of pixels within a standardised selected area of proximal plantar fascia. The 46 healthy subjects were examined on 2 occasions 7–10 days apart, and 18 of them were assessed by 2 examiners. Statistical analyses were performed using intraclass correlation coefficient and linear regression analysis. Results Good correlation was found between the averaged VI ratios and Newman's qualitative scale (ρ = 0.70; pplantar fascia, and can predict pain reduction after intervention. This index can be used to characterise the changes in vascularity of patients with plantar fasciitis, and it may also be helpful for evaluating treatment and monitoring the progress after intervention in future studies. PMID:22167513

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

    Science.gov (United States)

    Vahdatpour, Babak; Kianimehr, Lida; Moradi, Ahmad; Haghighat, Shila

    2016-01-01

    The present study aimed to clinically examine the effects of platelet-rich plasma (PRP) on improvement of plantar fasciitis and its related manifestations. This single-blind randomized controlled trial was performed on 32 consecutive patients with the final diagnosis of plantar fasciitis that were randomly assigned to the case group (that received PRP, n = 16) and the control group (that received corticosteroid as methylprednisolone 1 ml plus lidocaine 1 ml, n = 16). The endpoints in the present study were changes in the visual analog scale score and the modified Roles and Maudsley score (RMS) from baseline, 1-month, 3 months, and 6 months follow-up. Plantar fascia was also assessed by B-mode sonography before and also 3 months after primary assessment. Regarding the pain severity, the PRP group had significantly higher mean pain score at 3 time points of before injection, as well as 1 and 3 months after PRP use when compared to the corticosteroid group (P plantar fasciitis. This healing effect may be begun at least 3 months after injection.

  13. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report.

    Science.gov (United States)

    Shetty, Vijay D; Dhillon, Mandeep; Hegde, Chintan; Jagtap, Prajyot; Shetty, Suvin

    2014-03-01

    Plantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis. We undertook a prospective non-randomized study to compare the efficacy of traditional corticosteroid injection (Steroid group) to PRP injection (PRP group), in a cohort of patients. We studied both groups of patients before and after the injections using Visual Analogue Score (VAS), the Foot & Ankle Disability Index (FADI) and American Foot and Ankle Score (AFAS). Our study confirms that there is significant clinical improvement in PRP group at three months after the injection. The use of PRP injection can be an attractive alternative in the treatment of disabling, recalcitrant plantar fasciitis. Cohort study. Level 3. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  14. Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial.

    Science.gov (United States)

    Mardani-Kivi, Mohsen; Karimi Mobarakeh, Mahmoud; Hassanzadeh, Zabihallah; Mirbolook, Ahmadreza; Asadi, Kamran; Ettehad, Hossein; Hashemi-Motlagh, Keyvan; Saheb-Ekhtiari, Khashayar; Fallah-Alipour, Keyvan

    2015-01-01

    The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute (plantar fasciitis. Of the 116 eligible patients, 68 were randomized to 2 equal groups of 34 patients, each undergoing either ESWT or CSI. The ESWT method included 2000 impulses with energy of 0.15 mJ/mm(2) and a total energy flux density of 900 mJ/mm(2) for 3 consecutive sessions at 1-week intervals. In the CSI group, 40 mg of methyl prednisolone acetate plus 1 mL of lidocaine 2% was injected into the maximal tenderness point at the inframedial calcaneal tuberosity. The success and recurrence rates and pain intensity measured using the visual analog scale, were recorded and compared at the 3-month follow-up visit. The pain intensity had reduced significantly in all patients undergoing either technique. However, the value and trend of pain reduction in the CSI group was significantly greater than those in the ESWT group (p  .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial.

    Science.gov (United States)

    Kamonseki, Danilo H; Gonçalves, Geiseane A; Yi, Liu C; Júnior, Império Lombardi

    2016-06-01

    To compare the effect of stretching with and without muscle strengthening of the foot alone or foot and hip on pain and function in patients with plantar fasciitis. Single blind randomized controlled trial. Eighty-three patients with plantar fasciitis were allocated to one of three treatment options for an eight-week period: Foot Exercise Group (FEG - extrinsic and intrinsic foot muscles), Foot and Hip Exercise Group (FHEG - abductor and lateral rotator muscles) and Stretching Alone Exercise Group (SAEG). A visual analog scale for pain, the Foot and Ankle Outcome Score and the Star Excursion Balance Test. All evaluations were performed before treatment and after the last treatment session. Improvements were found in all groups regarding the visual analog scale, the pain, activities of daily living, sports and recreation, quality of life (p  0.05). All three exercise protocols analyzed led to improvements at eight-week follow-up in pain, function and dynamic lower limb stability in patients with plantar fasciitis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Lou, Jing; Wang, Shuai; Liu, Shuitao; Xing, Gengyan

