Nodular fasciitis (NF) is a benign and self-limiting fibroblastic proliferation that originates from the superficial fascia and extends into the subcutaneous tissue or muscle. It typically manifests in individuals aged 20 to 35 years, with rare occurrences observed in patients over the age of 60 years. We herein report a case involving a 75-year-old man with NF in the right vocal cord. The patient sought medical attention at the Department of Otolaryngology of our hospital because of a 1-month history of hoarseness and breathlessness. The diagnosis was unable to be confirmed through preoperative pathological examination. After admission to our hospital, various examinations were completed and surgical treatment was performed, and the postoperative histopathological findings revealed the presence of NF in the right vocal cord. NF of the vocal cord is a rare clinical entity. Given its rapid progression and propensity for marked infiltration, it often poses diagnostic challenges because it can mimic various malignant soft tissue tumors. Therefore, thorough exclusion of other neoplastic lesions is imperative prior to confirming the diagnosis of NF through pathological examination. Local surgical resection remains the primary treatment modality.

METHODS: We report a case of intraneural nodular fasciitis in the forearm initially suspected as a schwannoma, emphasizing the importance of accurate diagnosis. A 40-year-old woman presented with mass on the lateral aspect of her right forearm and radial neuropathy symptoms for 2 months. An excisional biopsy and histopathological examination confirmed nodular fasciitis. Postoperative evaluation at 4.5 years found no pain, paralysis, or recurrence.
CONCLUSIONS: Awareness of nodular fasciitis is crucial to prevent misdiagnosis and unnecessary treatment. Despite its rapid growth, nodular fasciitis generally has an excellent prognosis without long-term consequences.

Necrotizing soft tissue infections are a heterogeneous group of severe infections of the skin, connective tissue and muscles in which necrotic destruction of the tissue occurs at the site of infection. Various bacteria are known as \"typical\" triggering pathogens and the infection can occur on the entire surface of the body. Necrotizing soft tissue infections are always a time-sensitive emergency associated with high mortality. Many affected patients are critically ill and require treatment in an intensive care unit. The rapid and radical surgical treatment is an essential part of management and in addition an adequate and timely antimicrobial treatment is of great importance. The health consequences for surviving patients are often severe, as extensive soft tissue damage leads to functional impairments. In many cases extensive plastic surgery follow-up is necessary. Therefore, necrotizing soft tissue infections are \"complicated\" in every phase of the disease and require interprofessional treatment. This review article provides a current overview of various aspects of the diagnostics, treatment and aftercare of necrotizing soft tissue infections.
UNASSIGNED: Unter dem Begriff „nekrotisierende Weichgewebsinfektion“ wird eine heterogene Gruppe schwerer Infektionen der Haut, des Bindegewebes und der Muskulatur, bei denen es zu nekrotischem Gewebeuntergang am Infektionsort kommt, zusammengefasst. Eine Reihe unterschiedlicher Bakterien ist als „typische“ auslösende Erreger bekannt; die Infektion kann an der kompletten Körperoberfläche auftreten. Es handelt sich bei nekrotisierenden Weichgewebsinfektionen immer um einen zeitkritischen Notfall, der mit einer hohen Sterblichkeit assoziiert ist. Viele betroffene Patienten müssen auf einer Intensivtherapiestation behandelt werden. Die zügige und radikale chirurgische Behandlung ist essenzieller Teil des Managements, daneben ist eine adäquate und zeitgerechte Antibiotikatherapie von großer Bedeutung. Wird die akute Erkrankung überlebt, sind die gesundheitlichen Folgen für betroffene Patienten oft gravierend, da ausgedehnte Weichgewebsschäden zu funktionellen Beeinträchtigungen führen. In vielen Fällen ist eine langwierige plastisch-chirurgische Nachsorge erforderlich. Somit sind nekrotisierende Weichgewebsinfektion in jeder Erkrankungsphase „kompliziert“ und bedürfen einer interprofessionellen Behandlung. Dieser Übersichtsartikel gibt einen aktuellen Überblick über verschiedene Aspekte der Diagnostik, Therapie und Nachsorge nekrotisierender Weichgewebsinfektionen.

