Postoperative pyoderma gangrenosum (PPG), also known as postoperative progressive gangrene of Cullen, is a rare and rapidly evolving complication of surgical procedures. Since the first description by Cullen in 1924 (Surg Gynecol Obstet 1924; 38: 579-582) various case reports have been published. Even in typical cases PPG is often misdiagnosed and therefore wrongly treated; the unknown aetiology makes treatment difficult. The therapies used for pyoderma gangrenosum include systemic corticosteroids, azathioprine, dapsone, mercaptopurine, sulphasalazine, sulphapyridine, thalidomide, cyclophosphamide, clofazimine, isotretinoin, immunoglobulins and cyclosporin. We report on two patients with PPG following breast surgery who were successfully treated with low-dose cyclosporin (2.5-5 mg/kg per day).
We describe a subacute intracranial subdural haematoma following lumbar myelography. This rare but potentially life-threatening complication has been reported both after lumbar myelography and following lumbar puncture for spinal anaesthesia. We review 16 previously reported cases of intracranial haemorrhage following lumbar myelography, and discuss the pathogenesis. In all reported cases post-puncture headache was the leading symptom and should therefore be regarded as a warning sign.
Intraoperative neurophysiological mapping and monitoring of eloquent brain areas can be combined with image-guided localisation to enhance the safety and efficacy of surgical procedures in the motor cortex. We designed a new type of cortical electrode which can be repeatedly placed on the cortical surface and allows accurate and reproducible stimulation by means of a navigation pointer. The newly designed device consists of a monopolar electrode contact for direct cortical stimulation, housed in a holder which allows placement, easy removal, and precise repeated placement of a surgical navigation pointer. It can be used for navigation-guided, high-frequency anodal monopolar cortical stimulation (MCS) for the mapping of eloquent cortex, and for monitoring of motor pathways. While the cortex is stimulated, compound muscle action potentials (CMAP) are recorded from muscles of the contralateral extremities and are assessed both qualitatively and quantitatively. When the device is used in combination with intraoperative navigation, the stimulation sites may optionally be registered or displayed on the system monitor. This allows repeated pinpointing and obviates the need for strip or grid electrodes in the operative field; although such electrodes may be useful for continuous monitoring, they often are in the surgeon's way. In addition, the primary and supplementary motor cortex can be mapped by determining the location of the sites of stimulation on surface-projected images of the cerebral cortex.
Diabetic foot ulcer will lead to a significant prolonged stress to the patients. Biological dressings like type 1 bovine collagen particles has advantage over conventional dressing in terms of early healing of wound. A total of 100 patients suffering from ulcer were taken randomly for this study after explaining the procedure and purpose of study. This was a comparative study between conventional dressing of ulcer and dressing with type 1 bovine collagen particles. There was significant difference in the result of collagen granules and conventional dressing. Collagen granules had better healing response rate. AIMS AND OBJECTIVES.To study the efficacy of topical agent type 1 bovine collagen granules in the management of diabetic foot ulcers. METHODOLOGYThe patients who were admitted for diabetic foot ulcer at Dept. of Surgery, KIMS, Karad, tertiary care teaching centre during the study period were screened. 50 patients in the test group were treated with topical dressings of collagen granules. The control group of 50 patients was treated with conventional topical dressings and bedside debridement. Ulcer was noted using visual score. RESULTSThe reduction of slough is as early as 3 rd week in test group than the control group. The number of patients with 75-100% wound filled with granulation tissue is as early as 3 rd week in test group than the control group where it took more than 4 weeks. The number of patients who underwent secondary suturing, skin grafting, and flap are significantly higher and also as early as 3 rd week in test group than the control group. CONCLUSIONCollagen granules topical application enhanced wound healing of diabetic foot ulcer as compared to conventional treatment modalities.
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