    2017-08-01

    The objective of this meta-analysis was to investigate the efficacy of extracorporeal shock wave therapy in the treatment of recalcitrant plantar fasciitis without local anesthesia. The Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched from inception to September 2015 for randomized controlled trials comparing ESWT without local anesthesia versus placebo for treatment of plantar fasciitis in adults. The primary outcome was the 12-week post-intervention success rate of reducing the visual analog scale score by 60% from baseline at the first step in the morning, reducing the VAS score by 60% from baseline during daily activities, reducing the Roles and Maudsley score, reducing overall heel pain, and reducing pain after applying a force meter. Nine studies were included in the meta-analysis. Compared with placebo, ESWT significantly improved the success rate of reducing overall heel pain, reducing the VAS score by 60% at the first step in the morning and during daily activities, improving the Roles and Maudsley score to excellent or good, and reducing heel pain after application of a pressure meter. ESWT seems to be particularly effective in relieving pain associated with RPF. ESWT should be considered when traditional treatments have failed. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) understand the recovery rates for nonsurgical treatment of plantar fasciitis, (2) understand the role of extracorporeal shockwave therapy (ESWT) in the treatment of recalcitrant plantar fasciitis, and (3) understand the indications to incorporate ESWT in the treatment plan of recalcitrant plantar fasciitis. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of

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

    Science.gov (United States)

    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. 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; 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. A retrospective study of 22 patients with necrotising fasciitis treated at the University Clinical Center of Kosovo (2005-2010).

    Science.gov (United States)

    Arifi, Hysni M; Duci, Shkelzen B; Zatriqi, Violeta K; Ahmeti, Hasan R; Ismajli, Vildane H; Gashi, Musli M; Zejnullahu, Ylber M; Mekaj, Agon Y

    2013-08-01

    Necrotising fasciitis (NF) is a destructive invasive infection of skin, subcutaneous tissue and deep fascia. The aim of the study is to determine the causative agents of NF, its localisation, predisposing factors and comorbid conditions, duration of treatment and distribution of NF in different age groups and over the years. We conducted a retrospective study including 22 patients with NF from 2005 to 2010 in the University Clinical Center of Kosovo. The data were collected and analysed from the archives and protocols of the University Clinical Center of Kosovo. The average age of patients was 56·9 years. In eight cases or 36·4% of total patients studied, NF was caused by monobacterial agents with a predominance of Pseudomonas aeruginosa (five cases or 22·7% of total infections). Polybacterial agents were responsible for NF infection in other 14 cases (63·6%). Majority of the patients had other comorbidities like diabetes, trauma and prior history of surgical interventions. Diabetes was present in 17 patients or 77·3%. The remaining five patients (22·7%) had previous trauma and recent surgical intervention. Average length of treatment was 43 days. The hospital mortality rate in our case series was 22·6%. Early identification and diagnosis of NF significantly improves outcome and reduces mortality. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  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. [Necrotizing fasciitis, myositis, arthritis, and streptococcal toxic shock syndrome caused by group G Streptococcus. Report of one case].

    Science.gov (United States)

    Ayala-Gaytán, Juan Jacobo; Martínez-Vela, Ángel; Náñez-Terreros, Homero; Guajardo-Lara, Claudia Elena; Valdovinos-Chávez, Salvador Bruno

    2014-01-01

    Necrotizing fasciitis (NF), myositis, and streptococcal toxic shock syndrome (STSS) associated with group G ß-hemolytic streptococcus (GGS) occasionally coincide. We describe a case of GGS simultaneously occurring with NF, myositis, arthritis, and STSS in an 83-year-old woman with sequelae of cerebrovascular disease, hospitalized after two days of fever and with a painful swollen left foot. She was hypotensive, her foot had purplish discoloration, which showed blisters spreading to the lower third of the leg, and no crepitus was present. Fluid, vasopressive support, tigecyclin, and clindamycin were used. Debrided tissue and fluid aspirated from the knee joint revealed Gram-positive cocci. The patient developed renal and respiratory failure on the fifth day, requiring support. She underwent amputation above the knee of the left leg, after which her condition improved. She was discharged one month later. GGS can cause life-threatening infections such as NF, myositis, and/or STSS. GGS usually afflicts aging patients with comorbid states, and occasionally healthy subjects.

  5. Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study

    Science.gov (United States)

    Ribeiro, Ana Paula; João, Silvia Maria Amado; Dinato, Roberto Casanova; Tessutti, Vitor Daniel; Sacco, Isabel Camargo Neves

    2015-01-01

    Aim/Hypothesis The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage. Objective Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners. Methods Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20–80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (pplantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area. PMID:26375815

  6. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis.

    Science.gov (United States)

    Wu, Yung-Tsan; Chang, Chih-Ya; Chou, Yu-Ching; Yeh, Chun-Chang; Li, Tsung-Ying; Chu, Heng-Yi; Chen, Liang-Cheng

    2017-05-01

    To evaluate the therapeutic benefit of ultrasound-guided pulsed radiofrequency (PRF) stimulation at the posterior tibial nerve (PTN) in patients with recalcitrant plantar fasciitis (PF). A prospective, randomized, double-blinded, placebo-controlled trial (12-wk follow-up). Outpatient local medical center settings. Patients (N=36) with recalcitrant PF underwent randomization, and all were included in the final data analysis. Patients in the PRF group were treated with 1 dose of ultrasound-guided PRF stimulation at the PTN, and those in the control group received 1 dose of 2% lidocaine, 0.5mL, injected at the PTN under ultrasound guidance. The visual analog scale (first-step and overall pain), American Orthopedic Foot-Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasonographic thickness of the plantar fascia were evaluated at 1, 4, 8, and 12 weeks after treatment. Thirty-six patients (20 feet per group) completed the study. The PRF group had a significantly larger improvement in first-step pain, overall pain, and AOFAS score (all Pplantar fascia thickness (P<.05), compared with those of the control group at all observed time points. This study shows that ultrasound-guided PRF stimulation at the PTN is effective for treating recalcitrant PF. This simple, reproducible method could be a novel strategy for managing recalcitrant PF. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. A Case Report of Heel Pain Mimicking Plantar Fasciitis and Osteosarcoma: A Unique Presentation of a Nora's Lesion.

