Pilgrim Five, Suite 5 5 Pilgrim Park Road Waterbury, VT 05676
Annotating PDFs using Adobe Reader XI Version 1.4 January 14, 2014
1. Update to Adobe Reader XI
The screen images in this document were captured on a Windows PC running Adobe Reader XI. Editing of DJS proofs requires the use of Acrobat or Reader XI or higher. At the time of this writing, Adobe Reader XI is freely available and can be downloaded from http://get.adobe.com/reader/
2. What are eProofs?
eProof files are self-contained PDF documents for viewing on-screen and for printing. They contain all appropriate formatting and fonts to ensure correct rendering on-screen and when printing hardcopy. DJS sends eProofs that can be viewed, annotated, and printed using the free version of Acrobat Reader XI (or higher).
3. Comment & Markup toolbar functionality D
A. Show the Comment & Markup toolbar The Comment & Markup toolbar doesn’t appear by default. Do one of the following: • Select View > Comment > Annotations. • Click the Comment button in the Task toolbar.
A
Note: If you’ve tried these steps and the Annotation Tools do not appear, make sure you have updated to version XI or higher.
B. Select a commenting or markup tool from the Annotations window. Note: After an initial comment is made, the tool changes back to the Select tool so that the comment can be moved, resized, or edited. (The Pencil, Highlight Text, and Line tools stay selected.)
B
C
E
A. Insert Text tool B. Replace Text tool C. Delete Text tool D. Sticky Note tool E. Text Correction Markup tool
C. Keep a commenting tool selected Multiple comments can be added without reselecting the tool. Select the tool to use (but don’t use it yet). • Right Click on the tool. • Select Keep Tool Selected.
4. Using the comment and markup tools
To insert, delete, or replace text, use the corresponding tool. Select the tool, then select the text with the cursor (or simply position it) and begin typing. A pop-up note will appear based upon the modification (e.g., inserted text, replacement text, etc.). Use the Properties bar to format text in pop-up notes. A pop-up note can be minimized by selecting the button inside it. A color-coded symbol will remain behind to indicate where your comment was inserted, and the comment will be visible in the Comments List.
5. The Properties bar
The Properties bar can be used to add formatting such as bold or italics to the text in your comments. To view the Properties bar, do one of the following: • Right-click the toolbar area; choose Properties Bar. • Press [Ctrl-E]
1
... continues on page 2
6. Inserting symbols or special characters
An ‘insert symbol’ feature is not available for annotations, and copying/pasting symbols or non-keyboard characters from Microsoft Word does not always work. Use angle brackets < > to indicate these special characters (e.g., , ).
7. Editing near watermarks and hyperlinked text
eProof documents often contain watermarks and/or hyperlinked text. Selecting characters near these items can be difficult using the mouse alone. To edit an eProof which contains text in these areas, do the following: • Without selecting the watermark or hyperlink, place the cursor near the area for editing. • Use the arrow keys to move the cursor beside the text to be edited. • Hold down the shift key while simultaneously using arrow keys to select the block of text, if necessary. • Insert, replace, or delete text, as needed.
8. Summary of main functions
A. Insert text - Use Insert Text tool (position cursor and begin typing) B. Replace text - Use Replace Text tool (select text and begin typing) C. Delete text - Use Strikethrough Text tool (select text and press delete key) Note: The Text Correction Markup tool combines the functions of all three tools. D. Sticky Note - Use Sticky Note tool to add comments not related to text correction.
9. Reviewing changes
To review all changes, do the following: • Click the Comments button to reveal the comment tools • Click the triangle next to Comments List (if not already visible) Note: Selecting a correction in the list will highlight the corresponding item in the document, and vice versa.
10. Still have questions?
Try viewing our brief training video at https://authorcenter.dartmouthjournals.com/Article/PdfAnnotation
A B C
D
2
NUMBER
OF
AUTHOR QUERIES DATE 2/22/2014 JOB NAME TAS ARTICLE 1300511 QUERIES FOR AUTHORS
Brief Reports
THIS QUERY FORM MUST BE RETURNED WITH ALL PROOFS; HOWEVER, PLEASE MARK YOUR CORRECTIONS DIRECTLY ONTO THE PROOFS, NOT ONTO THIS SHEET.
AU1: Verify page range for reference 2.
Brief Reports Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ‘‘Instructions for Authors’’.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author. In general, authors of case reports should use the Brief Report format.
