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Sample records for fournier gangrene presenting

  1. An unusual presentation of Fournier's gangrene.

    LENUS (Irish Health Repository)

    Kearney, D E

    2011-06-01

    INTRODUCTION: Fournier\\'s gangrene is a rare severe necrotising fasciitis of the genitalia. CASE: A case of Fournier\\'s gangrene caused by perforated sigmoid diverticulitis in a patient with systemic lupus erythematosus is presented along with a review of the relevant literature.

  2. Presentation and Diagnosis of Fournier Gangrene.

    Science.gov (United States)

    Voelzke, Bryan B; Hagedorn, Judith C

    2018-04-01

    Necrotizing fasciitis is a severe type of necrotizing soft tissue infection involving the superficial fascia and subcutaneous tissues. Fournier gangrene, a type of necrotizing fasciitis, affects the genitalia or perineum. Although a rare health condition, Fournier gangrene can result in significant morbidity and unnecessary mortality following delay in diagnosis and management. We provide a review of relevant presenting features to aid diagnosis and allow timely surgical management of this serious infectious condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Fournier gangrene.

    Science.gov (United States)

    Parry, Nadiah

    2015-03-01

    Fournier gangrene is a rapidly progressive necrotizing infection of the perineal and genital fascia, often polymicrobial. Severity is increased in older patients, diabetics and the immunocompromised. As in this case, the disease can have an indolent onset. Early recognition and aggressive treatment is important.

  4. Fournier's gangrene as first presentation of promyelocytic leukemia

    NARCIS (Netherlands)

    Faber, HJ; Girbes, ARJ; Daenen, S

    A 50-year-old male is described who presented with Fournier's gangrene as what is probably the first manifestation of a newly diagnosed acute myelogenous leukemia (AML), promyelocytic type or variant type M-3, according to the FAB classification. Despite aggressive fluid resuscitation, tuned

  5. Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Milović Novak

    2008-01-01

    Full Text Available Background. Fournier's gangrene (FG represents a necrotizing infection of the skin and subcutaneous soft tissue of the external genitalia and perineum. It arises as a result of propagation of anorectal, urogenital and skin infections. The principles of treatment include improving general condition of a patient, debridement of wound, excision of necrotic tissue, combined antibiotic therapy, hyperbaric oxygen therapy and reconstructive procedures. It is a rare but very serious condition which regardless to aggressive treatment can lead to a lethal outcome in up to 20-30% of patients. Case report. Since the year 2000 we have treated six patients with FG. We presented the course and positive treatment outcome in a 65- year-old male patient with numerous comorbid conditions, nonregulated insulin-dependent diabetes, hypertension, previous myocardial infarction, chronic viral hepatitis and thrombocytopenia, rehabilitation was complicated with heart failure, atrial fibrillation and pulmonary thromboembolism. The treatment consisted of two extensive debridement of the wound with removing necrotic tissue, drainage, consolidation of state of health, correction of his blood sugar levels and thrombocytopenia, antimycotic and combination of three antibiotics and hyperbaric oxygen therapy. In two delayed surgical procedures reconstruction of a large defect of the urethra was performed. Conclusion. A patient with numerous and serious comorbid conditions with FG could recover as a result of teamwork of urologists, infective medicine specialists, cardiologists, endocrinologist, vascular and plastic surgeons.

  6. Fournier gangrene in pregnancy.

    Science.gov (United States)

    Sinha, Rinkita; Arachchi, Asiri; Lee, Peter; Marwan, Kareem

    2015-06-01

    Fournier gangrene is a rare and rapidly progressive necrosis of the perineal and genitourinary region. Although predominantly affecting men, we describe an unusual presentation in pregnancy. A 30-year old primigravid woman in the third trimester of pregnancy presented with a history of low back pain. Subsequently, a diagnosis of perianal sepsis and associated Fournier gangrene was established. The patient underwent an emergency cesarean delivery followed by radical surgical debridement and colostomy. Expedited delivery, timely diagnosis of gangrene, urgent, extensive debridement, and broad-spectrum antibiotic coverage contributed largely to effective management of this rare presentation in pregnancy.

  7. [Fournier gangrene: presentation of 6 cases with no mortality].

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    Comín Novella, Laura; del Val Gil, José María; Oset García, Mónica

    2008-07-01

    Fournier's gangrene is a serious and potentially lethal rare infection of perineal and external genital that must be treated as a medical and surgical emergency. The aim of this study is to share our experience over the last 10 years in the management of this disease. We carried out a descriptive and retrospective chart review of patients diagnosed and treated for this pathology in our Hospital over the last 10 years. The patient age, sex, risk factors, urgent laboratory investigations, presenting symptoms, duration of hospital stay, microbiological findings, and number of debridements were recorded. Six patients had this pathology, all males, with a mean age of 58.5 years. Half of them (50%) showed predisposing factors, but none of them showed a clear aetiology. The initial symptomatology was perineal or perianal phlegmon-abscess with a torpid evolution and gangrene. The treatment was intravenous antibiotics and debridement, which was repeated in 4 patients. The most commonly isolated microorganism was Escherichia coli followed by Acinetobacter and Bacteroides. The mean hospital stay was 32 days. There were no deaths recorded in this study. Fournier's gangrene is a serious disease that occurs in patients with risk factors. Early surgical treatment and broad-spectrum antibiotics are important.

  8. Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report.

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    Moslemi, Mohammd Kazem; Sadighi Gilani, Mohammad Ali; Moslemi, Ali Akbar; Arabshahi, Ali

    2009-12-03

    Fournier gangrene is a rare necrotising fascitis of the perineum and genitals caused by a mixture of aerobic and anaerobic microorganisms. The first case was described by Baurienne in 1764 but the condition was named by Fournier in 1883 who reported the cases of five men with the condition with no apparent etiology. Infection most commonly arises from the skin, urethra, or rectal regions. Despite appropriate therapy, mortality in this disease is still high. We report a case of a low rectal malignancy presenting as Fournier gangrene. This case report serves to highlight an extremely unusual presentation of rectal cancer, a common surgical pathology. The patient is a 48 years old Afghanian male that admitted with Fournier gangrene. In the course of medical and surgical treatment the presence of extensive rectal adenocarcinoma was discovered. After partial recovery, standard loop colostomy was inserted. Skin grafting of necrotic areas was performed and systemic rectal cancer chemotherapy initiated after full stabilization. Fournier gangrene is an uncommon but life threatening condition with high associated mortality and morbidity. Usually there is an underlying cause for the development of Fournier gangrene, that if addressed correctly, can lead to a good outcome. Early diagnosis and treatment decrease the morbidity and mortality of this life threatening condition. Good management is based on aggressive debridement, broad spectrum antibiotics and intensive supportive care.

  9. Group C streptococcal sepsis complicating Fournier gangrene.

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    Marinella, Mark A

    2005-09-01

    Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical debridement and broad-spectrum antibiotic therapy. We describe a case of Fournier gangrene in a young diabetic man that was associated with group C streptococcal bacteremia, an association previously unreported in the literature to our knowledge.

  10. Gangrena de Fournier Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Gabriel González Sosa

    2010-09-01

    Full Text Available Se presenta el caso de un paciente con gangrena de Fournier o fascitis necrosante. Después de su ingreso en la Unidad de Cuidados Intensivos se le realizó tratamiento quirúrgico precoz (incisión y drenaje amplio de toda la zona afectada así como desbridamiento de la zona de necrosis; se tomó muestra de pus para estudio microbiológico y se comenzó tratamiento antibiótico de inmediato (ceftriaxona, amikacina y metronidazol. Se identificaron como agentes causantes del proceso Pseudomonas aeruginosa y Escherichia coli (sensibles a la ceftriaxona y la amikacina. Como tratamiento coadyuvante, se aplicaron 10 sesiones de cámara hiperbárica y 12 dosis de factor de crecimiento humano recombinante liofilizado, que se infiltraron en el interior de la zona quirúrgica para contribuir al cierre por tercera intención.This is the case of a patient presenting with Fournier gangrene of necrotizing fasciitis. After admission in Intensive Care Unit (ICU he undergoes an early surgical treatment (incision and wide drainage of the whole involved zone as well as debridement of necrosis zone; a pus sample was took for microbiologic study and a immediate antibiotic treatment was started (Ceftriaxone, Amikacin and Metronidazole. Pseudomonas aeruginosa and Escherichia coli (sensitive to Ceftriaxone and Amikacin were identified as the causative agents of process. As adjuvant treatment ten sessions of hyperbaric chamber were applied and twelve dose of lyophilized recombinant human growth factor with infiltration into the surgical zone for the third intention closure.

