Fournier's gangrene and diabetic ketoacidosis with lower-than-anticipated glucose levels associated with SGLT-2 inhibitor: A double trouble

Empagliflozin has a demonstrated cardiovascular benefit. It is co-prescribed as a glucose-lowering medication in patients with type II diabetes mellitus. Herein, we discuss dual-emergency side-effects, Fournier's gangrene (FG) and diabetic ketoacidosis with lower-than-anticipated glucose levels in a patient on Empagliflozin, a sodium-glucose transport protein 2 inhibitor (SGLT-2i). The pathophysiologic mechanism of FG in correlation with SGLT-2i is not yet elucidated. SGLT-2i increase predisposition to genital mycotic and urinary infections, a mechanism favouring FG. A patient with type II diabetes mellitus on SGLT-2i presented with acute necrotic infection of the scrotum and simultaneous diabetic ketoacidosis with lower-than-anticipated glucose levels. This dual emergency was managed with debridement and medical treatment on lines of diabetes ketoacidosis, respectively. A re-look at this group of glucose-lowering medications from bedside towards benchtop research may help to prod into any other mechanistic basis of these life-threatening clinical occurrences.     

特发性阴囊坏疽的诊治--附6例报告

目的探讨特发性阴囊坏疽的病因和诊治,提高该病的诊疗水平。方法回顾性分析我院收治的经手术病理确诊的6例特发性阴囊坏疽患者的临床资料,并结合文献复习。结朵6例患者年龄41～68岁,分别合并有糖尿病、急性淋病、尿道狭窄伴感染、肛周脓肿、褥疮伴感染出血、阴囊皮肤抓伤。6例阴囊坏死物渗出物培养均有致病菌生长。予局部多次彻底的清创、引流和广谱抗生素的联合应用及全身支持治疗,3例另予高压氧治疗。5例治愈,1例合并糖尿病患者死于感染中毒性休克、多器官功能衰竭。结论早期诊断,及时广泛、多次彻底清除坏死组织,联合应用广谱抗生素以及全身支持治疗是提高疗效的关键。     

我院地震伤员气性坏疽防控措施与实施

目的 探讨在5.12大地震后前沿医院短时间集中收治大量地震伤员的特殊情况下,采取及时正确医院感染管理,预防控制伤员气性坏疽发生和院内感染.方法 (1)医院感染管理部门和医院医务人员提高对气性坏疽的认识,制定气性坏疽相关的医院感染院预防控制措施;(2)院前对地震伤员按伤口情况分诊,对伤员去污染处理;(3)加强气性坏疽的筛查;(4)对气性坏疽患者早诊断、早隔离、早治疗,采取严格消毒措施.结果 本院收治1 400多地震伤员只发现1例气性坏疽患者,后无第2代病例发生.结论 在5.12大地震后,医院短时间集中收治大批地震伤员,本院采取医院感染消毒隔离预防控制气性坏疽的措施是及时正确的.     

Gas gangrene after colonoscopy

A case of spontaneous clostridial myonecrosis developing shortly after diagnostic colonoscopy is described. The prime underlying factor proved to be an unsuspected colonic cancer, developing in a patient with pre-existing ulcerative colitis and sclerosing cholangitis.     

The features and aetiology of Fournier's gangrene.

This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier''s gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier''s gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum.     

U型管在Fournier坏疽治疗中的应用

目的 探讨Fournier坏疽的创面处理方法。方法 报告7例Fournier坏疽的临床特点，进行简要文献复习。对7例Fournier坏疽创面经自制U管冲洗换药法处理。结果 7例经冲洗、抗炎等综合治疗，均治愈。无1例死亡，其中创面5例经换药一期愈合2例经二期缝合治愈。结论 Fournier坏疽是一种延期及阴囊、阴茎及软组织间隙的感染坏死性筋膜炎其治疗中的创面处理十分困难。采用的经自制U管冲洗法处理创面。行之有效。创面痊愈周期平均缩短15d。     

手术治疗Fournier坏疽的体会

目的探讨外科手术治疗Fournier坏疽的经验体会。方法对盛京医院普通外科的11例Fournier坏疽患者,采用早期广泛清创手术,术后局部充分引流,配合应用广谱抗生素进行治疗。对病例的临床资料及治疗效果进行分析。结果 11例患者均痊愈出院,无1例死亡。结论彻底清创与充分引流是成功治疗Fournier坏疽的关键。     

阴囊坏疽6例临床分析

目的探讨阴囊坏疽的临床特点。方法对6例男性阴囊坏疽患者临床资料进行回顾性分析。患者年龄43-78岁,平均57岁,其中阴囊坏疽4例,伴会阴皮肤坏疽2例。6例均行外科清创、引流、抗感染治疗。结果6例均经清创引流、抗感染及对症支持治疗,3例康复,3例死亡。其中2例死于败血症,1例死于多器官功能衰竭。结论早期诊断、早期清创是治疗阴囊坏疽成功的关键。     