    Science.gov (United States)

    Rushing, Calvin J; Rogers, Diana E; Spinner, Steven M; Gajzer, David C

    Bizarre parosteal osteochondromatous proliferation, otherwise known as "Nora's lesion," is a rare benign neoplasm first described by Nora in 1983. The exact etiology of this neoplasm remains unknown, and its presentation in the lower extremity presents a diagnostic challenge, as both clinical and radiologic features cannot fully differentiate it from other neoplasms. We present the case of a 48-year-old female with plantar heel pain secondary to Nora's lesion mimicking plantar fasciitis and periosteal osteosarcoma. Following bone biopsy for histopathologic analysis, the patient's symptoms spontaneously resolved, and she returned to activity with complete resolution of symptoms 18 months post biopsy. Bizarre parosteal osteochondromatous proliferation as an etiology for plantar heel pain has not been previously described in the literature. Although rare, it should be considered in the differential diagnosis for patients presenting with plantar heel pain, especially after failed conservative treatment. Following diagnostic confirmation by histopathology, complete surgical excision is the treatment of choice. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Caridean Shrimps found in Land-Locked Saltwater Pools at four Indo-West Pacific Localities (Sinai Peninsula, Funafuti Atoll, Maui and Hawaii Islands), with the description of one new genus and four new species

    NARCIS (Netherlands)

    Holthuis, L.B.

    1973-01-01

    At several occasions red coloured caridean shrimps have been reported from tropical land-locked saltwater pools. These pools are situated at some distance from the sea, but, because the level of the water rises and falls with the tides, must have subterranean connections with the sea. The shrimps

  9. Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

    Science.gov (United States)

    Shah, Amit; Best, Alistair J; Rennie, Winston J

    2016-06-01

    Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (plantar fat pad by using a lateral heel approach. © 2016 by the American Institute of Ultrasound in Medicine.

  10. Dissolved Strontium and Barium in Fresh and Saltwater: a 2-year Study in the Calcasieu River to the Gulf of Mexico

    Science.gov (United States)

    He, S.; Xu, Y. J.

    2016-02-01

    Strontium and barium to calcium ratios are often used as proxies for tracking animal movement across salinity gradients. As sea level rise continues, many estuarine rivers face saltwater intrusion, which may cause changes in mobility and distribution of these metals upstream. Despite intensive research on metal adsorption and desorption in marine systems, knowledge of the spatiotemporal distribution of these elements along estuarine rivers is still limited. In this study, we conducted an intensive monitoring of Sr and Ba dynamics along an 88-km long estuary, the Calcasieu River, which has been strongly affected by saltwater intrusion. Over the period from May 2013 to July 2015, we collected monthly water samples and performed in-situ water quality measurements at six sites from the upstream to the river mouth. Water samples were analyzed for dissolved Sr, Ba, and Ca concentrations. In-situ measurements of salinity, pH, water temperature, dissolved oxygen concentration, and specific conductance were taken. Our preliminary data showed that the Sr and Ca concentrations and the Sr/Ca ratio all increased significantly with decreasing distance to the Gulf of Mexico, while the Ba/Ca ratio decreased with decreasing distance to the Gulf. The spatial variation in Ba concentration was marginal. The Sr and Ca concentrations and ratios were positively related to salinity, while Ba/Ca was negatively related to salinity. All the elemental concentrations and ratios had considerable seasonal and interannual variations. There were significant differences among sampling months for all the elemental concentrations and ratios (p<0.05), and there were significant differences among sampling years for the Sr and Ca concentrations and the Ba/Ca ratio (p<0.05).

  11. Changes in zooplankton community, and seston and zooplankton fatty acid profiles at the freshwater/saltwater interface of the Chowan River, North Carolina