  11. [Reconstructive methods after Fournier gangrene].

    Science.gov (United States)

    Wallner, C; Behr, B; Ring, A; Mikhail, B D; Lehnhardt, M; Daigeler, A

    2016-04-01

    Fournier's gangrene is a variant of the necrotizing fasciitis restricted to the perineal and genital region. It presents as an acute life-threatening disease and demands rapid surgical debridement, resulting in large soft tissue defects. Various reconstructive methods have to be applied to reconstitute functionality and aesthetics. The objective of this work is to identify different reconstructive methods in the literature and compare them to our current concepts for reconstructing defects caused by Fournier gangrene. Analysis of the current literature and our reconstructive methods on Fournier gangrene. The Fournier gangrene is an emergency requiring rapid, calculated antibiotic treatment and radical surgical debridement. After the acute phase of the disease, appropriate reconstructive methods are indicated. The planning of the reconstruction of the defect depends on many factors, especially functional and aesthetic demands. Scrotal reconstruction requires a higher aesthetic and functional reconstructive degree than perineal cutaneous wounds. In general, thorough wound hygiene, proper pre-operative planning, and careful consideration of the patient's demands are essential for successful reconstruction. In the literature, various methods for reconstruction after Fournier gangrene are described. Reconstruction with a flap is required for a good functional result in complex regions as the scrotum and penis, while cutaneous wounds can be managed through skin grafting. Patient compliance and tissue demand are crucial factors in the decision-making process.

  12. Fournier\\'s gangrene secondary to prolonged use of Steroid ...

    African Journals Online (AJOL)

    A case of Fournier's gangrene in a patient that had used a steroid containing bleaching cream for five years is reported with a brief discussion on the possible mode of action of the cream. Other effects of the cream (striae, 'bleaching') are also noted. We also present this case as a rare cause of Fournier's gangrene.

  13. Fournier gangrene: first manifestation of occult rectal cancer.

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    Ruiz-Tovar, J; Córdoba, L; Devesa, J M

    2011-01-01

    Fournier gangrene is a necrotizing fasciitis of the genital and perineal region. Diverse factors predispose to Fournier gangrene, such as diabetes mellitus, ethylism, liver dysfunction, haematological disorders, obesity or recent regional instrumentation. Rectal tumours can also predispose to Fournier gangrene; most of the reported cases are perforated or unresectable colorectal tumours, but some cases of anorectal cancer diagnosed after recovery from Fournier gangrene have also been reported. In these cases, the presence of a rectal tumour at the time of, or prior to, diagnosis of Fournier gangrene could not be ruled out. We present three cases of rectal cancer whose first manifestation was as Fournier gangrene.

  14. Fournier's gangrene current approaches.

    Science.gov (United States)

    Ozkan, Omer F; Koksal, Neset; Altinli, Ediz; Celik, Atilla; Uzun, Mehmet A; Cıkman, Oztekin; Akbas, Alpaslan; Ergun, Ersin; Kiraz, Hasan A; Karaayvaz, Muammer

    2016-10-01

    Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  15. Gangrena de Fournier Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Emilio Simón Barroso de la Cruz

    2005-12-01

    Full Text Available Se realizó esta revisión relativa a la gangrena de Fournier, motivada por la presentación de una caso atendido en la Sección de Urología del Hospital General Docente de San Antonio de los Baños “Iván Portuondo,” de la provincia de La Habana en el año 2002. Se trató con antibióticos por vía endovenosa y se le practicó desbridamiento quirúrgico y orquiectomía izquierda. La aparición de esta enfermedad es poco frecuente, por lo que se recomienda ante la aparición de la sintomatología correspondiente en el nivel primario de atención ampliar los conocimientos sobre la fascitis necrotizante del periné o Síndrome de Fournier, que es nuestro objetivo final, para la atención temprana en el nivel secundario según los más avanzados criterios médicos. Se ha mantenido la confidencialidad y el consentimiento informado.A review of Fournier's gangrene was made motivated by the report of a case that received attention at the Urology Section of “Iván Portuondo” General Teaching Hospital of San Antonio de los Baños, in 2002. The patient was treated with antibiotics by endovenous route and he underwent surgical débridement and left orchidectomy. The appearance of this disease is uncommon, so when the corresponding symptomatology appears at the primary health care level it is recommended to .widen the knowledge of necrotizing fasciitis of the perineum, or Fournier's syndrome that is our final objective for the early attention at the secondary health care level, according to the most advanced medical criteria. Confidentiality and the informed consent were maintained.

  16. Fournier's Gangrene: Current Practices

    Science.gov (United States)

    Mallikarjuna, M. N.; Vijayakumar, Abhishek; Patil, Vijayraj S.; Shivswamy, B. S.

    2012-01-01

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes. PMID:23251819

  17. Fournier gangrene: a series of 12 patients.

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    Hosseini, Seyed Jalil; Rahmani, Mohammadreza; Razzaghi, Mohammadreza; Barghi, Mohammadreza; Hosseini Moghaddam, Seyed Mohammad Mehdi

    2006-01-01

    Fournier gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia, the perineum, or the abdominal wall that is associated with high morbidity and mortality. In this series, we describe 12 patients with Fournier gangrene who had presented to our medical center. Twelve men had been diagnosed with Fournier gangrene in Shohada-e-Tajrish hospital between March 2002 and September 2005. Their medical records were reviewed and the Fournier Gangrene Severity Index scores before and after the treatment were determined. Fifty percent of the patients were diabetic and their mean age was 58.2 +/- 17.8 years. The mean delay between the onset of the disease and the admission was 4.9 days and the mortality rate was 16.6%. The median Fournier Gangrene Severity Index scores before the admission and at the time of discharge were 4.5 (range, 0 to 11) and 0 (range, 0 to 9), respectively (P = .005). One of the patients who died had the scores of 11 and 9, respectively. Split-thickness skin graft was performed for 5 patients (41.7%). In Fournier gangrene, a rapid diagnosis and emergent surgical intervention is crucial. The Fournier Gangrene Severity Index seems to be an excellent tool for outcome prediction.

  18. Fournier's gangrene--current concepts.

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    Wróblewska, Marta; Kuzaka, Bolesław; Borkowski, Tomasz; Kuzaka, Piotr; Kawecki, Dariusz; Radziszewski, Piotr

    2014-01-01

    Fournier's gangrene (FG) is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital, or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin. It is believed that the occurrence of the disease in women is underreported and may be unrecognised by some clinicians. Fournier's gangrene is a life-threatening condition, constituting an urological emergency. Many patients with Fournier's gangrene have medical or surgical conditions, which are predisposing factors to this disease or its more severe or fatal course. These comprise diabetes mellitus, hypertension, alcoholism and advanced age. Recent reports in the literature point to changes in the epidemiology of FG, comprising an increasing age of patients. Several authors reported that the mean age of FG patients is at present 53-55 years. Prognosis in FG patients is based on FGSI (Fournier's gangrene severity index) score. Despite the progress in medical care for FG patients, the mortality rate reported in the literature remains high--most often 20-40%, but ranges from 4% to 80%. The most common isolates cultured from FG lesions are both Gram-positive and Gram-negative, as well as strictly anaerobic bacteria. Recently community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an etiological agent of FG with severe clinical course and even fulminant sepsis. Rarely FG may have a fungal etiology, being caused by yeast-like fungi Candida spp. or by moulds. Antibiotics should be administered parenterally and in doses high enough to reach an effective concentration in the infected tissues.

  19. [Gangrene of Fournier, treatment, classification].

    Science.gov (United States)

    Kharchenko, D A; Dubinskiĭ, N V; Tunik, R A; Kovalenko, E A; Tolstoĭ, R A; Omel'chenko, S D; Chernukha, L V; Mykhaĭlyk, A N

    2009-05-01

    The experience of treatment with favorable outcome of 3 patients, in whom gangrene of Fournier was diagnosed, was summarized.The necessity of application of "agressive" surgical tactics in early terms of the disease was stressed.

