Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.
*Alcoholic Intoxication/etiology ; Alcoholism/diagnosis ; Blister/complications/*diagnosis ; Cellulitis/diagnosis ; Diagnosis, Differential ; Fasciitis, Necrotizing/diagnosis ; Humans ; Male ; Middle Aged ; Necrosis/complications/diagnosis ; Sweat Gland Diseases/complications/*diagnosis ; Vibrio Infections/diagnosis

Between 1992 and 1995 at Sung Ae Hospital, general surgery was performed on 39 patients with a spontaneous pneumothorax, a pyothorax, a traumatic hemopneumothorax. Thoracoscopic surgery was performed with laparoscopic materials and instruments. The mean age was 26.1 years (range 16 to 54). The female to male ratio was 6.8 : 1. The indication for this surgery were recurrence in 17 patient, persistent air leakage after closed thoracotomy in 12, a visible bleb on the chest X-ray or chest CT result in 5, diagnosis in 2, and bilateral occurrence in 1. Thoracoscopies were performed on 39 patients, but operation were performed on 37 patients. The two patients the bullae could not be found. The operative procedures were stapling with Endo-GIA (21 cases), Endo-loop ligation (15 cases), and thoracoscopic examination (1 case). Tirty-six of the 39 patients were treated successfully. The one case histories of two patients could not be found, and one case was managed through a limited posterolateral thoracotomy. The causes of failure were an obscured operative field due to massive bleeding and a foreign body which was two large to remove from the thoracic cavity through the skin incision. A total of 16 postoperative complications oscurred in 11 patients. This rate is somewhat higher than those of other reports because of our lack of experiences during the initial years of the study, but it decreased progressively as experience was accumulated and instruments were improved. Operative mortality was absent. These patients were cured of their problems and benefitted from the decreased trauma of access by reduced pain, rapid recovery, and decreased scarring of the skin. In conclusion, videothoracoscopic surgery carries low morbidity and mortality and high diagnostic and therapeutic success rates and can be effectively applied to the surgical treatment of thoracic disease.
Blister ; Cicatrix ; Diagnosis ; Empyema, Pleural ; Female ; Foreign Bodies ; Hemopneumothorax ; Hemorrhage ; Hospitals, General ; Humans ; Ligation ; Male ; Mortality ; Pneumothorax ; Postoperative Complications ; Recurrence ; Skin ; Surgical Procedures, Operative ; Thoracic Cavity ; Thoracic Diseases ; Thoracoscopy ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed