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BACKGROUND: The role of hyperbaric oxygen therapy (HBOT) in necrotizing soft tissue infections (NSTI) is mainly based on small retrospective studies. A previous study using the 1998-2009 National Inpatient Sample (NIS) found HBOT to be associated with decreased mortality in NSTI. Given the argument of advancements in critical care, we aimed to investigate the continued role of HBOT in NSTI. METHODS: The 2012-2020 National Inpatient Sample (NIS) was queried for NSTI admissions who received surgery. 60,481 patients between 2012-2020 were included, 600 (

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. [ABSTRACT FROM AUTHOR]

Intra-articular tumours are uncommonly encountered in routine practice and may present diagnostic challenges to pathologists. Challenges unique to this site include distinction from more common reactive synovial conditions, which are far more common; histologic variability; superimposed reactive changes; and often, lack of provided clinicoradiological context. This article reviews the pathology of the synovial tumours and tumour-like lesions, including diagnostic pearls, pitfalls and rare entities. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusions and significanceCervical 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.This study aims to identify key inflammatory indicators and assess their diagnostic accuracy for CNF.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.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.CRP and NLR have been verified as key inflammatory indicators with satisfactory diagnostic abilities for CNF diagnosis, providing a strong foundation for future studies. [ABSTRACT FROM AUTHOR]

La fasciite à éosinophiles (FE), ou maladie de Shulman, est une pathologie rare du tissu conjonctif caractérisée par un œdème et une induration douloureuse des membres et du tronc, souvent associés à une hyperéosinophilie et une hypergammaglobulinémie. Elle provoque des arthralgies et une limitation des amplitudes articulaires induisant un important retentissement fonctionnel et une altération de la qualité de vie. Depuis sa description par Shulman en 1974, plus de 300 cas ont été rapportés. Nous présentons ici une revue des actualités diagnostiques, physiopathologiques, et thérapeutiques de cette maladie. L'imagerie par résonance magnétique est utile pour orienter le diagnostic et la biopsie. Le diagnostic repose sur la biopsie cutanée profonde comportant le fascia qui met en évidence un œdème, une scléro-fibrose du fascia musculaire et du tissu sous-cutané et un infiltrat inflammatoire parfois composé de polynucléaires éosinophiles. Des formes secondaires à l'utilisation des inhibiteurs de checkpoint ont été décrites et l'apparition d'une sclérose cutanée chez ces patients doit faire évoquer le diagnostic. La physiopathologie reste mal connue et la prise en charge mal codifiée, reposant sur des données issues de cohorte rétrospectives et cas cliniques. Le traitement de première intention consiste en corticothérapie orale, parfois associée à un immunosuppresseur, en premier lieu le méthotrexate. Une meilleure compréhension de la physiopathologie permet d'envisager de nouvelles perspectives thérapeutiques et de préciser la place de thérapies ciblées telles que les inhibiteurs de l'interleukine 5 (IL-5) et de l'IL-6. Eosinophilic fasciitis (EF) is a rare connective tissue disorder characterized by painful edema and induration of the limbs and trunk, likely associated with hypereosinophilia and hypergammaglobulinemia. EF causes arthralgia and range of motion limitation, leading to significant functional impairment and poor quality of life. Since its description by Shulman in 1974, over 300 cases have been reported. We present here a review of the latest diagnostic, pathophysiological and therapeutic developments in this disease. Magnetic resonance imaging appears useful to guide diagnosis and biopsy. Diagnosis is based on a deep skin biopsy involving the fascia, which will reveal edema, sclerofibrosis of the muscular fascia and subcutaneous tissue, and an inflammatory infiltrate sometimes composed of eosinophilic polynuclear cells. EF may occur in patients treated with immune checkpoint inhibitors and the diagnosis should be raised in case of cutaneous sclerosis in these patients. The pathophysiology of the disease remains poorly understood, and its management lacks randomized, controlled, blinded trials. First-line treatment consists in oral corticosteroid therapy, sometimes combined with an immunosuppressant, mainly methotrexate. A better understanding of the pathophysiology has opened new therapeutic perspectives and clarified the role of targeted therapies in the management of EF, such as interleukin-6 inhibitors, whose efficacy has been reported in several cases. [ABSTRACT FROM AUTHOR]

