Saltwater-barrier line in Florida : concepts, considerations, and site examples

USGS Publications Warehouse

Hughes, Jerry L.

1979-01-01

Construction of canals and enlargement of streams in Florida has been mostly to alleviate impact of floods and to drain wetlands for development. Land drainage and heavy pumpage from coastal water-table aquifers has degraded potable ground and surface water with saltwater. Control of saltwater intrusion is possible through implementation of certain hydrologic principles. State of Florida statute 373.033 provides for a saltwater-barrier line in areas of saltwater intrusion along canals. A saltwater-barrier line is defined as the allowable landward limit that a canal shall be constructed or enlarged or a stream deepened or enlarged without a salinity-control structure seaward of the saltwater-barrier line. The salinity control structure controls saltwater intrusion along a surface-water channel and assists in controlling saltwater intrusion into shallow aquifers. This report briefly reviews the fundamentals of saltwater intrusion in surface-water channels and associated coastal aquifers, describes the effects of established saltwater-barrier lines in Florida, and gives a history of the use and benefits of salinity-control structures. (Woodard-USGS).

Plantar fasciitis

MedlinePlus

... Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 58. Ferri FF. Plantar fasciitis. ... FF ed. Ferri's Clinical Advisor 2016 . Philadelphia, PA: Elsevier; 2016:970. Kadakia AR. Heel pain and plantar ...

Platelet-rich plasma and plantar fasciitis.

PubMed

Monto, Raymond R

2013-12-01

Plantar fasciitis is the most common cause of heel pain and can prove difficult to treat in its most chronic and severe forms. Advanced cases of plantar fasciitis are often associated with ankle stiffness, heel spurs, and other conditions and can lead to extensive physical disability and financial loss. Most available traditional treatments, including orthoses, nonsteroidal anti-inflammatory drugs, and steroid injections have a paucity of supportive clinical evidence. More invasive treatments, ranging from corticosteroid and botulinum-A toxin injections to shockwave therapy and plantar fasciotomy, have demonstrated varying clinical success in severe cases but carry the potential for serious complication and permanent disability. Platelet-rich plasma has recently been demonstrated to be helpful in managing chronic severe tendinopathies when other techniques have failed. This review examines the pathophysiology, diagnostic options, nonoperative treatment modalities, and surgical options currently used for plantar fasciitis. It also focuses on the clinical rationale and available evidence for using autologous platelet-rich plasma to treat severe refractory chronic plantar fasciitis.

Plantar Fasciitis

MedlinePlus

... medicine help? Aspirin, acetaminophen (one brand name: Tylenol), naproxen (brand name: Aleve), or ibuprofen (some brand names: ... Kids and Teens, Men, WomenTags: fasciitis, foot, heel, plant, soreness September 1, 2000 Copyright © American Academy of ...

Saltwater Wetlands.

ERIC Educational Resources Information Center

Naturescope, 1986

1986-01-01

Provides information about saltwater wetlands. Contains seven learning activities which deal with "making" a mud snail, plants and animals of mangroves, and the effects of tides on salt marshes. Included are reproducible handouts and worksheets for several of the activities. (TW)

[Functional impairment and radiologic fasciitis under erlotinib therapy].

PubMed

Osdoit, S; Wierzbicka, E; Guillet, G

2011-01-01

Targeted molecules are recent and valuable weapons in the management of certain cancers. Among them, erlotinib is an inhibitor of epidermal growth factor receptor approved in non-small lung cancer and pancreatic cancer after failure of first line treatment. Erlotinib is responsible for many cutaneous side effects. We report a case of acute symptomatic fasciitis that has occurred during erlotinib therapy. To our knowledge it is the first case described. A 56-year-old man was treated with erlotinib for a metastatic non-small lung adenocarcinoma. Shortly after the treatment by erlotinib was introduced, he had a severe acneiform rash resistant to doxycycline treatment. After a year of treatment, he presented intense pain in the legs with functional impairment. Medical imaging confirmed fasciitis. It regressed along with the rash after using strong topical corticosteroids during ten days. Besides bacterial fasciitis, inflammatory and oedematous fasciitis have varied aetiologies. The occurrence of a documented fasciitis during anti EGFR-therapy is original and raises the question of underlying mechanism. We suggest three pathophysiological mechanisms: spreading by contiguity; paraneoplastic fasciitis, or specific lesion of the fascia due to anti-EGFR. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Plantar fasciitis and its relationship with hallux limitus.

PubMed

Aranda, Yolanda; Munuera, Pedro V

2014-05-01

We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

Saltwater intrusion in coastal regions of North America

USGS Publications Warehouse

Barlow, Paul M.; Reichard, Eric G.

2010-01-01

Saltwater has intruded into many of the coastal aquifers of the United States, Mexico, and Canada, but the extent of saltwater intrusion varies widely among localities and hydrogeologic settings. In many instances, the area contaminated by saltwater is limited to small parts of an aquifer and to specific wells and has had little or no effect on overall groundwater supplies; in other instances, saltwater contamination is of regional extent and has resulted in the closure of many groundwater supply wells. The variability of hydrogeologic settings, three-dimensional distribution of saline water, and history of groundwater withdrawals and freshwater drainage has resulted in a variety of modes of saltwater intrusion into coastal aquifers. These include lateral intrusion from the ocean; upward intrusion from deeper, more saline zones of a groundwater system; and downward intrusion from coastal waters. Saltwater contamination also has occurred along open boreholes and within abandoned, improperly constructed, or corroded wells that provide pathways for vertical migration across interconnected aquifers. Communities within the coastal regions of North America are taking actions to manage and prevent saltwater intrusion to ensure a sustainable source of groundwater for the future. These actions can be grouped broadly into scientific monitoring and assessment, engineering techniques, and regulatory approaches.

Group A streptococcal necrotizing fasciitis in the emergency department.

PubMed

Lin, Jiun-Nong; Chang, Lin-Li; Lai, Chung-Hsu; Lin, Hsi-Hsun; Chen, Yen-Hsu

2013-11-01

Group A Streptococcal (GAS) necrotizing fasciitis is a critical emergency. Patients with necrotizing fasciitis principally present to emergency departments (EDs), but most studies are focused on hospitalized patients. An ED patient-based retrospective study was conducted to investigate the clinical characteristics, associated factors, and outcomes of GAS necrotizing fasciitis in the ED. Patients visiting the ED from January 2005 through December 2011 with the diagnosis of GAS necrotizing fasciitis were enrolled. All patients with the diagnosis of noninvasive skin and soft-tissue infections caused by GAS were included as the control group. During the study period, 75 patients with GAS necrotizing fasciitis were identified. Males accounted for 84% of patients. The most prevalent underlying disease was diabetes mellitus (45.3%). Bullae were recognized in 37.3% of patients. One third of cases were complicated by bacteremia. Polymicrobial infections were found in 30.7% of patients. Overall mortality rate for GAS necrotizing fasciitis was 16%. Patients aged >60 years with diabetes mellitus, liver cirrhosis, and gout were considerably more likely to have GAS necrotizing fasciitis than noninvasive infections. Patients presenting with bacteremia, shock, duration of symptoms/signs <5 days, low white blood cell count, low platelet count, and prolonged prothrombin time were associated with increased mortality. Surgery is a significantly negative factor for mortality of patients with GAS necrotizing fasciitis (odds ratio = 0.16; 95% confidence interval 0.002-0.16; p < 0.001). A better understanding of the associated factors and initiation of adequate treatments will allow for improved survival after GAS necrotizing fasciitis. Copyright © 2013 Elsevier Inc. All rights reserved.

Origins and delineation of saltwater intrusion in the Biscayne aquifer and changes in the distribution of saltwater in Miami-Dade County, Florida

USGS Publications Warehouse

Prinos, Scott T.; Wacker, Michael A.; Cunningham, Kevin J.; Fitterman, David V.

2014-01-01

Intrusion of saltwater into parts of the shallow karst Biscayne aquifer is a major concern for the 2.5 million residents of Miami-Dade County that rely on this aquifer as their primary drinking water supply. Saltwater intrusion of this aquifer began when the Everglades were drained to provide dry land for urban development and agriculture. The reduction in water levels caused by this drainage, combined with periodic droughts, allowed saltwater to flow inland along the base of the aquifer and to seep directly into the aquifer from the canals. The approximate inland extent of saltwater was last mapped in 1995. An examination of the inland extent of saltwater and the sources of saltwater in the aquifer was completed during 2008–2011 by using (1) all available salinity information, (2) time-series electromagnetic induction log datasets from 35 wells, (3) time-domain electromagnetic soundings collected at 79 locations, (4) a helicopter electromagnetic survey done during 2001 that was processed, calibrated, and published during the study, (5) cores and geophysical logs collected from 8 sites for stratigraphic analysis, (6) 8 new water-quality monitoring wells, and (7) analyses of 69 geochemical samples. The results of the study indicate that as of 2011 approximately 1,200 square kilometers (km2) of the mainland part of the Biscayne aquifer were intruded by saltwater. The saltwater front was mapped farther inland than it was in 1995 in eight areas totaling about 24.1 km2. In many of these areas, analyses indicated that saltwater had encroached along the base of the aquifer. The saltwater front was mapped closer to the coast than it was in 1995 in four areas totaling approximately 6.2 km2. The changes in the mapped extent of saltwater resulted from improved spatial information, actual movement of the saltwater front, or a combination of both. Salinity monitoring in some of the canals in Miami-Dade County between 1988 and 2010 indicated influxes of saltwater, with maximum

Fatal Necrotizing Fasciitis Due to Streptococcus pneumoniae: A Case Report

PubMed Central

Park, So-Youn; Park, So Young; Moon, Soo-youn; Son, Jun Seong

2011-01-01

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis. PMID:21218041

Necrotizing fasciitis: contribution and limitations of diagnostic imaging.

PubMed

Malghem, Jacques; Lecouvet, Frédéric E; Omoumi, Patrick; Maldague, Baudouin E; Vande Berg, Bruno C

2013-03-01

Necrotizing fasciitis is a rare, rapidly spreading, deep-seated infection causing thrombosis of the blood vessels located in the fascia. Necrotizing fasciitis is a surgical emergency. The diagnosis typically relies on clinical findings of severe sepsis and intense pain, although subacute forms may be difficult to recognize. Imaging studies can help to differentiate necrotizing fasciitis from infections located more superficially (dermohypodermitis). The presence of gas within the necrotized fasciae is characteristic but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, which can be visualized using computed tomography and, above all, magnetic resonance imaging (high signal on contrast-enhanced T1 images and T2 images, best seen with fat saturation). These findings lack specificity, as they can be seen in non-necrotizing fasciitis and even in non-inflammatory conditions. Signs that support a diagnosis of necrotizing fasciitis include extensive involvement of the deep intermuscular fascias (high sensitivity but low specificity), thickening to more than 3mm, and partial or complete absence on post-gadolinium images of signal enhancement of the thickened fasciae (fairly high sensitivity and specificity). Ultrasonography is not recommended in adults, as the infiltration of the hypodermis blocks ultrasound transmission. Thus, imaging studies in patients with necrotizing fasciitis may be challenging to interpret. Although imaging may help to confirm deep tissue involvement and to evaluate lesion spread, it should never delay emergency surgical treatment in patients with established necrotizing fasciitis. Copyright © 2012. Published by Elsevier SAS.

A saltwater flotation technique to identify unincubated eggs

USGS Publications Warehouse

Devney, C.A.; Kondrad, S.L.; Stebbins, K.R.; Brittingham, K.D.; Hoffman, D.J.; Heinz, G.H.

2009-01-01

Field studies on nesting birds sometimes involve questions related to nest initiation dates, length of the incubation period, or changes in parental incubation behavior during various stages of incubation. Some of this information can be best assessed when a nest is discovered before the eggs have undergone any incubation, and this has traditionally been assessed by floating eggs in freshwater. However, because the freshwater method is not particularly accurate in identifying unincubated eggs, we developed a more reliable saltwater flotation method. The saltwater method involves diluting a saturated saltwater solution with freshwater until a salt concentration is reached where unincubated eggs sink to the bottom and incubated eggs float to the surface. For Laughing Gulls (Leucophaeus atricilla), floating eggs in freshwater failed to identify 39.0% (N = 251) of eggs that were subsequently found by candling to have undergone incubation prior to collection. By contrast, in a separate collection of gull eggs, no eggs that passed the saltwater test (N = 225) were found by a later candling to have been incubated prior to collection. For Double-crested Cormorants (Phalacrocorax auritus), floating eggs in freshwater failed to identify 15.6% (N = 250) of eggs that had undergone incubation prior to collection, whereas in a separate collection, none of the eggs that passed the saltwater test (N = 85) were found by a later candling to have been incubated prior to collection. Immersion of eggs in saltwater did not affect embryo survival. Although use of the saltwater method is likely limited to colonial species and requires calibrating a saltwater solution, it is a faster and more accurate method of identifying unincubated eggs than the traditional method of floating eggs in freshwater.

Nodular Fasciitis in the Axillary Tail of the Breast

PubMed Central

Samardzic, Dejan; Chetlen, Alison; Malysz, Jozef

2014-01-01

Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass. PMID:25426226

Nodular Fasciitis with Cortical Erosion of the Hand

PubMed Central

Park, Jin Sung; Lee, Jong-Sil; Na, Jae-Boem

2012-01-01

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present. PMID:22379562

[Necrotizing fasciitis after varicella].

PubMed

Gonçalves, E; Furtado, F; Estrada, J; Vale, M C; Pinto, M; Santos, M; Moura, G; Vasconcelos, C

2001-01-01

Necrotizing fasciitis is a rare and severe infection characterised by extremely rapid progressive involvement of the superficial fascias and deep dermal layers of the skin, with resultant vasculitis and necrosis. The authors present three clinical cases of necrotizing fasciitis; all three patients previously had varicella rash, rapid progressive spreading erythema with severe pain and toxic shock syndrome. Two patients had positive cultures of b-haemolytic streptococcus. Early stage differential diagnosis with celulitis, aggressive antibiotic treatment and pediatric intensive care support are essential. However, the main therapy is early extensive surgical approach involving all indurate areas, down to and including the muscle fascia.

Predicting plantar fasciitis in runners.

PubMed

Warren, B L; Jones, C J

1987-02-01

Ninety-one runners were studied to determine whether specific variables were indicative of runners who had suffered with plantar fasciitis either presently or formerly vs runners who had never suffered with plantar fasciitis. Each runner was asked to complete a running history, was subjected to several anatomical measurements, and was asked to run on a treadmill in both a barefoot and shoe condition at a speed of 3.35 mps (8 min mile pace). Factor coefficients were used in a discriminant function analysis which revealed that, when group membership was predicted, 63% of the runners could be correctly assigned to their group. Considering that 76% of the control group was correctly predicted, it was concluded that the predictor variables were able to correctly predict membership of the control group, but not able to correctly predict the presently or formerly injured sufferers of plantar fasciitis.

Serratia marcescens Necrotizing Fasciitis Presenting as Bilateral Breast Necrosis

PubMed Central

Rehman, Tayyab; Moore, Thomas A.

2012-01-01

Serratia marcescens is an extremely rare cause of necrotizing fasciitis. We report the first case of necrotizing fasciitis of the chest wall due to infection with S. marcescens that initially manifested as bilateral breast necrosis. The patient had a fulminant course leading to death within 72 h of presentation. Literature pertinent to S. marcescens-mediated necrotizing fasciitis is also reviewed. PMID:22837315

Hyperemia in plantar fasciitis determined by power Doppler ultrasound.

PubMed

McMillan, Andrew M; Landorf, Karl B; Gregg, Julie M; De Luca, Jason; Cotchett, Matthew P; Menz, Hylton B

2013-12-01

Cross-sectional observational study. To investigate the presence of soft tissue hyperemia in plantar fasciitis with power Doppler ultrasound. Localized hyperemia is an established feature of tendinopathy, suggesting that neurovascular in-growth may contribute to tendon-associated pain in some patients. The presence of abnormal soft tissue vascularity can be assessed with Doppler ultrasound, and a positive finding can assist with targeted treatment plans. However, very little is known regarding the presence of hyperemia in plantar fasciitis and the ability of routine Doppler ultrasound to identify vascular in-growth in the plantar fascia near its proximal insertion. This observational study included 30 participants with plantar fasciitis unrelated to systemic disease and 30 age- and sex-matched controls. Ultrasound examination was performed with a 13- to 5-MHz linear transducer, and power Doppler images were assessed by 2 blinded investigators. Hyperemia of the plantar fascia was present in 8 of 30 participants with plantar fasciitis and in 2 of 30 controls. The between-group difference for hyperemia, using a 4-point scale, was statistically significant, with participants with plantar fasciitis showing increased Doppler ultrasound signal compared to controls (Mann-Whitney U, P = .03). However, the majority of participants with plantar fasciitis with evidence of hyperemia demonstrated very mild color changes, and only 3 were found to have moderate or marked hyperemia. Mild hyperemia can occur with plantar fasciitis, but most individuals will not exhibit greater soft tissue vascularity when assessed with routine Doppler ultrasound. Clinicians treating plantar fasciitis should not consider a positive Doppler signal as essential for diagnosis of the condition but, rather, as a feature that may help to refine the treatment plan for an individual patient.

Necrotizing fasciitis and its mimics: what radiologists need to know.

PubMed

Chaudhry, Ammar A; Baker, Kevin S; Gould, Elaine S; Gupta, Rajarsi

2015-01-01

The purpose of this article is to review the imaging features of necrotizing fasciitis and its potential mimics. Key imaging features are emphasized to enable accurate and efficient interpretation of variables that are essential in appropriate management. Necrotizing fasciitis is a medical emergency with potential lethal outcome. Dissecting gas along fascial planes in the absence of penetrating trauma (including iatrogenic) is essentially pathognomonic. However, the lack of soft-tissue emphysema does not exclude the diagnosis. Mimics of necrotizing fasciitis include nonnecrotizing fasciitis (eosinophilic, paraneoplastic, inflammatory (lupus myofasciitis, Churg-Strauss, nodular, or proliferative), myositis, neoplasm, myonecrosis, inflammatory myopathy, and compartment syndrome. Necrotizing fasciitis is a clinical diagnosis, and imaging can reveal nonspecific or negative findings (particularly during the early course of disease). One should be familiar with salient clinical and imaging findings of necrotizing fasciitis to facilitate a more rapid and accurate diagnosis and be aware that its diagnosis necessitates immediate discussion with the referring physician.

Odontogenic cervical necrotizing fasciitis, etiological aspects.

PubMed

Juncar, M; Bran, S; Juncar, R I; Baciut, M F; Baciut, G; Onisor-Gligor, F

2016-01-01

Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft-tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential. In this study, we selected 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin, treated in the Clinic of Oral and Maxillofacial Surgery in Cluj-Napoca during January 1996-December 2012. In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-72.69]), the rest of the patients having 1-4 types of systemic disorders; type 2 diabetes mellitus was the most frequent type of underlying systemic disorder. From the appearance of the first symptoms until the presentation for treatment, a time interval of 2-30 days elapsed. During this time period, 78.18% (95% confidence interval [CI] [65.49-89.06]) of the patients received antibiotic treatment, but without results. Mandibular molars were the most frequent starting point of the disease, and the submandibular space was the first affected by the disease, 47.27% (95% CI [32.76-61.79]). Bacteriological exams showed that facultatively aerobic/anaerobic G + bacteria were the most frequently identified (72.22% [58.21-83.60]). The odontogenic lesions of the lower molars, complicated by submandibular space infections, are the most frequent starting point of odontogenic cervicofacial necrotizing fasciitis. Delayed surgical treatment and strict antibiotic therapy play an important role in favoring the development of odontogenic necrotizing fasciitis.

Clinical Parameters and Outcomes in Periorbital Necrotizing Fasciitis.

PubMed

Wladis, Edward J; Levin, Flora; Shinder, Roman

2015-01-01

To describe the clinical features associated with periorbital necrotizing fasciitis and to correlate these features with clinical outcomes. The case logs of 3 surgeons were used to identify cases of necrotizing fasciitis. Chart reviews were performed to characterize clinical metrics, and statistical analyses were performed. Seventeen patients (9 males, 8 females; mean age = 48.1 years, standard deviation = 22.6 years) were identified with periorbital necrotizing fasciitis. Of these patients, 52.9% did not have immunodeficiencies, and 52.9% did not have antecedent trauma or infected facial lesions. One patient died from necrotizing fasciitis. A history of immunosuppression correlated with the requirement for exenteration, but did not correlate visual acuity of worse than 20/40 upon discharge from the hospital. Most of the patients (68.75%) were discharged with visual acuity of better than 20/40 in the affected eye. This study represents the largest case series of patients with periorbital necrotizing fasciitis. Most of the patients in this series did not have immunodeficiencies, and the majority were discharged with favorable visual acuities. Nonetheless, a history of immunosuppression correlated with the need for exenteration, but was not statistically linked with worse visual outcomes.

[Assessment of plantar fasciitis using shear wave elastography].

PubMed

Zhang, Lining; Wan, Wenbo; Zhang, Lihai; Xiao, Hongyu; Luo, Yukun; Fei, Xiang; Zheng, Zhixin; Tang, Peifu

2014-02-01

To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis. The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion. The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126). SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.

Staphylococcus pseudintermedius necrotizing fasciitis in a dog.

PubMed

Weese, J Scott; Poma, Roberta; James, Fiona; Buenviaje, Gilbert; Foster, Robert; Slavic, Durda

2009-06-01

Staphylococcus pseudintermedius was implicated as the cause of rapidly progressive and fatal necrotizing fasciitis in a dog. The isolate was methicillin-susceptible and did not contain genes encoding the Panton-Valentine leukocidin. While Streptococcus canis is typically considered to be the main cause of necrotizing fasciitis in dogs, staphylococci should also be considered.

Necrotizing Fasciitis of the Chest Wall: Report of Pediatric Cases.

PubMed

Kumar, Monica; Meeks, Andrew; Kearl, Liza

2015-09-01

Necrotizing fasciitis is a soft tissue infection uncommonly described in children and is associated with significant morbidity and mortality if not treated early and aggressively. Reports of cases involving the upper torso are rare in general. In adults, necrotizing fasciitis is most commonly described in the abdomen, perineum, and extremities. For children, particularly neonates, necrotizing fasciitis most commonly involves the trunk presenting as omphalitis. In this report, we describe 2 pediatric cases of necrotizing fasciitis of the chest wall that presented within 6 months from each other at Los Angeles County Hospital/University of Southern California Pediatric Emergency Department. Both cases involved previously healthy children with above normal body mass indices of 36 and 25.6, respectively. These cases are noteworthy because of the rarity of necrotizing fasciitis among children especially in the chest wall, atypical presentation with nonspecific symptoms which made the diagnosis challenging, and suggestion that obesity may be a potential risk factor. Despite the rarity of this disease, the information presented in these cases may aid in raising the index of suspicion for diagnosis of necrotizing fasciitis.

Staphylococcus pseudintermedius necrotizing fasciitis in a dog

PubMed Central

Weese, J. Scott; Poma, Roberta; James, Fiona; Buenviaje, Gilbert; Foster, Robert; Slavic, Durda

2009-01-01

Staphylococcus pseudintermedius was implicated as the cause of rapidly progressive and fatal necrotizing fasciitis in a dog. The isolate was methicillin-susceptible and did not contain genes encoding the Panton-Valentine leukocidin. While Streptococcus canis is typically considered to be the main cause of necrotizing fasciitis in dogs, staphylococci should also be considered. PMID:19721787

Pasteurella multocida ecthyma complicated by necrotizing fasciitis.

PubMed

Milani-Nejad, Nima; Tyler, Kelly; Grieco, Carmine A; Kaffenberger, Benjamin H

2017-04-15

Necrotizing fasciitis is a serious infection of the skin and soft tissues. Pasteurella multocida is rarely reported to cause necrotizing fasciitis and is associated with high mortality. We describe a female patient with a past medical history of diabetes mellitus and myeloproliferative disorder presenting with bullae and erythema of the right forearm secondary to P. multocida infection after possible cat bite. Despite adequate antibiotic coverage she developed necrotizing fasciitis diagnosed clinically and on diagnostic imaging. Patient was taken to the operating room emergently and underwent irrigation and debridement with subsequent split-skin graft. She recovered well after the surgeries and was discharge on intravenous antibiotics. At clinic follow-up, her wounds were healing well without any significant new symptoms.

Conjunctive Management of Multi-Aquifer System for Saltwater Intrusion Mitigation

NASA Astrophysics Data System (ADS)

Tsai, F. T. C.; Pham, H. V.

2015-12-01

Due to excessive groundwater withdrawals, many water wells in Baton Rouge, Louisiana experience undesirable chloride concentration because of saltwater intrusion. The study goal is to develop a conjunctive management framework that takes advantage of the Baton Rouge multi-aquifer system to mitigate saltwater intrusion. The conjunctive management framework utilizes several hydraulic control techniques to mitigate saltwater encroachment. These hydraulic control approaches include pumping well relocation, freshwater injection, saltwater scavenging, and their combinations. Specific objectives of the study are: (1) constructing scientific geologic architectures of the "800-foot" sand, the "1,000-foot" sand, the "1,200-foot" sand, the "1,500-foot" sand, the "1,700-foot" sand, and the "2,000-foot" sand, (2) developing scientific saltwater intrusion models for these sands. (3) using connector wells to draw native groundwater from one sand and inject to another sand to create hydraulic barriers to halt saltwater intrusion, (4) using scavenger wells or well couples to impede saltwater intrusion progress and reduce chloride concentration in pumping wells, and (5) reducing cones of depression by relocating and dispersing pumping wells to different sands. The study utilizes optimization techniques and newest LSU high performance computing (HPC) facilities to derive solutions. The conjunctive management framework serves as a scientific tool to assist policy makers to solve the urgent saltwater encroachment issue in the Baton Rouge area. The research results will help water companies as well as industries in East Baton Rouge Parish and neighboring parishes by reducing their saltwater intrusion threats, which in turn would sustain Capital Area economic development.

Periorbital Necrotizing Fasciitis Secondary to Candida parapsilosis and Streptococcus pyogenes.

PubMed

Zhang, Matthew; Chelnis, James; Mawn, Louise A

Necrotizing fasciitis is most often caused by either polymicrobial bacterial infections or by Gram-positive organisms, such as Streptococcus or Staphylococcus; however, rare cases of fungal necrotizing fasciitis have been reported. Candida parapsilosis is an emerging fungal pathogen. This fungus grows in either a yeast or pseudohyphal form. C. parapsilosis has been reported to cause keratitis, intraocular infection, and seeding of frontalis slings. C. parapsilosis is a commensal of human skin and can be acquired by nosocomial spread. Necrotizing fasciitis due to Candida has rarely been reported, but to date C. parapsilosis has not been identified as the causative organism in necrotizing fasciitis. This is the first documented case of human periocular soft tissue infection by C. parapsilosis, and also the first report providing evidence of mycotic infection in a necrotizing fasciitis concurrently infected by Streptococcus pyogenes.

Primary Care Management of Plantar Fasciitis.

PubMed

Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

2015-01-01

Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed.

Plantar fascia softening in plantar fasciitis with normal B-mode sonography.

PubMed

Wu, Chueh-Hung; Chen, Wen-Shiang; Wang, Tyng-Guey

2015-11-01

To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé's test was used to identify where the differences occurred. Compared to healthy participants (red pixel intensity: 146.9 ± 9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4 ± 7.3, p = 0.01), symptomatic sides of unilateral plantar fasciitis (127.1 ± 7.4, p < 0.001), and both sides of bilateral plantar fasciitis (129.4 ± 7.5, p < 0.001). There were no significant differences in plantar fascia thickness or green or blue pixel intensity among these groups. Sonoelastography revealed that the plantar fascia is softer in patients with typical clinical manifestations of plantar fasciitis, even if they exhibit no abnormalities on B-mode sonography.

Necrotizing fasciitis: treatment concepts and clinical results.

PubMed

Leiblein, M; Marzi, I; Sander, A L; Barker, J H; Ebert, F; Frank, J

2018-04-01

Necrotizing fasciitis is a life-threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. The management of infected tissues requires a rapid diagnosis, immediate aggressive surgical management and an extended debridement. In some cases early amputations of the affected tissues and maximum intensive care treatment, in case of sepsis, are required. Due to a rising number of cases we aimed to evaluate our patients in a retrospective review. All patients diagnosed with necrotizing fasciitis from 2014 to 2016 (21 months) in our level one trauma center were identified. Their charts were reviewed and data were analyzed in terms of demographic and social information, microbiological results, therapeutic course, socio-economic outcome and mortality. We found 15 patients with necrotizing fasciitis. None of these died in the observation period. The mean number of surgical interventions was seven. Two patients underwent limb amputation; diabetes mellitus was assigned with a significant higher risk for amputation. The mean hospitalization was 32 days, including 8 days on intensive care unit. Of the discovered bacteria 93% were sensitive to the initial antibiotic treatment with Ampicillin, Clindamycin and Clont. Surgical therapy is indicated if necrotizing fasciitis is suspected. Diabetes mellitus was a clinical predictor of limb amputation in patients with necrotizing fasciitis in our cohort. Aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole is recommended as initial calculated antibiotic treatment.

Treatment of Plantar Fasciitis With Botulinum Toxin.

PubMed

Ahmad, Jamal; Ahmad, Stacy H; Jones, Kennis

2017-01-01

This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P < .05). By that time, 0 (0%) and 3 (12%) patients who received IBTA and saline, respectively, underwent surgery for recalcitrant plantar fasciitis ( P < .005). Compared with placebo saline injection, using IBTA to treat plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. I, Randomized, double-blinded, placebo-controlled study.

[Necrotizing Fasciitis: A comprehensive review].

PubMed

Carbonetti, F; Carusi, V; Guidi, M; David, V

Even though necrotizing fasciitis is considered a rare disease, the spreading of the predisposing factors such as diabetes and chronic diseases, contribute to increase the incidence of this infection. Thus, how to diagnose and treat this clinical pathology, which represents an emerging need. This infection could be fatal for patients if not early diagnosed and treated and it represents a challenge both for the clinicians both for the surgeons. From this consideration was born the idea to write this review article in order to furnish to the readers a helpful tool in the management of this disease starting from its clinical and epidemiological features leading to the diagnosis, both clinical and radiological, and concluding with the treatment both medical both surgical .This article reviews literature on PubMed/MEDLINE with key words "necrotizing", "fasciitis" and "necrotizing fasciitis" from 1967 to 2014, considering all the aspects of the disease. The authors attempt to draw comparisons to their own experience managing this condition to give an Italian perspective to the condition.

Triple diagnostics for early detection of ambivalent necrotizing fasciitis.

PubMed

Hietbrink, Falco; Bode, Lonneke G; Riddez, Louis; Leenen, Luke P H; van Dijk, Marijke R

2016-01-01

Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct. Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented. In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis. In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.

Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess - Rare and Perilous.

PubMed

Amaranathan, Anandhi; Sahoo, Ashok Kumar; Barathi, Deepak; Shankar, Gomathi; Sistla, Sarath Chandra

2017-01-17

Necrotizing fasciitis is one of the uncommon presentations of a rapidly spreading subcutaneous tissue infection. Although the actual cause is unclear in many cases, most of them are due to the rapid proliferation of microorganisms. Retroperitoneal necrotizing fasciitis is extremely rare. It is a potentially lethal infection that requires immediate and aggressive surgical care. Early diagnosis is the key to a better prognosis. The possibility of retroperitoneal necrotizing fasciitis should be suspected in patients with symptoms of sepsis that are disproportionate to clinical findings. The rapid deterioration of the patient also gives a clue towards the diagnosis. We report a 35-year-old male with perianal abscess who had been progressed to retroperitoneal necrotizing fasciitis. The patient was managed successfully with aggressive debridement and drainage after laparotomy. Appropriate antibiotics were used to combat the sepsis. The patient recovered well at follow up, three months after discharge. Another patient, a 45-year-old male with a retroperitoneal abscess, progressed to retroperitoneal necrotizing fasciitis, and extra peritoneal drainage and debridement was done. Antibiotics depending upon the culture and sensitivity were used to control sepsis. But the patient succumbed to death 45 days after surgery due to uncontrolled sepsis. Necrotizing fasciitis of any anatomical site needs aggressive surgical care with early intervention. But retroperitoneal necrotizing fasciitis needs an extra effort for diagnosis. After diagnosis, it needs timely surgical intervention and appropriate antibiotic therapy for the recovery of the patients.

Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults.

PubMed

Nahin, Richard L

2018-03-26

This study provides prevalence estimates of plantar fasciitis in U.S. adults, as well as the types and frequencies of pharmaceutical treatment specifically for this pain. Data are from the 2013 National Health and Wellness Survey, a large (n = 75,000) internet panel survey designed to approximate the adult U.S. Strengths of associations are determined using multivariable logistic regression. It was estimated that .85% (95% confidence interval [CI] = .77-.92) of the sample reported diagnosed plantar fasciitis with pain in the past month. Higher prevalence of plantar fasciitis was seen in women (1.19%; referent) versus men (.47%), in those aged 45 to 64 (1.33%) versus those aged 18 to 44 (.53%; referent) years, and in the obese (1.48%) versus those with a body mass <25 (.29%; referent). Prescription medications for pain were used by 41.04% of plantar fasciitis respondents, but only 6.31% attributed this use specifically to plantar fasciitis pain. Nonsteroidal anti-inflammatory drugs (4.01%) and opioids (2.21%) were the most prevalent prescription drugs used specifically for plantar fasciitis pain. Almost 70% of individuals with plantar fasciitis used over the counter (OTC) analgesics for general pain management, with OTC nonsteroidal anti-inflammatory drugs being used by 49.47% and acetaminophen by 26.93% of respondents. Individuals diagnosed by medical specialists had twice the odds of using prescription drugs as those diagnosed by other providers (odds ratio = 2.12; 95% CI = 1.01-4.46). Non-Hispanic black individuals were more likely to use prescription pain medications specifically for plantar fasciitis pain than non-Hispanic white individuals (odds ratio = 3.02; 95% CI = 1.05-8.70). The current study provides additional insights into the pain and disability associated with plantar fasciitis, as well as the pharmaceutical treatments being used for its management. Prescription as well as OTC medications are used to manage plantar fasciitis symptoms

A case of labio-facial necrotizing fasciitis complicating acne.

PubMed

Eltayeb, Amel Salah; Ahmad, Abdelnasir Gafar; Elbeshir, Elnour Ibrahim

2016-04-23

Facial necrotizing fasciitis is extremely rare. Most of the cases reported in literature are related to dental, sinus, tonsillar and salivary glands causes, but rarely as consequence of skin infection. We report a unique case of lower lip cellulitis, which was initially misdiagnosed as angioedema and subsequently progressed into lower lip necrotizing fasciitis. This is a case report of necrotizing fasciitis involving the lower lip as a consequence of infected skin acne in a 19 year old black female. The patient had been diagnosed earlier as a case of angioedema by a physician and treated accordingly. She was mildly anemic, hyponatremic and hypokalemic. Treatment was started immediately by incision, drainage and full debridement of the whole necrotic tissue. Triple antibiotic therapy was administered and daily irrigation and dressing were performed until full recovery. Complete healing occurred within a month by secondary intention. This case demonstrates the misdiagnosis of a lip swelling leading to the development of labiofacial necrotizing fasciitis, a serious and life threatening condition. Lip angioedema is a common condition; however, lip fasciitis is rare. A broad differential diagnosis in case of lower lip swelling is essential to avoid inappropriate treatment delay.

Nodular Fasciitis of External Auditory Canal

PubMed Central

Ahn, Jihyun; Kim, Sunyoung; Park, Youngsil

2016-01-01

Nodular fasciitis is a pseudosarcomatous reactive process composed of fibroblasts and myofibroblasts, and it is most common in the upper extremities. Nodular fasciitis of the external auditory canal is rare. To the best of our knowledge, less than 20 cases have been reported to date. We present a case of nodular fasciitis arising in the cartilaginous part of the external auditory canal. A 19-year-old man complained of an auricular mass with pruritus. Computed tomography showed a 1.7 cm sized soft tissue mass in the right external auditory canal, and total excision was performed. Histologic examination revealed spindle or stellate cells proliferation in a fascicular and storiform pattern. Lymphoid cells and erythrocytes were intermixed with tumor cells. The stroma was myxoid to hyalinized with a few microcysts. The tumor cells were immunoreactive for smooth muscle actin, but not for desmin, caldesmon, CD34, S-100, anaplastic lymphoma kinase, and cytokeratin. The patient has been doing well during the 1 year follow-up period. PMID:27304679

Deaths from Necrotizing Fasciitis in the United States, 2003–2013

PubMed Central

Arif, N.; Yousfi, S.; Vinnard, C.

2017-01-01

SUMMARY Necrotizing fasciitis is a life-threatening infection requiring urgent surgical and medical therapy. Our objective was to estimate the mortality burden of necrotizing fasciitis in the United States, and to identify time trends in the incidence rate of necrotizing fasciitis-related mortality. We obtained data from the National Center for Health Statistics, which receives information from death certificates from all states, including demographic information and cause of death. The U.S. Multiple Cause of Death Files were searched from 2003 through 2013 for a listing of NF (ICD10 code M72.6) as either the underlying or contributing cause of death. We identified a total of 9,871 necrotizing fasciitis-related deaths in the U.S. between 2003 and 2013 (Figure 1), corresponding to a crude mortality rate of 4.8 deaths per 1,000,000 person-years, without a significant time trend. Compared to white individuals, the incidence rate of necrotizing fasciitis-associated death was greater among black, Hispanic, and American Indian individuals, and lower among Asian individuals. Streptococcal infection was most commonly identified in cases where a pathogen was reported. Diabetes mellitus and obesity were more commonly observed among necrotizing fasciitis-related deaths compared with deaths due to other causes. Racial differences in the incidence of necrotizing fasciitis-related deaths merits further investigation. PMID:26548496

Raised serum lactate: a marker of necrotizing fasciitis?

PubMed

Murphy, George; Markeson, Daniel; Choa, Robert; Armstrong, Anthony

2013-12-01

Distinguishing necrotizing fasciitis from non-necrotizing soft-tissue infections remains a difficult clinical judgement call, with a paucity of diagnostic aids to the clinician. The aim of this study was to assess raised serum lactate as a point-of-care test to aid in differentiating necrotizing from non-necrotizing soft tissue infections. The authors performed a post-hoc analysis of a prospectively compiled database. All patients referred to a single surgeon (A.P.A.) as suspected cases of necrotizing fasciitis at one hospital between September 2000 and September 2010 were included. Serum lactate at presentation was recorded, along with demographic and outcome data. Using histological evidence of tissue necrosis as the 'gold standard', patients were divided into those with or without necrotizing fasciitis, and their serum lactate at presentation compared. Fifty three patients met the inclusion criteria. Twenty eight had histologically proven necrosis, 25 did not. Serum lactate (mean±SD) was 4.1±1.62 mmol/l in the necrotizing fasciitis group and 1.8±0.46 mmol/l in the non-necrotizing fasciitis group (p≤0.0001). A serum lactate level above 2.0 mmol/l had a sensitivity of 1.00 and a specificity of 0.76 for necrotizing fasciitis in this series. In this series of patients with suspected necrotizing soft tissue infection, serum lactate levels above 2.0 mmol/l at presentation were strongly associated with the presence of tissue necrosis. Although no test can be relied upon in isolation, our results suggest that serum lactate is a promising adjunct to the diagnosis of necrotizing infection, which could help to expedite appropriate management. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis.

PubMed

Cheung, R T H; Sze, L K Y; Mok, N W; Ng, G Y F

2016-09-01

Plantar fasciitis, a common injury in runners, has been speculated to be associated with weakness of the intrinsic foot muscles. A recent study reported that atrophy of the intrinsic forefoot muscles might contribute to plantar fasciitis by destabilizing the medial longitudinal arch. However, intrinsic foot muscle volume difference between individuals with plantar fasciitis and healthy counterparts remains unknown. This study examined the relationship of intrinsic foot muscle volume and incidence of plantar fasciitis. Case-control study. 20 experienced (≥5 years) runners were recruited. Ten of them had bilateral chronic (≥2 years) plantar fasciitis while the others were healthy characteristics-matched runners. Intrinsic muscle volumes of the participants' right foot were scanned with a 1.5T magnetic resonance system and segmented using established methods. Body-mass normalized intrinsic foot muscle volumes were compared between runners with and without chronic plantar fasciitis. There was significant greater rearfoot intrinsic muscle volume in healthy runners than runners with chronic plantar fasciitis (Cohen's d=1.13; p=0.023). A similar trend was also observed in the total intrinsic foot muscle volume but it did not reach a statistical significance (Cohen's d=0.92; p=0.056). Forefoot volume was similar between runners with and without plantar fasciitis. These results suggest that atrophy of intrinsic foot muscles may be associated with symptoms of plantar fasciitis in runners. These findings may provide useful information in rehabilitation strategies of chronic plantar fasciitis. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

PubMed

Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

2016-04-01

Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory. © The Author(s) 2015.

Traumatic abdominal hernia complicated by necrotizing fasciitis.

PubMed

Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

2014-11-01

Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

Review of 58 patients with necrotizing fasciitis in the Netherlands.

PubMed

van Stigt, Sander F L; de Vries, Janneke; Bijker, Jilles B; Mollen, Roland M H G; Hekma, Edo J; Lemson, Susan M; Tan, Edward C T H

2016-01-01

Necrotizing fasciitis is a rare, life threatening soft tissue infection, primarily involving the fascia and subcutaneous tissue. In a large cohort of patients presenting with Necrotizing fasciitis in the Netherlands we analysed all available data to determine the causative pathogens and describe clinical management and outcome. We conducted a retrospective, multicentre cohort study of patients with a necrotizing fasciitis between January 2003 and December 2013 in an university medical hospital and three teaching hospitals in the Netherlands. We only included patients who stayed at the Intensive Care Unit for at least one day. Fifty-eight patients were included. The mortality rate among those patients was 29.3 %. The central part of the body was affected in 28 patients (48.3 %) and in 21 patients (36.2 %) one of the extremities. Most common comorbidity was cardio vascular diseases in 39.7 %. Thirty-nine patients (67.2 %) were operated within 24 h after presentation. We found a type 1 necrotizing fasciitis in 35 patients (60.3 %) and a type 2 in 23 patients (39.7 %). Our study, which is the largest study in Europe, reaffirmed that Necrotizing fasciitis is a life threatening disease with a high mortality. Early diagnosis and adequate treatment are necessary to improve the clinical outcome. Clinical awareness off necrotizing fasciitis remains pivotal.

Necrotizing fasciitis due to Serratia marcescens: case report and review of the literature.

PubMed

Majumdar, Rohit; Crum-Cianflone, Nancy F

2016-06-01

Necrotizing fasciitis is a severe, life-threatening infection.  Serratia marcescens, a Gram-negative bacterium, is an extremely rare cause of necrotizing fasciitis. A case of S. marcescens necrotizing fasciitis is described, and a comprehensive review of the literature (1966-2015) of monomicrobial cases due to this organism performed. We report the first case of S. marcescens necrotizing fasciitis in the setting of calciphylaxis associated with end-stage renal disease.  A comprehensive review of the literature of S. marcescens necrotizing fasciitis is provided to enhance the awareness of this increasingly recognized infection, and to provide a concise summary of risk factors, treatment, and outcome. Our case and review highlight the potential risk factors for S. marcescens necrotizing fasciitis, including underlying renal disease and open wounds, and demonstrate the emergence of this organism as a cause of severe, life-threatening soft tissue infections.

Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan.

PubMed

Tsai, Yao-Hung; Hsu, Wei-Hsiu; Huang, Kuo-Chin; Yu, Pei-An; Chen, Chi-Lung; Kuo, Liang Tseng

2017-10-01

Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis. Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups. None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae (p=0.000), patients with underlying chronic disease (p=0.019), white blood cell counts (p=0.035), segmented white cell counts (p=0.02), and days of hospitalization (p=0.001). Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm 3 and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

How effective is acupuncture for reducing pain due to plantar fasciitis?

PubMed Central

Thiagarajah, Anandan Gerard

2017-01-01

INTRODUCTION Plantar fasciitis is a commonly seen outpatient condition that has numerous treatment modalities of varying degrees of efficacy. This systematic review aimed to determine the effectiveness of acupuncture in reducing pain caused by plantar fasciitis. METHODS Online literature searches were performed on the PubMed and Cochrane Library databases for studies on the use of acupuncture for pain caused by plantar fasciitis. Studies designed as randomised controlled trials and that compared acupuncture with standard treatments or had real versus sham acupuncture arms were selected. The Delphi list was used to assess the methodological quality of the studies retrieved. RESULTS Three studies that compared acupuncture with standard treatment and one study on real versus sham acupuncture were found. These showed that acupuncture significantly reduced pain levels in patients with plantar fasciitis, as measured on the visual analogue scale and the Plantar Fasciitis Pain/Disability Scale. These benefits were noted between four and eight weeks of treatment, with no further significant reduction in pain beyond this duration. Side effects were found to be minimal. CONCLUSION Although acupuncture may reduce plantar fasciitis pain in the short term, there is insufficient evidence for a definitive conclusion regarding its effectiveness in the longer term. Further research is required to strengthen the acceptance of acupuncture among healthcare providers. PMID:27526703

How effective is acupuncture for reducing pain due to plantar fasciitis?

PubMed

Thiagarajah, Anandan Gerard

2017-02-01

Plantar fasciitis is a commonly seen outpatient condition that has numerous treatment modalities of varying degrees of efficacy. This systematic review aimed to determine the effectiveness of acupuncture in reducing pain caused by plantar fasciitis. Online literature searches were performed on the PubMed and Cochrane Library databases for studies on the use of acupuncture for pain caused by plantar fasciitis. Studies designed as randomised controlled trials and that compared acupuncture with standard treatments or had real versus sham acupuncture arms were selected. The Delphi list was used to assess the methodological quality of the studies retrieved. Three studies that compared acupuncture with standard treatment and one study on real versus sham acupuncture were found. These showed that acupuncture significantly reduced pain levels in patients with plantar fasciitis, as measured on the visual analogue scale and the Plantar Fasciitis Pain/Disability Scale. These benefits were noted between four and eight weeks of treatment, with no further significant reduction in pain beyond this duration. Side effects were found to be minimal. Although acupuncture may reduce plantar fasciitis pain in the short term, there is insufficient evidence for a definitive conclusion regarding its effectiveness in the longer term. Further research is required to strengthen the acceptance of acupuncture among healthcare providers. Copyright: © Singapore Medical Association

Ultrasound elastography in the early diagnosis of plantar fasciitis.

PubMed

Lee, So-Yeon; Park, Hee Jin; Kwag, Hyon Joo; Hong, Hyun-Pyo; Park, Hae-Won; Lee, Yong-Rae; Yoon, Kyung Jae; Lee, Yong-Taek

2014-01-01

The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis. We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet. Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P=.027, respectively]. US elastography is useful for the early diagnosis of plantar fasciitis. Copyright © 2014 Elsevier Inc. All rights reserved.

[Cervical necrotizing fasciitis caused by Klebsiella pneumoniae: three cases report and review of literature].

PubMed

Cong, Tiechuan; Liu, Yuhe; Gao, Weihua; Li, Tiancheng; Wang, Quangui; Xiao, Shuifang; Qin, Yong

2013-10-01

To analyze the clinical manifestations of three cases of cervical necrotizing fasciitis caused by klebsiella pneumoniae and to analyze the published articles concerning the relationship between invasive klebsiella syndrome and necrotizing fasciitis in Chinese Mainland. We have retrospectively analyzed three cases of cervical necrotizing fasciitis caused by klebsiella pneumoniae treated in our department between 2003 and 2012. We also reviewed the Chinese-language scientific literature included in the WanFang data by searching with the following key words: necrotizing fasciitis, klebsiella pneumoniae and liver abscess. These patients recovered uneventfully without obvious complications or disseminated infection foci. Sporadic cases of invasive klebsiella syndrome were reported without necrotizing fasciitis involvement in Chinese Mainland. Cervical necrotizing fasciitis caused by klebsiella pneumoniae may give rise to disseminated infection but there has been no such case report in Chinese Mainland.

Oklahoma’s recent earthquakes and saltwater disposal

PubMed Central

Walsh, F. Rall; Zoback, Mark D.

2015-01-01

Over the past 5 years, parts of Oklahoma have experienced marked increases in the number of small- to moderate-sized earthquakes. In three study areas that encompass the vast majority of the recent seismicity, we show that the increases in seismicity follow 5- to 10-fold increases in the rates of saltwater disposal. Adjacent areas where there has been relatively little saltwater disposal have had comparatively few recent earthquakes. In the areas of seismic activity, the saltwater disposal principally comes from “produced” water, saline pore water that is coproduced with oil and then injected into deeper sedimentary formations. These formations appear to be in hydraulic communication with potentially active faults in crystalline basement, where nearly all the earthquakes are occurring. Although most of the recent earthquakes have posed little danger to the public, the possibility of triggering damaging earthquakes on potentially active basement faults cannot be discounted. PMID:26601200

Necrotizing Fasciitis of the Lower Extremity Caused by Serratia marcescens A Case Report.

PubMed

Heigh, Evelyn G; Maletta-Bailey, April; Haight, John; Landis, Gregg S

2016-03-01

Necrotizing fasciitis is a rare and potentially fatal infection, with mortality of up to 30%. This case report describes a patient recovering from a laryngectomy for laryngeal squamous cell cancer who developed nosocomial necrotizing fasciitis of the lower extremity due to Serratia marcescens . Only eight cases of necrotizing fasciitis exclusive to the lower extremity due to S marcescens have been previously reported. Patients with S marcescens necrotizing fasciitis of the lower extremity often have multiple comorbidities, are frequently immunosuppressed, and have a strikingly high mortality rate.

Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

PubMed Central

Malone, Terry R.

2004-01-01

Objective: Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model. Data Sources: We searched MEDLINE, SPORT Discus, and CINAHL from 1966 to 2003 using the key words plantar fasciitis, windlass mechanism, pronation, heel pain, and heel spur. Data Synthesis: We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments. Conclusions/Recommendations: Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment. PMID:16558682

Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy.

PubMed

Yanbin, Xu; Haikun, Chu; Xiaofeng, Ji; Wanshan, Yang; Shuangping, Liu

2015-01-01

Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Adjunctive hyperbaric oxygen for necrotizing fasciitis.

PubMed

Levett, Denny; Bennett, Michael H; Millar, Ian

2015-01-15

Hyperbaric oxygen therapy (HBOT) involves the therapeutic administration of 100% oxygen in a pressure chamber at pressures above one atmosphere absolute. This therapy has been used as an adjunct to surgery and antibiotics in the treatment of patients with necrotizing fasciitis with the aim of reducing morbidity and mortality. To review the evidence concerning the use of HBOT as an adjunctive treatment for patients with necrotizing fasciitis (NF). Specifically, we wish to address the following questions.1. Does administration of HBOT reduce mortality or morbidity associated with NF?2. What adverse effects are associated with use of HBOT in the treatment of individuals with NF? We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid (1966 to September 2014); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ovid (1982 to September 2014); EMBASE Ovid (1980 to September 2014); and the Database of Randomised Controlled Trials in Hyperbaric Medicine (DORCTHIM, M Bennett) (from inception to September 2014). In addition, we performed a systematic search of specific hyperbaric literature sources. This included handsearching of relevant hyperbaric textbooks; hyperbaric journals (Hyperbaric Medicine Review, South Pacific Underwater Medicine Society Journal, European Journal of Underwater and Hyperbaric Medicine, Aviation Space and Environmental Medicine Journal); and conference proceedings of the major hyperbaric societies (Undersea and Hyperbaric Medical Society, South Pacific Underwater Medicine Society, European Underwater and Baromedical Society, International Congress of Hyperbaric Medicine). We included all randomized and pseudo-randomized trials (trials in which an attempt at randomization has been made but the method was inappropriate, for example, alternate allocation) that compared the effects of HBOT with the effects of no HBOT (no treatment or sham) in the treatment of children and adults with necrotizing

[About two cases of primitive necrotizing fasciitis of the chest wall].

PubMed

Rabiou, S; Lakranbi, M; Issoufou, I; Ammor, F Z; Belliraj, L; Ouadnouni, Y; Smahi, M

2016-05-01

Necrotizing fasciitis is a severe bacterial necrotic infection that affects the skin and soft tissues. We report a rare observation of necrotizing fasciitis located at the thoracic wall. The management requires an appropriate antibiotherapy preceding a large necrosectomy taking all the affected areas, thus preparing the underlying tissues for a possible skin graft. Through these two observations and a literature review, we describe the medical and surgical management of necrotizing fasciitis. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Cervicofacial necrotizing fasciitis following periodontal abscess.

PubMed

Medeiros, Rui; Catunda, Ivson de Sousa; Queiroz, Isaac Vieira; de Morais, Hecio Henrique Araujo; Leao, Jair Carneiro; Gueiros, Luiz Alcino Monteiro

2012-01-01

Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

Saltwater Intrusion Through Submerged Caves due to the Venturi Effect

NASA Astrophysics Data System (ADS)

Khazmutdinova, K.; Nof, D.

2016-12-01

Saltwater intrusion into freshwater sources is a concern in coastal areas. In order to reduce the intrusion of seawater the physical mechanisms that allow this to occur must be understood. This study presents an approach to quantify saltwater intrusion in karstic coastal aquifers due to the presence of submerged caves. Many water-filled caves have variable tunnel cross-sections and often have narrow connections between two otherwise large tunnels. Generally, the diameter of these restrictions is 1 - 2 m and the flow speed within them is approximately 1 - 5 m/s. Main cave tunnels can be 10 - 20 times bigger than restrictions, and have flow speeds ranging anywhere between 0.5 cm/s and 20 cm/s. According to Bernoulli's theorem, in order to balance high velocities within a restriction, the pressure has to drop as the water flow passes through a narrow tunnel. This is expected to influence the height to which a deeper saline aquifer can penetrate in conduits connecting the narrow restriction and saltwater. For sufficiently small restrictions, saline water can invade the freshwater tunnel. The intrusion of saltwater from a deeper, saline aquifer into a fresh groundwater system due to the Venturi effect in submerged caves was computed, and an analytical and a qualitative model that captures saltwater intrusion into a fresh aquifer was developed. Using Bernoulli's theorem, we show that depths from which the saline water can be drawn into the freshwater tunnel reach up to 450 m depending on the difference in the density between fresh and saltwater. The velocity of the saline upward flow is estimated to be 1.4 m/s using the parameters for Wakulla Spring, a first order magnitude spring in Florida, with a saltwater interface 180 m below the spring cave system.

[Necrotizing fasciitis in head and neck area].

PubMed

Sántha, Beáta; Sári, Katalin; Fülep, Zoltán; Patyi, Márta; Oberna, Ferenc

2017-03-01

Necrotizing fasciitis is a fulminant infection of the deeper layers of skin and subcutaneous tissues characterized by progressive soft tissue necrosis and high mortality. It rarely occurs in the head and neck area. The clinical picture includes non-specific but typical local and systemic symptoms. The treatment is a complex, multidisciplinary task which includes radical surgical exploration, debridement and drainage, empirically started and then targeted intravenous antibiotics and supportive therapy. Authors report a case of necrotizing fasciitis localized on the right side of the face which caused multi-organ failure and phlegmone of the neck.

Necrotizing fasciitis due to Streptococcus mitis caused by accidental human bite.

PubMed

Bastug, Aliye; Kislak, Sumeyye; Mutlu, Nevzat Mehmet; Akcaboy, Zeynep Nur; Koksal, Asude; Sertcelik, Ahmet; Ünlü, Ramazan Erkin; Akinci, Esragul; Bodur, Hurrem

2016-01-31

Human bite wounds are more prone to infection than animal bites, which may cause necrotizing soft tissue infections such as myositis, fasciitis. Both aerobic and anaerobic microorganisms may be responsible, including Streptococcus spp., Staphylococcus aureus, Peptostreptococcus spp. Necrotizing fasciitis is characterized by serious tissue destruction and systemic toxicity with high morbidity and mortality. We report a patient with Streptococcus mitis associated necrotizing fasciitis on the upper extremity resulting from an accidental human bite, which caused nearly fatal infection. Prophylactic antibiotic treatment should be given after a human bite to prevent infection. If the infection signs and symptoms develop, rapid diagnosis, appropriate antibiotic and surgical therapy should be administered immediately. Streptococcus mitis is a viridans streptococcus, usually known as a relatively benign oral streptococcus. To our knowledge, this is the first necrotizing fasciitis case due to Streptococcus mitis after human bite.

Multi-limb necrotizing fasciitis in a patient with rectal cancer

PubMed Central

Liu, Shirley Yuk Wah; Ng, Simon Siu Man; Lee, Janet Fung Yee

2006-01-01

Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors, including malignancy, alcoholism, malnutrition, diabetes, male gender and old age. There are only scanty case reports in the literature describing its rare association with colorectal malignancy. All published cases are attributed to bowel perforation resulting in necrotizing fasciitis over the perineal region. Isolated upper or lower limb diseases are rarely identified. Simultaneous upper and lower limb infection in colorectal cancer patients has never been described in the literature. We report an unusual case of multi-limb necrotizing fasciitis in a patient with underlying non-perforated rectal carcinoma. PMID:16937546

A case of fatal necrotizing fasciitis arising from chronic lymphedema.

PubMed

Jun, Young Joon; Kang, In Sook; Lee, Jung Ho; Kim, Sue Min; Kim, Young Jin

2013-12-01

Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.

Necrotizing fasciitis: 11-year retrospective case review in South Auckland.

PubMed

Kulasegaran, Suheelan; Cribb, Benjamin; Vandal, Alain C; McBride, Stephen; Holland, David; MacCormick, Andrew D

2016-10-01

The aims of this paper were to review our experience with necrotizing fasciitis at Middlemore Hospital and to define the trends in incidence, inpatient mortality and microbiological profile. A computerized search of the electronic medical records was undertaken to identify adult patients with a diagnosis of necrotizing fasciitis between January 2000 and December 2010. A retrospective review of the clinical records was performed. Of the 138 patients with necrotizing fasciitis identified, 129 had their diagnosis confirmed at operation. The mortality at 30 days was 20.3% (95% confidence interval (CI) 13.9%-28.0%). There was a significant reduction in hospital mortality in each successive year of the study period with an odds ratio of 0.84 (95% CI 0.71-0.98, P = 0.03). A pattern of increasing incidence was noted until February 2004 (95% CI September 2002-July 2005). This was followed by a significant decrease in incidence. The empirical antibiotic regime of clindamycin, gentamicin and penicillin provides satisfactory cover against 95% of the causative pathogens. This represents the largest single-centre published case series in New Zealand. Despite concerns of increasing incidence and mortality associated with necrotizing fasciitis in New Zealand, the experience in South Auckland shows a decrease in incidence of necrotizing fasciitis since 2004 and a statistically significant decreasing trend in hospital mortality. © 2015 Royal Australasian College of Surgeons.

Ratio of Major Ions in Groundwater to Determine Saltwater Intrusion in Coastal Areas

NASA Astrophysics Data System (ADS)

Sudaryanto; Naily, Wilda

2018-02-01

Saltwater or seawater intrusion into groundwater aquifers occurs mostly in big cities and developing coastal cities. Coastal hydrology is associated with complex and highly dynamic environmental characteristics of interactions between groundwater, surface water, and water from the estuary. The rise of sea levels and excessive use of groundwater for clean water source trigger saltwater intrusion. Identification of saltwater intrusion into groundwater can be done by groundwater sampling and major ion analysis. The major ions dissolved in water are Ca, Mg, Na, K, Cl, HCO3, and SO4; the major ion ratios are Cl/Br, Ca/Mg, Ca/ (HCO3 and SO4), and Na/Cl. By knowing whether groundwater quality has been or has not been influenced by saltwater, groundwater zones can be determined in every coastal area. In addition, by analyzing and reviewing some concepts about the intrusion or contamination of saltwater into groundwater, there will be sufficient results for the identification of saltwater intrusion.

Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants: A Systematic Review.

PubMed

Wojtera, Monika; Cheng, Horace; Fiorini, Kyle; Coughlin, Kevin; Barton, Michelle; Strychowsky, Julie

2018-02-07

There is no consensus regarding approaches to infantile group B streptococcal (GBS) head and neck cellulitis and necrotizing fasciitis. We present a case of GBS necrotizing cellulitis and summarizes the literature regarding the presentation and management of infantile head and neck GBS cellulitis and necrotizing fasciitis. The literature was searched using PubMed, Web of Science, EMBASE, and Medline (inception to April 2017) by two independent review authors. Inclusion criteria encompassed case reports or case series of infants less than 12 months of age with GBS cellulitis of the head and neck, or with GBS necrotizing fasciitis without restriction to the head and neck. Data were extracted using tables developed a priori by two independent review authors, and discrepancies were resolved by consensus. An infant presenting at 33 days of age with GBS facial necrotizing fasciitis was successfully treated conservatively with antibiotics. Our literature search identified 40 infants with GBS head and neck cellulitis. Late-onset (98%), male gender (65%), and prematurity (58%) predominated. Penicillins were the main therapy used (97%). The 12 identified cases of necrotizing fasciitis were associated with polymicrobial etiology (36%) and broad-spectrum antibiotic use. Seventy-five percent required debridement, including four of five (80%) cases involving the head and neck. Skin and soft tissue involvement is an uncommon manifestation of late-onset GBS infection which requires antibiotic therapy and possibly surgical debridement cases with necrotizing fasciitis.

Skin-Sparing Débridement for Necrotizing Fasciitis in Children.

PubMed

Rüfenacht, Magali S; Montaruli, Ernesto; Chappuis, Eléonore; Posfay-Barbe, Klara M; La Scala, Giorgio C

2016-09-01

Necrotizing fasciitis is a serious soft-tissue infection associated with sepsis and tissue destruction. Surgical management usually requires extensive débridement of necrotic fascia and overlying skin, with significant aesthetic and functional consequences. The authors review the outcome of all recent cases of necrotizing fasciitis treated with skin-sparing débridement at their institution. The authors conducted a retrospective review of all of their cases of necrotizing fasciitis treated with skin-sparing débridement. Medical records were evaluated with a standard form gathering relevant demographic and clinical data. All cases were confirmed as necrotizing fasciitis histologically. Ten patients were admitted with a diagnosis of necrotizing fasciitis. The median age of the patients was 4.9 years (range, 1.7 to 15.1 years). The majority of initial lesions were caused by chickenpox, mostly on the trunk. Interval from admission to surgery was 6 hours (range, 1 to 27.5 hours), with a median hospital stay of 11 days (range, 5 to 43 days). Median fasciectomy was 2.5 percent (range, 1 to 15 percent) of total body surface area, with a median skin excision of 0.25 percent of total body surface area (range, 0.1 to 3 percent). All patients received intravenous amoxicillin/clavulanic acid plus clindamycin. Delayed direct closure was possible for all patients. Median follow-up was 17 months (range, 3 to 79 months). There was no death in this series. This surgical management restricts skin excision to the area of definite skin necrosis, limiting skin excision to one-tenth of excised fascia, with long-term favorable cosmetic and functional results. Therapeutic, IV.

[Dentogene Focus as a Rare Cause of Necrotizing Fasciitis].

