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Necrotizing fasciitis is a rare but potentially lethal infection of the skin and soft tissue, commonly seen in the perianal and gluteal regions. Concomitant diabetes is a predisposing factor. Primary necrotizing fasciitis of the breast is rare in healthy women. In this article, we present a very rare case of breast necrotizing fasciitis in the context of the literature. We report the case of a 35-year-old female patient who had given birth two months prior to admission and developed necrotizing fasciitis of the breast during lactation. The patient presented to the emergency department with sepsis. Examination revealed widespread erythema, dark discoloration, edema, and necrotic areas indicative of wet gangrene and crepitation in the left breast. Necrotizing fasciitis is a rapid and aggressive disease that can be fatal, and delayed diagnosis may unfortunately result in death. Therefore, careful evaluation of all suspected cases, especially for patients with risk factors, is crucial for early diagnosis and timely treatment. This case highlights the importance of recognizing necrotizing fasciitis of the breast in lactating women to ensure prompt and appropriate management, potentially saving lives., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2024 by the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health published by Galenos Publishing House.)

Objective: We aimed to investigate whether there is a relationship between blood fibrinogen levels during hospitalization of patients hospitalized for conservative treatment due to acute cholecystitis (AC) in our clinic. Patients underwent surgery and were discharged with medical treatment., Patients and Methods: The files of 118 patients who were hospitalized due to the diagnosis of AC and planned for conservative medical treatment in our clinic between January 2018 and February 2020 were recorded, prospectively. The patients were divided into two groups as those who responded to conservative treatment (Group 1), and those who were operated urgently despite conservative treatment (Group 2). Increase in gallbladder wall thickness, presence of pericholecystic fluid and hydrops sac on ultrasound and computed tomography (CT) were considered significant for the diagnosis of acute cholecystitis. Blood fibrinogen levels were measured in all patients during hospitalization., Results: The mean age of 118 patients included in the study was 58.32 (19-96) years. There were 77 patients in Group 1 and 41 patients in Group 2. Serum fibrinogen level was found to be 298.34±111.7 mg/dl in Group 1 and 637±124.5 mg/dl in Group 2, and a statistically significant difference was found (p<0.001). When the cut-off value for the fibrinogen level was taken as 564.50 mg/dl, the sensitivity and specificity of the test were found to be 75.6% and 61%, respectively in showing surgical treatment., Conclusions: As a result of our study, we concluded that when the data obtained are evaluated, it should be kept in mind that despite medical treatment, there is an urgent need for an operation in patients with acute cholecystitis, and in patients with high plasma fibrinogen level (cut-off) at first admission.

This study aimed to compare the accuracy and reliability of Alvarado Score (AS) and Appendicitis Inflammatory Response Score (AIRS) in pregnant women undergoing surgery for acute appendicitis (AA). The files of 53 pregnant women with a diagnosis of AA who underwent surgery in our clinic between February 2014 and December 2018 were examined retrospectively. The patients were divided into 3 groups as follows: first trimester between 0 and 14 weeks, second trimester between 15 and 28 weeks, and third trimester between 29 and 42 weeks. The AS and AIRS values were calculated according to preoperative physical examination and laboratory results. The mean age of the patients was 28.58 (18-44) years. According to the pathology results, appendicitis was detected in 16 of 23 patients in the first trimester, in 22 of 25 patients in the second trimester, and in 2 of 5 patients in the third trimester. The AIRS was ≥ 9 in 9 patients and the AS was ≥ 7 in 19 of the 23 patients in the 1st trimester, while the AIRS was ≥ 9 in 11 patients and the AS was ≥ 7 in 19 of the 25 patients in the 2nd trimester. However, in the 3rd trimester, the AIRS was ≥ 9 in 2 patients and AS was ≥ 7 in 4 of the 5 patients. In conclusion, when the data obtained from the present study were evaluated, it was determined that both AS and AIRS are effective methods for diagnosing AA in pregnant women., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Iliocaval outflow obstruction was investigated in patients with venous ulcers caused by primary superficial disease and chronic deep vein disease METHODS: After clinical assessment, patients with healed or active venous leg ulcers underwent lower extremity duplex ultrasound examination to identify the presence of venous disease in the superficial, deep and perforating systems. Bilateral contrast venography and intravascular ultrasound examination were then performed to determine the presence and degree of iliocaval obstructive lesions., Results: This retrospective study included a total of 59 patients with 71 legs presenting active or healed ulcer. There were 16 limbs (22.5%) with superficial venous reflux associated with normal infrainguinal deep veins (group I) and 55 limbs (77.5%) with infrainguinal post-thrombotic deep venous disease (group II). Using venography and intravascular ultrasound examination, the incidence of >50% of venous obstruction in the iliocaval system in groups I and II were 75% and 83.6%, respectively. All obstructive lesions in group I were nonthrombotic. However, group II included thrombotic, nonthrombotic and combinations of the two types of obstructions. Group II had more ulcers (1.73 ± 1.3 vs 1.17 ± 0.5; P = .03), larger ulcers (>6 cm in 34.1% vs 8.3%), longer duration of ulcers (71.3 ± 110.5 months vs 37.9 ± 40.4 months; P = .03), smaller diameter of refluxing superficial veins (7.7 ± 2.6 mm vs 15.1 ± 6.6 mm; P = .001), and higher incidence of occluded iliocaval systems (18 [32.7%] vs 0; P = .003) than group I. After the exclusion of bilateral cases and thrombotic obstructions, the incidence of >50% nonthrombotic obstruction in ipsilateral and contralateral sides was 76.5% and 24.4%, respectively (P = .003)., Conclusions: The results of this study revealed that the majority of patients with venous ulcers with either infrainguinal primary superficial or post-thrombotic deep venous disease had an element of iliocaval venous obstruction., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)