Necrotising fasciitis is a clinical spectrum of disease. It affects a wide age group and can have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in the management of the entire spectrum of necrotising fasciitis.

Summary and conclusionsThe value of fibrinolytic enhancement with an anabolic steroid (stanozolol) combined with elastic stockings in treating venous lipodermatosclerosis was assessed in a six-month double-blind cross-over trial. Thirty-four legs of 23 patients in whom other treatments had failed were studied. The patients were randomly divided into two groups who were treated with either stanozolol plus elastic stockings or placebo plus elastic stockings for three months, and then vice versa. Treatment with or without stanozolol caused the area of lipodermatosclerosis to decrease, but the rate of healing when patients took stanozolol was double that when they took the placebo, and this was assumed to be biologically important. Stanozolol also reduced the incidence of extravascular fibrin detected in skin biopsy specimens. The elastic stockings with placebo produced significant decreases in leg volume, ankle circumference, and skin thickness.Stanozolol is valuable in treating intractable lipodermatosclerosis, giving relief of pain and reducing induration, inflammation, tenderness, and pigmentation. IntroductionWe have described the apparent bcneficial effect on venous lipodermatosclcrosis (liposclerosis; the changes in the skin and subcutancous changes commonly knowvn as "the postphlcbitic lcg") of stimulating blood fibrinolytic activity wvith the anabolic

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This paper reports a 5-year experience of a surgical day case unit. Over 10 000 patients were treated in the three specialties of gynaecology, orthopaedics and general surgery. Seventy patients (0.7%) were admitted to the inpatient beds of the hospital directly from the day case unit. These patients were reviewed to determine if any avoidable factors had played a part. Two-fifths of the admissions after suction termination of pregnancy were of patients of more than 12 weeks' gestation. Admission was necessary on 10 occasions after orthopaedic and general surgical operations when the procedure was too extensive or too painful to aliow the patient to be discharged home. Complications of anaesthesia, either local (n =5) or general (n = 15), constituted the largest cause for admission. Postoperative nausea, vomiting and drowsiness became less frequent after a change in technique to the use of a short-acting anaesthetic agent (12 in the 3 years before; two in the 2 years after).Day case surgery is safe and should rarely be foliowed by the need for hospital admission. Based on our experience, we recommend the use of short-acting agents for general anaesthesia, and we advise against day case surgery in patients who require a general anaesthetic for longer than 60 min, or who need extensive surgery. ResultsDuring the study period 10 348 patients were treated in the surgical day unit. There were 3232 gynaecological cases, 2120 being for termination of pregnancy. There Present address and correspondence to:

Fourteen patients with longstanding lipodermatosclerosis of their lower legs, secondary to venous disease in 11, were treated for three months with stanozolol, a drug that enhances fibrinolytic activity. No other treatment was given and no change made in existing treatment. All the patients improved. Two were cured in three months, three were able to stop treatment in the next three to 11 months, and the other nine continued to improve. Fibrinolytic enhancement, with stanozolol, seems to be a worthwhile addition to the treatment of venous liposclerosis and deserves further study. 434 BRITISH MEDICAL JOURNAL 13 AUGUST 1977 (DBCLT),4 the fibrin plate lysis area (FPLA),3 and the plasma fibrinogen level.6 In some patients hand vein tissue fibrinolytic activity was measured.3 All patients were given stanozolol, 5 mg twice a day, by mouth.8 9 No other changes were made in their treatment. The effect of treatment on the liposclerosis was assessed objectively, by mapping out the area of induration and recording it on graph paper, and subjectively, by asking the patient if there was any change in the texture or pain in the abnormal tissues. Results The table shows the blood fibrinolytic activity ofthe 14 patients before and after three months' treatment with stanozolol. All the values were abnormal before treatment and showed a significant improvement. Change in blood fibrinolytic activity in 14 patients with venous liposcierosis after 3 months' treatment with stanozolol