PubMed

Kloth, Christopher; Hoefert, Sebastian; Fischborn, Till; Schraml, Christina

2017-02-01

History and clinical findings  We elaborate the case of a 72-year-old patient who presented with a painful swelling of the lower jaw in the emergency unit. Investigations and diagnosis  In the clinical examination and the CT scan, a widespread cervical emphysema was found which raised suspicion for the presence of a necrotizing fasciitis of the head and neck due to aerogenic infection. Close spatial vicinity to the teeth of the left upper and lower jaw was present, so that the necrotizing fasciitis was assumed to be odontogenic. Treatment and course  Based on the clinical presentation and the imaging findings the diagnosis of necrotizing fasciitis in the sense of a possible infection with gas building bacteria accompanying with an infection of the mediastinum was made. Immediately performed therapy included sternotomy and extended surgical debridement of necrosis. Conclusion  The presented case emphasizes that necrotizing fasciitis due to gas-producing infections should be considered as a differential diagnosis for cervical soft tissue emphysema for which an odontogenic focus is the most common cause. Rapid diagnosis is essential for successful treatment consisting of immediate surgical debridement and intravenous antibiotics. © Georg Thieme Verlag KG Stuttgart · New York.

Plantar Fasciitis: Will Physical Therapy Help My Foot Pain?

PubMed

2017-02-01

One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In 2014, the Orthopaedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy. The results of this study support prior studies that show faster recovery time for those who receive evidence-based physical therapy for their foot pain. J Orthop Sports Phys Ther 2017;47(2):56. doi:10.2519/jospt.2017.0501.

Comparative Genome Analyses Reveal Distinct Structure in the Saltwater Crocodile MHC

PubMed Central

Jaratlerdsiri, Weerachai; Deakin, Janine; Godinez, Ricardo M.; Shan, Xueyan; Peterson, Daniel G.; Marthey, Sylvain; Lyons, Eric; McCarthy, Fiona M.; Isberg, Sally R.; Higgins, Damien P.; Chong, Amanda Y.; John, John St; Glenn, Travis C.; Ray, David A.; Gongora, Jaime

2014-01-01

The major histocompatibility complex (MHC) is a dynamic genome region with an essential role in the adaptive immunity of vertebrates, especially antigen presentation. The MHC is generally divided into subregions (classes I, II and III) containing genes of similar function across species, but with different gene number and organisation. Crocodylia (crocodilians) are widely distributed and represent an evolutionary distinct group among higher vertebrates, but the genomic organisation of MHC within this lineage has been largely unexplored. Here, we studied the MHC region of the saltwater crocodile (Crocodylus porosus) and compared it with that of other taxa. We characterised genomic clusters encompassing MHC class I and class II genes in the saltwater crocodile based on sequencing of bacterial artificial chromosomes. Six gene clusters spanning ∼452 kb were identified to contain nine MHC class I genes, six MHC class II genes, three TAP genes, and a TRIM gene. These MHC class I and class II genes were in separate scaffold regions and were greater in length (2–6 times longer) than their counterparts in well-studied fowl B loci, suggesting that the compaction of avian MHC occurred after the crocodilian-avian split. Comparative analyses between the saltwater crocodile MHC and that from the alligator and gharial showed large syntenic areas (>80% identity) with similar gene order. Comparisons with other vertebrates showed that the saltwater crocodile had MHC class I genes located along with TAP, consistent with birds studied. Linkage between MHC class I and TRIM39 observed in the saltwater crocodile resembled MHC in eutherians compared, but absent in avian MHC, suggesting that the saltwater crocodile MHC appears to have gene organisation intermediate between these two lineages. These observations suggest that the structure of the saltwater crocodile MHC, and other crocodilians, can help determine the MHC that was present in the ancestors of archosaurs. PMID:25503521

Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric☆☆☆

PubMed Central

Santos, Leandro Emílio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brandão; Soares, Eduardo Augusto Marques

2014-01-01

Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed. PMID:26229777

Gastrocnemius recession for recalcitrant plantar fasciitis in overweight and obese patients.

PubMed

Ficke, Brooks; Elattar, Osama; Naranje, Sameer M; Araoye, Ibukunoluwa; Shah, Ashish B

2017-06-07

Plantar fasciitis is a common foot pathology that is typically treated non-operatively. However, a minority of patients fail non-operative management, develop chronic symptoms, and request a surgical option. Gastrocnemius recession has recently been shown to be effective for the treatment of chronic plantar fasciitis. The purpose of this paper is to present evidence that gastrocnemius recession is safe and effective in the subset of chronic plantar fasciitis patients who are overweight and obese. We retrospectively reviewed 18 cases (17 patients) of chronic plantar fasciitis in overweight or obese patients who underwent gastrocnemius recession (mean age=46years, mean body mass index=34.7kg/m 2 , mean follow-up=20months). Data was gathered regarding pre-operative and post-operative pain (visual analog scale, 0-10), Foot Function Index score, and complications. Mean Foot Function Index score improved from 66.4 (range, 32.3-97.7) preoperatively to 26.5 (range, 0-89.4) postoperatively (p<0.01). Mean pain score improved from 8.3 (range, 5-10) preoperatively to 2.4 (range, 0-7) at final follow-up (p<0.01). Gastrocnemius recession improved foot function and pain symptoms in overweight and obese patients with chronic plantar fasciitis. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Monomicrobial Necrotizing Fasciitis Caused by Aeromonas hydrophila and Klebsiella pneumoniae

PubMed Central

Tsai, Yao-Hung; Shen, Shih-Hsun; Yang, Tien-Yu; Chen, Po-Han; Huang, Kuo-Chin; Lee, Mel S.

2015-01-01

Objective To compare specific characteristics and clinical outcomes of monomicrobial necrotizing fasciitis caused by Aeromonas hydrophila and Klebsiella pneumoniae. Material and Methods Cases of monomicrobial necrotizing fasciitis caused by A. hydrophila (n = 11) and K. pneumoniae (n = 7) over an 8-year period were retrospectively reviewed. Differences in mortality, patient characteristics, clinical presentations, and laboratory data were compared between the A. hydrophila and the K. pneumoniae groups. Results The clinical signs and symptoms at the time of presentation did not differ significantly (p > 0.05) between the two groups. The A. hydrophila group had a significantly shorter interval between contact and admission (1.55 ± 0.52 vs. 5.14 ± 2.12 days, p < 0.001) and significant lower total white blood cell counts (10,245 ± 5,828 vs. 19,014 ± 11,370 cells/mm3, p < 0.045) than the K. pneumoniae group in the emergency room. Hepatic dysfunction was associated with mortality in patients with A. hydrophila infection, while diabetes mellitus was associated with mortality in patients with K. pneumoniae infection. Overall, 5 (45.5%) patients in the A. hydrophila group and 3 (42.8%) in the K. pneumoniae group died. Conclusion The initial clinical course of A. hydrophila monomicrobial necrotizing fasciitis was characterized by more rapidly progressive disease than that of the K. pneumoniae infection. Patients with hepatic dysfunction and necrotizing fasciitis should be suspected of having A. hydrophila infection, and diabetic patients with necrotizing fasciitis should be suspected of having K. pneumoniae infection initially. PMID:26066555

Monomicrobial Necrotizing Fasciitis Caused by Aeromonas hydrophila and Klebsiella pneumoniae.

PubMed

Tsai, Yao-Hung; Shen, Shih-Hsun; Yang, Tien-Yu; Chen, Po-Han; Huang, Kuo-Chin; Lee, Mel S

2015-01-01

To compare specific characteristics and clinical outcomes of monomicrobial necrotizing fasciitis caused by Aeromonashydrophila and Klebsiella pneumoniae. Cases of monomicrobial necrotizing fasciitis caused by A. hydrophila (n = 11) and K. pneumoniae (n = 7) over an 8-year period were retrospectively reviewed. Differences in mortality, patient characteristics, clinical presentations, and laboratory data were compared between the A. hydrophila and the K. pneumoniae groups. The clinical signs and symptoms at the time of presentation did not differ significantly (p > 0.05) between the two groups. The A. hydrophila group had a significantly shorter interval between contact and admission (1.55 ± 0.52 vs. 5.14 ± 2.12 days, p < 0.001) and significant lower total white blood cell counts (10,245 ± 5,828 vs. 19,014 ± 11,370 cells/mm(3), p < 0.045) than the K. pneumoniae group in the emergency room. Hepatic dysfunction was associated with mortality in patients with A. hydrophila infection, while diabetes mellitus was associated with mortality in patients with K. pneumoniae infection. Overall, 5 (45.5%) patients in the A. hydrophila group and 3 (42.8%) in the K. pneumoniae group died. The initial clinical course of A. hydrophila monomicrobial necrotizing fasciitis was characterized by more rapidly progressive disease than that of the K. pneumoniae infection. Patients with hepatic dysfunction and necrotizing fasciitis should be suspected of having A. hydrophila infection, and diabetic patients with necrotizing fasciitis should be suspected of having K. pneumoniae infection initially. © 2015 S. Karger AG, Basel.

Graphite Based Electrode for ECG Monitoring: Evaluation under Freshwater and Saltwater Conditions.

PubMed

Thap, Tharoeun; Yoon, Kwon-Ha; Lee, Jinseok

2016-04-15

We proposed new electrodes that are applicable for electrocardiogram (ECG) monitoring under freshwater- and saltwater-immersion conditions. Our proposed electrodes are made of graphite pencil lead (GPL), a general-purpose writing pencil. We have fabricated two types of electrode: a pencil lead solid type (PLS) electrode and a pencil lead powder type (PLP) electrode. In order to assess the qualities of the PLS and PLP electrodes, we compared their performance with that of a commercial Ag/AgCl electrode, under a total of seven different conditions: dry, freshwater immersion with/without movement, post-freshwater wet condition, saltwater immersion with/without movement, and post-saltwater wet condition. In both dry and post-freshwater wet conditions, all ECG-recorded PQRST waves were clearly discernible, with all types of electrodes, Ag/AgCl, PLS, and PLP. On the other hand, under the freshwater- and saltwater-immersion conditions with/without movement, as well as post-saltwater wet conditions, we found that the proposed PLS and PLP electrodes provided better ECG waveform quality, with significant statistical differences compared with the quality provided by Ag/AgCl electrodes.

Periocular necrotizing fasciitis in an infant.

PubMed

Proia, Alan D

Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Necrotizing Fasciitis as a Complication of a Continuous Sciatic Nerve Catheter Using the Lateral Popliteal Approach.

PubMed

Dott, Daltry; Canlas, Christopher; Sobey, Christopher; Obremskey, William; Thomson, Andrew Brian

Necrotizing fasciitis is an infection of the soft tissue that is characterized by rapidly spreading inflammation and subsequent necrosis. It is a rare complication of peripheral nerve blocks. We report a rare case of necrotizing fasciitis after placement of a peripheral nerve catheter. A 58-year-old woman presented for an elective right second metatarsal resection and received a sciatic nerve catheter for postoperative pain control. On postoperative day 7, clinical examination and imaging supported the diagnosis of necrotizing fasciitis. Multiple reports have been published of necrotizing fasciitis after single-shot peripheral nerve block injections, neuraxial anesthesia, and intramuscular injections. This case highlights the potential for the rare complication of necrotizing fasciitis after peripheral nerve catheter placement.

Saltwater Intrusion: Climate change mitigation or just water resources management?

NASA Astrophysics Data System (ADS)

Ferguson, G. A.; Gleeson, T.

2011-12-01

Climate change and population growth are expected to substantially increase the vulnerability of global water resources throughout the 21st century. Coastal groundwater systems are a nexus of the world's changing oceanic and hydrologic systems and a critical resource for the over one billion people living in coastal areas as well as for terrestrial and offshore ecosystems. Synthesis studies and detailed simulations predict that rising sea levels could negatively impact coastal aquifers by causing saltwater to intrude landward within coastal aquifers or by saltwater inundation of coastal regions. Saltwater intrusion caused by excessive extraction is already impacting entire island nations and globally in diverse regions such as Nile River delta in Egypt, Queensland, Australia and Long Island, USA. However, the vulnerability of coastal aquifers to sea level rise and excessive extraction has not been systematically compared. Here we show that coastal aquifers are much more vulnerable to groundwater extraction than predicted sea level rise in wide-ranging hydrogeologic conditions and population densities. Low lying areas with small hydraulic gradients are more sensitive to climate change but a review of existing coastal aquifer indicates that saltwater intrusion problems are more likely to arise where water demand is high. No cases studies were found linking saltwater intrusion to sea level rise during the past century. Humans are a key driver in the hydrology of coastal aquifers and that adapting to sea level rise at the expense of better water management is misguided.

Nodular Fasciitis of the Breast Previously Misdiagnosed as Breast Carcinoma

PubMed Central

Ozben, Volkan; Aydogan, Fatih; Karaca, Fatih Can; Ilvan, Sennur; Uras, Cihan

2009-01-01

Summary Background Nodular fasciitis of the breast is a rare benign pathology that can mimic breast cancer clinically, radiologically, and histopathologically. Case Report An 18-year-old female patient had first visited a physician in a different center with the complaint of a lump in her left breast. Breast examination had revealed a palpable mass located in the left upper outer quadrant. Ultrasonography had demonstrated a hypoechoic lesion. Excisional biopsy of the lump had been performed and histopathologic examination misdiagnosed this lump as a mesenchymal tumor. The patient was then referred to our clinic for further investigations. Pathologic revision was performed and the diagnosis of nodular fasciitis of the breast was established. Conclusion Awareness of this rare clinical entity, nodular fasciitis, in the breast eliminates the misdiagnosis of breast cancer. PMID:20877676

[Necrotizing fasciitis: study of 17 cases presenting a low mortality rate].

PubMed

Kibadi, K; Forli, A; Martin Des Pallieres, T; Debus, G; Moutet, F; Corcella, D

2013-04-01

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. The originality of this study is to present a series of necrotizing fasciitis treated and followed these last five years, and to compare the therapeutic results with those of the literature. We led a retrospective study on the patients treated for necrotizing fasciitis between 2005 and 2009 by bringing together the demographic and clinical data, the bacteriological examinations and the results of management. Follow-up data from these patients during period of study (five years) were notified. Seventeen patients were treated (11 men and six women). The average age of the patients was 52 years (ranging from 28 to 82 years). Risk factors of necrotizing fasciitis for our patients were: nonsteroidal anti-inflammatory drugs (82.2%), cutaneous wound (76.4%), obesity (29.4%), oto-rhino-laryngologic diseases (23.5%), alcoholic and drug addicts (23.5%), and diabetis (11.7%). The most isolated and responsible germ was Streptococcus pyogenes in 75.5% of cases. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensible to the antibiotics being administered (clindamycin in 70.5% of cases). The surgical management was early done with an average delay of 2.7 days (ranging from 1 to 15 days). We observed a low mortality rate (11.7%). One patient died during the period of follow-up after one year (average follow-up of 2.0 years; 1-3 years). Contrary to the data from the literature, this study presents a decrease of the mortality in necrotizing fasciitis with an early treatment and an adequate management. The precocity and the quality of surgical procedures as well as the presence of an underlying disease are determining factors for successful management of necrotizing fasciitis. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States.

PubMed

Fraser, John J; Glaviano, Neal R; Hertel, Jay

2017-02-01

Study Design Retrospective observational study. Background Plantar fasciitis is responsible for 1 million ambulatory patient care visits annually in the United States. Few studies have investigated practice patterns in the treatment of patients with plantar fasciitis. Objective To assess physical therapist utilization and employment of manual therapy and supervised rehabilitation in the treatment of patients with plantar fasciitis. Methods A retrospective review of the PearlDiver patient record database was used to evaluate physical therapist utilization and use of manual therapy and supervised rehabilitation in patients with plantar fasciitis between 2007 and 2011. An International Classification of Diseases code (728.71) was used to identify plantar fasciitis, and Current Procedural Terminology codes were used to identify evaluations (97001), manual therapy (97140), and rehabilitation services (97110, 97530, 97112). Results A total of 819 963 unique patients diagnosed with plantar fasciitis accounted for 5 739 737 visits from 2007 to 2011, comprising 2.7% of all patients in the database. Only 7.1% (95% confidence interval: 7.0%, 7.1%) of patients received a physical therapist evaluation. Of the 57 800 patients evaluated by a physical therapist (59.8% female), 50 382 (87.2% ± 0.4%) received manual therapy, with significant increases in utilization per annum. A large proportion (89.5% ± 0.4%) received rehabilitation following physical therapist evaluation. Conclusion Despite plantar fasciitis being a frequently occurring musculoskeletal condition, a small proportion of patients with plantar fasciitis were seen by physical therapists. Most patients who were evaluated by a physical therapist received manual therapy and a course of supervised rehabilitation as part of their plan of care. Level of Evidence Treatment, level 2a. J Orthop Sports Phys Ther 2017;47(2):49-55. doi:10.2519/jospt.2017.6999.

[Fulminant isolated necrotizing fasciitis of the chest wall, complicating thoracic empyema].

PubMed

Kovács, Ottó; Szántó, Zoltán; Krasznai, Géza

2016-03-01

Authors introduce the case of a 64-year-old male patient with fulminant isolated necrotizing fasciitis of the chest wall, complicating empyema thoracis of unknown origin. The patient's co-morbidities were hypertension, ischaemic heart disease, atrial fibrillation with oral anticoagulation. The real etiology was revealed post mortem, due to the rapid progression. The autopsy demonstrated that the fasciitis was caused by a small blunt thoracic trauma (haematoma), not emerged from patient's history and was not visible during physical examination. Authors review diagnostic pitfalls, leading to delayed recognition in addition to this very case. After quick diagnosis surgical debridement, targeted wide spectrum antibiotics and maximal intensive care are the basic pillars of the management of necrotizing fasciitis.

Plantar Fasciitis: Prescribing Effective Treatments.

ERIC Educational Resources Information Center

Shea, Michael; Fields, Karl B.

2002-01-01

Plantar fasciitis is an extremely common, painful injury seen among people in running and jumping sports. While prognosis for recovery with conservative care is excellent, prolonged duration of symptoms affects sports participation. Studies on treatment options show mixed results, so finding effective treatments can be challenging. A logical…

Rare Complication of Stomas: Peristomal Necrotizing Fasciitis.

PubMed

Peker, Kivanc Derya; Ilhan, Burak M

2016-12-01

A stoma formation is a frequently performed procedure in patients undergoing colorectal surgery. Although stoma formation is a simple process, it should be performed with caution. The aim of this study was to attract physicians' attention to this rare disease and also to identify the surgical and medical treatment options for peristomal necrotizing fasciitis as a rare complication. Risk factors including age, sex, additional diseases, previous surgical procedures, source of infection, physical findings, and vital signs of 14 patients with peristomal necrotizing fasciitis over a period of 10 years from 2005 to 2015 were retrospectively evaluated. Of the 14 patients, 9 were men and 5 were women. The average age was 63.28 years (range, 45-85 years). Risk factors were also observed: diabetes mellitus, 4 (28.57%); obesity, 3 (21.42%); alcoholism, 1 (7.14%); and malignancy, 10 (71.42%). Prophylactic antibiotic treatment was given to all patients, and they all underwent debridement and stoma replacement. Peristomal necrotizing fasciitis is an urgent and mortal disease. Risk factors, physical findings, and infection sources should be determined, and treatment modalities should be applied immediately. Medical treatment and surgical options should be performed, and vacuum devices should also be considered when treating this complication.

Surgery for Patients With Recalcitrant Plantar Fasciitis

PubMed Central

Wheeler, Patrick; Boyd, Kevin; Shipton, Mary

2014-01-01

Background: Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. Purpose: To assess the outcome following surgical intervention for patients with plantar fasciitis. Study Design: Case series; Level of evidence, 4. Methods: Seventy-nine patients were identified from operative diaries undergoing plantar fasciotomy surgery between 1993 and 2009. They were contacted to investigate long-term results using self-reported outcome measures. Results: Sixty-eight responses were received (86% response rate), with an average of 7 years (range, 1-15 years) of follow-up. Patients reported an average reduction in pain by visual analog scale of 79%, and 84% of patients were happy with the surgical results. Greater success was achieved in patients with shorter duration of symptoms preoperatively. No deterioration in success was seen over time. Conclusion: Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. The results of current operative techniques need to be fully investigated for longer term success, as do the outcomes of newer nonoperative management strategies. PMID:26535314

Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome

PubMed Central

2009-01-01

Objective Necrotizing fasciitis is a life threatening soft-tissue infection with a high morbidity and mortality. Prompt treatment based on extensive surgical debridement and antibiotic therapies are the therapeutic principles. Methods The medical records of patients with necrotizing fasciitis (n = 26) from 1996 to 2005 were retrospectively analyzed. Results The localization of necrotizing fasciitis was most commonly the trunk (42.3%). Type I polymicrobial infection was the dominating infection. The involvement of anaerobic bacteria was associated with an increase in the number of surgical revisions (p = 0.005). Length of postoperative intensive care unit stay, duration of postoperative ventilation and mortality were significantly increased in the ASA IV-V group. Computed tomography displayed only a limited significance as diagnostic tool for initial diagnosis. Conclusions In severe cases the combination of necrotic skin and soft tissue gas facilitates the correct diagnosis, which should than be followed by immediate - and most often - repeated debridement. If anaerobes are isolated an early and aggressive second look is necessary. PMID:19258208

Assessment of saltwater intrusion in southern coastal Broward County, Florida

USGS Publications Warehouse

Merritt, M.L.

1996-01-01

Of the counties in southeastern Florida, Broward County has experienced some of the most severe effects of saltwater intrusion into the surficial Biscayne aquifer because, before 1950, most public water-supply well fields in the county were constructed near the principal early population centers located less than 5 miles from the Atlantic Ocean. The construction of major regional drainage canals in the early 20th century caused a lowering of the water table and a gradual inland movement of the saltwater front toward the well fields. The U.S. Geological Survey began field investigations of saltwater intrusion in the Biscayne aquifer of southeastern Broward County in 1939. As part of the present study, the positions of the saltwater front in 1945, 1969, and 1993 were estimated using chloride concentrations of water samples collected between 1939 and 1994 from various monitoring and exploratory wells. The data indicate that, between 1945 and 1993, the saltwater front has moved as much as 0.5 mile inland in parts of the study area. The position and movement of the saltwater front were simulated numerically to help determine which of the various hydrologic factors and water-management features characterizing the coastal subsurface environment and its alteration by man are of significance in increasing or decreasing the degree of saltwater intrusion. Two representational methods were applied by the selection and use of appropriate model codes. The SHARP code simulates the position of the saltwater front as a sharp interface, which implies that no transition zone (a zone in which a gradational change between freshwater and saltwater occurs) separates freshwater and saltwater. The Subsurface Waste Injection Program (SWIP) code simulates a two-fluid, variable-density system using a convective-diffusion approach that includes a representation of the transition zone that occurs between the freshwater and saltwater bodies. The models were applied to: (1) approximately

The Effects of Saltwater Intrusion to Flood Mitigation Project

NASA Astrophysics Data System (ADS)

Azida Abu Bakar, Azinoor; Khairudin Khalil, Muhammad

2018-03-01

The objective of this study is to determine the effects of saltwater intrusion to flood mitigation project located in the flood plains in the district of Muar, Johor. Based on the studies and designs carried out, one of the effective flood mitigation options identified is the Kampung Tanjung Olak bypass and Kampung Belemang bypass at the lower reaches of Sungai Muar. But, the construction of the Kampung Belemang and Tanjung Olak bypass, while speeding up flood discharges, may also increase saltwater intrusion during drought low flows. Establishing the dynamics of flooding, including replicating the existing situation and the performance with prospective flood mitigation interventions, is most effectively accomplished using computer-based modelling tools. The finding of this study shows that to overcome the problem, a barrage should be constructed at Sungai Muar to solve the saltwater intrusion and low yield problem of the river.

Extracorporeal shock wave treatment for chronic plantar fasciitis (heel pain).

PubMed

Ho, C

2007-01-01

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis (or heel pain). These waves may help to accelerate the healing process via an unknown mechanism. (2) ESWT, which is performed as an outpatient procedure, is intended to alleviate the pain due to chronic plantar fasciitis. (3) Results from randomized controlled trials have been conflicting. Six trials reported data that favour ESWT over placebo or conservative treatment for efficacy outcomes, while three trials showed no significant difference between the ESWT group and the placebo group. (4) The lack of convergent findings from randomized trials of ESWT for chronic plantar fasciitis suggests uncertainty about its effectiveness. The evidence reviewed in this bulletin does not support the use of this technology for this condition.

Potential for saltwater intrusion into the lower Tamiami aquifer near Bonita Springs, southwestern Florida

USGS Publications Warehouse

Shoemaker, W. Barclay; Edwards, K. Michelle

2003-01-01

A study was conducted to examine the potential for saltwater intrusion into the lower Tamiami aquifer beneath Bonita Springs in southwestern Florida. Field data were collected, and constant- and variable-density ground-water flow simulations were performed that: (1) spatially quantified modern and seasonal stresses, (2) identified potential mechanisms of saltwater intrusion, and (3) estimated the potential extent of saltwater intrusion for the area of concern. MODFLOW and the inverse modeling routine UCODE were used to spatially quantify modern and seasonal stresses by calibrating a constant-density ground-water flow model to field data collected in 1996. The model was calibrated by assuming hydraulic conductivity parameters were accurate and by estimating unmonitored ground-water pumpage and potential evapotranspiration with UCODE. Uncertainty in these estimated parameters was quantified with 95-percent confidence intervals. These confidence intervals indicate more uncertainty (or less reliability) in the estimates of unmonitored ground-water pumpage than estimates of pan-evaporation multipliers, because of the nature and distribution of observations used during calibration. Comparison of simulated water levels, streamflows, and net recharge with field data suggests the model is a good representation of field conditions. Potential mechanisms of saltwater intrusion into the lower Tamiami aquifer include: (1) lateral inland movement of the freshwater-saltwater interface from the southwestern coast of Florida; (2) upward leakage from deeper saline water-bearing zones through natural upwelling and upconing, both of which could occur as diffuse upward flow through semiconfining layers, conduit flow through karst features, or pipe flow through leaky artesian wells; (3) downward leakage of saltwater from surface-water channels; and (4) movement of unflushed pockets of relict seawater. Of the many potential mechanisms of saltwater intrusion, field data and variable

Effects of climate change on saltwater intrusion at Hilton Head Island, SC. U.S.A.

USGS Publications Warehouse

Payne, Dorothy F.

2010-01-01

Sea‐level rise and changes in precipitation patterns may contribute to the occurrence and affect the rate of saltwater contamination in the Hilton Head Island, South Carolina area. To address the effects of climate change on saltwater intrusion, a threedimensional, finite‐element, variable‐density, solute‐transport model was developed to simulate different rates of sea‐level rise and variation in onshore freshwater recharge. Model simulation showed that the greatest effect on the existing saltwater plume occurred from reducing recharge, suggesting recharge may be a more important consideration in saltwater intrusion management than estimated rates of sea‐level rise. Saltwater intrusion management would benefit from improved constraints on recharge rates by using model‐independent, local precipitation and evapotranspiration data, and improving estimates of confining unit hydraulic properties.

Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis.

PubMed

Zhou, Binghua; Zhou, You; Tao, Xu; Yuan, Chengsong; Tang, Kanglai

2015-01-01

Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis. Copyright © 2015 American College of

Electrical Resistivity Imaging of Saltwater and Freshwater Along the Coast of Monterey Bay

NASA Astrophysics Data System (ADS)

Knight, R. J.; Pidlisecky, A.; Moran, T.; Goebel, M.

2014-12-01

A coastal region represents a dynamic interface where the processes of saltwater intrusion and freshwater flow create complex spatial and temporal changes in water chemistry. These changes in water chemistry affect both human use of coastal groundwater aquifers and the functioning of coastal ecosystems. Mapping out the subsurface distribution of saltwater and freshwater is a critical step in predicting, and managing, changes in water chemistry in coastal regions. Our research is focused on California's Monterey Bay region where agriculturally-intensive land meets the sensitive marine environment of the Monterey Bay National Marine Sanctuary. Along the coast of Monterey Bay extensive groundwater extraction (groundwater provides more than 80% of the area's water supply) has led to saltwater intrusion into aquifers at various locations. To date, the mapping of saltwater intrusion has relied on measurements of changing water chemistry in monitoring wells. But it is challenging with wells to capture the spatially complex hydrostratigraphy resulting from changing depositional environments and numerous faulting events. We suggest that geophysical methods be used to map and monitor the distribution of saltwater and freshwater by acquiring non-invasive, high-resolution continuous images of the subsurface. In a pilot study conducted over the past four years, we used electrical resistivity imaging to successfully identify regions of saltwater and freshwater 150 m below sea level along a 7 km stretch of the southern Monterey Bay coast. We employed large-offset electrical resistance tomography using a 96-electrode system with an overall array length of 860 m. The results showed excellent agreement with measurements in nearby monitoring wells. The large-scale image provided by the geophysical measurements revealed the hydrostratigraphic controls on the spatial distribution of the saltwater/freshwater interface. In October 2014 we will expand this study, using large

Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review.

PubMed

Huffer, Dean; Hing, Wayne; Newton, Richard; Clair, Mike

2017-03-01

The aim was to critically evaluate the literature investigating strength training interventions in the treatment of plantar fasciitis and improving intrinsic foot musculature strength. A search of PubMed, CINHAL, Web of Science, SPORTSDiscus, EBSCO Academic Search Complete and PEDRO using the search terms plantar fasciitis, strength, strengthening, resistance training, intrinsic flexor foot, resistance training. Seven articles met the eligibility criteria. Methodological quality was assessed using the modified Downs and Black checklist. All articles showed moderate to high quality, however external validity was low. A comparison of the interventions highlights significant differences in strength training approaches to treating plantar fasciitis and improving intrinsic strength. It was not possible to identify the extent to which strengthening interventions for intrinsic musculature may benefit symptomatic or at risk populations to plantar fasciitis. There is limited external validity that foot exercises, toe flexion against resistance and minimalist running shoes may contribute to improved intrinsic foot musculature function. Despite no plantar fascia thickness changes being observed through high-load plantar fascia resistance training there are indications that it may aid in a reduction of pain and improvements in function. Further research should use standardised outcome measures to assess intrinsic foot musculature strength and plantar fasciitis symptoms. Copyright © 2016 Elsevier Ltd. All rights reserved.

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis

PubMed Central

Lewis, Rebecca D.; Wright, Paul; McCarthy, Laine H.

2016-01-01

Clinical Question In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Answer Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer A Search Terms Plantar fasciitis, heel pain, treatment, orthotics, Limits Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted January 16, 2014; updated January 20, 2015 Inclusion Criteria Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Exclusion Criteria Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis. PMID:26855444

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis.

PubMed

Lewis, Rebecca D; Wright, Paul; McCarthy, Laine H

2015-12-01

In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer: A Search Terms: Plantar fasciitis, heel pain, treatment, orthotics, Limits: Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted: January 16, 2014; updated January 20, 2015 INCLUSION CRITERIA: Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis.

Necrotizing Fasciitis of the Abdominal Wall Caused by Serratia Marcescens

PubMed Central

Lakhani, Naheed A.; Narsinghani, Umesh; Kumar, Ritu

2015-01-01

In this article, we present the first case of necrotizing fasciitis affecting the abdominal wall caused by Serratia marcescens and share results of a focused review of S. marcescens induced necrotizing fasciitis. Our patient underwent aorto-femoral bypass grafting for advanced peripheral vascular disease and presented 3 weeks postoperatively with pain, erythema and discharge from the incision site in the left lower abdominal wall and underwent multiple debridement of the affected area. Pathology of debrided tissue indicated extensive necrosis involving the adipose tissue, fascia and skeletal muscle. Wound cultures were positive for Serratia marcescens. She was successfully treated with antibiotics and multiple surgical debridements. Since necrotizing fasciitis is a medical and surgical emergency, it is critical to examine infectivity trends, clinical characteristics in its causative spectrum. Using PubMed we found 17 published cases of necrotizing fasciitis caused by Serratia marcescens, and then analyzed patterns among those cases. Serratia marcescens is prominent in the community and hospital settings, and information on infection presentations, risk factors, characteristics, treatment, course, and complications as provided through this study can help identify cases earlier and mitigate poor outcomes. Patients with positive blood cultures and those patients where surgical intervention was not provided or delayed had a higher mortality. Surgical intervention is a definite way to establish the diagnosis of necrotizing infection and differentiate it from other entities. PMID:26294949

Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality.

PubMed

Wong, Chin-Ho; Chang, Haw-Chong; Pasupathy, Shanker; Khin, Lay-Wai; Tan, Jee-Lim; Low, Cheng-Ooi

2003-08-01

Necrotizing fasciitis is a life-threatening soft-tissue infection primarily involving the superficial fascia. The present report describes the clinical presentation and microbiological characteristics of this condition as well as the determinants of mortality associated with this uncommon surgical emergency. The medical records of eighty-nine consecutive patients who had been admitted to our institution for necrotizing fasciitis from January 1997 to August 2002 were reviewed retrospectively. The paucity of cutaneous findings early in the course of the disease makes the diagnosis difficult, and only thirteen of the eighty-nine patients had a diagnosis of necrotizing fasciitis at the time of admission. Preadmission treatment with antibiotics modified the initial clinical picture and often masked the severity of the underlying infection. Polymicrobial synergistic infection was the most common cause (forty-eight patients; 53.9%), with streptococci and enterobacteriaceae being the most common isolates. Group-A streptococcus was the most common cause of monomicrobial necrotizing fasciitis. The most common associated comorbidity was diabetes mellitus (sixty-three patients; 70.8%). Advanced age, two or more associated comorbidities, and a delay in surgery of more than twenty-four hours adversely affected the outcome. Multivariate analysis showed that only a delay in surgery of more than twenty-four hours was correlated with increased mortality (p < 0.05; relative risk = 9.4). Early operative débridement was demonstrated to reduce mortality among patients with this condition. A high index of suspicion is important in view of the paucity of specific cutaneous findings early in the course of the disease.

Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature.

PubMed

Gunaratne, Dakshika A; Tseros, Evan A; Hasan, Zubair; Kudpaje, Akshay S; Suruliraj, Anand; Smith, Mark C; Riffat, Faruque; Palme, Carsten E

2018-06-22

Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality. © 2018 Wiley Periodicals, Inc.

[Postoperative necrotizing fasciitis: a rare and fatal complication].

PubMed

Ghezala, Hassen Ben; Feriani, Najla

2016-01-01

Postoperative parietal complications can be exceptionally severe and serious threatening vital prognosis. Necrotizing fasciitis is a rare infection of the skin and deep subcutaneous tissues, spreading along fascia and adipose tissue. It is mainly caused by group A streptococcus (streptococcus pyogenes) but also by other bacteria such as Vibrio vulnificus, Clostridium perfringens or Bacteroides fragilis. Necrotizing fasciitis is a real surgical and medical emergency. We report, in this study, a very rare case of abdominal parietal gangrene occurring in a 75-year-old woman on the fifth day after surgery for an ovarian cyst. Evolution was marked by occurrence of a refractory septic shock with a rapidly fatal course on the third day of management.

Effective use of surface-water management to control saltwater intrusion

NASA Astrophysics Data System (ADS)

Hughes, J. D.; White, J.

2012-12-01

The Biscayne aquifer in southeast Florida is susceptible to saltwater intrusion and inundation from rising sea-level as a result of high groundwater withdrawal rates and low topographic relief. Groundwater levels in the Biscayne aquifer are managed by an extensive canal system that is designed to control flooding, supply recharge to municipal well fields, and control saltwater intrusion. We present results from an integrated surface-water/groundwater model of a portion of the Biscayne aquifer to evaluate the ability of the existing managed surface-water control network to control saltwater intrusion. Surface-water stage and flow are simulated using a hydrodynamic model that solves the diffusive-wave approximation of the depth-integrated shallow surface-water equations. Variable-density groundwater flow and fluid density are solved using the Oberbeck--Boussinesq approximation of the three-dimensional variable-density groundwater flow equation and a sharp interface approximation, respectively. The surface-water and variable-density groundwater domains are implicitly coupled during each Picard iteration. The Biscayne aquifer is discretized into a multi-layer model having a 500-m square horizontal grid spacing. All primary and secondary surface-water features in the active model domain are discretized into segments using the 500-m square horizontal grid. A 15-year period of time is simulated and the model includes 66 operable surface-water control structures, 127 municipal production wells, and spatially-distributed daily internal and external hydrologic stresses. Numerical results indicate that the existing surface-water system can be effectively used in many locations to control saltwater intrusion in the Biscayne aquifer resulting from increases in groundwater withdrawals or sea-level rise expected to occur over the next 25 years. In other locations, numerical results indicate surface-water control structures and/or operations may need to be modified to control

Necrotizing fasciitis: epidemiology and clinical predictors for amputation

PubMed Central

Khamnuan, Patcharin; Chongruksut, Wilaiwan; Jearwattanakanok, Kijja; Patumanond, Jayanton; Tantraworasin, Apichat

2015-01-01

Background Necrotizing fasciitis, a relatively uncommon infection involving the skin, subcutaneous tissue, and fascia, is a rapidly progressive soft tissue infection and a medical and surgical urgency. Delayed debridement, with subsequent huge soft tissue loss is associated with loss of limb and infection and is the most common cause of mortality. The purpose of this work is to describe the epidemiology of necrotizing fasciitis and to identify the clinical characteristics that may be used to predict amputation in routine clinical practice. Methods Retrospective cohort study data were collected from three general hospitals located in the Chiang Rai, Kamphaeng Phet, and Phayao provinces in northern Thailand. Epidemiologic data for all patients with a surgically confirmed diagnosis of necrotizing fasciitis between 2009 and 2012 were collected. Medical records and reviews were retrieved from inpatient records, laboratory reports, and registers. Clinical predictors for amputation were analyzed by multivariable risk regression. Results A total of 1,507 patients with a diagnosis of necrotizing fasciitis were classified as being with amputation (n=127, 8.4%) and without amputation (n=1,380, 91.6%). The most common causative Gram-positive and Gram-negative pathogens were Streptococcus pyogenes (33.3% in the amputation group and 40.8% in the non-amputation group) and Escherichia coli (25% in the amputation group and 17.1% in the non-amputation group). Predictive factors for amputation included gangrene (risk ratio [RR] 4.77, 95% confidence interval [CI] 2.70–8.44), diabetes mellitus (RR 3.08, 95% CI 1.98–4.78), skin necrosis (RR 2.83, 95% CI 2.52–3.18), soft tissue swelling (RR 1.76, 95% CI 1.24–2.49), and serum creatinine values ≥1.6 mg/dL on admission (RR 1.71, 95% CI 1.38–2.12). All data were analyzed using the multivariable risk regression generalized linear model. Conclusion The most causative pathogens were S. pyogenes and E. coli. Clinical predictors for

A Fatal Case of Multidrug Resistant Acinetobacter Necrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection

PubMed Central

Niazi, Masooma

2014-01-01

Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis. PMID:25349748

A fatal case of multidrug resistant acinetobacter necrotizing fasciitis: the changing scary face of nosocomial infection.

PubMed

Sinha, Nupur; Niazi, Masooma; Lvovsky, Dmitry

2014-01-01

Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.

Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis.

PubMed

Ahmad, Jamal; Karim, Ammar; Daniel, Joseph N

2016-09-01

This study classified plantar heel spurs and their relationship to plantar fasciitis. Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis. The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P < .05). With treatment, patients with larger spurs had the greatest improvement in function and pain (P < .05). Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs. Level III, comparative series. © The Author(s) 2016.

Monomicrobial Klebsiella pneumoniae Necrotizing Fasciitis With Liver Abscess: A Case Report and Literature Review.

PubMed

Chen, Ching-En; Shih, Yu-Chung

2017-03-01

Necrotizing fasciitis is one of the most life-threatening soft tissue infections and usually follows a major or minor trauma. Published reports regarding single microorganism liver abscess caused by Klebsiella pneumoniae in Taiwan indicate a septic metastasis rate about 12%. Although a hematogenous origin of necrotizing fasciitis from a liver abscess is rare in Taiwan, it remains possible in our clinical practice. A 75-year-old man with a history of diabetes and liver abscess had a status of postdrainage 5 years earlier. The patient presented with elevated body temperature, swelling, and pain over the left hand and forearm for 4 days before coming to our emergency room. We performed a fasciotomy procedure under the preliminary diagnosis of necrotizing fasciitis. The patient's blood cultures yielded K. pneumoniae, and therefore recurrence of liver abscess was confirmed by ultrasonography. After treating with percutaneous drainage and third cephalosporin intravenously, the patient recovered and discharged on the 50th day after admission. Necrotizing fasciitis is a life-threatening soft tissue infectious disease. Once K. pneumoniae is identified both in blood and wound cultures of a diabetic patient with necrotizing fasciitis, it is recommended that the metastatic lesions undergo complete abdominal evaluation by the hematogenous route.

The Effectiveness of Low-Dye Taping in Reducing Pain Associated With Plantar Fasciitis.

PubMed

Verbruggen, Laura A; Thompson, Melissa M; Durall, Chris J

2018-01-01

Plantar fasciitis is one of the most common musculoskeletal disorders of the foot. Initial treatment of plantar fasciitis is typically conservative and may include heel padding, steroid injections, night splinting, calf stretching, ultrasound, foot orthoses, and taping. However, while custom foot orthoses are a common treatment method for plantar fasciitis, there is often a waiting period of a few weeks for them to be manufactured and delivered. Therefore, taping of the foot is often used as a temporary treatment to alleviate pain during the initial waiting period. Furthermore, taping may also be used as an alternative to foot orthoses for patients who may not tolerate the plantar pressures of an orthotic or for tight-fitting footwear that may not accommodate insoles. Specifically, the low-Dye taping (LDT) technique is one of the most frequently used methods, and recent literature has suggested that it may improve pain outcomes. Therefore, this critically appraised topic was conducted to determine the extent to which current evidence supports the use of LDT to reduce pain in patients with plantar fasciitis.

The role of contrast enhanced computed tomography in the diagnosis of necrotizing fasciitis and comparison with the laboratory risk indicator for necrotizing fasciitis (LRINEC).

PubMed

Carbonetti, Francesco; Cremona, Antonio; Carusi, Valentina; Guidi, Marco; Iannicelli, Elsa; Di Girolamo, Marco; Sergi, Daniela; Clarioni, Alvise; Baio, Giulio; Antonelli, Giulio; Fratini, Luca; David, Vincenzo

2016-02-01

To evaluate the diagnostic efficacy of contrast enhanced computed tomography (CECT) in emergency departments for diagnosis of necrotizing fasciitis (NF) and for differential diagnosis of other musculoskeletal infections; to correlate radiological findings with the laboratory risk indicator for necrotizing fasciitis (LRINEC). 7 radiological parameters to be analysed on CECT scans were established, exams of 36 patients with proven diagnosis of NF (n 12) and other musculoskeletal infections (n 24) were retrospectively reviewed; LRINEC score was calculated. Fisher's test and Spearman's and Kendall's coefficients of rank correlations were performed. Two parameters were found to be strongly associated with the diagnosis of NF: involvement of the fascia (Spearman's ρ of 0.888, p < 0.001) and lack of fascial enhancement (Spearman's ρ of 0.672, p < 0.001). LRINEC score did not show strong association with the presence of fasciitis NF (Spearman's ρ of 0.490, p = 0.0024). Computed tomography (CT) parameters, which are significantly associated with the diagnosis of NF, are the involvement of the fascia and its lack of enhancement; LRINEC score could be high (>5) also in other musculoskeletal infections. Final diagnosis of necrosis among the fascia is surgical. Presence of gas is not a specific sign of necrotizing fasciitis being present in other musculoskeletal infections. CT could easily discriminate NF from other musculoskeletal infections, adds an important value to clinical and laboratory tests in diagnosis of NF in an emergency context when magnetic resonance imaging, which is superior to CT in this discernment, could not be performed.

Supercritical Saltwater Spray for Marine Cloud Brightening (MCB)

NASA Astrophysics Data System (ADS)

Neukermans, A.; Cooper, G. F.; Foster, J.; Galbraith, L. K.; Johnston, D.; Ormond, B.; Wang, Q.

2012-12-01

Solar Radiation Management (SRM), including both stratospheric sulfur aerosol delivery and MCB, has emerged as the leading contender for geoengineering. Field research in MCB would require a technique capable of producing 1017 salt nuclei/sec from a single source on a seagoing vessel. Spraying supercritical saltwater has emerged as a viable technology, at least for research purposes. Under optimum conditions a single 50-μm nozzle produces 1014 suitable nuclei/sec. Power consumption is high (1-2 MW), but 95% of the required energy is in the form of heat that can probably be obtained from wasted ship-engine heat. While its implementation is conceptually simple, the corrosive nature of supercritical saltwater makes the material requirements very demanding. Progress on this work is detailed.

Neonatal necrotizing fasciitis of the scrotum caused by Streptococcus agalactiae.

PubMed

Kuroda, Junpei; Inoue, Nobuaki; Satoh, Hiroyuki; Fukuzawa, Ryuji; Terakawa, Toshiro; Hasegawa, Yukihiro

2015-04-01

We herein describe the case of a 27-day-old male infant who was brought to the emergency room for intermittent crying, and swelling of the left scrotum. Based on the clinical findings, necrotizing fasciitis was suspected, and surgical intervention was successfully completed within a few hours of admission. Streptococcus agalactiae type Ia was cultured from the drained abscess, and was considered the causative pathogen. To our knowledge, this is the first report of neonatal necrotizing fasciitis caused by S. agalactiae. Prompt diagnosis and immediate surgical debridement are crucial in the initial management of this disease. © 2015 Japan Pediatric Society.

Sonographic Findings in Necrotizing Fasciitis: Two Ends of the Spectrum.

PubMed

Shyy, William; Knight, Roneesha S; Goldstein, Ruth; Isaacs, Eric D; Teismann, Nathan A

2016-10-01

Necrotizing fasciitis is a rare but serious disease, and early diagnosis is essential to reducing its substantial morbidity and mortality. The 2 cases presented show that the key clinical and radiographic features of necrotizing fasciitis exist along a continuum of severity at initial presentation; thus, this diagnosis should not be prematurely ruled out in cases that do not show the dramatic features familiar to most clinicians. Although computed tomography and magnetic resonance imaging are considered the most effective imaging modalities, the cases described here illustrate how sonography should be recommended as an initial imaging test to make a rapid diagnosis and initiate therapy.

Necrotizing fasciitis caused by perforated appendicitis: a case report.

PubMed

Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

2015-01-01

Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

Necrotizing Fasciitis of the Abdominal Wall in a Premature Infant: A Case Study.

PubMed

Narvey, Michael; Byrne, Paul; Fraser, Debbie

2017-01-01

We present a first report of necrotizing fasciitis of the abdominal wall in a 23-day-of-age, former 32-week-gestation premature infant. She was successfully treated with antibiotics without the need for initial debridement. After reviewing the etiology of necrotizing fasciitis, we discuss the unique aspects of this case, including the noninvasive approach to initial treatment, which we consider significantly contributed to her survival.

Flat Feet and a Diagnosis of Plantar Fasciitis in a Marine Corps Recruit.

PubMed

Lurati, Ann R

2015-04-01

A 22-year-old man sought care at an orthopedic clinic for acute plantar fasciitis. He reported that he had begun an intensive exercise program to prepare himself for Marine Corps Officer Candidate School. Pes Planus, or flat feet, was noted on physical examination. This article reviews the diagnoses of pes planus and plantar fasciitis as well as current intervention strategies. © 2015 The Author(s).

Potential for saltwater intrusion into the Upper Floridan aquifer, Hernando and Manatee counties, Florida

USGS Publications Warehouse

Mahon, G.L.

1989-01-01

Pumpage from the Upper Floridan aquifer has caused a lowering of the potentiometric surface and has increased potential for saltwater intrusion into the aquifer in coastal areas of west-central Florida. Groundwater withdrawals are likely to increase because of expected population growth, especially in coastal areas. To increase the understanding of the potential and mechanics of saltwater intrusion, two sites were selected for study. Data were collected at each site from a centrally located deep well, and digital models were developed to simulate groundwater flow and solute transport. The northern site is in Hernando County near the town of Aripeka. The test well in the area was drilled about 1 mile from the coast to a depth of 820 ft. Freshwater was present in the carbonate rock aquifer to a depth of about 500 ft and saltwater occurred from 560 ft to the base of the aquifer at about 750 ft. Between the freshwater and saltwater is the zone of transition, also referred to as the freshwater-saltwater interface. The southern site is in Manatee County near the town of Rubonia. Drilling of the test well was completed at 1,260 ft, just below the base of the Upper Floridan aquifer. The transition zone in this well occurs between 875 and 975 ft within a highly permeable zone. Digital simulations show flow patterns similar to the cyclic flow of seawater and interface theory. Simulations have shown that saltwater contamination of coastal wells would not be noticed as quickly as water-level declines resulting from inland pumpage. (USGS)

Saltwater intrusion into tidal freshwater marshes alters the biogeochemical processing of organic carbon

NASA Astrophysics Data System (ADS)

Neubauer, S. C.; Franklin, R. B.; Berrier, D. J.

2013-07-01

Environmental perturbations in wetlands affect the integrated plant-microbial-soil system, causing biogeochemical responses that can manifest at local to global scales. The objective of this study was to determine how saltwater intrusion affects carbon mineralization and greenhouse gas production in coastal wetlands. Working with tidal freshwater marsh soils that had experienced roughly 3.5 yr of in situ saltwater additions, we quantified changes in soil properties, measured extracellular enzyme activity associated with organic matter breakdown, and determined potential rates of anaerobic carbon dioxide (CO2) and methane (CH4) production. Soils from the field plots treated with brackish water had lower carbon content and higher C : N ratios than soils from freshwater plots, indicating that saltwater intrusion reduced carbon availability and increased organic matter recalcitrance. This was reflected in reduced activities of enzymes associated with the hydrolysis of cellulose and the oxidation of lignin, leading to reduced rates of soil CO2 and CH4 production. The effects of long-term saltwater additions contrasted with the effects of short-term exposure to brackish water during three-day laboratory incubations, which increased rates of CO2 production but lowered rates of CH4 production. Collectively, our data suggest that the long-term effect of saltwater intrusion on soil CO2 production is indirect, mediated through the effects of elevated salinity on the quantity and quality of autochthonous organic matter inputs to the soil. In contrast, salinity, organic matter content, and enzyme activities directly influence CH4 production. Our analyses demonstrate that saltwater intrusion into tidal freshwater marshes affects the entire process of carbon mineralization, from the availability of organic carbon through its terminal metabolism to CO2 and/or CH4, and illustrate that long-term shifts in biogeochemical functioning are not necessarily consistent with short

Saltwater intrusion into tidal freshwater marshes alters the biogeochemical processing of organic carbon

NASA Astrophysics Data System (ADS)

Neubauer, S. C.; Franklin, R. B.; Berrier, D. J.

2013-12-01

Environmental perturbations in wetlands affect the integrated plant-microbial-soil system, causing biogeochemical responses that can manifest at local to global scales. The objective of this study was to determine how saltwater intrusion affects carbon mineralization and greenhouse gas production in coastal wetlands. Working with tidal freshwater marsh soils that had experienced ~ 3.5 yr of in situ saltwater additions, we quantified changes in soil properties, measured extracellular enzyme activity associated with organic matter breakdown, and determined potential rates of anaerobic carbon dioxide (CO2) and methane (CH4) production. Soils from the field plots treated with brackish water had lower carbon content and higher C : N ratios than soils from freshwater plots, indicating that saltwater intrusion reduced carbon availability and increased organic matter recalcitrance. This was reflected in reduced activities of enzymes associated with the hydrolysis of cellulose and the oxidation of lignin, leading to reduced rates of soil CO2 and CH4 production. The effects of long-term saltwater additions contrasted with the effects of short-term exposure to brackish water during three-day laboratory incubations, which increased rates of CO2 production but lowered rates of CH4 production. Collectively, our data suggest that the long-term effect of saltwater intrusion on soil CO2 production is indirect, mediated through the effects of elevated salinity on the quantity and quality of autochthonous organic matter inputs to the soil. In contrast, salinity, organic matter content, and enzyme activities directly influence CH4 production. Our analyses demonstrate that saltwater intrusion into tidal freshwater marshes affects the entire process of carbon mineralization, from the availability of organic carbon through its terminal metabolism to CO2 and/or CH4, and illustrate that long-term shifts in biogeochemical functioning are not necessarily consistent with short

An Analysis of Vulvar Necrotizing Fasciitis in the Unique and Ethnically Diverse Hawaiian Population

PubMed Central

Busse, Raydeen

2010-01-01

Vulvar necrotizing fasciitis is a surgical emergency with a high rate of morbidity and mortality. Our case series adds seven patients to the literature and presents the first group that is predominantly of Pacific-Islander origin. This study not only confirms traditional risk factors such as diabetes mellitus, obesity and hypertension but investigates ethnicity and socioeconomic status as risk factors. Also presented is a case of recurrent necrotizing fasciitis initially involving the vulva, then the back. In any patient for which there is suspicion of vulvar necrotizing fasciitis, surgical diagnosis remains the gold standard and facilitates rapid debridement of all necrotic tissues. Aggressive surgical debridement with broad spectrum antibiotic coverage is required to minimize mortality. PMID:20222491

Necrotizing Fasciitis - Report of ten cases and review of recent literature

PubMed Central

Al Shukry, S; Ommen, J

2013-01-01

Necrotizing fasciitis is an uncommon disease that results in gross morbidity and mortality if not diagnosed and treated in its early stages. At onset, however, it is difficult to differentiate from other superficial skin conditions such as cellulitis. Family physicians must have a high level of suspicion and low threshold for surgical referral when confronted with cases of pain, fever, and erythema. We present ten cases of necrotizing fasciitis managed in a provincial secondary hospital in Oman over 3 years ago. A review of recent literature is also presented. PMID:23904882

Experimental saltwater intrusion in coastal aquifers using automated image analysis: Applications to homogeneous aquifers

NASA Astrophysics Data System (ADS)

Robinson, G.; Ahmed, Ashraf A.; Hamill, G. A.

2016-07-01

This paper presents the applications of a novel methodology to quantify saltwater intrusion parameters in laboratory-scale experiments. The methodology uses an automated image analysis procedure, minimising manual inputs and the subsequent systematic errors that can be introduced. This allowed the quantification of the width of the mixing zone which is difficult to measure in experimental methods that are based on visual observations. Glass beads of different grain sizes were tested for both steady-state and transient conditions. The transient results showed good correlation between experimental and numerical intrusion rates. The experimental intrusion rates revealed that the saltwater wedge reached a steady state condition sooner while receding than advancing. The hydrodynamics of the experimental mixing zone exhibited similar traits; a greater increase in the width of the mixing zone was observed in the receding saltwater wedge, which indicates faster fluid velocities and higher dispersion. The angle of intrusion analysis revealed the formation of a volume of diluted saltwater at the toe position when the saltwater wedge is prompted to recede. In addition, results of different physical repeats of the experiment produced an average coefficient of variation less than 0.18 of the measured toe length and width of the mixing zone.

Using state-of-the-art technology to evaluate saltwater intrusion in the Biscayne aquifer of Miami-Dade County, Florida

USGS Publications Warehouse

Prinos, Scott T.

2014-01-01

The fresh groundwater supplies of many communities have been adversely affected or limited by saltwater intrusion. An insufficient understanding of the origin of intruded saltwater may lead to inefficient or ineffective water-resource management. A 2008–2012 cooperative U.S. Geological Survey (USGS) and Miami-Dade County study of saltwater intrusion describes state-of-the art technology used to evaluate the origin and distribution of this saltwater.

Management of plantar fasciitis in the outpatient setting

PubMed Central

Lim, Ang Tee; How, Choon How; Tan, Benedict

2016-01-01

Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

Management of plantar fasciitis in the outpatient setting.

PubMed

Lim, Ang Tee; How, Choon How; Tan, Benedict

2016-04-01

Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. Copyright: © Singapore Medical Association.

Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens

PubMed Central

2011-01-01

Background Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen. Methods Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2). Results Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors. Conclusions Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis. PMID:21208438

A comparison of coupled freshwater-saltwater sharp-interface and convective-dispersive models of saltwater intrusion in a layered aquifer system

USGS Publications Warehouse

Hill, Mary C.

1988-01-01

Simulated results of the coupled freshwater-saltwater sharp interface and convective-dispersive numerical models are compared by using steady-state cross-sectional simulations. The results indicate that in some aquifers the calculated sharp interface is located further landward than would be expected.

Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.

PubMed

Monto, Raymond Rocco

2014-04-01

Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat. In this study, autologous platelet-rich plasma (PRP), a concentrated bioactive blood component rich in cytokines and growth factors, was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection (pretreatment = time 0) and at 3, 6, 12, and 24 months following injection treatment. Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis. The cortisone group had a pretreatment average AOFAS score of 52, which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months, then dropped to near baseline levels of 58 at 12 months, and continued to decline to a final score of 56 at 24 months. In contrast, the PRP group started with an average pretreatment AOFAS score of 37, which increased to 95 at 3 months, remained elevated at 94 at 6 and 12 months, and had a final score of 92 at 24 months. PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis. Level I, prospective randomized comparative series.

Necrotizing Fasciitis of Thoracic and Abdominal Wall with Emphysematous Pyelonephritis and Retroperitoneal Abscess

PubMed Central

Khaladkar, Sanjay Mhalasakant; Jain, Kunaal Mahesh; Kuber, Rajesh; Gandage, Sidappa

2018-01-01

Emphysematous pyelonephritis is a life-threatening severe form of pyelonephritis usually occurring in patients with diabetes mellitus with or without obstructive uropathies in whom there is necrotizing infection leading to the gas production of an unclear mechanism involving the renal parenchyma and the collecting system. Necrotizing fasciitis is characterized by progressive necrosis of fat and fascia due to deep-seated infection of subcutaneous tissue. It has a fulminant course with considerable mortality. Diabetes Mellitus is a common predisposing factor. The combined occurrence of emphysematous pyelonephritis and necrotizing fasciitis is extremely unusual. Early recognition and management is mandatory to avoid mortality. We report a case of a 53-year-old female, a known case of Type II diabetes mellitus, who presented with necrotizing fasciitis of thoracic and abdominal wall with emphysematous pyelonephritis in the left kidney with a retroperitoneal abscess. PMID:29541493

How We Manage Plantar Fasciitis (With Memory Jogger).

ERIC Educational Resources Information Center

Tanner, Suzanne M.; Harvey, Jack S.

1988-01-01

Common among runners and athletes who participate in jumping sports, plantar fasciitis is an overuse injury that is potentially incapacitating, causes heel and arch pain, and usually occurs after sudden increases in running mileage, frequency, or speed. Therapy is described. (Author/CB)

Necrotizing fasciitis: a case report of a premature infant with necrotizing enterocolitis.

PubMed

Casey, Denise M; Stebbins, Karen; Howland, Victoria

2013-01-01

Necrotizing fasciitis (NF) is a severe infection involving the superficial fascia, subcutaneous tissue, and, occasionally, deeper tissue layers. Usual treatment is with surgical debridement in combination with antibiotics. In review of the literature there is one neonatal report of NF associated with necrotizing enterocolitis. We present a case report of a 25 week gestation infant with necrotizing fasciitis and the complexity of wound and pain management presented for the nursing staff in the neonatal intensive care unit. Copyright © 2013 Elsevier Inc. All rights reserved.

Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature.

PubMed

Marchesi, Andrea; Marcelli, Stefano; Parodi, Pier C; Perrotta, Rosario E; Riccio, Michele; Vaienti, Luca

2017-04-01

Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Stochastic Optimization for an Analytical Model of Saltwater Intrusion in Coastal Aquifers

PubMed Central

Stratis, Paris N.; Karatzas, George P.; Papadopoulou, Elena P.; Zakynthinaki, Maria S.; Saridakis, Yiannis G.

2016-01-01

The present study implements a stochastic optimization technique to optimally manage freshwater pumping from coastal aquifers. Our simulations utilize the well-known sharp interface model for saltwater intrusion in coastal aquifers together with its known analytical solution. The objective is to maximize the total volume of freshwater pumped by the wells from the aquifer while, at the same time, protecting the aquifer from saltwater intrusion. In the direction of dealing with this problem in real time, the ALOPEX stochastic optimization method is used, to optimize the pumping rates of the wells, coupled with a penalty-based strategy that keeps the saltwater front at a safe distance from the wells. Several numerical optimization results, that simulate a known real aquifer case, are presented. The results explore the computational performance of the chosen stochastic optimization method as well as its abilities to manage freshwater pumping in real aquifer environments. PMID:27689362

Fulminant cerebral infarction of anterior and posterior cerebral circulation after ascending type of facial necrotizing fasciitis.

PubMed

Lee, Jun Ho; Choi, Hui-Chul; Kim, Chulho; Sohn, Jong Hee; Kim, Heung Cheol

2014-01-01

Necrotizing fasciitis is a soft tissue infection that is characterized by extensive necrosis of the subcutaneous fat, neurovascular structures, and fascia. Cerebral infarction after facial necrotizing fasciitis has been rarely reported. A 61-year-old woman with diabetes was admitted with painful swelling of her right cheek. One day later, she was stuporous and quadriplegic. A computed tomographic scan of her face revealed right facial infection in the periorbital soft tissue, parotid, buccal muscle, and maxillary sinusitis. A computed tomographic scan of the brain revealed cerebral infarction in the right hemisphere, left frontal area, and both cerebellum. Four days later, she died from cerebral edema and septic shock. Involvement of the cerebral vasculature, such as the carotid or vertebral artery by necrotizing fasciitis, can cause cerebral infarction. Facial necrotizing fasciitis should be treated early with surgical treatment and the appropriate antibiotic therapy. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series.

PubMed

van Egmond, Jeroen C; Breugem, Stefan J M; Driessen, Marcel; Bruijn, Daniel J

2015-06-01

Plantar fasciitis is the most common cause of heel pain. Diverse non-operative treatment options are available. The purpose of this study was to determine if a single platelet-rich-plasma injection at the origin of the plantar fascia in patients with plantar fasciitis gives a functional improvement. Patients with plantar fasciitis and failed conservative treatment were included in this retrospective study. Included patients were sent four questionnaires after platelet-rich-plasma injection. Primary outcome is functional improvement, determined by foot function index in which lower scores correlates with a better foot function. A total of 61 feet in 58 patients were included. The median foot function index before treatment was 69.4 and after treatment 31.8, which is a significant decrease. In 80.3% of the patients the foot function index decreased. Therefore platelet-rich-plasma injection seems to be effective in treatment of patients with plantar fasciitis when conservative treatment failed.

ACUTE TOXICITY OF PARA-NONYLPHENOL TO SALTWATER ANIMALS

EPA Science Inventory

?para-Nonylphenol (PNP), a mixture of alkylphenols used in producing nonionic surfactants, is distributed widely in surface waters and aquatic sediments, where it can affect saltwater species. This article describes a database for acute toxicity of PNP derived for calculating a n...

Modeling Approach for Estimating Co-Produced Water Volumes and Saltwater Disposal Volumes in Oklahoma

NASA Astrophysics Data System (ADS)

Murray, K. E.

