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The Early Middle Ages
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
Paul had a typical understanding of skin infections for his time. What is known today as cellulitis, Paul reiterates Galen's definition of phlegmon, a red and painful swelling caused by an accumulation of good blood in the tissues. But “when yellow bile is seated in a part, it is called herpes,” and “when blood and yellow bile together are collected in a part, erysipelas is formed.”32 Erysipelas was considered a very serious disease, “particularly about the head; so that if active treatment be not resorted to, it will sometimes prove fatal to the patient by suffocation.”33 When the inflammation generates pus, an abscess develops. When the inflammation does not form pus or resolve, gangrene and sphacelus manifest. The former refers to the early changes of “mortification;” the latter, a stage beyond gangrene when the affected area becomes “totally insensible.”34 Swollen glands are referred to as phyma, bubo, or phygethlon. A carbuncle occurs “when blood having become more melancholic than natural, ferments and fixes in a part.”35 Much of this information is simply a repeat of Galen's comments on the same terms.
Acute Care Emergency Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Marcelo A. F. Ribeiro, Mansoor Khan
Patients with a phlegmon on the right lower quadrant should be treated with intravenous antibiotics. The authors do not recommend immediate appendicectomy in patients with phlegmon associated with perforated appendicitis.
Perforated Diverticulitis
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Whatever the mechanism, the diverticular inflammation can evolve in a spectrum of different conditions, ranging from self-limiting diverticulitis to free perforation with faeculent peritonitis associated with systemic sepsis. Erosion into the surrounding tissues may result in the development of a phlegmon. Whilst diverticula can erode into the adjacent blood vessels resulting in bleeding, diverticulosis and not diverticulitis is associated with bleeding. The presence of a localised abscess indicates an earlier perforation that has been sealed off or healed spontaneously. Likewise, purulent peritonitis resulting from perforated diverticulitis is probably the result of either a communication between the abdominal cavity and the bowel lumen or rupture of a diverticular abscess. Faecal peritonitis, by comparison, is often due to stercoral ulceration.
The first historical description of chronic subdural hematoma: A tale of inaccurate interpretation, inaccurate quoting and inaccurate requoting
Published in Journal of the History of the Neurosciences, 2023
Ruben Dammers, Dana C. Holl, Brenda Kapiteijn, Erwin J. O. Kompanje
In 2000, Killeffer referred to Willis as the first to describe a CSDH (Killeffer, Killeffer, and Schochet 2000). “In the seventeenth century, Thomas Willis provided one of the earliest descriptions of a CSDH in the postmortem state.” This university scholar experienced a great headache that lasted for two weeks. With that he suffered from fever, convulsions, and confusion (“talking light-headed”) for which he was treated. However, death followed shortly. The main postmortem findings suggested the presence of a phlegmon and bleeding from a sinus. The presence of an acute inflammation is not typically seen in CSDH, and bleeding in CSDH is seen when opening the dura and not from the sinus as described in this case. Therefore, it is unlikely that this university scholar suffered from a CSDH. This case was also referred to as being a venous infarction with an underlying septic thrombosis (Hughes 1989). The latter description seems more likely when taking into consideration the findings of the postmortem study and the clinical symptoms fever and convulsions, which are rare in patients diagnosed with CSDH.
Muscle flaps for sternoclavicular joint septic arthritis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Barkat Ali, Timothy R. Petersen, Anil Shetty, Christopher Demas, Jess D. Schwartz
Table 2 shows the operative characteristics. A minority of patients in each group had phlegmon at initial debridement. More patients needing reconstruction following concomitant rib resection required post-operative blood transfusions. Concomitant involvement of ribs, was found to be a significant predictor of delayed reconstruction (57.7% vs. 22.2, p = .030), more need for serial debridement’s (2 vs 1, p = .009), increased days from debridement to reconstruction for a subset of patients (75% percentile of 8 days vs. 0 days, p = .024), and longer hospital stay (18 vs. 9, p = .006). Flap complications were higher in rib resection group, 26.9% versus 5.6% in no rib resection group (p = .67). All wounds healed without any patients experiencing total flap loss. This included seroma, hematoma, lung herniation, and retained drain. All patients reported good shoulder function at average follow up of 31 months (Table 3).
IL-6 inhibitor for the treatment of rheumatoid arthritis: A comprehensive review
Published in Modern Rheumatology, 2019
Atsushi Ogata, Yasuhiro Kato, Shinji Higa, Kazuyuki Yoshizaki
IL-6 deficient mice displayed significantly delayed cutaneous wound healing compared to wild-type control animals [112]. This characteristic occurred because IL-6 is a growth factor of epidermal keratinocytes [113]. The American College of Rheumatology guidelines recommend five-week TCZ-IV holding and two-week TCZ-SC holding prior to surgery in patients undergoing arthroplasty; moreover, TCZ should be restarted after careful assessment of the patient’s wound status and surgical and nonsurgical site infections [114]. However, no increase in complications of superficial or deep infections or delays in wound healing after joint surgery were reported in patients who ceased TCZ-IV administration two weeks prior to surgery and restarted TCZ two weeks after surgery [115]. The incidence of delayed wound healing in TCZ-treated RA patients was higher in patients with foot and spinal surgeries [116]. We should be aware that mild injuries often cause phlegmon without obvious symptoms during TCZ therapy. Wounds must be disinfected to prevent phlegmon development.