  20. Fournier gangrene: role of imaging.

    Science.gov (United States)

    Levenson, Robin B; Singh, Ajay K; Novelline, Robert A

    2008-01-01

    Fournier gangrene is a rapidly progressing necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency with a potentially high mortality rate. Although the diagnosis of Fournier gangrene is often made clinically, emergency computed tomography (CT) can lead to early diagnosis with accurate assessment of disease extent. CT not only helps evaluate the perineal structures that can become involved by Fournier gangrene, but also helps assess the retroperitoneum, to which the disease can spread. Findings at CT include asymmetric fascial thickening, subcutaneous emphysema, fluid collections, and abscess formation. Subcutaneous emphysema is the hallmark of Fournier gangrene but is not seen in all cases. Compared with radiography and ultrasonography, CT provides a higher specificity for the diagnosis of Fournier gangrene and superior evaluation of disease extent; however, diagnosis and evaluation can also be performed with these other modalities. The administration of broad-spectrum antibiotics and aggressive surgical débridement of the nonviable tissue are both essential for successful treatment. An awareness of the CT features of Fournier gangrene is imperative for prompt diagnosis and effective treatment planning. (c) RSNA, 2008

  1. Isolated Fournier's gangrene of the penis.

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    Obi, A O

    2016-01-01

    To share experience on the presentation and management of 4 cases of isolated penile Fournier's gangrene. Clinical and demographic data of four patients with isolated penile Fournier's gangrene seen over an 8-year period (January 2006-December 2013) were reviewed. All patients had intravenous fluid resuscitation, emergency surgical debridement, and broad-spectrum intravenous antibiotics. Fournier's gangrene of the penis was, respectively, due to long segment anterior urethral stricture, penile edema from poorly controlled congestive cardiac failure, penile abrasion from oral sex and idiopathic. The mean age of the patients was 34.3 ± 5.6 years. One patient with urethral stricture had urinary tract infection. The patients presented with a prodromal period of genital pain and fever followed by genital swelling, gangrene, and ulceration. The most common wound swab isolates were Staphylococcus aureus and Escherichia coli. Only the skin and dartos fascia were affected with sparing of the corporal cylinders. Mean hospital stay was 17.3 ± 3.0 days and mean Fournier's gangrene severity index (FGSI) was 4.0 ± 0.8. Wound closure was achieved by split skin grafting in 2 patients, delayed primary closure in the third and healing by secondary intention in the fourth patient. Subjectively assessed erectile function was preserved in all four patients. Isolated Fournier's gangrene of the penis is very rare. It is associated with low FGSI and sparing of the three corporal cylinders. It may rarely follow oral sexual practice.

  2. Fournier gangrene and unexpected death.

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    Bury, Danielle; Byard, Roger W

    2012-11-01

    Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70-year-old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case. © 2012 American Academy of Forensic Sciences.

  3. Fournier's gangrene. A clinical review.

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    Singh, Ariana; Ahmed, Kamran; Aydin, Abdullatif; Khan, Muhammad Shamim; Dasgupta, Prokar

    2016-10-05

    Fournier's gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier's gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier's gangrene, in particular the various prognostic indicators and management strategies. A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier's gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Fournier's gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents

  4. Fournier's gangrene in the HIV era | Ngugi | African Health Sciences

    African Journals Online (AJOL)

    Background: Fournier's gangrene is a devastating condition that affects mostly patients whose immunity has been reduced. There is increasing evidence for increasing incidence of the disease in those with HIV disease. Objective: To evaluate the presentation, bacteriology and outcome of Fournier's gangrene in our area in ...

  5. Fournier's gangrene during ACTH therapy.

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    Numoto, Shingo; Kurahashi, Hirokazu; Azuma, Yoshiteru; Numaguchi, Atsushi; Nakahara, Kozaburo; Tainaka, Takahisa; Takasu, Michihiko; Yamakawa, Kiyoshi; Nago, Nozomi; Muto, Taichiro; Kitagawa, Yoshiro; Okumura, Akihisa

    2017-05-01

    Fournier's gangrene is an infectious necrotizing fasciitis of the perineal, genital, or perianal regions and is uncommon in children. Adrenocorticotropic hormone (ACTH) is effective for the treatment of infantile spasms; however, suppression of immune function is one of the major adverse effects of this approach. We encountered a 2-month-old boy with infantile spasms that had been treated with ACTH and had developed complicating Fournier's gangrene. Strangulation of a right inguinal hernia was observed after ACTH treatment. Although surgical repair was successful and no intestinal injuries were detected, swelling and discoloration of the right scrotum developed in association with pyrexia and a severe inflammatory response. A scrotal incision revealed pus with a putrid smell. The patient was subsequently diagnosed with Fournier's gangrene complicated by septic shock and disseminated intravascular coagulation. Extensive debridement and intensive care was performed. Enterobactor aerogenes, methicillin-resistant Staphylococcus aureus, and Enterococcus faecalis were isolated from the pus. Meropenem, teicoplanin, and clindamycin were administered to control the bacterial infection. The patient was discharged from the intensive care unit without any obvious neurological sequelae. Suppression of immune function associated with ACTH therapy may have been related to the development of Fournier's gangrene in this case. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  6. A case of Fournier's gangrene after hydrocelectomy

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    Popper, Helmut; Pummer, Karl

    2012-01-01

    An uncommon case of Fournier's gangrene following hydrocelectomy is described. A 78-year-old male with no remarkable previous history, who underwent hydrocelectomy in another hospital, developed Fournier's gangrene 15 days later. The patient required wide aggressive surgical debridement, hyperbaric oxygen chamber and broad-spectrum antibiotic coverage. Afterwards the patient was referred for plastic surgery. Fournier's gangrene is a polymicrobial infection of perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Fournier's gangrene following hydrocelectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management. PMID:24578938

  7. Fournier's Gangrene: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Prasan Kumar Hota

    2012-01-01

    Full Text Available Fournier's gangrene is a very serious surgical emergency seen all over the world. With the newer advancement of surgical techniques and critical care medicine, the mortality and morbidity of this disease has come down significantly over a period of time. An early diagnosis including evaluation of predisposing and etiological factors, metabolic and physiological parameters with prompt resuscitation, aggressive surgical debridement, broad-spectrum antibiotic coverage, and continuous monitoring of all the parameters is essential for a good outcome, therefore reducing the high mortality and morbidity of this condition. In this study, we report 2 different cases of Fournier gangrene. Our first case was a young, nondiabetic, and without any multiorgan failure, who was managed successfully with good outcome. The second case was a 67-year-old man with diabetes and multiorgan dysfunction with extensive gangrene at presentation, who recovered well, but with a stormy postoperative period.

  8. Fournier's Gangrene: Report of 2 Cases

    Science.gov (United States)

    Hota, Prasan Kumar

    2012-01-01

    Fournier's gangrene is a very serious surgical emergency seen all over the world. With the newer advancement of surgical techniques and critical care medicine, the mortality and morbidity of this disease has come down significantly over a period of time. An early diagnosis including evaluation of predisposing and etiological factors, metabolic and physiological parameters with prompt resuscitation, aggressive surgical debridement, broad-spectrum antibiotic coverage, and continuous monitoring of all the parameters is essential for a good outcome, therefore reducing the high mortality and morbidity of this condition. In this study, we report 2 different cases of Fournier gangrene. Our first case was a young, nondiabetic, and without any multiorgan failure, who was managed successfully with good outcome. The second case was a 67-year-old man with diabetes and multiorgan dysfunction with extensive gangrene at presentation, who recovered well, but with a stormy postoperative period. PMID:23326734

  9. Prognostic factors in Fournier gangrene.

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    Ruiz-Tovar, Jaime; Córdoba, Luis; Devesa, Jose Manuel

    2012-01-01

    Fournier gangrene is a necrotizing fasciitis, arising in the genital and perineal area. This entity is still associated with a high mortality rate despite improvements in antibiotic and surgical treatment. This is a retrospective study of all the patients diagnosed and surgically treated for Fournier gangrene at General University Hospital Ramon y Cajal between 1988 and 2008. Possible prognostic factors that could have any influence on the evolution of Fournier gangrene were analyzed. Seventy patients were analyzed, 62 males (88.6%) and 8 females (11.4%) with a mean age of 57.9 ± 13.5 years. Most frequent clinical manifestations were perineal pain (82.9%) and fever (60%). Physical examination revealed edema (91.4%), erythema (88.6%) and perineal skin necrosis (60%). All the patients underwent surgical debridement of necrotic tissue. In 54.3% reoperations were necessary for new surgical debridements. Medical complications rate was 27.1% and mortality one 22.9%. Ethylism, coexistence of neoplasms, presence of skin necrosis, myonecrosis, abdominal wall affection, number of debrided areas, reoperations, concentration of creatinine in serum>1.4 mg/dL, and hemoglobin <10 g/dL, and platelet count <150 × 10(9)/L in whole blood are associated with higher mortality rates. Identification of prognostic factors may help to determine high-risk patients in order to establish an optimal treatment, according to severity of the infection and general status. Copyright © 2012. Published by Elsevier B.V.