2016-12-01

Management of produced fluids has become an important issue in Oklahoma because large volumes of saltwater are co-produced with oil and gas, and disposed into saltwater disposal wells at high rates. Petroleum production increased from 2009-2015, especially in central and north-central Oklahoma where the Mississippian and Hunton zones were redeveloped using horizontal wells and dewatering techniques that have led to a disproportional increase in produced water volumes. Improved management of co-produced water, including desalination for beneficial reuse and decreased saltwater disposal volumes, is only possible if spatial and temporal trends can be defined and related to the producing zones. It is challenging to quantify the volumes of co-produced water by region or production zone because co-produced water volumes are generally not reported. Therefore, the goal of this research is to estimate co-produced water volumes for 2008-present with an approach that can be replicated as petroleum production shifts to other regions. Oil and gas production rates from subsurface zones were multiplied by ratios of H2O:oil and H2O:gas for the respective zones. Initial H2O:oil and H2O:gas ratios were adjusted/calibrated, by zone, to maximize correlation of county-scale produced H2O estimates versus saltwater disposal volumes from 2013-2015. These calibrated ratios were then used to compute saltwater disposal volumes from 2008-2012 because of apparent data gaps in reported saltwater disposal volumes during that timeframe. This research can be used to identify regions that have the greatest need for produced water treatment systems. The next step in management of produced fluids is to explore optimal energy-efficient strategies that reduce deleterious effects.

Cryptococcal necrotizing fasciitis in a patient after renal transplantation--a case report.

PubMed

Yoneda, T; Itami, Y; Hirayama, A; Saka, T; Yoshida, K; Fujimoto, K

2014-01-01

A 50-year-old man, who had received an ABO-incompatible living related preemptive renal transplantation 1 year before, presented with painful lesions on both lower extremities and fever. At first, bacterial cellulitis was suspected and antibiotic therapy was initiated, but it was not effective. The serum cryptococcal antigen titer was 1:4,098, and pathologic examination of debrided tissue and wound pus culture revealed cryptococcal necrotizing fasciitis. Liposomal amphotericin B and fluconazole were started, and repeated debridement and skin grafting were performed. Because his graft function deteriorated because of antibody-mediated rejection and polyoma viral nephropathy, hemodialysis was induced on day 9 of hospitalization. During the treatment, he suffered repeated urinary tract infections, which were treated with antibiotics, and cytomegalovirus retinopathy, which was treated with ganciclovir. His cryptococcal necrotizing fasciitis was successfully cured by the combination of antimicrobial treatment and surgical procedures. He could walk with a cane and was discharged on day 298 of hospitalization. Cryptococcal necrotizing fasciitis in renal transplant recipients is so rare that only 14 cases have been reported. The mortality is not very high, but the prognosis of the patient is complicated by worsening of the cryptococcal infection of the central nervous system (CNS). Early detection and treatment to prevent spreading to other sites, especially the CNS or disseminated disease, is very important in cases of cryptococcal necrotizing fasciitis. Copyright © 2014 Elsevier Inc. All rights reserved.

Cervical necrotizing fasciitis and myositis in a western lowland gorilla (Gorilla gorilla gorilla).

PubMed

Allender, M C; McCain, S L; Ramsay, E C; Schumacher, J; Ilha, M R S

2009-06-01

A 39-yr-old wild-caught, female western lowland gorilla (Gorilla gorilla gorilla) died during an immobilization to assess swelling and apparent pain of the cervical region. Necropsy revealed a fistulous tract containing plant material in the oropharynx, above the soft palate, communicating with a left-sided cervical necrotizing fasciitis and myositis. Alpha-hemolytic Streptococcus and Prevotella sp. were isolated from the cervical lesion. This is a report of cervical necrotizing fasciitis in a western lowland gorilla.

Periorbital Necrotising Fasciitis after Minor Skin Trauma

PubMed Central

Günel, Ceren; Eryılmaz, Aylin; Başal, Yeşim; Toka, Ali

2014-01-01

Necrotizing fasciitis (NF) is a fatal and rare disease, mainly located in extremity and body. Due to the good blood supply, the occurrence of this infective disease of skin and subcutaneous tissue/fascia is much rarer in the head and neck region. In this study, we represent periorbital necrotizing fasciitis case in a patient with normal immune system. The patient applied the emergency clinic with the complaints of swelling and redness on the left eye. It was found out that a skin incision occurred at 2 cm below the left eye with razor blade 2 days ago. After taking swab culture sample, patient was started on parenteral Vancomycin + Ampicillin-Sulbactam treatment. It was observed that necrosis spread within hours and an emergent deep surgical debridement was performed. Following the debridement, it was observed that periorbital edema began to regress prominently on the 1st day of the treatment. Treatment was carried on with daily wound care and parenteral antibiotherapy. The patient was discharged from the hospital with slightly cosmetic defect. PMID:25309766

Fungal necrotizing fasciitis, an emerging infectious disease caused by Apophysomyces (Mucorales).

PubMed

Chander, Jagdish; Stchigel, Alberto Miguel; Alastruey-Izquierdo, Ana; Jayant, Mayank; Bala, Kiran; Rani, Hena; Handa, Uma; Punia, Rajpal Singh; Dalal, Usha; Attri, Ashok Kumar; Monzon, Araceli; Cano-Lira, José Francisco; Guarro, Josep

2015-01-01

The mucoralean fungi are emerging causative agents of primary cutaneous infections presenting in the form of necrotizing fasciitis. The aim of this study was to investigate a series of suspected necrotizing fasciitis cases by Apophysomyces species over one-year period in a northern Indian hospital. The clinical details of those patients suspected to suffer from fungal necrotizing fasciitis were recorded. Skin biopsies from local wounds were microscopically examined and fungal culturing was carried out on standard media. The histopathology was evaluated using conventional methods and special stains. Apophysomyces isolates were identified by their morphology and by molecular sequencing of the internal transcribed spacer (ITS) region of the ribosomal genes. Antifungal susceptibility testing was carried out following EUCAST guidelines and treatment progress was monitored. Seven patients were found to be suffering from necrotizing fasciitis caused by Apophysomyces spp. Six isolates were identified as Apophysomyces variabilis and one as Apophysomyces elegans. Five patients had previously received intramuscular injections in the affected area. Three patients recovered, two died and the other two left treatment against medical advice and are presumed to have died due to their terminal illnesses. Posaconazole and terbinafine were found to be the most active compounds against A. variabilis, while the isolate of A. elegans was resistant to all antifungals tested. Apophysomyces is confirmed as an aggressive fungus able to cause fatal infections. All clinicians, microbiologists and pathologists need to be aware of these emerging mycoses as well as of the risks involved in medical practices, which may provoke serious fungal infections such as those produced by Apophysomyces. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

Comparison of Radial Shockwaves and Conventional Physiotherapy for Treating Plantar Fasciitis

PubMed Central

Greve, Júlia Maria D’Andréa; Grecco, Marcus Vinicius; Santos-Silva, Paulo Roberto

2009-01-01

OBJECTIVE: To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS: Thirty-two patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 was composed of 16 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 was composed of 16 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 47.3 ± 10.3 years (range 25–68); 81% were female, 87% were overweight, 56% had bilateral impairment, and 75% used analgesics regularly. RESULTS: Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment. CONCLUSION: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment. PMID:19219314

[Necrotizing fasciitis of the upper and lower extremities].

PubMed

Kückelhaus, M; Hirsch, T; Lehnhardt, M; Daigeler, A

2017-04-01

Necrotizing fasciitis is a potentially fatal soft tissue infection that may affect the upper and lower extremities, scrotum, perineum and abdominal wall. Typically, the infection demonstrates rapid spreading along the fascial planes leading to sepsis with mortality rates of 15-46%. Without adequate treatment, the mortality rate increases to close to 100%. There are four groups of pathogens that can lead to necrotizing fasciitis, namely beta-hemolytic group A streptococci, mixed infections with obligate and facultative anaerobes, clostridium species and fungal infections. Clinical signs may include erythema, edema and pain out of proportion in the early stages and soft tissue necrosis with bullae during the subsequent course. In some cases, only a deterioration of the general condition is evident and the aforementioned clinical symptoms are initially missing. The decision for treatment is based on the clinical diagnosis and surgical debridement is the cornerstone of treatment, accompanied by broad spectrum i.v. antibiotic treatment, e. g. with penicillin, ciprofloxacin and clindamycin.

The difference between temperate and tropical saltwater species' acute sensitivity to chemicals is relatively small.

PubMed

Wang, Zhen; Kwok, Kevin W H; Lui, Gilbert C S; Zhou, Guang-Jie; Lee, Jae-Seong; Lam, Michael H W; Leung, Kenneth M Y

2014-06-01

Due to a lack of saltwater toxicity data in tropical regions, toxicity data generated from temperate or cold water species endemic to North America and Europe are often adopted to derive water quality guidelines (WQG) for protecting tropical saltwater species. If chemical toxicity to most saltwater organisms increases with water temperature, the use of temperate species data and associated WQG may result in under-protection to tropical species. Given the differences in species composition and environmental attributes between tropical and temperate saltwater ecosystems, there are conceivable uncertainties in such 'temperate-to-tropic' extrapolations. This study aims to compare temperate and tropical saltwater species' acute sensitivity to 11 chemicals through a comprehensive meta-analysis, by comparing species sensitivity distributions (SSDs) between the two groups. A 10 percentile hazardous concentration (HC10) is derived from each SSD, and then a temperate-to-tropic HC10 ratio is computed for each chemical. Our results demonstrate that temperate and tropical saltwater species display significantly different sensitivity towards all test chemicals except cadmium, although such differences are small with the HC10 ratios ranging from 0.094 (un-ionised ammonia) to 2.190 (pentachlorophenol) only. Temperate species are more sensitive to un-ionised ammonia, chromium, lead, nickel and tributyltin, whereas tropical species are more sensitive to copper, mercury, zinc, phenol and pentachlorophenol. Through comparison of a limited number of taxon-specific SSDs, we observe that there is a general decline in chemical sensitivity from algae to crustaceans, molluscs and then fishes. Following a statistical analysis of the results, we recommend an extrapolation factor of two for deriving tropical WQG from temperate information. Copyright © 2013 Elsevier Ltd. All rights reserved.

Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman.

PubMed

Monié, Marguerite; Drieux, Laurence; Nzili, Bernadette; Dicko, Michèle; Goursot, Catherine; Greffard, Sandrine; Decré, Dominique; Mézière, Anthony

2014-01-01

Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis.

Cervical Necrotizing Fasciitis--The Value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an Indicative Parameter.

PubMed

Sandner, Annett; Moritz, Stefan; Unverzagt, Susanne; Plontke, Stefan K; Metz, Dietrich

2015-12-01

Cervical necrotizing fasciitis (CNF) is uncommon, difficult to diagnose, and rapidly progressive. The objective of the present study was to determine the predictive value of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for CNF. The LRINEC score for 16 consecutive cases of CNF and 595 cases of severe non-necrotizing neck infections was determined over a 6.5-year period in a single-center retrospective cohort study and case report. CNF was confirmed by histologic examination and operative report documentation. Using a cutoff score of 6, the LRINEC score had a sensitivity of 0.94 (95% confidence interval [CI] 0.92 to 0.96) and specificity of 0.94 (95% CI 0.70 to 1.00). The positive predictive value was 0.29 (95% CI 0.17 to 0.44), and the negative predictive value was 0.99 (95% CI 0.99 to 1.00). The LRINEC score can detect early cases of CNF. Patients with a LRINEC score of ≥6 must be carefully evaluated for the presence of CNF. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Molecular Dynamics Study of the Bulk and Interface Properties of Frother and Oil with Saltwater and Air

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chong, Leebyn; Lai, Yungchieh; Gray, McMahan

For water treatment purposes, the separation processes involving surfactants and crude oil at seawater-air interfaces are of importance for chemical and energy industries. Little progress has been made in understanding the nanoscale phenomena of surfactants on oily saltwater-air interfaces. This work focuses on using molecular dynamics with a united-atom force field to simulate the interface of linear alkane oil, saltwater, and air with three surfactant frothers: methyl isobutyl carbinol (MIBC), terpineol, and ethyl glycol butyl ether (EGBE). For each frother, although the calculated diffusivities and viscosities are lower than the expected experimental values, our results showed that diffusivity trends betweenmore » each frother agree with experiments but was not suitable for viscosity. Binary combinations of liquid (frother or saltwater)-air and liquid-liquid interfaces are equilibrated to study the density profiles and interfacial tensions. The calculated surface tensions of the frothers-air interfaces are like that of oil-air, but lower than that of saltwater-air. Only MIBC-air and terpineol-air interfaces agreed with our experimental measurements. For frother-saltwater interfaces, the calculated results showed that terpineol has interfacial tensions higher than those of the MIBC-saltwater. Here, the simulated results indicated that the frother-oil systems underwent mixing such that the density profiles depicted large interfacial thicknesses.« less

Molecular Dynamics Study of the Bulk and Interface Properties of Frother and Oil with Saltwater and Air

DOE PAGES

Chong, Leebyn; Lai, Yungchieh; Gray, McMahan; ...

2017-03-15

For water treatment purposes, the separation processes involving surfactants and crude oil at seawater-air interfaces are of importance for chemical and energy industries. Little progress has been made in understanding the nanoscale phenomena of surfactants on oily saltwater-air interfaces. This work focuses on using molecular dynamics with a united-atom force field to simulate the interface of linear alkane oil, saltwater, and air with three surfactant frothers: methyl isobutyl carbinol (MIBC), terpineol, and ethyl glycol butyl ether (EGBE). For each frother, although the calculated diffusivities and viscosities are lower than the expected experimental values, our results showed that diffusivity trends betweenmore » each frother agree with experiments but was not suitable for viscosity. Binary combinations of liquid (frother or saltwater)-air and liquid-liquid interfaces are equilibrated to study the density profiles and interfacial tensions. The calculated surface tensions of the frothers-air interfaces are like that of oil-air, but lower than that of saltwater-air. Only MIBC-air and terpineol-air interfaces agreed with our experimental measurements. For frother-saltwater interfaces, the calculated results showed that terpineol has interfacial tensions higher than those of the MIBC-saltwater. Here, the simulated results indicated that the frother-oil systems underwent mixing such that the density profiles depicted large interfacial thicknesses.« less

Sequential necrotizing fasciitis caused by the monomicrobial pathogens Streptococcus equisimilis and extended-spectrum beta-lactamase-producing Escherichia coli.

PubMed

Endo, Akiko; Matsuoka, Ryosuke; Mizuno, Yasushi; Doi, Asako; Nishioka, Hiroaki

2016-08-01

Necrotizing fasciitis is a rapidly progressing bacterial infection of the superficial fascia and subcutaneous tissue that is associated with a high mortality rate and is caused by a single species of bacteria or polymicrobial organisms. Escherichia coli is rarely isolated from patients with monomicrobial disease. Further, there are few reports of extended-spectrum beta-lactamase (ESBL)-producing E. coli associated with necrotizing fasciitis. We report here our treatment of an 85-year-old man who was admitted because of necrotizing fasciitis of his right thigh. Streptococcus equisimilis was detected as a monomicrobial pathogen, and the infection was cured by amputation of the patient's right leg and the administration of antibiotics. However, 5 days after discontinuing antibiotic therapy, he developed necrotizing fasciitis on his right upper limb and died. ESBL-producing E. coli was the only bacterial species isolated from blood and skin cultures. This case demonstrates that ESBL-producing E. coli can cause monomicrobial necrotizing fasciitis, particularly during hospitalization and that a different bacterial species can cause disease shortly after a previous episode. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Necrotizing fasciitis: eight-year experience and literature review.

PubMed

Wang, Jinn-Ming; Lim, Hwee-Kheng

2014-01-01

To describe clinical, laboratory, microbiological features, and outcomes of necrotizing fasciitis. From January 1, 2004 to December 31, 2011, 115 patients (79 males, 36 females) diagnosed with necrotizing fasciitis were admitted to Mackay Memorial Hospital in Taitung. Demographic data, clinical features, location of infection, type of comorbidities, microbiology and laboratory results, and outcomes of patients were retrospectively analyzed. Among 115 cases, 91 survived (79.1%) and 24 died (20.9%). There were 67 males (73.6%) and 24 females (26.4%) with a median age of 54 years (inter-quartile ranges, 44.0-68.0 years) in the survival group; and 12 males (50%) and 12 females (50%) with a median age of 61 years (inter-quartile ranges, 55.5-71.5 years) in the non-surviving group. The most common symptoms were local swelling/erythema, fever, pain/tenderness in 92 (80%), 87 (76%) and 84 (73%) patients, respectively. The most common comorbidies were liver cirrhosis in 54 patients (47%) and diabetes mellitus in 45 patients (39%). A single organism was identified in 70 patients (61%), multiple pathogens were isolated in 20 patients (17%), and no microorganism was identified in 30 patients (26%). The significant risk factors were gender, hospital length of stay, and albumin level. Necrotizing fasciitis, although not common, can cause notable rates of morbidity and mortality. It is important to have a high index of suspicion and increase awareness in view of the paucity of specific cutaneous findings early in the course of the disease. Prompt diagnosis and early operative debridement with adequate antibiotics are vital. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

Necrotizing Fasciitis Versus Pyoderma Gangrenosum: Securing the Correct Diagnosis! A Case Report and Literature Review

PubMed Central

Bisarya, Kamal; Azzopardi, Silvan; Lye, George; Drew, Peter James

2011-01-01

Objective: To highlight the key differences in history, examination, and management of pyoderma gangrenosum and necrotizing fasciitis and to outline the importance of distinguishing these 2 conditions. Method: We present a case report of a gentleman with a background of ulcerative colitis having a 1-week history of an erythematous wound and localized abscess to the right leg that failed to respond to antibiotic treatment and later on to surgical debridement of a presumed necrotizing fasciitis. Following referral to our plastic surgery unit, a diagnosis of pyoderma gangrenosum was made and this was confirmed following a response to steroid therapy within 48 hours. A literature review of pyoderma gangrenosum cases misdiagnosed for necrotizing fasciitis was carried out to compare and contrast pitfalls in misdiagnosing these 2 conditions. Results: Literature review of 10 cases confirmed the association of pyoderma gangrenosum with inflammatory bowel disease, hematological disease, and surgical trauma. The presence of necrotic tissue in a pyoderma gangrenosum lesion can be a diagnostic pitfall; although blood and tissue culture investigations are usually negative in pyoderma gangrenosum, this may not always be the case. Inflammatory markers can be significantly high in pyoderma gangrenosum and pyrexia is not a feature limited to necrotizing fasciitis. Conclusions: Inappropriate surgical debridement of pyoderma gangrenosum can cause rapid extension of the lesion by enhancing the posttraumatic response and lead to potential reconstructive challenges with psychological repercussions. On the contrary, treating necrotizing fasciitis with immunosuppressive therapy may worsen the condition. The importance of understanding the pathogenesis, clinical features, and management of both conditions cannot be overemphasized. PMID:21625613

Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult

PubMed Central

Mifsud, Simon; Schembri, Emma Louise; Mallia Azzopardi, Charles; Zammit, Maria Alessandra

2013-01-01

A 35-year-old woman with a 3-day history of chickenpox, presented to the hospital in septic shock and with multifocal, non-adjacent lesions of necrotising fasciitis. Necrotising fasciitis is a rare yet life-threatening complication of chickenpox. Blood cultures and wound swabs confirmed the presence of Streptococcus pyogenes. The initial emergency management included oxygen, aggressive fluid resuscitation and antimicrobial therapy. Once the patient was stabilised, surgical management ensued. This included debridement and eventual grafting of the necrotic skin lesions. Intensive management and follow-up for 8 weeks were required before the patient was deemed fit for discharge. PMID:24130210

Saltwater intrusion coupled with drought accelerates carbon loss from a brackish coastal wetland

NASA Astrophysics Data System (ADS)

Wilson, B.; Troxler, T.

2017-12-01

Coastal wetlands, such as the Everglades, are critical ecosystems for blue carbon (C) storage, yet this storage capacity is vulnerable to environmental change, such as saltwater intrusion and altered hydrology. Saltwater intrusion can stress vegetation and bring new metabolites for microbial respiration, thereby altering the C cycle. Drought can reduce the depth of water covering the wetland soil, and, in extreme cases, lead to exposed soil surface. This increases oxygen levels, thus speeding up C decomposition and potentially leading to peat collapse. The combined effects of both saltwater intrusion and drought on coastal marshes, however, are still uncertain, but recent evidence suggests that saltwater intrusion accelerates C loss from wetlands when coupled with drought. Our objective was to determine the change in CO2 flux, decomposition, root and shoot production, and elevation in a brackish water marsh under conditions of drought and elevated salinity. During the onset of drought, soil CO2 efflux increased by 124% and 237% in the ambient and elevated salinity treatments, respectively, compared to the control. Within one month, elevated salinity decreased net ecosystem production (NEP) by 40%, while after 6 months it had decreased by 85%. During the onset of the drought, there was no difference in NEP with ambient salinity between the inundated and exposed monoliths (-3.4 ± 0.8 vs. -4.2 ± 2.0 μmol CO2 m-2 s-1, respectively). However, drought conditions in the elevated salinity treatment resulted in more CO2 release in the exposed monoliths than the inundated monoliths (1.5 ± 0.4 vs. -0.5 ± 0.3 μmol CO2 m-2 s-1, respectively). Elevation change collected at the end of the experiment will allow us to test if elevated salinity combined with drought contributes to peat collapse, and what mechanisms of ecosystem C cycling has the greatest influence. While the restoration of water flows to the southern Everglades is hypothesized to mitigate the periods of

Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

PubMed

Mahindra, Pankaj; Yamin, Mohammad; Selhi, Harpal S; Singla, Sonia; Soni, Ashwani

2016-01-01

Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis. Copyright 2016, SLACK Incorporated.

Necrotizing fasciitis following saphenofemoral junction ligation with long saphenous vein stripping: a case report.

PubMed

Smith, Stella Ruth; Aljarabah, Moayad; Ferguson, Graeme; Babar, Zahir

2010-05-27

Necrotizing fasciitis is a rare condition with a mortality rate of around 34%. It can be mono- or polymicrobial in origin. Monomicrobial infections are usually due to group A streptococcus and their incidence is on the rise. They normally occur in healthy individuals with a history of trauma, surgery or intravenous drug use. Post-operative necrotizing fasciitis is rare but accounts for 9 to 28% of all necrotizing fasciitis. The incidence of wound infection following saphenofemoral junction ligation and vein stripping is said to be less than 3%, although this complication is probably under-reported. We describe a case of group A streptococcus necrotizing fasciitis following saphenofemoral junction ligation and vein stripping. A 39-year-old woman presented three days following a left sided saphenofemoral junction ligation with long saphenous vein stripping at another institution. She had a three day history of fever, rigors and swelling of the left leg. She was pyrexial and shocked. She had a very tender, swollen left groin and thigh, with a small blister anteriorly and was in acute renal failure. She was prescribed intravenous penicillin and diagnosed with necrotizing fasciitis. She underwent extensive debridement of her left thigh and was commenced on clindamycin and imipenem. Post-operatively, she required ventilatory and inotropic support with continuous veno-venous haemofiltration. An examination 12 hours after surgery showed no requirement for further debridement. A group A streptococcus, sensitive to penicillin, was isolated from the debrided tissue. A vacuum assisted closure device was fitted to the clean thigh wound on day four and split-skin-grafting was performed on day eight. On day 13, a wound inspection revealed that more than 90% of the graft had taken. Antibiotics were stopped on day 20 and she was discharged on day 22. Necrotizing fasciitis is a very serious complication for a relatively minor, elective procedure. To the best of our knowledge, this

Necrotizing fasciitis following saphenofemoral junction ligation with long saphenous vein stripping: a case report

PubMed Central

2010-01-01

Introduction Necrotizing fasciitis is a rare condition with a mortality rate of around 34%. It can be mono- or polymicrobial in origin. Monomicrobial infections are usually due to group A streptococcus and their incidence is on the rise. They normally occur in healthy individuals with a history of trauma, surgery or intravenous drug use. Post-operative necrotizing fasciitis is rare but accounts for 9 to 28% of all necrotizing fasciitis. The incidence of wound infection following saphenofemoral junction ligation and vein stripping is said to be less than 3%, although this complication is probably under-reported. We describe a case of group A streptococcus necrotizing fasciitis following saphenofemoral junction ligation and vein stripping. Case Presentation A 39-year-old woman presented three days following a left sided saphenofemoral junction ligation with long saphenous vein stripping at another institution. She had a three day history of fever, rigors and swelling of the left leg. She was pyrexial and shocked. She had a very tender, swollen left groin and thigh, with a small blister anteriorly and was in acute renal failure. She was prescribed intravenous penicillin and diagnosed with necrotizing fasciitis. She underwent extensive debridement of her left thigh and was commenced on clindamycin and imipenem. Post-operatively, she required ventilatory and inotropic support with continuous veno-venous haemofiltration. An examination 12 hours after surgery showed no requirement for further debridement. A group A streptococcus, sensitive to penicillin, was isolated from the debrided tissue. A vacuum assisted closure device was fitted to the clean thigh wound on day four and split-skin-grafting was performed on day eight. On day 13, a wound inspection revealed that more than 90% of the graft had taken. Antibiotics were stopped on day 20 and she was discharged on day 22. Conclusion Necrotizing fasciitis is a very serious complication for a relatively minor, elective

Saltwater intrusion in the surficial aquifer system of the Big Cypress Basin, southwest Florida, and a proposed plan for improved salinity monitoring

USGS Publications Warehouse

Prinos, Scott T.

2013-01-01

The installation of drainage canals, poorly cased wells, and water-supply withdrawals have led to saltwater intrusion in the primary water-use aquifers in southwest Florida. Increasing population and water use have exacerbated this problem. Installation of water-control structures, well-plugging projects, and regulation of water use have slowed saltwater intrusion, but the chloride concentration of samples from some of the monitoring wells in this area indicates that saltwater intrusion continues to occur. In addition, rising sea level could increase the rate and extent of saltwater intrusion. The existing saltwater intrusion monitoring network was examined and found to lack the necessary organization, spatial distribution, and design to properly evaluate saltwater intrusion. The most recent hydrogeologic framework of southwest Florida indicates that some wells may be open to multiple aquifers or have an incorrect aquifer designation. Some of the sampling methods being used could result in poor-quality data. Some older wells are badly corroded, obstructed, or damaged and may not yield useable samples. Saltwater in some of the canals is in close proximity to coastal well fields. In some instances, saltwater occasionally occurs upstream from coastal salinity control structures. These factors lead to an incomplete understanding of the extent and threat of saltwater intrusion in southwest Florida. A proposed plan to improve the saltwater intrusion monitoring network in the South Florida Water Management District’s Big Cypress Basin describes improvements in (1) network management, (2) quality assurance, (3) documentation, (4) training, and (5) data accessibility. The plan describes improvements to hydrostratigraphic and geospatial network coverage that can be accomplished using additional monitoring, surface geophysical surveys, and borehole geophysical logging. Sampling methods and improvements to monitoring well design are described in detail. Geochemical analyses

Movement of the saltwater interface in the surficial aquifer system in response to hydrologic stresses and water-management practices, Broward County, Florida

USGS Publications Warehouse

Dausman, Alyssa M.; Langevin, Christian D.

2005-01-01

A study was conducted to evaluate the relation between water-level fluctuations and saltwater intrusion in Broward County, Florida. The objective was achieved through data collection at selected wells in Broward County and through the development of a variable-density ground-water flow model. The numerical model is representative of many locations in Broward County that contain a well field, control structure, canal, the Intracoastal Waterway, and the Atlantic Ocean. The model was used to simulate short-term movement (from tidal fluctuations to monthly changes) and long-term movement (greater than 10 years) of the saltwater interface resulting from changes in rainfall, well-field withdrawals, sea-level rise, and upstream canal stage. The SEAWAT code, which is a combined version of the computer codes, MODFLOW and MT3D, was used to simulate the complex variable-density flow patterns. Model results indicated that the canal, control structure, and sea level have major effects on ground-water flow. For periods greater than 10 years, the upstream canal stage controls the movement and location of the saltwater interface. If upstream canal stage is decreased by 1 foot (0.3048 meter), the saltwater interface takes 50 years to move inland and stabilize. If the upstream canal stage is then increased by 1 foot (0.3048 meter), the saltwater interface takes 90 years to move seaward and stabilize. If sea level rises about 48 centimeters over the next 100 year as predicted, then inland movement of the saltwater interface may cause well-field contamination. For periods less than 10 years, simulation results indicated that a 3-year drought with increased well-field withdrawals probably will not have long-term effects on the position of the saltwater interface in the Biscayne aquifer. The saltwater interface returns to its original position in less than 10 years. Model results, however, indicated that the interface location in the lower part of the surficial aquifer system takes

Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen.

PubMed

Yahav, D; Duskin-Bitan, H; Eliakim-Raz, N; Ben-Zvi, H; Shaked, H; Goldberg, E; Bishara, J

2014-11-01

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection. It is usually caused by Streptococcus pyogenes and other Gram-positive bacteria. Several reports, however, emphasize the importance of Gram-negative rods in this infection. We retrospectively studied all cases of monomicrobial necrotizing fasciitis hospitalized in our center during the years 2002-2012. We compared clinical characteristics and outcomes of patients with Gram-negative versus Gram-positive infection. Forty-five cases were reviewed, 19 caused by Gram-negative organisms, 10 of them Escherichia coli, and 26 caused by Gram-positive organisms, 10 of them S. pyogenes. Compared to Gram-positive infections, patients with Gram-negative infections were more likely to have a baseline malignancy (9/19, 47.4%) or to have undergone recent surgery (4/19, 42.3%). The 30-day mortality was higher among Gram-negative infected patients (8/19, 42.1% vs. 8/26, 30.8%). Creatine phosphokinase (CPK) was elevated in a minority of patients with Gram-negative necrotizing fasciitis, and its absolute value was lower than in Gram-positive necrotizing fasciitis. In our center, 42% of monomicrobial necrotizing fasciitis cases were found to be caused by Gram-negative organisms, mostly E. coli. These infections usually appeared in immunocompromised or postoperative patients, often presented with normal CPK levels, and were associated with high mortality rates.

Tigecycline salvage therapy for necrotizing fasciitis caused by Vibrio vulnificus: Case report in a child.

PubMed

Lin, Yu-San; Hung, Min-Hsiang; Chen, Chi-Chung; Huang, Kuo-Feng; Ko, Wen-Chien; Tang, Hung-Jen

2016-02-01

Necrotizing fasciitis caused by Vibrio vulnificus is rarely reported in children. We describe a 12-year-old immunocompetent boy with necrotizing fasciitis caused by V. vulnificus. He was cured by radical and serial debridement and salvage therapy with intravenous cefpirome plus tigecycline. The in vitro antibacterial activity of combination regimens and a literature review of pediatric V. vulnificus infection are described. Copyright © 2013. Published by Elsevier B.V.

Low dose radiotherapy for plantar fasciitis. Treatment outcome of 171 patients.

PubMed

Badakhshi, Harun; Buadch, Volker

2014-12-01

Although the effectiveness of low-dose radiotherapy for chronic degenerative and inflammatory diseases has been documented in previous studies, patient-reported clinical outcomes are rarely available. This study aimed to determine the effect of low-dose radiotherapy on patients with painful plantar fasciitis. From 2002 to 2008, 200 patients older than 65 years of age with painful plantar fasciitis were treated in our hospital. Records from 171 of these patients were available for analysis. All patients were treated with an identical dose of 3Gy using identical equipment and techniques. Response was evaluated with patient-reported questionnaires and clinical visits. Minimum-term follow-up was 18 months, with mean follow-up at 54 months. Three months after receiving low-dose radiotherapy, 67.3% of patients had no or mild pain, and 57.9% had no or discrete mobility restriction. At a mean of 54 months, 61.4% of patients had no or mild pain and 64.9% of patients had no or discrete mobility restriction; 60.8% of patients reported improved quality of life. Low-dose radiotherapy is effective in most patients with painful plantar fasciitis. Due to minimal side effects and low costs, it represents an excellent treatment option compared to conventional therapies or surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

Behavioral responses of Magellanic Penguins (Spheniscus magellanicus) (Foster) to saltwater versus freshwater.

PubMed

Reisfeld, Laura; Moraes, Kaue; Spaulussi, Lygia; Cardoso, Ricardo Cesar; Ippolito, Laura; Gutierrez, Rafael; Silvatti, Bruna; Pizzutto, Cristiane Schilbach

2013-01-01

The most common penguin species found along the coast of Brazil is the Magellanic Penguin (Spheniscus magellanicus). These penguins spend most of their time foraging for food in the oceans. This information is vital to the maintenance of this species in captivity. The goal of this study was to evaluate the behavioral response of a group of Magellanic Penguins (S. magellanicus) in two different conditions of water--fresh and salt. The work was divided into two phases. First, animals were kept in enclosures with access to freshwater. Then they were housed with access to saltwater. Behaviors were recorded by scan sampling per interval of time, totaling 7,200 records for each animal. The results show that the use of saltwater for this group of animals kept in captivity was more effective for increasing the time the animals spent in the water, increasing foraging behavior, stimulating swimming, and providing display of typical behaviors of the species, showing that access to a saltwater environment is an important tool in trying to provide well-being for this species in captivity. © 2013 Wiley Periodicals, Inc.

The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital--a prospective study.

PubMed

Magala, John; Makobore, Patson; Makumbi, Timothy; Kaggwa, Sam; Kalanzi, Edris; Galukande, Moses

2014-07-28

Necrotizing fasciitis is an infectious process characterized by rapidly progressing necrosis of superficial fascia and subcutaneous tissue with subsequent necrosis of overlying skin.Necrotizing fasciitis is a rare but fatal infection. The worldwide incidence is at 0.4 per 100,000. Mortality is up to 80% with no intervention, and 30-50% with intervention. Delay in intervention is associated with poor outcome. The risk factors for necrotizing fasciitis are diabetes mellitus, HIV, malignancy, illicit drug use, malnutrition among others.The aim of this study was to describe the clinical presentation and early outcomes of necrotizing fasciitis amongst Ugandan patients. A prospective descriptive case series study conducted at Mulago National Referral and Teaching hospital from 5th January to 30th April 2011. Patients with necrotizing fasciitis were consecutively recruited after clinical evaluation, laboratory and microbiological tests were performed. Aggressive debridement was done and broad-spectrum antibiotics administered. Patients were followed up on surgical wards. Ethical approval was obtained. Thirty five patients were recruited over a 4 months period. More males were affected with, M: F 3:1. The 20-40 years age group was most affected. Attainment of healthy granulation tissue took 19 days on average. Mortality rate was 14% (5/35). Limbs were the most affected body parts 20/35 (57%), the scrotum and perineum (23%). Among infants the scalp was the most affected. Co-morbidities included HIV 8/35 (17%), and DM (5%) among others. The commonest organisms were gram negative. Split skin grafting was necessary in 74% (26/35) of patients. There were a high number of patients with necrotizing fasciitis; it was associated with low mortality but high morbidity (long hospital stay). There was a high preponderance to males and limbs were the more affected body parts.

The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital- a prospective study

PubMed Central

2014-01-01

Background Necrotizing fasciitis is an infectious process characterized by rapidly progressing necrosis of superficial fascia and subcutaneous tissue with subsequent necrosis of overlying skin. Necrotizing fasciitis is a rare but fatal infection. The worldwide incidence is at 0.4 per 100,000. Mortality is up to 80% with no intervention, and 30-50% with intervention. Delay in intervention is associated with poor outcome. The risk factors for necrotizing fasciitis are diabetes mellitus, HIV, malignancy, illicit drug use, malnutrition among others. The aim of this study was to describe the clinical presentation and early outcomes of necrotizing fasciitis amongst Ugandan patients. Methods A prospective descriptive case series study conducted at Mulago National Referral and Teaching hospital from 5th January to 30th April 2011. Patients with necrotizing fasciitis were consecutively recruited after clinical evaluation, laboratory and microbiological tests were performed. Aggressive debridement was done and broad-spectrum antibiotics administered. Patients were followed up on surgical wards. Ethical approval was obtained. Results Thirty five patients were recruited over a 4 months period. More males were affected with, M: F 3:1. The 20-40 years age group was most affected. Attainment of healthy granulation tissue took 19 days on average. Mortality rate was 14% (5/35). Limbs were the most affected body parts 20/35 (57%), the scrotum and perineum (23%). Among infants the scalp was the most affected. Co-morbidities included HIV 8/35 (17%), and DM (5%) among others. The commonest organisms were gram negative. Split skin grafting was necessary in 74% (26/35) of patients. Conclusion There were a high number of patients with necrotizing fasciitis; it was associated with low mortality but high morbidity (long hospital stay). There was a high preponderance to males and limbs were the more affected body parts. PMID:25069415

Effects of chronic exposure to 12‰ saltwater on the endocrine physiology of juvenile American alligator (Alligator mississippiensis).

PubMed

Faulkner, P C; Burleson, M L; Simonitis, L; Marshall, C; Hala, D; Petersen, L H

2018-05-18

American alligator ( Alligator mississippiensis , Linnaeus) habitats are prone to saltwater intrusion following major storms, hurricanes or droughts. Anthropogenic impacts affecting hydrology of freshwater systems may exacerbate saltwater intrusion into freshwater habitats. The endocrine system of alligators is susceptible to changes in the environment but it is currently not known how the crocodilian physiological system responds to environmental stressors such as salinity. Juvenile alligators were exposed to 12‰ saltwater for 5 weeks to determine effects of chronic exposure to saline environments. Following 5 weeks, plasma levels of hormones (e.g., progesterone, testosterone, estradiol, corticosterone, aldosterone, angiotensin II) were quantified using LC-MS/MS. Compared to freshwater kept subjects, saltwater exposed alligators had significantly elevated plasma levels of corticosterone, 11-deoxycortisol, 17α-hydroxyprogesterone, testosterone, 17β-estradiol, estrone and estriol while pregnenolone and angiotensin II (ANG II) were significantly depressed and aldosterone (ALDO) levels were unchanged (slightly depressed). However, saltwater exposure did not affect gene expression of renal mineralo- and glucorticoid (MR, GR) and angiotensin type 1 (AT-1) receptors or morphology of lingual glands. On the other hand, saltwater exposure significantly reduced plasma glucose concentrations whereas parameters diagnostic of perturbed liver function (enzymes AST, ALT) and kidney function (creatinine, creatine kinase) were significantly elevated. Except for plasma potassium levels (K + ), plasma ions Na + and Cl - were significantly elevated in saltwater alligators. Overall, this study demonstrated significant endocrine and physiological effects in juvenile alligators chronically exposed to a saline environment. Results provide novel insights into the effects of a natural environmental stressor (salinity) on renin-angiotensin-aldosterone system and steroidogenesis of

Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis.

PubMed

Lee, Sae Yong; McKeon, Patrick; Hertel, Jay

2009-02-01

To perform a meta-analysis examining the effects of foot orthoses on self-reported pain and function in patients with plantar fasciitis. MEDLINE, SPORTDiscus, and CINAHL were searched from their inception until December 2007 using the terms "foot", "plantar fascia", "arch", "orthotic", "orthoses" and "plantar fasciitis". Original research studies which met these criteria were included: (1) randomised controlled trials or prospective cohort designs, (2) the patients had to be suffering from plantar fasciitis at the time of recruitment, (3) evaluated the efficacy of foot orthoses with self-reported pain and/or function, (4) means, standard deviations, and sample size of each group had to be reported. We utilised the Roos, Engstrom, and Soderberg (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606-611) night splint condition to compare our pooled orthoses results. The meta-analysis results showed significant reductions in pain after orthotic intervention. The Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606-611) study also showed significant reduction in pain after night splint treatment. The meta-analysis results also showed significant increases in function after orthotic use. In contrast, the Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606-611) study did not show a significant increase in function after night splinting for 12 weeks. The use of foot orthoses in patients with plantar fasciitis appears to be associated with reduced pain and increased function.

One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

PubMed Central

Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea

2013-01-01

OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.

PubMed

Gamba, Carlo; Sala-Pujals, Aleix; Perez-Prieto, Daniel; Ares-Vidal, Jesus; Solano-Lopez, Alberto; Gonzalez-Lucena, Gemma; Ginés-Caspedosa, Alberto

2018-04-01

The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition. Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients. In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36. The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning. Level IV, case series.

[Pyoderma gangrenosum after intramedullary nailing of tibial shaft fracture: A differential diagnosis to necrotizing fasciitis].

PubMed

Hackl, S; Merkel, P; Hungerer, S; Friederichs, J; Müller, N; Militz, M; Bühren, V

2015-12-01

Pyoderma gangrenosum is a rare non-infectious neutrophilic dermatitis, whereas necrotizing fasciitis is a life-threatening bacterial soft tissue infection of the fascia and adjacent skin. As in the case described here after intramedullary nailing, the clinical appearance of both diseases can be similar. Because of the completely different therapeutic approach and a worse outcome in the case of false diagnosis, pyoderma gangrenosum should always be taken into consideration before treating necrotizing fasciitis.

Hydrogeology and extent of saltwater intrusion on Manhasset Neck, Nassau County, New York

USGS Publications Warehouse

Stumm, Frederick; Lange, Andrew D.; Candela, J.L.

2002-01-01

Manhasset Neck, a peninsula on the northern shore of Long Island, N.Y., is underlain by unconsolidated deposits that form a sequence of aquifers and confning units. Ground water at several public-supply wells has been affected by the intrusion of saltwater from the surrounding embayments (Manhasset Bay, Long Island Sound, Hempstead Harbor). Twenty-two boreholes were drilled during 1992-96 for the collection of hydrogeologic, geochemical, and geophysical data to delineate the subsurface geology and the extent of saltwater intrusion within the peninsula. A series of continuous high-resolution seismic- reflection surveys was completed in 1993 and 1994 to delineate the character and extent of the hydrogeologic deposits beneath the embayments surrounding Manhasset Neck.The new drill-core data indicate two hydrogeologic units--the North Shore aquifer and the North Shore confining unit--where the Lloyd aquifer, Raritan confining unit, and the Magothy aquifer have been completely removed by glacial erosion.Water levels at selected observation wells were measured quarterly throughout the study. These data, and continuous water-level records, indicate that (1) the upper glacial (water-table) and Magothy aquifers are hydraulically connected and that their water levels do not respond to tidal fluctuations, and (2) the Lloyd and North Shore aquifers also are hydraulically connected, but their water levels do respond to pumping and tidal fluctuations.Offshore seismic-reflection surveys in the surrounding embayments, and drill-core samples, indicate at least four glacially eroded buried valleys with subhorizontal, parallel reflectors indicative of draped bedding that is interpreted as infilling by silt and clay. The buried valleys (1) truncate the surrounding coarse-grained deposits, (2) are asymmetrical and steep sided, (3) trend northwest-southeast, (4) are 2 to 4 miles long and about 1 mile wide, and (5) extend to more than 400 feet below sea level.Water from 12 public

Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs.

PubMed

Chang, Ryan; Kent-Braun, Jane A; Hamill, Joseph

2012-06-01

Due to complexity of the plantar intrinsic foot muscles, little is known about their muscle architecture in vivo. Chronic plantar fasciitis may be accompanied by muscle atrophy of plantar intrinsic foot muscles and tibialis posterior compromising the dynamic support of the foot prolonging the injury. Magnetic resonance images of the foot may be digitized to quantify muscle architecture. The first purpose of this study was to estimate in vivo the volume and distribution of healthy plantar intrinsic foot muscles. The second purpose was to determine whether chronic plantar fasciitis is accompanied by atrophy of plantar intrinsic foot muscles and tibialis posterior. Magnetic resonance images were taken bilaterally in eight subjects with unilateral plantar fasciitis. Muscle perimeters were digitally outlined and muscle signal intensity thresholds were determined for each image for volume computation. The mean volume of contractile tissue in healthy plantar intrinsic foot muscles was 113.3 cm(3). Forefoot volumes of plantar fasciitis plantar intrinsic foot muscles were 5.2% smaller than healthy feet (P=0.03, ES=0.26), but rearfoot (P=0.26, ES=0.08) and total foot volumes (P=0.07) were similar. No differences were observed in tibialis posterior size. While the total volume of plantar intrinsic foot muscles was similar in healthy and plantar fasciitis feet, atrophy of the forefoot plantar intrinsic foot muscles may contribute to plantar fasciitis by destabilizing the medial longitudinal arch. These results suggest that magnetic resonance imaging measures may be useful in understanding the etiology and rehabilitation of chronic plantar fasciitis. Copyright © 2011 Elsevier Ltd. All rights reserved.

Orbital compressed air and petroleum injury mimicking necrotizing fasciitis.

PubMed

Mellington, Faye E; Bacon, Annette S; Abu-Bakra, Mohammed A J; Martinez-Devesa, Pablo; Norris, Jonathan H

2014-09-01

Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management. Copyright © 2014 Elsevier Inc. All rights reserved.

Wetting and evaporation of salt-water nanodroplets: A molecular dynamics investigation.

PubMed

Zhang, Jun; Borg, Matthew K; Sefiane, Khellil; Reese, Jason M

2015-11-01

We employ molecular dynamics simulations to study the wetting and evaporation of salt-water nanodroplets on platinum surfaces. Our results show that the contact angle of the droplets increases with the salt concentration. To verify this, a second simulation system of a thin salt-water film on a platinum surface is used to calculate the various surface tensions. We find that both the solid-liquid and liquid-vapor surface tensions increase with salt concentration and as a result these cause an increase in the contact angle. However, the evaporation rate of salt-water droplets decreases as the salt concentration increases, due to the hydration of salt ions. When the water molecules have all evaporated from the droplet, two forms of salt crystals are deposited, clump and ringlike, depending on the solid-liquid interaction strength and the evaporation rate. To form salt crystals in a ring, it is crucial that there is a pinned stage in the evaporation process, during which salt ions can move from the center to the rim of the droplets. With a stronger solid-liquid interaction strength, a slower evaporation rate, and a higher salt concentration, a complete salt crystal ring can be deposited on the surface.

Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

PubMed Central

Nazerani, Shahram; Maghari, Ahmad; Kalantar Motamedi, Mohammad Hosein; Vahedian Ardakani, Jalal; Rashidian, Nikdokht; Nazerani, Tina

2012-01-01

ABSTRACT Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition. PMID:24350113

Modeling of sediment transport in a saltwater lake with supplemental sandy freshwater.

PubMed

Liang, Li; Deng, Yun; Li, Ran; Li, Jia

2018-06-22

Considering the highly complex flow structure of saltwater lakes during freshwater supplementation, a three-dimensional numerical model was developed to simulate suspended sediment transport in saltwater lakes. The model was validated using measurements of the salinity and sediment concentration during a pumping test at Yamdrok Lake. The simulation results were in quantitative agreement with the measured data. The observed and simulated results also indicated that the wind stress and vertical salinity gradient have a significant influence on salinity and sediment transport in a saltwater lake. The validated model was then used to predict and analyze the contributions of wind, the supplement flow rate and salinity stratification to the sediment transport process in Yamdrok Lake during continuous river water supplementation. The simulation results showed that after the sandy river water was continuously discharged into the saltwater lake, the lateral diffusion trends of the sediment exhibited three stages: linear growth in the inflow direction, logarithmic growth in the wind direction, and stabilization. Furthermore, wind was the dominant factor in driving the lake flow pattern and sediment transport. Specifically, wind can effectively reduce the area of the sediment diffusion zone by increasing the lateral sediment carrying and dilution capacities. The effect of inflow on the lake current is negligible, but the extent of the sediment turbidity zone mainly depends on the inflow. Reducing the inflow discharge can decrease the area of the sediment turbidity zone to proportions that far exceed the proportions of inflow discharge reductions. In addition, the high-salinity lake water can support the supplemented freshwater via buoyancy forces, which weaken vertical mixing and sediment settlement and increase lake currents and sediment diffusion near the surface.

Burn Center Management of Necrotizing Fasciitis

DTIC Science & Technology

2003-06-01

caesarian sec- tion, vaginal delivery with episiotomy, percutaneous endoscopic gastrostomy, laparoscopy, dental extrac- tion, or liposuction .1,6–11...fasciitis was related to a trivial or unknown injury in six cases and to a small (2% TBSA) contact burn in one case. Two cases re- sulting from liposuction ...31 F Liposuction surgery None 22 8 41 49 Survived 5 48 F Liposuction surgery None 9 6 13 19 Expired 6 72 F Unknown Age, HTN 8 4 51 55 Survived 7 33 M

Necrotizing Fasciitis: An Emergency Medicine Simulation Scenario

PubMed Central

Galust, Henrik; Oliverio, Matthew H; Giorgio, Daniel J; Espinal, Alexis M

2016-01-01

Necrotizing fasciitis (NF) is a rare and rapidly progressing life-threatening infectious process. By progressing through a simulation involving a patient with NF and participating in a post-scenario debriefing, learners will gain the necessary skills and knowledge to properly diagnose and manage patients with NF. Learners are taught to initiate appropriate and timely treatment and to advocate on behalf of their patient after inappropriate pushback from consultants to improve outcomes. PMID:27733963

Necrotizing Fasciitis: An Emergency Medicine Simulation Scenario.

PubMed

Galust, Henrik; Oliverio, Matthew H; Giorgio, Daniel J; Espinal, Alexis M; Ahmed, Rami

2016-08-31

Necrotizing fasciitis (NF) is a rare and rapidly progressing life-threatening infectious process. By progressing through a simulation involving a patient with NF and participating in a post-scenario debriefing, learners will gain the necessary skills and knowledge to properly diagnose and manage patients with NF. Learners are taught to initiate appropriate and timely treatment and to advocate on behalf of their patient after inappropriate pushback from consultants to improve outcomes.

Necrotizing fasciitis in a patient with type 2 diabetes mellitus.

PubMed

Kanuck, David M; Zgonis, Thomas; Jolly, Gary Peter

2006-01-01

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. We present a case of limb salvage in a 52-year-old patient with type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome.

Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial.

PubMed

Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz

2014-01-01

Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group. The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

Lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis.

PubMed

Sadek, Ahmed Fathy; Fouly, Ezzat Hassan; Elian, Mostafa Mohammed

2015-08-01

To compare the outcome following lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis. 30 women and 3 men aged 30 to 60 (mean, 45) years with resistant plantar fasciitis were randomised to undergo release of the first branch of the lateral plantar nerve with (group 1, n=18) or without (group 2, n=15) calcaneal drilling. Patients were followed up for a mean of 27 months. According to the modified Mayo scoring system for plantar fasciotomy, group 1 was superior to group 2 in terms of score (93.9±6.97 vs. 83±8.2, p<0.001) and grading (15 excellent, 2 good, and one fair vs. 6 excellent, 4 good, and 5 fair; p=0.031). Three patients in group one and one patient in group 2 (16.7% vs. 6.6%, p=0.381) developed complications of heel numbness, foot oedema, and 2 cases of superficial wound infection, respectively. Adding calcaneal drilling to release of the first branch of the lateral plantar nerve achieves better outcome than release alone in patients with resistant plantar fasciitis.

Ten years of treating necrotizing fasciitis.

PubMed

Nordqvist, Gunnar; Walldén, Axel; Brorson, Håkan; Tham, Johan

2015-05-01

Necrotizing fasciitis is a soft tissue infection characterized by rapid progression and a high mortality rate. The objective of this study was to investigate diagnosis, causative microbial agents, comorbidities, antibiotic regimen and outcome regarding this disease at Skåne University Hospital in Malmö, Sweden. From medical records, we identified 33 patients treated from January 2003 to January 2013, 31 of whom could be included in our investigation. The infections were monomicrobial in 87% of the cases, and most were caused by group A streptococci. The rate of polymicrobial infections was lower than in other studies. In addition to blood and wound cultures, a rapid antigen detection test for group A streptococci was used in a majority of the cases as a supplement to other diagnostic tools. The time from onset of symptoms to surgery proved to be significantly shorter for patients infected with group A streptococci than for other patients. The mortality rate among all patients was 19%, which is lower than much of the historical material but in line with some more recent studies of this disease. Our results indicate that low mortality rates can be achieved by surgery, appropriate antibiotics and good supportive care. Furthermore, we show that the use of the rapid antigen detection test for group A streptococci, in this setting, helps to shorten the time to surgical intervention in patients suffering from necrotizing fasciitis. This also helps to guide the antibiotic treatment into a narrower spectrum.

Going Out on a Limb: Do Not Delay Diagnosis of Necrotizing Fasciitis in Varicella Infection.

PubMed

Sturgeon, Jonathan P; Segal, Laura; Verma, Anita

2015-07-01

Necrotizing fasciitis (NF) is a rare complication of varicella zoster (chicken pox) infection. Its diagnosis can be delayed or missed, which increases mortality and morbidity, because it initially presents similarly to cellulitis. We present the case of a 5-year-old boy who presented with a swollen leg, the difficulties in the diagnosis of NF, and a review of the literature. Necrotizing fasciitis complicating varicella zoster in children is associated with 3.4% mortality, although this rises to 13.6% in streptococcal toxic shock syndrome. Seventy-one percent of cases are confirmed as being caused by group A β-hemolytic Streptococcus. The association of NF with chicken pox is discussed along with the difficulties in diagnosis and treatment options. Necrotizing fasciitis is a surgical emergency and should be considered by all emergency department acute care practitioners in cases of varicella in which fever is enduring and swelling or pain is disproportionate. Because of the difficulty in diagnosis, senior opinion should be sought early.

Extent and source of saltwater intrusion into the alluvial aquifer near Brinkley, Arkansas, 1984

USGS Publications Warehouse

Morris, E.E.; Bush, W.V.

1986-01-01

An approximate area of 56 sq mi of the alluvial aquifer just north of Brinkley, Arkansas, has been contaminated by saltwater (chloride concentration > or = 50 mg/L) intruded from underlying aquifers. The contamination was mapped from water quality data for 217 wells. Saltwater problems appear to have spread rapidly in the alluvial aquifer since the late 1940's. Chemical comparisons indicate that the alluvial aquifer was contaminated by water from the Sparta aquifer which in turn was contaminated by the underlying Nacatoch aquifer. The possibility of intrusion into the alluvial aquifer through abandoned oil and gas test wells was investigated but no evidence could be found to support this possibility. Upward movement into the alluvial aquifer from the underlying Sparta aquifer through the thinned or absent Jackson confining unit appears to be the principal reason for saltwater in the alluvial aquifer. Increased withdrawals of water from the alluvial aquifer for irrigation and public supply appear to have contributed to this upward movement. (Author 's abstract)

Evaluation of Flow Paths and Confluences for Saltwater Intrusion and Its Influence on Fish Species Diversity in a Deltaic River Network

NASA Astrophysics Data System (ADS)

Shao, X.; Cui, B.; Zhang, Z.; Fang, Y.; Jawitz, J. W.

2016-12-01

Freshwater in a delta is often at risk of saltwater intrusion, which has been a serious issue in estuarine deltas all over the world. Salinity gradients and hydrologic connectivity in the deltas can be disturbed by saltwater intrusion, which can fluctuate frequently and locally in time and space to affect biotic processes and then to affect the distribution patterns of the riverine fishes throughout the river network. Therefore, identifying the major flow paths or locations at risk of saltwater intrusion in estuarine ecosystems is necessary for saltwater intrusion mitigation and fish species diversity conservation. In this study, we use the betweenness centrality (BC) as the weighted attribute of the river network to identify the critical confluences and detect the preferential flow paths for saltwater intrusion through the least-cost-path algorithm from graph theory approach. Moreover, we analyse the responses of the salinity and fish species diversity to the BC values of confluences calculated in the river network. Our results show that the most likely location of saltwater intrusion is not a simple gradient change from sea to land, but closely dependent on the river segments' characteristics. In addition, a significant positive correlation between the salinity and the BC values of confluences is determined in the Pearl River Delta. Changes in the BC values of confluences can produce significant variation in the fish species diversity. Therefore, the dynamics of saltwater intrusion are a growing consideration for understanding the patterns and subsequent processes driving fish community structure. Freshwater can be diverted into these major flow paths and critical confluences to improve river network management and conservation of fish species diversity under saltwater intrusion.

Autologous whole blood versus corticosteroid local injection in treatment of plantar fasciitis: A randomized, controlled multicenter clinical trial.

PubMed

Karimzadeh, Afshin; Raeissadat, Seyed Ahmad; Erfani Fam, Saleh; Sedighipour, Leyla; Babaei-Ghazani, Arash

2017-03-01

Plantar fasciitis is the most common cause of heel pain. Local injection modalities are among treatment options in patients with resistant pain. The aim of the present study was to evaluate the effect of local autologous whole blood compared with corticosteroid local injection in treatment of plantar fasciitis. In this randomized controlled multicenter study, 36 patients with chronic plantar fasciitis were recruited. Patients were allocated randomly into three treatment groups: local autologous blood, local corticosteroid injection, and control groups receiving no injection. Patients were assessed with visual analog scale (VAS), pressure pain threshold (PPT), and plantar fasciitis pain/disability scale (PFPS) before treatment, as well as 4 and 12 weeks post therapy. Variables of pain and function improved significantly in both corticosteroid and autologous blood groups compared to control group. At 4 weeks following treatment, patients in corticosteroid group had significantly lower levels of pain than patients in autologous blood and control groups (higher PPT level, lower PFPS, and VAS). After 12 weeks of treatment, both corticosteroid and autologous blood groups had lower average levels of pain than control group. The corticosteroid group showed an early sharp and then more gradual improvement in pain scores, but autologous blood group had a steady gradual drop in pain. Autologous whole blood and corticosteroid local injection can both be considered as effective methods in the treatment of chronic plantar fasciitis. These treatments decrease pain and significantly improve function compared to no treatment.

Community-acquired necrotizing fasciitis caused by Acinetobacter calcoaceticus: a case report and literature review.

PubMed

Nonaka, Yuko; Nagae, Masaaki; Omae, Takahito; Yamamoto, Shuhei; Horitani, Ryosuke; Maeda, Daigen; Yoshinaga, Takayuki

2014-05-01

A 61-year-old man presented with pain in the abdomen and right lower limb. He had a history of hepatitis B virus-induced liver cirrhosis, but had not been visiting the outpatient clinic and did not receive any medication. Cutaneous necrosis and bulla were observed on his abdomen and right lower limb. The necrotic skin was incised, and he was diagnosed with necrotizing fasciitis. A nonfermentative Gram-negative bacillus infection was confirmed from aspirated fluid and blood cultures. Therefore, meropenem and immunoglobulins were administered. Because necrosis was widespread, surgical debridement was performed. Thereafter, Acinetobacter calcoaceticus infection was confirmed by semi-quantitative PCR using the bullous fluid and blood cultures. Meropenem was administered for 3 weeks, followed by levofloxacin alone for 1 week. The patient's condition improved; therefore, skin grafting was performed as planned and yielded a favorable response. After rehabilitation, the patient could walk without support and infection did not recur. However, he had severe liver cirrhosis and large esophageal varices, and he eventually died from sudden varix rupture. Necrotizing fasciitis is an uncommon soft tissue infection, associated with high morbidity and mortality, and early recognition and treatment are crucial for survival. Acinetobacter is rarely associated with necrotizing fasciitis. Although this is a very rare case of the occurrence of necrotizing fasciitis due to A. calcoaceticus infection, we believe that this organism can be pathogenic in immunocompromised patients such as those with liver cirrhosis by reporting this case. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: a randomized clinical trial.

PubMed

Yucel, Ufuk; Kucuksen, Sami; Cingoz, Havva T; Anliacik, Emel; Ozbek, Orhan; Salli, Ali; Ugurlu, Hatice

2013-12-01

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Randomized clinical trial. Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

Geophysical characterization of saltwater intrusion in a coastal aquifer: The case of Martil-Alila plain (North Morocco)

NASA Astrophysics Data System (ADS)

Himi, Mahjoub; Tapias, Josefiina; Benabdelouahab, Sara; Salhi, Adil; Rivero, Luis; Elgettafi, Mohamed; El Mandour, Abdenabi; Stitou, Jamal; Casas, Albert

2017-02-01

Several factors can affect the quantity and the quality of groundwater resources, but in coastal aquifers seawater intrusion is often the most significant issue regarding freshwater supply. Further, saltwater intrusion is a worldwide issue because about seventy percent of the world's population lives in coastal regions. Generally, fresh groundwater not affected by saltwater intrusion is characterized by low salinity and therefore low electrical conductivity (EC) values. Consequently, high values of EC in groundwater along the coastline are usually associated to seawater intrusion. This effect is amplified if the coastal aquifer is overexploited with a subsequent gradual displacement of the freshwater-saltwater interface towards the continent. Delineation of marine intrusion in coastal aquifers has traditionally relied upon observation wells and collection of water samples. This approach may miss important hydrologic features related to saltwater intrusion in areas where access is difficult and where wells are widely spaced. Consequently, the scarcity of sampling points and sometimes their total absence makes the number of data available limited and most of the time not representative for mapping the spatial and temporal variability of groundwater salinity. In this study, we use a series of geophysical methods for characterizing the aquifer geometry and the extension of saltwater intrusion in the Martil-Alila coastal region (Morocco) as a complement to geological and hydrogeochemical data. For this reason, we carried out three geophysical surveys: Gravity, Electrical Resistivity and Frequency Domain Electromagnetic. The geometry of the basin has been determined from the interpretation of a detailed gravity survey. Electrical resistivity models derived from vertical electrical soundings allowed to characterize the vertical and the lateral extensions of aquifer formations. Finally, frequency domain electromagnetic methods allowed delineating the extension of the

Drug induced neutropaenia--a trigger for necrotising fasciitis?

PubMed

Foulkes, Rhiannon; Hoare, David; Somasekar, Krishnamurthy

2011-08-04

The authors present a case of necrotising fasciitis of the peristomal area, in a patient who had undergone a previous ileostomy for ulcerative colitis. This was associated with neutropaenia, secondary to carbimazole, which had been commenced a few weeks previously for thyrotoxicosis. The authors therefore, stress the importance of monitoring patients closely for possible side effects and complications, while they are on immunosuppressive medication.

Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

PubMed

Cottom, James M; Baker, Joseph S

2016-10-01

When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot. Copyright © 2016 Elsevier Inc. All rights reserved.

Responses of hybrid striped bass to waterborne and dietary copper in freshwater and saltwater

USGS Publications Warehouse

Bielmyer, G.K.; Gatlin, D.; Isely, J.J.; Tomasso, J.; Klaine, S.J.

2005-01-01

Mechanisms of copper toxicity and consequences of exposure vary due to uptake route and ionoregulatory status. The goal of this research was to develop a model fish system to assess the influence of different Cu exposure routes (waterborne or dietary) on bioavailability, uptake, and effects in hybrid striped bass (Morone chrysops×Morone saxatilis) acclimated to fresh- or saltwater. Initially, hybrid striped bass were exposed to dietary Cu concentrations of 571, 785, and 1013 μg Cu/g, along with a control (∼ 5 μg Cu/g), for 14 days in saltwater. Intestinal and liver Cu accumulated in a dose-dependent manner in fish exposed to increasing levels of dietary Cu. Chronic (42 days) experiments were then conducted to determine sub-lethal effects of aqueous, dietary, and combined aqueous and dietary Cu exposures to both freshwater- and saltwater-acclimated hybrid striped bass. Growth and Cu accumulation in the gill, intestine, and liver were measured. Although no significant effects were observed in fish exposed to waterborne Cu, those exposed through the diet accumulated significant liver and intestinal Cu but showed no significant change in growth. Overall, these results suggest that at the levels tested, exposure to elevated waterborne Cu did not cause significant long-term tissue Cu accumulation, whereas dietary Cu exposure caused significant liver and intestinal Cu accumulation in hybrid striped bass which was comparable in both freshwater and saltwater (15 g/L).