Fournier’s Gangrene after Urethral Rupture: An Uncommon Complication of a Common Procedure
serum creatinine: 1.0 mg%, random blood sugar: 235mg%, liver function tests: within normal range). An emergency de´bridement was decided. During surgery, a traumatic urethral rupture resulting from catheterization was revealed (Fig. 1). All necrotic tissue was excised (Fig. 2) and urethral reconstruction was performed by the urologists. Pus was sent for culture and sensitivity test. Postoperatively, the patient was managed with broad-spectrum antibiotics and wet dressing. Culture revealed Staphylococcus aureus and Escherichia coli sensitive to cefoperazone and ampicillin. He responded well to treatment. On the 12th postoperative day, a vacuum-assisted closure (VAC) system dressing performed. He was discharged on the 25th postoperative day. At 6-week follow-up the patient presented with a sound postoperative course without symptoms. FG is a rare but extremely serious surgical emergency with high mortality rates between 30 and 50 per cent1, 2 standing for an acute, infective necrotizing fasciitis of the genitourinary tract affecting perineal or perianal regions2 and both sexes. Incidence and severity are increased in elderly people.1, 2 Diabetes mellitus and alcohol abuse pose the highest rates among the predisposing factors. Others include malnutrition, chronic glucocorticoid therapy, cardiac disorders, and immunosuppression.1, 2 Perineal and genital skin infections are usually revealed as preliminary causes. Trauma in the urogenital
F1 F2
web color only
Fournier’s gangrene (FG) is a serious and fulminant infection of the genitalia and perineum. This clinical condition was first described by Jean Alfred Fournier (1832 to 1914), a dermatologist and venereologist.1 Infection represents an imbalance between host immunity and the virulence of the causative microorganisms. FG affects both sexes with a male predominance. Furthermore, predisposing factors such as diabetes mellitus, alcohol abuse, and the causes of FG are major issues that have to be considered and highlighted.1, 2 A 79-year-old man was admitted to our clinic with fever (38.8°C) and painful swelling of the scrotum for three days. There was a history of a Foley catheter insertion a week before for urinary retention as a result of prostatic hyperplasia. The patient had a history of diabetes mellitus, was not an alcoholic, and he was not from a filarial endemic zone. On examination, he was conscious. There was no pallor, jaundice, or lymphadenopathy. He was mildly dehydrated and tachypneic (28 breaths per minute) with a regular heart rate of 120 beats/min and blood pressure of 120/78 mmHg. Physical examination revealed no other abnormality beyond scrotum enlargement with edema and tenderness without palpable crepitation. There was patchy gangrene all over the scrotum with foul-smelling purulent discharge. A provisional diagnosis of FG was made. Initially, the patient was rapidly resuscitated with appropriate fluids and electrolytes. The classic’’ triple therapy’’ of antibiotics including third-generation cephalosporins, penicillin, and metronidazole was administered. Laboratory studies showed hemoglobin 13.2 g/dL and white cell count 21,500/cm3 with polymorph nuclear leucocytosis (normal, 88%). Biochemical parameters were essentially normal (blood urea: 42 mg%, Drs. Mamarelis and Moris contributed equally. Address correspondence and reprint requests to Demetrios Moris, M.D., Anastasiou Gennadiou 56, 11474, Athens, Greece. E-mail:
[email protected].
FIG. 1. Traumatic urethral catheterization revealed intraoperatively.
1
THE AMERICAN SURGEON
web color only
2
FIG. 2.
Excision of necrotic tissue.
and perineal regions has also been reported as another common cause, including pelvic and perineal injury or pelvic interventions.1, 2 In practice, there are three types of necrotizing soft tissue infections. Type I is a combination of Gram-positive and Gram-negative bacteria along with anaerobes (multimicrobial). Type II is usually caused by Group A Streptococcus but may be associated with S. aureus (monomicrobial). Type III infection is caused by Vibrio vulnificus.1, 2 In diagnostic dilemmas, imaging can facilitate its diagnosis. Conventional radiography may show gas in the soft tissue.3 Ultrasonography is very useful in detecting gas in the scrotal wall.3 Computing tomography features of FG include soft tissue thickening and inflammation having a greater diagnostic value for evaluation of extent of the disease.3 Initial resuscitation with fluids and electrolyte therapy may be mandatory for the management of FG. Furthermore, in patients presenting with septic shock, restoring the cardiopulmonary homeostasis is imperative.2 The main stay of the treatment of FG is urgent surgical de´bridement of all necrotic tissue as well as high doses of broad-spectrum antibiotics.2 The empiric triple therapy of antibiotics is third-generation cephalosporins or aminoglycosides, plus penicillin and metronidazole.2 De´bridement of the necrotic tissue as soon
May 2014
Vol. 80
as possible is important to stop the progress of the infection and simultaneous elimination of systemic effects of toxins and bacteria.2 VAC system dressing has shown a dramatic improvement with minimizing skin effects and speeding tissue healing.4 At the end of therapy if significant tissue loss exists, reconstruction by a plastic surgeons can be applied. Different techniques have been used to provide skin cover including transplantation of testes, free skin grafts, axial groin flaps, and muscle cutaneous flaps.4 Split-thickness skin graft seems to be the treatment of choice in treating perineal and scrotal skin defects.4 In a nutshell, FG is an extremely aggressive and rapidly developing soft tissue infection with a high mortality rate. The various causes of FG have to be taken into consideration to identify high-risk patients to pursue earlier treatment. We present an uncommon complication of urethral catheterization, in which urethral rupture led to FG. It is recommended to use a multidisciplinary approach in early diagnoses and treatment of FG to achieve low morbidity and mortality rates. Georgios Mamarelis, M.D. Demetrios Moris, M.D. Spiridon Vernadakis, M.D, Ph.D., M.Sc. Surgery and Transplantation Unit ‘‘Laikon’’ General Hospital Athens, Greece REFERENCES
1. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg 2000;87:718–28. 2. Mallikarjuna MN, Vijayakumar A, Patil VS, et al. Fournier’s gangrene: current practices. ISRN Surg 2012;2012:942437. 3. Levenson RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics 2008;28:519–28. 4. Chen SY, Fu JP, Wang CH, et al. Fournier gangrene: a review of 41 patients and strategies for reconstruction. Ann Plast Surg 2010;64:765–9.
AU1