  10. Fungal Fourniers Gangrene in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Winston Crowell

    2016-01-01

    Full Text Available Fournier's Gangrene is a rapidly progressive necrotizing fasciitis of the groin, perianal and perineal region that is often polymicrobial in nature, often averaging 3 species of bacteria per patient. The typical infection can be due to a host of microbes, including gram positive, gram negative and anaerobic species including. Many of the causative organisms are found in the normal microbial flora of the perineum. Therefore, Fourniers is an opportunistic infection most commonly affecting the immunosuppressed. The majority of Fournier's gangrene are bacterial; however there have been cases of fungal Fournier's gangrene reported in the literature.

  11. A clinical case of Fournier gangrene.

    Science.gov (United States)

    Iordache, F M; Beuran, M; Turculeţ, C; Vasilescu, C; Surdeanu, D

    2012-01-01

    To present a case of Fournier gangrene and the specific surgical therapy A 71-year old patient with a two days history of pain in the perineal region, swelling, developing necrosis and foul-smelling lesions was examined in emergency settings. The swelling of subcutaneous plane involved the flank regions, mainly on the left side. The investigations were performed (full blood count, blood urea, electrolytes, coagulation profile). A Fournier gangrene was diagnosed and surgery performed under general anesthesia. Broad spectrum antibiotics were given concomitantly. The first surgical procedure consisted in surgical debridement and excision of all the necrotic tissue. Cultures were taken. We performed counter incisions bilaterally on both flanks. The communication through the fascial planes was clearly demonstrated, especially on the left side. A loop colostomy was also performed. Multiple re-excisions were further employed. Due to a precarious evolution, the patient were on mechanical ventilation for 13 days. Inotrope medication was given for a total of 19 days and, the antibiotherapy adapted to the antibiogram (Bacterioides eggerthii was identified). The reconstruction of the perineum was later performed and, after 3 months, the colostomy was closed in good conditions without further complications. Early recognition and aggressive surgical excision are mandatory for success in patients with Fournier gangrene. Colonic diversion can be very useful if employed from the beginning.

  12. Fournier's gangrene with an unusual urologic etiology.

    Science.gov (United States)

    Fialkov, J M; Watkins, K; Fallon, B; Kealey, G P

    1998-08-01

    Fournier's gangrene is a necrotizing infection affecting the male genitalia and perineum, caused by synergistic aerobic and anaerobic organisms. We report on a previously undescribed upper urinary tract etiology for this life-threatening infection.

  13. Fournier's gangrene in a patient after third-degree burns: a case report

    Directory of Open Access Journals (Sweden)

    Iavazzo Christos

    2009-05-01

    Full Text Available Abstract Introduction Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis. Case presentation We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed. Conclusion Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections.

  14. Gangrene

    Science.gov (United States)

    ... Left untreated, internal gangrene can be fatal. Fournier's gangrene. Fournier's gangrene involves the genital organs. Men are more ... affected, but women can develop this type of gangrene as well. Fournier's gangrene usually arises due to an infection in ...

  15. Fournier gangrene in spinal cord injury: a case report.

    Science.gov (United States)

    Nambiar, Prabhakaran K; Lander, Stuart; Midha, Meena; Ha, Chang

    2005-01-01

    Fournier gangrene is a necrotizing fasciitis of the perineal and genital region resulting from polymicrobial infection in which infection spreads along fascial planes, causing soft-tissue necrosis. If surgical debridement and control of infection are delayed, the disease can progress and result in septic shock, multiorgan failure, and death. Initial symptoms are severe pain in the genital region followed by swelling and erythema. In patients with spinal cord injury (SCI), lack of pain sensation could cause delay in seeking medical attention. SCI patients are at higher risk for Fournier gangrene secondary to neurogenic bladder, neurogenic bowel, and impaired sensation. A literature search resulted in only 1 report of Fournier gangrene with localized necrosis of the scrotum in a patient with SCI. Case report of a 47-year-old man with C4 tetraplegia. Patient presented with a necrotic ulceration on the ventral aspect of the penis and scrotum of 2 days duration and was diagnosed with fulminant Fournier gangrene. Patients with SCI are at higher risk for Fournier gangrene secondary to neurogenic bladder, neurogenic bowel, and impaired sensation. Mortality is high. Prevention and early diagnosis are essential. Prompt aggressive intervention is warranted to maximize outcomes.

  16. A 12-month-old infant with Fournier gangrene associated with varicella.

    Science.gov (United States)

    Cortés, Jeff R; Arratia, Jorge A; Jaime, Rodolfo

    2007-10-01

    Fournier gangrene is a progressive infection of the genital and perianal regions. It is a truly rare entity in association with varicella. There is only a single case published in the literature. We present the second case of a Fournier gangrene associated with varicella in an infant.

  17. Fournier's gangrene complicating vasectomy | Lema | East African ...

    African Journals Online (AJOL)

    Journal Home > Vol 80, No 9 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Fournier's gangrene complicating vasectomy. VM Lema. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  18. Fournier gangrene: rare complication of rectal cancer.

    Science.gov (United States)

    Ossibi, Pierlesky Elion; Souiki, Tarik; Ibn Majdoub, Karim; Toughrai, Imane; Laalim, Said Ait; Mazaz, Khalid; Tenkorang, Somuah; Farih, My Hassan

    2015-01-01

    Fournier's Gangrene is a rare complication of rectal cancer. Its discovery is often delayed. It's incidence is about 0.3/100,000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis.

  19. Fournier's gangrene secondary to appendicectomy | Onyenyirionwu ...

    African Journals Online (AJOL)

    Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the ...

  20. Fournier gangrene. Approaches to diagnosis and treatment.

    Science.gov (United States)

    Unal, Bulent; Kocer, Belma; Ozel, Ebru; Bozkurt, Betul; Yildirim, Osman; Altun, Buket; Dolapci, Mete; Cengiz, Omer

    2006-07-01

    To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus (DM) as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene. Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively. The mean age of the patients was 52.8 years. There were 8 female (30.8%) and 18 male (69.2%) patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus (DM) and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients. In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene.

  1. Computed Tomography findings in Fournier's gangrene

    International Nuclear Information System (INIS)

    Isusi, M.; Campo, M.; Oleaga, L.; Grande, J.; Grande, D.

    2000-01-01

    To assess the utility of computed tomography (CT) as an imaging technique in the diagnosis and determination of the extension of Fournier's gangrene (FG). We report the cases of six patients who had been clinically diagnosed as having FG, CT, enhanced by oral and intravenous contrast media, was performed in all the patients. All six patients presented soft tissue masses and gas in the scrotal region, which were also detected in the perineal region in five. In two patients, the gas extended toward anterior abdominal wall and in one of them, it also observed in anterior and posterior para renal space. The major predisposing factors were diabetes and alcoholism and the most common triggering factor was urologic disease. CT confirms the existence of FG and aids in assessing its extension and, in some cases, in identifying the underlying cause. (Author) 15 refs

  2. Fournier's gangrene - a rare complication of hydrocele aspiration

    International Nuclear Information System (INIS)

    Ali, M.Z.

    2004-01-01

    A case of Fournier's gangrene of scrotum with systemic inflammatory response syndrome resulting from hydrocele aspiration in young male patient is presented. He was treated with antibiotics, wide local debridement of scrotal skin with evacuation of pus and gas; followed by serial debridements and dressings. Secondary suturing of scrotal defect was done after 02 weeks. (author)

  3. Fournier's gangrene: Clinical case and review of the literature

    Directory of Open Access Journals (Sweden)

    Remigio Pernetti

    2016-10-01

    Full Text Available Fournier's gangrene is a life-threatening acute necrotizing fasciitis of perianal,genitourinary and perineal areas. Nowadays, is well known that Fournier gangrene is almost never an idiopathic disease. In this article we report a case of a 70-year-old patient that initially was not treated properly. The gold standard therapy of the Fournier's gangrene remains today a complete, early and extended surgical debridement.

  4. Validation and simplification of Fournier's gangrene severity index.

    Science.gov (United States)

    Lin, Tsung-Yen; Ou, Chien-Hui; Tzai, Tzong-Shin; Tong, Yat-Ching; Chang, Chien-Chen; Cheng, Hong-Lin; Yang, Wen-Horng; Lin, Yung-Ming

    2014-07-01

    To validate the predictive value of Fournier's Gangrene Severity Index in patients with Fournier gangrene and to facilitate patient mortality risk-stratification by simplifying the Fournier's Gangrene Severity Index. From January 1989 to December 2011, 85 male patients with clinically-documented Fournier's gangrene undergoing intensive treatment and with complete medical records were recruited. The demographic information and nine parameters of Fournier's Gangrene Severity Index were compared between survivors and non-survivors. The parameters that showed a significant difference between the two groups were selected to generate a simplified scoring index. Of the 85 patients recruited, 16 patients died of the disease with mortality rate of 18.8%. The Fournier's Gangrene Severity Index score at initial diagnosis was significantly higher in non-survivors than in survivors. Of the nine parameters of Fournier's Gangrene Severity Index, the scores of serum creatinine level, hematocrit level and serum potassium level were significantly different between the two groups. However, the mean body temperatures, heart rate, respiration rate, white blood cell count, serum sodium and bicarbonate levels were non-significantly different. Of the 12 patients with chronic kidney disease or end-stage renal disease, 10 died of severe sepsis. A simplified scoring index including parameters of creatinine, hematocrit and potassium was generated, which provided sensitivity and specificity of 87% and 77% in predicting patient mortality, respectively. The predictive values of this simplified Fournier's Gangrene Severity Index were shown to be non-inferior to Fournier's Gangrene Severity Index in our patients. The simplified Fournier's Gangrene Severity Index is easy to use at initial diagnosis, and offers a way to compare outcomes in different clinical populations. © 2014 The Japanese Urological Association.

  5. Fournier's Gangrene due to Masturbation in an Otherwise Healthy Male

    Directory of Open Access Journals (Sweden)

    Jason D. Heiner

    2012-01-01

    Full Text Available Fournier's gangrene is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic, or otherwise immune-compromised individuals. Here, we report an unusual case of Fournier's gangrene due to excessive masturbation in an otherwise healthy 29-year-old male who presented to the emergency department complaining of two days of fever, vomiting, and diffuse myalgias. Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant resulting in recurrent penile erythema and minor skin abrasions. Examination of the patient's perineum was consistent with Fournier's gangrene and included significant erythema, edema, and calor of the penis and scrotum with a large malodorous eschar. He was given intravenous antibiotics and immunoglobulin and promptly underwent three surgical debridements of the scrotum and penis with split-thickness skin grafting. Complications from excessive masturbation are exceedingly rare, but as this case illustrates, they can be life threatening.

  6. Fournier's Gangrene due to Masturbation in an Otherwise Healthy Male.

    Science.gov (United States)

    Heiner, Jason D; Eng, Katisha D; Bialowas, Todd A; Devita, Diane

    2012-01-01

    Fournier's gangrene is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic, or otherwise immune-compromised individuals. Here, we report an unusual case of Fournier's gangrene due to excessive masturbation in an otherwise healthy 29-year-old male who presented to the emergency department complaining of two days of fever, vomiting, and diffuse myalgias. Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant resulting in recurrent penile erythema and minor skin abrasions. Examination of the patient's perineum was consistent with Fournier's gangrene and included significant erythema, edema, and calor of the penis and scrotum with a large malodorous eschar. He was given intravenous antibiotics and immunoglobulin and promptly underwent three surgical debridements of the scrotum and penis with split-thickness skin grafting. Complications from excessive masturbation are exceedingly rare, but as this case illustrates, they can be life threatening.

  7. Fournier's gangrene: review of 120 patients and predictors of mortality.

    Science.gov (United States)

    Yılmazlar, Tuncay; Işık, Özgen; Öztürk, Ersin; Özer, Ali; Gülcü, Barış; Ercan, İlker

    2014-09-01

    Fournier's gangrene (FG) is a devastating and potentially fatal disease requiring prompt and aggressive debridement. In this study, it was aimed to assess the predictors of mortality in a large cohort. Prospectively maintained data of patients with FG were analyzed. Demographic data, duration of symptoms, Uludag Fournier's Gangrene Severity Index (UFGSI) scores, co-morbidities [particularly diabetes mellitus (DM)], etiologies, number of debridement, stoma requirements, length of intensive care unit and hospital stay, and morbidity and mortality rates were reviewed. Multivariate analysis was performed in order to determine factors affecting mortality. 120 patients (81 males) were included in the study. Median age was 58 (22-85) years. UFGSI score was median 9 (1-30). DM was present in 69 (57.5%) patients. Etiology of FG was perianal in fifty-nine, urogenital in 52, and skin in 9 patients. Median debridement count was 3 (1-12). Thirty-one patients required stoma. Forty-eight patients were admitted to intensive care unit and 25 patients required mechanical ventilation. Overall mortality rate was 20.8%. Multivariate analysis revealed UFGSI as the only predictor of mortality (p=0.001). Mortality rate was 13.64 times higher for patients with a UFGSI score of 9 or higher. Fournier's gangrene is a mortal disease requiring emergency surgery. UFGSI is an efficient predictor of mortality for patients with FG.

  8. Severe Fournier's gangrene in a patient with rectal cancer: case report and literature review.

    Science.gov (United States)

    Yoshino, Yu; Funahashi, Kimihiko; Okada, Rei; Miura, Yasuyuki; Suzuki, Takayuki; Koda, Takamaru; Yoshida, Kimihiko; Koike, Junichi; Shiokawa, Hiroyuki; Ushigome, Mitsunori; Kaneko, Tomoaki; Nagashima, Yasuo; Goto, Mayu; Kurihara, Akiharu; Kaneko, Hironori

    2016-09-01

    Fournier's gangrene in the setting of rectal cancer is rare. Treatment for Fournier's gangrene associated with rectal cancer is more complex than other cases of Fournier's gangrene. We report on a patient with severe Fournier's gangrene in the setting of locally advanced rectal cancer who was treated with a combined modality therapy. A 65-year-old man presented with general fatigue and anal pain. The medical and surgical histories were unremarkable. A black spot on the perineal skin surrounded by erythema was found on physical examination, suspicious for Fournier's gangrene. Computed tomography scan showed a rectal tumor invading into the bladder (clinically T4bN2M0) and abscess formation with emphysema around the rectum. He was thus diagnosed with locally advanced rectal cancer and Fournier's gangrene with a severity index score of 12 points. We created a diverting loop colostomy of the transverse colon and performed extensive debridement of the perineum and perianal area. Fifty days later, the patient underwent radical total pelvic exenteration with sacrectomy. In addition, reconstruction of the soft tissue defect was performed using the rectus muscle, the gluteus maximus muscle, and the femoral muscle. Histopathological findings of the specimen were as follows: the tumor was a moderately adenocarcinoma with invasion to the bladder and the prostate (T4b), metastases to four resected lymph nodes (N2), and lymphovascular invasion. There were no major postoperative complications, and the patient was discharged 108 days postoperatively. We report a rare case of locally invasive rectal cancer associated with Fournier's gangrene. This case highlights a usual cause of Fournier's gangrene. Physicians should be cognizant not only of the more common condition but also of the rare presentations including those associated with rectal cancer.

  9. Fournier's gangrene – analysis of 78 cases La gangrene perineale a ...

    African Journals Online (AJOL)

    Objectives: To describe the epidemiologic, diagnostic and therapeutic aspects of Fournier's gangrene. Patients and Methods : This retrospective study was carried out on 78 patients (77 males and 1 female) treated for Fournier's gangrene at the University Hospital of Treichville, Abidjan, Côte d'Ivoire, between January 1998 ...