Cervical necrotizing fasciitis: report of 6 cases and review of literature.

PubMed

Cruz Toro, P; Callejo Castillo, À; Tornero Saltó, J; González Compta, X; Farré, A; Maños, M

2014-12-01

Necrotizing fasciitis in the cervical region is a rare entity, characterized by a fulminant infection that causes extensive necrosis of the subcutaneous tissue and fascial planes, with high mortality and morbidity rates. The origin is generally odontogenic or pharyngeal, involving a mixed flora of microorganisms. Descending infection and mediastinal involvement are usually associated and are the main complications. The aim of the present study was to review the cases treated in our department and analyze diagnosis and treatment, supplementing the understanding of the disease. A retrospective study was performed on the clinical records of patients admitted to our center between January 2005 and June 2010 with diagnosis of necrotizing cervical fasciitis. Six clinical records were reviewed. The origin of the infection was mainly oropharyngeal and odontogenic, with a mixed flora of Prevotella, Peptostreptococcus and coagulase-negative Staphylococcus. All patients presented mediastinal involvement: superior mediastinitis in 4 patients and superior and postero-inferior mediastinitis in 2 cases. All patients underwent early drainage by bilateral cervicotomy with mediastinal drainage by a cervical approach in those with superior mediastinal affection, and associated thoracotomy, in a single surgical step, for postero-inferior mediastinitis. Temporary tracheotomy was performed in all cases. All received broad spectrum antibiotics, with a medium hospital stay of 37 days. There were no deaths reported. Concerning cervical necrotizing fasciitis, early diagnosis and surgical treatment associated to antibiotics and intensive medical care are essential to obtain a favorable outcome. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Necrotizing fasciitis caused by Haemophilus influenzae type b in a patient with rectal cancer treated with combined bevacizumab and chemotherapy: a case report.

PubMed

Ugai, Tomotaka; Norizuki, Masataro; Mikawa, Takahiro; Ohji, Goh; Yaegashi, Makito

2014-04-12

Recently, necrotizing fasciitis has been reported in patients treated with bevacizumab, usually secondary to wound healing complications, gastrointestinal perforations, or fistula formation. The risk of invasive Haemophilus influenzae type b infection is significantly increased in immunocompromised hosts. However, necrotizing fasciitis due to Haemophilus influenzae type b in a patient treated with combined bevacizumab and chemotherapy has not been previously reported. A 59-year-old woman was admitted to the intensive care unit after sudden onset of fever, chills, and right thigh pain. She received chemotherapy with fluorouracil, irinotecan, and bevacizumab for colon cancer 10 days prior to admission. The advancing erythematous margin and her worsening clinical condition prompted us to suspect necrotizing fasciitis and consult the orthopedics department for a fascia biopsy and debridement. Surgical exploration revealed a murky dishwater-colored pus exudate from the incision site and the lack of a shiny appearance of the fascia that also suggested necrotizing fasciitis. After 2 days, the final results of the blood and exudate cultures confirmed the presence of Haemophilus influenzae type b. A diagnosis of necrotizing fasciitis due to Haemophilus influenzae type b was made. The patient required recurrent surgical debridement and drainage, but she recovered from the septic shock. We report a case of necrotizing fasciitis due to Haemophilus influenzae type b in a patient without injury and with rectal cancer treated with combined bevacizumab and chemotherapy. Physicians should consider invasive Haemophilus influenzae type b disease in the presence of necrotizing fasciitis in patients treated with this combined treatment modality.

Nodular fasciitis of the external auditory canal in six Egyptian children.

PubMed

Abdel-Aziz, Mosaad; Khattab, Hany; El-bosraty, Hussam; El-hoshy, Hassan; Hesham, Ahmed; Al-taweel, Hayam W

2008-05-01

Nodular fasciitis of external auditory canal may mimic a malignant tumor due to its progressive course, so it was the aim of this study to focus on a new etiology for aural masses to avoid unnecessary aggressive treatment. Retrospective study on six children presented with aural masses that were diagnosed pathologically to have nodular fasciitis. Presentation of the cases clinically, radiologically and pathologically was carried out. Surgical excision of the lesions was done through the external canal with follow up of the cases for 1 year. Recurrence was detected in two cases, one after 2 months and the other after 4 months. Re-excision was carried out without recurrence till the end of the follow up period. Proper diagnosis of this lesion is mandatory to avoid aggressive treatment (radical surgery and/or radiotherapy) as the disease has favorable prognosis with local excision.

Application of Time-Domain Electromagnetic Method in Investigating Saltwater Intrusion of Santiago Island (Cape Verde)

NASA Astrophysics Data System (ADS)

Gonçalves, Rui; Farzamian, Mohammad; Monteiro Santos, Fernando A.; Represas, Patrícia; Mota Gomes, A.; Lobo de Pina, A. F.; Almeida, Eugénio P.

2017-11-01

Santiago Island, the biggest and most populated island of the Cape Verde Republic, is characterised by limited surface waters and strong dependence on groundwater sources as the primary source of natural water supply for extensive agricultural activity and human use. However, as a consequence of the scarce precipitation and high evaporation as well as the intense overexploitation of the groundwater resources, the freshwater management is also in a delicate balance with saltwater at coastal areas. The time-domain electromagnetic (TDEM) method is used to locate the extent of saltwater intrusion in four important agricultural regions in Santiago Island; São Domingos, Santa Cruz, São Miguel, and Tarrafal. The application of this method in Santiago Island proves it to be a successful tool in imaging the fresh/saltwater interface location. Depths to the saline zones and extensions of saline water are mapped along eight TDEM profiles.

Disposal of saltwater during well construction--Problems and solutions

USGS Publications Warehouse

Pitt, William A.; Meyer, Frederick W.; Hull, John E.

1977-01-01

The recent interest in the disposal of treated sewage effluent by deep-well injection into salt-water-filled aquifers has increased the need for proper disposal of salt water as more wells are drilled and tested each year.The effects on an unconfined aquifer of the improper disposal of salt water associated with the construction of three wells in southeastern Florida emphasize this need. In two of the wells provisions to prevent and detect salt-water contamination of the unconfined aquifer were practically nonexistent, and in one well extensive provisions were made. Of the three drilling sites the one with proper provision for detection presented no serious problem, as the ground water contaminated by the salt water was easily located and removed. The provisions consisted of drilling a brine-injection well to dispose of salt water discharged in drilling and testing operations, using a closed drilling circulation system to reduce spillage, installing shallow observation wells to map the extent and depth of any salt-water contamination of the shallow aquifer, and installing a dewatering system to remove contaminated ground water.

Decreased necrotizing fasciitis capacity caused by a single nucleotide mutation that alters a multiple gene virulence axis

PubMed Central

Olsen, Randall J.; Sitkiewicz, Izabela; Ayeras, Ara A.; Gonulal, Vedia E.; Cantu, Concepcion; Beres, Stephen B.; Green, Nicole M.; Lei, Benfang; Humbird, Tammy; Greaver, Jamieson; Chang, Ellen; Ragasa, Willie P.; Montgomery, Charles A.; Cartwright, Joiner; McGeer, Allison; Low, Donald E.; Whitney, Adeline R.; Cagle, Philip T.; Blasdel, Terry L.; DeLeo, Frank R.; Musser, James M.

2010-01-01

Single-nucleotide changes are the most common cause of natural genetic variation among members of the same species, but there is remarkably little information bearing on how they alter bacterial virulence. We recently discovered a single-nucleotide mutation in the group A Streptococcus genome that is epidemiologically associated with decreased human necrotizing fasciitis (“flesh-eating disease”). Working from this clinical observation, we find that wild-type mtsR function is required for group A Streptococcus to cause necrotizing fasciitis in mice and nonhuman primates. Expression microarray analysis revealed that mtsR inactivation results in overexpression of PrsA, a chaperonin involved in posttranslational maturation of SpeB, an extracellular cysteine protease. Isogenic mutant strains that overexpress prsA or lack speB had decreased secreted protease activity in vivo and recapitulated the necrotizing fasciitis-negative phenotype of the ΔmtsR mutant strain in mice and monkeys. mtsR inactivation results in increased PrsA expression, which in turn causes decreased SpeB secreted protease activity and reduced necrotizing fasciitis capacity. Thus, a naturally occurring single-nucleotide mutation dramatically alters virulence by dysregulating a multiple gene virulence axis. Our discovery has broad implications for the confluence of population genomics and molecular pathogenesis research. PMID:20080771

Decreased necrotizing fasciitis capacity caused by a single nucleotide mutation that alters a multiple gene virulence axis.

PubMed

Olsen, Randall J; Sitkiewicz, Izabela; Ayeras, Ara A; Gonulal, Vedia E; Cantu, Concepcion; Beres, Stephen B; Green, Nicole M; Lei, Benfang; Humbird, Tammy; Greaver, Jamieson; Chang, Ellen; Ragasa, Willie P; Montgomery, Charles A; Cartwright, Joiner; McGeer, Allison; Low, Donald E; Whitney, Adeline R; Cagle, Philip T; Blasdel, Terry L; DeLeo, Frank R; Musser, James M

2010-01-12

Single-nucleotide changes are the most common cause of natural genetic variation among members of the same species, but there is remarkably little information bearing on how they alter bacterial virulence. We recently discovered a single-nucleotide mutation in the group A Streptococcus genome that is epidemiologically associated with decreased human necrotizing fasciitis ("flesh-eating disease"). Working from this clinical observation, we find that wild-type mtsR function is required for group A Streptococcus to cause necrotizing fasciitis in mice and nonhuman primates. Expression microarray analysis revealed that mtsR inactivation results in overexpression of PrsA, a chaperonin involved in posttranslational maturation of SpeB, an extracellular cysteine protease. Isogenic mutant strains that overexpress prsA or lack speB had decreased secreted protease activity in vivo and recapitulated the necrotizing fasciitis-negative phenotype of the DeltamtsR mutant strain in mice and monkeys. mtsR inactivation results in increased PrsA expression, which in turn causes decreased SpeB secreted protease activity and reduced necrotizing fasciitis capacity. Thus, a naturally occurring single-nucleotide mutation dramatically alters virulence by dysregulating a multiple gene virulence axis. Our discovery has broad implications for the confluence of population genomics and molecular pathogenesis research.

Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up

PubMed Central

Li, Shuming; Shen, Tong; Liang, Yongshan; Zhang, Ying; Bai, Bo

2014-01-01

Plantar fasciitis is the most common cause of heel pain in adults. A novel alternative medical instrument, the miniscalpel-needle (MSN), which is based on an acupuncture needle, has been recently developed in China. The objective of this study was to evaluate the effectiveness of the MSN release treatment versus that of traditional steroid injection for plantar fasciitis. Patients with plantar fasciitis were randomly assigned to 2 groups and followed up for 12 months, with 29 receiving MSN treatment and 25 receiving steroid injection treatment. The results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Our data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection. PMID:25114704

Stratigraphic controls on saltwater intrusion in the Dominguez Gap area of coastal Los Angeles

USGS Publications Warehouse

Edwards, Brian D.; Ehman, Kenneth D.; Ponti, Daniel J.; Reichard, Eric G.; Tinsley, John; Rosenbauer, Robert J.; Land, Michael T.

2009-01-01

The Los Angeles Basin is a densely populated coastal area that significantly depends on groundwater. A part of this groundwater supply is at risk from saltwater intrusion-the impetus for this study. High-resolution seismic-reflection data collected from the Los Angeles-Long Beach Harbor Complex have been combined with borehole geophysical and descriptive geological data from four nearby ??400-m-deep continuously cored wells and with borehole geophysical data from adjacent water and oil wells to characterize the Pliocene to Holocene stratigraphy of the Dominguez Gap coastal aquifer system. The new data are shown as a north-south, two- dimensional, sequence-stratigraphic model that is compared to existing lithostratigraphic models of the Los Angeles Basin in an attempt to better understand pathways of saltwater intrusion into coastal aquifers. Intrusion of saltwater into the coastal aquifer system generally is attributed to over-pumping that caused the hydraulic gradient to reverse during the mid-1920s. Local water managers have used the existing lithostratigraphic model to site closely spaced injection wells of freshwater (barrier projects) attempting to hydraulically control the saltwater intrusion. Improved understanding of the stratigraphic relationships can guide modifications to barrier design that will allow more efficient operation. Allostratigraphic nomenclature is used to define a new sequence-stratigraphic model for the area because the existing lithostratigraphic correlations that have been used to define aquifer systems are shown not to be time-correlative. The youngest sequence, the Holocene Dominguez sequence, contains the Gaspur aquifer at its base. The Gaspur aquifer is intruded with saltwater and consists of essentially flat-lying gravelly sands deposited by the ancestral Los Angeles River as broad channels that occupied a paleovalley incised into the coastal plain during the last glacio-eustatic highstand. The underlying sequences are deformed into

Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound.

PubMed

Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

2015-01-01

although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis.

Treatment of Plantar Fasciitis With Radial Soundwave "Early" Is Better Than After 6 Months: A Pilot Study.

PubMed

Saxena, Amol; Hong, Brian K; Yun, Andrew S; Maffulli, Nicola; Gerdesmeyer, Ludger

Extracorporeal shock wave therapy/radial soundwave therapy has been predominantly used for chronic or recalcitrant plantar fasciitis with strong scientific evidence of reliable outcomes. Most of the studies included patients with plantar fasciitis with symptoms >6 months in duration. Only 2 known studies have investigated acute plantar fasciitis, which is <6 weeks in duration. They both found suboptimal results for the use of extracorporeal shock wave therapy. To the best of our knowledge, no studies have investigated radial soundwave therapy for the subacute stage or early stage of plantar fasciitis. Data were prospectively collected from 28 eligible patients who underwent radial soundwave therapy (RSWT) during a 9-month period in 2014. Of the 28 subjects, 14 were enrolled in the "early group" with a symptom duration of <3 months and 14 in the "standard/control" group with a symptom duration of >6 months. The pretreatment and posttreatment visual analog scale scores, Roles-Maudlsey scores, and activity level were recorded and compared. The early implementation of RSWT yielded comparable outcomes when compared with the standard group. RSWT is a valid treatment modality that can be implemented soon after the initial treatment options or first-phase treatment options have failed. Early treatment is more likely to allow for maintenance of patients' activity level. Also, waiting 6 months to treat plantar fasciitis with RSWT results in delays and inferior results. Early treatment is better for active and athletic patients. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

PubMed

Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

2015-07-01

Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study.

PubMed

Jain, Kowshik; Murphy, Philip N; Clough, Timothy M

2015-12-01

Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection. 60 heels with intractable plantar fasciitis who had failed conservative treatment were randomised to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared. Pre-injection, the two groups were well matched with no statistically significant difference. At 3 months, all three outcome scores had significantly improved from their pretreatment level in both groups. The scores in the Steroid arm were marginally better than in the PRP arm, but this difference was not statistically significant. At 6 months, there was no statistically significant difference between the two groups, though there was a trend for the PRP scores to become better than the Steroid scores. At 12 months, the RM, VAS and AOFAS scores in the PRP arm (1.9, 3.3 and 88.5) were significantly better than the Steroid arm (2.6, 5.3 and 75) with P values of .013, .028 and .033, respectively. PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection. Copyright © 2015 Elsevier Ltd. All rights reserved.

The use of negative pressure in critical necrotizing fasciitis treatment: a case presentation.

PubMed

Ge, Kui; Xu, Bing; Wu, Jia-Jun; Wu, Minjie; Lu, Shuliang; Xie, Ting

2014-09-01

Surgery complemented by antibiotics forms the backbone of the successful management of necrotizing fasciitis. But it will be very difficult to clear away extensive necrotizing tissue thoroughly in critically ill patients when their vital signs are unstable. The authors report the case of a 33-year-old woman who had extensive necrotizing fasciitis of the right lower limb with septic shock. The patient was severely anemic and malnutrition and had been given conservative debridement at bedside, that is, only detached necrotizing tissues was taken away while some other necrotizing tissue still remained, so that the skin tissue within the same area could be saved as much as possible. After debridement, negative pressure was applied at 125 mm Hg. Broad-spectrum antibiotics and effective supplementation were also complemented, thus controlling the septic shock. All necrotizing tissues were detached, and the sparing vital skin on necrotizing fascia was preserved successfully after negative pressure treatment. The patient was finally saved. In conclusion, negative pressure treatment may help diminish toxin absorbance, detach gangrene tissue, and preserve sparing vital tissue. This case suggests the value of combined use of negative pressure therapy and conservative debridement in critically ill patients with extensive necrotizing fasciitis. © The Author(s) 2014.

Estimated effects of projected ground-water withdrawals on movement of the saltwater front in the Floridan aquifer, 1976-2000, west-central Florida

USGS Publications Warehouse

Wilson, William Edward

1982-01-01

Maps of observed 1976 and simulated 2000 potentiometric surfaces were used to estimate rates of saltwater encroachment and theoretical predevelopment equilibrium positions of the saltwater-freshwater interface in west-central Florida. The observed saltwater front, defined by the 19,000 milligrams-per-liter line of equal chloride concentration in the lower part of the Floridan aquifer, corresponds closely to a theoretical predevelopment equilibrium position of a saltwater-freshwater interface. The interface position was computed by the Ghyben-Herzberg method, using heads from a map of the predevelopment potentiometric surface. In maps of both the observed May 1976 and simulated May 2000 potentiometric surface, the saltwater front was within a large seasonal cone of depression in parts of Hillsborough, Manatee, and Sarasota Counties. Average landward flow rate of the front was computed to be 0.30 foot per day in May 1976 and 0.36 foot per day in May 2000. Seaward potentiometric-surface gradient under simulated October 2000 conditions averaged 8.8 x 10-5 foot per foot less than under observed September 1976 conditions. Regional observation wells are desirable for monitoring potentiometric-level changes in western Hardee County and eastern Manatee County and for monitoring water-quality changes along the saltwater front, on its landward side, from mid-Sarasota County northward to Hillsborough County. Net landward movement of the saltwater front in the lower part of the Floridan aquifer is probably occurring under existing conditions. Pumping during 1976-2000 would probably increase slightly the rate of movement. However, rates are so slow that on a regional basis saltwater encroachment under existing and projected conditions is not presently a threat to the existing freshwater resources. The maximum projected regional landward movement, under 'worst case' conditions, of the saltwater front between 1976 and 2000 is estimated to be about one-half mile. Significant local

Evaluation of the effects of sea-level change and coastal canal management on saltwater intrusion in the Biscayne aquifer of south Florida, USA

NASA Astrophysics Data System (ADS)

Hughes, J. D.; Sifuentes, D. F.; White, J.

2015-12-01

Sea-level increases are expected to have an effect on the position of the freshwater-saltwater interface in the Biscayne aquifer in south Florida as a result of the low topographic relief of the area and high rates of groundwater withdrawal from the aquifer. To study the effects that future sea-level increases will have on saltwater intrusion in the Biscayne aquifer in Broward County, Florida, a three-dimensional, variable-density, groundwater-flow and transport model was developed. The model was calibrated to observed groundwater heads and chloride concentrations for a 62-year period that includes historic increases in sea level, development of a surface-water management system to control flooding, and increases in groundwater withdrawals as the area transitioned from agricultural to urban land uses. Sensitivity analyses indicate that downward leakage of saltwater from coastal canals and creeks was the primary source of saltwater to the Biscayne aquifer during the last 62-years in areas where the surface-water system is not actively managed and is tidally influenced. In areas removed from the coastal canals and creeks or under active surface-water management, historic groundwater withdrawals were the primary cause of saltwater intrusion into the aquifer. Simulation of future conditions suggests that possible increases in sea level will result in additional saltwater intrusion. Model scenarios suggest that additional saltwater intrusion will be greatest in areas where coastal canals and creeks were historically the primary source of seawater. Future saltwater intrusion in those areas, however, may be reduced by relocation of salinity-control structures.

[Case-control study of stretching exercise on treatment of plantar fasciitis].

PubMed

Wu, Chun-wei; Zheng, Ping; Wu, Jian; Lu, Jie; Yan, An

2013-04-01

To evaluate the effect of different methods of physical therapy on plantar fasciitis. From June 2009 to March 2012,30 patients with plantar fasciitis were randomly divided into 3 groups including phonophoresis (PH) combined with stretching exercise, ultrasound (US) combined with stretching exercise,stretching exercise, 10 patiens in each group. In stretching exercise group, there were 2 males and 8 females with an average age of (46.7+/-6.5) years old,the mean constitutional index duration was (26.7+/-2.8) kg/m2. In US combined with stretching exercise group, there were 4 males and 6 females with an average age of (45.8+/-6.1) years old,the mean constitutional index duration was (26.4+/-3.4) kg/m2. In PH combined with stretching exercise group,there were 3 males and 7 females with an average age of (48.4+/-8.0) years old,the mean constitutional index duration was (25.4+/-3.0) kg/m2. Patients in PH and US were treated for 10 min everyday by ultrasound, 5 times per week, lasted for 4 weeks; and patients by ultrasound therapy in PH were treated with diclofenac diethylamine at the same time. All the 30 patients received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards,and three months later. Morning pain was evaluated by VAS, and the sub-scale of FFI evaluated the affected foot function. Patients's general status and original pain state of plantar fasciitis before treatment had no significant difference among three groups. There were statistical differences of morning pain and FFI-disability score between PH group and stretching exercise group at 1 month (P<0.05), and no statistical differences among three groups at 3 months (P>0.05). Compared with before therapy,the pain and disability score of three groups significantly improved in the three points of time (P<0.05). Stretching exercises and combining with PH or US are effective for pain and disability in patients with plantar fasciitis

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

PubMed

Cottom, James M; Maker, Jared M

2016-01-01

Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A fatal case of necrotizing fasciitis caused by Serratia marcescens.

PubMed

Curtis, Christopher E; Chock, Stefan; Henderson, Terrance; Holman, Michael J

2005-03-01

A patient with a history of type II diabetes mellitus (DM), end stage renal disease (ESRD), and congestive heart failure (CHF) developed necrotizing fasciitis caused by Serratia marcescens after scraping his leg on rocks in a river while fishing. Aggressive management with surgical debridement, antibiotics, and pressure support was unsuccessful.

The Texas saltwater angler population: a longitudinal perspective (1989-2005)

Treesearch

Yung-Ping (Emilio) Tseng; Robert B. Ditton

2007-01-01

This paper focuses on selected human dimensions indicators of the Texas recreational fishery using the Index of Qualitative Variation (IQV) and Spearman Rank-Order Correlation Coefficient. Minority (Hispanic, Spanish, and females) participation and the overall participation rate in saltwater fishing did not keep pace with a dramatic population...

Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

PubMed Central

Yamakado, Kotaro

2013-01-01

We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging. PMID:23875139

A multilayered sharp interface model of coupled freshwater and saltwater flow in coastal systems: Model development and application

USGS Publications Warehouse

Essaid, Hedeff I.

1990-01-01

A quasi three-dimensional, finite difference model, that simulates freshwater and saltwater flow separated by a sharp interface, has been developed to study layered coastal aquifer systems. The model allows for regional simulation of coastal groundwater conditions, including the effects of saltwater dynamics on the freshwater system. Vertically integrated freshwater and saltwater flow equations incorporating the interface boundary condition are solved within each aquifer. Leakage through confining layers is calculated by Darcy's law, accounting for density differences across the layer. The locations of the interface tip and toe, within grid blocks, are tracked by linearly extrapolating the position of the interface. The model has been verified using available analytical solutions and experimental results. Application of the model to the Soquel-Aptos basin, Santa Cruz County, California, illustrates the use of the quasi three-dimensional, sharp interface approach for the examination of freshwater-saltwater dynamics in regional systems. Simulation suggests that the interface, today, is still responding to long-term Pleistocene sea level fluctuations and has not achieved equilibrium with present day sea level conditions.

Theory and application of an approximate model of saltwater upconing in aquifers

USGS Publications Warehouse

McElwee, C.; Kemblowski, M.

1990-01-01

Motion and mixing of salt water and fresh water are vitally important for water-resource development throughout the world. An approximate model of saltwater upconing in aquifers is developed, which results in three non-linear coupled equations for the freshwater zone, the saltwater zone, and the transition zone. The description of the transition zone uses the concept of a boundary layer. This model invokes some assumptions to give a reasonably tractable model, considerably better than the sharp interface approximation but considerably simpler than a fully three-dimensional model with variable density. We assume the validity of the Dupuit-Forchheimer approximation of horizontal flow in each layer. Vertical hydrodynamic dispersion into the base of the transition zone is assumed and concentration of the saltwater zone is assumed constant. Solute in the transition zone is assumed to be moved by advection only. Velocity and concentration are allowed to vary vertically in the transition zone by using shape functions. Several numerical techniques can be used to solve the model equations, and simple analytical solutions can be useful in validating the numerical solution procedures. We find that the model equations can be solved with adequate accuracy using the procedures presented. The approximate model is applied to the Smoky Hill River valley in central Kansas. This model can reproduce earlier sharp interface results as well as evaluate the importance of hydrodynamic dispersion for feeding salt water to the river. We use a wide range of dispersivity values and find that unstable upconing always occurs. Therefore, in this case, hydrodynamic dispersion is not the only mechanism feeding salt water to the river. Calculations imply that unstable upconing and hydrodynamic dispersion could be equally important in transporting salt water. For example, if groundwater flux to the Smoky Hill River were only about 40% of its expected value, stable upconing could exist where

Determination of bioactivity of chemical fractions of liquid wastes using freshwater and saltwater algae and crustaceans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walsh, G.E.; Garnas, R.L.

1983-03-01

Complex wastes from industrial and municipal outfalls were fractionated chemically and tested for toxicity with freshwater and saltwater algae and crustaceans. The organic fraction of each waste was subfractionated into acid-, base-, and neutral-extractable portions, and the inorganic fraction was subfractionated into its anion and cation components. All wastes affected growth of the algae Skeletonema costatum (saltwater) and Monoraphidium capricornutum (freshwater) or survival of Mysidopsis bahia (saltwater) and Daphnia magna (freshwater). Usually, bioactivity was limited to one or two subfractions. In some cases, algal growth was stimulated by a fraction or subfraction, whereas stimulation was not detected in whole waste.more » It is suggested that fractionation must be done in order to estimate the full potential impact of complex wastes on aquatic systems. The method can also be used to identify toxic factors before application of cost-effective control technology.« less

Monitoring Coastal Marshes for Persistent Saltwater Intrusion

NASA Technical Reports Server (NTRS)

Kalcic, Maria; Hall, Callie; Fletcher, Rose; Russell, Jeff

2009-01-01

Primary goal: Provide resource managers with remote sensing products that support ecosystem forecasting models requiring salinity and inundation data. Work supports the habitat-switching modules in the Coastal Louisiana Ecosystem Assessment and Restoration (CLEAR) model, which provides scientific evaluation for restoration management (Visser et al., 2008). Ongoing work to validate flooding with radar (NWRC/USGS) and enhance persistence estimates through "fusion" of MODIS and Landsat time series (ROSES A.28 Gulf of Mexico). Additional work will also investigate relationship between saltwater dielectric constant and radar returns (Radarsat) (ROSES A.28 Gulf of Mexico).

Administration of an Herbal Complex, Jakyak-Gamcho-Tang (JGT), for Plantar Fasciitis in Military Medical Service: A Case Report.

PubMed

Kwon, Seungwon; Jung, Woo-Sang; Moon, Sang-Kwan; Cho, Ki-Ho; Shin, Kyoung-Ho

Plantar fasciitis is a common disease affecting the heel and plantar side of the foot. This condition can be improved within 6 months with conservative treatments such as stretching, nonsteroidal anti-inflammatory drugs (NSAIDs), extracorporeal shockwave therapy, and corticosteroid injection. However, soldiers need a faster and safer therapy for symptomatic relief to meet the requirements of their occupation. In this report, we reveal that Jakyak-Gamcho-Tang (JGT), an herbal complex, had a positive effect in a case series of 10 military patients with plantar fasciitis. We treated 10 patients with chronic and acute plantar fasciitis with the JGT herbal complex for 21.00 ± 5.72 days. During JGT administration, the patients continued to perform calf-strengthening exercises. After JGT administration, the average foot function index (FFI) score was reduced from 41.11 ± 7.86 to 1.65 ± 3.60 and the average facial rating scale (FRS) was reduced from 5.65 ± 0.88 to 0.40 ± 0.70. A statistically significant difference was observed between the average FFI and FRS measured before and after treatment (paired t test, P < .001). At the conclusion of JGT treatment, all 10 patients (100%) had reduced symptoms of plantar fasciitis. In 7 out of the 10 patients (70%), no pain was experienced after the treatment. In this case series, we show the clinical effects of JGT on pain control in patients with plantar fasciitis. Further clinical studies investigating the effects of JGT are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

PubMed Central

Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

2015-01-01

Summary Background although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. Methods this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. Results increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. Conclusion US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis. PMID:26958538

Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis.

PubMed

Chen, Hongying; Ho, Hok-Ming; Ying, Michael; Fu, Siu Ngor

2013-10-01

Single-cohort laboratory-based study. To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis. Background Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis. Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. There were significantly higher VI (mean ± SD, 2.4% ± 1.4%) and fascia thickness (5.0 ± 1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4% ± 0.5%; fascia thickness, 3.3 ± 0.7 mm) and with the dominant side of the controls (VI, 1.6% ± 0.4%; fascia thickness, 2.9 ± 0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia

Evaluation of the Impact of Groundwater Pumping on Freshwater-Saltwater Interface Fluctuations in a Coastal Aquifer of South Korea

NASA Astrophysics Data System (ADS)

Yoon, H.; Kim, Y.; Lee, S. H.; Ha, K.

2017-12-01

It is necessary to monitor the variation of freshwater-saltwater interface for the sustainable use of groundwater resources in coastal areas. In the present study, we developed a device to measure the location of the freshwater-saltwater interface based on the concept of the neutral buoyancy and installed it in a coastal aquifer of the western sea, South Korea. To evaluate the impact of pumping on the groundwater and saltwater-freshwater interface level, we designed nine different pumping scenarios and monitored the groundwater and saltwater-freshwater interface levels of pumping well and two observation wells. The result of monitoring groundwater level shows that the response of observation wells to the pumping is relatively fast and high, however, the response of freshwater-saltwater interface occurred when the pumping rate and duration are over 25m3/day and 48hours, respectively. For the prediction and simulation of the groundwater level fluctuation under groundwater pumping events, we designed a artificial neural network based time series model considering rainfall, tide, and pumping rate as input components. The result of the prediction shows that the correlation coefficient between observed and estimated groundwater levels is as high as 0.7. It is expected that the result of this research can provide useful information for the effective management of groundwater resources in the study area.

Saltwater-freshwater mixing fluctuation in shallow beach aquifers

NASA Astrophysics Data System (ADS)

Han, Qiang; Chen, Daoyi; Guo, Yakun; Hu, Wulong

2018-07-01

Field measurements and numerical simulations demonstrate the existence of an upper saline plume in tidally dominated beaches. The effect of tides on the saltwater-freshwater mixing occurring at both the upper saline plume and lower salt wedge is well understood. However, it is poorly understood whether the tidal driven force acts equally on the mixing behaviours of above two regions and what factors control the mixing fluctuation features. In this study, variable-density, saturated-unsaturated, transient groundwater flow and solute transport numerical models are proposed and performed for saltwater-freshwater mixing subject to tidal forcing on a sloping beach. A range of tidal amplitude, fresh groundwater flux, hydraulic conductivity, beach slope and dispersivity anisotropy are simulated. Based on the time sequential salinity data, the gross mixing features are quantified by computing the spatial moments in three different aspects, namely, the centre point, length and width, and the volume (or area in a two-dimensional case). Simulated salinity distribution varies significantly at saltwater-freshwater interfaces. Mixing characteristics of the upper saline plume greatly differ from those in the salt wedge for both the transient and quasi-steady state. The mixing of the upper saline plume largely inherits the fluctuation characteristics of the sea tide in both the transverse and longitudinal directions when the quasi-steady state is reached. On the other hand, the mixing in the salt wedge is relatively steady and shows little fluctuation. The normalized mixing width and length, mixing volume and the fluctuation amplitude of the mass centre in the upper saline plume are, in general, one-magnitude-order larger than those in the salt wedge region. In the longitudinal direction, tidal amplitude, fresh groundwater flux, hydraulic conductivity and beach slope are significant control factors of fluctuation amplitude. In the transverse direction, tidal amplitude and beach

The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

PubMed Central

Ang, Teck Wee Andrew

2015-01-01

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient’s daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4–12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks. PMID:26311907

The effectiveness of corticosteroid injection in the treatment of plantar fasciitis.

PubMed

Ang, Teck Wee Andrew

2015-08-01

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

Epiglottitis and necrotizing fasciitis: a life-threatening complication of infectious mononucleosis.

PubMed

Caballero, Miguel; Sabater, Francisco; Traserra, Jose; Alòs, Llucia; Bernal-Sprekelsen, Manuel

2005-10-01

Life-threatening cervical complications associated with infectious mononucleosis are rare. The combination of acute epiglottitis and subsequent necrotizing fasciitis of the head and neck in a patient with infectious mononucleosis has not been reported to date.A 47-year-old female with infectious mononucleosis and epiglottitis was admitted to hospital for i.v. therapy. Owing to her poor clinical condition and the spread of the infection to the throat and superior mediastinum, as evidenced by CT, a cervical debridement was performed. After cervical debridement, histological findings were consistent with necrotizing fasciitis. The bacteria identified were Streptococcus viridans, Veilonella spp. and Capnocytophaga spp. The patient was hospitalized for 33 days.Mononucleosis, usually a benign condition, may be associated with life-threatening septic complications in the neck and chest. Serial CT or MRI scans are necessary to assess the development of the infection in the deep layers of the neck. Rapid medical treatment, extensive surgical debridement and intensive care are vital.

Simulation of saltwater movement in the Floridan aquifer system, Hilton Head Island, South Carolina

USGS Publications Warehouse

Bush, Peter W.

1988-01-01

Freshwater to supply Hilton Head Island, S.C., is obtained from the upper permeable zone of the Upper Floridan aquifer. Long-term pumping at Savannah, Ga., and the steadily increasing pumping on Hilton Head Island, have lowered Upper Floridan heads near the center of the island from about 10 feet above sea level to about 6 to 7 feet below sea level. The seaward hydraulic gradient that existed before pumping began has been reversed, thus increasing the potential for saltwater intrusion. Simulations of predevelopment, recent, and future ground-water flow in the Floridan aquifer system beneath the north end of Hilton Head Island and Port Royal Sound are presented. A finite-element model for fluid-density-dependent ground-water flow and solute transport was used in cross section. The general configuration of the simulated predevelopment flowfield is typical of a coastal aquifer having a seaward gradient in the freshwater. The freshwater flows toward Port Royal Sound over an intruding wedge of saltwater. The simulated flowfield at the end of 1983 shows that ground water in the Floridan aquifer system beneath most of Hilton Head Island has reversed its predevelopment direction and is moving toward Savannah. The distribution of chloride concentrations, based on simulation at the end of 1983, is about the same as the predevelopment distribution of chloride concentrations obtained from simulation. Results of two 50-year simulations from 1983 to 2034 suggest that there will be no significant threat of saltwater intrusion into the upper permeable zone of the Upper Floridan aquifer if heads on Hilton Head Island remain at current levels for the next 45 to 50 years. However, if head decline continues at the historical rate, any flow that presently occurs from the north end of the island toward Port Royal Sound will cease, allowing lateral intrusion of saltwater to proceed. Even under these conditions, chloride concentrations in the upper permeable zone of the Upper Floridan

Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture

PubMed Central

Al-Reshaid, Reshaid Abdullah; Madbouly, Khaled; Al-Jasser, Abdullah

2010-01-01

Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture. PMID:20882163

Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

PubMed

Grieve, Rob; Palmer, Shea

2017-06-01

To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. Online questionnaire survey. Practising physiotherapists across the UK who treat patients with plantar fasciitis. Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Effects of sea-level rise and pumpage elimination on saltwater intrusion in the Hilton Head Island area, South Carolina, 2004-2104

USGS Publications Warehouse

Payne, Dorothy F.

2010-01-01

Saltwater intrusion of the Upper Floridan aquifer has been observed in the Hilton Head area, South Carolina since the late 1970s and currently affects freshwater supply. Rising sea level in the Hilton Head Island area may contribute to the occurrence of and affect the rate of saltwater intrusion into the Upper Floridan aquifer by increasing the hydraulic gradient and by inundating an increasing area with saltwater, which may then migrate downward into geologic units that presently contain freshwater. Rising sea level may offset any beneficial results from reductions in groundwater pumpage, and thus needs to be considered in groundwater-management decisions. A variable-density groundwater flow and transport model was modified from a previously existing model to simulate the effects of sea-level rise in the Hilton Head Island area. Specifically, the model was used to (1) simulate trends of saltwater intrusion from predevelopment to the present day (1885-2004) and evaluate the conceptual model, (2) project these trends from the present day into the future based on different potential rates of sea-level change, and (3) evaluate the relative influences of pumpage and sea-level rise on saltwater intrusion. Four scenarios were simulated for 2004-2104: (1) continuation of the estimated sea-level rise rate over the last century, (2) a doubling of the sea-level rise, (3) a cessation of sea-level rise, and (4) continuation of the rate over the last century coupled with an elimination of all pumpage. Results show that, if present-day (year 2004) pumping conditions are maintained, the extent of saltwater in the Upper Floridan aquifer will increase, whether or not sea level continues to rise. Furthermore, if all pumpage is eliminated and sea level continues to rise, the simulated saltwater extent in the Upper Floridan aquifer is reduced. These results indicate that pumpage is a strong driving force for simulated saltwater intrusion, more so than sea-level rise at current rates

Hydrological modification, saltwater intrusion, and tree water use of a Pterocarpus officinalis swamp in Puerto Rico

NASA Astrophysics Data System (ADS)

Colón-Rivera, Ricardo J.; Feagin, Rusty A.; West, Jason B.; López, Natalia B.; Benítez-Joubert, Rafael J.

2014-06-01

Tidal freshwater forested wetlands occupy a narrow ecological space determined by the balance between saltwater and freshwater inputs to the system. However, this balance is not well understood. In the Caribbean, tidal freshwater-forested wetlands dominated by Pterocarpus officinalis are vulnerable to changes in tidal influence and freshwater inputs. In this setting, the seasonal interactions of saltwater and freshwater inputs create less than ideal conditions for these forests to survive. Hence, it is crucial to have a better understanding of the hydrologic context of these and other tidal freshwater forested wetlands. We examined the extent of tidal forcing and saltwater influence in the largest Pterocarpus swamp of Puerto Rico by installing automated water level and conductivity recorders across a tidal creek transect at four different distances from the ocean, and by using water stable isotopes ratios (δD, δ18O) as natural tracers to determine the most important freshwater sources for tree transpiration. Records of water level and salinity revealed that the amount of rainfall was most influential on saltwater wedge migration in the creek for locations at the front and back of the tidal network, but that tidal dynamics were most influential at the middle section of the tidal network. Saltwater intrusion into the deepest parts of the tidal network was most prominent during sustained dry periods. Isotopic ratios of the surface water samples in the forest revealed that most of the water there was derived from freshwater runoff, but there was a seasonal change in its relative contribution to the forest hydrology. During the dry season, high δ values suggested the presence of runoff-derived water that had undergone evaporation, and saline influences were found in locations where past deforestation created preferential pathways for this water. During both seasons, δ 18O values of groundwater revealed the influence of saline water at depths 60 cm and greater near

Necrotizing fasciitis associated with primary cutaneous B-cell lymphoma. A case report.

PubMed

Spiridakis, K G; Intzepogazoglou, D S; Flamourakis, M E; Sfakianakis, E E; Daskalaki, A V; Vakonaki, E K; Rahmanis, E; Kostakis, G E; Christodoulakis, M S

2017-01-01

Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the deeper skin layers and subcutaneous tissues that moves along the facial planes. We present the rare case of a patient with necrotizing fasciitis associated with high malignancy b-cell lymphoma. Our purpose is to investigate the probable connection between the two pathologies and evaluate the importance of early surgical intervention. 51-year old Caucasian woman presented at the E.R. with history of a painful left thigh over a week and fever up to 38,4°C over the last three days. Necrosis of the soft tissues and fascial planes were observed clinically. After the initial treatment and due to the patient's multiple organ dysfunction (septic shock), she was transferred to the ICU were she was intubated resuscitated with IV fluids and given IV antibiotics. 24 hours after the admission it was decided that the patient should undergo surgery and an extensive debridement of the necrotic area was performed. The antibiogram of the blood culture revealed streptococcus pyogenes and she was administered penicillin while intubated and monitored in the ICU until the seventh postoperative day. On the eighth post-day she was transferred back to the surgical department, hemodynamically normal and stable. She was discharged one month later and she was referred to a plastic surgery center for the final reconstruction surgery. This case highlights that the high index of suspicion and the early aggressive surgical intervention seems to be very critical to improve survival of the patients with necrotizing fasciitis.

Acute appendicitis complicated with necrotizing fasciitis in a patient with adult-onset Still's disease: A case report.

PubMed

Huang, Zheng-Hao; Chiu, Yu-Chen; Ho, Li-Lu; Fan, Hsiu-Lung; Lu, Chun-Chi

2018-02-01

Adult-onset Still disease (AOSD) is a rare systemic inflammatory disease of unknown etiology characterized by evanescent salmon-pink rash, spiking fever, arthralgia/ arthritis, and lymphadenopathy. AOSD sometimes was fatal when it is complicated by macrophage activation syndrome (MAS) or hemophagocytic lymphohistiocytosis (HLH). Nonetheless, the literature provides no recommendations for treatment of AOSD patients with severe sepsis. A previously healthy 65-year-old man with history of AOSD was referred to our hospital for persistent right lower quadrant abdominal pain for 2 days. One week later, an abdominal wall abscess and hematoma developed by extravasation from the inferior epigastric vessels, complicated by necrotizing fasciitis of the right thigh and groin region. To our best knowledge, this case was the first reported case of a perforated appendix complicated with necrotizing fasciitis in a patient with AOSD. The patient was diagnosed as acute appendicitis complicated with necrotizing fasciitis and abdominal wall abscess. This case received intravenous tigecycline injection and daily 10 mg prednisolone initially, and shifted to daily intravenous hydrocortisone 200 mg for suspected MAS or HLH. This patient underwent surgical intervention and debridement for necrotizing fasciitis. The patient's symptoms progressed worse rapidly. He died from cytomegalovirus viremia and bacterial necrotizing fasciitis complicated by septic shock. (1) The steroid dose was difficult to titrate when AOSD complicated by sepsis. The differential diagnosis from MAS/HLH with bacterial/viral infection related severe sepsis was difficult but critical for decision making from clinicians and rheumatologists. (2) The conservative treatment with antibiotics for perforated appendix is safe but has a higher failure rate in immunocomprised patients such as systemic lupus erythematosus and AOSD. Early surgical intervention might contribute to better outcome. (3) The abdominal wall abscess

Ultrasound- versus Palpation-Guided Injection of Corticosteroid for Plantar Fasciitis: A Meta-Analysis

PubMed Central

Yu, Aixi; Qi, Baiwen

2014-01-01

Background It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis. Methods Databases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Results Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI. Conclusion Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research. PMID:24658102

Necrotizing fasciitis: strategies for diagnosis and management.

PubMed

Taviloglu, Korhan; Yanar, Hakan

2007-08-07

Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

[Percutaneous surgery for plantar fasciitis due to a calcaneal spur].

PubMed

Apóstol-González, Saúl; Herrera, Jesús

2009-01-01

Determine the efficacy of percutaneous surgical treatment for talalgia due to a calcaneal spur. This is an observational, descriptive, clinical series analyzing the outcomes of 10 patients with a diagnosis of talalgia due to plantar fasciitis with a calcaneal spur treated with percutaneous foot surgery. The end result was assessed with a visual analog scale (VAS) to measure pain, the patients' opinion and their return to activities of daily living. Central tendency and scatter measurements were calculated. The inferential analysis was done with the non-parametric chi square (chi2) test. Most patients were females (90%) and mean age was 40.5 years. Follow-up was 12 months. One patient had bleeding of the approached area. Pain was reduced from 8 to 1.5 in the VAS. Nine patients returned to their activities. Two patients had occasional mild pain upon prolonged bipedestation. Ninety percent of results were satisfactory. Percutaneous foot surgery in talalgias caused by plantar fasciitis due to a calcaneal spur is a simple and effective method. It reduces the operative time and allows for an early return of patients to their activities of daily living.

Map of the approximate inland extent of saltwater at the base of the Biscayne aquifer in the Model Land Area of Miami-Dade County, Florida, 2016

USGS Publications Warehouse

Prinos, Scott T.

2017-07-11

The inland extent of saltwater at the base of the Biscayne aquifer in the Model Land Area of Miami-Dade County, Florida, was mapped in 2011. Since that time, the saltwater interface has continued to move inland. The interface is near several active well fields; therefore, an updated approximation of the inland extent of saltwater and an improved understanding of the rate of movement of the saltwater interface are necessary. A geographic information system was used to create a map using the data collected by the organizations that monitor water salinity in this area. An average rate of saltwater interface movement of 140 meters per year was estimated by dividing the distance between two monitoring wells (TPGW-7L and Sec34-MW-02-FS) by the travel time. The travel time was determined by estimating the dates of arrival of the saltwater interface at the wells and computing the difference. This estimate assumes that the interface is traveling east to west between the two monitoring wells. Although monitoring is spatially limited in this area and some of the wells are not ideally designed for salinity monitoring, the monitoring network in this area is improving in spatial distribution and most of the new wells are well designed for salinity monitoring. The approximation of the inland extent of the saltwater interface and the estimated rate of movement of the interface are dependent on existing data. Improved estimates could be obtained by installing uniformly designed monitoring wells in systematic transects extending landward of the advancing saltwater interface.

Impact of the bottom drag coefficient on saltwater intrusion in the extremely shallow estuary

NASA Astrophysics Data System (ADS)

Lyu, Hanghang; Zhu, Jianrong

2018-02-01

The interactions between the extremely shallow, funnel-shaped topography and dynamic processes in the North Branch (NB) of the Changjiang Estuary produce a particular type of saltwater intrusion, saltwater spillover (SSO), from the NB into the South Branch (SB). This dominant type of saltwater intrusion threatens the winter water supplies of reservoirs located in the estuary. Simulated SSO was weaker than actual SSO in previous studies, and this problem has not been solved until now. The improved ECOM-si model with the advection scheme HSIMT-TVD was applied in this study. Logarithmic and Chézy-Manning formulas of the bottom drag coefficient (BDC) were established in the model to investigate the associated effect on saltwater intrusion in the NB. Modeled data and data collected at eight measurement stations located in the NB from February 19 to March 1, 2017, were compared, and three skill assessment indicators, the correlation coefficient (CC), root-mean-square error (RMSE), and skill score (SS), of water velocity and salinity were used to quantitatively validate the model. The results indicated that the water velocities modeled using the Chézy-Manning formula of BDC were slightly more accurate than those based on the logarithmic BDC formula, but the salinities produced by the latter formula were more accurate than those of the former. The results showed that the BDC increases when water depth decreases during ebb tide, and the results based on the Chézy-Manning formula were smaller than those based on the logarithmic formula. Additionally, the landward net water flux in the upper reaches of the NB during spring tide increases based on the Chézy-Manning formula, and saltwater intrusion in the NB was enhanced, especially in the upper reaches of the NB. At a transect in the upper reaches of the NB, the net transect water flux (NTWF) is upstream in spring tide and downstream in neap tide, and the values produced by the Chézy-Manning formula are much larger than

Orbital necrotizing fasciitis and osteomyelitis caused by arcanobacterium haemolyticum: a case report.

PubMed

Stone, Lindsay A; Harshbarger, Raymond J

2015-01-01

The facial region is infrequently affected by necrotizing infections. Orbital necrotizing infections are even rarer, seen following trauma, local skin infection, and sinusitis. The authors report a unique case of orbital necrotizing fasciitis and osteomyelitis resulting from Arcanobacterium Haemolyticum ethmoid sinusitis. No prior occurrences of Arcanobacterial species orbital necrotizing fasciitis/osteomyelitis have been reported.A 16-year-old boy presented to the ER with a 3-day history of fever, chills, headache, and sinus pressure. CT scan revealed soft tissue swelling of the right orbit, forehead, and ethmoid sinusitis. Within 24 hours of admission, he suffered rapidly progressive swelling and erythema of the right orbit and forehead with diminished visual acuity, despite broad-spectrum antibiotics. Orbital exploration revealed frankly necrotic fascia and periosteum along the superior aspect. Lateral canthotomy, cantholysis, decompression of the optic nerve, and soft tissue debridement with bone biopsy was performed. Operative specimens isolated Arcanobacterium Haemolyticum. Pathologic examination revealed right orbital osteomyelitis.

Necrotizing Fasciitis of the lower extremity: a case report and current concept of diagnosis and management

PubMed Central

Naqvi, GA; Malik, SA; Jan, W

2009-01-01

Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge. PMID:19527519

Single-specialty management and reconstruction of necrotizing fasciitis of the upper extremities: clinical and economic benefits from a case series.

PubMed

Mattison, Gennaya; Leis, Amber R; Gupta, Subhas C

2014-05-01

Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. Improved

Mapping saltwater intrusion in the Biscayne Aquifer, Miami-Dade County, Florida using transient electromagnetic sounding

USGS Publications Warehouse

Fitterman, David V.

2014-01-01

Saltwater intrusion in southern Florida poses a potential threat to the public drinking-water supply that is typically monitored using water samples and electromagnetic induction logs collected from a network of wells. Transient electromagnetic (TEM) soundings are a complementary addition to the monitoring program because of their ease of use, low cost, and ability to fill in data gaps between wells. TEM soundings have been used to map saltwater intrusion in the Biscayne aquifer over a large part of south Florida including eastern Miami-Dade County and the Everglades. These two areas are very different with one being urban and the other undeveloped. Each poses different conditions that affect data collection and data quality. In the developed areas, finding sites large enough to make soundings is difficult. The presence of underground pipes further restricts useable locations. Electromagnetic noise, which reduces data quality, is also an issue. In the Everglades, access to field sites is difficult and working in water-covered terrain is challenging. Nonetheless, TEM soundings are an effective tool for mapping saltwater intrusion. Direct estimates of water quality can be obtained from the inverted TEM data using a formation factor determined for the Biscayne aquifer. This formation factor is remarkably constant over Miami-Dade County owing to the uniformity of the aquifer and the absence of clay. Thirty-six TEM soundings were collected in the Model Land area of southeast Miami-Dade County to aid in calibration of a helicopter electromagnetic (HEM) survey. The soundings and HEM survey revealed an area of saltwater intrusion aligned with canals and drainage ditches along U.S. Highway 1 and the Card Sound Road. These canals and ditches likely reduced freshwater levels through unregulated drainage and provided pathways for seawater to flow at least 12.4 km inland.

Necrotizing fasciitis: the Howard University Hospital experience.

PubMed

Walker, M; Hall, M

1983-02-01

All surgical cases from 1965 to 1980 and autopsy cases from 1974 to 1980 diagnosed at Howard University Hospital as necrotizing fasciitis (NF) were reviewed. Eight patient fulfilled the criteria for NF, which included (1) fascial necrosis, (2) spreading cellulitis with undermining of fascial planes, and (3) systemic toxicity as evidenced by altered mental state and hyperthermia. Bacteroides fragilis was commonly found in our most recent cases. Poor prognostic signs included (1) documented bacteremia, (2) preoperative hypotension (systolic blood pressure lower than 80 mmHg), and (3) hypocalcemia (serum calcium less than 7.0 mg/dL). Therapy consisted of wide debridement with systemic antibiotics and delayed skin grafting when needed.

Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study.

PubMed

Costantino, C; Vulpiani, M C; Romiti, D; Vetrano, M; Saraceni, V M

2014-02-01

Plantar fasciitis is one of the most common causes of pain in the inferior heel and is very frequent in some running sports. It affects up to 10% of general population and accounts for 11% to 15% of all foot pain symptomatology. Several treatments have been suggested, but there is no evidence supporting a specific conservative management strategy. Evaluation of the efficacy of combined cryoultrasound therapy on chronic plantar fasciitis with heel spurs resistant to pharmacological and instrumental therapies. Single-blind randomized clinical trial. 102 consecutive patients affected by chronic plantar fasciitis with painful symptomatology for at least 6 months, intensity of pain higher than 5 on the VAS score, presence of heel spurs, use of plantar orthoses and ineffectiveness of previous therapies. The patients were randomized into two groups: Group A treated with cryoultrasound therapy and Group B with cryotherapy. Our protocol was based on 10 daily treatments, lasting 20 minutes. Each participant was evaluated using VAS score before (T0) the treatment and 3 months (T1), 12 months (T2) and 18 months (T3) after. Effectiveness index was calculated from T1 to T3. Both treatments have been found effective. The difference in pain intensity on the VAS scale between the two groups at T2 was 4.35 points in favor of Group A (IC 95% 3.75; 4.95; P<0.001), reaching the primary end point. The difference in pain intensity on the VAS scale between the two groups at T1, T2 and T3 was 3.00, 4.35 and 4.81 respectively, showing a statistically significant difference between VAS average scores at all follow-ups in favor of Group A. Scores of at least 66% at the effectiveness index were only achieved in Group A (P values <0.001). Cryoultrasound therapy could be an efficient treatment option for chronic plantar fasciitis. Cryoultrasound therapy promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis, granted its high therapeutic efficiency

Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus.

PubMed

Lee, Yao-Chou; Hor, Lien-I; Chiu, Haw-Yen; Lee, Jing-Wei; Shieh, Shyh-Jou

2014-06-01

In Taiwan, the aquatic environment and endemic hepatitis contribute to the high susceptibility of Vibrio vulnificus infection. A multidisciplinary treatment protocol for necrotizing fasciitis caused by V. vulnificus was developed in our institute, namely, ceftriaxone or ceftazidime combined with doxycycline or minocycline followed by an emergency fasciotomy and intensive care unit admission. We retrospectively reviewed 100 cases to evaluate the effectiveness of our treatment protocol and identify independent predictors of mortality to improve clinical outcomes. Cases of culture-confirmed V. vulnificus infection between January 1996 and December 2011 were reviewed. Necrotizing fasciitis was surgically diagnosed if these criteria were met: necrotic fascia, "dishwater discharge", and loss of resistance while doing finger dissection along the fascia plane. One hundred cases met these criteria and were included for analysis. Eighteen patients died (18 % mortality). Unknown injury events, presence of multiple skin lesions, leukocytes < 10,000 cells/mm(3), platelets < 100,000/mm(3), serum creatinine ≥1.3 mg/dL, serum albumin < 2.5 mg/dL, and delayed treatment beyond 3 days post-injury or symptom onset were associated with significantly higher mortality. Multivariate analysis showed that treatment delayed beyond 3 days is an independent factor indicating a poor prognosis (OR 10.75, 95 % CI 1.02-113.39, p = 0.048). Early diagnosis and prompt treatment within 3 days post-injury or symptom onset should be the goal for treating patients with necrotizing fasciitis caused by V. vulnificus. Additional investigations to rescue patients with a prolonged disease course of necrotizing fasciitis (≥3 days) may be important.

Bibliography on the occurrence and intrusion of saltwater in aquifers along the Atlantic Coast of the United States

USGS Publications Warehouse

Barlow, Paul M.; Wild, Emily C.

2002-01-01

Freshwater aquifers along the Atlantic coast of the United States are vulnerable to the intrusion of saltwater from saline waters that bound the aquifers along their seaward margins. Incidences of saltwater intrusion have been documented along the Atlantic coast for more than 100 years. This report provides a bibliography of published literature relating to the occurrence and intrusion of saltwater along the Atlantic coast of the United States, including all of the coastal States from Maine to Florida (including the coast of Florida along the Gulf of Mexico). The bibliography contains 549 references that date from 1896 to 2001. The bibliography contains references to books, journal articles, and government and other technical reports and maps that could be readily obtained through a scientific library. Conference papers and abstracts, unpublished manuscripts, publications in press, newspaper articles, consulting reports, and reports prepared by local or regional water companies or water districts are omitted from the bibliography.

Simulation of Variable-Density Ground-Water Flow and Saltwater Intrusion beneath Manhasset Neck, Nassau County, New York, 1905-2005

USGS Publications Warehouse

Monti, Jack; Misut, Paul E.; Busciolano, Ronald J.

2009-01-01

The coastal-aquifer system of Manhasset Neck, Nassau County, New York, has been stressed by pumping, which has led to saltwater intrusion and the abandonment of one public-supply well in 1944. Measurements of chloride concentrations and water levels in 2004 from the deep, confined aquifers indicate active saltwater intrusion in response to public-supply pumping. A numerical model capable of simulating three-dimensional variable-density ground-water flow and solute transport in heterogeneous, anisotropic aquifers was developed using the U.S. Geological Survey finite-element, variable-density, solute-transport simulator SUTRA, to investigate the extent of saltwater intrusion beneath Manhasset Neck. The model is composed of eight layers representing the hydrogeologic system beneath Manhasset Neck. Four modifications to the area?s previously described hydrogeologic framework were made in the model (1) the bedrock-surface altitude at well N12191 was corrected from a previously reported value, (2) part of the extent of the Raritan confining unit was shifted, (3) part of the extent of the North Shore confining unit was shifted, and (4) a clay layer in the upper glacial aquifer was added in the central and southern parts of the Manhasset Neck peninsula. Ground-water flow and the location of the freshwater-saltwater interface were simulated for three conditions (time periods) (1) a steady-state (predevelopment) simulation of no pumping prior to about 1905, (2) a 40-year transient simulation based on 1939 pumpage representing the 1905-1944 period of gradual saltwater intrusion, and (3) a 60-year transient simulation based on 1995 pumpage representing the 1945-2005 period of stabilized withdrawals. The 1939 pumpage rate (12.1 million gallons per day (Mgal/d)) applied to the 1905-1944 transient simulation caused modeled average water-level declines of 2 and 4 feet (ft) in the shallow and deep aquifer systems from predevelopment conditions, respectively, a net decrease of 5

Plantar fasciitis: A randomized comparative study of platelet rich plasma and low dose radiation in sportspersons.

PubMed

Gogna, Paritosh; Gaba, Sahil; Mukhopadhyay, Reetadyuti; Gupta, Rakesh; Rohilla, Rajesh; Yadav, Lakhpat

2016-08-01

Plantar Fasciitis makes up about 15% of patients requiring professional care due to foot symptoms. The treatment methods are numerous with none proving to be clearly superior to others. We aimed to compare two common treatment methods in search of the best treatment. All consecutive sportspersons presenting to our OPD with clinical diagnosis of plantar fasciitis underwent treatment consisting of stretching exercises, activity modification, and NSAID's for 6 months. First 40 patients who did not respond to the treatment were divided randomly into two groups of 20 patients each, Group A (Platelet rich plasma - PRP) and Group B (low dose radiation - LDR). At the time of final follow-up (6 months) the mean improvement in the pain score (Visual-Analogue-Scale), American Orthopaedic Foot and Ankle Score (AOFAS) and Plantar fascia thickness on ultrasound were compared. Significant improvement in all 3 parameters was noted at the time of final follow up within both groups. When compared to each other, the difference in outcome of both these Groups on the given 3 parameters came out to be insignificant (p>0.05). PRP is as good as LDR in patients with chronic recalcitrant plantar fasciitis not responding to physical therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis.

PubMed

Assad, Salman; Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

2016-12-05

We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.

Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

PubMed Central

Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

2016-01-01

We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.  PMID:28083457

Hydrogeology and extent of saltwater intrusion of the Great Neck peninsula, Great Neck, Long Island, New York

USGS Publications Warehouse

Stumm, Frederick

2001-01-01

Great Neck, a peninsula, in the northwestern part of Nassau County, N.Y., is underlain by unconsolidated deposits that form a sequence of aquifers and confining units. Seven public-supply wells have been affected by the intrusion of saltwater from the surrounding embayments (Little Neck Bay, Long Island Sound, Manhasset Bay). Fifteen observation wells were drilled in 1991–96 for the collection of hydrogeologic, geochemical, and geophysical data to delineate the subsurface geology and extent of saltwater intrusion within the peninsula. Continuous high-resolution seismic-reflection surveys in the embayments surrounding the Great Neck peninsula and the Manhasset Neck peninsula to the east were completed in 1993 and 1994.Two hydrogeologic units are newly proposed herein.the North Shore aquifer and the North Shore confining unit. The new drill-core data collected in 1991–96 indicate that the Lloyd aquifer, the Raritan confining unit, and the Magothy aquifer have been completely removed from the northern part of the peninsula by extensive glacial erosion.Water levels at selected observation wells were measured quarterly throughout the study. The results from two studies of the effects of tides on ground-water levels in 1992 and 1993 indicate that water levels at wells screened within the North Shore and Lloyd aquifers respond to tides and pumping effects, but those in the overlying upper glacial aquifer (where the water table is located) do not. Data from quarterly water-level measurements and the tidal-effect studies indicate the North Shore and Lloyd aquifers to be hydraulically connected.Offshore seismic-reflection surveys in the surrounding embayments indicate at least two glacially eroded buried valleys with subhorizontal, parallel reflectors indicative of draped bedding that is interpreted as infilling by silt and clay. The buried valleys (1) truncate the surrounding coarse-grained deposits, (2) are asymmetrical and steep sided, (3) trend northwest

76 FR 32142 - Proposed Information Collection; Comment Request; Alaska Saltwater Sportfishing Economic Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-03

... Collection; Comment Request; Alaska Saltwater Sportfishing Economic Survey AGENCY: National Oceanic and... a survey to collect data for conducting economic analyses of marine sport fishing in Alaska. This survey is necessary to understand the factors that affect the economic value of marine recreational...

Investigation of Saltwater Intrusion and Recirculation of Seawater for Henry Constant Dispersion and Velocity-Dependent Dispersion Problems and Field-Scale Problem

NASA Astrophysics Data System (ADS)

Motz, L. H.; Kalakan, C.

2013-12-01

Three problems regarding saltwater intrusion, namely the Henry constant dispersion and velocity-dependent dispersion problems and a larger, field-scale velocity-dependent dispersion problem, have been investigated to determine quantitatively how saltwater intrusion and the recirculation of seawater at a coastal boundary are related to the freshwater inflow and the density-driven buoyancy flux. Based on dimensional analysis, saltwater intrusion and the recirculation of seawater are dependent functions of the independent ratio of freshwater advective flux relative to the density-driven vertical buoyancy flux, defined as az (or a for an isotropic aquifer), and the aspect ratio of horizontal and vertical dimensions of the cross-section. For the Henry constant dispersion problem, in which the aquifer is isotropic, saltwater intrusion and recirculation are related to an additional independent dimensionless parameter that is the ratio of the constant dispersion coefficient treated as a scalar quantity, the porosity, and the freshwater advective flux, defined as b. For the Henry velocity-dependent dispersion problem, the ratio b is zero, and saltwater intrusion and recirculation are related to an additional independent dimensionless parameter that is the ratio of the vertical and horizontal dispersivities, or rα = αz/αx. For an anisotropic aquifer, saltwater intrusion and recirculation are also dependent on the ratio of vertical and horizontal hydraulic conductivities, or rK = Kz/Kx. For the field-scale velocity-dependent dispersion problem, saltwater intrusion and recirculation are dependent on the same independent ratios as the Henry velocity-dependent dispersion problem. In the two-dimensional cross-section for all three problems, freshwater inflow occurs at an upgradient boundary, and recirculated seawater outflow occurs at a downgradient coastal boundary. The upgradient boundary is a specified-flux boundary with zero freshwater concentration, and the downgradient

Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination.

