BackgroundNecrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier’s gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease.MethodsWe conducted a retrospective study in patients who presented, during the last decade, at four University Surgical Departments in the area of Athens, Greece, with an admission diagnosis of NF. Demographic, clinical, and laboratory data were gathered, and the preoperative and surgical treatment, as well as the postoperative treatment was analyzed for these patients.ResultsA total of 62 patients were included in the study. The mean age of patients was 63.7 (47 male patients). Advanced age (over 65 years) (P < 0.01) and female sex (P = 0.04) correlated significantly with mortality. Perineum was the mostly infected site (46.8%), followed by the lower limbs (35.5%), the upper limbs, and the axillary region (8.1%). Diabetes mellitus was the most common coexisting disease (40.3%), followed by hypertension (25.8%) and obesity (17.7%). The most common symptom was local pain and tenderness (90.3%). Septic shock occurred in eight patients (12.9%) and strongly correlated with mortality (P < 0.01). Laboratory data were used to calculate the LRINEC score of every patient retrospectively; 26 patients (41.9%) had LRINEC score under 6, 20 patients (32.3%) had LRINEC score 6–8, and 16 patients (25.8%) had LRINEC score >9. Surgical debridement was performed in all patients (mean number of repeated debridement 4.8), and in 16 cases (25.8%) the infected limb was amputated. The mean length of hospital stay was 19.7 days, and the overall mortality rate of our series was 17.7%.ConclusionDiagnosis of NF requires high suspect among clinicians, as its clinical image is non-specific. Laboratory tests can depict the severity of the disease; therefore, they must be carefully evaluated. Urgent surgical debridement is the mainstay of treatment in all patients; the need of repetitive surgical debridement is undisputed.

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Mucinous cystic neoplasms (MCNs) of the pancreas represent one of the most common primary pancreatic cystic neoplasms, accounting for approximately half of these cases. MCNs are observed almost exclusively in women, and most commonly are located in the body/tail of the pancreas. In contrast to SCNs, MCNs have malignant potential. Proliferative changes (hyperplasia with or without atypia, borderline changes, non-invasive or carcinomas in-situ, and invasive carcinomas) can often be observed within the same neoplasm. Several risk factors for the presence of underlying malignancy within an MCN have recently been recognized. Cross-sectional imaging is of key importance for the diagnostic evaluation of patients with a cystic pancreatic lesion. Cyst fluid examination (cytology, biochemical/genetic analysis) is possible by using fine needle aspiration of the MCN, usually under endoscopic guidance, and may provide useful information for the differential diagnosis. Since MCNs have malignant potential, surgical resection is the treatment of choice.

Arterial conduits that use donor iliac arteries represent a reliable technique for graft revascularization in orthotopic liver transplantation. We reviewed 757 consecutive liver transplantations performed between 1989 and 1995 for acute or chronic liver disease in adults and children. Of these, 218 patients received arterial conduits that used donor iliac arteries. The incidence of hepatic artery thrombosis (HAT) for conduits was 4.1% (9 of 218 patients) compared with 4% (22 of 539 patients) for direct arterial anastomosis. Patients in the arterial conduit group included 66% (99 of 159) of the children younger than 5 years of age, 75% (67 of 89) of all patients who underwent retransplantation, and, in particular, 25 patients regrafted for HAT. Arterial conduits provide an effective and reliable method of revascularization in patients at higher risk of arterial thrombosis. The actuarial 3-year patency rate for conduits is 95% and the incidence of HAT is similar to that in standard arterial anastomoses. Copyright 1998 by the American Association for the Study of Liver DiseasesH epatic artery thrombosis (HAT) remains an important cause of graft loss after liver transplantation. 1,2 Because the potential collateral supply to the graft is severed at the time of hepatectomy, the transplanted liver is particularly dependent on the arterial blood flow and HAT leads to retransplantation in up to 75% of patients, with a mortality rate approaching 50%. 3 Arterial conduits that use donor iliac arteries were developed to overcome arterial inflow problems, 4-6 and we have reviewed our experience with the use of this technique. MethodsWe reviewed 757 consecutive orthotopic liver transplantations (OLTs) performed between January 1989 and December 1995 for acute or chronic liver disease in adults and children. Of these, 218 grafts were revascularized by means of donor iliac artery anastomosed to the infrarenal aorta. These conduits were prepared from donor iliac arteries, occasionally from splenic artery, and exceptionally from saphenous vein, the latter being used for the initial living related liver transplantations. The common iliac arteries were retrieved at the end of the donor operation, carefully avoiding excessive traction to reduce the risk of intimal damage, and were stored in University of Wisconsin solution at 4°C.Whenever possible, iliac arteries from the same donors were used to construct the infrarenal conduit. Occasionally, these were unsuitable because of atherosclerosis or intimal damage, and we used the most recently retrieved ABO group-compatible vessels.The vascular grafts were prepared on the back table just before use and subsequently anastomosed to the infrarenal aorta, which was side-clamped by means of either an interrupted or a continuous 5/0 or 6/0 polypropylene suture. The graft was brought to the lesser sac through the transverse mesocolon, behind the stomach and in front of the pancreas. The distal end was subsequently anastomosed to the common hepatic artery or to the celiac trunk of the donor wit...

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