Magyar sebészet
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After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. ⋯ We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.
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Pancreatic trauma is relatively uncommon, but it has high morbidity and mortality rates, especially when the diagnosis is delayed or inappropriate surgery is attempted. We analysed the management of 11 patients in a university teaching hospital treated with distal pancreatic transsection without (grade II--according AAST score) and with main pancreatic duct (MPD) injury (grade III) caused by blunt abdominal trauma. The average age of the 10 male and 1 female patients was 24.9 years (5-56). ⋯ Every patients needed subsequent resection (1), internal drainage due to fistula (2), or drainage of developed abscess (2). Three of them had severe septic and pulmonary complications; one patient with MPD injury died. Patients who require delayed surgery after an unsuccessful period of conservative treatment or a subsequent operation due to undetected MPD injury demonstrated higher pancreas-specific mortality and morbidity rate.