PubMed

Ahn, Jae Hoon; Lee, Choong Woo; Park, ChanJoo; Kim, Yoon-Chung

2016-01-01

Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid. We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone. The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified. Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position. The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.

Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis.

PubMed

Broholm, R; Pingel, J; Simonsen, L; Bülow, J; Johannsen, F

2017-12-01

Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Periocular necrotising fasciitis: a multicentre case series.

PubMed

Rajak, Saul N; Figueira, Edwin C; Haridas, Anjana S; Satchi, Khami; Uddin, Jimmy M; McNab, Alan A; Rene, Cornelius; Sullivan, Timothy J; Rose, Geoffrey E; Selva, Dinesh

2016-11-01

Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone. Twenty-nine patients (20 men; 69%) with PONF were identified and followed up for between 2 months and 10 years (median 57, mean 52.6 months) between 1990 and 2013. Conditions associated with chronic immunocompromise were present in 16/29 (55%). Twenty-one (75%) recalled minor periocular trauma or an infected lesion, two having been assaulted by the same assailant. Systemic shock occurred in 6/29 (21%) patients and 1 died. Group A, β-haemolytic Streptococcus was the most common bacterium identified (25/29, 86%). Intravenous antibiotics were used in all patients, and up to five tissue debridements were required to control the disease in 23/29 (74%); reconstructive surgery was required in 12/29 (41%) patients. One patient died from the disease and visual loss occurred in four eyes of four patients (14%). PONF has a better prognosis than disease elsewhere in the body, but is still associated with significant risk of visual loss and a small risk of death. Intravenous antibiotic treatment with cautious observation may be reasonable in selected patients with a low threshold for debridement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Necrotizing fasciitis – a diagnostic dilemma: two case reports

PubMed Central

2014-01-01

Introduction Necrotizing soft tissue infections can affect various tissue planes. Although predisposing etiologies are many, they mostly center on impaired immunity occurring directly or indirectly and loss of integrity of protective barriers which predispose to infection. The nonspecific presentation may delay diagnosis and favor high mortality. Case presentation Two case vignettes are presented. The first patient, a 44-year-old healthy South Asian man with a history of repeated minor traumatic injury presented to a primary health care center with a swollen left lower limb. He was treated with antibiotics with an initial diagnosis of cellulitis. Because he deteriorated rapidly and additionally developed intestinal obstruction, he was transferred to our hospital which is a tertiary health care center for further evaluation and management. Prompt clinical diagnosis of necrotizing soft tissue infection was made and confirmed on magnetic resonance imaging as necrotizing fasciitis. Urgent debridement was done, but the already spread infection resulted in rapid clinical deterioration with resultant mortality. The second patient was a 35-year-old South Asian woman with systemic lupus erythematous receiving immunosuppressive therapy who developed left lower limb pain and fever. Medical attention was sought late as she came to the hospital after 4 days. Her condition deteriorated rapidly as she developed septic shock and died within 2 days. Conclusions Necrotizing fasciitis can be fatal when not recognized and without early intervention. Clinicians and surgeons alike should have a greater level of suspicion and appreciation for this uncommon yet lethal infection. PMID:24965382

Cervical necrotizing fasciitis: management challenges in poor resource environment.

PubMed

Adekanye, Abiola Grace; Umana, A N; Offiong, M E; Mgbe, R B; Owughalu, B C; Inyama, M; Omang, H M

2016-09-01

Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20-71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.

The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis

PubMed Central

2011-01-01

Introduction Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities. Methods In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality. Results Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival. Conclusions Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures. PMID:21693053

Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study.

PubMed

Macias, David M; Coughlin, Michael J; Zang, Kerry; Stevens, Faustin R; Jastifer, James R; Doty, Jesse F

2015-01-01

Plantar fasciitis affects nearly 1 million persons in the United States at any one time. Conservative therapies have been reported to successfully treat 90% of plantar fasciitis cases; however, for the remaining cases, only invasive therapeutic solutions remain. This investigation studied newly emerging technology, low-level laser therapy. From September 2011 to June 2013, 69 subjects were enrolled in a placebo-controlled, randomized, double-blind, multicenter study that evaluated the clinical utility of low-level laser therapy for the treatment of unilateral chronic fasciitis. The volunteer participants were treated twice a week for 3 weeks for a total of 6 treatments and were evaluated at 5 separate time points: before the procedure and at weeks 1, 2, 3, 6, and 8. The pain rating was recorded using a visual analog scale, with 0 representing "no pain" and 100 representing "worst pain." Additionally, Doppler ultrasonography was performed on the plantar fascia to measure the fascial thickness before and after treatment. Study participants also completed the Foot Function Index. At the final follow-up visit, the group participants demonstrated a mean improvement in heel pain with a visual analog scale score of 29.6 ± 24.9 compared with the placebo subjects, who reported a mean improvement of 5.4 ± 16.0, a statistically significant difference (p < .001). Although additional studies are warranted, these data have demonstrated that low-level laser therapy is a promising treatment of plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

An alternating voltage battery with two salt-water oscillators

NASA Astrophysics Data System (ADS)

Cervellati, Rinaldo; Soldà, Roberto

2001-05-01

We built a simple alternating voltage battery that periodically reverses value and sign of its electromotive force (emf). This battery consists of two coupled concentration salt-water oscillators that are phase shifted by initially extracting some drops of salt solution from one of the two oscillators. Although the actual frequency (period: ˜30 s) and emf (˜±55 mV) is low, our battery is suitable to demonstrate a practical application of oscillating systems in the physical, chemical, or biological laboratory for undergraduates. Interpretation of the phenomenon is given.

Modeling saltwater intrusion in highly heterogeneous coastal aquifers

NASA Astrophysics Data System (ADS)

Safi, Amir; El-Fadel, Mutasem; Doummar, Joanna; Abou Najm, Majdi; Alameddine, Ibrahim

2016-04-01

In this study, a 3D variable-density flow and solute transport model SEAWAT was used to examine the impact of macroscopic variation in a soil matrix on widening or narrowing the thickness of the saltwater-freshwater mixing zone. Located along the Eastern Mediterranean (Beirut), the pilot aquifer consists of karstified limestone of Cretaceous age overlain by Upper Tertiary and Quaternary unconsolidated deposits. The model used the advanced pilot-points parameterization coupled with PEST to characterize spatial heterogeneity. Historically simulated water levels were relied upon to reduce potential numerical instabilities induced by insensitive parameters in transient calibration. The latter demonstrated a high degree of heterogeneity in the middle parts of the aquifer and along western coastlines with specification of a high hydraulic conductivity and low storativity in fault networks. The response of the aquifer to seasonal stresses such as climate cycles, pumping rates and recharge rates was manifested as high fluctuations in potentiometric surface due to potential fast flow pathways along faults. The final distribution of saltwater intrusion supports two mechanisms 1) lateral encroachment of recent seawater into the western zone of the aquifer which is of most concern due to high horizontal hydraulic conductivity in the wave direction and 2) upconing in the northwest and southwest of the aquifer due to large vertical hydraulic conductivities that tend to exacerbate the vertical movement of salinity. Acknowledgments This study is part of a program on climate change and seawater intrusion along the Eastern Mediterranean funded by the International Development Research Center (IDRC) of Canada at the American University of Beirut (AUB). Special thanks are extended to Dr. Charlotte Macalister at IDRC for her support and feedback in implementing this program.

Successfully treated necrotizing fasciitis using extracorporeal life support combined with hemoadsorption device and continuous renal replacement therapy.

PubMed

Eid, Maroua; Fouquet, Olivier; Darreau, Cédric; Pierrot, Marc; Kouatchet, Achille; Mercat, Alain; Baufreton, Christophe

2018-03-01

Necrotizing fasciitis represents a life-threatening infectious condition that causes spreading necrotisis of superficial fascia and subcutaneous cellular tissues. We describe the case of a patient diagnosed with septic and toxic shocks leading to multiple organ failure successfully treated with a combination of extracorporeal life support, continuous renal replacement therapy, and a hemoadsorption device. A 41-year-old patient presented with necrotizing fasciitis and multi-organ failure. Initial extracorporeal life support therapy was implanted, compensating for systolic failure. Due to acute renal failure that persisted in time, continuous renal replacement therapy was added. Despite these treatments and as a last attempt to control the septic condition, a CytoSorb ® hemoadsorption device was installed in parallel to the extracorporeal life support circuit and two sessions were run. During the days following CytoSorb ® treatment, hemodynamic stabilization was observed, as well as normalization of lactic acidosis and blood parameters. This case describes the successful use of CytoSorb ® with continuous renal replacement therapy and extracorporeal life support in a combined way to overcome a critical phase of septic shock in a young adult patient. This combination of treatments turned out to be efficient for this patient in the context of necrotizing fasciitis.

Are there any reasons to change our behavior in necrotizing fasciitis with the advent of new antibiotics?

PubMed

Menichetti, Francesco; Giuliano, Simone; Fortunato, Simona

2017-04-01

The treatment of necrotizing fasciitis requires a multifaceted approach, consisting of surgical source control with immediate surgical debridement along with life support, clinical monitoring, and antimicrobial therapy. Many drugs are now available for the treatment of this life-threatening infectious disease, and the purpose of this review is to provide the reader with an updated overview of the newest therapeutic options. Because most necrotizing soft tissue infections are polymicrobial, broad-spectrum coverage is advisable. Acceptable monotherapy regimens include piperacillin-tazobactam or a carbapenem. However, drugs such as ceftolozane-tazobactam, ceftazidime-avibactam in association with an antianaerobic agent (metronidazole or clindamycin) are currently available as valuable alternatives. The new cephalosporins active against methicillin-resistant Staphylococcus aureus (MRSA), ceftaroline, and ceftobiprole share similar antibacterial activity against Gram-positive cocci, and they might be considered as an alternative to nonbetalactam anti-MRSA agents for necrotizing fasciitis management. Two new long-acting lypoglycopeptides - oritavancin and dalbavancin - share the indications for acute bacterial skin and skin structure infections and had similar activity against Gram-positive cocci including MRSA and streptococci. Carbapenem-sparing agents are particularly suitable for antimicrobial stewardship strategy. The new long-acting lypoglycopeptides are very effective in treating necrotizing fasciitis and are uttermost attractive for patients requiring short hospital stays and early discharge.

COMPARATIVE TOXICITY OF FLUORANTHENE TO FRESHWATER AND SALTWATER SPECIES UNDER FLUORESCENT AND ULTRAVIOLET LIGHT

EPA Science Inventory

The acute and chronic toxicity of fluoranthene was determined for a diverse group of freshwater and saltwater species under both standard laboratory fluorescent light and ultraviolet (UV) light test conditions. Acute tests with 21 species demonstrated that fluoranthene was not le...

Investigation of the acute plantar fasciitis with contrast-enhanced ultrasound and shear wave elastography - first results.

PubMed

Putz, Franz Josef; Hautmann, Matthias G; Banas, Miriam C; Jung, Ernst Michael

2017-01-01

The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain. In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis. 23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding tissue. All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p = 0.0005) and peak (p = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue. CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy.

Simulation of ground-water flow and movement of the freshwater-saltwater interface in the New Jersey coastal plain

USGS Publications Warehouse

Pope, Daryll A.; Gordon, Alison D.

1999-01-01

The confined aquifers of the New Jersey Coastal Plain are sands that range in thickness from 50 to 600 feet and are separated by confining units. The confining units are composed of silts and clays that range in thickness from 500 to 1,000 feet. The aquifers are recharged by precipitation on their outcrop areas. This water then flows laterally downdip and vertically to the deeper confined aquifers. The confined aquifers ultimately discharge to the Raritan and Delaware Bays and to the Atlantic Ocean. In 1988, ground-water withdrawals from confined and unconfined New Jersey Coastal Plain aquifers were approximately 345 million gallons per day, more than 75 percent of which was pumped from the confined aquifers. These withdrawals have created large cones of depression in several Coastal Plain aquifers near populated areas, particularly in Camden and Monmouth Counties. The continued decline of water levels in confined aquifers can cause saltwater intrusion, reduce stream discharge near the outcrop areas, and threaten the quality of the ground-water supply. SHARP, a quasi-three-dimensional finite-difference computer model that can simulate freshwater and saltwater flow, was used to simulate the ground-water flow system in the New Jersey Coastal Plain, including the location and movement of the freshwater-saltwater interface in nine aquifers and eight intervening confining units. The freshwater-saltwater interface is defined as the hypothetical line seaward of which the chloride concentration is equal to or greater than 10,000 milligrams per liter. Model simulations were used to estimate the location and movement of the freshwater-saltwater interface resulting from (1) eustatic sea-level changes over the past 84,000 years, (2) ground-water withdrawals from 1896 through 1988, (3) and future ground-water withdrawals from 1988 to 2040 from Coastal Plain aquifers. Simultion results showed that the location and movement of the freshwater-saltwater interface are more dependent

Necrotizing Fasciitis of the Periorbital Region Complicated by Combined Central Retinal Artery Occlusion, Central Retinal Vein Occlusion, and Posterior Ciliary Occlusion.

PubMed

Sultan, Harris; Malik, Amina; Li, Helen K; Chévez-Barrios, Patricia; Lee, Andrew G

A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.

Current Concepts in the Management of Necrotizing Fasciitis

PubMed Central

Misiakos, Evangelos P.; Bagias, George; Patapis, Paul; Sotiropoulos, Dimitrios; Kanavidis, Prodromos; Machairas, Anastasios

2014-01-01

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis. NF is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the laboratory risk indicator for necrotizing fasciitis score or Fournier’s gangrene severity index score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites. Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue. PMID:25593960

Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center.

PubMed

Elander, Johanna; Nekludov, Michael; Larsson, Agneta; Nordlander, Britt; Eksborg, Staffan; Hydman, Jonas

2016-12-01

To provide retrospective, descriptive information on patients with cervical necrotizing fasciitis treated at a single center during the years 1998-2014, and to evaluate the outcome of a newly introduced treatment strategy. Retrospective analysis of clinical data obtained from medical records. Mortality, pre-morbidity, severity of illness, primary site of infection, type of bacteria, time parameters. The observed 3-month mortality was 6/59 (10 %). The most common initial foci of the infection were pharyngeal, dental or hypopharyngeal. The most common pathogen was Streptococcus milleri bacteria within the Streptococcus anginosus group (66 % of the cases). Using a combined treatment with early surgical debridement combined with hyperbaric oxygen treatment, it is possible to reduce the mortality rate among patients suffering from cervical necrotizing fasciitis, compared to the expected mortality rate and to previous historical reports. Data indicated that early onset of hyperbaric oxygen treatment may have a positive impact on survival rate, but no identifiable factor was found to prognosticate outcome.

Effect of volcanic dykes on coastal groundwater flow and saltwater intrusion: A field-scale multiphysics approach and parameter evaluation

NASA Astrophysics Data System (ADS)

Comte, J.-C.; Wilson, C.; Ofterdinger, U.; González-Quirós, A.

2017-03-01

Volcanic dykes are common discrete heterogeneities in aquifers; however, there is a lack of field examples of, and methodologies for, comprehensive in situ characterization of their properties with respect to groundwater flow and solute transport. We have applied an integrated multiphysics approach to quantify the effect of dolerite dykes on saltwater intrusion in a coastal sandstone aquifer. The approach involved ground geophysical imaging (passive magnetics and electrical resistivity tomography), well hydraulic testing, and tidal propagation analysis, which provided constraints on the geometry of the dyke network, the subsurface saltwater distribution, and the sandstone hydrodynamic properties and connectivity. A three-dimensional variable-density groundwater model coupled with a resistivity model was further calibrated using groundwater and geophysical observations. A good agreement of model simulations with tide-induced head fluctuations, geophysically derived pore water salinities, and measured apparent resistivities was obtained when dykes' hydraulic conductivity, storativity, and effective porosity are respectively about 3, 1, and 1 orders of magnitude lower than the host aquifer. The presence of the dykes results in barrier-like alterations of groundwater flow and saltwater intrusion. Preferential flow paths occur parallel to observed dyke orientations. Freshwater inflows from upland recharge areas concentrate on the land-facing side of the dykes and saltwater penetration is higher on their sea-facing side. This has major implications for managing groundwater resources in dyke-intruded aquifers, including in coastal and island regions and provides wider insights on preferential pathways of groundwater flow and transport in highly heterogeneous aquifer systems.

Assessment of TDEM data sensitivity to changes in geoelectric structure as a result of saltwater intrusion

NASA Astrophysics Data System (ADS)

Nenna, V.; Knight, R. J.

2011-12-01

Pressure from increasing population as well as agricultural and industrial use of freshwater coastal aquifers makes these groundwater resources increasingly vulnerable to saltwater intrusion. Effective management strategies are required to protect these aquifers from overuse and salination. However, development and implementation of these strategies is often complicated by limited information about the complex hydrogeologic structures, properties and processes that govern groundwater flow and saltwater intrusion. To justify the cost of acquiring additional information, water managers need to demonstrate that the value of the acquired information, in terms of the ability to make a decision, exceeds the cost. Traditional hydrologic measurements from wells can give accurate information on hydrogeologic properties, but they are costly and spatially limited. In this study, we propose the use of time-domain electromagnetic (TDEM) methods as a non-invasive alternative to traditional hydrologic measurements for characterizing saltwater intrusion in an unconfined aquifer in Northern California. The aquifer system in this region consists of the unconfined aquifer and an underlying confined freshwater aquifer, which are separated by a clay layer. At our research site, the water in the unconfined aquifer is saline in places, but the underlying, confined aquifer shows no evidence of saltwater intrusion. Water managers require information about the hydraulic connectivity of these two aquifers, as well as the extent of saltwater intrusion in the unconfined aquifer to mitigate the potential for saltwater intrusion into the confined freshwater aquifer. Prior to October 2007, four monitoring wells were drilled approximately 100 m inland from the coast and spanning roughly 300 m from south to north. Wells were drilled to depths between 280 m and 460 m. During construction, lithology information and drilling samples were collected on 1.5 m intervals. Induction logs were also collected

Ascending Facial Necrotizing Fasciitis in a Patient Taking a Bisphosphonate.

PubMed

Kim, Dong Hwi; Lee, Ji Sung; Pyo, Sung Woon; Lee, Jung Ho

2017-02-01

Facial necrotizing fasciitis (NF) is a rare fulminant infection of the soft and connective tissues that spreads along the fascial planes of the face. Its origins most commonly involve odontogenic infection and it is usually associated with a history of dentoalveolar surgery, such as tooth extraction or implant placement. We present a case of ascending facial NF with odontogenic origin in a patient taking a bisphosphonate. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Diagnosis and Treatment of Pediatric Necrotizing Fasciitis: A Systematic Review of the Literature.

PubMed

Zundel, Sabine; Lemaréchal, Angela; Kaiser, Philipp; Szavay, Philipp

2017-04-01

Introduction  Pediatric necrotizing fasciitis (NF) is a rare but severe, life-threatening infection. Early diagnosis is crucial to reduce morbidity and mortality, but initial symptoms are nonspecific. Little sound data exists on factors aiding clinicians to recognize NF in children. With a systematic literature review, we aimed to better characterize pediatric NF. We focused on triggers, symptoms, and laboratory and microbiological findings and differences between pediatric adult patients. Materials and Methods  A literature research was conducted according to the guidance of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses." Articles published between January 2010 and October 2015 were included. Data extraction was performed as an iterative process. Results  A total of 32 articles describing 53 pediatric patients with NF were included in the analysis. Overall mortality was 15.4%. Frequency peaks were found for neonates and children aged between 1 and 2 years. These two age groups were predominantly affected on the torso. Another frequency peak was found in patients aged around 10 years of age. These patients were predominantly affected on the extremities and face. In general, early symptoms were found to be fever, erythema, localized selling, and tenderness or pain. "Pain out of proportion" was not mentioned as a typical symptom. Fever and leukocytosis were more common in teenage patients. Monomicrobial necrotizing (type 2) fasciitis was much more common than polymicrobial (type 1) fasciitis. Next to Streptococci and Staphylococci, Pseudomonas aeruginosa was often isolated. Early aggressive surgical treatment was the treatment of choice. Conclusions  Pediatric NF has distinguishing features that differ from adult NF. Knowledge of these details should increase early diagnosis and improve treatment. Georg Thieme Verlag KG Stuttgart · New York.

[Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis].

PubMed

Yan, Wenguang; Sun, Shaodan; Li, Xuhong

2014-12-01

To observe the therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis. A total of 153 plantar with plantar fasciitis were randomly divided into a combined group (n=51), an extracorporeal shock wave group (n=53) and an orthopaedic group (n=49). The combined group received treatment of both extracorporeal shock wave and orthopaedic insole while the extracorporeal shock wave or the orthopaedic group only received the treatment of extracorporeal shock wave or orthopaedic insole. The therapeutic parameters such as visual analogue scale (VAS) scores, continued walking time and thickness of the plantar fascia were monitored before and aft er the treatment for 2 weeks, 1 month and 3 months, respectively. The VAS scores in the 3 groups were all reduced after the treatment compared with the corresponding scores before the therapy (P< 0.05). The VAS score in the extracorporeal shock wave group was greater than that in the orthopedic group after the treatment for 2 weeks. The VAS score in the combined group was smaller than that in the orthopedic group after the treatment for 2 weeks and 3 months (P< 0.05). The VAS scores in the orthopedic group and the combined group were smaller than those in the extracorporeal shock wave group after the treatment for 1 month or 3 months (P< 0.05). The continued walking time and thickness of the plantar fascia was improved after the treatment (P< 0.05). The cure rate and total effective rate in the combination group were obviously greater than those in the two other groups. The cure rate in the orthopedic group was greater than that in the extracorporeal shock wave group (P< 0.05). Extracorporeal shock wave combined with orthopaedic insole therapy is an effective method to treat plantar fasciitis. It is recommended to spread in clinic.

Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

PubMed Central

Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

2013-01-01

Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

Cervical necrotizing fasciitis of nonodontogenic origin: case report and review of literature.

PubMed

Suárez, Aldo; Vicente, Mario; Tomás, Jose A; Floría, Luis M; Delhom, José; Baquero, Mari C

2014-11-01

Cervical necrotizing fasciitis (CNF) is a potentially fatal infection characterized by generalized necrosis of the cervical fascia that progresses rapidly. The incidence of this entity corresponds to 2.6% of all infections of the head and neck. The most frequent primary origin is dental infection, although other causes exist that should be evaluated.Delay in the diagnosis of this entity may lead to rapid progression and fatal outcome. Patients often present immunosuppression or systemic diseases that predispose them to this pathology. Cervical necrotizing fasciitis is associated with mortality rates of 7% to 20% depending on the extension of the cervical lesion. The highest rates correspond to cases that progress to mediastinitis or septic shock, which are the main and most frequent complications. Early detection and adequate emergency treatment are critical in the management of these patients and may reduce morbimortality and improve survival. The emergency services should be prepared to manage such cases efficiently, through a multidisciplinary treatment by coordinating emergency surgery with critical support and clinical stabilization of patients.We present a case of CNF of non odontogenic origin managed in our hospital.

Freshwater-saltwater transition zone movement during aquifer storage and recovery cycles in Brooklyn and Queens, New York City, USA

USGS Publications Warehouse

Misut, P.E.; Voss, C.I.

2007-01-01

Freshwater storage in deep aquifers of Brooklyn and Queens, New York, USA, is under consideration as an emergency water supply for New York City. The purpose of a New York City storage and recovery system is to provide an emergency water supply during times of drought or other contingencies and would entail longer-term storage phases than a typical annual cycle. There is concern amongst neighboring coastal communities that such a system would adversely impact their local water supplies via increased saltwater intrusion. This analysis uses three-dimensional modeling of variable-density ground-water flow and salt transport to study conditions under which hypothetical aquifer storage and recovery (ASR) may not adversely impact the coastal water supplies. A range of storage, pause, and recovery phase lengths and ASR cycle repetitions were used to test scenarios that emphasize control of potential saltwater intrusion. The USGS SUTRA code was used to simulate movement of the freshwater-saltwater transition zones in a detailed model of the upper glacial, Jameco, Magothy, and Lloyd aquifers of western Long Island, New York. Simulated transition zones in the upper glacial, Jameco, and Magothy aquifers reach a steady state for 1999 stress and recharge conditions within 1 ka; however, saltwater encroachment is ongoing in the Lloyd (deepest) aquifer, for which the effects of the rise in sea level since deglaciation on transition zone equilibration are retarded by many ka due to the thick, overlying Raritan confining unit. Pumping in the 20th century has also caused widening and landward movement of the Lloyd aquifer transition zone. Simulation of scenarios of freshwater storage by injection followed by phases of pause and recovery by extraction indicates that the effect of net storage when less water is recovered than injected is to set up a hydraulic saltwater intrusion barrier in the Lloyd aquifer which may have beneficial effects to coastal water users. ?? 2007 Elsevier B

Freshwater saltwater transition zone movement during aquifer storage and recovery cycles in Brooklyn and Queens, New York City, USA

NASA Astrophysics Data System (ADS)

Misut, Paul E.; Voss, Clifford I.

2007-04-01

SummaryFreshwater storage in deep aquifers of Brooklyn and Queens, New York, USA, is under consideration as an emergency water supply for New York City. The purpose of a New York City storage and recovery system is to provide an emergency water supply during times of drought or other contingencies and would entail longer-term storage phases than a typical annual cycle. There is concern amongst neighboring coastal communities that such a system would adversely impact their local water supplies via increased saltwater intrusion. This analysis uses three-dimensional modeling of variable-density ground-water flow and salt transport to study conditions under which hypothetical aquifer storage and recovery (ASR) may not adversely impact the coastal water supplies. A range of storage, pause, and recovery phase lengths and ASR cycle repetitions were used to test scenarios that emphasize control of potential saltwater intrusion. The USGS SUTRA code was used to simulate movement of the freshwater-saltwater transition zones in a detailed model of the upper glacial, Jameco, Magothy, and Lloyd aquifers of western Long Island, New York. Simulated transition zones in the upper glacial, Jameco, and Magothy aquifers reach a steady state for 1999 stress and recharge conditions within 1 ka; however, saltwater encroachment is ongoing in the Lloyd (deepest) aquifer, for which the effects of the rise in sea level since deglaciation on transition zone equilibration are retarded by many ka due to the thick, overlying Raritan confining unit. Pumping in the 20th century has also caused widening and landward movement of the Lloyd aquifer transition zone. Simulation of scenarios of freshwater storage by injection followed by phases of pause and recovery by extraction indicates that the effect of net storage when less water is recovered than injected is to set up a hydraulic saltwater intrusion barrier in the Lloyd aquifer which may have beneficial effects to coastal water users.

Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial.

PubMed

Rastegar, Shirvan; Baradaran Mahdavi, Sadegh; Hoseinzadeh, Babak; Badiei, Sajad

2018-01-01

Plantar fasciitis is a common cause of heel pain. Considering different interventions which are applied for patients with plantar fasciitis, dry needling is proposed as a new modality of treatment recently. The aim of this study is to evaluate the effectiveness of dry needling versus steroid injection for plantar fasciitis. Sixty-six patients were recruited to this single-blind clinical trial study. Participants were randomly allocated to receive 1 ml (40 mg) of Depo-Medrol (methylprednisolone acetate) or dry needling. They were followed up for 12 months and monitored for total perception of pain using the visual analogue scale (VAS), with data obtained in baseline and at three weeks, six weeks, three months, six months and one year after treatment. Mean VAS score before treatment was 6.96 ± 0.87 for the steroid group and 6.41 ± 0.83 for the dry-needling group (P value = 0.54). Steroid injection reduced VAS scores rapidly until three weeks after treatment compared with dry needling (0.32 ± 0.71 and 3.47 ± 1.32, respectively; P value < 0.001). However, patients who were underwent dry needling reported lower VAS scores at the end of follow-up compared with the steroid group (0.69 ± 0.93 and 2.09 ± 1.58, respectively; P value = 0.004). Over the long term, 82.3% and 17.6% of changes in pain were contributed to time since treatment and treatment method, respectively (P values < 0.001). Steroid injection can palliate plantar heel pain rapidly but dry needling can provide more satisfactory results for patients with plantar fasciitis in the long term.

Plantar fasciitis (fasciosis) treatment outcome study: plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement.

PubMed

Fabrikant, Jerry M; Park, Tae Soon

2011-06-01

Ultrasound, well recognized as an effective diagnostic tool, reveals a thickening of the plantar fascia in patients with plantar fasciitis/fasciosis disease. The authors hypothesized that ultrasound would also reveal a decrease in the plantar fascia thickness for patients undergoing treatment for the disease, a hypothesis that, heretofore, had been only tested on a limited number of subjects. They conducted a more statistically significant study that found that clinical treatment with injection and biomechanical correction does indeed diminish plantar fascia thickness as shown on ultrasound. The study also revealed that patients experience the most heightened plantar fascia tenderness toward the end of the day, and improvement in their symptomatic complaints were associated with a reduction in plantar fascia thickness. As a result, the authors conclude that office-based ultrasound can help diagnose and confirm plantar fasciitis/fasciosis through the measurement of the plantar fascia thickness. Because of the advantages of ultrasound--that it is non-invasive with greater patient acceptance, cost effective and radiation-free--the imaging tool should be considered and implemented early in the diagnosis and treatment of plantar fasciitis/fasciosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

Simulation of freshwater-saltwater interfaces in the Brooklyn-Queens aquifer system, Long Island, New York

USGS Publications Warehouse

Kontis, Angelo L.

1999-01-01

The seaward limit of the fresh ground-water system underlying Kings and Queens Counties on Long Island, N.Y., is at the freshwater-saltwater transition zone. This zone has been conceptualized in transient-state, three-dimensional models of the aquifer system as a sharp interface between freshwater and saltwater, and represented as a stationary, zero lateral-flow boundary. In this study, a pair of two-dimensional, four-layer ground-water flow models representing a generalized vertical section in Kings County and one in adjacent Queens County were developed to evaluate the validity of the boundary condition used in three-dimensional models of the aquifer system. The two-dimensional simulations used a model code that can simulate the movement of a sharp interface in response to transient stress. Sensitivity of interface movement to four factors was analyzed; these were (1) the method of simulating vertical leakage between freshwater and saltwater; (2) recharge at the normal rate, at 50-percent of the normal rate, and at zero for a prolonged (3-year) period; (3) high, medium, and low pumping rates; and (4) pumping from a hypothetical cluster of wells at two locations. Results indicate that the response of the interfaces to the magnitude and duration of pumping and the location of the hypothetical wells is probably sufficiently slow that the interfaces in three-dimensional models can reasonably be approximated as stationary, zero-lateral- flow boundaries.

Coastal ground water at risk - Saltwater contamination at Brunswick, Georgia and Hilton Head Island, South Carolina

USGS Publications Warehouse

Krause, Richard E.; Clarke, John S.

2001-01-01

IntroductionSaltwater contamination is restricting the development of ground-water supply in coastal Georgia and adjacent parts of South Carolina and Florida. The principal source of water in the coastal area is the Upper Floridan aquifer—an extremely permeable and high-yielding aquifer—which was first developed in the late 1800s. Pumping from the aquifer has resulted in substantial ground-water-level decline and subsequent saltwater intrusion of the aquifer from underlying strata containing highly saline water at Brunswick, Georgia, and with encroachment of sea-water into the aquifer at the northern end of Hilton Head Island, South Carolina. The saltwater contamination at these locations has constrained further development of the Upper Floridan aquifer in the coastal area and has created competing demands for the limited supply of freshwater. The Georgia Department of Natural Resources, Georgia Environmental Protection Division (GaEPD) has restricted permitted withdrawal of water from the Upper Floridan aquifer in parts of the coastal area (including the Savannah and Brunswick areas) to 1997 rates, and also has restricted additional permitted pumpage in all 24 coastal area counties to 36 million gallons per day above 1997 rates. These actions have prompted interest in alternative management of the aquifer and in the development of supplemental sources of water supply including those from the shallower surficial and upper and lower Brunswick aquifers and from the deeper Lower Floridan aquifer.

Development and evaluation of a regression-based model to predict cesium-137 concentration ratios for saltwater fish.

PubMed

Pinder, John E; Rowan, David J; Smith, Jim T

2016-02-01

Data from published studies and World Wide Web sources were combined to develop a regression model to predict (137)Cs concentration ratios for saltwater fish. Predictions were developed from 1) numeric trophic levels computed primarily from random resampling of known food items and 2) K concentrations in the saltwater for 65 samplings from 41 different species from both the Atlantic and Pacific Oceans. A number of different models were initially developed and evaluated for accuracy which was assessed as the ratios of independently measured concentration ratios to those predicted by the model. In contrast to freshwater systems, were K concentrations are highly variable and are an important factor in affecting fish concentration ratios, the less variable K concentrations in saltwater were relatively unimportant in affecting concentration ratios. As a result, the simplest model, which used only trophic level as a predictor, had comparable accuracies to more complex models that also included K concentrations. A test of model accuracy involving comparisons of 56 published concentration ratios from 51 species of marine fish to those predicted by the model indicated that 52 of the predicted concentration ratios were within a factor of 2 of the observed concentration ratios. Copyright © 2015 Elsevier Ltd. All rights reserved.

Re-plumbing the coast: Untangling the effects of climate change and water management on vulnerability of coastal landscapes to saltwater incursion

NASA Astrophysics Data System (ADS)

Bhattachan, A.; BenDor, T.; Ardón, M.; Bernhardt, E. S.; Wright, J. P.; Emanuel, R. E.

2016-12-01

The Atlantic Coastal Plain of the United States has been altered drastically in the past century to support agriculture, real estate, and recreational activities. In a landscape with minimal hydraulic gradients and potentially large fluctuations in sea level, the effects of introducing artificial drainages (e.g., ditches and canals) on hydrological properties are often drastic and sometimes unpredictable. In this study, we focus on a portion of the outer coastal plain of North Carolina that ranges in elevation between 6 to -5 meters a.m.s.l. To this end, we use a high-resolution, Lidar-derived digital elevation model to study the effects of artificial drainages on landscape elevation, flow accumulation, and drainage density within an 800-km2 study area. Specifically, we use image-processing techniques to filter artificial drainages from the region and compare hydrologically relevant landscape metrics with and without these features. In general, artificial drainages lower land elevation, short-circuit otherwise natural flow paths and lead to increased ( 3 times) drainage density across the landscape. We also calculate a saltwater intrusion vulnerability index (SIVI), with and without canals and ditches, to investigate the contribution of this infrastructure to saltwater intrusion vulnerability in this low-lying coastal region. The SIVI represents the ability of the freshwater to impede the inland migration of saltwater during drought periods or as sea level rises. Our results show that the construction of artificial drainages would in fact lead to an increase in vulnerability to saltwater intrusion and this pattern is consistent across all four major land-cover (wetlands, agriculture, shrub and forest) in our study area. Thus, combined with extant saltwater impacts on freshwater-dependent landscapes across our study area, our findings are immediately relevant to this region and to similar coastal regions worldwide.

Prospective study of percutaneous radiofrequency nerve ablation for chronic plantar fasciitis.

PubMed

Erken, H Yener; Ayanoglu, Semih; Akmaz, Ibrahim; Erler, Kaan; Kiral, Ahmet

2014-02-01

Chronic plantar heel pain is one of the most painful foot conditions and is generally associated with plantar fasciitis. This study reports 2-year follow-up results of radiofrequency nerve ablation (RFNA) of the calcaneal branches of the inferior calcaneal nerve in patients with chronic heel pain associated with plantar fasciitis. After receiving approval from the institutional review board, we prospectively evaluated the results of the RFNA of the calcaneal branches of the inferior calcaneal nerve on 35 feet in 29 patients with plantar heel pain between 2008 and 2011. All of the patients who were treated had been complaining of heel pain for more than 6 months and had failed conservative treatment. All of the patients were evaluated (quantitatively) using the average 10-point Visual Analog Scale (VAS) before treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. We also evaluated 26 feet in 20 patients with American Orthopaedic Foot and Ankle Society scale (AOFAS) scores before the treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. The average VAS score of the feet was 9.2 ± 1.9 before treatment, 0.5 ± 1.3 at 1 month after the procedure, 1.5 ± 2.1 at 1-year follow-up, and 1.3 ± 1.8 at 2-year follow-up (P < .001). The average AOFAS scores of the patients were 66.9 ± 8.1 (range, 44-80) before treatment, 95.2 ± 6.1 (range, 77-100) at 1 month after the procedure, 93 ± 7.5 (range, 71-100) at the 1-year follow-up, and 93.3 ± 7.9 (range, 69-100) at the 2-year follow-up. At the 1- and 2-year follow-up, 85.7% of the patients rated their treatment as very successful or successful. These findings suggest that RFNA of the calcaneal branches of the inferior calcaneal nerve was an effective pain treatment option for chronic heel pain associated with plantar fasciitis that did not respond to other conservative treatment options. Level IV, retrospective case series.

Shock wave therapy for chronic proximal plantar fasciitis.

PubMed

Ogden, J A; Alvarez, R; Levitt, R; Cross, G L; Marlow, M

2001-06-01

Three hundred two patients with chronic heel pain caused by proximal plantar fasciitis were enrolled in a study to assess the treatment effects consequent to administration of electrohydraulicall-generated extracorporeal shock waves. Symptoms had been present from 6 months to 18 years. Each treated patient satisfied numerous inclusion and exclusion criteria before he or she was accepted into this study, which was approved by the Food and Drug Administration as a randomized, double-blind evaluation of the efficacy of shock wave therapy for this disorder. Overall, at the predetermined evaluation period 3 months after one treatment, 56% more of the treated patients had a successful result by all four of the evaluation criteria when compared with the patients treated with a placebo. This difference was significant and corroborated the fact that this difference in the results was specifically attributable to the shock wave treatment, rather than any natural improvement caused by the natural history of the condition. The current study showed that the directed application of electrohydraulic-generated shock waves to the insertion of the plantar fascia onto the calcaneus is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been present for at least 6 months and has been refractory to other commonly used nonoperative therapies. This technology, when delivered using the OssaTron (High Medical Technology, Kreuz-lingen, Switzerland), has been approved by the Food and Drug Administration specifically for the treatment of chronic proximal plantar fasciitis. The results suggest that this therapeutic modality should be considered before any surgical options, and even may be preferable to cortisone injection, which has a recognized risk of rupture of the plantar fascia and recurrence of symptoms.

A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report.

PubMed

Shetty, Vijay D; Dhillon, Mandeep; Hegde, Chintan; Jagtap, Prajyot; Shetty, Suvin

2014-03-01

Plantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis. We undertook a prospective non-randomized study to compare the efficacy of traditional corticosteroid injection (Steroid group) to PRP injection (PRP group), in a cohort of patients. We studied both groups of patients before and after the injections using Visual Analogue Score (VAS), the Foot & Ankle Disability Index (FADI) and American Foot and Ankle Score (AFAS). Our study confirms that there is significant clinical improvement in PRP group at three months after the injection. The use of PRP injection can be an attractive alternative in the treatment of disabling, recalcitrant plantar fasciitis. Cohort study. Level 3. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis.

PubMed

Frankel, Jonathan K; Rezaee, Rod P; Harvey, Donald J; McBeath, Evan R; Zender, Chad A; Lavertu, Pierre

2015-11-01

Cervical necrotizing fasciitis is an aggressive infection that can be rapidly fatal if aggressive therapies are not initiated early. Negative pressure wound therapy has been established as an effective tool in promoting wound healing, but its use in the acutely infected wound has been avoided because it limits frequent irrigations and standard dressing changes. We discuss a novel application of negative pressure wound therapy with instillation in an immunocompromised patient with extensive cervical necrotizing fasciitis. The negative pressure wound therapy with instillation provided pain relief by minimizing the frequency of dressing changes, increased the speed of healing, helped to control infection, and facilitated the development of a healthy wound bed sufficient for reconstruction with a split thickness skin graft. The role of negative pressure wound therapy with instillation continues to expand and can be used in the management of both acute and chronic wounds in the head and neck. © 2015 Wiley Periodicals, Inc.

Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis--a feasibility study.

PubMed

Zelen, Charles M; Poka, Attila; Andrews, James

2013-10-01

Specialized treatment of plantar fasciitis that can reduce inflammation and promote healing may be a possible alternative prior to surgical intervention. We report the results of a randomized clinical trial examining the efficacy of micronized dehydrated human amniotic/chorionic membrane (mDHACM) injection as a treatment for chronic refractory plantar fasciitis. An institutional review board-approved, prospective, randomized, single-center clinical trial was performed. Forty-five patients were randomized to receive injection of 2 cc 0.5% Marcaine plain, then either 1.25 cc saline (controls), 0.5 cc mDHACM, or 1.25 cc mDHACM. Follow-up visits occurred over 8 weeks to measure function, pain, and functional health and well-being. Significant improvement in plantar fasciitis symptoms was observed in patients receiving 0.5 cc or 1.25 cc mDHACM versus controls within 1 week of treatment and throughout the study period. At 1 week, American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scores increased by a mean of 2.2 ± 17.4 points for controls versus 38.7 ± 11.4 points for those receiving 0.5 cc mDHACM (P < .001) and 33.7 ± 14.0 points for those receiving 1.25 cc mDHACM (P < .001). By week 8 AOFAS Hindfoot scores increased by a mean of 12.9 ± 16.9 points for controls versus 51.6 ± 10.1 and 53.3 ± 9.4 for those receiving 0.5 cc and 1.25 cc mDHACM, respectively (both P < .001). No significant difference in treatment response was observed in patients receiving 0.5 cc versus 1.25 cc mDHACM. In patients with refractory plantar fasciitis, mDHACM is a viable treatment option. Larger studies are needed to confirm our findings. Level I, prospective randomized study.

Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis.

PubMed

Fong, Daniel Tik-Pui; Pang, Kai-Yip; Chung, Mandy Man-Ling; Hung, Aaron See-Long; Chan, Kai-Ming

2012-12-01

It is a routine practice to prescribe a combination of rocker shoes and custom-made foot orthoses for patients with plantar fasciitis. Recently, there has been a debate on this practice, and studies have shown that the individual prescription of rocker shoes or custom-made foot orthoses is effective in treating plantar fasciitis. The aim of this study was to evaluate and compare the immediate therapeutic effects of individually prescribed rocker sole shoes and custom-made foot orthoses, and a combined prescription of them on plantar fasciitis. This was a cross-over study. Fifteen patients with unilateral plantar fasciitis were recruited; they were from both genders and aged between 40 and 65. Subjects performed walking trials which consisted of one 'unshod' condition and four 'shod' conditions while wearing baseline shoes, rocker shoes, baseline shoes with foot orthotics, and rocker shoes with foot orthotics. The study outcome measures were the immediate heel pain intensity levels as reflected by visual analog scale pain ratings and the corresponding dynamic plantar pressure redistribution patterns as evaluated by a pressure insole system. The results showed that a combination of rocker shoes and foot orthoses produced a significantly lower visual analog scale pain score (9.7 mm) than rocker shoes (30.9 mm) and foot orthoses (29.5 mm). With regard to baseline shoes, it also significantly reduced the greatest amount of medial heel peak pressure (-33.58%) without overloading other plantar regions when compared to rocker shoes (-7.99%) and foot orthoses (-28.82%). The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Treatment of Chronic Plantar Fasciitis with Noninvasive Interactive Neurostimulation: A Prospective Randomized Controlled Study.

PubMed

Razzano, Cristina; Carbone, Stefano; Mangone, Massimiliano; Iannotta, M Raffaella; Battaglia, Alessandro; Santilli, Valter

The initial treatment of plantar fasciitis should be conservative, with most cases responding to standard physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), heel pads, and stretching. In cases of chronic refractory symptoms, more invasive treatment could be necessary. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of the present prospective randomized controlled study was to evaluate whether the use of NIN for chronic plantar fasciitis could result in greater improvement in a foot functional score, lower levels of reported pain, reduced patient consumption of NSAIDs, and greater patient satisfaction compared with electric shockwave therapy in patients without a response to standard conservative treatment. The patients were randomized using random blocks to the NIN program (group 1) or electric shockwave therapy (group 2). The outcome measurements were the pain subscale of the validated Foot Function Index (PS-FFI), patient-reported subjective assessment of the level of pain using a standard visual analog scale, and daily intake of NSAID tablets (etoricoxib 60 mg). The study group was evaluated at baseline (time 0), week 4 (time 1), and week 12 (final follow-up point). Group 1 (55 patients) experienced significantly better results compared with group 2 (49 patients) in term of the PS-FFI score, visual analog scale score, and daily intake of etoricoxib 60 mg. NIN was an effective treatment of chronic resistant plantar fasciitis, with full patient satisfaction in >90% of cases. The present prospective randomized controlled study showed superior results for noninvasive neurostimulation compared with electric shockwave therapy, in terms of the functional score, pain improvement, and use of NSAIDs. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis

PubMed Central

Ragab, Ehab Mohamed

2009-01-01

Background Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. Patients and methods This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. Results In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. Conclusion Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF. PMID:20033696

Coastal Marsh Monitoring for Persistent Saltwater Intrusion

NASA Technical Reports Server (NTRS)

Hall, Callie M.

2008-01-01

This viewgraph presentation reviews NASA's work on the project that supports the Gulf of Mexico Alliance (GOMA) Governors Action Plan to monitor the coastal wetlands for saltwater intrusion. The action items that relate to the task are: (1) Obtain information on projected relative sea level rise, subsidence, and storm vulnerability to help prioritize conservation projects, including restoration, enhancement, and acquisition, and (2) Develop and apply ecosystem models to forecast the habitat structure and succession following hurricane disturbance and changes in ecological functions and services that impact vital socio-economic aspects of coastal systems. The objectives of the program are to provide resource managers with remote sensing products that support ecosystem forecasting models requiring salinity and inundation data. Specifically, the proposed work supports the habitat-switching modules in the Coastal Louisiana Ecosystem Assessment and Restoration (CLEAR) model, which provides scientific evaluation for restoration management.

Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials.

PubMed

Lou, Jing; Wang, Shuai; Liu, Shuitao; Xing, Gengyan

2017-08-01

The objective of this meta-analysis was to investigate the efficacy of extracorporeal shock wave therapy in the treatment of recalcitrant plantar fasciitis without local anesthesia. The Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched from inception to September 2015 for randomized controlled trials comparing ESWT without local anesthesia versus placebo for treatment of plantar fasciitis in adults. The primary outcome was the 12-week post-intervention success rate of reducing the visual analog scale score by 60% from baseline at the first step in the morning, reducing the VAS score by 60% from baseline during daily activities, reducing the Roles and Maudsley score, reducing overall heel pain, and reducing pain after applying a force meter. Nine studies were included in the meta-analysis. Compared with placebo, ESWT significantly improved the success rate of reducing overall heel pain, reducing the VAS score by 60% at the first step in the morning and during daily activities, improving the Roles and Maudsley score to excellent or good, and reducing heel pain after application of a pressure meter. ESWT seems to be particularly effective in relieving pain associated with RPF. ESWT should be considered when traditional treatments have failed. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) understand the recovery rates for nonsurgical treatment of plantar fasciitis, (2) understand the role of extracorporeal shockwave therapy (ESWT) in the treatment of recalcitrant plantar fasciitis, and (3) understand the indications to incorporate ESWT in the treatment plan of recalcitrant plantar fasciitis. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of

Transfer status: a risk factor for mortality in patients with necrotizing fasciitis.

PubMed

Holena, Daniel N; Mills, Angela M; Carr, Brendan G; Wirtalla, Chris; Sarani, Babak; Kim, Patrick K; Braslow, Benjamin M; Kelz, Rachel R

2011-09-01

Necrotizing fasciitis (NF) is a rapidly progressive disease that requires urgent surgical debridement for survival. Interhospital transfer (IT) may be associated with delay to operation, which could increase mortality. We hypothesized that mortality would be higher in patients undergoing surgical debridement for necrotizing fasciitis after IT compared to Emergency Department (ED) admission. We performed a retrospective cohort analysis from 2000-2006 using the Nationwide Inpatient Sample. Inclusion criteria were age >18 years, primary diagnosis of NF, and surgical therapy within 72 hours of admission. Logistic regression was used to assess the relationship between admission source, patient and hospital variables, and mortality. We identified 9,958 cases over the study period. Patients in the ED group were more likely to be nonwhite and of lower income when compared with patients in the IT group. Unadjusted mortality was higher in the IT group than ED group (15.5% vs 8.7%, P < .001). After adjusting for potential confounders, odds of mortality were still greater in the IT (OR 2.04, CI 95% 1.60-2.59, P < .001). Interhospital transfer is associated with increased risk of in-hospital mortality after surgical therapy for NF, a finding which persists after controlling for patient and hospital level variables. Copyright © 2011 Mosby, Inc. All rights reserved.

The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

PubMed Central

Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

2015-01-01

[Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

Comparative Effectiveness of Radial Extracorporeal Shockwave Therapy and Ultrasound-Guided Local Corticosteroid Injection Treatment for Plantar Fasciitis.

PubMed

Hocaoglu, Sehriban; Vurdem, Umit Erkan; Cebicci, Mehtap Aykac; Sutbeyaz, Serap Tomruk; Guldeste, Zuhal; Yunsuroglu, Serap Gurek

2017-05-01

We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy. Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n = 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment. Significant improvements were observed in the rESWT group in VAS, HTI, and FFI scores and PFT at the end of treatment and were maintained during follow-up. Posttreatment improvements in VAS, HTI, and FFI scores and PFT were also seen in the corticosteroid group but were not maintained for VAS and FFI scores after the completion of therapy and were lost at 1 and 6 months, respectively. No serious treatment-related complications occurred. Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.

Hydrogeology, simulation of regional ground-water flow, and saltwater intrusion, Potomac-Raritan-Magothy Aquifer System, Northern Coastal Plain of New Jersey

USGS Publications Warehouse

Pucci, Amleto A.; Pope, Daryll A.; Gronberg, JoAnn M.

1994-01-01

Chloride concentrations in well-water samples from the middle aquifer were as high as 6,000 mg/L in Sayreville Borough in 1987; concentrations in samples from drive-point wells from the same aquifer near the Washington Canal, the main source of saltwater, were as high as 7,100 mg/L. The migration of the saltwater front at about 470 feet per year to the southeast is influenced mainly by a thinning of the middle aquifer, which constrains flow, and by the locations of regional cones of depression caused by groundwater withdrawals.

[Epidemiology of invasive group A streptococcal infections in developed countries : the Canadian experience with necrotizing fasciitis].

PubMed

Ovetchkine, Ph; Bidet, Ph; Minodier, Ph; Frère, J; Bingen, E

2014-11-01

In industrialized countries, group A streptococcal infections were a source of concern, mainly due to the occurrence of rheumatic fever and its cardiac complications. At present, the incidence of rheumatic fever is decreasing in these countries, giving way to an increasing occurrence of invasive streptococcal group A infections with high level of morbidity and mortality. Streptococcal necrotizing fasciitis, a specific entity, emerged these last decades, often in association with chickenpox. The introduction of the varicella vaccine in the province of Quebec routine immunization program, was followed by a significant decrease in the number of necrotizing fasciitis or other skin and soft-tissues infections in our pediatric population. However, in our experience at the CHU Sainte-Justine, this immunization program has not been helpful to reduce the overall incidence of invasive group A streptococcal infections. Conversely, an increase in the number of pleuro-pulmonary and osteo-articular infections was observed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse.

PubMed

Pushkar, Dmitry Y; Vasilchenko, Mikhail I; Kasyan, George R

2013-10-01

Necrotising fasciitis is a severe form of soft tissue infection. Herein, we present an unreported complication of the transvaginal repair of a pelvic organ prolapse (POP) with trocar-guided polypropylene mesh and a concomitant hysterectomy. A 61-year-old Caucasian female who had been using an intrauterine device (IUD) for 30 years presented with a stage 3 pelvic organ prolapse. A genital ultrasound examination confirmed the presence of an IUD, but found no endometrial abnormalities. The surgical management was limited to a transvaginal hysterectomy and simultaneous anterior vaginal wall repair augmented with trocar-guided mesh. A morphological examination of the removed uterus confirmed the presence of the intrauterine device and additionally found endometrial cancer (T1N0M0), which was not revealed during the preoperative ultrasound. Within 6 days of the surgery, she developed anaerobic bilateral necrotising fasciitis on both thighs. Non-clostridial streptococci were identified in the wound. After 18 days of intensive care, the patient died of fatal coagulopathy.

Early diagnosis of post-varicella necrotising fasciitis: A medical and surgical emergency

PubMed Central

Xavier, Rose; Abraham, Bobby; Cherian, Vinod Jacob; Joseph, Jobin I.

2016-01-01

Necrotising fasciitis (NF) is an extremely rare complication of a rather common paediatric viral exanthem varicella. Delayed diagnosis and treatment can lead to significant morbidity and mortality. Laboratory risk indicator of NF score aids in early clinical diagnosis in suspected cases of post-varicella NF thus enabling timely intervention. Surgery delayed for more than 24 hours, is an independent risk factor for death. Surgical debridement with good antibiotic coverage is the definitive treatment for NF. PMID:27251524

The correlation between plantar fascia thickness and symptoms of plantar fasciitis.

PubMed

Mahowald, Sarah; Legge, Bradford S; Grady, John F

2011-01-01

The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ± 1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P < 0.005). This study provides evidence that changing thickness of the plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols.

Cryopreserved human amniotic membrane injection for plantar fasciitis: a randomized, controlled, double-blind pilot study.

PubMed

Hanselman, Andrew E; Tidwell, John E; Santrock, Robert D

2015-02-01

Treatment options for plantar fasciitis have resulted in varied patient outcomes. The aim of this study was to compare a novel treatment, cryopreserved human amniotic membrane (c-hAM), to a traditional treatment, corticosteroid. Our hypothesis was that c-hAM would be safe and comparable to corticosteroids for plantar fasciitis in regard to patient outcomes. A randomized, controlled, double-blind, single-center pilot study was completed. Patients were randomized into one of 2 treatment groups: c-hAM or corticosteroid. Patients received an injection at their initial baseline visit with an option for a second injection at their first 6-week follow-up. Total follow-up was obtained for 12 weeks after the most recent injection. The primary outcome measurement was the Foot Health Status Questionnaire (FHSQ). The secondary outcome measurements were the Visual Analog Scale (VAS) and verbally reported percentage improvement. Data were analyzed between groups for the 2 different cohorts (1 injection versus 2 injections). Twenty-three patients had complete follow-up. Fourteen were randomized to receive corticosteroid and 9 were randomized to receive c-hAM. Three patients in each group received second injections. With the numbers available, the majority of outcome measurements showed no statistical difference between groups. The corticosteroid did, however, have greater FHSQ shoe fit improvement (P = .0244) at 6 weeks, FHSQ general health improvement (P = .0132) at 6 weeks, and verbally reported improvement (P = .041) at 12 weeks in the one-injection cohort. Cryopreserved hAM had greater FHSQ foot pain improvement (P = .0113) at 18 weeks in the 2-injection cohort. Cryopreserved hAM injection may be safe and comparable to corticosteroid injection for treatment of plantar fasciitis. This is a pilot study and requires further investigation. Level I, prospective randomized trial. © The Author(s) 2014.

Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center.

PubMed

Lee, Ching-Yu; Li, Yen-Yao; Huang, Tsan-Wen; Huang, Tsung-Yu; Hsu, Wei-Hsiu; Tsai, Yao-Hung; Huang, Jou-Chen; Huang, Kuo-Chin

2016-12-01

No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis.

PubMed

Chou, Andrew Chia Chen; Ng, Sean Yung Chuan; Su, David Hsien Ching; Singh, Inderjeet Rikhraj; Koo, Kevin

2016-12-01

Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF. Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations. There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations. RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Effects of lowering interior canal stages on salt-water intrusion into the shallow aquifer in Southeast Palm Beach County, Florida

USGS Publications Warehouse

Land, Larry F.

1975-01-01

Land in southeast Palm Beach County is undergoing a large-scale change in use, from agricultural to residential. To accommodate residential use, a proposal has been made by developers to the Board of the Lake Worth Drainage District to lower the canal stages in the interior part of the area undergoing change. This report documents one of the possible effects of such lowering. Of particular interest to the Board was whether the lower canal stages would cause an increase in salt-water intrusion into the shallow aquifer along the coast. The two main tools used in the investigation were a digital model for aquifer evaluation and an analytical technique for predicting the movement of the salt-water front in response to a change of ground-water flow into the ocean. The method of investigation consisted of developing a digital ground-water flow model for three east-west test strips. They pass through the northern half of municipal well fields in Lake Worth, Delray Beach, and Boca Raton. The strips were first modeled with no change in interior canal stages. Then they were modeled with a change in canal stages of 2 to 4 feet (0.6 to 1.6 metres). Also, two land development schemes were tested. One was for a continuation of the present level of land development, simulated by continuing the present pumpage rates. The second scheme was for land development to continue until the maximum allowable densities were reached, simulated by increasing the pumping rates. The results of the test runs for an east-west strip through Lake Worth show that lowering part of the interior canal water levels 3 feet (1.0 metre), as done in 1961, does not affect the aquifer head or salt-water intrusion along the coastal area of Lake Worth. As a result, no effect in the coastal area would be expected as a result of canal stage lowering in other, interior parts of the study area. Results from the other test runs show that lowering interior canal water levels by as much as 4 feet (1.2 metres) would

Simulated interaction between freshwater and saltwater and effects of ground-water pumping and sea-level change, lower Cape Cod aquifer system, Massachusetts

USGS Publications Warehouse

Masterson, John P.

2004-01-01

The U.S. Geological Survey, in cooperation with the National Park Service, Massachusetts Executive Office of Environmental Affairs, Cape Cod Commission, and the Towns of Eastham, Provincetown, Truro, and Wellfleet, began an investigation in 2000 to improve the understanding of the hydrogeology of the four freshwater lenses of the Lower Cape Cod aquifer system and to assess the effects of changing ground-water pumping, recharge conditions, and sea level on ground-water flow in Lower Cape Cod, Massachusetts. A numerical flow model was developed with the computer code SEAWAT to assist in the analysis of freshwater and saltwater flow. Model simulations were used to determine water budgets, flow directions, and the position and movement of the freshwater/saltwater interface. Model-calculated water budgets indicate that approximately 68 million gallons per day of freshwater recharge the Lower Cape Cod aquifer system with about 68 percent of this water moving through the aquifer and discharging directly to the coast, 31 percent flowing through the aquifer, discharging to streams, and then reaching the coast as surface-water discharge, and the remaining 1 percent discharging to public-supply wells. The distribution of streamflow varies greatly among flow lenses and streams; in addition, the subsurface geology greatly affects the position and movement of the underlying freshwater/saltwater interface. The depth to the freshwater/saltwater interface varies throughout the study area and is directly proportional to the height of the water table above sea level. Simulated increases in sea level appear to increase water levels and streamflows throughout the Lower Cape Cod aquifer system, and yet decrease the depth to the freshwater/saltwater interface. The resulting change in water levels and in the depth to the freshwater/saltwater interface from sea-level rise varies throughout the aquifer system and is controlled largely by non-tidal freshwater streams. Pumping from large

Necrotizing fasciitis due to Vibrio cholerae non-O1/non-O139 after exposure to Austrian bathing sites.

PubMed

Hirk, Sonja; Huhulescu, Steliana; Allerberger, Franz; Lepuschitz, Sarah; Rehak, Sonja; Weil, Sandra; Gschwandtner, Elisabeth; Hermann, Michael; Neuhold, Stephanie; Zoufaly, Alexander; Indra, Alexander

2016-02-01

We report on two cases of necrotizing fasciitis of the lower leg due to nontoxigenic Vibrio cholerae (V. cholerae). A 73-year-old woman (case 1) and an 80-year-old man (case 2) were hospitalized with symptoms of necrotizing fasciitis on July 18 and August 15, 2015, respectively. In both cases, symptoms started the day after swimming in local ponds. Swabs gained intraoperatively and a blood culture from the male patient, yielded V. cholerae non-O1/non-O139, negative for cholera toxin gene ctx and positive for hemolysin genes hlyA and hlyB. Water samples taken from pond A on August 17, 2015 (32 days after exposure of case 1) and from pond B on August 20, 2015 (7 days after exposure of case 2) yielded non-O1/non-O139 V. cholerae in most-probable numbers of > 11,000 per 100 ml each. The occurrence of two cases of necrotizing fasciitis within a 1 month period related to two Austrian non-saline bathing waters, previously not known to harbor V. cholerae, is probably linked to the prevailing extreme weather conditions (heat wave, drought) this summer in Austria. While case 1 was discharged in good clinical condition after 73 days, case 2 died after four months of hospitalization. Public health authorities are challenged to assess the effects of long-term climate change on pathogen growth and survival in continental bodies of fresh water.

Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis.

PubMed

Ozan, Fırat; Koyuncu, Şemmi; Gürbüz, Kaan; Öncel, Eyyüp Sabri; Altay, Taşkın

2017-06-01

We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 ( P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment ( P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 ( P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. Level II: Therapeutic study.

Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis.

PubMed

Engkananuwat, Phoomchai; Kanlayanaphotporn, Rotsalai; Purepong, Nithima

2018-01-01

Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale-foot and ankle score, and range of motion in ankle dorsiflexion ( P < .001). More participants in group 2 described their symptoms as being much improved to being completely improved than those in group 1. The simultaneous stretching of the Achilles tendon and plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon-only group (n = 7; 28%). II, lesser quality RCT or prospective comparative study.

75 FR 53953 - The National Saltwater Angler Registry Program; Designation of Exempted States for Anglers, Spear...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-02

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XX66 The National Saltwater Angler Registry Program; Designation of Exempted States for Anglers, Spear Fishers, and For-Hire... as exempted states for anglers, spear fishers and for-hire fishing vessels. NMFS has designated the...

Necrotizing fasciitis secondary to enterocutaneous fistula: three case reports.

PubMed

Gu, Guo-Li; Wang, Lin; Wei, Xue-Ming; Li, Ming; Zhang, Jie

2014-06-28

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.

Necrotizing fasciitis secondary to enterocutaneous fistula: Three case reports

PubMed Central

Gu, Guo-Li; Wang, Lin; Wei, Xue-Ming; Li, Ming; Zhang, Jie

2014-01-01

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management. PMID:24976737

Ultrasound-guided injection for plantar fasciitis: A brief review

PubMed Central

Nair, AS; Sahoo, RK

2016-01-01

Plantar fasciitis (PF) is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US) imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation. PMID:27833490

Changes in the saltwater interface corresponding to the installation of a seepage barrier near Lake Okeechobee, Florida

USGS Publications Warehouse

Prinos, Scott T.; Valderrama, Robert

2015-01-01

At five of the monitoring-well cluster locations, a long-screened well was also installed for monitoring and comparison purposes. These long-screened wells are 160 to 200 ft deep, and have open intervals ranging from 145 to 185 ft in length. Water samples were collected at depth intervals of about 5 to 10 ft, using 3-ft-long straddle packers to isolate each sampling interval. The results of monitoring conducted using these long-screened interval wells were generally too variable to identify any changes that might be associated with the seepage barrier. Samples from one of these long-screened interval wells failed to detect the saltwater interface evident in samples and TSEMIL datasets from a collocated well cluster. This failure may have been caused by downward flow of freshwater from above the saltwater interface in the well bore.

Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial.

PubMed

Lai, Ta-Wei; Ma, Hsiao-Li; Lee, Meng-Shiunn; Chen, Po-Ming; Ku, Ming-Chou

2018-03-01

Extracorporeal shockwave therapy (ESWT) and corticosteroid injection (CSI) are treatment options for plantar fasciitis. Their clinical outcome comparison remains a debate. Also, the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive. A total of 97 patients with chronic plantar fasciitis were enrolled in the randomized prospective trial. Forty-seven patients received extracorporeal shock wave therapy (ESWT), and fifty patients received corticosteroid injection (CSI). The thickness of the plantar fascia was evaluated respectively before ESWT and CSI, and at the 4 th and 12 th week after ESWT and CSI by ultrasonography. Pain level and clinical outcomes were recorded using visual analogue scale (VAS) and 100-points scoring systems. Correlation analysis was performed between the thickness change and clinical outcome. Under ultrasonography, we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4 th week (p=0.048). VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection (0.001 and p⟨0.001, at 4 th and 12 th week). On the assessment of 100-points scoring systems, the pain level of patients with ESWT was lower than those with CSI at the 12 th week (p⟨0.001). On the other hand, the increase of plantar fascia thickness at 4 th week was positively correlated with the decrease of VAS score at 12 th week follow-up (R=0.302, P=0.039). At 4 th week after treatment, the thickness of plantar fascia increased. Then it decreased gradually, but not to the baseline at 12 th week. On the pain level outcome at 12 th week, extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis. The more change of plantar fascia after ESWT, the more efficient on clinical outcome.

Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report.

PubMed

Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Water color component analysis in saltwater intrusion reach: a case study in Shawan-Humen Watercourse, Pearl River Estuary

NASA Astrophysics Data System (ADS)

Fang, Li-gang; Chen, Shui-Sen; Li, Dan; Zhang, Lixin; Li, Dong

2008-11-01

The saline water color component characteristic (chlorophyll-a and chromophoric dissolved organic matter (CDOM)) and their spatial change tendency in the Pearl River Estuary from the In-situ data in December of 2006 was studied. Based on the experimental results, the mixing behavior of CDOM in the Shawan-Humen Watercourse was analyzed. The mixing behavior was controlled by topography, hydrological and biological factors, and the relationships among absorption characteristics of CDOM (at 400 nm, ag400). Contained is a discussion of chlorophyll-a concentration and salinity. The chlorophyll-a concentration decreases with increasing CDOM absorption under a salinity of 10, while the chlorophyll-a concentration decreases with increasing salinity. The salinity becomes less aggressive towards the Lingding Bay in the saltwater intrusion reach of Shawan-Humen, and a low chlorophyll-a concentration area occurs in the Shiziyang riverway where the salinity is greater than 20. The highest chlorophyll-a concentration of surface water was observed in the Dadaoshawei site of the Shawan tributary reach- where the saltwater and freshwater interface. The slope distribution of the CDOM spectral absorption curve in the Shawan-Humen watercourse was increased towards the Lingding Bay direction. The spectral slope S value of CDOM varied from 0.0107 to 0.0121 nm-1 with an average value of 0.0116 nm-1. This was an indication that the terrestrial river input was the main resource of CDOM in the Shawan-Humen watercourse. The high correlation (R2=0.9458)of surface water and bottom water (-7.5m ) salinity showed that salinity can be monitored by remote sensing. The ag400 in the saltwater intrusion reach showed conservative behavior, indicating strong characteristics of the CDOM it reflected. There was a correlative relationship between ag400, chlorophyll-a concentration and the salinity, showing that a water color analysis technique can be used to study the distribution and behavior of salinity

Arsenic speciation in environmental multimedia samples from the Youngsan River Estuary, Korea: A comparison between freshwater and saltwater.

PubMed

Hong, Seongjin; Choi, Sung-Deuk; Khim, Jong Seong

2018-06-01

Differences in the distribution, partitioning, and bioaccumulation characteristics of arsenicals between freshwater and saltwater systems remain poorly understood. To determine the characteristics of distribution and behavior of arsenicals, multimedia environmental samples including water, suspended particles, zooplankton, sediments, and porewater were collected from inner (five sites, freshwater) and outer (five sites, saltwater) regions of the estuary dike of the Youngsan River Estuary in South Korea (Nov., 2012). Six organic and inorganic forms of As were separated and measured using HPLC-ICP/MS equipped with an anion exchange column. Concentrations of arsenicals in water samples of the inner region (mean = 1.5 μg As L -1 ) were significantly lower than in those of the outer region (mean = 5.2 μg As L -1 ). Conversely, concentrations of As in suspended particles in the inner region (mean = 14 μg As g -1 ) were much greater than in the outer region (mean = 5.7 μg As g -1 ). The field-based distribution coefficient (K d ) for As depended strongly on salinity; relatively greater K d values were found in freshwater compared with saltwater. The As V was found to be the major form of As in all water and particle samples in both inner and outer regions. The zooplankton species were significantly distinguishable between the inner and outer regions; cladocerans were the most dominant species in freshwater and cyclopoida were predominantly found in saltwater. The As concentrations in zooplankton were shown to be particle-concentration dependent, suggesting that dietary exposure plays a substantial role in the bioaccumulation of As. Inorganic arsenicals, such as As V and As III were the most dominant forms found in zooplankton. Partitioning behavior of As between porewater and sediments was similar to that in water-particle distributions. The results of the present study enhance the understanding of As biogeochemistry in river and estuarine environments

Tracer adsorption in sand-tank experiments of saltwater up-coning

NASA Astrophysics Data System (ADS)

Jakovovic, Danica; Post, Vincent E. A.; Werner, Adrian D.; Männicke, Oliver; Hutson, John L.; Simmons, Craig T.

2012-01-01

SummaryThis study aims to substantiate otherwise unresolved double-peaked plumes produced in recent saltwater up-coning experiments (see Jakovovic et al. (2011), Numerical modelling of saltwater up-coning: Comparison with experimental laboratory observations, Journal of Hydrology 402, 261-273) through additional laboratory testing and numerical modelling. Laboratory experimentation successfully reproduced the double-peaked plume demonstrating that this phenomenon was not an experimental nuance in previous experiments. Numerical modelling by Jakovovic et al. (2011) was extended by considering adsorption effects, which were needed to explain the observed up-coning double peaks of both previous and current laboratory experiments. A linear adsorption isotherm was applied in predicting dye tracer (Rhodamine WT) behaviour in the sand-tank experiments using adsorption parameters obtained experimentally. The same adsorption parameters were tested on all laboratory experiments and it was found that adsorption had insignificant effect on experiments with high pumping rates. However, low pumping rates produced pronounced spatial velocity variations within the dense salt plume beneath the pumping well, with velocities within the plume increasing from the centre of the plume towards the interface. The dye tracer was retarded relative to the salt and was transported preferentially along the higher-velocity paths (i.e. along the edges of the salt plume) towards the well forming double-peaked up-coning patterns. This illustrates the sensitive adsorptive nature of Rhodamine WT and that care should be taken when it is used in similar sand-tank experiments. Observations from this study offer insight into the separation of chemicals in natural systems due to different adsorption characteristics and under conditions of density-dependent flow.

Using transportation networks to inform valuation of water quality changes for saltwater recreation on Cape Cod, MA

EPA Science Inventory

Estimating the non-market value of beaches for saltwater recreation is complex. An individual’s preference for a beach depends on beach characteristics and perception. When choosing one beach over another, an individual balances these personal preferences with any additiona...

Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis.

PubMed

Fleischer, Adam E; Albright, Rachel H; Crews, Ryan T; Kelil, Tatiana; Wrobel, James S

2015-10-01

The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play. © 2015 by the American Institute of Ultrasound in Medicine.

Surgical Treatment of Bone Marrow Lesion Associated with Recurrent Plantar Fasciitis: A Case Report Describing an Innovative Technique Using Subchondroplasty®.

PubMed

Bernhard, Kaitlyn; Ng, Alan; Kruse, Dustin; Stone, Paul A

2018-04-06

Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty ® (SCP ® ; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP ® was used with repeat fasciotomy. SCP ® involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP ® , the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Necrotizing fasciitis of the breast: a case managed without mastectomy.

PubMed

Soliman, M O; Ayyash, E H; Aldahham, A; Asfar, S

2011-01-01

To report a rare presentation of necrotizing fasciitis (NF) in the breast and its management. A 61-year-old non-diabetic lady presented with a painful swollen right breast and yellowish discharge associated with fever for the last few days. Based on clinical examination and haematological parameters, a provisional diagnosis of breast abscess was made that later proved to be a case of NF. She was managed conservatively with repeated debridement followed by split-skin grafting with preservation of the breast. This case showed that NF of the breast can present as a simple breast abscess which was managed conservatively. Copyright © 2011 S. Karger AG, Basel.

Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis.

PubMed

Fox, Thomas Peter; Oliver, Govind; Wek, Caesar; Hester, Thomas

2013-08-16

We report the case of a 72-year-old woman suffering with severe plantar fasciitis who received a therapeutic corticosteroid injection. Two-and-a-half years after the injection she developed a small calcified lump under the skin which subsequently caused ulceration and infection. She went on to develop a diabetic foot infection requiring an extended course of intravenous antibiotics.

Endoscopic Plantar Fasciotomy vs Open Radiofrequency Microtenotomy for Recalcitrant Plantar Fasciitis.

PubMed

Wang, Weining; Rikhraj, Inderjeet Singh; Chou, Andrew Chia Chen; Chong, Hwei Chi; Koo, Kevin Oon Thien

2018-01-01

Although usually self-limiting, around 10% of patients develop recalcitrant plantar fasciitis despite conservative treatment. In such cases, operative intervention can be offered. Traditionally, plantar fasciotomy has been the treatment of choice, but recently, there has been a push for more minimally invasive approaches. Radiofrequency microtenotomy has also been increasingly used as a treatment option. In this study, we compare the outcomes of endoscopic plantar fasciotomy and open radiofrequency microtenotomy. Patients treated in our institution with either procedure between 2007 and 2015 were included and interviewed at baseline and 3 months, 6 months, and 12 months postoperatively using the American Orthopaedic Foot & Ankle Society (AOFAS) and 36-item Medical Outcomes Short Form (SF-36) questionnaires. They were asked questions to evaluate their expectation and satisfaction postoperatively. Demographic and clinicopathological data were prospectively collected from clinical charts and electronic records. There was no difference in either treatment arms preoperatively and an overall improvement in all functional outcomes postoperatively. However, patients who had endoscopic plantar fasciotomy fared better at 3 months compared to patients who underwent open microtenotomy with the visual analog score component of the AOFAS hindfoot score (HINDVAS) and the social functioning and role-functioning-emotional reaching statistical significance ( P = .027, P = .03, and P = .03, respectively). There was no difference in functional outcomes at 6 or 12 months postoperatively. Endoscopic plantar fasciotomy was associated with an earlier improvement in functional outcome in our study. However, both treatments had equivalent outcomes at 1-year follow-up, suggesting that either method is reasonable in the treatment of chronic plantar fasciitis. Level III, comparative study.

Scrotal Reconstruction with Integra Following Necrotizing Fasciitis.

PubMed

Dent, Briar L; Dinesh, Anant; Khan, Khuram; Engdahl, Ryan

2018-01-01

Scrotal loss from Fournier's gangrene can be a devastating injury with esthetic and functional consequences. Local reconstructive options can be limited by the presence of infection or the loss of neighboring tissue from debridement. Integra TM bilayer matrix wound dressing is a well-established reconstructive modality, but only one report exists of its use in scrotal reconstruction and this was not in the setting of Fournier's gangrene. We report the successful use of Integra and a subsequent split-thickness skin graft for reconstruction of the anterior scrotum and coverage of the exposed testes in a 43-year-old man who developed Group A Streptococcus necrotizing fasciitis of his right lower extremity, groin, and scrotum requiring serial operative debridements. Stable testicular coverage was achieved with closely matched skin and minimal donor-site morbidity. Further study and a larger sample size will be necessary to better understand the advantages and disadvantages of scrotal reconstruction with Integra.

Management of Necrotizing Fasciitis and Its Surgical Aspects.

PubMed

Sun, Xiaofang; Xie, Ting

2015-12-01

Necrotizing fasciitis (NF) is a severe and rapidly progressive infectious disease that attacks superficial an as well as deep fascia, subcutaneous fat tissue, and muscle. Although the incidence is of relatively low frequency, the median mortality is high. NF is a great burden to patients and hospitals. The most common cause of NF is trauma injuries, followed by other conditions with comorbidity. A classification for NF was presented concerning microbial cause, depth of infection, and anatomy. But the value of classification is not convincing. Early diagnosis of NF is essential and still to be realized by far. Information from clinic or laboratory might contribute to the purpose. Surgery is used in exploration debridement and tissue reconstruction as the main method with NF. Negative pressure wound therapy has proved to be useful in improving wound bed preparation and healing. © The Author(s) 2015.

Predictive uncertainty analysis of a saltwater intrusion model using null-space Monte Carlo

USGS Publications Warehouse

Herckenrath, Daan; Langevin, Christian D.; Doherty, John

2011-01-01

Because of the extensive computational burden and perhaps a lack of awareness of existing methods, rigorous uncertainty analyses are rarely conducted for variable-density flow and transport models. For this reason, a recently developed null-space Monte Carlo (NSMC) method for quantifying prediction uncertainty was tested for a synthetic saltwater intrusion model patterned after the Henry problem. Saltwater intrusion caused by a reduction in fresh groundwater discharge was simulated for 1000 randomly generated hydraulic conductivity distributions, representing a mildly heterogeneous aquifer. From these 1000 simulations, the hydraulic conductivity distribution giving rise to the most extreme case of saltwater intrusion was selected and was assumed to represent the "true" system. Head and salinity values from this true model were then extracted and used as observations for subsequent model calibration. Random noise was added to the observations to approximate realistic field conditions. The NSMC method was used to calculate 1000 calibration-constrained parameter fields. If the dimensionality of the solution space was set appropriately, the estimated uncertainty range from the NSMC analysis encompassed the truth. Several variants of the method were implemented to investigate their effect on the efficiency of the NSMC method. Reducing the dimensionality of the null-space for the processing of the random parameter sets did not result in any significant gains in efficiency and compromised the ability of the NSMC method to encompass the true prediction value. The addition of intrapilot point heterogeneity to the NSMC process was also tested. According to a variogram comparison, this provided the same scale of heterogeneity that was used to generate the truth. However, incorporation of intrapilot point variability did not make a noticeable difference to the uncertainty of the prediction. With this higher level of heterogeneity, however, the computational burden of

A Feasibility Study Comparing Platelet-Rich Plasma Injection With Saline for the Treatment of Plantar Fasciitis Using a Prospective, Randomized Trial Design.

PubMed

Johnson-Lynn, Sarah; Cooney, Alan; Ferguson, Diarmaid; Bunn, Deborah; Gray, William; Coorsh, Jonathan; Kakwani, Rajesh; Townshend, David

2018-05-01

Platelet-rich plasma (PRP) has been advocated for treatment of plantar fasciitis but there are few good-quality clinical trials to support its use. We conducted a feasibility study of PRP versus saline for treatment of plantar fasciitis. Patients with 6 months or more of magnetic resonance imaging-proven plantar fasciitis, who had failed conservative treatment were invited to participate in the study. Patients were block randomized to either PRP or an equivalent volume of saline. The techniques used for injection and rehabilitation were standardized for both groups. The patient and assessor were blinded. Visual analogue scale (VAS) for pain and painDETECT score were recorded preoperatively and at 6 months follow-up. From 35 patients approached, 28 (19 female, mean age 50 years) were recruited, with 14 randomized to each arm. At 6 months, 8 patients (28.6%) were lost to follow-up. There was a significant change in VAS score from baseline to follow-up in both intervention (mean change 37.2, P = .008) and control (mean change 42.2, P = .003) groups. There was no correlation between preoperative painDETECT score and change in VAS. Recruitment and loss to follow-up rates were relatively high. Both treatments resulted in a similar, significant, improvement in symptoms. Level II.

Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal.

PubMed

Yetışır, Fahri; Şarer, Akgün Ebru; Acar, H Zafer

2015-01-01

Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA) with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT). Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

Synergy of climate change and local pressures on saltwater intrusion in heterogeneous coastal aquifers

NASA Astrophysics Data System (ADS)

Abou Najm, M.; Safi, A.; El-Fadel, M.; Doummar, J.; Alameddine, I.

2016-12-01

The relative importance of climate change induced sea level rise on the salinization of a highly urbanized karstified coastal aquifers were compared with non-sustainable pumping. A 3D variable-density groundwater flow and solute transport model was used to predict the displacement of the saltwater-freshwater interface in a pilot aquifer located along the Eastern Mediterranean. The results showed that the influence of sea level rise was marginal when compared with the encroachment of salinity associated with anthropogenic abstraction. Model predictions of salinity mass and volumetric displacement of the interface corresponding to a long-term monthly transient model showed that the saltwater intrusion dynamic is highly sensitive to change in the abstraction rates which were estimated based on combinations of water consumption rates and population growth rates. Salinity encroachment, however, appeared to be more sensitive to water consumption rates in comparison to population growth rates, where a 50% increase in the rate of former led to four times more intrusion as compared to an equivalent increase in population growth rate over 20 years. Coupling both increase in population growth and increased consumption rates had a synergistic effect that aggravated the intrusion beyond the sum of the individual impacts. Adaptation strategies targeting a decrease in groundwater exploitation proved to be effective in retarding the intrusion.

Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis.

PubMed

Scheuer, R; Friedrich, M; Hahne, J; Holzapfel, J; Machacek, P; Ogon, M; Pallamar, M

2016-03-01

Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis. 284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19-77 weeks after the first application of ESWT. 76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors. Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions. In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Pulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study.

PubMed

Osman, Ayman M; El-Hammady, Dina H; Kotb, Mohamed M

2016-01-01

Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations. To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency (TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantar fasciitis pain. Prospective comparative study. Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut University Hospital. Twenty patients with refractory chronic bilateral plantar fasciitis received PRF to the medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the other heel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking up from bed and after prolonged walking, and satisfaction score were used for assessment of studied patients at one, 3, 6, 12, and 24 weeks from the intervention. All studied patients showed significant improvement in their pain scale after the intervention that lasted for 24 weeks; however, the PRF heels had significantly better pain scale and satisfaction scores at the first and third weeks assessments when compared to the TRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3 weeks for the TRF (P < 0.001). No randomization. PRF to the medial calcaneal nerve is a safe and effective method for treatment of chronic plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial

Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial

PubMed Central

Lai, Ta-Wei; Ma, Hsiao-Li; Lee, Meng-Shiunn; Chen, Po-Ming; Ku, Ming-Chou

2018-01-01

Objectives: Extracorporeal shockwave therapy (ESWT) and corticosteroid injection (CSI) are treatment options for plantar fasciitis. Their clinical outcome comparison remains a debate. Also, the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive. Methods: A total of 97 patients with chronic plantar fasciitis were enrolled in the randomized prospective trial. Forty-seven patients received extracorporeal shock wave therapy (ESWT), and fifty patients received corticosteroid injection (CSI). The thickness of the plantar fascia was evaluated respectively before ESWT and CSI, and at the 4th and 12th week after ESWT and CSI by ultrasonography. Pain level and clinical outcomes were recorded using visual analogue scale (VAS) and 100-points scoring systems. Correlation analysis was performed between the thickness change and clinical outcome. Results: Under ultrasonography, we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4th week (p=0.048). VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection (0.001 and p<0.001, at 4th and 12th week). On the assessment of 100-points scoring systems, the pain level of patients with ESWT was lower than those with CSI at the 12th week (p<0.001). On the other hand, the increase of plantar fascia thickness at 4th week was positively correlated with the decrease of VAS score at 12th week follow-up (R=0.302, P=0.039). Conclusions: At 4th week after treatment, the thickness of plantar fascia increased. Then it decreased gradually, but not to the baseline at 12th week. On the pain level outcome at 12th week, extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis. The more change of plantar fascia after ESWT, the more efficient on clinical outcome. PMID:29504578

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients.

PubMed

Cottom, James M; Maker, Jared M; Richardson, Phillip; Baker, Joseph S

2016-01-01

Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Simulated effects of pumping and drought on ground-water levels and the freshwater-saltwater interface on the north fork of Long Island, New York

USGS Publications Warehouse

Misut, Paul E.; Schubert, Christopher E.; Bova, Richard G.; Colabufo, Steven R.

2004-01-01

Ground water is the sole source of freshwater on the North Fork of Long Island. Future demands for the limited freshwater supply during a prolonged drought could cause drawdowns that induce saltwater intrusion and render the supply unusable. The freshwater system on the North Fork contains several localized, hydraulically isolated aquifers bounded by salty water. The need for information on the ability of these aquifers to meet future demands prompted a 4-year study to develop a ground-water flow model to simulate several proposed pumping scenarios under long-term average conditions and during a hypothetical drought, and to delineate the resulting ground-water levels and movement of the freshwater-saltwater interface. The model code selected was SHARP, a quasi-three-dimensional finite-difference method of simulating freshwater and saltwater flow simultaneously.Two sets of four proposed pumping scenarios were evaluated. The first represented average recharge from precipitation during 2006-20; the second represented the same period and conditions except for a 5-year period of drought conditions. The average-recharge simulations used the long-term (1959-99) rate of recharge; the drought simulations applied a 20-percent reduction in recharge rate and a 20-percent increase in the 1999 rate of agricultural pumpage during 2011–15.The simulated movement of the freshwater-saltwater interface in future withdrawal and recharge scenarios indicates that the interface may rise beneath pumped wells at Inlet Drive, Brecknock Hall, Main Bayview Road, Islands End, North Road, and Alvah's Lane. Either (1) movement of the interface to within 50 feet of the well screen, (2) a large percent change in the distance between the interface and the well screen, or (3) movement of the interface through a clay layer is a cause for concern. Wellfields in which saltwater intrusion does not appear to be a cause for concern were those at Ackerly Pond, Kenney's Road, Middle Road, Rocky Point Road

Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature.

PubMed

Cortese, Antonio; Pantaleo, Giuseppe; Borri, Antonio; Amato, Massimo; Claudio, Pier Paolo

2017-02-01

Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin. In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need. Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

[Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident].

PubMed

Mayayo, Emilio; Stchigel, Alberto M; Cano, José F; Bernal-Escoté, Xana; Guarro, Josep

2013-01-03

Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.

Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial.

PubMed

Eslamian, Fariba; Shakouri, Seyed Kazem; Jahanjoo, Fatemeh; Hajialiloo, Mehrzad; Notghi, Faraz

2016-09-01

Plantar fasciitis is a self-limiting condition, but can be painful and disabling. Among the different treatments which exist, corticosteroid injections are effective and popular. Extracorporeal shock wave therapy (ESWT) is another treatment modality used for resistant conditions. In this study, the authors evaluated the efficacy of radial ESWT versus corticosteroid injections in the treatment of chronic plantar fasciitis. Randomized clinical trial. Physical medicine and rehabilitation research center in a university hospital. Forty patients with plantar fasciitis who did not respond to conservative treatment. Patients were allocated to radial ESWT with 2000 shock waves/session of 0.2 mJ/mm(2) (n = 20) or local methylprednisolone injections (n = 20). Pain in the morning and during the day based on a visual analog scale (VAS), functional abilities using the foot function index (FFI), and satisfaction were evaluated before treatment and at 4 and 8 weeks after treatment. Patients (average age: 42.1± 8.20) received five sessions of ESWT or single steroid injection. Changes in the VAS in morning and during the day and the FFI throughout the study period were significant in both groups (P < 0.001). ESWT group had a higher reduction in VAS in morning and better function in FFI, but these changes were insignificant statistically [FFI decreased to 19.65 ± 21.26 points (67.4% improvement) in ESWT vs 31.50 ± 20.53 points (47.7%) in injection group at week 8, P = 0.072)]. Good or excellent results in the opinions of patients were achieved in 55% of ESWT and 30% of corticosteroid injection groups (P = 0.11). Both interventions caused improvement in pain and functional ability 2 months after treatment. Although inter-group differences were not significant, the FFI was improved more with ESWT and patients were more satisfied with ESWT, thus shockwave therapy seems a safe alternative for management of chronic plantar fasciitis. © 2016 American

Groundwater Modeling in Coastal Arid Regions Under the Influence of Marine Saltwater Intrusion

NASA Astrophysics Data System (ADS)

Walther, Marc; Kolditz, Olaf; Grundmann, Jens; Liedl, Rudolf

2010-05-01

The optimization of an aquifer's "safe yield", especially within agriculturally used regions, is one of the fundamental tasks for nowaday's groundwater management. Due to the limited water ressources in arid regions, conflict of interests arise that need to be evaluated using scenario analysis and multicriterial optimization approaches. In the context of the government-financed research project "International Water Research Alliance Saxony" (IWAS), the groundwater quality for near-coastal, agriculturally used areas is investigated under the influence of marine saltwater intrusion. Within the near-coastal areas of the study region, i.e. the Batinah plains of Northern Oman, an increasing agricultural development could be observed during the recent decades. Simultaneously, a constant lowering of the groundwater table was registered, which is primarily due to the uncontrolled and unsupervised mining of the aquifers for the local agricultural irrigation. Intensively decreased groundwater levels, however, cause an inversion of the hydraulic gradient which is naturally aligned towards the coast. This, in turn,leads to an intrusion of marine saltwater flowing inland, endangering the productivity of farms near the coast. Utilizing the modeling software package OpenGeoSys, which has been developed and constantly enhanced by the Department of Environmental Informatics at the Helmholtz Centre for Environmental Research Leipzig (UFZ; Kolditz et al., 2008), a three-dimensional, density-dependent model including groundwater flow and mass transport is currently being built up. The model, comprehending three selected coastal wadis of interest, shall be used to investigate different management scenarios. The main focus of the groundwater modelling are the optimization of well positions and pumping schemes as well as the coupling with a surface runoff model, which is also used for the determination of the groundwater recharge due to wadi runoff downstream of retention dams. Based on

Effectiveness of polydeoxyribonucleotide injection versus normal saline injection for treatment of chronic plantar fasciitis: a prospective randomised clinical trial.

PubMed

Kim, Jae Kwang; Chung, Jae Yoon

2015-07-01

Polydeoxyribonucleotide (PDRN) has been used for the treatment of chronic tendinosis. This prospective randomised study was conducted to evaluate the efficacy and complications of PDRN injection for treatment of plantar fasciitis. Forty patients with a clinical diagnosis of plantar fasciitis were randomly allocated to PDRN injection (PDRN group, n = 20) or normal saline injection (placebo group, n = 20). Injections were performed weekly for three weeks. Clinical evaluations were done at baseline and four and 12 weeks after treatment began using the visual analogue scale (VAS) for foot pain and Manchester-Oxford Foot Questionnaire (MOXFQ). We also monitored the complications in both groups at one, two, four and 12 weeks after initial treatment. The PDRN group achieved a significant improvement in VAS and MOXFQ scores at four weeks after treatment, and this improvement continued until 12 weeks after treatment. On the other hand, the placebo group did not achieve a significant improvement in the VAS or MOXFQ scores at four or 12 weeks. The initial VAS and MOXFQ scores of the PDRN group were not significantly different from those of the placebo group. At four weeks after treatment, the VAS and MOXFQ scores of the PDRN group were better than those of the placebo group, but the difference was not statistically significant. At 12 weeks after treatment, the VAS and MOXFQ scores of the PDRN group were significantly better than those of the placebo group. We noticed no injection-related complications, such as itching, urticaria, redness or infection signs around the injection site in either group. PDRN injection is an effective and safe treatment option and may be considered for plantar fasciitis.

Successful treatment of a necrotizing fasciitis patient caused by Mucor indicus with amphotericin B and skin grafting.

PubMed

Luo, Yijin; Zeng, Fanqin; Huang, Xiaowen; Li, Qun; Tan, Guozhen; Xi, Liyan; Lu, Changming; Guo, Qing

2014-04-01

Cutaneous mucormycosis, an uncommon disease caused by Mucorales, predominantly occurs in immunocompromised host. The present case is a primary cutaneous mucormycosis due to Mucor indicus in an immunocompetent individual. It is with the features of necrotizing fasciitis over the right pretibial area. We are presenting this case owing to its rarity and the successful treatment with amphotericin B and skin grafting.

Hydrogeology and Extent of Saltwater Intrusion in the Northern Part of the Town of Oyster Bay, Nassau County, New York: 1995–98

USGS Publications Warehouse

Stumm, Frederick; Lange, Andrew D.; Candela, Jennifer L.

2004-01-01

The Oyster Bay study area, in the northern part of Nassau County, N.Y., is underlain by unconsolidated deposits that form a sequence of aquifers and confining units. At least one production well has been affected by the intrusion of saltwater from Hempstead Harbor, Long Island Sound, and Cold Spring Harbor. Nineteen boreholes were drilled during 1995-98 for the collection of hydrogeologic, geochemical, and geophysical data to delineate the subsurface geology and the extent of saltwater intrusion. Continuous high-resolution marine-seismic-reflection surveys in the surrounding embayments of the Oyster Bay study area were conducted in 1996.New drill-core data indicate two hydrogeologic units—the North Shore aquifer and the North Shore confining unit—where the Lloyd aquifer, the Raritan confining unit, and the Magothy aquifer have been completely removed by glacial erosion.Water levels at 95 observation wells were measured quarterly during 1995–98. These data and continuous water-level records indicated that (1) the upper glacial (water-table) and Magothy aquifers are hydraulically connected and that their water levels did not respond to tidal fluctuations, and (2) the Lloyd and North Shore aquifers are hydraulically connected and their water levels responded to pumping and to tidal fluctuations.Marine seismic-reflection surveys in the surrounding embayments indicate at least four glacially eroded buried valleys with subhorizontal, parallel reflectors indicative of draped bedding that is interpreted as infilling by silt and clay. The buried valleys (1) truncate the surrounding coarse-grained deposits, (2) are asymmetrical and steep sided, (3) trend northwest-southeast, (4) are several miles long and about 1 mile wide, and (5) extend to more than 500 feet below sea level.Water samples taken during 1995–98 from three production wells and six observation wells screened in the upper glacial and Magothy aquifers contained volatile organic compounds in concentrations

Consequences and mitigation of saltwater intrusion induced by short-circuiting during aquifer storage and recovery in a coastal subsurface

NASA Astrophysics Data System (ADS)

Gerardus Zuurbier, Koen; Stuyfzand, Pieter Jan

2017-02-01

Coastal aquifers and the deeper subsurface are increasingly exploited. The accompanying perforation of the subsurface for those purposes has increased the risk of short-circuiting of originally separated aquifers. This study shows how this short-circuiting negatively impacts the freshwater recovery efficiency (RE) during aquifer storage and recovery (ASR) in coastal aquifers. ASR was applied in a shallow saltwater aquifer overlying a deeper, confined saltwater aquifer, which was targeted for seasonal aquifer thermal energy storage (ATES). Although both aquifers were considered properly separated (i.e., a continuous clay layer prevented rapid groundwater flow between both aquifers), intrusion of deeper saltwater into the shallower aquifer quickly terminated the freshwater recovery. The presumable pathway was a nearby ATES borehole. This finding was supported by field measurements, hydrochemical analyses, and variable-density solute transport modeling (SEAWAT version 4; Langevin et al., 2007). The potentially rapid short-circuiting during storage and recovery can reduce the RE of ASR to null. When limited mixing with ambient groundwater is allowed, a linear RE decrease by short-circuiting with increasing distance from the ASR well within the radius of the injected ASR bubble was observed. Interception of deep short-circuiting water can mitigate the observed RE decrease, although complete compensation of the RE decrease will generally be unattainable. Brackish water upconing from the underlying aquitard towards the shallow recovery wells of the ASR system with multiple partially penetrating wells (MPPW-ASR) was observed. This leakage may lead to a lower recovery efficiency than based on current ASR performance estimations.

Examining the degree of pain reduction using a multielement exercise model with a conventional training shoe versus an ultraflexible training shoe for treating plantar fasciitis.

PubMed

Ryan, Michael; Fraser, Scott; McDonald, Kymberly; Taunton, Jack

2009-12-01

Plantar fasciitis is a common injury to the plantar aponeurosis, manifesting as pain surrounding its proximal insertion at the medial calcaneal tubercle. Pain is typically worse in the morning when getting out of bed, and may subside after the tissue is sufficiently warmed up. For running-based athletes and individuals who spend prolonged periods of time on their feet at work, plantar fasciitis may become recalcitrant to conservative treatments such as ice, rest, and anti-inflammatory medication. Exercise-based therapies have received only limited attention in the literature for this common problem, yet they are becoming increasingly validated for pain relief and positive tissue remodeling at other sites of similar soft-tissue overuse injury. This study reports on pain outcomes in individuals experiencing chronic plantar fasciitis while wearing a shoe with an ultraflexible midsole (Nike Free 5.0) (FREE) versus a conventional training (CON) shoe in a 12-week multielement exercise regimen, and after a 6-month follow-up. Adults with >or= 6-month history of painful heel pain were recruited and randomly assigned to wear 1 of the 2 shoes. All subjects completed the same exercise protocol. A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes.

A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial.

PubMed

Konjen, Nipaporn; Napnark, Tapakorn; Janchai, Siriporn

2015-01-01

To compare the effectiveness ofradial extracorporeal shock wave therapy (rSWET) and ultrasound therapy (US) in the treatment of chronic plantar fasciitis. Randomized controlled trial. Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. Thirty patients who were diagnosed with plantar fasciitis for at least 3 months and who had not responded to other forms of conservative treatment were recruited for this study. They were randomly divided into two groups of 15 patients. The rESWT group was treated with 1 session per week and the US group with 3 sessions per week, with both groups undergoing a total of 6 consecutive weeks of treatment. Visual analog scale (VAS) assessments were performed before and after treatment at 1, 3, 6, 12, and 24 weeks. The mobility subscale of the plantar fasciitis pain and disability scale (PFPS) was measured before and after treatment. Patient satisfaction was evaluated at the conclusion of the 6-week treatment protocol. VAS pain intensity scores were significantly decreased in both groups (p < 0.001), when measured after treatment at 1, 3, 6, 12, and 24 weeks. The VAS pain scores for the rESWT group dropped significantly more than those of the US group (p < 0.001). At the end of treatment, the PFPS mobility subscale scores in both groups were significantly decreased (p < 0.001). Similar to the VAS pain score outcome, the PFPS mobility subscale score for the rESWT group decreased significantly more than that of the US group (p < 0.001). Patient satisfaction was significantly higher in the rESWT group, relative to the US group (p = 0.025). In chronic plantar fasciitis treatment, both rESWT and US were found to be effective in reducing pain and increasing mobility; however, statistical analysis showed that rESWT is significantly more effective than US.

Simulation of groundwater flow in the "1,500-foot" sand and "2,000-foot" sand and movement of saltwater in the "2,000-foot" sand of the Baton Rouge area, Louisiana

USGS Publications Warehouse

Heywood, Charles E.; Griffith, Jason M.

2013-01-01

Groundwater withdrawals have caused saltwater to encroach into freshwater-bearing aquifers beneath Baton Rouge, Louisiana. Groundwater investigations in the 1960s identified a freshwater-saltwater interface located at the Baton Rouge Fault, across which abrupt changes in water levels occur. Aquifers south of the fault generally contain saltwater, and aquifers north of the fault contain freshwater, though limited saltwater encroachment has been detected within 7 of the 10 aquifers north of the fault. The 10 aquifers beneath the Baton Rouge area, which includes East and West Baton Rouge Parishes, Pointe Coupee Parish, and East and West Feliciana Parishes, provided about 167 million gallons per day (Mgal/day) for public supply and industrial use in 2010. Groundwater withdrawals from an aquifer that is 2,000-feet (ft) deep in East Baton Rouge Parish (the “2,000-foot” sand of the Baton Rouge area) have caused water-level drawdown up to 356 ft and induced saltwater movement northward across the fault. Groundwater withdrawals from the “2,000-foot” sand averaged 23.9 Mgal/d during 2010. Saltwater encroachment threatens wells that are located about 3 miles north of the fault, where industrial withdrawals account for about 66 percent of the water withdrawn from the “2,000-foot” sand in East Baton Rouge Parish. Constant and variable-density groundwater models were developed with the MODFLOW and SEAWAT groundwater modeling codes to evaluate strategies to control saltwater migration, including changes in the distribution of groundwater withdrawals and installation of “scavenger” wells to intercept saltwater before it reaches existing production wells. Five hypothetical scenarios simulated the effects of different groundwater withdrawal options on groundwater levels within the “1,500-foot” sand and the “2,000-foot” sand and the transport of saltwater within the “2,000-foot” sand. Scenario 1 is considered a base case for comparison to the other four

Numerical and physical modeling of cutoff walls against saltwater intrusion

NASA Astrophysics Data System (ADS)

Crestani, Elena; Camporese, Matteo; Salandin, Paolo

2017-04-01

Seawater intrusion is a relevant problem for many communities living in small islands, where the amount of fresh water available for human consumption depends on the delicate equilibrium between the natural groundwater recharge from rainfall and the surrounding sea. However, it can represent a significant issue also for coastal regions where groundwater is extracted for water supply: an excessive extraction to meet growing demands for drinking water and irrigation purposes leads to a decrease of seaward flows of fresh water and consequently to an increase of seawater intrusion into coastal aquifers. Cutoff walls represent one of the possible strategies that can be adopted to reduce seawater intrusion into coastal aquifers and to limit the inland progression of the saltwater wedge. In this study, on the basis of several preliminary simulations developed by the SUTRA code, a cutoff wall occluding 70% of the aquifer depth is designed for a physical experiment, whose setup details are reported as follows. The physical model represents the terminal part of a coastal aquifer and consists of a flume 500 cm long, 30 cm wide and 60 cm high, filled for an height of 49 cm with glass beads with a d50 of 0.6 mm and a uniformity coefficient d60/d10 1.5. The resulting porous medium is homogeneous, with porosity of about 0.37 and hydraulic conductivity of about 1.3 10-3 m/s. Upstream from the sandbox, a tank filled by freshwater provides recharge for the aquifer. The downstream tank simulates the sea and red food dye is added to the saltwater to easily visualize the salt wedge. The volume of the downstream tank is about five times the upstream one, and, due to the small filtration discharge, minimizing salt concentration variations due to the incoming freshwater flow. The hydraulic gradient during the tests is constant, due to the fixed water level in the tanks. Water levels and discharged flow rate are continuously monitored. The cutoff wall was realized with sodium bentonite

Eosinophilic fasciitis associated with hypereosinophilia, abnormal bone-marrow karyotype and inversion of chromosome 5.

PubMed

Ferguson, J S; Bosworth, J; Min, T; Mercieca, J; Holden, C A

2014-03-01

We report the case of a male patient presenting with eosinophilia, pulmonary oedema and eosinophilic fasciitis (EF). He had the classic clinical appearance and magnetic resonance imaging of EF. Cytogenetic analysis of the bone marrow revealed a previously undescribed pericentric inversion of chromosome 5. Overall, the presentation was consistent with a diagnosis of chronic eosinophilic leukaemia, not otherwise specified (CEL-NOS). Dermatologists should consult a haematologist in cases of EF, in order to rule out possible haematological malignancies. © 2013 British Association of Dermatologists.

Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

PubMed Central

Ribeiro, Ana Paula; Trombini-Souza, Francis; Tessutti, Vitor; Lima, Fernanda Rodrigues; de Camargo Neves Sacco, Isabel; João, Sílvia Maria Amado

2011-01-01

OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms. PMID:21808870

Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

PubMed

Pfeffer, G; Bacchetti, P; Deland, J; Lewis, A; Anderson, R; Davis, W; Alvarez, R; Brodsky, J; Cooper, P; Frey, C; Herrick, R; Myerson, M; Sammarco, J; Janecki, C; Ross, S; Bowman, M; Smith, R

1999-04-01

Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

A rare case of necrotizing fasciitis caused by Vibrio cholerae O8 in an immunocompetent patient.

PubMed

Dobrović, Karolina; Rudman, Franjo; Ottaviani, Donatella; Šestan Crnek, Sandra; Leoni, Francesca; Škrlin, Jasenka

2016-10-01

We report a case of necrotizing fasciitis of the leg caused by Vibrio cholerae O8 in a 63-year-old immunocompetent man after he had been fishing in a lake on a Croatian island. The strain was cytotoxic, invasive and adhesive and contained a fragment of the gene for El Tor-like hemolysin (El Tor hlyA). After surgical and antibiotic treatment, the patient fully recovered.

Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Canyilmaz, Emine, E-mail: dremocan@ktu.edu.tr; Canyilmaz, Fatih; Aynaci, Ozlem

2015-07-01

Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, andmore » a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.« less

Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis.

PubMed

Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

2015-07-01

The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Methods for culturing saltwater rotifers (Brachionus plicatilis) for rearing larval zebrafish.

PubMed

Lawrence, Christian; Sanders, Erik; Henry, Eric

2012-09-01

The saltwater rotifer, Brachionus plicatilis, is widely used in the aquaculture industry as a prey item for first-feeding fishes due to its ease of culture, small size, rapid reproductive rate, and amenability to enrichment with nutrients. Despite the distinct advantages of this approach, rotifers have only been sporadically utilized for rearing larval zebrafish, primarily because of the common misconception that maintaining cultures of rotifers is difficult and excessively time-consuming. Here we present simple methods for maintaining continuous cultures of rotifers capable of supporting even the very largest zebrafish aquaculture facility, with minimal investments in materials, time, labor, and space. Examples of the methods' application in one large, existing facility is provided, and troubleshooting of common problems is discussed.

Comparison of formation mechanism of fresh-water and salt-water lacustrine organic-rich shale

NASA Astrophysics Data System (ADS)

Lin, Senhu

2017-04-01

Based on the core and thin section observation, major, trace and rare earth elements test, carbon and oxygen isotopes content analysis and other geochemical methods, a detailed study was performed on formation mechanism of lacustrine organic-rich shale by taking the middle Permian salt-water shale in Zhungaer Basin and upper Triassic fresh-water shale in Ordos Basin as the research target. The results show that, the middle Permian salt-water shale was overall deposited in hot and dry climate. Long-term reductive environment and high biological abundance due to elevated temperature provides favorable conditions for formation and preservation of organic-rich shale. Within certain limits, the hotter climate, the organic-richer shale formed. These organic-rich shale was typically distributed in the area where palaeosalinity is relatively high. However, during the upper Triassic at Ordos Basin, organic-rich shale was formed in warm and moist environment. What's more, if the temperature, salinity or water depth rises, the TOC in shale decreases. In other words, relatively low temperature and salinity, stable lake level and strong reducing conditions benefits organic-rich shale deposits in fresh water. In this sense, looking for high-TOC shale in lacustrine basin needs to follow different rules depends on the palaeoclimate and palaeoenvironment during sedimentary period. There is reason to believe that the some other factors can also have significant impact on formation mechanism of organic-rich shale, which increases the complexity of shale oil and gas prediction.

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial.

PubMed

Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

2018-01-01

Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Patients in both groups ( n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. One month after intervention, VAS morning showed significant improvement in intervention group ( P = 0.006) and RMS showed better improvement in intervention group ( P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups ( P = 0.292). This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

[Prognostic analysis of plantar fasciitis treated by pneumatic ballistic extracorporeal shock wave versus ultrasound guided intervention].

PubMed

Huo, Xiu-Lin; Wang, Ke-Tao; Zhang, Xiao-Ying; Yang, Yi-Tian; Cao, Fu-Yang; Yang, Jing; Yuan, Wei-Xiu; Mi, Wei-Dong

2018-02-20

To compare the medium- and long-term effect of pneumatic ballistic extracorporeal shock wave versus ultrasound-guided hormone injection in the treatment of plantar fasciitis. The clinical data were collected from patients with plantar fasciitis admitted to PLA General Hospital pain department from September, 2015 to February, 2017. The patients were randomly divided into ultrasound-guided drug injection group and shock wave group. The therapeutic parameters including the numerical rating scale (NRS) scores in the first step pain in the morning, American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, and thickness of the plantar fascia were monitored before and at 1 week, 1 month, 3 months, and 6 months after the treatment. The recurrence rate, effectiveness, and patient satisfaction were compared between the two groups at 6 months after the treatment. Thirty-nine patients were enrolled in shock wave group and 38 patients in ultrasound group. The NRS scores in the first step pain in the morning were lowered after treatment in both groups (P<0.05), and the scores were significantly lower in ultrasound group than in shock wave group at 1 week and 1 month (P<0.01), but significantly higher in ultrasound group than in shock wave group at 3 and 6 months after treatment (P<0.05). The AOFAS functional scores were increased in both groups (P<0.05) at 6 months after treatment, was significantly lower in ultrasound group than in shock wave group than group B (90.44∓13.27 vs 75.76∓21.40; P<0.05). The effective rates in shock wave group and ultrasound group were 92.31% and 76.32%, respectively (P<0.05). Recurrence was found in 1 patient (2.56%) in shock wave group and in 8 (21.05%) in ultrasound group (P<0.05). The patient satisfaction scores were significantly higher in shock wave group than in ultrasound group (8.13∓2.67 vs 6.63∓3.75, P=0.048). Pneumatic ballistic extracorporeal shock achieves better medium- and long-term outcomes than ultrasound

Necrotizing Fasciitis in a Pediatric Patient Caused by Lancefield Group G Streptococcus: Case Report and Brief Review of the Literature

PubMed Central

Rausch, John; Foca, Marc

2011-01-01

We report a case of necrotizing fasciitis with an accompanying toxic shock syndrome caused by Group G Streptococcus in a pediatric patient with a lymphatic malformation. Pediatricians need to be aware of the possibility of such infections, especially in those with vascular/lymphatic malformations, as early treatment is critical for survival. PMID:22242030

Necrotizing Fasciitis of the Breast Requiring Emergent Radical Mastectomy.

PubMed

Ward, Nicholas D; Harris, Jennifer W; Sloan, David A

2017-01-01

Necrotizing fasciitis is a rare, aggressive, soft-tissue infection that results in necrosis of skin, subcutaneous tissue, and fascia. It spreads rapidly and may progress to sepsis, multi-organ failure, and death. Predisposing conditions include diabetes, chronic alcoholism, advanced age, vascular disease, and immunosuppression and many cases are preceded by an injury or invasive procedure. Necrotizing soft-tissue infection of the breast is uncommon, with only a few reported cases in the literature. We present a 53-year-old diabetic woman who presented to the emergency room with several weeks of worsening breast and shoulder pain, swelling, and erythema. Upon formal evaluation by the surgical service, a necrotizing soft-tissue infection was suspected, and the patient was scheduled for emergent, surgical debridement. Because of the aggressive nature and high mortality of this disease, immediate surgical intervention, coupled with antibiotic therapy and physiologic support, is necessary to prevent complications and death. © 2016 Wiley Periodicals, Inc.

How will induced seismicity in Oklahoma respond to decreased saltwater injection rates?

PubMed Central

Langenbruch, Cornelius; Zoback, Mark D.

2016-01-01

In response to the marked number of injection-induced earthquakes in north-central Oklahoma, regulators recently called for a 40% reduction in the volume of saltwater being injected in the seismically active areas. We present a calibrated statistical model that predicts that widely felt M ≥ 3 earthquakes in the affected areas, as well as the probability of potentially damaging larger events, should significantly decrease by the end of 2016 and approach historic levels within a few years. Aftershock sequences associated with relatively large magnitude earthquakes that occurred in the Fairview, Cherokee, and Pawnee areas in north-central Oklahoma in late 2015 and 2016 will delay the rate of seismicity decrease in those areas. PMID:28138533

Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: a case report.

PubMed

Chauhan, Deepender; Arora, Ritu; Das, Sima; Shroff, Daraius; Narula, Ritesh

2007-01-01

Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report

PubMed Central

Arora, Ritu; Das, Sima; Shroff, Daraius; Narula, Ritesh

2007-01-01

Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards. PMID:17699947

Necrotizing Fasciitis and The Diabetic Foot.

PubMed

Iacopi, Elisabetta; Coppelli, Alberto; Goretti, Chiara; Piaggesi, Alberto

2015-12-01

Necrotizing fasciitis (NF) represents a rapidly progressive, life-threatening infection involving skin, soft tissue, and deep fascia. An early diagnosis is crucial to treat NF effectively. The disease is generally due to an external trauma that occurs in predisposed patients: the most important risk factor is represented by diabetes mellitus. NF is classified into 3 different subtypes according to bacterial strains responsible: type 1 associated to polymicrobial infection, type 2 NF, generally associated to Streptococcus species, often associated to Staphylococcus aureus and, eventually, Type 3, due to Gram-negative strains, such as Clostridium difficile or Vibrio. NF is usually characterized by the presence of the classic triad of symptoms: local pain, swelling, and erythema. In daily clinical practice immune-compromised or neuropathic diabetic patients present with atypical symptomatology. This explains the high percentage of misdiagnosed cases in the emergency department and, consequently, the worse outcome presented by these patients. Prompt aggressive surgical debridement and antibiotic systemic therapy are the cornerstone of its treatment. These must be associated with an accurate systemic management, consisting in nutritional support, glycemic compensation, and hemodynamic stabilization. Innovative methods, such as negative pressure therapy, once the acute conditions have resolved, can help fasten the surgical wound closure. Prompt management can improve prognosis of patients affected from NF reducing limb loss and saving lives. © The Author(s) 2015.

Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial.

PubMed

Chew, Kelvin Tai Loon; Leong, Darren; Lin, Cindy Y; Lim, Kay Kiat; Tan, Benedict

2013-12-01

To evaluate the efficacy of autologous conditioned plasma (ACP) compared with extracorporeal shockwave (ESWT) and conventional treatments for plantar fasciitis. Randomized trial. Sports medicine center in a tertiary care hospital. Fifty-four subjects (age range, 29-71 years) with unilateral chronic plantar fasciitis with more than 4 months of symptoms. Subjects randomized to 3 groups: 19 to ACP and conventional treatment (ACP group), 19 to ESWT and conventional treatment (ESWT group), and 16 to conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated. Outcomes were pain-Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasound plantar fascia thickness assessed at baseline before treatment and at 1 month, 3 months, and 6 months after treatment. VAS, AOFAS ankle-hindfoot scale, and plantar fascia thickness improved in all groups. Significant VAS pain score improvements in the ACP group compared with conventional treatment at month 1 (P = .037) and for the ESWT group compared with conventional treatment at months 1, 3, and 6 (P = .017, P = .022, and P = .042). The AOFAS ankle-hindfoot scale score improved in the ACP group at months 3 and 6 (P = .004 and P = .013) and, for the ESWT group, at months 1 and 3 (P = .011 and P = .003) compared with conventional treatment. Significant improvements in plantar fascia thickness were seen in the ACP group at months 1 and 3 compared with conventional treatments (P = .015 and P = .014) and at months 3 and 6 compared with the ESWT group (P = .019 and P = .027). No adverse events reported. Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in improved pain and functional outcomes compared with conventional treatment alone. There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements, although the ACP group demonstrated greater

Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis.

PubMed

Miyamoto, Wataru; Yasui, Youichi; Miki, Shinya; Kawano, Hirotaka; Takao, Masato

2017-10-14

To evaluate the medium-term clinical results of endoscopic plantar fascia release (EPFR) using a suprafascial approach for recalcitrant plantar fasciitis. Twenty-four feet of twenty-three patients who underwent EPFR using a suprafascial approach were followed up for more than 2 years using the American Orthopedic Foot and Ankle Society (AOFAS) score. The AOFAS score at final follow-up was compared between patients who participated in athletic activity (group A) and those who were sedentary (group S) and between those with and those without calcaneal spur (group with CS and group without CS, respectively). The ability of patients to return to athletic activity, and if so, the time interval between surgery and return to athletic activity, were investigated in group A. Complications were recorded. The median follow-up duration was 48 months. The mean AOFAS score in all patients increased significantly between before surgery and final follow-up (P < 0.001). The mean score in group A at final follow-up was significantly higher than that in group S (P < 0.05). However, there was no significant difference in the mean score at final follow-up between the groups with and without CS. In group A, all patients could return to athletic activity after a median 8 weeks. Injury to the first branch of the lateral plantar nerve occurred in three feet. EPFR using a suprafascial approach was effective for recalcitrant plantar fasciitis. However, the prognosis of sedentary patients was inferior to that of patients engaged in athletic activity. IV.

Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection.

PubMed

Kim, Minchul; Choi, Yun Sun; You, Myung-Won; Kim, Jin Su; Young, Ki Won

2016-12-01

The aim of this study was to investigate whether ultrasound elastography can demonstrate the outcome of the treatment in comparison with gray-scale imaging. Sixteen patients (mean age, 46.9 years) with plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment. Individuals graded their heel pain on a 100-mm visual analogue scale (VAS) and underwent gray-scale ultrasonography and sonoelastography. Collagen was injected in the heels. Fascial thickness and hypoechogenicity, perifascial edema, and plantar fascial elasticity were evaluated. Follow-up sonoelastography and VAS grading were done 3 months after the injection. Statistical analyses were performed by the paired t test and the Fisher exact test. A P < 0.05 was considered statistically significant. Mean plantar fascial thickness showed insignificant decrease on follow-up (from 4.30 [1.37] to 4.23 [1.15] mm, P = 0.662). Fascial hypoechogenicity and perifascial edema did not change significantly after treatment. The mean strain ratio of the plantar fascia was significantly increased (from 0.71 [0.24] to 1.66 [0.72], P = 0.001). Softening of the plantar fascia decreased significantly after injection (from 12 to 3 ft, P = 0.004). Twelve (75%) of 16 patients showed significant VAS improvement at the follow-up. Sonoelastography revealed a hardening of the plantar fascia after collagen injection treatment and could aid in monitoring the improvement of the symptoms of plantar fasciitis, in cases where gray-scale imaging is inconclusive.

The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial.

PubMed

Shashua, Anat; Flechter, Shlomo; Avidan, Liat; Ofir, Dani; Melayev, Alex; Kalichman, Leonid

2015-04-01

A single-blind randomized controlled trial. To evaluate the efficacy of ankle and midfoot mobilization on pain and function of patients with plantar fasciitis (PF). Plantar fasciitis is a degenerative process of the plantar fascia, with a lifetime prevalence of approximately 10%. Limited ankle dorsiflexion is a common finding and apparently acts as a contributing factor to the development of PF. Fifty patients with PF, aged 23 to 73 years, were randomly assigned to either the intervention or control group. Both groups received 8 treatments, twice a week, consisting of stretching exercises and ultrasound. In addition, the intervention group received mobilization of the ankle and midfoot joints. Dorsiflexion range of motion was measured at the beginning and at the end of treatment. The results were evaluated by 3 outcomes: the numeric pain-rating scale, Lower Extremity Functional Scale, and algometry. No significant difference was found between groups in any of the outcomes. Both groups showed a significant difference in the numeric pain-rating scale and Lower Extremity Functional Scale. Both groups significantly improved in dorsiflexion range of motion, with no difference between groups. The addition of ankle and foot joint mobilization aimed at improving dorsiflexion range of motion is not more effective than stretching and ultrasound alone in treating PF. The association between limited ankle dorsiflexion and PF is most probably due to soft tissue limitations, not the joints. Trial registered at ClinicalTrials.gov (registration number NCT01439932). Therapy, level 1b.

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

PubMed Central

Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

2018-01-01

Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis. PMID:29862211

Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial.

PubMed

Kamonseki, Danilo H; Gonçalves, Geiseane A; Yi, Liu C; Júnior, Império Lombardi

2016-06-01

To compare the effect of stretching with and without muscle strengthening of the foot alone or foot and hip on pain and function in patients with plantar fasciitis. Single blind randomized controlled trial. Eighty-three patients with plantar fasciitis were allocated to one of three treatment options for an eight-week period: Foot Exercise Group (FEG - extrinsic and intrinsic foot muscles), Foot and Hip Exercise Group (FHEG - abductor and lateral rotator muscles) and Stretching Alone Exercise Group (SAEG). A visual analog scale for pain, the Foot and Ankle Outcome Score and the Star Excursion Balance Test. All evaluations were performed before treatment and after the last treatment session. Improvements were found in all groups regarding the visual analog scale, the pain, activities of daily living, sports and recreation, quality of life (p < 0.001) and other symptoms (p < 0.01) subscales of the Foot and Ankle Outcome Score as well as posterolateral movement, posteromedial movement and composite score (p < 0.001) on the Star Excursion Balance Test. No time-group interactions were found for any of the variables (p > 0.05). All three exercise protocols analyzed led to improvements at eight-week follow-up in pain, function and dynamic lower limb stability in patients with plantar fasciitis. Copyright © 2015 Elsevier Ltd. All rights reserved.

New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

PubMed

Yin, Mengchen; Chen, Ni; Huang, Quan; Marla, Anastasia Sulindro; Ma, Junming; Ye, Jie; Mo, Wen

2017-12-01

To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. Randomized, controlled, prospective study. Outpatient of local medical center settings. Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm 2 , respectively (a rate of 8 impulses per second), were applied. The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e [.011+42.807×heel spur+.109×edema+5.395×VAS score] ) -1 .The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The

Hydrogeology, water quality, and saltwater intrusion in the Upper Floridan Aquifer in the offshore area near Hilton Head Island, South Carolina, and Tybee Island, Georgia, 1999-2002

USGS Publications Warehouse

Falls, W. Fred; Ransom, Camille; Landmeyer, James E.; Reuber, Eric J.; Edwards, Lucy E.

2005-01-01

To assess the hydrogeology, water quality, and the potential for saltwater intrusion in the offshore Upper Floridan aquifer, a scientific investigation was conducted near Tybee Island, Georgia, and Hilton Head Island, South Carolina. Four temporary wells were drilled at 7, 8, 10, and 15 miles to the northeast of Tybee Island, and one temporary well was drilled in Calibogue Sound west of Hilton Head Island. The Upper Floridan aquifer at the offshore and Calibogue sites includes the unconsolidated calcareous quartz sand, calcareous quartz sandstone, and sandy limestone of the Oligocene Lazaretto Creek and Tiger Leap Formations, and the limestone of the late Eocene Ocala Limestone and middle Avon Park Formation. At the 7-, 10-, and 15-mile sites, the upper confining unit between the Upper Floridan and surficial aquifers correlates to the Miocene Marks Head Formation. Paleochannel incisions have completely removed the upper confining unit at the Calibogue site and all but a 0.8-foot-thick interval of the confining unit at the 8-mile site, raising concern about the potential for saltwater intrusion through the paleochannel-fill sediments at these two sites. The paleochannel incisions at the Calibogue and 8-mile sites are filled with fine- and coarse-grained sediments, respectively. The hydrogeologic setting and the vertical hydraulic gradients at the 7- and 10-mile sites favored the absence of saltwater intrusion during predevelopment. After decades of onshore water use in Georgia and South Carolina, the 0-foot contour in the regional cone of depression of the Upper Floridan aquifer is estimated to have been at the general location of the 7- and 10-mile sites by the mid-1950s and at or past the 15-mile site by the 1980s. The upward vertical hydraulic gradient reversed, but the presence of more than 17 feet of upper confining unit impeded the downward movement of saltwater from the surficial aquifer to the Upper Floridan aquifer at the 7- and 10-mile sites. At the 10

Modeling the Effects of Storm Surge from Hurricane Jeanne on Saltwater Intrusion into the Surficial Aquifer, East-Central Florida (USA)

NASA Astrophysics Data System (ADS)

Xiao, H.; Wang, D.; Hagen, S. C.; Medeiros, S. C.; Hall, C. R.

2017-12-01

Saltwater intrusion (SWI) that has been widely recognized as a detrimental issue causing the deterioration of coastal aquifer water quality and degradation of coastal ecosystems. While it is widely recognized that SWI is exacerbated worldwide due to global sea-level rise, we show that increased SWI from tropical cyclones under climate change is also a concern. In the Cape Canaveral Barrier Island Complex (CCBIC) located in east-central Florida, the salinity level of the surficial aquifer is of great importance to maintain a bio-diverse ecosystem and to support the survival of various vegetation species. Climate change induced SWI into the surficial aquifer can lead to reduction of freshwater storage and alteration of the distribution and productivity of vegetation communities. In this study, a three-dimensional variable-density SEAWAT model is developed and calibrated to investigate the spatial and temporal variation of salinity level in the surficial aquifer of CCBIC. We link the SEAWAT model to surge model data to examine the effects of storm surge from Hurricane Jeanne. Simulation results indicate that the surficial aquifer salinity level increases significantly right after the occurrence of storm surge because of high aquifer permeability and rapid infiltration and diffusion of the overtopping saltwater, while the surficial aquifer salinity level begins to decrease after the fresh groundwater recharge from the storm's rainfall. The tropical storm precipitation generates an effective hydraulic barrier further impeding SWI and providing seaward freshwater discharge for saltwater dilution and flushing. To counteract the catastrophic effects of storm surge, this natural remediation process may take at least 15-20 years or even several decades. These simulation results contribute to ongoing research focusing on forecasting regional vegetation community responses to climate change, and are expected to provide a useful reference for climate change adaptation planning

Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.

PubMed

Mohseni-Bandpei, Mohammad Ali; Nakhaee, Masoomeh; Mousavi, Mohammad Ebrahim; Shakourirad, Ali; Safari, Mohammad Reza; Vahab Kashani, Reza

2014-08-01

Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Soft tissue injury of the lower extremity complicated by type II necrotising fasciitis highlighting the need for astute clinical practices and proper treatment.

PubMed

Sabre, Alexander; Robles, Carlos G; Krisar-White, Patricia; Farricielli, Laurie

2014-06-27

Necrotising fasciitis (NF) is a soft tissue bacterial-derived infection characterised clinically by fulminant tissue destruction of the poorly blood-supplied muscle fascia and overlying subcutaneous fat. Although these infections first appear as minor superficial manifestations, they are capricious in nature and often lead to sepsis, organ failure and high mortality. We report a case of type II necrotising fasciitis in a 39-year-old Caucasian female patient who presented to the emergency department with cellulitis of her right foot and lower leg that rapidly developed into tissue necrosis. The patient course is of unique interest due to progressive history over a 104 days time frame with complications following surgical treatments and outpatient follow-up. We highlight the importance of early detection and pertinent clinical awareness from a wide range of medical specialties that were involved in this case, and how this process is critical, in order to properly diagnose and treat NF-derived tissue infections. 2014 BMJ Publishing Group Ltd.