UNASSIGNED: Cervical necrotizing fasciitis (CNF) is a life-threatening bacterial infection with a diagnostic challenge. Currently, there is insufficient evidence on the diagnostic accuracy of inflammatory indicators in CNF.
UNASSIGNED: This study aims to identify key inflammatory indicators and assess their diagnostic accuracy for CNF.
UNASSIGNED: A diagnostic case-control study was conducted at a tertiary healthcare facility from January 2020 to December 2023. Laboratory data from patients with CNF and non-CNF at admission were evaluated. Key inflammatory indicators were identified through consistent outcomes from multivariable logistic regression and receiver operating characteristic curves analyses. The diagnostic accuracy of these indicators, with the results of combined tests, were calculated.
UNASSIGNED: CNF was confirmed in 21 of the 67 patients investigated. C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) were identified as key inflammatory indicators, with sensitivities of 0.905 and 0.810, and specificities of 0.870 and 0.913, respectively, at CRP threshold of 165.0 mg/L and NLR of 15.8. Combining CRP and NLR in parallel and serial tests increased sensitivity to 0.952 and specificity to 1.0, respectively.
UNASSIGNED: CRP and NLR have been verified as key inflammatory indicators with satisfactory diagnostic abilities for CNF diagnosis, providing a strong foundation for future studies.

Immunoglobulin A vasculitis (IgAV) is a systemic small-vessel vasculitis caused by the deposition of IgA-based immune complexes, with myalgia being a rare complication. This study reports a pediatric case of IgAV with fasciitis. A five-year-old boy with no previous medical history was admitted to the hospital with abdominal pain and repeated bilious vomiting. Palpable purpura was observed on his face and right upper limb. Abdominal ultrasound and contrast-enhanced CT revealed decreased peristalsis and wall thickening of the fluid-filled duodenum, leading to a diagnosis of IgAV. Initial treatment with prednisolone and fasting improved his symptoms, but he complained of bilateral calf pain from day five with normal creatinine kinase levels. Fat-suppressed MRI on day 10 revealed high-signal areas around the soleus muscle, diagnosing fasciitis. Following steroid dose reduction, his myalgia worsened with difficulty falling asleep and the disability of standing up. Increasing the prednisolone dose alleviated his symptoms. The patient was discharged on day 23 without further myalgia. The pathogenesis of myalgia in IgAV remains unclear, but this case indicated a complication of fascial vasculitis and the effectiveness of steroid therapy. In conclusion, IgAV can be complicated by muscle involvement, and fasciitis should be considered a differential diagnosis of myalgia when creatinine kinase levels are normal. While supportive care is primary, steroid therapy should be considered depending on disease severity.

Eosinophilic fasciitis (EF) remains a diagnostic challenge due to its rarity and resemblance to scleroderma. This case report aims to provide a cohesive exploration of EF\'s clinical nuances, emphasizing the importance of accurate diagnosis and effective management. A 52-year-old male developed bilateral forearm and calf hardening, along with erythema, pruritus, and pain four months prior to the presentation in our Clinic. The symptoms initially debuted bilaterally in the forearms and progressed to involve the calves, distal arms, and thighs. Clinical examination revealed symmetrical plaques on forearms and calves, featuring erythematous, hyper, and hypopigmented elements extending proximally, a positive \"groove sign\" and a moderate difficulty in knee joint flexion. Despite these findings, the patient was generally in good condition, without any other notable clinical signs. Initial laboratory findings showed slightly increased percentual eosinophil levels, elevated C-reactive protein (CRP), normal erythrocyte sedimentation rate (ESR), and negative antinuclear and scleroderma specific antibodies. Magnetic resonance imaging (MRI) demonstrated enhanced fascial signal and thickening while the fascia-muscle biopsy revealed marked edema and inflammatory lymphoplasmacytic infiltrate, consistent with the diagnosis of EF. The patient showed a favorable response to systemic corticosteroids. EF predominantly affects males aged 30 to 60 and is characterized by a sudden onset and unclear etiological factors. Differential diagnosis requires careful exclusion of scleroderma and other mimicking conditions. Diagnostic modalities such as skin-muscle biopsy and MRI reveal characteristic findings like inflammatory infiltrate and fascial thickening. Accurate diagnosis and differentiation from scleroderma are crucial, with early intervention involving glucocorticoids and immunosuppressive agents improving long-term outcomes.

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Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients\' symptoms.
METHODS: A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study.
RESULTS: Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8-1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001).
CONCLUSIONS: The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period.

A 67 year-old male was admitted in the ICU because of multi-organ failure due to sepsis secondary to Fournier\'s gangrene. He had sustained radical prostatectomy in the last 48 hours. Peritoneal fluid and fatty tissue biopsies grew Aspergillus Fumigatus without concomitant pulmonary involvement. Postoperative acquisition via exogenous and endogenous routes is discussed, as this nosocomial entity is very rarely reported apart from peritoneal dialysis, especially in non-immunosuppressed patients.

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