  10. Fournier gangrene: our approach and patients.

    Science.gov (United States)

    Fajdic, Josip; Gotovac, Nikola; Hrgovic, Zlatko

    2011-01-01

    This retrospective analysis presents our experience in treating Fournier gangrene (FG) and aims to bring in focus diagnostic and therapeutic problems as well as early and aggressive treatment. A total of 16 male patients were included in the study. The gastrointestinal form was seen in 5 and the urogenital form in 11 patients. The subjects ranged in age from 39 to 74 years (average 61) for the urogenital, and from 48 to 72 (average 58) for the gastrointestinal form. Other conditions were seen in 9 patients (diabetes mellitus was most common). Most patients were infected with several bacteria. We performed colostomy in 1 patient, orchidectomy in 2 patients, cystostomy in 2 patients and penis amputation in 1 patient. Ultrasound-guided biopsy or aspiration, and CT was also used. Aggressive surgical necrectomy and aggressive antimicrobial therapy was used. Treatment was successful in 14 of 16 patients (87.5%). The length of hospitalization was 19-58 days (average 48) for the urogenital form and 24-56 days (average 41) for the gastrointestinal form. Mortality was 12.5%. A lethal outcome was recorded in two patients infected with methicillin-resistant Staphylococcus aureus. The average time between onset and hospitalization was 3-11 days (5 on average) for urogenital FG and 4-10 days (average 6) for gastrointestinal FG. Treatment was significantly longer in patients with a comorbidity, such as diabetes or liver cirrhosis due to alcohol abuse. Early diagnosis as well as intensive and aggressive treatment are key to successful treatment of FG. Comorbidity increases length of therapy and lowers the chance for recovery. Disease can be seen again several years after the initial outburst. Copyright © 2011 S. Karger AG, Basel.

  11. Pleomorphic malignant fibrous histiocytoma/undifferentiated high-grade pleomorphic sarcoma of the scrotum in a patient presenting as fournier gangrene: a case report.

    Science.gov (United States)

    Guo, Juan; Zhou, Shengmei; Rao, Nagesh P; Pez, Gholam H

    2010-10-01

    Pleomorphic malignant fibrous histiocytoma (MFH), also known as undifferentiated high-grade pleomorphic sarcoma according to the latest World Health Organization classification, is a diagnosis of exclusion and extremely rare in adult scrotal/paratesticular region. Clinical presentation of scrotal/paratesticular pleomorphic MFH is usually a painless and gradual scrotal swelling. We report a case of scrotal MFH in a 63-year-old man who presented as Fournier gangrene after 10-month painful scrotal swelling and multiple procedures. The specimen of emergent debridement was submitted for pathologic and bacteriologic examination. Microscopically, the lesion had marked architectural and cytologic pleomorphism. The neoplastic cells were positive for vimentin, but negative for all lineage-specific markers. Fluorescence in-situ hybridization showed an aneuploid karyotype and negative results for lipomatous tumor abnormalities. Bacterial cultures of the specimen showed extensive growth of virulent polymicrobes. The diagnosis of scrotal/paratesticular pleomorphic MFH with concurrent Fournier gangrene was made. Thoracic computed tomography scan showed bilateral multiple pulmonary nodules. The patient died 1 month later.

  12. [Our experience in Fournier's gangrene with severe septic shock].

    Science.gov (United States)

    Lukász, Péter; Ecsedy, Gábor; Lovay, Zoltán; Nagy, István; Kári, Dániel; Vörös, Attila; Ender, Ferenc

    2014-06-01

    Fournier's gangrene is a rare, rapidly progressing necrotizing fasciitis, which involves the genital area and perineum, progresses towards the thighs and abdominal wall through fascial plains. In our surgical department we treated seven patients with Fournier's gangrene between 2007 and 2011. Early diagnosis, immediate radical surgical debridement, necrosectomy, appropriate antibiotics and intensive care are all required and necessary for the successful treatment. Despite appropriate therapy, two patients were lost in septic shock.

  13. Magnetic resonance imaging in the diagnosis of Fournier's gangrene

    International Nuclear Information System (INIS)

    Kickuth, R.; Adams, S.; Kirchner, J.; Simon, S.; Liermann, D.; Pastor, J.

    2001-01-01

    Magnetic resonance imaging and ultrasound are the imaging modalities recommended in the early diagnosis of Fournier's gangrene. Because of the high mortality of this inflammatory disease early diagnosis is essential to initiate adequate surgical and medical treatment. In the clinical literature only a handful of cases, in which diagnosis of Fournier's gangrene is based on MRI findings, have been reported; therefore, we report another case which shows the ability of MRI especially to determine the point of origin and extension of disease. (orig.)

  14. Fournier's gangrene of scrotum in a patient with AIDS.

    OpenAIRE

    Murphy, M; Buckley, M; Corr, J; Vinayagamoorthy, S; Grainger, R; Mulcahy, F M

    1991-01-01

    Fournier's gangrene of the scrotum, a form of necrotising fasciitis, is a rare but potentially fatal disorder. Predisposing conditions include chronic alcoholism and diabetes mellitus, possibly as a result of impaired immunity. Fournier's syndrome, occurring in a patient with AIDS, is described.

  15. Stepwise minimal debridement in Fournier's gangrene: a technical ...

    African Journals Online (AJOL)

    Fournier's gangrene, so called after the French physician who first described this condition in 1883, is a necrotizing fasciitis of the perineum and the genitalia. It is a fulminant gangrene of the genitalia. It is a polymicrobial infection caused by gram-positive, gram-negative anaerobic bacteria.1-4 The infection is said to spread ...

  16. Fournier's gangrene: A retrospective analysis of 25 patients.

    Science.gov (United States)

    Yücel, Metin; Özpek, Adnan; Başak, Fatih; Kılıç, Ali; Ünal, Ethem; Yüksekdağ, Sema; Acar, Aylin; Baş, Gürhan

    2017-09-01

    Fournier's gangrene is a surgical emergency that progresses rapidly and insidiously and results in high morbidity and mortality rates unless it is immediately diagnosed and managed. Here we analyze the outcomes of patients who were followed up and treated for Fournier's gangrene. We conducted a retrospective analysis of the medical data of 25 patients operated on for Fournier's gangrene between January 2010 and June 2015. The diagnosis of Fournier's gangrene was made by performing a physical examination. Patients who had genital, perineal, and perianal tenderness; induration; cyanosis; gangrene; and subcutaneous crepitation were considered as having Fournier's gangrene. Following resuscitation, aggressive surgical debridement was performed and vacuum-assisted closure (VAC) was conducted in addition to debridement in select patient. Repeat debridements were performed as requirement. This study included 25 patients. Fourteen patients (56%) were females and 11 (44%) were males. The mean age of the patients was 54.3 years (range: 27-82 years). The mean duration of hospital stay was 21.4 days; the mean number of debridements performed was 2.4. Thirteen patients (52%) had perianal abscesses, and 20 (80%) had diabetes mellitus. All patients underwent extensive debridement; 16 patients (64%) underwent VAC in addition to debridement. Patients undergoing VAC had significantly longer durations of hospital stay and a higher mean number of debridements performed (p=0.004 and p=0.048, respectively). An ostomy was made in one patient, and one patient died. In Fournier's gangrene, early diagnosis, effective resuscitation, aggressive debridement, and VAC application in suitable cases may reduce the morbidity and mortality rates and the need for an ostomy.

  17. Fournier gangrene as a manifestation of undiagnosed metastatic perforated colorectal cancer.

    Science.gov (United States)

    Chan, Cyrus C; Williams, Mallory

    2013-01-01

    Abstract Fournier gangrene is a necrotizing soft tissue infection involving the perineum. We present a case of Fournier gangrene as the clinical presentation of perforated metastatic rectal cancer. The patient is a 78-year-old man in a nursing home who presented to our institution with necrosis and ischemia of the scrotum. After wide debridement of necrotic tissue and bilateral orchiectomy, computed tomography was carried out to investigate abnormal findings seen on his chest X-ray, which revealed multiple pulmonary metastases as well as a mass highly suspicious for a perforated rectal mass. Once stable, a diverting colostomy and biopsies of the rectal mass were performed, confirming the presence of a metastatic, poorly differentiated rectal adenocarcinoma. Albeit an unusual etiology of Fournier gangrene, this case highlights the rare but important causes of this deadly condition and teaches us to be cognizant of the variations in the presentation of colorectal cancer.