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    Deborah A. Lichti

    2017-08-01

    Full Text Available The variability in zooplankton fatty acid composition may be an indicator of larval fish habitat quality as fatty acids are linked to fish larval growth and survival. We sampled an anadromous fish nursery, the Chowan River, during spring of 2013 in order to determine how the seston fatty acid composition varied in comparison with the zooplankton community composition and fatty acid composition during the period of anadromous larval fish residency. The seston fatty acid profiles showed no distinct pattern in relation to sampling time or location. The mesozooplankton community composition varied spatially and the fatty acid profiles were typical of freshwater species in April. The Chowan River experienced a saltwater intrusion event during May, which resulted in brackish water species dominating the zooplankton community and the fatty acid profile showed an increase in polyunsaturated fatty acids (PUFA, in particular eicosapentaenoic acid (EPA and docosahexaenoic acid (DHA. The saltwater intrusion event was followed by an influx of freshwater due to high precipitation levels in June. The zooplankton community composition once again became dominated by freshwater species and the fatty acid profiles shifted to reflect this change; however, EPA levels remained high, particularly in the lower river. We found correlations between the seston, microzooplankton and mesozooplankton fatty acid compositions. Salinity was the main factor correlated to the observed pattern in species composition, and fatty acid changes in the mesozooplankton. These data suggest that anadromous fish nursery habitat likely experiences considerable spatial variability in fatty acid profiles of zooplankton prey and that are correlated to seston community composition and hydrodynamic changes. Our results also suggest that sufficient prey density as well as a diverse fatty acid composition is present in the Chowan River to support larval fish production.

  12. Changes in zooplankton community, and seston and zooplankton fatty acid profiles at the freshwater/saltwater interface of the Chowan River, North Carolina.

    Science.gov (United States)

    Lichti, Deborah A; Rinchard, Jacques; Kimmel, David G

    2017-01-01

    The variability in zooplankton fatty acid composition may be an indicator of larval fish habitat quality as fatty acids are linked to fish larval growth and survival. We sampled an anadromous fish nursery, the Chowan River, during spring of 2013 in order to determine how the seston fatty acid composition varied in comparison with the zooplankton community composition and fatty acid composition during the period of anadromous larval fish residency. The seston fatty acid profiles showed no distinct pattern in relation to sampling time or location. The mesozooplankton community composition varied spatially and the fatty acid profiles were typical of freshwater species in April. The Chowan River experienced a saltwater intrusion event during May, which resulted in brackish water species dominating the zooplankton community and the fatty acid profile showed an increase in polyunsaturated fatty acids (PUFA), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The saltwater intrusion event was followed by an influx of freshwater due to high precipitation levels in June. The zooplankton community composition once again became dominated by freshwater species and the fatty acid profiles shifted to reflect this change; however, EPA levels remained high, particularly in the lower river. We found correlations between the seston, microzooplankton and mesozooplankton fatty acid compositions. Salinity was the main factor correlated to the observed pattern in species composition, and fatty acid changes in the mesozooplankton. These data suggest that anadromous fish nursery habitat likely experiences considerable spatial variability in fatty acid profiles of zooplankton prey and that are correlated to seston community composition and hydrodynamic changes. Our results also suggest that sufficient prey density as well as a diverse fatty acid composition is present in the Chowan River to support larval fish production.

  13. Salt-water encroachment, geology, and ground-water resources of Savannah area, Georgia and South Carolina

    Science.gov (United States)

    Counts, H.B.; Donsky, Ellis

    1964-01-01

    The Savannah area consists of about 2,300 square miles of the Coastal Plain along the coast of eastern Georgia and southeastern South Carolina. Savannah is near the center of the area. Most of the large ground-water developments are in or near Savannah. About 98 percent of the approximately 60 mgd of ground water used is pumped from the principal artesian aquifer, which is composed of about 600 feet of limestone of middle Eocene, Oligocene, and early Miocene ages. Industrial and other wells of large diameter yield as much as 4,200 gpm from the principal artesian aquifer. Pumping tests and flow-net analyses show that the coefficient of transmissibility averages about 200,000 gpd per ft in the immediate Savannah area. The specific capacity of wells in the principal artesian aquifer generally is about 50 gpm per ft of drawdown. The coefficient of storage of the principal artesian aquifer is about 0.0003 in the Savannah area. Underlying the Savannah area are a series of unconsolidated and semiconsolidated sediments ranging in age from Late Cretaceous to Recent. The Upper Cretaceous, Paleocene, and lower Eocene sediments supply readily available and usable water in other parts of the Coastal Plain, but although the character and physical properties of these formations are similar in the Savannah area to the same properties in other areas, the hydraulic and structural conditions appear to be different. Deep test wells are needed to evaluate the ground-water potential of these rocks. The lower part of the sediments of middle Eocene age acts as a confining layer to the vertical movement of water into or out of the principal artesian aquifer. Depending on the location and depth, the principal artesian aquifer consists of from one to five geologic units. The lower boundary of the aquifer is determined by a reduction in permeability and an increase in salt-water content. Although the entire limestone section is considered water bearing, most of the ground water used in the

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

    Science.gov (United States)

    Chiew, Seet Khing; Ramasamy, Thamil Selvee; Amini, Farahnaz

    2016-01-01

    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. PMID:27904584

  15. Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Ana Paula Ribeiro

    Full Text Available The etiology of plantar fasciitis (PF has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage.Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners.Forty-five runners with unilateral PF (30 acute and 15 chronic and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20-80% of the first vertical peak was calculated. Groups were compared by ANOVAs (p<0.05.Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic compared with controls (p<0.01. Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01.Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic. In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area.