阴囊坏疽的诊断和治疗(附13例报告)

目的探讨阴囊坏疽的诊治方法。方法回顾分析13例阴囊坏疽患者的临床资料。结果对13例患者均行早期多切口切开引流和广泛清创,10例患者行膀胱造瘘术,9例经二期缝合后痊愈。结论早期多切口切开引流,广泛清创,及时纠正休克,使用广谱抗生素,全身支持治疗和必要的重复清创是治疗成功的关键。注意卫生、保持局部清洁及提高卫生保健意识是其重要预防措施。     

突发性阴茎阴囊坏疽6例

[背景 ]突发性阴茎阴囊坏疽是一种极严重的少见疾病 .[病例报告 ]自 1989年 5月～1998年 4月间共收治 6例 ,其中阴茎皮肤坏疽 3例 ,阴囊皮肤坏疽 3例 .[讨论 ]临床特点是病情发展迅速 ,在较短时间内阴茎和阴囊肿痛 ,坏死 ,渗液 ,有恶臭 ,患者全身中毒症状明显等 .治疗上联合使用多种有效抗生素 ,及早切开引流和切除坏死组织 ,适时移植皮瓣或缝合伤口、修补创面 .     

Comprehensive treatment for gas gangrene of the limbs in earthquakes

Background Mortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients. Methods We retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China＇s Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene.     

肠道菌群及其代谢产物作为阿尔茨海默病诊断生物标志物的研究进展

阿尔茨海默病(Alzheimer's disease,AD)是老年期痴呆最常见的一种类型,随着脑-肠轴理论的提出,越来越多的研究证实AD的发生发展与肠道菌群构成及其代谢产物的改变密切相关.本文就近年肠道菌群及其代谢产物在AD领域的研究进行综述和讨论,以此为着眼点,阐述以粪便为标本的肠道菌群及其代谢产物检查作为AD诊...     

前列腺素E1治疗糖尿病肢端坏疽疗效观察

目的探讨前列腺素E1对糖尿病肢端坏疽的治疗效果。方法自2004年6月~2006年2月对58例患者,采取随机分组,治疗组30例用前列腺素E1加基础治疗方法,对照组28例用复方丹参加基础治疗,观察84 d。结果治疗组溃疡总有效率90%,疼痛总有效率83%,观察组溃疡总有效率60%,疼痛总有效率57%,治疗前后两组患者的股动脉、腘动脉及足背动脉内径和血流量差异均有统计学意义(P<0.05)。结论前列腺素E1是治疗糖尿病肢端坏疽的有效药物。     

The pathophysiological and molecular basis of Bartter's and Gitelman's syndromes

Molecular defects affecting the transport of sodium, potassium and chloride in the nephron through the ROMK K⁺ channel, Na⁺/K⁺/2Cl^- cotransporter, the Na⁺/Cl^- cotransporter and chloride channel have been identified in patients with Bartter''s and Gitelman''s syndromes. Defects of the angiotensin II type I receptor and CFTR have also being described. These defects are simple (ie, most are single amino acid substitutions) but affect key elements in tubular transport. The simplicity of the genetic defects may explain why the inheritance of these conditions remains unclear in most kindreds (ie, not just recessive or dominant) and emphasises the crucial importance of the conformational structure of these channels. Application of this molecular information will allow the early genetic identification of patients with these syndromes and enable us to differentiate between the various disorders at a functional level. It may also identify a sub-group in which the heterozygous form may make patients potentially exquisitely sensitive to diuretics.


     

阿尔茨海默病患者的视觉环路损害特征及其临床应用的研究进展

阿尔茨海默病(Alzheimer's disease,AD)是老年入中最常见的痴呆类型,表现为进展性、不可逆转的多维度认知功能障碍.视觉功能障碍是AD及其高风险人群轻度认知功能障碍(mild cognitive impairment,MCI)的认知损害特征之一,视觉环路功能障碍是其视觉症状的主要机制.利用神经影像学可以...     

地震伤并发气性坏疽的创面处理

目的总结地震伤并发气性坏疽的创面处理方法。方法回顾性分析18例地震伤并发气性坏疽患者的早期临床表现、诊断、创面处理及预后情况。结果18例中16例截肢患者未再行第2次截肢术,2例行清创及肢体局部切开减压,未行截肢术,所有患者临床治愈出院。结论早诊断,旱治疗,全面管理患者创面,尽可能缩小组织坏死范围,提高临床救治水平,可减低病死率,同时还可避免院内交叉感染的发生。     

Alpha-烯醇化酶与疾病的相关性

alpha-烯醇化酶(α-enolase, ENO1)是原核及真核细胞内糖酵解过程中的限速酶,参与纤溶酶原的激活和纤溶酶活化过程,促进肌生成和肌肉再生,调控细胞增殖与凋亡等过程,其在细胞内外表达量的变化与疾病的发生发展过程密切相关,如阿尔兹海默病、类风湿关节炎、肿瘤、心血管疾病等。