  18. Squamous cell carcinoma developing in the scar of Fournier's gangrene – Case report

    International Nuclear Information System (INIS)

    Chintamani; Shankar, Manu; Singhal, Vinay; Singh, JP; Bansal, Anju; Saxena, Sunita

    2004-01-01

    Squamous cell carcinoma of the scrotum is rare and its development in the scar of Fournier's gangrene is still rarer. A 65-year-old gentleman presented with a small non-healing ulcer developing on right hemi-scrotum two years after the treatment for Fournier's gangrene. On histological examination it was found to be squamous cell carcinoma. He was successfully managed by surgery in the form of wide local excision and ilio-inguinal lymph node dissection followed by adjuvant radiotherapy and chemotherapy. Squamous cell carcinoma can develop in the scar of Fournier's gangrene after a long delay, which differentiates it from other scar carcinomas or Marjolin's ulcer

  19. Management of a young female patient with Fournier's gangrene and Lemierre's syndrome.

    Science.gov (United States)

    Aslanidis, Theodoros; Myrou, Athena; Giannakou-Peftoulidou, Maria

    2014-01-01

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery.

  20. Fascitis necrotizant of the perinea (Gangrene of Fournier)

    International Nuclear Information System (INIS)

    Marquez, Juan R; Martinez, Carlos E; Escobar, Jaime; Hormaza, Jose A; Sanchez, William

    2000-01-01

    The Gangrene of Fournier (GF) it is one of the last stages and the most serious in the call perineal sepsis; it is defined like a synergic fascitis necrotizant of the genital area that produces thrombosis of the subcutaneous microvasculature for an endarteritis obliterative, secondary to a bacterial dissemination that produce the necrosis and it gangrenes of the underlying tissue. The paper includes etiology and image studies among other topics

  1. Fournier gangrene: Rare complication of rectal cancer | Ossibi | Pan ...

    African Journals Online (AJOL)

    Fournier's Gangrene is a rare complication of rectal cancer. It's discovery is often delayed. It's incidence is about 0.3/100 000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis. AJOL African Journals Online. HOW TO USE ...

  2. [Fournier gangrene. A retrospective study of 41 cases].

    Science.gov (United States)

    Torremadé Barreda, Jose; Millán Scheiding, Mónica; Suárez Fernández, Cristina; Cuadrado Campaña, Jose María; Rodríguez Aguilera, José; Franco Miranda, Eladio; Biondo, Sebastiano

    2010-04-01

    Fournier's gangrene is a rapidly progressing necrotizing fascitis that affects the perineal and genital area. Mortality still remains high. The aim of this study was to evaluate the epidemiological progression and morbidity-mortality of Fournier's gangrene at our centre over the past 10 years. Retrospective study of 41 patients treated for Fournier's gangrene between 1998 and 2007. Variables studied included, demographic variables, aetiology, microbiology, surgical and antibiotic treatment, morbidity, and mortality. The mean age of the patients was 60, and 93% were male. The most common co-morbidity was diabetes (49%), followed by alcoholism (46%) and immunosuppression or neoplasia (34%). The origin was perianal in 66% of cases, followed by a urological origin (32%). The median time from the onset of symptoms to diagnosis was 3 days. Several surgical debridements were required in 49% of the patients, and the mortality rate was 29%. Most cases had positive cultures (93%), and in 76% more than one microorganism was isolated (enterobacteriaceae and anaerobic flora). In the bivariate analysis, antimicrobial treatment with carbapenems and the absence of systemic complications were associated with lower mortality. Fournier's gangrene continues to be a severe surgical emergency, with a high mortality rate. Early diagnosis and aggressive surgical and antibiotic therapy are necessary for adequate management.

  3. Management of a young female patient with Fournier's gangrene ...

    African Journals Online (AJOL)

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, ...

  4. A case of Fournier gangrene complicating idiopathic nephrotic syndrome of childhood.

    Science.gov (United States)

    Wright, A J; Lall, A; Gransden, W R; Joyce, M R; Rowsell, A; Clark, G

    1999-11-01

    A 10-year-old boy presenting with steroid resistant nephrotic syndrome developed Fournier gangrene of the scrotum. Antimicrobial drug therapy, intravenous albumin, excision of necrotic scrotum and left orchidectomy followed by skin grafting 3 weeks later led to an excellent cosmetic and medical result. Six months later he remains nephrotic on diuretic and angiotensin converting enzyme inhibitor medication.

  5. Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene

    Directory of Open Access Journals (Sweden)

    Feng-Shu Chang, MD

    2018-01-01

    Conclusions:. The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.

  6. A conservative approach to perineal Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Giulio Milanese

    2015-03-01

    Full Text Available Fournier’s gangrene (FG is a disease involving necrosis of perineum and external genitalia; in 95% of cases it is possible to diagnose the Fournier’s gangrene just by physical examination. The clinical presentation of FG varies from an initial localized infection to large areas with necrotizing infection. The disease typically affect elderly men (6°-7° decade with important systemic comorbidities; women are less frequently affected. Despite improvements in diagnosis and management, the mortality rate nowadays is between 20% and 43%. The severity and mortality of the disease is dependent upon the general condition of the patient at presentation and upon the rate of spread of the infection. Treatment involves a multidisciplinary approach: intensive systematic management, broad-spectrum antibiotic therapy, early surgical debridement (wide abscission of necrotic tissues and surgical drainage of peritoneum, scrotum, penis, and inguinal areas, hyperbaric oxygen therapy; surgery can eventually be repeated if necessary; reconstructive surgery has an important role in the final treatment of the disease. The technical difficulties frequently encountered and the inability to make a complete removal of the necrotizing tissues at the time of surgery in some cases has led to the application of combined techniques, in view of the enhancement effect of specific advanced medications, targeted antibiotic therapy and hyperbaric medicine. We have considered 6 patients affected by Fournier’s gangrene treated at our institution; all the patients received treatment with the help of plastic surgeons of the same institution. After debridement, all the patients were treated with advanced specific dressings consisting of plates and strips made of calcium alginate, hydrogels and polyurethane and twodimensional cavity foams. Reconstructive surgery was necessary in one case. Hyperbaric oxygen therapy (HBO has been performed in all cases. The multidisciplinary

  7. [Fournier gangrene (necrotizing fasciitis) in a woman with diabetes mellitus].

    Science.gov (United States)

    Kamper, Lars; Piroth, W; Haage, P

    2009-08-01

    A 67-year-old woman with insuline-dependent diabetes mellitus and chronic alcohol abuse was admitted with impaired consciousness and fever. Physical examination showed a livid induration of the perineal and vaginal soft tissues with crepitations. Laboratory tests showed greatly elevated infection parameters. Abdominal computed tomography revealed perineal and vaginal subcutaneous gas accumulation extending into the ventral abdominal wall. The combination of an obscure infection and subcutaneous genital gas accumulation suggested the diagnosis of Fournier gangrene, a necrotizing fasciitis. In spite of administration of broad-spectrum antibiotics and repeated surgical removal of necrotic tissue the patient died of multiple organ failure. Successful treatment of Fournier gangrene critically depends on immediate treatment. Administration of broad-spectrum antibiotics and aggressive surgical resection of the necrotic tissue may prevent continuing spreading of the infection. Computed tomography provides an early diagnosis and guides the presurgical evaluation of the subcutaneous spread. Georg Thieme Verlag KG Stuttgart * New York.

  8. [Fournier gangrene: evaluation of prognostic factors in 90 patients].

    Science.gov (United States)

    Medina Polo, J; Tejido Sánchez, A; de la Rosa Kehrmann, F; Felip Santamaría, N; Blanco Alvarez, M; Leiva Galvis, O

    2008-01-01

    This study evaluates the risk factors and prognostic variables that affect survival of patients with gangrene of Fournier. The study retrospectively analyzed 90 consecutive patients with gangrene of Fournier treated in our institution between 1975 and 2008. We evaluated the average age, associated systemic diseases, and the source, time of evolution and extent of necrotizing fasciitis. The outcomes were assessed according to whether the patient survived or died. All patients had aggressive surgical debridement, and received parenteral antibiotic therapy. The mortality rate was 34.4%. The mean age was 63.0 years (range 33-95), a statistically significant difference was found between the age of the survivors (median age, 59.84 years) and those who died (median age, 70.20 years) (p = 0.001). Medical comorbidities were identified in 51 patients; the death rate was higher in patients who had any medical disease, especially those who suffered from cancer. Although diabetes mellitus was the most common associated pathology, it was not related to a statistically significant worst prognosis. The source of the infection was identified in 62 patients, who showed a higher mortality (p = 0.015), the mortality rate when a urological source is identified was 50%. Moreover, patients suffering from a more extensive necrotizing infection showed a worst prognosis. The gangrene of Fournier has a high mortality rate. Large series are required to study prognostic variables of this disease. The patient age, the presence of systemic risk factors, especially cancer, a urological source of infection and the extent of the disease have impact on the prognosis of Fournier's gangrene.