  16. Necrotizing fasciitis in a newborn infant: a case report Fasciíte necrosante em neonato: relato de caso

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Jornada Krebs

    2001-04-01

    Full Text Available We report the case of a one-day-old newborn infant, female, birth weight 1900 g, gestational age 36 weeks presenting with necrotizing fasciitis caused by E. coli and Morganella morganii. The newborn was allowed to fall into the toilet bowl during a domestic delivery. The initial lesion was observed at 24 hours of life on the left leg at the site of the venipuncture for the administration of hypertonic glucose solution. Despite early treatment, a rapid progression occurred resulting in a fatal outcome. We call attention to the risk presented by this serious complication in newborns with a contaminated delivery, and highlight the site of the lesion and causal agents.Os autores relatam o caso de um recém-nascido com um dia de vida, sexo feminino, com peso de nascimento de 1900g e idade gestacional de 36 semanas que apresentou fasciíte necrosante causada por E. coli e Morganella morganii. O parto foi domiciliar, com queda acidental no vaso sanitário durante o nascimento. A lesão inicial foi observada com 24 horas de vida, na perna esquerda em local de venopunção para a administração de solução de glicose hipertônica. Apesar do tratamento precoce, houve progressão rápida, com evolução fatal. Os autores chamam a atenção para o risco desta complicação grave em recém-nascido de parto contaminado, destacando o local da lesão e os agentes etiológicos.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. Platelet-rich plasma as a treatment for plantar fasciitis: A meta-analysis of randomized controlled trials.

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    Yang, Wei-Yi; Han, Yan-Hong; Cao, Xue-Wei; Pan, Jian-Ke; Zeng, Ling-Feng; Lin, Jiong-Tong; Liu, Jun

    2017-11-01

    Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF compared with the efficacy and safety of steroid treatments. Databases (PubMed, EMBASE, and The Cochrane Library) were searched from their establishment to January 30, 2017, for randomized controlled trials (RCTs) comparing PRP with steroid injections as treatments for PF. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were the visual analogue scale (VAS), Foot and Ankle Disability Index (FADI), American Orthopedic Foot and Ankle Society (AOFAS) scale, and the Roles and Maudsley score (RMS). The statistical analysis was performed with RevMan 5.3.5 software. Nine RCTs (n = 430) were included in this meta-analysis. Significant differences in the VAS were not observed between the 2 groups after 4 [weighted mean difference (WMD) = 0.56, 95% confidence interval (95% CI): -1.10 to 2.23, P = .51, I = 89%] or 12 weeks of treatment (WMD = -0.49, 95% CI: -1.42 to 0.44, P = .30, I = 89%). However, PRP exhibited better efficacy than the steroid treatment after 24 weeks (WMD = -0.95, 95% CI: -1.80 to -0.11, P = .03, I = 85%). Moreover, no significant differences in the FADI, AOFAS, and RMS were observed between the 2 therapies (P > .05). Limited evidence supports the conclusion that PRP is superior to steroid treatments for long-term pain relief; however, significant differences were not observed between short and intermediate effects. Because of the small sample size and the limited number of high-quality RCTs, additional high-quality RCTs with larger sample sizes are required to validate this result.

  3. 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.

  4. 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.

  5. 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

    Science.gov (United States)

    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.

  6. 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.

  7. 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.

  8. 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.

  9. Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: a network meta-analysis.

    Science.gov (United States)

    Hsiao, Ming-Yen; Hung, Chen-Yu; Chang, Ke-Vin; Chien, Kuo-Liong; Tu, Yu-Kang; Wang, Tyng-Guey

    2015-09-01

    To compare the efficacy of autologous blood-derived products (ABPs), CSs and shock-wave (SW) therapy in the treatment of plantar fasciitis. Electronic databases were searched for studies that compared ABPs, CSs and SW therapy for the treatment of plantar fasciitis, published up to June 2014. The primary and secondary outcomes were reduction in visual analogue scale (VAS) score at 3 and 6 months and odds ratio of treatment success, respectively. Groups were compared by traditional pair-wise meta-analysis and by network meta-analysis. Seven randomized controlled trials and three quasi-experimental studies that included 604 patients were enrolled. Pair-wise meta-analysis indicated a trend favouring ABPs over CSs regarding VAS reduction at 3 months; this benefit was significant in a subgroup analysis of platelet-rich plasma (PRP) vs CSs. There were no significant between-group differences in VAS reduction at 6 months and in treatment success. Network meta-analysis showed that ABPs had the highest probability of being the best treatment at 3 months, but ABPs were slightly inferior to SW for VAS reduction at 6 months. Although SW therapy had the highest likelihood of treatment success, the between-group differences in probabilities were less remarkable than those for pain reduction at 3 and 6 months. ABPs, followed by CSs, were best in providing relief from pain at 3 months. SW therapy and ABPs had similar probabilities of providing pain relief at 6 months, and were better than CSs at that time. Subgroup analysis indicated that an ABP regimen consisting of platelet-rich plasma improves treatment efficacy. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Physical examination variables predict response to conservative treatment of non-chronic plantar fasciitis: Secondary analysis of a randomized placebo controlled footwear study

    Science.gov (United States)

    Matzkin-Bridger, Jonathon; Fascione, Jeanna; Crews, Ryan; Bruning, Nicholas; Jarrett, Beth