Soft tissue injury of the lower extremity complicated by type II necrotising fasciitis highlighting the need for astute clinical practices and proper treatment

PubMed Central

Sabre, Alexander; Robles, Carlos G; Krisar-White, Patricia; Farricielli, Laurie

2014-01-01

Necrotising fasciitis (NF) is a soft tissue bacterial-derived infection characterised clinically by fulminant tissue destruction of the poorly blood-supplied muscle fascia and overlying subcutaneous fat. Although these infections first appear as minor superficial manifestations, they are capricious in nature and often lead to sepsis, organ failure and high mortality. We report a case of type II necrotising fasciitis in a 39-year-old Caucasian female patient who presented to the emergency department with cellulitis of her right foot and lower leg that rapidly developed into tissue necrosis. The patient course is of unique interest due to progressive history over a 104 days time frame with complications following surgical treatments and outpatient follow-up. We highlight the importance of early detection and pertinent clinical awareness from a wide range of medical specialties that were involved in this case, and how this process is critical, in order to properly diagnose and treat NF-derived tissue infections. PMID:24973350

The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis.

PubMed

Kuyucu, Ersin; Koçyiğit, Figen; Erdil, Mehmet

2015-09-01

Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Simulation of groundwater flow in the "1,500-foot" sand and "2,000-foot" sand, with scenarios to mitigate saltwater migration in the "2,000-foot" sand of the Baton Rouge area, Louisiana

USGS Publications Warehouse

Heywood, Charles E.; Griffith, Jason M.; Lovelace, John K.

2014-01-01

Groundwater withdrawals have caused saltwater to encroach into freshwater-bearing aquifers beneath Baton Rouge, Louisiana. Groundwater investigations in the 1960s identified a freshwater-saltwater interface located at the Baton Rouge Fault, across which abrupt changes in water levels occur. Aquifers south of the fault generally contain saltwater, and aquifers north of the fault contain freshwater, though limited saltwater encroachment has been detected within 7 of the 10 aquifers north of the fault. The 10 aquifers beneath the Baton Rouge area, which includes East and West Baton Rouge Parishes, Pointe Coupee Parish, and East and West Feliciana Parishes, provided about 167 million gallons per day (Mgal/d) for public supply and industrial use in 2010. Groundwater withdrawals from the “2,000-foot” sand in East Baton Rouge Parish have caused water-level drawdown as great as 356 feet (ft) and induced saltwater movement northward across the fault. Saltwater encroachment threatens industrial wells that are located about 3 miles north of the fault. Constant and variable-density groundwater models were developed with the MODFLOW and SEAWAT groundwater modeling codes to evaluate strategies to control saltwater migration, including changes in the distribution of groundwater withdrawals and installation of “scavenger” wells to intercept saltwater before it reaches existing production wells. Six hypothetical scenarios simulated the effects of different groundwater withdrawal options on groundwater levels within the “1,500-foot” sand and the “2,000-foot” sand and the transport of saltwater within the “2,000-foot” sand during 2008–47. Scenario 1 is considered a base case for comparison to the other five scenarios and simulates continuation of 2007 reported groundwater withdrawals. Scenario 2 simulates discontinuation of withdrawals from seven selected industrial wells located in the northwest corner of East Baton Rouge Parish and predicts that water levels

Assessing impacts of climate change, sea level rise, and drainage canals on saltwater intrusion to coastal aquifer

NASA Astrophysics Data System (ADS)

Rasmussen, P.; Sonnenborg, T. O.; Goncear, G.; Hinsby, K.

2012-07-01

Groundwater abstraction from coastal aquifers is vulnerable to climate change and sea level rise because both may potentially impact saltwater intrusion and hence groundwater quality depending on the hydrogeological setting. In the present study the impacts of sea level rise and changes in groundwater recharge are quantified for an island located in the Western Baltic Sea. Agricultural land dominates the western and central parts of the island, which geologically are developed as push moraine hills and a former lagoon (later wetland area) behind barrier islands to the east. The low-lying central area of the island was extensively drained and reclaimed during the second half of the 19th century. Summer cottages along the beach on the former barrier islands dominate the eastern part of the island. The main water abstraction is for holiday cottages during the summer period (June-August). The water is abstracted from 11 wells drilled to a depth of around 20 m in the upper 5-10 m of a confined chalk aquifer. Increasing chloride concentrations have been observed in several abstraction wells and in some cases the WHO drinking water standard has been exceeded. Using the modeling package MODFLOW/MT3D/SEAWAT the historical, present and future freshwater-sea water distribution is simulated. The model is calibrated against hydraulic head observations and validated against geochemical and geophysical data from new investigation wells, including borehole logs, and from an airborne transient electromagnetic survey. The impact of climate changes on saltwater intrusion is found to be sensitive to the boundary conditions of the investigated system. For the flux-controlled aquifer to the west of the drained area only changes in groundwater recharge impacts the freshwater-sea water interface whereas sea level rise do not result in increasing sea water intrusion. However, on the barrier islands to the east of the reclaimed area below which the sea is hydraulically connected to the

Vacuum-assisted closure as a surgical assistant in life-threatening necrotizing fasciitis in children

PubMed Central

Al-Subhi, FS; Zuker, RM; Cole, WG

2010-01-01

Necrotizing fasciitis is a severe soft tissue infection that can involve skin, subcutaneous fat, fascia and muscle. It can result in devastating sequelae including tissue necrosis, sepsis, toxic shock syndrome, cardiopulmonary collapse and death. To control rapidly spreading necrosis, early diagnosis and aggressive surgical treatment with extensive radical debridement of the affected areas is necessary, as well as systemic administration of broad-spectrum antimicrobials and, very often, intensive care support. The subatmospheric negative pressure dressing has been previously used in acute and complex wounds management. The concept of using vacuum-assisted closure dressing as another management component is presented in the current article. PMID:22131841

Complete remission of plantar fasciitis with a gluten-free diet: relationship or just coincidence?

PubMed

Paoloni, Marco; Tavernese, Emanuela; Ioppolo, Francesco; Fini, Massimo; Santilli, Valter

2014-09-01

We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To the best of our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Progress report on studies of salt-water encroachment on Long Island, New York, 1953

USGS Publications Warehouse

Lusczynski, N.J.; Upson, J.E.

1954-01-01

Nearly all the water used on Long Island, N. Y., is derived by wells from the thick and extensive water-bearing formations that underlie and compose the entire island. The unconsolidated deposits, consisting of sand, gravel, and clay, range in thickness from a few feet in northern Queens County to more than 2,000 feet in southern Suffolk County. Four main and relatively distinct aquifers, all interconnected hydraulically to a greater or lesser degree, have been recognized and delineated at least in a general way. They are, from younger to older, the upper Pleistocene deposits, in which the ground water is mainly unconfined, and three formations in which the water is generally confined - the Jameco gravel, of Pleistocene age, and the Magothy (?) formation and the Lloyd sand member of the Rartian formation, both of Lake Cretaceous age. Except for some artificial recharge, these aquifers are replenished entirely by infiltration of precipitation. Under natural conditions, the fresh water moves into and through the formations, discharging into the sea. With the growth of population on Long Island and the continuously increasing use of water over the years, not only has the infiltration of precipitation been seriously impeded at places, but the withdrawals from the ground-water reservoir have increased markedly. These factors have upset the natural balance between the fresh surface and ground water of the island and the surrounding sea water, and with increased use of water will do so more and more, thus leading to salt-water encroachment. In a sense, the whole problem of utilization of ground water on Long Island is one of determining how much ground water can be withdrawn without serious salt-water encroachment.

Correlation between computerised findings and Newman's scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis

PubMed Central

Chen, H; Ho, H M; Ying, M; Fu, S N

2012-01-01

Objectives The purpose of this study was to correlate findings on small vessel vascularity between computerised findings and Newman's scaling using power Doppler ultrasonography (PDU) imaging and its predictive value in patients with plantar fasciitis. Methods PDU was performed on 44 patients (age range 30–66 years; mean age 48 years) with plantar fasciitis and 46 healthy subjects (age range 18–61 years; mean age 36 years). The vascularity was quantified using ultrasound images by a customised software program and graded by Newman's grading scale. Vascular index (VI) was calculated from the software program as the ratio of the number of colour pixels to the total number of pixels within a standardised selected area of proximal plantar fascia. The 46 healthy subjects were examined on 2 occasions 7–10 days apart, and 18 of them were assessed by 2 examiners. Statistical analyses were performed using intraclass correlation coefficient and linear regression analysis. Results Good correlation was found between the averaged VI ratios and Newman's qualitative scale (ρ = 0.70; p<0.001). Intratester and intertester reliability were 0.89 and 0.61, respectively. Furthermore, higher VI was correlated with less reduction in pain after physiotherapeutic intervention. Conclusions The computerised VI not only has a high level of concordance with the Newman grading scale but is also reliable in reflecting the vascularity of proximal plantar fascia, and can predict pain reduction after intervention. This index can be used to characterise the changes in vascularity of patients with plantar fasciitis, and it may also be helpful for evaluating treatment and monitoring the progress after intervention in future studies. PMID:22167513

Modification of saltwater stress response in Cyprinus carpio (Linnaeus, 1758) pre-exposed to pesticide indoxacarb.

PubMed

Ghelichpour, Melika; Taheri Mirghaed, Ali; Mirzargar, Seyed Saeed; Joshaghani, Hamidreza; Ebrahimzadeh Mousavi, Hoseinali

2018-01-01

To evaluate the effects of indoxacarb on saltwater stress response in Cyprinus carpio, the fish were pre-exposed to indoxacarb (0, 0.75, 1.5 and 3mg/L denoted as CP, 0.75IT, 1.5IT and 3IT, respectively) for 21 days and then released to saltwater. A negative control (CN) group was included (the fish were held in indoxacarb-free water for the entire experiment). The fish were sampled immediately (0h) and 24, 48 and 72h after the salinity exposure for the analysis of plasma cortisol, glucose and sodium, chloride, potassium and calcium levels. All fish pre-exposed to 3mg/L indoxacarb, died after the first day of salinity challenge. CP showed typical cortisol response after the salinity challenge, but, cortisol response of the fish pre-exposed to indoxacarb (0.75IT and 1.5IT) was blocked. Plasma glucose increased significantly in all groups compared to the CN; however, this elevation had no consistent trend in 0.75IT and 1.5IT which indicated interference in glucose response due to indoxacarb exposure. Plasma sodium increased (compared to CN) in all groups after the salinity challenge. However, elevation in plasma chloride and potassium was significantly different among the groups and the indoxacarb-treated fish showed slightly sooner ionic disturbance. The results clearly indicate that indoxacarb impairs stress response of C. carpio and the fish may not be able to respond normally to additional stressors, which threatens their survival. Copyright © 2017 Elsevier Inc. All rights reserved.

A conceptual framework and monitoring strategy for movement of saltwater in the coastal plain aquifer system of Virginia

USGS Publications Warehouse

Mcfarland, E. Randolph

2015-09-04

The saltwater-movement monitoring strategy is limited and constrained. Relative monitoring needs among groundwater-production wells, and construction of observation wells, depend on the accuracy of previously mapped groundwater chloride iso-concentration surfaces. Production wells in similar proximity to saltwater can differ in aquifer hydraulic conductivity, rates of withdrawal, and screened-interval lengths. Only production wells making withdrawals reported to the Virginia Department of Environmental Quality have been accounted for; undocumented production wells can result in spurious changes in groundwater chloride concentration. Upconing observation wells should be as close as possible to corresponding production wells, so long as production wells are not damaged by borehole deviation. Projected locations of some lateral-intrusion observation wells may be precluded and require adjustment. Depths of upconing and lateral-intrusion observation wells may also require adjustment to be within the same aquifer as their corresponding production wells. Existing unused wells can be adapted as observation wells if differences from specified locations and construction are kept to a minimum and are accounted for. Where multiple production wells are in proximity, a modified monitoring approach may be needed to determine their net effect on changes in chloride concentration, and may require more than one lateral-intrusion observation well depending on the vertical positions of production-well screened intervals.

Application of the top specified boundary layer (TSBL) approximation to initial characterization of an inland aquifer mineralization 1. Direct contact between fresh and saltwater

USGS Publications Warehouse

Rubin, H.; Buddemeier, R.W.

1998-01-01

This paper presents a basic study in generalized terms that originates from two needs: (1) to understand the major mechanisms involved in the mineralization of groundwater of the Great Bend Prairie aquifer of Kansas by saltwater originating from a deeper Permian bedrock formation, and (2) to develop simple, robust tools that can readily be used for local assessment and management activities in the salt-affected region. A simplified basic conceptual model is adopted, incorporating two horizontal layers of porous medium which come into contact at a specific location within the model domain. The top layer is saturated with freshwater, and the bottom layer is saturated with saltwater. The paper considers various stages of approximation which can be useful for simplified simulation of the build-up of the transition zone (TZ) between the freshwater and the saltwater. The hierarchy of approximate approaches leads to the development of the top specified boundary layer (TSBL) method, which is the major tool used in this study for initial characterization of the development of the TZ. It is shown that the thickness of the TZ is mainly determined by the characteristic dispersivity. The build-up of the TZ is completed after a time period equal to the time needed to advect a fluid particle along the whole extent of the TZ. Potential applications and the effects of natural recharge and pumpage on salinity transport in the domain are discussed and evaluated in the context of demonstrating the practicality of the TSBL approach.

Application and evaluation of electromagnetic methods for imaging saltwater intrusion in coastal aquifers: Seaside Groundwater Basin, California

USGS Publications Warehouse

Nenna, Vanessa; Herckenrather, Daan; Knight, Rosemary; Odlum, Nick; McPhee, Darcy

2013-01-01

Developing effective resource management strategies to limit or prevent saltwater intrusion as a result of increasing demands on coastal groundwater resources requires reliable information about the geologic structure and hydrologic state of an aquifer system. A common strategy for acquiring such information is to drill sentinel wells near the coast to monitor changes in water salinity with time. However, installation and operation of sentinel wells is costly and provides limited spatial coverage. We studied the use of noninvasive electromagnetic (EM) geophysical methods as an alternative to installation of monitoring wells for characterizing coastal aquifers. We tested the feasibility of using EM methods at a field site in northern California to identify the potential for and/or presence of hydraulic communication between an unconfined saline aquifer and a confined freshwater aquifer. One-dimensional soundings were acquired using the time-domain electromagnetic (TDEM) and audiomagnetotelluric (AMT) methods. We compared inverted resistivity models of TDEM and AMT data obtained from several inversion algorithms. We found that multiple interpretations of inverted models can be supported by the same data set, but that there were consistencies between all data sets and inversion algorithms. Results from all collected data sets suggested that EM methods are capable of reliably identifying a saltwater-saturated zone in the unconfined aquifer. Geophysical data indicated that the impermeable clay between aquifers may be more continuous than is supported by current models.

Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis.

PubMed

Gurcay, Eda; Kara, Murat; Karaahmet, Ozgur Zeliha; Ata, Ayşe Merve; Onat, Şule Şahin; Özçakar, Levent

We compared the effectiveness of ultrasound (US)-guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p < .001 for all) and FAOS subscale (p < .01 for all) scores had improved at the first and sixth week follow-up visits in both groups. Although the plantar fascia thickness had decreased significantly in both groups at the sixth week (p < .001 for both), the heel pad thickness remained unchanged (p > .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US-guided corticosteroid injections are safe and effective in the short-term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot-related quality of life. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluation of Well Records and Geophysical Logs for Determining the Presence of Freshwater, Saltwater, and Gas Above the Marcellus Shale, South-Central New York

EPA Pesticide Factsheets

Records of water wells in NWIS and records and geophysical logs of gas wells in ESOGIS were evaluated to provide a preliminary determination of the presence of freshwater, saltwater, and gas above the Marcellus Shale in south-central New York.

Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital.

PubMed

Jabbour, Gaby; El-Menyar, Ayman; Peralta, Ruben; Shaikh, Nissar; Abdelrahman, Husham; Mudali, Insolvisagan Natesa; Ellabib, Mohamed; Al-Thani, Hassan

2016-01-01

Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients. A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors). During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population. The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

Necrotizing Fasciitis: How Reliable are the Cutaneous Signs?

PubMed Central

Kiat, Ho Jun; En Natalie, Yap Hui; Fatimah, Lateef

2017-01-01

Necrotizing fasciitis (NF) is a surgical emergency. It is often aggressive and characterized by the rapidly progressive inflammatory infection of the fascia that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissue. As the disease progresses, thrombosis of the affected cutaneous perforators subsequently devascularizes the overlying skin. The course indeed can be a fulminant one. The diagnosis of NF, especially in the early stages, is extremely challenging, and it can be very close in presentation to other skin and subcutaneous tissue infections. The primary site of the pathology is the deep fascia. Necrosis of the tissues and fascia may manifest as erythema without sharp margins, swelling, warmth, shiny, and exquisitely tender areas. Pain out of proportion to physical examination findings may be observed. The subcutaneous tissue may be firm and indurated such that the underlying muscle groups cannot be distinctly palpated. Eventually, as the overlying skin is stripped of its blood supply, skin necrosis ensues and hemorrhagic bullae form. Bacteremia and sepsis invariably develop when the infection is well established. This paper discusses some of issues related to the cutaneous signs found in NF and also provides a review the current, available literature on the subject matter. PMID:29097860

Pediatric cervicofacial necrotizing fasciitis: a case report and review of a 10-year national pediatric database.

PubMed

King, Ericka; Chun, Robert; Sulman, Cecille

2012-04-01

To present a case of a pediatric cervicofacial necrotizing fasciitis (NF), a rapidly progressive infection, and a review of a 10-year pediatric inpatient database. Case report and review. Pediatric intensive care unit. A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code 728.86 (NF), was the inclusion criteria for the Kids' Inpatient Database (KID) in 1997 and 2006. A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from 1997 and 2006, the relative risk of being discharged with NF in 2006 vs 1997 was 1.4 (95% CI, 9.95-2.28). Age at diagnosis of NF was older in 2006 compared with 1997 (11.5 years vs 8.05 years; P < .001). Deaths with a diagnosis of NF increased from 1997 compared with 2006: from 3.9% to 5.4%. In 2006, the odds of death were 15.1 times higher in pediatric discharges with a diagnosis of NF compared with discharges without a diagnosis of NF (P < .001; 95% CI, 9.3-23.1). Even with the advent of new treatments and antibiotics, the incidence and death rates of NF have changed little over the past 10 years. While it is still a rare diagnosis, knowledge and awareness of necrotizing fasciitis with aggressive medical and surgical treatment are still the foundation in disease survival.

Diel use of a saltwater creek by white-tip reef sharks Triaenodon obesus (Carcharhiniformes: Carcharhinidae) in Academy Bay, Galapagos Islands.

PubMed

Peñiaherrera, César; Hearn, Alex R; Kuhn, Angela

2012-06-01

White-tip reef sharks are common inhabitants of the shallow waters surrounding the Galapagos Islands, where several known aggregation sites have become touristic attractions. With the aim to describe site fidelity and residency patterns of the white-tip reef sharks in a saltwater creek, we used the ultrasonic telemetry method. The study was undertaken in a saltwater channel South of Academy Bay, Santa Cruz Island, from May 2008-September 2009. A total of nine transmitters were attached to sharks and ultrasonic receivers were deployed at the inner and outside areas of the creek. From the total of fitted sharks, four lost their transmitters. The results obtained with the remaining sharks showed an elevated use of the inner area of the channel during the day, with more use of the external area during the night. However, none of the sharks were detected at the site every day, suggesting that they may have a number of preferred sites within their home range. More studies are needed to detail the home range and habitat use of this species, and to guide its protection level in the Academy Bay area.

Molecular Epidemiologic Comparison of 2 Unusual Clusters of Group A Streptococcal Necrotizing Fasciitis in Hawaii

PubMed Central

Erdem, Guliz; Ford, Jacqueline M.; Kanenaka, Rebecca Y.; Abe, Lucienne; Yamaga, Karen; Effler, Paul V.

2006-01-01

Two clusters of necrotizing fasciitis (NF) due to group A streptococcus (GAS) were identified on the Hawaiian islands of Kauai and Maui during 1997 and 2002, respectively. The emm gene sequence types and the pulsed-field gel electrophoresis patterns were determined for 6 isolates recovered from patients with NF and for 116 isolates recovered from patients with temporally associated community-acquired GAS infection. No predominant emm type was identified, and the emm types of 64 (52.5%) of the isolates were considered to be uncommon in the continental United States. These findings suggest that unusual emm types might be responsible for invasive GAS infections in patients from Hawaii. PMID:15909276

Multi-channel resistivity investigations of the freshwater-saltwater interface: A new tool to study an old problem

USGS Publications Warehouse

Swarzenski, P.W.; Kruse, S.; Reich, C.; Swarzenski, W.V.

2007-01-01

It has been well established that fresh or brackish groundwater can exist both near and far from shore in many coastal and marine environments. The often permeable nature of marine sediments and the underlying bedrock provides abundant pathways for submarine groundwater discharge. While submarine groundwater discharge as a coastal hydrogeological phenomenon has been widely recognized, only recent advances in both geochemical tracers and geophysical tools have enabled a realistic, systematic quantification of the scales and rates of this coastal groundwater discharge. Here we present multichannel electrical resistivity results using both a time series, stationary cable that has 56 electrodes spaced 2 m apart, as well as a 120 m streaming resistivity cable that has two current-producing electrodes and eight potential electrodes spaced 10 m apart. As the cable position remains fixed in stationary mode, we can examine in high resolution tidal forcing on the freshwater-saltwater interface. Using a boat to conduct streaming resistivity surveys, relatively large spatial transects can be rapidly (travel speed -2-3 knots) acquired in shallow (-1-20 m) waters. Sediment formation factors, used to convert resistivity values to salinity, were calculated from porewater and sediment samples collected during the installation of an offshore well in Tampa Bay, Florida, USA. Here we examine the seabed resistivity from sites within Tampa Bay using both stationary and streaming configurations and discuss their overall effectiveness as a new tool to examine the dynamic nature of the freshwater-saltwater interface.

Saltwater contamination in the managed low-lying farmland of the Venice coast, Italy: An assessment of vulnerability.

PubMed

Da Lio, Cristina; Carol, Eleonora; Kruse, Eduardo; Teatini, Pietro; Tosi, Luigi

2015-11-15

The original morphology and hydrogeology of many low-lying coastlands worldwide have been significantly modified over the last century through river diversion, embankment built-up, and large-scale land reclamation projects. This led to a progressive shifting of the groundwater-surficial water exchanges from naturally to anthropogenically driven. In this human-influenced hydrologic landscape, the saltwater contamination usually jeopardizes the soil productivity. In the coastland south of Venice (Italy), several well log measurements, chemical and isotope analyses have been performed over the last decade to characterize the occurrence of the salt contamination. The processing of this huge dataset highlights a permanent variously-shaped saline contamination up to 20km inland, with different conditions in relation with the various geomorphological features of the area. The results point out the important role of the land reclamation in shaping the present-day salt contamination and reveal the contribution of precipitation, river discharge, lagoon and sea water to the shallow groundwater in the various coastal sectors. Moreover, an original vulnerability map to salt contamination in relation to the farmland productivity has been developed taking into account the electrical conductivity of the upper aquifer in the worst condition, the ground elevation, and the distance from salt and fresh surface water sources. Finally, the study allows highlighting the limit of traditional investigations in monitoring saltwater contamination at the regional scale in managed Holocene coastal environments. Possible improvements are outlined. Copyright © 2015 Elsevier B.V. All rights reserved.

Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis.

PubMed

Chua, Wei Chuan; Mazlan, Mohd Zulfakar; Ali, Saedah; Che Omar, Sanihah; Wan Hassan, Wan Mohd Nazaruddin; Seevaunnantum, S Praveena; Mohd Zaini, Rhendra Hardy; Hassan, Mohd Hasyizan; Muhd Besari, Alwi; Abd Rahman, Zaidah; Salmuna Ayub, Zeti Norfidiyati; Abd Ghani, Sabrina; Yaacob, Normalinda; Wan Rosli, Wan Rosilawati

2017-01-01

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.

Necrotizing Fasciitis: Diagnostic Challenges in a Mute Bedridden Patient with Atypical Laboratory Parameters

PubMed Central

Lohiya, Ghan-Shyam; Tan-Figueroa, Lilia; Krishna, Vijay; Lohiya, Sunita

2012-01-01

A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient's right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C), and leukocytosis (count: 13 × 109/L; was 6.5 × 109/L ten days earlier). Necrotizing fasciitis (NF) was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms. PMID:23197984

Necrotizing fasciitis: diagnostic challenges in a mute bedridden patient with atypical laboratory parameters.

PubMed

Lohiya, Ghan-Shyam; Tan-Figueroa, Lilia; Krishna, Vijay; Lohiya, Sunita

2012-01-01

A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient's right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C), and leukocytosis (count: 13 × 10(9)/L; was 6.5 × 10(9)/L ten days earlier). Necrotizing fasciitis (NF) was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.

Hemoadsorption in a Case of Severe Septic Shock and Necrotizing Fasciitis Caused by Nontraumatic Renal Rupture due to Pyelonephritis with Obstructive Uropathy.

PubMed

Kousoulas, Lampros; Wittel, Uwe; Fichtner-Feigl, Stefan; Utzolino, Stefan

2018-01-01

Nontraumatic renal rupture due to pyelonephritis with obstructive uropathy is an uncommon but life-threatening situation. A 25-year-old female presented to the emergency department with acute worsening of abdominal pain that began four weeks earlier. She was found to have peritonitis, leukocytosis, severe lactic acidosis, and a pronounced anemia and imaging was consistent with nontraumatic renal rupture with retroperitoneal abscess, perforation of the colon, and severe necrotizing fasciitis of the right lower limb. She underwent a right nephrectomy, a right hemicolectomy, surgical debridement of the retroperitoneum, and an upper thigh amputation. Due to severe septic shock and rhabdomyolysis with acute renal failure we performed a combined treatment of hemoadsorption using a Cytosorb hemoadsorber and continuous venovenous hemodialysis (CVVHD). Subsequently the patient recovered and was discharged home with no signs of infections and with normal renal function. We present a case of pyelonephritis with nontraumatic renal rupture leading to necrotizing fasciitis with osteomyelitis of the lower limb. The early treatment of the patient with a Cytosorb hemoadsorber led to a rapid hemodynamic and metabolic stabilization and preservation of the renal function, suggesting that hemoadsorption might be a rescue therapy in patients with severe septic shock and traumatic rhabdomyolysis.

Standardized reference ideogram for physical mapping in the saltwater crocodile (Crocodylus porosus).

PubMed

Dalzell, P; Miles, L G; Isberg, S R; Glenn, T C; King, C; Murtagh, V; Moran, C

2009-01-01

Basic cytogenetic data, such as diploid number and general chromosome morphology, are available for many reptilian species. Here we present a detailed cytogenetic examination of the saltwater crocodile (Crocodylus porosus) karyotype, including the creation of the first fully annotated G-band standard ideogram for any crocodilian species. The C. porosus karyotype contains macrochromosomes and has a diploid number of 34. This study presents a detailed description of each chromosome, permitting unambiguous chromosome identification. The fully annotated standardized C. porosus ideogram provides the backbone to a standard nomenclature system which can be used to accurately identify specific band locations. Seven microsatellite containing fosmid clones were fluorescently labeled and used as fluorescent in situ hybridization (FISH) probes for physical localization. Chromosome locations for each of these FISH probes were successfully assigned, demonstrating the utility of the fully annotated ideogram for genome mapping. Copyright 2010 S. Karger AG, Basel.

The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients' activity level and pain localization

NASA Astrophysics Data System (ADS)

Hanada, M.; Takahashi, M.; Matsuyama, Y.

2017-12-01

In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (P<0.001 in both groups), the degree of improvement in the VAS for pain score in group R was not significantly different from that in group D (P=0.061 ). The VAS for tenderness score also significantly improved in both groups R and D (P<0.001 in both groups), but there was also no significant difference between the degree of improvement in the VAS for tenderness in group R and that in group D (P=0.41 ). However, the degree of improvement in the VAS for pain and VAS for tenderness scores was significantly greater in group E than that in group W (P<0.001, =0.042 , respectively). We concluded that ESWT was effective for treating plantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.

Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial.

PubMed

Mardani-Kivi, Mohsen; Karimi Mobarakeh, Mahmoud; Hassanzadeh, Zabihallah; Mirbolook, Ahmadreza; Asadi, Kamran; Ettehad, Hossein; Hashemi-Motlagh, Keyvan; Saheb-Ekhtiari, Khashayar; Fallah-Alipour, Keyvan

2015-01-01

The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute (<6-week duration) symptomatic plantar fasciitis. Of the 116 eligible patients, 68 were randomized to 2 equal groups of 34 patients, each undergoing either ESWT or CSI. The ESWT method included 2000 impulses with energy of 0.15 mJ/mm(2) and a total energy flux density of 900 mJ/mm(2) for 3 consecutive sessions at 1-week intervals. In the CSI group, 40 mg of methyl prednisolone acetate plus 1 mL of lidocaine 2% was injected into the maximal tenderness point at the inframedial calcaneal tuberosity. The success and recurrence rates and pain intensity measured using the visual analog scale, were recorded and compared at the 3-month follow-up visit. The pain intensity had reduced significantly in all patients undergoing either technique. However, the value and trend of pain reduction in the CSI group was significantly greater than those in the ESWT group (p < .0001). In the ESWT and CSI groups, 19 (55.9%) and 5 (14.7%) patients experienced treatment failure, respectively. Age, gender, body mass index, and recurrence rate were similar between the 2 groups (p > .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Necrotizing fasciitis: The need for urgent surgical intervention and the impact of intravenous drug use.

PubMed

Waldron, Carmel; Solon, Jacqueline Gemma; O'Gorman, Joanne; Humphreys, Hilary; Burke, John Patrick; McNamara, Deborah Ann

2015-08-01

Necrotizing fasciitis (NF) is a relatively rare infection of soft tissues. This study reviewed the epidemiology and pathophysiology of admissions to a tertiary referral hospital over a twelve year period comparing outcomes and findings with international norms and to identify potential areas of change to optimise outcomes. A retrospective review of patients diagnosed with NF from Jan 1st 1999 to Dec 31st 2011 was performed. Patient demographics, risk factors, operative procedures, microbiology results and outcomes were recorded. Comparative analysis was performed. 37 patients were admitted with NF, comprising 30 males and 7 females with a median age of 55 years. The most common site of infection was the perineum (51%). The overall mortality rate was 29% and was significantly associated with age greater than 60 years (p = 0.0018) and the presence of one or more risk factor (p = 0.0046). The number of surgical procedures ranged from one to fifteen with a median length of stay of 35.5 days. There was a significant increase in the number of admissions in 2009-2010 (p < 0.001), coinciding with the emergence of NF in intravenous drug users (IVDU). 43% of patients (n = 16/37) required skin grafting, which was significantly higher in the IVDU group (n = 5/6, p = 0.0232). Necrotizing fasciitis remains a significant life-threatening event. The diversity of causative pathogens emphasises the need for prompt microbiology/infectious diseases consultation. The increased occurrence within the IVDU cohort in this study highlights the need for a heightened level of clinical suspicion in these patients to prompt early surgical intervention. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

The saltwater-freshwater interface in the Tertiary limestone aquifer, southeast Atlantic outer-continental shelf of the U.S.A.

USGS Publications Warehouse

Johnston, R.H.

1983-01-01

Hydrologic testing in an offshore oil well abandoned by Tenneco, Inc., determined the position of the saltwater-freshwater interface in Tertiary limestones underlying the Florida-Georgia continental shelf of the U.S.A. Previous drilling (JOIDES and U.S.G.S. AMCOR projects) established the existence of freshwater far offshore in this area. At the Tenneco well 55 mi. (???88 km) east of Fernandina Beach, Florida, drill-stem tests made in the interval 1050-1070 ft. (320-326 m) below sea level in the Ocala Limestone recovered a sample with a chloride concentration of 7000 mg l-1. Formation water probably is slightly fresher. Pressure-head measurements indicated equivalent freshwater heads of 24-29 ft. (7.3-8.8 m) above sea level. At the coast (Fernandina Beach), a relatively thin transition zone separating freshwater and saltwater occurs at a depth of 2100 ft. (640 m) below sea level. Fifty-five miles (???88 km) offshore, at the Tenneco well, the base of freshwater is ???1100 ft. (???335 m) below sea level. The difference in approximate depth to the freshwater-saltwater transition at these two locations suggests an interface with a very slight landward slope. Assuming the Hubbert interface equation applies here (because the interface and therefore freshwater flow lines are nearly horizontal) the equilibrium depth to the interface should be 40 times the freshwater head above sea level. Using present-day freshwater heads along the coast in the Hubbert equation results in depths to the interface of less than the observed 2100 ft. (640 m). Substituting predevelopment heads in the equation yields depths greater than 2100 ft. (640 m). Thus the interface appears to be in a transient position between the position that would be compatible with present-day heads and the position that would be compatible with predevelopment heads. This implies that some movement of the interface from the predevelopment position has occurred during the past hundred years. The implied movement is

Imaging Saltwater Intrusion Along the Coast of Monterey Bay Using Long-Offset Electrical Resistivity Tomography

NASA Astrophysics Data System (ADS)

Goebel, M.; Knight, R. J.; Pidlisecky, A.

2016-12-01

Coastal regions represent a complex dynamic interface where saltwater intrusion moves seawater landward and groundwater discharge moves freshwater seaward. These processes can have a dramatic impact on water quality, affecting both humans and coastal ecosystems. The ability to map the subsurface distribution of fresh and salt water is a critical step in predicting and managing water quality in coastal regions. This is commonly accomplished using wells, which are expensive and provide point information, which may fail to capture the spatial complexity in subsurface conditions. We present an alternate method for acquiring data, long-offset Electrical Resistivity Tomography (ERT), which is non-invasive, cost effective, and can address the problem of poor spatial sampling. This geophysical method can produce continuous profiles of subsurface electrical resistivity to a depth of 300 m, with spatial resolution on the order of tens of meters. Our research focuses on the Monterey Bay region, where sustained groundwater extraction over the past century has led to significant saltwater intrusion. ERT was acquired along 40 kilometers of the coast using the roll along method, allowing for continuous overlap in data acquisition. Electrodes were spaced every 22.2 m, with a total of 81 electrodes along the 1.8 km active cable length. The data show a complex distribution of fresh and salt water, influenced by geology, groundwater pumping, recharge, and land-use. While the inverted ERT resistivity profiles correspond well with existing data sets and geologic interpretations in the region, the spatial complexity revealed through the ERT data goes beyond what is known from traditional data sources alone. This leads us to conclude that this form of data can be extremely useful in informing and calibrating groundwater flow models, making targeted management decisions, and monitoring changes in subsurface salinities over time.

Vulnerbility of production wells in the Potomac-Raritan-Magothy aquifer system to saltwater intrusion from the Delaware River in Camden, Gloucester, and Salem Counties, New Jersey

USGS Publications Warehouse

Navoy, Anthony S.; Voronin, Lois M.; Modica, Edward

2005-01-01

The Potomac-Raritan-Magothy aquifer system is hydraulically connected to the Delaware River in parts of Camden and Gloucester Counties, New Jersey, and has more limited contact with the river in Salem County, New Jersey. The aquifer system is used widely for water supply, and 122 production wells that are permitted by the New Jersey Department of Environmental Protection to pump more than 100,000 gallons per year in the three counties are within 2 miles of the river. During drought, saltwater may encroach upstream from the Atlantic Ocean and Delaware Bay to areas where the aquifer system is recharged by induced infiltration through the Delaware River streambed. During the drought of the mid-1960's, water with a chloride concentration in excess of potability standards (250 mg/L (milligrams per liter)) encroached into the reach of the river that recharges the aquifer system. The vulnerability of the major production wells in the area to similar saltwater encroachment in the future is a concern to water managers. This vulnerability was evaluated by investigating two scenarios: (1) a one-time recurrence of the conditions approximating those that occurred in the1960's, and (2) the recurrence of those same conditions on an annual basis. Results of ground-water-flow simulation in conjunction with particle tracking and one-dimensional transport analysis indicate that the wells that are most vulnerable to saltwater intrusion are those in the Morris and Delair well fields in Camden County. A single 30-day event during which the concentration of dissolved chloride or sodium exceeds 2,098 mg/L or 407 mg/L, respectively, in the Delaware River would threaten the potability of water from these wells, given New Jersey drinking-water standards of 250 mg/L for dissolved chloride and 50 mg/L for dissolved sodium. This chloride concentration is about six times that observed in the river during the 1960's drought. An annually occurring 1-month event during which the concentrations of

Simulation of groundwater flow pathlines and freshwater/saltwater transition zone movement, Manhasset Neck, Nassau County, New York

USGS Publications Warehouse

Misut, Paul; Aphale, Omkar

2014-01-01

A density-dependent groundwater flow and solute transport model of Manhasset Neck, Long Island, New York, was used to analyze (1) the effects of seasonal stress on the position of the freshwater/saltwater transition zone and (2) groundwater flowpaths. The following were used in the simulation: 182 transient stress periods, representing the historical record from 1920 to 2011, and 44 transient stress periods, representing future hypothetical conditions from 2011 to 2030. Simulated water-level and salinity (chloride concentration) values are compared with values from a previously developed two-stress-period (1905–1944 and 1945–2005) model. The 182-stress-period model produced salinity (chloride concentration) values that more accurately matched the observed salinity (chloride concentration) values in response to hydrologic stress than did the two-stress-period model, and salinity ranged from zero to about 3 parts per thousand (equivalent to zero to 1,660 milligrams per liter chloride). The 182-stress-period model produced improved calibration statistics of water-level measurements made throughout the study area than did the two-stress-period model, reducing the Lloyd aquifer root mean square error from 7.0 to 5.2 feet. Decreasing horizontal and vertical hydraulic conductivities (fixed anisotropy ratio) of the Lloyd and North Shore aquifers by 20 percent resulted in nearly doubling the simulated salinity(chloride concentration) increase at Port Washington observation well N12508. Groundwater flowpath analysis was completed for 24 production wells to delineate water source areas. The freshwater/saltwater transition zone moved toward and(or) away from wells during future hypothetical scenarios.

Unexpected lower testosterone in faster growing farmed saltwater crocodile (Crocodylus porosus) hatchlings.

PubMed

Finger, John W; Thomson, Peter C; Isberg, Sally R

2016-01-15

Agricultural production of the saltwater crocodile (Crocodylus porosus) is an emergent industry in northern Australia with many of the factors affecting production remaining unknown. In this study, we sought to expand upon our previous findings of reference corticosterone and immune function by reporting baseline sex hormone levels [testosterone (TEST) and estradiol (ESTR)] and their association with growth. This was achieved by sampling 253 hatchling crocodiles repeatedly at 3, 6, and 9months of age. Sampling age had a significant effect on both TEST (p<0.001) and ESTR (p<0.001) suggesting climatic/abiotic factors have an influence even in prepubescent crocodiles. Stress, as measured by plasma corticosterone, had no detectable effect on plasma ESTR or TEST levels. Unexpectedly however, TEST was higher in slower-growing crocodiles, which is contrary to what has been reported for the American alligator. ESTR was not associated with growth. Copyright © 2015 Elsevier Inc. All rights reserved.

Dry cupping for plantar fasciitis: a randomized controlled trial.

PubMed

Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

2017-05-01

[Purpose] The purpose of this study was to determine the effects of dry cupping on pain and function of patients with plantar fasciitis. [Subjects and Methods] Twenty-nine subjects (age 15 to 59 years old, 20 females and 9 males), randomly assigned into the two groups (dry cupping therapy and electrical stimulation therapy groups), participated in this study. The research design was a randomized controlled trial (RCT). Treatments were provided to the subjects twice a week for 4 weeks. Outcome measurements included the Visual Analogue Pain Scale (VAS) (at rest, first in the morning, and with activities), the Foot and Ankle Ability Measure (FAAM), the Lower Extremity Functional Scale (LEFS), as well as the pressure pain threshold. [Results]The data indicated that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function significantly in the population tested, as all the 95% Confidence Intervals (CIs) did not include 0 except for the pressure pain threshold. There was no significant difference between the dry cupping therapy and electrical stimulation groups in all the outcome measurements. [Conclusion] These results support that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function in the population tested.

Dry cupping for plantar fasciitis: a randomized controlled trial

PubMed Central

Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

2017-01-01

[Purpose] The purpose of this study was to determine the effects of dry cupping on pain and function of patients with plantar fasciitis. [Subjects and Methods] Twenty-nine subjects (age 15 to 59 years old, 20 females and 9 males), randomly assigned into the two groups (dry cupping therapy and electrical stimulation therapy groups), participated in this study. The research design was a randomized controlled trial (RCT). Treatments were provided to the subjects twice a week for 4 weeks. Outcome measurements included the Visual Analogue Pain Scale (VAS) (at rest, first in the morning, and with activities), the Foot and Ankle Ability Measure (FAAM), the Lower Extremity Functional Scale (LEFS), as well as the pressure pain threshold. [Results]The data indicated that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function significantly in the population tested, as all the 95% Confidence Intervals (CIs) did not include 0 except for the pressure pain threshold. There was no significant difference between the dry cupping therapy and electrical stimulation groups in all the outcome measurements. [Conclusion] These results support that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function in the population tested. PMID:28603360

Hemoadsorption in a Case of Severe Septic Shock and Necrotizing Fasciitis Caused by Nontraumatic Renal Rupture due to Pyelonephritis with Obstructive Uropathy

PubMed Central

Wittel, Uwe; Fichtner-Feigl, Stefan; Utzolino, Stefan

2018-01-01

Background Nontraumatic renal rupture due to pyelonephritis with obstructive uropathy is an uncommon but life-threatening situation. Case Presentation A 25-year-old female presented to the emergency department with acute worsening of abdominal pain that began four weeks earlier. She was found to have peritonitis, leukocytosis, severe lactic acidosis, and a pronounced anemia and imaging was consistent with nontraumatic renal rupture with retroperitoneal abscess, perforation of the colon, and severe necrotizing fasciitis of the right lower limb. She underwent a right nephrectomy, a right hemicolectomy, surgical debridement of the retroperitoneum, and an upper thigh amputation. Due to severe septic shock and rhabdomyolysis with acute renal failure we performed a combined treatment of hemoadsorption using a Cytosorb hemoadsorber and continuous venovenous hemodialysis (CVVHD). Subsequently the patient recovered and was discharged home with no signs of infections and with normal renal function. Conclusion We present a case of pyelonephritis with nontraumatic renal rupture leading to necrotizing fasciitis with osteomyelitis of the lower limb. The early treatment of the patient with a Cytosorb hemoadsorber led to a rapid hemodynamic and metabolic stabilization and preservation of the renal function, suggesting that hemoadsorption might be a rescue therapy in patients with severe septic shock and traumatic rhabdomyolysis. PMID:29854478

Groundwater flow in the transition zone between freshwater and saltwater: a field-based study and analysis of measurement errors

NASA Astrophysics Data System (ADS)

Post, Vincent E. A.; Banks, Eddie; Brunke, Miriam

2018-02-01

The quantification of groundwater flow near the freshwater-saltwater transition zone at the coast is difficult because of variable-density effects and tidal dynamics. Head measurements were collected along a transect perpendicular to the shoreline at a site south of the city of Adelaide, South Australia, to determine the transient flow pattern. This paper presents a detailed overview of the measurement procedure, data post-processing methods and uncertainty analysis in order to assess how measurement errors affect the accuracy of the inferred flow patterns. A particular difficulty encountered was that some of the piezometers were leaky, which necessitated regular measurements of the electrical conductivity and temperature of the water inside the wells to correct for density effects. Other difficulties included failure of pressure transducers, data logger clock drift and operator error. The data obtained were sufficiently accurate to show that there is net seaward horizontal flow of freshwater in the top part of the aquifer, and a net landward flow of saltwater in the lower part. The vertical flow direction alternated with the tide, but due to the large uncertainty of the head gradients and density terms, no net flow could be established with any degree of confidence. While the measurement problems were amplified under the prevailing conditions at the site, similar errors can lead to large uncertainties everywhere. The methodology outlined acknowledges the inherent uncertainty involved in measuring groundwater flow. It can also assist to establish the accuracy requirements of the experimental setup.

Potential consequences of saltwater intrusion associated with Hurricanes Katrina and Rita: Chapter 6C in Science and the storms-the USGS response to the hurricanes of 2005

USGS Publications Warehouse

Steyer, Gregory D.; Perez, Brian C.; Piazza, Sarai C.; Suir, Glenn

2007-01-01

Hurricanes Katrina and Rita pushed salt water from the Gulf of Mexico well inland into freshwater marsh communities in coastal Louisiana. This paper describes the spatial extent of saltwater intrusion and provides an initial assessment of impacts (salt stress) to coastal marsh vegetation communities.

High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

PubMed

Rathleff, M S; Mølgaard, C M; Fredberg, U; Kaalund, S; Andersen, K B; Jensen, T T; Aaskov, S; Olesen, J L

2015-06-01

The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role.

PubMed

El-Menyar, Ayman; Asim, Mohammad; Mudali, Insolvisagan N; Mekkodathil, Ahammed; Latifi, Rifat; Al-Thani, Hassan

2017-03-07

Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to evaluate the prognostic value of LRINEC scoring in NF patients. A retrospective analysis was conducted for patients who were admitted with NF between 2000 and 2013. Based on LRINEC points, patients were classified into (Group 1: LRINEC < 6 and Group 2: LRINEC ≥ 6). The 2 groups were analyzed and compared. Primary outcomes were hospital length of stay, septic shock and hospital death. A total of 294 NF cases were identified with a mean age 50.9 ± 15 years. When compared to Group1, patients in Group 2 were 5 years older (p = 0.009), more likely to have diabetes mellitus (61 vs 41%, p < 0.001), Pseudomonas aeruginosa infection (p = 0.004), greater Sequential Organ Failure Assessment (SOFA) score (11.5 ± 3 vs 8 ± 2, p = 0.001), and prolonged intensive care (median 7 vs 5 days) and hospital length of stay (22 vs 11 days, p = 0.001). Septic shock (37 vs. 15%, p = 0.001) and mortality (28.8 vs. 15.0%, p = 0.005) were also significantly higher in Group 2 patients. Using Receiver operating curve, cutoff LRINEC point for mortality was 8.5 with area under the curve of 0.64. Pearson correlation analysis showed a significant correlation between LRINEC and SOFA scorings (r = 0.51, p < 0.002). Early diagnosis, simplified risk stratification and on-time management are vital to achieve better outcomes in patients with NF. Beside its diagnostic role, LRINEC scoring could predict worse hospital outcomes in patients with NF and simply identify the high-risk patients. However, further prospective studies are needed to support this finding.

Comparison of extracorporeal shock wave therapy with botulinum toxin type A in the treatment of plantar fasciitis.

PubMed

Roca, Bernardino; Mendoza, María A; Roca, Manuel

2016-10-01

To compare the efficacy of extracorporeal shock wave therapy (ESWT) with botulinum toxin type A (BoNT-A) in the treatment of plantar fasciitis (PF). Open label, prospective, randomized study. A total of 72 patients were included. In all participants the median (and interquartile range) of the visual analog scale (VAS) of pain result, when taking the first steps, was 8 (6-9) points before treatment and 6 (4-8) points after treatment (p < 0.001). In the group of patients that received ESWT, the median (and interquartile range) of improvement in the VAS of pain result, when taking the first steps, was 2 (1-4) points, and in the group of patients that received BoNT-A the same result was 1 (0-2) points (p = 0.009). In the group of patients that received ESWT, the median (and interquartile range) of improvement in the Roles and Maudsley scale of pain result was 1 (0-1) points, and in the group of patients that received BoNT-A the same result was 0 (0-1) points (p = 0.006). In a multivariate analysis use of ESWT and lower weight were associated with improvement of pain with treatment in at least one of the three VAS of pain scales used in the study. ESWT was superior to BoNT-A in the control of pain in patients with PF. Implications for Rehabilitation Plantar fasciitis is characterized by pain at the calcaneal origin of the plantar fascia, exacerbated by weight bearing after prolonged periods of rest. Although studies comparing extracorporeal shock wave therapy or botulinum toxin type A to placebo suggest a superiority of the first one, no reliable data exist about it. Extracorporeal shock wave therapy was superior to botulinum toxin type A in the control of pain in patients with PF.

Application of a Silicone Sheet in Negative-Pressure Wound Therapy to Treat an Abdominal Wall Defect after Necrotizing Fasciitis.

PubMed

Shin, Jin Su; Choi, Hwan Jun

2017-01-01

Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel.

Deaths from necrotizing fasciitis in the United States, 2003-2013.

PubMed

Arif, N; Yousfi, S; Vinnard, C

2016-04-01

Necrotizing fasciitis (NF) is a life-threatening infection requiring urgent surgical and medical therapy. Our objective was to estimate the mortality burden of NF in the United States, and to identify time trends in the incidence rate of NF-related mortality. We obtained data from the National Center for Health Statistics, which receives information from death certificates from all states, including demographic information and cause of death. The U.S. Multiple Cause of Death Files were searched from 2003 to 2013 for a listing of NF (ICD-10 code M72.6) as either the underlying or contributing cause of death. We identified a total of 9871 NF-related deaths in the United States between 2003 and 2013, corresponding to a crude mortality rate of 4·8 deaths/1,000,000 person-years, without a significant time trend. Compared to white individuals, the incidence rate of NF-associated death was greater in black, Hispanic, and American Indian individuals, and lower in Asian individuals. Streptococcal infection was most commonly identified in cases where a pathogen was reported. Diabetes mellitus and obesity were more commonly observed in NF-related deaths compared to deaths due to other causes. Racial differences in the incidence of NF-related deaths merits further investigation.

The integration of acetic acid iontophoresis, orthotic therapy and physical rehabilitation for chronic plantar fasciitis: a case study

PubMed Central

Costa, Ivano A; Dyson, Anita

2007-01-01

A 15-year-old female soccer player presented with chronic plantar fasciitis. She was treated with acetic acid iontophoresis and a combination of rehabilitation protocols, ultrasound, athletic taping, custom orthotics and soft tissue therapies with symptom resolution and return to full activities within a period of 6 weeks. She reported no significant return of symptoms post follow-up at 2 months. Acetic acid iontophoresis has shown promising results and further studies should be considered to determine clinical effectiveness. The combination of acetic acid iontophoresis with conservative treatments may promote recovery within a shorter duration compared to the use of one-method treatment approaches. PMID:17885679

High Prevalence of Obesity and Female Gender Among Patients With Concomitant Tibialis Posterior Tendonitis and Plantar Fasciitis.

PubMed

Reb, Christopher W; Schick, Faith A; Karanjia, Homyar N; Daniel, Joseph N

2015-10-01

The link between increased body weight and hindfoot complaints is largely based on correlation to single foot pathology. We retrospectively reviewed 6879 patients with tibialis posterior tendonitis (TPT), plantar fasciitis (PF), or both. Among patients with either TPT or PF, 1 in 11 (9%) had both. We then compared age, gender, and body mass index among these groups. Patients with both diagnoses were neither statistically older nor more obese than patients with single diagnoses. However, they were statistically more female. Given the overall high prevalence of obesity in the study population, we feel these data support the link between obesity and multiple foot pathology. Prognostic, Level IV: Case series. © 2015 The Author(s).

Linking river, floodplain, and vadose zone hydrology to improve restoration of a coastal river affected by saltwater intrusion.

PubMed

Kaplan, D; Muñoz-Carpena, R; Wan, Y; Hedgepeth, M; Zheng, F; Roberts, R; Rossmanith, R

2010-01-01

Floodplain forests provide unique ecological structure and function, which are often degraded or lost when watershed hydrology is modified. Restoration of damaged ecosystems requires an understanding of surface water, groundwater, and vadose (unsaturated) zone hydrology in the floodplain. Soil moisture and porewater salinity are of particular importance for seed germination and seedling survival in systems affected by saltwater intrusion but are difficult to monitor and often overlooked. This study contributes to the understanding of floodplain hydrology in one of the last bald cypress [Taxodium distichum (L.) Rich.] floodplain swamps in southeast Florida. We investigated soil moisture and porewater salinity dynamics in the floodplain of the Loxahatchee River, where reduced freshwater flow has led to saltwater intrusion and a transition to salt-tolerant, mangrove-dominated communities. Twenty-four dielectric probes measuring soil moisture and porewater salinity every 30 min were installed along two transects-one in an upstream, freshwater location and one in a downstream tidal area. Complemented by surface water, groundwater, and meteorological data, these unique 4-yr datasets quantified the spatial variability and temporal dynamics of vadose zone hydrology. Results showed that soil moisture can be closely predicted based on river stage and topographic elevation (overall Nash-Sutcliffe coefficient of efficiency = 0.83). Porewater salinity rarely exceeded tolerance thresholds (0.3125 S m(-1)) for bald cypress upstream but did so in some downstream areas. This provided an explanation for observed vegetation changes that both surface water and groundwater salinity failed to explain. The results offer a methodological and analytical framework for floodplain monitoring in locations where restoration success depends on vadose zone hydrology and provide relationships for evaluating proposed restoration and management scenarios for the Loxahatchee River.

Saltwater movement in the upper Floridan aquifer beneath Port Royal Sound, South Carolina

USGS Publications Warehouse

Smith, Barry S.

1994-01-01

Freshwater for Hilton Head Island, South Carolina, is supplied by withdrawals from the Upper Floridan aquifer. Freshwater for the nearby city of Savannah, Georgia, and for the industry that has grown adjacent to the city, has also been supplied, in part, by withdrawal from the Upper Floridan aquifer since 1885. The withdrawal of ground water has caused water levels in the Upper Floridan aquifer to decline over a broad area, forming a cone of depression in the potentiometric surface of the aquifer centered near Savannah. In 1984, the cone of depression extended beneath Hilton Head Island as far as Port Royal Sound. Flow in the aquifer, which had previously been toward Port Royal Sound, has been reversed, and, as a result, saltwater in the aquifer beneath Port Royal Sound has begun to move toward Hilton Head Island. The Saturated-Unsaturated Transport (SUTRA) model of the U.S. Geological Survey was used for the simulation of density-dependent ground-water flow and solute transport for a vertical section of the Upper Floridan aquifer and upper confining unit beneath Hilton Head Island and Port Royal Sound. The model simulated a dynamic equilibrium between the flow of seawater and freshwater in the aquifer near the Gyben-Herzberg position estimated for the period before withdrawals began in 1885; it simulated reasonable movements of brackish water and saltwater from that position to the position determined by chemical analyses of samples withdrawn from the aquifer in 1984, and it approximated hydraulic heads measured in the aquifer in 1976 and 1984. The solute-transport simulations indicate that the transition zone would continue to move toward Hilton Head Island even if pumping ceased on the island. Increases in existing withdrawals or additional withdrawals on or near Hilton Head Island would accelerate movement of the transition zone toward the island, but reduction in withdrawals or the injection of freshwater would slow movement toward the island, according to the

Comparative NMR studies of diffusional water permeability of red blood cells from different species: XVIII platypus (Ornithorhynchus anatinus) and saltwater crocodile (Crocodylus porosus).

PubMed

Benga, Gheorghe; Chapman, Bogdan E; Cox, Guy C; Kuchel, Philip W

2010-07-01

As part of a programme of comparative measurements of Pd (diffusional water permeability) the RBCs (red blood cells) from an aquatic monotreme, platypus (Ornithorhynchus anatinus), and an aquatic reptile, saltwater crocodile (Crocodylus porosus) were studied. The mean diameter of platypus RBCs was estimated by light microscopy and found to be approximately 6.3 microm. Pd was measured by using an Mn2+-doping 1H NMR (nuclear magnetic resonance) technique. The Pd (cm/s) values were relatively low: approximately 2.1 x 10(-3) at 25 degrees C, 2.5 x 10(-3) at 30 degrees C, 3.4 x 10(-3) at 37 degrees C and 4.5 at 42 degrees C for the platypus RBCs and approximately 2.8 x 10(-3) at 25 degrees C, 3.2 x 10(-3) at 30 degrees C, 4.5 x 10(-3) at 37 degrees C and 5.7 x 10(-3) at 42 degrees C for the crocodile RBCs. In parallel with the low water permeability, the Ea,d (activation energy of water diffusion) was relatively high, approximately 35 kJ/mol. These results suggest that "conventional" WCPs (water channel proteins), or AQPs (aquaporins), are probably absent from the plasma membranes of RBCs from both the platypus and the saltwater crocodile.

Improvement of a Clinical Score for Necrotizing Fasciitis: ‘Pain Out of Proportion’ and High CRP Levels Aid the Diagnosis

PubMed Central

Siegel, Ekkehard; Hanke, Eric; von Stebut, Esther

2015-01-01

Necrotizing fasciitis (NF) is a rare mono-/polymicrobial skin infection that spreads to underlying tissues. NF is quickly progressing and leads to life threatening situations. Immediate surgical debridement together with i.v. antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. We now compared the initial clinical and laboratory presentation of NF and cellulitis in detail to assess if a typical pattern can be identified that aids timely diagnosis of NF and avoidance of fatal outcome. 138 different clinical and laboratory features of 29 NF patients were compared to those of 59 age- and gender matched patients with severe erysipelas requiring a subsequent hospitalization time of ≥10 days. Differences in clinical presentation were not obvious; however, NF patients suffered significantly more often from strong pain. NF patients exhibited dramatically elevated CRP levels (5-fold, p>0.001). The overall laboratory risk indicator for necrotizing fasciitis (LRINEC) score was significantly higher in NF patients as compared to cellulitis. However, a modification of the score (alteration of laboratory parameters, addition of clinical parameters) led to a clear improvement of the score with a higher positive predictive value without losing specificity. In summary, clinical differentiation of NF from cellulitis appears to be hard. ‘Pain out of proportion’ may be an early sign for NF. An improvement of the LRINEC score emphasizing only relevant laboratory and clinical findings as suggested may aid the early diagnosis of NF in the future leading to improvement of disease outcome by enabling rapid adequate therapy. PMID:26196941

Potential effects of deepening the St. Johns River navigation channel on saltwater intrusion in the surficial aquifer system, Jacksonville, Florida

USGS Publications Warehouse

Bellino, Jason C.; Spechler, Rick M.

2013-01-01

The U.S. Army Corps of Engineers (USACE) has proposed dredging a 13-mile reach of the St. Johns River navigation channel in Jacksonville, Florida, deepening it to depths between 50 and 54 feet below North American Vertical Datum of 1988. The dredging operation will remove about 10 feet of sediments from the surficial aquifer system, including limestone in some locations. The limestone unit, which is in the lowermost part of the surficial aquifer system, supplies water to domestic wells in the Jacksonville area. Because of density-driven hydrodynamics of the St. Johns River, saline water from the Atlantic Ocean travels upstream as a saltwater “wedge” along the bottom of the channel, where the limestone is most likely to be exposed by the proposed dredging. A study was conducted to determine the potential effects of navigation channel deepening in the St. Johns River on salinity in the adjacent surficial aquifer system. Simulations were performed with each of four cross-sectional, variable-density groundwater-flow models, developed using SEAWAT, to simulate hypothetical changes in salinity in the surficial aquifer system as a result of dredging. The cross-sectional models were designed to incorporate a range of hydrogeologic conceptualizations to estimate the effect of uncertainty in hydrogeologic properties. The cross-sectional models developed in this study do not necessarily simulate actual projected conditions; instead, the models were used to examine the potential effects of deepening the navigation channel on saltwater intrusion in the surficial aquifer system under a range of plausible hypothetical conditions. Simulated results for modeled conditions indicate that dredging will have little to no effect on salinity variations in areas upstream of currently proposed dredging activities. Results also indicate little to no effect in any part of the surficial aquifer system along the cross section near River Mile 11 or in the water-table unit along the cross

Locational differences in mercury and selenium levels in 19 species of saltwater fish from New Jersey.

PubMed

Burger, Joanna; Jeitner, Christian; Gochfeld, Michael

2011-01-01

Individuals who fish, and their families that ingest self-caught fish, make decisions about where to fish, what type of fish to eat, and the quantity of fish to eat. While federal and state agencies often issue consumption advisories for some fish with high mercury (Hg) concentrations, advisories seldom provide the actual metal levels to the general public. There are few data for most saltwater fish, and even less information on variations in Hg levels in fish within a state or geographical region. The objective of this study was to provide Hg concentrations from 19 species of fish caught in different locations in New Jersey to (1) test the hypothesis that mean metal levels vary geographically, (2) provide this information to individuals who fish these coastal waters, and (3) provide a range of values for risk assessors who deal with saltwater fish exposure in the Northeastern United States. Selenium (Se) was also examined because of its purported moderating effect on the toxicity of Hg. Hg levels showed significant geographical variation for 10 of 14 species that were caught in more than one region of New Jersey, but there were significant locational differences for Se in only 5 of the fish. Mercury levels were significantly lower in fish collected from northern New Jersey (except for ling, Molva molva), compared to other regions. As might be expected, locational differences in Hg levels were greatest for fish species with the highest Hg concentrations (shark, Isurus oxyrinchus; tuna, Thunnus thynnus and T. albacares; striped bass, Morone saxatilis; bluefish, Pomatomus saltatrix). Fishers and their families might reduce their risk from Hg exposure not only by selecting fish generally lower in Hg, but by fishing predominantly in some regions over others, further lowering the potential risk. Health professionals might use these data to advise patients on which fish are safest to consume (in terms of Hg exposure) from particular geographical regions.

LOCATIONAL DIFFERENCES IN MERCURY AND SELENIUM LEVELS IN 19 SPECIES OF SALTWATER FISH FROM NEW JERSEY

PubMed Central

Burger, Joanna; Jeitner, Christian; Gochfeld, Michael

2014-01-01

Individuals who fish, and their families that ingest self-caught fish, make decisions about where to fish, what type of fish to eat, and the quantity of fish to eat. While federal and state agencies often issue consumption advisories for some fish with high mercury (Hg) concentrations, advisories seldom provide the actual metal levels to the general public. There are few data for most saltwater fish, and even less information on variations in Hg levels in fish within a state or geographical region. The objective of this study was to provide Hg concentrations from 19 species of fish caught in different locations in New Jersey to (1) test the hypothesis that mean metal levels vary geographically, (2) provide this information to individuals who fish these coastal waters, and (3) provide a range of values for risk assessors who deal with saltwater fish exposure in the Northeastern United States. Selenium (Se) was also examined because of its purported moderating effect on the toxicity of Hg. Hg levels showed significant geographical variation for 10 of 14 species that were caught in more than one region of New Jersey, but there were significant locational differences for Se in only 5 of the fish. Mercury levels were significantly lower in fish collected from northern New Jersey (except for ling, Molva molva), compared to other regions. As might be expected, locational differences in Hg levels were greatest for fish species with the highest Hg concentrations (shark, Isurus oxyrinchus; tuna, Thunnus thynnus and T. albacares; striped bass, Morone saxatilis; bluefish, Pomatomus saltatrix). Fishers and their families might reduce their risk from Hg exposure not only by selecting fish generally lower in Hg, but by fishing predominantly in some regions over others, further lowering the potential risk. Health professionals might use these data to advise patients on which fish are safest to consume (in terms of Hg exposure) from particular geographical regions. PMID:21598171

Presentations and treatment of childhood scleroderma: localized scleroderma, eosinophilic fasciitis, systemic sclerosis, and graft-versus-host disease.