Introduction: The oral cavity, the beginning of the digestive system, has diverse lesions affecting it other than Oral Squamous Cell Carcinoma (OSCC). Soft-tissue Tumours (STT) are uncommon lesions. Overlapping of the signs and symptoms in diverse conditions creates significant problems for reaching their definitive diagnosis. Histopathological Examination (HPE) plays a central role in giving their final diagnosis. Assessment of the clinical features, histopathology, along with Immunohistochemistry (IHC), helps in reaching an accurate diagnosis in these cases, which further aids in the proper management of the patient. Aim: To study the spectrum of oral cavity lesions and tumours with emphasis on STT. Materials and Methods: A retrospective cross-sectional study was conducted at the Department of Pathology and Otolaryngology, Dr. Ulhas Patil Medical College, Jalgaon, Maharashtra, India included the oral cavity lesion samples received over two years (from January 2021 to December 2022) in the histopathology section of a Medical College in Maharashtra, India. A total of 170 cases were included in the study. Complete clinical information including age, sex, anatomical location, clinical diagnosis, and histological subtypes were compiled. The HPE diagnosis were classified into four categories-Non neoplastic, Benign, Epithelial Proliferative lesions {including viral/Human Papillomavirus (HPV) related}/Intraepithelial neoplastic lesions/Precursor or Pre-malignant, and malignant with special emphasis on STTs found. The data was statistically analysed and the results were presented as percentages. Full details of the soft-tissue lesions were recorded, entered into an Excel sheet, and studied for the percentage-wise distribution of various recorded parameters. Results: A total of 170 cases were found. Male:female distribution was 2.78:1, and most patients were in the seventh decade, n=38 (22.35%). The most common lesions other than SCC, n=110 (64.71%) found were mucocele, chronic inflammatory lesion and wart. The Buccal Mucosa/Gingivo-buccal Sulcus (GBS) were the most commonly involved site, n=82 (48.24%). Malignant lesions were more common in the sixth and seventh decades, with a male preponderance of 2.71:1. The uncommon STTs found were-Benign: Haemangioma/pyogenic granuloma (n=2), a Schwanomma, and a Proliferative Fasciitis (PF); Malignant: two fibrosarcomas and a high-grade sarcoma. All three malignant STTs were found in males of the sixth decade involving the buccal mucosa. Conclusion: Among the variety of lesions found in the oral cavity, HPE facilitates the recognition of the STT, especially the malignant ones, aiding in proper management. Being an extremely uncommon entity at this site, the documentation of these findings is of utmost importance. [ABSTRACT FROM AUTHOR]

Introduction: The oral cavity, the beginning of the digestive system, has diverse lesions affecting it other than Oral Squamous Cell Carcinoma (OSCC). Soft-tissue Tumours (STT) are uncommon lesions. Overlapping of the signs and symptoms in diverse conditions creates significant problems for reaching their definitive diagnosis. Histopathological Examination (HPE) plays a central role in giving their final diagnosis. Assessment of the clinical features, histopathology, along with Immunohistochemistry (IHC), helps in reaching an accurate diagnosis in these cases, which further aids in the proper management of the patient. Aim: To study the spectrum of oral cavity lesions and tumours with emphasis on STT. Materials and Methods: A retrospective cross-sectional study was conducted at the Department of Pathology and Otolaryngology, Dr. Ulhas Patil Medical College, Jalgaon, Maharashtra, India included the oral cavity lesion samples received over two years (from January 2021 to December 2022) in the histopathology section of a Medical College in Maharashtra, India. A total of 170 cases were included in the study. Complete clinical information including age, sex, anatomical location, clinical diagnosis, and histological subtypes were compiled. The HPE diagnosis were classified into four categories-Non neoplastic, Benign, Epithelial Proliferative lesions {including viral/Human Papillomavirus (HPV) related}/Intraepithelial neoplastic lesions/Precursor or Pre-malignant, and malignant with special emphasis on STTs found. The data was statistically analysed and the results were presented as percentages. Full details of the soft-tissue lesions were recorded, entered into an Excel sheet, and studied for the percentage-wise distribution of various recorded parameters. Results: A total of 170 cases were found. Male:female distribution was 2.78:1, and most patients were in the seventh decade, n=38 (22.35%). The most common lesions other than SCC, n=110 (64.71%) found were mucocele, chronic inflammatory lesion and wart. The Buccal Mucosa/Gingivo-buccal Sulcus (GBS) were the most commonly involved site, n=82 (48.24%). Malignant lesions were more common in the sixth and seventh decades, with a male preponderance of 2.71:1. The uncommon STTs found were-Benign: Haemangioma/pyogenic granuloma (n=2), a Schwanomma, and a Proliferative Fasciitis (PF); Malignant: two fibrosarcomas and a high-grade sarcoma. All three malignant STTs were found in males of the sixth decade involving the buccal mucosa. Conclusion: Among the variety of lesions found in the oral cavity, HPE facilitates the recognition of the STT, especially the malignant ones, aiding in proper management. Being an extremely uncommon entity at this site, the documentation of these findings is of utmost importance.