The Netherlands journal of surgery
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Fournier's gangrene, a specific form of necrotizing fasciitis, predominantly affects the male genitals, perineum and perianal region. Most frequently Fournier's gangrene is caused by the synergistic action of aerobic and anaerobic microorganisms and leads to early septicaemia with a high mortality. The case histories of three patients with Fournier's gangrene are presented to illustrate the importance of early recognition and radical surgical débridement as essential objectives for therapeutic success. ⋯ The second patient presented with a rapidly progressive fasciitis secondary to a perianal abscess; immediate excision of all necrotic tissue was successfully performed. The third patient developed gangrene from an urogenital infectious focus, which was primarily treated by insufficient incisional and drainage therapy. Only after radical débridement his general condition rapidly improved.
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Rupture of the distal tendon of the biceps brachii muscle is easy to diagnose. For functional and cosmetic reasons the tendon to the radial tuberosity should be re-inserted. ⋯ Physical therapy is recommended. Complete functional repair and full recovery of strength can be expected in most cases.
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The only effective treatment of an aortocaval fistula is the surgical closure of the fistula opening with insertion of an aortic prosthesis to restore the arterial continuity. The diagnosis of this distinct but infrequent clinical entity is often missed because of lack of suspicion. Proper preoperative evaluation facilitates the choice of surgical approach and reduces the morbidity. ⋯ Cardiac failure was present in two of them. Successful surgical closure could be accomplished in two patients although the perioperative course was complicated by ventricular arrhythmia, profuse blood loss and an inferior vena cava syndrome. One patient with a spontaneous aortocaval fistula passed away due to intraoperative exsanguination.
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Dynamic hip-screw osteosynthesis was carried out in 121 patients with fractures of the proximal femur and intracapsular fractures of the femoral neck. Five patients died (4%). ⋯ Partial femoral head necrosis was seen in six patients. Fast and proper anatomic reduction and dynamic fixation with a central positioned hip-screw (sliding nail) for intracapsular femoral neck fractures, result in good fracture healing with a low incidence of segmental femoral head necrosis.