In 2011 a 60-year-old Caucasian man was admitted to the Emergency Department of our hospital due to scrotal and perineal pain and fever (39°C). They had been out of touch for some time. Gangrene can also occur in organs such as the gallbladder, intestines and muscles. A 56-year-old man with history of poorly controlled diabetes mellitus and alcoholism presents with severe scrotal pain and fever for 3 days.  WIfI: Risk stratification based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection. Each 1g/L increase of hemoglobin was associated with 2.8% lower prevalence of diabetes foot complications. An injury such as a burn, frostbite or a crush injury (where the body is subjected to a high degree of force or pressure, usually after being squeezed between two heavy objects) can suddenly restrict the flow of blood to tissue.
So, a tiny blister may turn into a stubborn ulcer. He also received symptomatic treatment for gangrene and CDI. As he notes, the skin develops a hard, dry eschar because of a lack of subcutaneous capillary flow to the area. Then, he was referred to RNL Bio to seek treatment with his preserved stem cells for treatment on September 15, 2010. This is more commonly seen in middle aged having immunosuppressive disorder like diabetes mellitus, malignancy and chronic alcoholism2. He was also affected by severe diabetic complications, including peripheral neuropathy and nephropathy leading to end-stage renal disease (ESRD) with daily urine output of less than 300 ml and was hemodialysis-dependent for the last one year. The study was approved by the Institutional Ethics Committee.
Arteriogram had a vasoocclusive disorder at the digital femoral artery an d CT abdomen showing a supra renal mass (8x6x5) cm border of head and body of pancreas displacing the right kidney inferiorly. The nerve damage can make it difficult for you to know if you have an open wound making it easy for it to go untreated. Special attention should be given to the feet of those with diabetes each day. In 1950 Smith and Krichner3 gave the following criteria for the clinical diagnosis of mucormycosis: (i) a blood tinged nasal discharge and facial pain, both on the same side, (iii) soft peri-orbital or peri-nasal swelling, going on to discoloration, induration and progressive vascular occlusion, (iii) ptosis of the eyelid, proptosis of the eyeball and complete ophthalmoplegia, (iv) multiple unrelated cranial nerve palsies, and (v) black, necrotic turbinates, easily mistaken for dried, crusted blood. Treatment involves removing all dead and diseased tissue and administering antibiotics. The dermis and subcutaneous tissue showed oedema, necrosis, bacterial colonies, acute inflammatory cell infiltrate in all the cases while thrombotic capillaries were observed in 3 cases. The most important benefits of this therapy include a reduction in the wound area together with induction of new granulation tissue, effective wound cleaning, and the continuous removal of wound exudate.
He did not realise the great opportunity that Swami had offered him by His Grace. One case required transverse colostomy with restoration of bowel continuity at a later stage. Five patients developed acute renal failure which was managed, while one patient died. The disease is classified as Type 1 when caused by a mixed anaerobic flora and other bacteria, and Type 2 when caused by Group A Streptococcus alone or in association with Staphylococcus aureus 7. Predisposing factors include –chronic and malignant diseases, psoriasis, surgery, and opened or closed trauma, among others8,9,10. The three main types of blood vessels are veins, arteries and capillaries.Antibiotics Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. But one thing is for sure: it is vital to stick to your treatment routine, refrain from smoking, select appropriate footwear and regularly get a therapeutic pedicure to minimise complications or postpone their onset.
The differential diagnosis includes cellulitis at initial stage. He does note this is an off-label use. The confirmation is mainly by histopathological examination of excised surgical material. The key feature in distinguishing necrotizing fasciitis from cellulitis is the location of the inflammation. In the former, the inflammation involves the subcutaneous fat, fascia, and muscle in addition to the dermis. Bacteriological tests from the wound exudates, blister fluid, excised tissue and aspirate material are essential for appropriate microbiologic diagnosis12. In our study, the culture was sterile in 5 cases.