    2016-01-01

    Background Plantar fasciitis is a common disabling condition and the prognosis of conservative treatment is difficult to predict. Objective To determine whether initial clinical findings could help predict patient response to conservative treatment primarily consisting of supportive footwear and stretching. Setting Patients were recruited and seen at two outpatient podiatric clinics in the Chicago, Illinois metropolitan area. Patients Seventy-seven patients with non-chronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous six months or were currently utilizing custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit three months after receiving the footwear intervention. Methods Treatment failure was considered a <50% reduction in heel pain at three month follow23 Logistic regression models evaluated the possible association between over thirty clinical and physical exam findings prospectively assessed at enrollment, and treatment response. Results Inability to dorsiflex the ankle past −5° (OR 27 3.9, p=.024), non-severe (≤ 7 on ordinal scale) first-step pain (OR 3.8, p=.021), and heel valgus in relaxed stance (OR 4.0, p=.014) each predicted treatment failure in multivariable analysis (Receiver operating characteristic area under the curve=.769). Limited ankle dorsiflexion also correlated with higher heel pain severity at initial presentation (r = −.312, p =.006). Conclusions Patients with severe ankle equinus were nearly four times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive as patients with less severe equinus and less severe pain at presentation did worse with

  11. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

    Science.gov (United States)

    Rathleff, M S; Mølgaard, C M; Fredberg, U; Kaalund, S; Andersen, K B; Jensen, T T; Aaskov, S; Olesen, J L

    2015-06-01

    The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Saltwater ecotoxicology of Ag, Au, CuO, TiO2, ZnO and C60 engineered nanoparticles: An overview.

    Science.gov (United States)

    Minetto, D; Volpi Ghirardini, A; Libralato, G

    2016-01-01

    This review paper examined 529 papers reporting experimental nanoecotoxicological original data. Only 126 papers referred to saltwater environments (water column and sediment) including a huge variety of species (n=51), their relative endpoints and engineered nanoparticles (ENPs) (n=38). We tried to provide a synthetic overview of the ecotoxicological effects of ENPs from existing data, refining papers on the basis of cross-cutting selection criteria and supporting a "mind the gap" approach stressing on missing data for hazard and risk assessment. After a codified selection procedure, attention was paid to Ag, Au, CuO, TiO2, ZnO and C60 ENPs, evidencing and comparing the observed nanoecotoxicity range of effect. Several criticisms were evidenced: i) some model organisms are overexploited like microalgae and molluscs compared to annelids, echinoderms and fish; ii) underexploited model organisms: mainly bacteria and fish; iii) exposure scenario variability: high species-specific and ENP scenarios including organism life stage and way of administration/spiking of toxicants; iv) scarce comparability between results due to exposure scenario variability; v) micro- and mesocosms substantially unexplored; vi) mixture effects: few examples are available only for ENPs and traditional pollutants; mixtures of ENPs have not been investigated yet; vii) effects of ions and ENPs: nAg, nCuO and nZnO toxicity aetiology is still a matter of discussion; viii) size and morphology effects of ENPs: scarcely investigated, justified and understood. Toxicity results evidenced that: nAu>nZnO>nAg>nCuO>nTiO2>C60. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. 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

  14. Diagnosing and Reconstructing Real-World Hydroclimatic Dynamics from Time Sequenced Data: The Case of Saltwater Intrusion into Coastal Wetlands in Everglades National Park

    Science.gov (United States)

    Huffaker, R.; Munoz-Carpena, R.

    2016-12-01

    There are increasing calls to audit decision-support models used for environmental policy to ensure that they correspond with the reality facing policy makers. Modelers can establish correspondence by providing empirical evidence of real-world dynamic behavior that their models skillfully simulate. We present a pre-modeling diagnostic framework—based on nonlinear dynamic analysis—for detecting and reconstructing real-world environmental dynamics from observed time-sequenced data. Phenomenological (data-driven) modeling—based on machine learning regression techniques—extracts a set of ordinary differential equations governing empirically-diagnosed system dynamics from a single time series, or from multiple time series on causally-interacting variables. We apply the framework to investigate saltwater intrusion into coastal wetlands in Everglades National Park, Florida, USA. We test the following hypotheses posed in the literature linking regional hydrologic variables with global climatic teleconnections: (1) Sea level in Florida Bay drives well level and well salinity in the coastal Everglades; (2) Atlantic Multidecadal Oscillation (AMO) drives sea level, well level and well salinity; and (3) AMO and (El Niño Southern Oscillation) ENSO bi-causally interact. The thinking is that salt water intrusion links ocean-surface salinity with salinity of inland water sources, and sea level with inland water; that AMO and ENSO share a teleconnective relationship (perhaps through the atmosphere); and that AMO and ENSO both influence inland precipitation and thus well levels. Our results support these hypotheses, and we successfully construct a parsimonious phenomenological model that reproduces diagnosed nonlinear dynamics and system interactions. We propose that reconstructed data dynamics be used, along with other expert information, as a rigorous benchmark to guide specification and testing of hydrologic decision support models corresponding with real-world behavior.

