Coagulation Parameters in the Patients with Fournier’s Gangrene

Aim: In this prospective study, we aimed to determine the coagulation parameters in the patients with Fournier’s gangrene. Methods: The study group is consisted of 12 consecutive Fournier’s gangrene patients (11 men and 1 woman) and control group is consisted of patients with Periurethral abscess (n=2), Scrotal abscess (n=4) and Epididimorchitis (n=4). Fibrinogen, protein C, protein S,␣antithrombin III, lupus anticoagulant, cardiolipin IgG and IgM, prothrombin time-international normalized ratio, activated partial thromboplastin time, platelet count, proaccelerin, antihemophilic globulin (FVIII), albumin, and calcium were evaluated in all subjects. Tissue specimens were taken from Fournier’s gangrene patients. These specimens were tested for arterial and venous thrombosis using light microscopy. Results: All of the patients with Fournier’s gangrene had both arterial and venous thrombosis in tissue specimens. The levels of fibrinogen and FVIII were high, the level of protein C was low in 12 patients. Lupus Anticoagulant was positive 11 of 12 patients. Conclusions: According to our findings, we think that some coagulation parameters (FVIII, Lupus anticoagulant, protein C, fibrinogen) may be diagnostic for Fournier’s gangrene.     

Scrotal and penile reconstruction using the vacuum-assisted closure device

Fournier’s gangrene is a necrotizing, soft tissue infection that spreads along the deep external fascial planes of the perineum, scrotum (or vagina), penis, thighs and lower abdomen. Due to the rapid progression of the disease, patients are frequently left with a large integumentary deficit. Treatment of the skin defect has been described in a multitude of ways including split-thickness skin grafting, burying the testes in the thighs, thigh flaps and a variety of myocutaneous and fasciocutaneous flaps. Many of the previously described techniques have worked well for smaller defects and for closure of wounds but fall short of aesthetic reconstruction of sexual organs. Described here is a technique using split-thickness skin grafts, with foam dressings as the bolster. This was performed using the vacuum-assisted closure device (Kinetic Concepts Inc, USA). This technique creates a natural appearing scrotum that holds the testes away from the body, in a physiological manner, and surfaces the penis with a natural appearance, in a functional manner. The technique results in nearly 100% graft take and greatly decreases length of hospital stay.     

Fournier's gangrene: Can aggressive treatment save life?

Fournier's gangrene (FG) is a rapidly progressive, fulminant infection of the scrotum, perineum and the abdominal wall. FG is caused by synergic aerobic and anaerobic organisms. Modern surgical series report mortality of up to 67% [2, 3]. This originally rare disease has become more frequent. Aggressive treatment including antibiotics, antigangrenous serum, and treatment of all accompanied diseases and disorders can be successful. Treatment also includes debridement and plastic corrections. Authors describe management of 8 patients with FG. Treatment of FG and all accompanied diseases was in all cases successful. Treatment costs of this kind of patients were approximately 20 times higher than treatment of patients with other urologic diseases.     

Terminal ileum gangrene secondary to a type Ⅳ paraesophageal hernia

Type Ⅳ paraesophageal hernia(PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type Ⅳ PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in Pub Med. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type Ⅳ PEH with incarceration of only the terminal ileum.     

Acute ischemic gangrene of the rectum: Report of 3 cases and review of literature

INTRODUCTIONAcute ischemia of the rectum resulting in full thickness necrosis is extremely uncommon because of its excellent blood supply.PRESENTATION OF CASEWe present 3 cases with spontaneous ischemic gangrene of the rectum. All three patients were elderly with atherosclerotic arterial disease and presented with hypotensive shock but in none of these patients we encountered a precipitating factor such as preceding vascular surgery or shock state.DISCUSSIONA high index of suspicion should be maintained in elderly patients with atherosclerotic disease who present with lower GI symptoms with hypotensive shock and an inflamed rectum on CT scan. Immediate beside proctoscopy should be offered to these patients and if the diagnosis is confirmed these patients should be taken to the operating room immediately. If the entire rectum is found to be gangrenous then an emergency APR should be performed and the perineal wound left open. If the rectum is partially gangrenous then a low anterior resection with Hartman's procedure for diversion is appropriate.CONCLUSIONPrompt diagnosis and resuscitation followed by immediate surgical intervention is necessary to save these elderly patients.     