PubMed

Hedrich, Christian Michael; Fiebig, Barbara; Hahn, Gabriele; Suttorp, Meinolf; Gahr, Manfred

2011-07-01

Juvenile scleroderma is a rare connective tissue disease that involves the skin and subcutaneous tissue. Among all presentations of juvenile scleroderma, localized scleroderma (JLSc) is the most frequent, followed by systemic disease (JSSc) and eosinophilic fasciitis (EF). In posttransplantation chronic graft-versus-host disease (GvHD), scleroderma-like skin involvement can occur. Systemic forms of juvenile scleroderma and GvHD can affect the internal organs, such as the lungs, the gastrointestinal tract, the heart, and kidneys and cause disability and severe, sometimes lethal, complications. Here, the authors give an overview of different presentations of juvenile scleroderma. They report their experience with the different forms and presentations of scleroderma, diagnostic workups, treatment, and outcome of all forms of childhood scleroderma in the context of the existing literature.

Molecular cloning and 3D model of first cytochrome P450 from CYP3A subfamily in saltwater crocodile (Crocodylus porosus).

PubMed

Tabassum, Rabia

2017-10-18

Cytochrome P450s (CYPs) play critical role in oxidative metabolism of numerous xenobiotics and endogenous compounds. The first CYP3A subfamily member in saltwater crocodile has been cloned and modelled for three-dimensional (3D) structure. The full-length cDNA was obtained employing reverse transcription polymerase chain reaction (RT-PCR) strategy and rapid amplification of cDNA ends (RACE). The cDNA sequence of 1659 nucleotides includes 132 nucleotides from 5' untranslated region (UTR), an open reading frame of 1527 nucleotides encoding 509 amino acids designated as CYP3A163. The alignment of CYP3A163 sequence with CYP3A subfamily across the lineages exhibit the loss of 1 residue in birds and 7 residues in mammals in comparison to reptiles suggesting the adaptation processes during evolution. The amino acid identity of CYP3A163 with Alligator mississippiensis CYP3A77 and Homo sapiens CYP3A4 is 91% and 62% respectively. The 3D structure of CYP3A163 modelled using human CYP3A4 structure as a template with Phyre 2 software, represents high similarity with its functionally important motifs and catalytic domain. Both sequence and structure of CYP3A163 display the common and conserved features of CYP3A subfamily. Overall, this study provides primary molecular and structural data of CYP3A163 required to investigate the xenobiotic metabolism in saltwater crocodiles. Copyright © 2017 Elsevier Inc. All rights reserved.

Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to fasciotomy.

PubMed

Weil, Lowell Scott; Roukis, Thomas S; Weil, Lowell Scott; Borrelli, Anthony H

2002-01-01

A review of the history, mechanism of action, and application of extracorporeal shock wave therapy for chronic plantar fasciitis is presented. The results of 40 feet treated with this modality are reviewed after a mean follow-up time of 8.4 months. All procedures were performed under intravenous sedation and local infiltrative anesthesia. An electrohydraulic shock wave with a mean of 20.6 kV combined with a mean of 2,506 pulses was used. The results of a similar demographic class of patients having undergone a percutaneous plantar fasciotomy at our institution were compared to the results of this cohort of shock wave patients. Eighty-two percent of the patients treated with extracorporeal shock wave therapy were successfully treated as compared to 83% with a percutaneous plantar fasciotomy. The mean score on the 11-point visual analog scale for satisfied patients was 7.9 preoperatively and 2.95 within 7 days postoperatively. After 3 months, the mean visual analog score was 4.2 or 50% of the preoperative value after a mean of 8.4 months following treatment. Eighty-three percent of the patients treated stated that shock wave therapy improved their symptoms. There were no complications encountered in any patient in this study. Extracorporeal shock wave therapy is an effective treatment, which significantly reduces the symptoms associated with chronic plantar fasciitis and compares favorably to the results achieved with surgical intervention in the form of a percutaneous plantar fasciotomy.

Integrating Desalination and Energy Storage using a Saltwater-based Hybrid Sodium-ion Supercapacitor.

PubMed

Guo, Zhaowei; Ma, Yuanyuan; Dong, Xiaoli; Hou, Mengyan; Wang, Yonggang; Xia, Yongyao

2018-06-11

Ever-increasing freshwater scarcity and energy crisis problems require efficient seawater desalination and energy storage technologies; however, each target is generally considered separately. Herein, a hybrid sodium-ion supercapacitor, involving a carbon-coated nano-NaTi 2 (PO 4 ) 3 -based battery anode and an activated-carbon-based capacitive cathode, is developed to combine desalination and energy storage in one device. On charge, the supercapacitor removes salt in a flowing saltwater electrolyte through Cl - electrochemical adsorption at the cathode and Na + intercalation at the anode. Discharge delivers useful electric energy and regenerates the electrodes. This supercapacitor can be used not only for energy storage with promising electrochemical performance (i.e., high power, high efficiency, and long cycle life), but also as a desalination device with desalination capacity of 146.8 mg g -1 , much higher than most reported capacitive and battery desalination devices. Finally, we demonstrate renewables to usable electric energy and desalted water through combining commercial photovoltaics and this hybrid supercapacitor. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Systematic review: plantar fasciitis and prolonged weight bearing.

PubMed

Waclawski, E R; Beach, J; Milne, A; Yacyshyn, E; Dryden, D M

2015-03-01

Plantar fasciitis (PF) is one of the most common causes of foot pain. Work can involve factors that may predispose to foot pain. To systematically review the evidence of the association between weight bearing (walking or standing) and PF among workers. Literature search of relevant indexing databases from inception to May 2012, grey literature, websites of relevant organizations and reference lists for all identified articles. Two reviewers independently selected studies for full review, assessed methodological quality and graded evidence. Findings were summarized qualitatively. Four studies were included; all were assessed as high or unclear risk of bias. Three studies were case-control studies; two used clinic populations and one used volunteers. The other study was cross-sectional involving the workforce of an assembly plant. A number of associations between PF and risk factors were identified including sex, obesity, foot biomechanics and job factors (e.g. job tenure). Two case-control studies and the cross-sectional study found an association with weight bearing, but the assessment of weight bearing varied (e.g. time on feet, time walking or standing). There was low-quality evidence to confirm a causal relationship (Royal College of General Practitioners (RCGP) * grade). This systematic review found low-quality evidence of an association between PF and weight-bearing tasks such as walking and standing on hard surfaces. The only occupations specifically identified as having higher risk were those associated with the engine assembly plant. Further research is required to fully determine the association between weight bearing and PF. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Necrotizing fasciitis of the hand and forearm : Acute surgical treatment and defect reconstruction with MatriDerm® and split-thickness skin graft].

PubMed

Niedermueller, B; Singer, G; Pickl, P; Jesacher, M

2018-03-01

This case report describes a 55-year-old male patient with type II necrotizing fasciitis (NF) of the hand and forearm. The rapid progression of the tissue infection could be successfully stopped with radical surgical débridement and antibiotic therapy. For the reconstruction of the extensive loss of soft tissue a combination of split-thickness skin graft (STSG) and the synthetic dermal substitute MatriDerm® was used. In cases of NF, MatriDerm® and STSG provide a rapidly available and simple alternative to other reconstruction techniques.

Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review

PubMed Central

Petraglia, Federica; Ramazzina, Ileana; Costantino, Cosimo

2017-01-01

Summary Background: Plantar fasciitis (PF) is reported in different sports mainly in running and soccer athletes. Purpose of this study is to conduct a systematic review of published literature concerning the diagnosis and treatment of PF in both recreational and élite athletes. The review was conducted and reported in accordance with the PRISMA statement. Methods: The following electronic databases were searched: PubMed, Cochrane Library and Scopus. As far as PF diagnosis, we investigated the electronic databases from January 2006 to June 2016, whereas in considering treatments all data in literature were investigated. Results: For both diagnosis and treatment, 17 studies matched inclusion criteria. The results have highlighted that the most frequently used diagnostic techniques were Ultrasonography and Magnetic Resonance Imaging. Conventional, complementary, and alternative treatment approaches were assessed. Conclusions: In reviewing literature, we were unable to find any specific diagnostic algorithm for PF in athletes, due to the fact that no different diagnostic strategies were used for athletes and non-athletes. As for treatment, a few literature data are available and it makes difficult to suggest practice guidelines. Specific studies are necessary to define the best treatment algorithm for both recreational and élite athletes. Level of evidence: Ib. PMID:28717618

Necrotizing fasciitis after scrotum skin injury in an infant: A case report.

PubMed

Ren, Z X; Liu, C L; Zhang, Q; Xu, F; Zheng, Y N; Li, X J; Yang, J

2018-03-01

Necrotizing fasciitis (NF) is a life-threatening situation that is rare in children, especially infants, and early diagnosis is challenging. Timely identification and broad-spectrum antibiotic and supportive treatment before surgical debridement are very important for survival and may reduce scar formation. A previously healthy 4-month-old infant was admitted to our pediatric intensive care unit (PICU) with a history of fever and cough for 5 days and extreme swelling of the scrotum for one day. Necrotic-like tissue without margins appeared on his scrotum and perineum in 24 hours. NF was suspected, and the patient soon developed shock. The patient underwent surgical debridement after his condition stabilized. Pathological analysis confirmed the diagnosis of NF. Broad-spectrum antibiotic, immediate fluid resuscitation, assistant ventilation, and vasoactive drugs were administered. Surgical debridement and autologous split-thickness skin grafting were performed. The wound recovered well after 2 months. Ultrasound revealed normal testicles, and no anorectal injury was found. Close clinical monitoring and timely treatment of skin injuries in sick children are very important. Sufficient antibiotic administration and supportive treatment before surgical debridement are crucial for survival from NF.

Combined use of frequency‐domain electromagnetic and electrical resistivity surveys to delineate the freshwater/saltwater interface near saline lakes in the Nebraska Sand Hills, Nebraska, USA

USGS Publications Warehouse

Ong, John T.; White, Eric A.; Lane, John W.; Halihan, Todd; Zlotnik, Vitaly A; Butler, Dwain K.

2009-01-01

We investigate the use of frequency‐domain electromagnetic (FDEM) and electrical resistivity (ER) surveys for rapid and detailed characterization of the direction of lake‐aquifer fluxes and the configuration of salt plumes generated from saline lakes. This methodology was developed and applied at several lakes in the Nebraska Sand Hills, Nebraska, in an area with both freshwater and saline lakes hydraulically connected to the freshwater surficial aquifer. The FDEM survey was conducted by mounting the instrument on a fiberglass cart towed by an all‐terrain vehicle. The towed FDEM surveys covered about 25 km per day and served as a reconnaissance method for choosing locations for the more quantitative and detailed ER surveys. Around the saline lakes, areas with high electrical conductivity are consistent with the regional direction of ground‐water flow. Lower electrical conductivity was measured around the freshwater lakes with anomalies correlating to a paleovalley axis inferred from previous studies. The efficacy of this geophysical approach is attributed to: (1) significant contrast in electrical conductivity between freshwater and saltwater, (2) near‐surface location of the freshwater/saltwater interface, (3) minimal cultural interference, and (4) relative homogeneity of the aquifer materials.

Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

PubMed

Shah, Amit; Best, Alistair J; Rennie, Winston J

2016-06-01

Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach. © 2016 by the American Institute of Ultrasound in Medicine.

Genome-wide QTL mapping of saltwater tolerance in sibling species of Anopheles (malaria vector) mosquitoes

PubMed Central

Smith, H A; White, B J; Kundert, P; Cheng, C; Romero-Severson, J; Andolfatto, P; Besansky, N J

2015-01-01

Although freshwater (FW) is the ancestral habitat for larval mosquitoes, multiple species independently evolved the ability to survive in saltwater (SW). Here, we use quantitative trait locus (QTL) mapping to investigate the genetic architecture of osmoregulation in Anopheles mosquitoes, vectors of human malaria. We analyzed 1134 backcross progeny from a cross between the obligate FW species An. coluzzii, and its closely related euryhaline sibling species An. merus. Tests of 2387 markers with Bayesian interval mapping and machine learning (random forests) yielded six genomic regions associated with SW tolerance. Overlap in QTL regions from both approaches enhances confidence in QTL identification. Evidence exists for synergistic as well as disruptive epistasis among loci. Intriguingly, one QTL region containing ion transporters spans the 2Rop chromosomal inversion that distinguishes these species. Rather than a simple trait controlled by one or a few loci, our data are most consistent with a complex, polygenic mode of inheritance. PMID:25920668

Subacute Peristomal Necrotizing Fasciitis Detected During Adjuvant Chemotherapy for Adenocarcinoma Rectum: Case Report on a Unique Presentation and Description of a Simple Surgical Strategy for Treatment.

PubMed

Ahmad, Humaid; Haider, Jahanzaib; Siddiqui, Sheeraz S; Naz, Sumbul; Nihal, Faizan; Alam, Shams Nadeem

2018-01-16

Necrotizing fasciitis (NF) is a rare entity with its subacute form being even rarer. The condition has also been described to occur in the peristomal area in relation to different clinical scenarios. However, it has not been described in the setting of adjuvant chemotherapy where these medications have already been given. While the diagnosis may be delayed or missed due to the subtle symptomatology of the indolent subacute form of NF, another reason for a delayed or missed diagnosis may be the excessive use of tape and the stoma belt around the stomal appliance to prolong the life of the appliance beyond its recommended days of usage due to economic constraints. This, in turn, covers a larger area around the peristomal skin and developing skin changes associated with necrotizing fasciitis. Despite the less aggressive presentation of the subacute form, it may still represent a unique surgical challenge in this setting, as the chemotherapy-induced neutropenia bound to occur a few days after the chemotherapy may expose the patient to serious complications at that time. As such, the surgical plan at the time of presentation may become the determinant of morbidity and mortality. Here, a case is presented of a young patient who underwent abdominoperineal resection for stage III adenocarcinoma of the rectum. He was referred to us on the day of the fourth cycle of adjuvant chemotherapy by the oncology service where he had received part of his chemotherapy regimen. On presentation, he was found to be having significant skin changes in the peristomal area consistent with necrotizing fasciitis despite being clinically stable. The authors present this unique case as a study from which many lessons can be learned. They also explain the thought process behind a well-planned but simple surgical strategy that was implemented with a successful patient outcome. In addition to describing this surgical strategy, the case report is concluded by highlighting some factors that

Quantitative analysis of production traits in saltwater crocodiles (Crocodylus porosus): II. age at slaughter.

PubMed

Isberg, S R; Thomson, P C; Nicholas, F W; Barker, S G; Moran, C

2005-12-01

Crocodile morphometric (head, snout-vent and total length) measurements were recorded at three stages during the production chain: hatching, inventory [average age (+/-SE) is 265.1 +/- 0.4 days] and slaughter (average age is 1037.8 +/- 0.4 days). Crocodile skins are used for the manufacture of exclusive leather products, with the most common-sized skin sold having 35-45 cm in belly width. One of the breeding objectives for inclusion into a multitrait genetic improvement programme for saltwater crocodiles is the time taken for a juvenile to reach this size or age at slaughter. A multivariate restricted maximum likelihood analysis provided (co)variance components for estimating the first published genetic parameter estimates for these traits. Heritability (+/-SE) estimates for the traits hatchling snout-vent length, inventory head length and age at slaughter were 0.60 (0.15), 0.59 (0.12) and 0.40 (0.10) respectively. There were strong negative genetic (-0.81 +/- 0.08) and phenotypic (-0.82 +/- 0.02) correlations between age at slaughter and inventory head length.

Saltwater intrusion in the Floridan aquifer system near downtown Brunswick, Georgia, 1957–2015

USGS Publications Warehouse

Cherry, Gregory S.; Peck, Michael

2017-02-16

IntroductionThe Floridan aquifer system (FAS) consists of the Upper Floridan aquifer (UFA), an intervening confining unit of highly variable properties, and the Lower Floridan aquifer (LFA). The UFA and LFA are primarily composed of Paleocene- to Oligocene-age carbonate rocks that include, locally, Upper Cretaceous rocks. The FAS extends from coastal areas in southeastern South Carolina and continues southward and westward across the coastal plain of Georgia and Alabama, and underlies all of Florida. The thickness of the FAS varies from less than 100 feet (ft) in aquifer outcrop areas of South Carolina to about 1,700 ft near the city of Brunswick, Georgia.Locally, in southeastern Georgia and the Brunswick– Glynn County area, the UFA consists of an upper water-bearing zone (UWBZ) and a lower water-bearing zone (LWBZ), as identified by Wait and Gregg (1973), with aquifer test data indicating the upper zone has higher productivity than the lower zone. Near the city of Brunswick, the LFA is composed of two permeable zones: an early middle Eocene-age upper permeable zone (UPZ) and a highly permeable lower zone of limestone (LPZ) of Paleocene and Late Cretaceous age that includes a deeply buried, cavernous, saline water-bearing unit known as the Fernandina permeable zone. Maslia and Prowell (1990) inferred the presence of major northeast–southwest trending faults through the downtown Brunswick area based on structural analysis of geophysical data, northeastward elongation of the potentiometric surface of the UFA, and breaches in the local confining unit that influence the area of chloride contamination. Pronounced horizontal and vertical hydraulic head gradients, caused by pumping in the UFA, allow saline water from the FPZ to migrate upward into the UFA through this system of faults and conduits.Saltwater was first detected in the FAS in wells completed in the UFA near the southern part of the city of Brunswick in late 1957. By the 1970s, a plume of groundwater

Dissolved Strontium and Barium in Fresh and Saltwater: a 2-year Study in the Calcasieu River to the Gulf of Mexico

NASA Astrophysics Data System (ADS)

He, S.; Xu, Y. J.

2016-02-01

Strontium and barium to calcium ratios are often used as proxies for tracking animal movement across salinity gradients. As sea level rise continues, many estuarine rivers face saltwater intrusion, which may cause changes in mobility and distribution of these metals upstream. Despite intensive research on metal adsorption and desorption in marine systems, knowledge of the spatiotemporal distribution of these elements along estuarine rivers is still limited. In this study, we conducted an intensive monitoring of Sr and Ba dynamics along an 88-km long estuary, the Calcasieu River, which has been strongly affected by saltwater intrusion. Over the period from May 2013 to July 2015, we collected monthly water samples and performed in-situ water quality measurements at six sites from the upstream to the river mouth. Water samples were analyzed for dissolved Sr, Ba, and Ca concentrations. In-situ measurements of salinity, pH, water temperature, dissolved oxygen concentration, and specific conductance were taken. Our preliminary data showed that the Sr and Ca concentrations and the Sr/Ca ratio all increased significantly with decreasing distance to the Gulf of Mexico, while the Ba/Ca ratio decreased with decreasing distance to the Gulf. The spatial variation in Ba concentration was marginal. The Sr and Ca concentrations and ratios were positively related to salinity, while Ba/Ca was negatively related to salinity. All the elemental concentrations and ratios had considerable seasonal and interannual variations. There were significant differences among sampling months for all the elemental concentrations and ratios (p<0.05), and there were significant differences among sampling years for the Sr and Ca concentrations and the Ba/Ca ratio (p<0.05).

Groundwater salinity in a floodplain forest impacted by saltwater intrusion

NASA Astrophysics Data System (ADS)

Kaplan, David A.; Muñoz-Carpena, Rafael

2014-11-01

Coastal wetlands occupy a delicate position at the intersection of fresh and saline waters. Changing climate and watershed hydrology can lead to saltwater intrusion into historically freshwater systems, causing plant mortality and loss of freshwater habitat. Understanding the hydrological functioning of tidally influenced floodplain forests is essential for advancing ecosystem protection and restoration goals, however finding direct relationships between hydrological inputs and floodplain hydrology is complicated by interactions between surface water, groundwater, and atmospheric fluxes in variably saturated soils with heterogeneous vegetation and topography. Thus, an alternative method for identifying common trends and causal factors is required. Dynamic factor analysis (DFA), a time series dimension reduction technique, models temporal variation in observed data as linear combinations of common trends, which represent unexplained common variability, and explanatory variables. DFA was applied to model shallow groundwater salinity in the forested floodplain wetlands of the Loxahatchee River (Florida, USA), where altered watershed hydrology has led to changing hydroperiod and salinity regimes and undesired vegetative changes. Long-term, high-resolution groundwater salinity datasets revealed dynamics over seasonal and yearly time periods as well as over tidal cycles and storm events. DFA identified shared trends among salinity time series and a full dynamic factor model simulated observed series well (overall coefficient of efficiency, Ceff = 0.85; 0.52 ≤ Ceff ≤ 0.99). A reduced multilinear model based solely on explanatory variables identified in the DFA had fair to good results (Ceff = 0.58; 0.38 ≤ Ceff ≤ 0.75) and may be used to assess the effects of restoration and management scenarios on shallow groundwater salinity in the Loxahatchee River floodplain.

Groundwater salinity in a floodplain forest impacted by saltwater intrusion.

PubMed

Kaplan, David A; Muñoz-Carpena, Rafael

2014-11-15

Coastal wetlands occupy a delicate position at the intersection of fresh and saline waters. Changing climate and watershed hydrology can lead to saltwater intrusion into historically freshwater systems, causing plant mortality and loss of freshwater habitat. Understanding the hydrological functioning of tidally influenced floodplain forests is essential for advancing ecosystem protection and restoration goals, however finding direct relationships between hydrological inputs and floodplain hydrology is complicated by interactions between surface water, groundwater, and atmospheric fluxes in variably saturated soils with heterogeneous vegetation and topography. Thus, an alternative method for identifying common trends and causal factors is required. Dynamic factor analysis (DFA), a time series dimension reduction technique, models temporal variation in observed data as linear combinations of common trends, which represent unexplained common variability, and explanatory variables. DFA was applied to model shallow groundwater salinity in the forested floodplain wetlands of the Loxahatchee River (Florida, USA), where altered watershed hydrology has led to changing hydroperiod and salinity regimes and undesired vegetative changes. Long-term, high-resolution groundwater salinity datasets revealed dynamics over seasonal and yearly time periods as well as over tidal cycles and storm events. DFA identified shared trends among salinity time series and a full dynamic factor model simulated observed series well (overall coefficient of efficiency, Ceff=0.85; 0.52≤Ceff≤0.99). A reduced multilinear model based solely on explanatory variables identified in the DFA had fair to good results (Ceff=0.58; 0.38≤Ceff≤0.75) and may be used to assess the effects of restoration and management scenarios on shallow groundwater salinity in the Loxahatchee River floodplain. Copyright © 2014 Elsevier B.V. All rights reserved.

Articular nodular fasciitis of the right shoulder joint: report of an unusual case with focus on immunohistochemical differential diagnosis.

PubMed

Tajima, Shogo; Zuki, Tomoyukisu; Koda, Kenji

2015-01-01

The mesenchymal lesion nodular fasciitis (NF) can affect various sites of the body but usually arises in subcutaneous tissue or occasionally skeletal muscle. NF is not commonly known to arise in joints, and articular NF is extremely rare. Herein, we present a case of a 54-year-old woman with articular NF. No sign of recurrence was observed after surgical piecemeal removal with a suspected positive surgical margin. In our case, a differential diagnosis of NF, desmoid-type fibromatosis, and low-grade myofibroblastic sarcoma was considered. Stromal hyalinization, a characteristic of articular NF, made the diagnosis somewhat difficult, although typical NF morphology was present. Immunohistochemical analysis of α-smooth muscle actin, desmin, β-catenin, and protein gene product 9.5 expression along with close morphological examination provided a reliable distinction.

Alcohol use disorder increases the risk of necrotizing fasciitis

PubMed Central

Yii, Yong-Cheng; Hsieh, Vivian Chia-Rong; Lin, Cheng-Li; Wang, Yu-Chiao; Chen, Wei-Kung

2017-01-01

Abstract This nationwide retrospective cohort study determined the association between alcohol use disorder (AUD) and the risk of necrotizing fasciitis (NF). This study used health insurance claims data of 52,212 in-patients with AUD and 208,848 controls randomly frequency-matched by age and sex at a 1:4 ratio. The AUD cohort included patients newly diagnosed with AUD between January 1, 2000 and December 31, 2008. The NF event occurrence was observed until December 31, 2011. We used the Kaplan–Meier method to present the cumulative incidence curve and Cox proportional hazard models to depict the risk of NF in patients with AUD. The incidence of NF was 19.4 per 10,000 person-years in the AUD cohort, which was nearly 7.73-fold higher than that in the comparison cohort (2.54 per 10,000 person-years). After adjustment for age, sex, and comorbidities, the patients with AUD exhibited a 3.55-fold higher risk of NF than did the controls (hazard ratio [HR] = 3.55, 95% confidence interval [CI] = 3.00–4.20). Nevertheless, in the AUD groups without any comorbidity, patients with AUD exhibited a significant 15.2-fold higher risk of NF than did the comparison cohort (HR = 15.2, 95% CI = 10.9–21.3). Moreover, the adjusted HRs of NF risk with respect to the severity of AUD were 2.15 (95% CI = 1.76–2.62), 4.54 (95% CI = 3.67–5.62), and 10.7 (95% CI = 8.66–13.2) for mild, moderate, and severe AUD, respectively. This study indicated that AUD should be considered an independent and significant risk factor for NF. PMID:28796035

Pathology of runting in farmed saltwater crocodiles (Crocodylus porosus) in Australia.

PubMed

Shilton, C; Brown, G P; Chambers, L; Benedict, S; Davis, S; Aumann, S; Isberg, S R

2014-09-01

Extremely poor growth of some individuals within a birth cohort (runting) is a significant problem in crocodile farming. We conducted a pathological investigation to determine if infectious disease is associated with runting in farmed saltwater crocodiles (Crocodylus porosus) and to look for evidence of other etiologies. In each of 2005 and 2007, 10 normal and 10 runt crocodiles, with an average age of 5.5 months and reared under identical conditions, were sampled. Laboratory testing included postmortem; histological examination of a wide variety of tissues (with quantitation of features that were noted subjectively to be different between groups); hematology; serum biochemistry (total protein, albumin, globulins, total calcium, phosphorus, and iron); bacterial culture of liver and spleen (2005 only); viral culture of liver, thymus, tonsil, and spleen using primary crocodile cell lines (2007 only); and serum corticosterone (2007 only). The only evidence of infectious disease was mild cutaneous poxvirus infection in 45% of normal and 40% of runt crocodiles and rare intestinal coccidia in 5% of normal and 15% of runt crocodiles. Bacterial and viral culture did not reveal significant differences between the 2 groups. However, runt crocodiles exhibited significant (P < .05) increases in adrenocortical cell cytoplasmic vacuolation and serum corticosterone, decreased production of bone (osteoporosis), and reduced lymphoid populations in the spleen, tonsil, and thymus. Runts also exhibited moderate anemia, hypoalbuminemia, and mild hypophosphatemia. Taken together, these findings suggest an association between runting and a chronic stress response (hyperactivity of the hypothalamic-pituitary-adrenal axis). © The Author(s) 2014.

Physical examination variables predict response to conservative treatment of non-chronic plantar fasciitis: Secondary analysis of a randomized placebo controlled footwear study

PubMed Central

Matzkin-Bridger, Jonathon; Fascione, Jeanna; Crews, Ryan; Bruning, Nicholas; Jarrett, Beth

2016-01-01

Background Plantar fasciitis is a common disabling condition and the prognosis of conservative treatment is difficult to predict. Objective To determine whether initial clinical findings could help predict patient response to conservative treatment primarily consisting of supportive footwear and stretching. Setting Patients were recruited and seen at two outpatient podiatric clinics in the Chicago, Illinois metropolitan area. Patients Seventy-seven patients with non-chronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous six months or were currently utilizing custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit three months after receiving the footwear intervention. Methods Treatment failure was considered a <50% reduction in heel pain at three month follow23 Logistic regression models evaluated the possible association between over thirty clinical and physical exam findings prospectively assessed at enrollment, and treatment response. Results Inability to dorsiflex the ankle past −5° (OR 27 3.9, p=.024), non-severe (≤ 7 on ordinal scale) first-step pain (OR 3.8, p=.021), and heel valgus in relaxed stance (OR 4.0, p=.014) each predicted treatment failure in multivariable analysis (Receiver operating characteristic area under the curve=.769). Limited ankle dorsiflexion also correlated with higher heel pain severity at initial presentation (r = −.312, p =.006). Conclusions Patients with severe ankle equinus were nearly four times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive as patients with less severe equinus and less severe pain at presentation did worse with

Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

PubMed Central

Neeki, Michael M.; Dong, Fanglong; Au, Christine; Toy, Jake; Khoshab, Nima; Lee, Carol; Kwong, Eugene; Yuen, Ho Wang; Lee, Jonathan; Ayvazian, Arbi; Lux, Pamela; Borger, Rodney

2017-01-01

Introduction Necrotizing fasciitis (NF) is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. Methods This was a 10-year retrospective chart-review study that included emergency department (ED) patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0–13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8), moderate risk (LRINEC score 6–7), and low risk (LRINEC score ≤5). All cases missing laboratory values were due to the absence of a C-reactive protein (CRP) value. Since the score for a negative or positive CRP value for the LRINEC score was 0 or 4 respectively, a LRINEC score of 0 or 1 without a CRP value would have placed the patient in the “low risk” group and a LRINEC score of 8 or greater without CRP value would have placed the patient in the “high risk” group. These patients missing CRP values were added to these respective groups. Results Among the 948 ED patients with cellulitis, more than one-tenth (10.7%, n=102 of 948) were moderate or high risk for NF based on LRINEC score. Of the 135 ED patients with a diagnosis of NF, 22 patients had valid CRP laboratory values and LRINEC scores were calculated. Among the other 113 patients without CRP values, six patients had a LRINEC score ≥ 8, and 19 patients had a LRINEC score ≤ 1. Thus, a total of 47 patients were further classified based on LRINEC score without a CRP value. More than

Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review.

PubMed

Roerdink, R L; Dietvorst, M; van der Zwaard, B; van der Worp, H; Zwerver, J

2017-10-01

Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is therefore to evaluate the complications and side effects of ESWT in order to determine whether ESWT is a safe treatment for PF. For this systematic review the databases PubMed, MEDLINE, Cochrane and Embase were used to search for relevant literature between 1 January 2005 and 1 January 2017. PRISMA guidelines were followed. Thirty-nine studies were included for this review, representing 2493 patients (2697 heels) who received between 6424 and 6497 ESWT treatment sessions, with an energy flux density between 0.01 mJ/mm 2 and 0.64 mJ/mm 2 and a frequency of 1000-3800 SWs. Average follow-up was 14.7 months (range: 24 h - 6 years). Two complications occurred: precordial pain and a superficial skin infection after regional anaesthesia. Accordingly, 225 patients reported pain during treatment and 247 reported transient red skin after treatment. Transient pain after treatment, dysesthesia, swelling, ecchymosis and/or petechiae, severe headache, bruising and a throbbing sensation were also reported. ESWT is likely a safe treatment for PF. No complications are expected at one-year follow-up. However, according to the current literature long-term complications are unknown. Better descriptions of treatment protocols, patient characteristics and registration of complications and side effects, especially pain during treatment, are recommended. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

PubMed

Sutera, R; Iovane, A; Sorrentino, F; Candela, F; Mularo, V; La Tona, G; Midiri, M

2010-03-01

This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients' history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position. Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position.

Forecasting Induced Seismicity Using Saltwater Disposal Data and a Hydromechanical Earthquake Nucleation Model

NASA Astrophysics Data System (ADS)

Norbeck, J. H.; Rubinstein, J. L.

2017-12-01

The earthquake activity in Oklahoma and Kansas that began in 2008 reflects the most widespread instance of induced seismicity observed to date. In this work, we demonstrate that the basement fault stressing conditions that drive seismicity rate evolution are related directly to the operational history of 958 saltwater disposal wells completed in the Arbuckle aquifer. We developed a fluid pressurization model based on the assumption that pressure changes are dominated by reservoir compressibility effects. Using injection well data, we established a detailed description of the temporal and spatial variability in stressing conditions over the 21.5-year period from January 1995 through June 2017. With this stressing history, we applied a numerical model based on rate-and-state friction theory to generate seismicity rate forecasts across a broad range of spatial scales. The model replicated the onset of seismicity, the timing of the peak seismicity rate, and the reduction in seismicity following decreased disposal activity. The behavior of the induced earthquake sequence was consistent with the prediction from rate-and-state theory that the system evolves toward a steady seismicity rate depending on the ratio between the current and background stressing rates. Seismicity rate transients occurred over characteristic timescales inversely proportional to stressing rate. We found that our hydromechanical earthquake rate model outperformed observational and empirical forecast models for one-year forecast durations over the period 2008 through 2016.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management.

PubMed

VanderMeulen, Heather; Pernica, Jeffrey M; Roy, Madan; Kam, April J

2017-06-01

To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

Changes in zooplankton community, and seston and zooplankton fatty acid profiles at the freshwater/saltwater interface of the Chowan River, North Carolina

PubMed Central

Rinchard, Jacques; Kimmel, David G.

2017-01-01

The variability in zooplankton fatty acid composition may be an indicator of larval fish habitat quality as fatty acids are linked to fish larval growth and survival. We sampled an anadromous fish nursery, the Chowan River, during spring of 2013 in order to determine how the seston fatty acid composition varied in comparison with the zooplankton community composition and fatty acid composition during the period of anadromous larval fish residency. The seston fatty acid profiles showed no distinct pattern in relation to sampling time or location. The mesozooplankton community composition varied spatially and the fatty acid profiles were typical of freshwater species in April. The Chowan River experienced a saltwater intrusion event during May, which resulted in brackish water species dominating the zooplankton community and the fatty acid profile showed an increase in polyunsaturated fatty acids (PUFA), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The saltwater intrusion event was followed by an influx of freshwater due to high precipitation levels in June. The zooplankton community composition once again became dominated by freshwater species and the fatty acid profiles shifted to reflect this change; however, EPA levels remained high, particularly in the lower river. We found correlations between the seston, microzooplankton and mesozooplankton fatty acid compositions. Salinity was the main factor correlated to the observed pattern in species composition, and fatty acid changes in the mesozooplankton. These data suggest that anadromous fish nursery habitat likely experiences considerable spatial variability in fatty acid profiles of zooplankton prey and that are correlated to seston community composition and hydrodynamic changes. Our results also suggest that sufficient prey density as well as a diverse fatty acid composition is present in the Chowan River to support larval fish production. PMID:28828262

[Influence of saltwater irrigation on the yield and quality of Cynodon dactylon under desert conditions].

PubMed

Zhou, Ruilian; Dov, Paternak; Zhao, Halin

2002-08-01

Responses of six varieties (Suwannee, Coast cross, Tifton44, Tifton68, Tifton78 and Tifton85) of Cynodon dactylon to irrigation-water salinity were investigated in field by means of a double line source experimental design. The digestibility of the grass by goat was analyzed using the rumen gastric justice digestion method. The results showed that the six varieties grew well, and had a high yield of fresh grass when eletro-conductivity (Eci) < 10 ds.m-1. Particularly when Eci = 4.4 ds.m-1, the fresh grass yield of Coast cross, Suwannee, Tifton44, Tifton68, Tifton78 and Tifton85 was respectively increased by 142.1%, 61.1%, 136%, 121.1%, 202.3% and 109.7%, in comparison with fresh water (Eci = 1.2) irrigation. Dry matter yield was also elevated with the increasing salinity of irrigated water. There was no obvious effect of salinity on crude protein, fiber and ash contents in the six varieties. Goats were fond of eating the hay irrigated by saline water, perhaps because of its higher digestibility. At least, the yield and quality of Cynodon dactylon were not effected by saltwater irrigation.

Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series.

PubMed

Bayetto, K; Cheng, A; Sambrook, P

2017-09-01

The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients. © 2017 Australian Dental Association.

Finite element modelling of radial shock wave therapy for chronic plantar fasciitis.

PubMed

Alkhamaali, Zaied K; Crocombe, Andrew D; Solan, Matthew C; Cirovic, Srdjan

2016-01-01

Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.

Physical Examination Variables Predict Response to Conservative Treatment of Nonchronic Plantar Fasciitis: Secondary Analysis of a Randomized, Placebo-Controlled Footwear Study.

PubMed

Wrobel, James S; Fleischer, Adam E; Matzkin-Bridger, Jonathon; Fascione, Jeanna; Crews, Ryan T; Bruning, Nicholas; Jarrett, Beth

2016-05-01

Plantar fasciitis is a common, disabling condition, and the prognosis of conservative treatment is difficult to predict. To determine whether initial clinical findings could help predict patient response to conservative treatment that primarily consisted of supportive footwear and stretching. Patients were recruited and seen at 2 outpatient podiatric clinics in the Chicago, Illinois, metropolitan area. Seventy-seven patients with nonchronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous 6 months or were currently using custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit 3 months after receiving the footwear intervention. Treatment failure was considered a <50% reduction in heel pain at 3 month follow-up. Logistic regression models evaluated the possible association between more than 30 clinical and physical examination findings prospectively assessed at enrollment, and treatment response. Inability to dorsiflex the ankle past -5° (odds ratio [OR] 3.9, P = .024), nonsevere (≤7 on ordinal scale) first-step pain (OR 3.8, P = .021), and heel valgus in relaxed stance (OR 4.0, P = .014) each predicted treatment failure in multivariable analysis (receiver operating characteristic area under the curve = .769). Limited ankle dorsiflexion also correlated with greater heel pain severity at initial presentation (r = - 0.312, P = .006). Patients with severe ankle equinus were nearly 4 times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus, earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive because patients with less severe equinus and less severe pain at presentation did worse with conservative care. Copyright © 2016 American Academy

[Necrotizing fasciitis, myositis, arthritis, and streptococcal toxic shock syndrome caused by group G Streptococcus. Report of one case].

PubMed

Ayala-Gaytán, Juan Jacobo; Martínez-Vela, Ángel; Náñez-Terreros, Homero; Guajardo-Lara, Claudia Elena; Valdovinos-Chávez, Salvador Bruno

2014-01-01

Necrotizing fasciitis (NF), myositis, and streptococcal toxic shock syndrome (STSS) associated with group G ß-hemolytic streptococcus (GGS) occasionally coincide. We describe a case of GGS simultaneously occurring with NF, myositis, arthritis, and STSS in an 83-year-old woman with sequelae of cerebrovascular disease, hospitalized after two days of fever and with a painful swollen left foot. She was hypotensive, her foot had purplish discoloration, which showed blisters spreading to the lower third of the leg, and no crepitus was present. Fluid, vasopressive support, tigecyclin, and clindamycin were used. Debrided tissue and fluid aspirated from the knee joint revealed Gram-positive cocci. The patient developed renal and respiratory failure on the fifth day, requiring support. She underwent amputation above the knee of the left leg, after which her condition improved. She was discharged one month later. GGS can cause life-threatening infections such as NF, myositis, and/or STSS. GGS usually afflicts aging patients with comorbid states, and occasionally healthy subjects.

Platelet-rich plasma as a treatment for plantar fasciitis

PubMed Central

Yang, Wei-yi; Han, Yan-hong; Cao, Xue-wei; Pan, Jian-ke; Zeng, Ling-feng; Lin, Jiong-tong; Liu, Jun

2017-01-01

Abstract Background: Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF compared with the efficacy and safety of steroid treatments. Methods: Databases (PubMed, EMBASE, and The Cochrane Library) were searched from their establishment to January 30, 2017, for randomized controlled trials (RCTs) comparing PRP with steroid injections as treatments for PF. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were the visual analogue scale (VAS), Foot and Ankle Disability Index (FADI), American Orthopedic Foot and Ankle Society (AOFAS) scale, and the Roles and Maudsley score (RMS). The statistical analysis was performed with RevMan 5.3.5 software. Results: Nine RCTs (n = 430) were included in this meta-analysis. Significant differences in the VAS were not observed between the 2 groups after 4 [weighted mean difference (WMD) = 0.56, 95% confidence interval (95% CI): −1.10 to 2.23, P = .51, I2 = 89%] or 12 weeks of treatment (WMD = −0.49, 95% CI: −1.42 to 0.44, P = .30, I2 = 89%). However, PRP exhibited better efficacy than the steroid treatment after 24 weeks (WMD = −0.95, 95% CI: −1.80 to −0.11, P = .03, I2 = 85%). Moreover, no significant differences in the FADI, AOFAS, and RMS were observed between the 2 therapies (P > .05). Conclusion: Limited evidence supports the conclusion that PRP is superior to steroid treatments for long-term pain relief; however, significant differences were not observed between short and intermediate effects. Because of the small sample size and the limited number of high-quality RCTs, additional high-quality RCTs with larger sample sizes are required to validate this result. PMID:29095303

A direct biocombinatorial strategy toward next generation, mussel-glue inspired saltwater adhesives.

PubMed

Wilke, Patrick; Helfricht, Nicolas; Mark, Andreas; Papastavrou, Georg; Faivre, Damien; Börner, Hans G

2014-09-10

Biological materials exhibit remarkable, purpose-adapted properties that provide a source of inspiration for designing new materials to meet the requirements of future applications. For instance, marine mussels are able to attach to a broad spectrum of hard surfaces under hostile conditions. Controlling wet-adhesion of synthetic macromolecules by analogue processes promises to strongly impact materials sciences by offering advanced coatings, adhesives, and glues. The de novo design of macromolecules to mimic complex aspects of mussel adhesion still constitutes a challenge. Phage display allows material scientists to design specifically interacting molecules with tailored affinity to material surfaces. Here, we report on the integration of enzymatic processing steps into phage display biopanning to expand the biocombinatorial procedure and enable the direct selection of enzymatically activable peptide adhesion domains. Adsorption isotherms and single molecule force spectroscopy show that those de novo peptides mimic complex aspects of bioadhesion, such as enzymatic activation (by tyrosinase), the switchability from weak to strong binders, and adsorption under hostile saltwater conditions. Furthermore, peptide-poly(ethylene oxide) conjugates are synthesized to generate protective coatings, which possess anti-fouling properties and suppress irreversible interactions with blood-plasma protein cocktails. The extended phage display procedure provides a generic way to non-natural peptide adhesion domains, which not only mimic nature but also improve biological sequence sections extractable from mussel-glue proteins. The de novo peptides manage to combine several tasks in a minimal 12-mer sequence and thus pave the way to overcome major challenges of technical wet glues.

Dissolved carbon dynamics in the freshwater-saltwater mixing zone of a coastal river entering the Northern Gulf of Mexico

NASA Astrophysics Data System (ADS)

He, S.; Xu, Y. J.

2017-12-01

Estuaries play an important role in the dynamics of dissolved carbon from freshwater to marine systems. This study aims to determine how dissolved inorganic carbon (DIC) and dissolved organic carbon (DOC) concentrations change along an 88-km long estuarine river with salinity ranging from 0.02 to 29.50. The study is expected to elucidate which processes most likely control carbon dynamics in a freshwater-saltwater mixing system, and to evaluate the net metabolism of this estuary using mixing curves and stable isotope analyses. From November 2014 to February 2016, water samples were collected and in-situ measurements on ambient water conditions were performed during eighteen field trips at six sites from upstream to downstream of the Calcasieu River, which enters the Northern Gulf of Mexico in the southern United States. δ13CDIC and δ13CDOC were measured from May 2015 to February 2017 during five of the field trips. The DIC concentration and δ13CDIC increased rapidly with increasing salinity in the mixing zone. The DIC concentrations appeared to be largely influenced by conservative mixing. The δ13CDIC values were close to those suggested by the conservative mixing model for May 2015, June 2015 and November 2015, but lower than those for July 2015 and February 2016, suggesting that an estuarine river can fluctuate from a balanced to a heterotrophic system (i.e., production/respiration < 1) seasonally. Unlike the DIC longitudinal trend, the DOC concentrations in the river estuary decreased from upstream to downstream, but to a much smaller degree. This river estuary consistently showed depleted δ13CDOC values (-30.56‰ to -25.92‰), suggesting that the DOC source in the mixing zone was highly terrestrially derived. However, in this relatively small isotopic range, δ13CDOC alone has limitations in differentiating carbon produced by aquatic photosynthesis from carbon produced by terrestrial photosynthesis in a river-ocean continuum. These findings suggest that

Expression Profiles of Branchial FXYD Proteins in the Brackish Medaka Oryzias dancena: A Potential Saltwater Fish Model for Studies of Osmoregulation

PubMed Central

Yang, Wen-Kai; Kang, Chao-Kai; Chang, Chia-Hao; Hsu, An-Di; Lee, Tsung-Han; Hwang, Pung-Pung

2013-01-01

FXYD proteins are novel regulators of Na+-K+-ATPase (NKA). In fish subjected to salinity challenges, NKA activity in osmoregulatory organs (e.g., gills) is a primary driving force for the many ion transport systems that act in concert to maintain a stable internal environment. Although teleostean FXYD proteins have been identified and investigated, previous studies focused on only a limited group of species. The purposes of the present study were to establish the brackish medaka (Oryzias dancena) as a potential saltwater fish model for osmoregulatory studies and to investigate the diversity of teleostean FXYD expression profiles by comparing two closely related euryhaline model teleosts, brackish medaka and Japanese medaka (O. latipes), upon exposure to salinity changes. Seven members of the FXYD protein family were identified in each medaka species, and the expression of most branchial fxyd genes was salinity-dependent. Among the cloned genes, fxyd11 was expressed specifically in the gills and at a significantly higher level than the other fxyd genes. In the brackish medaka, branchial fxyd11 expression was localized to the NKA-immunoreactive cells in gill epithelia. Furthermore, the FXYD11 protein interacted with the NKA α-subunit and was expressed at a higher level in freshwater-acclimated individuals relative to fish in other salinity groups. The protein sequences and tissue distributions of the FXYD proteins were very similar between the two medaka species, but different expression profiles were observed upon salinity challenge for most branchial fxyd genes. Salinity changes produced different effects on the FXYD11 and NKA α-subunit expression patterns in the gills of the brackish medaka. To our knowledge, this report is the first to focus on FXYD expression in the gills of closely related euryhaline teleosts. Given the advantages conferred by the well-developed Japanese medaka system, we propose the brackish medaka as a saltwater fish model for

Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges.

PubMed

Fais, Paolo; Viero, Alessia; Viel, Guido; Giordano, Renzo; Raniero, Dario; Kusstatscher, Stefano; Giraudo, Chiara; Cecchetto, Giovanni; Montisci, Massimo

2018-04-07

Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial.

PubMed

Ulusoy, Aslihan; Cerrahoglu, Lale; Orguc, Sebnem

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm 2 ; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm 2 ); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles-Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A Necrotizing Fasciitis Fake Out on Point-of-Care Ultrasound-Watch the Shadow.

PubMed

Thom, Christopher; Warlaumont, Mary

2017-04-01

Point-of-care ultrasound has an increasing role in characterizing soft-tissue infections and has been described previously in the evaluation of necrotizing fasciitis (NF). The identification of air within the soft tissues can be very suggestive of NF in the correct clinical context. A 78-year-old male presented to the emergency department with extensive lower-extremity redness and edema. A point-of-care ultrasound revealed hyperechoic areas within the soft tissues consistent with air, and the patient was taken to surgery and found to have NF. A 60-year-old female presented to the emergency department with physical examination findings consistent with severe cellulitis and associated sepsis. A point-of-care ultrasound revealed hyperechoic areas within the soft tissue that were very similar to the prior case. An emergent surgical consultation was placed due to concern for soft-tissue air and NF. However, these hyperechoic areas were found to be subcutaneous calcifications on subsequent imaging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Air within the soft tissue is easy to identify on point-of-care ultrasound and can expedite surgical evaluation in cases of suspected NF. Calcifications can mimic the appearance of air on ultrasound and the distinction between these objects can often be made based on the echotexture of the posterior acoustic shadow. Attention to the posterior acoustic shadow can facilitate correct identification of various structures and pathologies in a variety of clinical settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis

PubMed Central

Sun, Jiale; Gao, Fuqiang; Wang, Yanhua; Sun, Wei; Jiang, Baoguo; Li, Zirong

2017-01-01

Abstract Background: Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF. Methods: The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3. Results: Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97–3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI −0.01 to 2.03, P = .05, I2 = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49–3.16, P < .0001; OR 4.63, 95% CI 1.30–16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I2 = 81%, P = .005). Conclusion: This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions. PMID:28403111

Aeromonas sobria necrotizing fasciitis and sepsis in an immunocompromised patient: a case report and review of the literature

PubMed Central

2014-01-01

Introduction Aeromonas veronii biovar sobria is a rare cause of bacteremia, with several studies indicating that this isolate may be of particular clinical significance since it is enterotoxin producing. A wide spectrum of infections has been associated with Aeromonas species in developing countries that include gastroenteritis, wound infections, septicemia and lung infections. This infection, caused by Aeromonas species, is usually more severe in immunocompromised than immunocompetent individuals. We here describe a case of soft tissue infection and severe sepsis due to Aeromonas sobria in an immunocompromised patient. Case presentation A 74-year-old Caucasian man with a clinical history of chronic lymphocytic leukemia and immune thrombocytopenia, periodically treated with steroids, was admitted to our Intensive Care Unit because of necrotizing fasciitis and multiorgan failure due to Aeromonas sobria, which resulted in his death. The unfortunate coexistence of a Candida albicans infection played a key role in the clinical course. Conclusion Our experience suggests that early recognition and aggressive medical and surgical therapy are determinants in the treatment of severe septicemia caused by an Aeromonas sobria in an immunocompromised patient. PMID:25245365

A Case Report of Heel Pain Mimicking Plantar Fasciitis and Osteosarcoma: A Unique Presentation of a Nora's Lesion.

PubMed

Rushing, Calvin J; Rogers, Diana E; Spinner, Steven M; Gajzer, David C

Bizarre parosteal osteochondromatous proliferation, otherwise known as "Nora's lesion," is a rare benign neoplasm first described by Nora in 1983. The exact etiology of this neoplasm remains unknown, and its presentation in the lower extremity presents a diagnostic challenge, as both clinical and radiologic features cannot fully differentiate it from other neoplasms. We present the case of a 48-year-old female with plantar heel pain secondary to Nora's lesion mimicking plantar fasciitis and periosteal osteosarcoma. Following bone biopsy for histopathologic analysis, the patient's symptoms spontaneously resolved, and she returned to activity with complete resolution of symptoms 18 months post biopsy. Bizarre parosteal osteochondromatous proliferation as an etiology for plantar heel pain has not been previously described in the literature. Although rare, it should be considered in the differential diagnosis for patients presenting with plantar heel pain, especially after failed conservative treatment. Following diagnostic confirmation by histopathology, complete surgical excision is the treatment of choice. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A novel method for rearing first-feeding larval zebrafish: polyculture with Type L saltwater rotifers (Brachionus plicatilis).

PubMed

Best, Jason; Adatto, Isaac; Cockington, Jason; James, Althea; Lawrence, Christian

2010-09-01

Promoting high rates of growth and survival can be a major challenge in zebrafish culture, especially during the first-feeding stage. Here we describe a new rearing technique in which zebrafish larvae are polycultured in static tanks with Type "L" saltwater rotifers (Brachionus plicatilis) for the first 5 days of feeding (days 5-9 postfertilization). To demonstrate the effectiveness of this technique, we conducted rearing trials using fish from two different strains: AB and nacre. Growth, survival, water quality, and rotifer density were assayed daily through the polyculture phase (days 5-9), and during the transition to standard rearing conditions (days 10-12). After that point, once the fish were fully integrated onto recirculating systems, parameters were measured once per week out to day 30. In all trials, the fish displayed high rates of growth and survival throughout the three phases (polyculture, transition, and recirculating flow), indicating that this method may be employed during the critical first-feeding stage to help improve rearing performance in zebrafish facilities. Additionally, water quality parameters observed during the polyculture phase of the trials reveal that early zebrafish larvae are much more tolerant of elevated levels of ammonia and salinity than previously believed.

Simulation of saltwater movement in the Upper Floridan aquifer in the Savannah, Georgia-Hilton Head Island, South Carolina, area, predevelopment-2004, and projected movement for 2000 pumping conditions

USGS Publications Warehouse

Provost, Alden M.; Payne, Dorothy F.; Voss, Clifford I.

2006-01-01

A digital model was developed to simulate ground-water flow and solute transport for the Upper Floridan aquifer in the Savannah, Georgia-Hilton Head Island, South Carolina, area. The model was used to (1) simulate trends of saltwater intrusion from predevelopment to the present day (1885-2004), (2) project these trends from the present day into the future, and (3) evaluate the relative influence of different assumptions regarding initial and boundary conditions and physical properties. The model is based on a regional, single-density ground-water flow model of coastal Georgia and adjacent parts of South Carolina and Florida. Variable-density ground-water flow and solute transport were simulated using the U.S. Geological Survey finite-element, variable-density solute-transport simulator SUTRA, 1885-2004. The model comprises seven layers: the surficial aquifer system, the Brunswick aquifer system, the Upper Floridan aquifer, the Lower Floridan aquifer, and the intervening confining units. The model was calibrated to September 1998 water levels, for single-density freshwater conditions, then refined using variable density and chloride concentration to give a reasonable match to the trend in the chloride distribution in the Upper Floridan aquifer inferred from field measurements of specific conductance made during 2000, 2002, 2003, and 2004. The model was modified to simulate solute transport by allowing saltwater to enter the system through localized areas near the northern end of Hilton Head Island, at Pinckney Island, and near the Colleton River, and was calibrated to match chloride concentrations inferred from field measurements of specific conductance. This simulation is called the 'Base Case.'

Inferring spatial and temporal behavioral patterns of free-ranging manatees using saltwater sensors of telemetry tags

USGS Publications Warehouse

Castelblanco-Martínez, Delma Nataly; Morales-Vela, Benjamin; Slone, Daniel H.; Padilla-Saldívar, Janneth Adriana; Reid, James P.; Hernández-Arana, Héctor Abuid

2015-01-01

Diving or respiratory behavior in aquatic mammals can be used as an indicator of physiological activity and consequently, to infer behavioral patterns. Five Antillean manatees, Trichechus manatus manatus, were captured in Chetumal Bay and tagged with GPS tracking devices. The radios were equipped with a micropower saltwater sensor (SWS), which records the times when the tag assembly was submerged. The information was analyzed to establish individual fine-scale behaviors. For each fix, we established the following variables: distance (D), sampling interval (T), movement rate (D/T), number of dives (N), and total diving duration (TDD). We used logic criteria and simple scatterplots to distinguish between behavioral categories: ‘Travelling’ (D/T ≥ 3 km/h), ‘Surface’ (↓TDD, ↓N), ‘Bottom feeding’ (↑TDD, ↑N) and ‘Bottom resting’ (↑TDD, ↓N). Habitat categories were qualitatively assigned: Lagoon, Channels, Caye shore, City shore, Channel edge, and Open areas. The instrumented individuals displayed a daily rhythm of bottom activities, with surfacing activities more frequent during the night and early in the morning. More investigation into those cycles and other individual fine-scale behaviors related to their proximity to concentrations of human activity would be informative

A Comprehensive evaluation of groundwater vulnerability to saltwater up-coning and sea water intrusion in a coastal aquifer (case study: Ghaemshahr-juybar aquifer)

NASA Astrophysics Data System (ADS)

Motevalli, Alireza; Moradi, Hamid Reza; Javadi, Saman

2018-02-01

Aquifer salinization has recently increased significantly due to human activity and has caused irreparable environmental and economic effects. In this research, a new method is proposed for modeling the vulnerability to salinity for the Ghaemshahr-juybar aquifer. Specifically, the GALDIT (Sea water intrusion) and TAWLBIC (Saltwater up-coning) indices were combined to produce a map of vulnerability (Comprehensive Salinity Index or CSI) to seawater intrusion of a region near the coast and saltwater up-coning away from the coast, respectively. Single parameter and removal layer sensitivity analysis were performed in order to identify the sensitive parameters and achieve optimal weights (through the single-parameter method) of contributing factors in all three methods. The three optimized methods produced were GALDIT-Opt, TAWLBIC-Opt and CSI-Opt. To assess the accuracy of the original maps and optimal ones, the Pearson correlation was used. Results indicated that the Pearson correlation of the optimized GALDIT, TAWLBIC and CSI model was better than GALDIT, TAWLBIC and CSI. The results show that the increase in correlation between EC (Electrical Conductivity), TDS (Total Dissolved Solids) and SAR (Sodium Adsorption Ratio) from the GALDIT model to the CSI-Opt model from values of 0.64, 0.56 and 0.68 has improved to values of 0.81, 0.88 and 0.91, respectively. The highest concentration of EC, with a value of 7050 μs/cm, is sampled in the areas of the east and northwest of the Ghaemshahr-juybar aquifer, which are classified in the CSI-Opt model as high and very high vulnerability levels. The highest concentration of TDS and SAR has been found in the east, northwest and northeast of the Ghaemshahr-juybar aquifer with a value of 4724 ppm for TDS and 14 mg/l for SAR that have been modeled in the CSI-Opt index as highly vulnerable areas. Eventually, CSI mapping can be used as an efficient tool in prioritizing in terms of the vulnerability to aquifer salinity, carrying out

Correlation between the outcome of extracorporeal shockwave therapy and pretreatment MRI findings for chronic plantar fasciitis.

PubMed

Maki, Masahiro; Ikoma, Kazuya; Imai, Kan; Kido, Masamitsu; Hara, Yusuke; Arai, Yuji; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2015-05-01

The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) findings before extracorporeal shockwave therapy (ESWT) and the treatment outcome of ESWT. This study examined 50 feet with chronic plantar fasciitis. The scores before ESWT and after a six-month follow-up were investigated using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale and the Visual Analog Scale (VAS). MRI before ESWT was used for image evaluation. MRI revealed thickening of the plantar fascia (PF), and an investigation was conducted regarding the findings of a high-signal-intensity area (HSIA) inside the PF, edema near the PF, and bone marrow edema (BME) of the calcaneus. The average JSSF score and VAS score improved significantly at follow-up. In total, 44 feet were noted in the improved group. MRI revealed that the average amounts of PF thickening did not significantly differ between the improved group and the non-improved group. HSIA, edema near the PF, and BME were observed in 36, 41, and 11 feet in the improved group, respectively; and 2, 4, and 2 feet in the non-improved group, respectively. An HSIA in the PF predicted symptom improvement more easily than other MRI findings. IV.

Effect of monophasic pulsed current on heel pain and functional activities caused by plantar fasciitis.

PubMed

Alotaibi, Abdullah K; Petrofsky, Jerrold S; Daher, Noha S; Lohman, Everett; Laymon, Michael; Syed, Hasan M

2015-03-20

Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. This trial showed that MPC is useful in treating inferior heel symptoms caused by PF.

Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities caused by Plantar Fasciitis

PubMed Central

Alotaibi, Abdullah K.; Petrofsky, Jerrold S.; Daher, Noha S.; Lohman, Everett; Laymon, Michael; Syed, Hasan M.

2015-01-01

Background Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material/Methods Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. Conclusions This trial showed that MPC is useful in treating inferior heel symptoms caused by PF. PMID:25791231

Simulation of saltwater intrusion in a poorly karstified coastal aquifer in Lebanon (Eastern Mediterranean)

NASA Astrophysics Data System (ADS)

Khadra, Wisam M.; Stuyfzand, Pieter J.

2018-03-01

To date, there has been no agreement on the best way to simulate saltwater intrusion (SWI) in karst aquifers. An equivalent porous medium (EPM) is usually assumed without justification of its applicability. In this paper, SWI in a poorly karstified aquifer in Lebanon is simulated in various ways and compared to measurements. Time series analysis of rainfall and aquifer response is recommended to decide whether quickflow through conduits can be safely ignored. This aids in justifying the selection of the exemplified EPM model. To examine the improvement of SWI representation when discrete features (DFs) are embedded in the model domain, the results of a coupled discrete-continuum (CDC) approach (a hybrid EPM-DF approach) are compared to the EPM model. The two approaches yielded reasonable patterns of hydraulic head and groundwater salinity, which seem trustworthy enough for management purposes. The CDC model also reproduced some local anomalous chloride patterns, being more adaptable with respect to the measurements. It improved the overall accuracy of salinity predictions at wells and better represented the fresh-brackish water interface. Therefore, the CDC approach can be beneficial in modeling SWI in poorly karstified aquifers, and should be compared with the results of the EPM method to decide whether the differences in the outcome at local scale warrant its (more complicated) application. The simulation utilized the SEAWAT code since it is density dependent and public domain, and it enjoys widespread application. Including DFs necessitated manual handling because the selected code has no built-in option for such features.

Foot mobility and plantar fascia elasticity in patients with plantar fasciitis.

PubMed

Sahin, Namık; Oztürk, Alpaslan; Atıcı, Teoman

2010-01-01

In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (p<0.05). The reduced CIA, CMA, and PFL changes during weight bearing might show reduced foot mobility and plantar fascia elasticity, which may lead to posterior heel pain syndrome.

Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion.

PubMed

Erickson-Johnson, Michele R; Chou, Margaret M; Evers, Barbara R; Roth, Christopher W; Seys, Amber R; Jin, Long; Ye, Ying; Lau, Alan W; Wang, Xiaoke; Oliveira, Andre M

2011-10-01

Nodular fasciitis (NF) is a relatively common mass-forming and self-limited subcutaneous pseudosarcomatous myofibroblastic proliferation of unknown pathogenesis. Due to its rapid growth and high mitotic activity, NF is often misdiagnosed as a sarcoma. While studying the USP6 biology in aneurysmal bone cyst and other mesenchymal tumors, we identified high expression levels of USP6 mRNA in two examples of NF. This finding led us to further examine the mechanisms underlying USP6 overexpression in these lesions. Upon subsequent investigation, genomic rearrangements of the USP6 locus were found in 92% (44 of 48) of NF. Rapid amplification of 5'-cDNA ends identified MYH9 as the translocation partner. RT-PCR and direct sequencing revealed the fusion of the MYH9 promoter region to the entire coding region of USP6. Control tumors and tissues were negative for this fusion. Xenografts of cells overexpressing USP6 in nude mice exhibited clinical and histological features similar to human NF. The identification of a sensitive and specific abnormality in NF holds the potential to be used diagnostically. Considering the self-limited nature of the lesion, NF may represent a model of 'transient neoplasia', as it is, to our knowledge, the first example of a self-limited human disease characterized by a recurrent somatic gene fusion event. © 2011 USCAP, Inc All rights reserved

Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis.

PubMed

Wu, Yung-Tsan; Chang, Chih-Ya; Chou, Yu-Ching; Yeh, Chun-Chang; Li, Tsung-Ying; Chu, Heng-Yi; Chen, Liang-Cheng

2017-05-01

To evaluate the therapeutic benefit of ultrasound-guided pulsed radiofrequency (PRF) stimulation at the posterior tibial nerve (PTN) in patients with recalcitrant plantar fasciitis (PF). A prospective, randomized, double-blinded, placebo-controlled trial (12-wk follow-up). Outpatient local medical center settings. Patients (N=36) with recalcitrant PF underwent randomization, and all were included in the final data analysis. Patients in the PRF group were treated with 1 dose of ultrasound-guided PRF stimulation at the PTN, and those in the control group received 1 dose of 2% lidocaine, 0.5mL, injected at the PTN under ultrasound guidance. The visual analog scale (first-step and overall pain), American Orthopedic Foot-Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasonographic thickness of the plantar fascia were evaluated at 1, 4, 8, and 12 weeks after treatment. Thirty-six patients (20 feet per group) completed the study. The PRF group had a significantly larger improvement in first-step pain, overall pain, and AOFAS score (all P<.001), as well as plantar fascia thickness (P<.05), compared with those of the control group at all observed time points. This study shows that ultrasound-guided PRF stimulation at the PTN is effective for treating recalcitrant PF. This simple, reproducible method could be a novel strategy for managing recalcitrant PF. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.