  15. 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

  16. MRI of plantar fasciitis

    Energy Technology Data Exchange (ETDEWEB)

    Roger, B.; Grenier, P. [Service de Radiologie Polyvalente Diagnostique et Interventionelle, Hopital de la Pitie, 83, boulevard de l`Hopital, F-75651 Paris Cedex 13 (France)

    1997-12-01

    At present, MRI is the only imaging method that can precisely visualize lesions of the superficial plantar aponeurosis, whether they be musculoaponeurositides, enthesopathies or tears, and whether they be acute or chronic, with or without complications. By its direct visualization of the lesion, MRI enables an accurate assessment of the injury to be made and thereby better orients the therapeutic strategy. (orig.) With 11 figs., 15 refs.

  17. A bacterial artificial chromosome library for the Australian saltwater crocodile (Crocodylus porosus) and its utilization in gene isolation and genome characterization.

    Science.gov (United States)

    Shan, Xueyan; Ray, David A; Bunge, John A; Peterson, Daniel G

    2009-07-14

    Crocodilians (Order Crocodylia) are an ancient vertebrate group of tremendous ecological, social, and evolutionary importance. They are the only extant reptilian members of Archosauria, a monophyletic group that also includes birds, dinosaurs, and pterosaurs. Consequently, crocodilian genomes represent a gateway through which the molecular evolution of avian lineages can be explored. To facilitate comparative genomics within Crocodylia and between crocodilians and other archosaurs, we have constructed a bacterial artificial chromosome (BAC) library for the Australian saltwater crocodile, Crocodylus porosus. This is the first BAC library for a crocodile and only the second BAC resource for a crocodilian. The C. porosus BAC library consists of 101,760 individually archived clones stored in 384-well microtiter plates. NotI digestion of random clones indicates an average insert size of 102 kb. Based on a genome size estimate of 2778 Mb, the library affords 3.7 fold (3.7x) coverage of the C. porosus genome. To investigate the utility of the library in studying sequence distribution, probes derived from CR1a and CR1b, two crocodilian CR1-like retrotransposon subfamilies, were hybridized to C. porosus macroarrays. The results indicate that there are a minimum of 20,000 CR1a/b elements in C. porosus and that their distribution throughout the genome is decidedly non-random. To demonstrate the utility of the library in gene isolation, we probed the C. porosus macroarrays with an overgo designed from a C-mos (oocyte maturation factor) partial cDNA. A BAC containing C-mos was identified and the C-mos locus was sequenced. Nucleotide and amino acid sequence alignment of the C. porosus C-mos coding sequence with avian and reptilian C-mos orthologs reveals greater sequence similarity between C. porosus and birds (specifically chicken and zebra finch) than between C. porosus and squamates (green anole). We have demonstrated the utility of the Crocodylus porosus BAC library as a

  18. 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

  19. 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.

  20. Ultra-som contínuo no tratamento da fasciíte plantar crônica Continuous ultrasound for chronic plantar fasciitis treatment

    Directory of Open Access Journals (Sweden)

    Renata Graciele Zanon

    2006-01-01

    Full Text Available Neste trabalho avaliou-se a eficácia do ultra-som contínuo e alta intensidade como tratamento na fasciíte plantar. Foram avaliadas 22 pessoas, com dor a mais de seis meses, através de questionário funcional e escala visual para a dor no primeiro apoio matinal. Vinte e sete pés foram distribuídos nos grupos: grupo 1 (alongamento + ultra-som desligado e grupo 2 (alongamento + ultra-som 2 w/cm². Após 15 sessões de tratamento, foi realizada análise dos valores absolutos e das porcentagens de melhora das variáveis coletadas. Houve melhora funcional para os dois grupos, sem diferença entre eles. A análise dos valores absolutos de intensidade de dor (primeira, oitava e última sessão mostrou semelhança entre os grupos. A porcentagem de melhora nas 15 sessões não apresentou diferença entre os grupos. Esta porcentagem também foi calculada para dois períodos (antes e após a oitava sessão. Notou-se que a porcentagem de melhora das 15 sessões do grupo2 (46,5% foi inferior à porcentagem das oito primeiras sessões do grupo1 (54,6%. Portanto, o ultra-som contínuo com alta intensidade não acrescentou ganhos em relação à função e à dor; além disso, apenas a realização de alongamentos específicos foi eficaz para a redução de mais de 50% da dor na fasciíte plantar crônica.In this study, the efficiency of continuous high-power ultrasound was assessed for plantar fasciitis treatment. Twenty two individuals were assessed, reporting pain lasting more than six months, through a functional questionnaire and visual scale for pain at the first morning load. Twenty seven feet were distributed into two groups: group 1 (stretching + ultrasound turned off and group 2 (stretching + 2 w/cm² ultrasound. After 15 treatment sessions, an analysis of the absolute values and improvement percentages for collected variables was performed. A functional improvement was seen for both groups, with no difference between them. The analysis of the

  1. 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.

  2. 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

  3. 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

  4. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Ana P. Ribeiro

    2016-02-01

    Full Text Available 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 (R2=0.15 for acute phase PF; R2=0.17 for chronic PF and maximum force (R2=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 (R2=0.18 and chronic (R2=0.45. The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R2=0.19 and chronic (R2=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.