Single-stage revascularization and free flap coverage in the treatment of ischemic lower limb lesions

Old age, diabetes and atherosclerotic disease all have been considered to be relative contraindications for microsurgery. As such, gangrenous lesions of the lower limb traditionally resulted in staged amputations. A more aggressive approach, combining revascularization and free tissue transfer, allowed us to limit the level of amputation and to start early ambulation and rehabilitation, without the need for major orthotic help. Performing the vascular procedure, debridement, and free tissue transfer in one single intervention greatly reduces the number of operative procedures without substantial increase in operative time. Twenty consecutive patients underwent a combined free flap and revascularization procedure, two patients died perioperatively. One free flap was lost and needed replacement. All surviving patients were ambulating postoperatively.This paper was presented at the Eleventh Congress of the IPRAS, April 17–21, 1995, Yokohama, Japan     

Early CT findings of fournier’s gangrene in a healthy male

Early clinical identification of Fournier’s gangrene is imperative to avoid delay in the aggressive surgical debridement, antibiotic therapy, and sometimes hyperbaric oxygen treatments. We report on the early computed tomography findings of a non-gas-forming Fournier’s gangrene in a healthy male to aid urolo- gists, surgeons, and radiologists in the recognition of this rapidly progressive and often fatal infection.     

A clinico-pathological study of diabetic foot ulcers

During a 32-month period 94 foot ulcers in 54 diabetic patients aged 38-90 years (mean 64 years) were managed in a specialist foot clinic. Fifty-six percent were men, and they were significantly younger than women; 46% were taking insulin. Mean duration of diabetes was 13.4 years. Comparison with controls revealed a higher prevalence (p less than 0.01) of retinopathy (60% vs 23%), neuropathy (89% vs 31%), vasculopathy (71% vs 34%), arterial calcification (31% vs 20%) and previous lesions (54% vs 4%). There was no difference in quality of diabetic control, or smoking habit. A simple classification of lesions was used. All types yielded mixed cultures of microorganisms (average 2.1 per swab); the flora obtained was affected by systemic antibiotics. Abnormal pressure was judged to have contributed to all lesions occurring in areas of callus. In addition definable trauma precipitated the event in up to 60% of all other types. Lesions in areas of callus were more likely to have healed by the end of the study period, but average time to healing was significantly longer than other lesions. Despite intensive outpatient support, 33 patients spent a total of 1188 days in hospital during the 974 day period, an average of 36 days per patient and 1.2 beds per day. Further research is urgently required to define optimal methods of prevention and treatment of diabetic foot ulcers.     

C-反应蛋白检测在坏疽及穿孔性阑尾炎诊断中的价值

目的 探讨C-反应蛋白（CRP）检测在坏疽及穿孔性阑尾炎（GPA）诊断中的价值。方法 选择2016年10月至2017年10月蚌埠市第三人民医院收治的111例急性阑尾炎（AA）患者,患者均行阑尾切除术。根据术中所见及术后病理结果,分为急性单纯性阑尾炎（ASA）组（43例）、急性蜂窝织性阑尾炎（APA）组（48例）与坏疽及穿孔性阑尾炎（GPA）组（20例）,比较3组患者白细胞（WBC）计数、中性粒细胞百分比（N%）和CRP水平,同时绘制受试者工作曲线（ROC）,行logistic回归分析。结果 3组患者的CRP水平、WBC计数的差异有统计学意义（P<0.05）,GPA组患者的CRP水平高于ASA、APA组,ASA组患者WBC计数水平低于APA、GPA组,差异有统计学意义（P<0.05）。logistic回归分析显示,CRP是预测GPA的危险因素（P=0.001）。ROC结果显示：CRP的诊断效率优于WBC计数和N%,WBC计数、N%和CRP的曲线下面积分别为0.617、0.610和0.797（P=0.000）,CRP诊断GPA的约登指数为0.464,最佳监测点为41.94 mg/L （灵敏度为75.00%,特异性为71.43%）。结论 CRP水平在GPA患者中升高更为明显,可作为预测阑尾炎病理类型的辅助指标。     

The Role of the Platelet Mass Index (PMI) as a New Prognostic Factor in Fournier’s Gangrene

Introduction

Fournier’s Gangrene is a mortal disease. Monitoring of the prognosis of patients is of utmost importance while planning the treatment strategies.