This could be attributed to inadequate antibiotic therapy received from outside before coming to our hospital or fastidious anaerobic organisms. Without treatment, the infection can spread further and destroy increasing amounts of tissue. Treatment outcome is good when the disease is anatomically confined to the sinuses. The treatment options include radical surgical debridement of the entire necrotic tissue, frequent wound dressings with hypertonic saline, hyperbaric oxygen therapy, broad spectrum parenteral antibiotic therapy, and general and aggressive patient support measures12, 17,18 . The prognosis of necrotizing fascitiis depends on age, co-morbodities and severity of the septic syndrome. For patients under the age of 35, the mortality rate is significantly lower (0%) when compared to mortality in patients over 70 years of age (65%). Mortality may reach 100 % in surgically non treated patients19.
In conclusion, Fournier’s gangrene is an abrupt, rapidly progressive, gangrenous infection of the external genitalia and perineum and a real urologic emergency. Prompt diagnosis and early surgical intervention is required for a better outcome of these patients. References 1. Basoglu M, Gul O, Yildigran I, Balik AA, Ozbey I, Oren D. Fournier’s gangrene: review of fifteen cases. Am Surg 1997; 63(11):1019-21. 2.
Although researchers have shown that topical anesthetics in high concentrations can inhibit collagen synthesis and delay healing in experimental wounds, Dr. Fournier’s gangrene: Necrotizing fasciitis of the male genitalia. Br J Urol 1983; 55:85-88. 3. Paty R, Smith AD. Gangrene and Fournier’s gangrene. Urol Clin North Am 1992; 19:149-62.
4. Laucks SS. Fournier’s gangrene. Surg Clin North Am 1994; 74: 1339-52. 5. Vijay R. Fournier’s gangrene.
Available at: http://www Meditune Fournier’s Gangrene. htm. Accessed 15 DEC 2005 6. Morantes MC, Lipsky BA. “Flesh-eating bacteria”: return of an old nemesis. Dermatol 1995; 34(7)461-63. Dr.
Fink S, Chaudhuri TK, Davis HH. Necrotizing fasciitis and malpractice claims. South Med J 1999; 92(8):770-4. 8. Grubb RL, Figenshau RS. Urologic surgery. In: Doherty GM, Lowney JK, Reznik SI, Smith MA eds.
The Washington manual of surgery. 3rd ed . New York: Lippincott Williams and Wilknis; 2002: 687-705. 9. Nambiar PK, Lander S, Midha M, Ha C. Fournier’s gangrene in spinal cord injury: a case report. J Spinal Cord Med 2005; 28(2): 121-4.
10. Jiang T, Covington JA, Haile CA, Murphy JB, Rotolo FS, Lake AM. Fournier gangrene associated with Crohn disease. Mayo Clin Proc 2000; 75(6):647-9. 11. Benizri E, Fabiani P, Migliori G, et al. Gangrene of the perineum.
Urology1996; 47(6):935-9. 12. Flanigan RC. Diagnosis and treatment of gangrenous genitalia. Surg Clin North Am 1984; 64: 715-20. 13. Uppot RN, Levy HM, Patel PH.
Case54: Fournier’s gangrene. Radiology 2003 ; 226(1): 115-17. 14. Begley MG, Shawker TH, Robertson CN, Bock SN, Wei JP, Lotze MT. Fournier’s gangrene: diagnosis with scrotal USG. Radiology 1988; 169:387-9. 15.
Cumming MJ, Levi CS, Ackerman TE. US case of the day: Fournier gangrene. Radiographics 1994; 14:1423-24. 16. Atakan IH, Kaplan M, Kaya E, Aktoz T, Inci O. A life threatening infection: Fournier’s gangrene. Int Urol Nephrol 2002; 34(3): 387-92.
17. Sutherland ME, Merger AA. Necrotizing soft tissue infections. Surg Clin North Am 1994; 74: 591-607. 18. Lucca M, Unger HD, Devenny AMR. Tretment of Fournier’s gangrene with adjunctive hyperbaric oyygen therapy.
Am J Emer Med 1990; 8:385-7. 19. Kaul R, McGear A, Low DE, Green K, Scwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Am J Med 1997; 103:18-24.