  5. 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

  6. 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

  7. 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.

  8. Label-free proteomic analysis of environmental acidification-influenced Streptococcus pyogenes secretome reveals a novel acid-induced protein histidine triad protein A (HtpA) involved in necrotizing fasciitis.

    Science.gov (United States)

    Wen, Yao-Tseng; Wang, Jie-Siou; Tsai, Shu-Han; Chuan, Chiang-Ni; Wu, Jiunn-Jong; Liao, Pao-Chi

    2014-09-23

    Streptococcus pyogenes is responsible for various diseases. During infection, bacteria must adapt to adverse environments, such as the acidic environment. Acidic stimuli may stimulate S. pyogenes to invade into deeper tissue. However, how this acidic stimulus causes S. pyogenes to manipulate its secretome for facilitating invasion remains unclear. The dynamic label-free LC-MS/MS profiling identified 97 proteins, which are influenced by environmental acidification. Among these, 33 (34%) of the identified proteins were predicted to be extracellular proteins. Interestingly, classical secretory proteins comprise approximately 90% of protein abundance of the secretome in acidic condition at the stationary phase. One acid-induced secreted protein, HtpA, was selected to investigate its role in invasive infection. The mouse infected by the htpA deficient mutant showed lower virulence and smaller lesion area than the wild-type strain. The mutant strain was more efficiently cleared at infected skin than the wild-type strain. Besides, the relative phagocytosis resistance is lower in the mutant strain than in the wild-type strain. These data indicate that a novel acid-induced virulence factor, HtpA, which improves anti-phagocytosis ability for causing necrotizing fasciitis. Our investigation provides vital information for documenting the broad influences and mechanisms underlying the invasive behavior of S. pyogenes in an acidified environment. The acidified infected environment may facilitate S. pyogenes invasion from the mucosa to the deeper subepithelial tissue. The acid stimuli have been considered to affect the complex regulatory network of S. pyogenes for causing severe infections. Many of secreted virulence factors influenced by acidified environment may also play a crucial role in pathogenesis of invasive disease. To investigate temporal secretome changes under acidic environment, a comparative secretomics approach using label-free LC-MS/MS was undertaken to analyze

  9. 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.

  10. 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.

  11. 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.

  12. 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.

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

    African Journals Online (AJOL)

    Nigerian Journal of Clinical Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 19, No 3 (2016) >. Log in or Register to get access to full text downloads.

  14. Odontogenic cervical necrotizing fasciitis, etiological aspects

    African Journals Online (AJOL)

    2015-06-26

    Jun 26, 2015 ... Facultatively aerobic G+. Anaerobic. G−. Facultatively aerobic G− and facultatively aerobic G+. Total number of subjects. B. fragilis (1×1). 0. 0. 1. 0. 1. G + cocci + G − cocci (n×1). 0. 0. 0. 1. 1. E. cloacae (1×1). 1. 0. 0. 0. 1. E. faecalis + S. epidermidis + A. baumannii (3×1). 1. 2. 0. 0. 1. E. faecium (1×1). 0. 1. 0.

  15. Munchausen's syndrome--masquerading as necrotizing fasciitis.

    Science.gov (United States)

    Park, A J; Scerri, G V

    1996-03-01

    We would like to present a novel form of Munchausen's syndrome which presented us with a difficult problem in the midst of the recent media hysteria regarding flesh eating bacteria. This condition, first described by Richard Asher in 1951, is often very difficult to diagnose and it is not, therefore, surprising that the victims have been through several episodes of treatment before the suspicions of staff are raised. It owes its name to a fictitious character, Baron Karl Friedrich Hieronymus Freihess von Munchausen, who recounted extraordinary and wildly exaggerated exploits of adventure and daring, not unlike patients who present with this condition. Our enquiries revealed that the laid down procedure when faced with a patient with this condition is that the regional medical officer (RMO) should be contacted. It is then his responsibility to contact other RMOs, who in turn pass the information on to accident and emergency consultants in their area.

  16. 76 FR 37064 - National Saltwater Angler Registry Program

    Science.gov (United States)

    2011-06-24

    ... catch and effort data from a qualifying regional survey of recreational fishing, and enter into a... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE... as exempted states for anglers, spear fishers and for-hire fishing vessels. DATES: The designation of...

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

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

    , whether due to climate change (sea level rise, changes in groundwater recharge rates) or known factors (population growth and associated increases in water extraction rates), and the relative importance of each. They will combine this ...

  18. 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 ...

  19. Unusual presentation of necrotizing fasciitis in an HIV exposed infant

    African Journals Online (AJOL)

    Prof Ezechukwu

    the virus, thereby leading to immunodeficiency. HIV is the leading cause of childhood immunodeficiency in Nigeria . Although the role of immunodeficiency as a contributing factor in NF has been previously documented, this has been in the context of chicken pox , measles and acute lymphoblastic leukaemia . This is to our.

  20. Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy

    Science.gov (United States)

    ... fight infection. Some of these conditions include: Diabetes Kidney disease Cancer Other chronic health conditions that weaken the body’s immune system Symptoms Start Quickly, But Can Often Be Confusing People ...