  9. Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Are More Effective than the Fournier's Gangrene Severity Index for Predicting Poor Prognosis in Fournier's Gangrene.

    Science.gov (United States)

    Yim, Sang Un; Kim, Sun Woo; Ahn, Ji Hoon; Cho, Yang Hyun; Chung, Hoseok; Hwang, Eu Chang; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-04-01

    We investigated the value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as markers of mortality in patients with Fournier's gangrene. Records from 62 patients treated for Fournier's gangrene between 2003 and 2014 were reviewed retrospectively. Data were collected regarding medical history, symptoms, physical examination findings, admission laboratory tests, and the extent of body surface area involved (%). Fournier's Gangrene Severity Index score, NLR, and PLR were calculated. The data were assessed separately for surviving and deceased patients. Of the 62 patients, 36 survived (58%, group 1) and 26 died (42%, group 2). Parameters that were statistically different between the two groups (p Fournier's Gangrene Severity Index score, and admission laboratory parameters, including body temperature, heart rate, bicarbonate, albumin, and serum calcium. The average body surface area affected in group 2 was statistically different from that of group 1 (6.0% versus 2.3%, p = 0.001). A high Fournier's Gangrene Severity Index score (>9), high NLR (>8), and high PLR (>140) were associated more frequently with group 2 patients. Multivariable regression analysis showed that high NLR (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.25-17.3; p = 0.022) and high PLR (adjusted OR, 11.6; 95% CI, 2.7-49.5; p = 0.001) were independent prognostic factors for poor prognosis from Fournier's gangrene. However, the Fournier's Gangrene Severity Index score did not shown any statistically significant effect on mortality (p = 0.086). The Fournier's Gangrene Severity Index scoring system was not associated with determining poor prognosis, however, high NLR and high PLR were associated with predictors of mortality in patients with Fournier's gangrene.

  10. Isolated Fournier's gangrene of the penis

    African Journals Online (AJOL)

    2015-12-11

    Dec 11, 2015 ... by genital swelling, gangrene, and ulceration. The most common wound ... Only the skin and dartos fascia were affected with sparing of the corporal cylinders. .... of the subcutaneous tissues because of impaired venous and.

  11. [Fournier's gangrene: Cervical and facial extension. A very rare case].

    Science.gov (United States)

    Carloni, R; Pechevy, L; Isola, N; Vidal, L; Goga, D; Watier, E; Bertheuil, N

    2016-02-01

    Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. Enterostomy can decrease the mortality of patients with Fournier gangrene.

    Science.gov (United States)

    Li, Yan-Dong; Zhu, Wei-Fang; Qiao, Jian-Jun; Lin, Jian-Jiang

    2014-06-28

    To determine the significance of enterostomy in the emergency management of Fournier gangrene. The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed. The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P Fournier gangrene.

  13. Risk factors for mortality in fournier's gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI

    Directory of Open Access Journals (Sweden)

    Carlos Eugênio Lira Tenório

    Full Text Available ABSTRACT Objective To evaluate risk factors for mortality in patients with Fournier's gangrene (FG, with emphasis in the Simplified Fournier Gangrene Severe Index Score (SFGSI. Materials and Methods This was a cross-sectional study that was carried out from January 2010 to December 2014, with 124 patients treated for FG in a General Hospital. Several clinical and laboratory variables, including SFGSI, were evaluated and correlated with mortality through univariate analysis and logistic regression. Results Of the 124 patients, 99 were men (79.8%, the mean age was 50.8±19.5 years and the main comorbidity was diabetes mellitus (51.6%. The mortality rate was 25.8%. Variables that presented independent correlation with mortality were the extension of the lesion to the abdomen (OR=4.0, CI=1.10-14.68, p=0.03, hematocrit (OR=0.81, CI=0.73-0.90, p2 result was the largest of the independent predictors of mortality (OR=50.2; CI=13.18-191.47; p2 presented a higher correlation with mortality than any variable tested alone. It seems to be a promising alternative to evaluate predictors of mortality in Fournier's gangrene. The main advantage is easy applicability because it contains only three parameters and can be used immediately after patient's admission.

  14. Risk factors for mortality in fournier's gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI).

    Science.gov (United States)

    Tenório, Carlos Eugênio Lira; Lima, Salvador Vilar Correia; Albuquerque, Amanda Vasconcelos de; Cavalcanti, Mariana Pauferro; Teles, Flávio

    2018-01-01

    To evaluate risk factors for mortality in patients with Fournier's gangrene (FG), with emphasis in the Simplified Fournier Gangrene Severe Index Score (SFGSI). This was a cross-sectional study that was carried out from January 2010 to December 2014, with 124 patients treated for FG in a General Hospital. Several clinical and laboratory variables, including SFGSI, were evaluated and correlated with mortality through univariate analysis and logistic regression. Of the 124 patients, 99 were men (79.8%), the mean age was 50.8±19.5 years and the main comorbidity was diabetes mellitus (51.6%). The mortality rate was 25.8%. Variables that presented independent correlation with mortality were the extension of the lesion to the abdomen (OR=4.0, CI=1.10-14.68, p=0.03), hematocrit (OR=0.81, CI=0.73-0.90, p2 result was the largest of the independent predictors of mortality (OR=50.2; CI=13.18-191.47; p2 presented a higher correlation with mortality than any variable tested alone. It seems to be a promising alternative to evaluate predictors of mortality in Fournier's gangrene. The main advantage is easy applicability because it contains only three parameters and can be used immediately after patient's admission. Copyright® by the International Brazilian Journal of Urology.

  15. Fournier Gangrene Caused by Candida albicans in an Infant After Cardiac Surgery.

    Science.gov (United States)

    Jaworski, Radoslaw; Irga-Jaworska, Ninela; Naumiuk, Łukasz; Chojnicki, Maciej; Haponiuk, Ireneusz

    2017-04-01

    Fournier gangrene is a rare, rapidly progressive, life-threatening condition. We report a 23-day-old boy with pulmonary atresia and ventricular septal defect treated surgically, who developed Fournier gangrene. Emergency surgery was performed with tissue sampling for microbiological examination. Candida albicans was confirmed; caspofungin followed by fluconazole was administered with excellent results.

  16. Prospective evaluation of risk factors for mortality in patients of Fournier's gangrene: A single center experience

    Science.gov (United States)

    Vyas, Hari Gopal; Kumar, Anup; Bhandari, Vimal; Kumar, Niraj; Jain, Abhinav; Kumar, Rohit

    2013-01-01

    Introduction: Fournier's gangrene is an aggressive disease with high morbidity and mortality. The aim of this study was to assess risk factors associated with mortality among patients of Fournier's gangrene. Materials and Methods: Between May 2011 and September 2012, all patients of Fournier's gangrene treated at our center were included in the study. All patients underwent emergency surgical debridement and received broad spectrum intravenous antibiotics. Their baseline characteristics, treatment, and follow-up data were recorded and analyzed. Results: A total of 30 patients were included in the study. Of these, six patients (20%) died during the treatment. Age Fournier gangrene severity index (FGSI) score Fournier's gangrene, increased age, total leukocyte count, extent of the area involved, septic shock at admission, VAS score, and FGSI score at admission have a significant association with mortality. PMID:24082432

  17. Manejo de la Gangrena de Fournier: Nuestra experiencia / Fourniers Gangrene Management: Our Experience

    OpenAIRE

    Etcheverry MG; Pierini A; Brosutti O; Ruiz G; Canga V

    2015-01-01

    Fournier ‘s gangrene (GF) is an infection that rapidly expands and affects the perineum, perianal region and the external genitalia. Without early treatment, based on life support, antibiotics and surgery it has a high mortality, even today. A retrospective, observational study was performed. All patients treated for GF in General Surgery third level hospital for the period between January 2002 and April 2014 were included. 23 patients are described and several variables regarding the diag...

  18. Rectal cancer and Fournier's gangrene - current knowledge and therapeutic options.

    Science.gov (United States)

    Bruketa, Tomislav; Majerovic, Matea; Augustin, Goran

    2015-08-14

    Fournier's gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.

  19. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report

    LENUS (Irish Health Repository)

    Zgraj, Oskar

    2011-12-12

    Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  20. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene: a case report

    Directory of Open Access Journals (Sweden)

    Zgraj Oskar

    2011-12-01

    Full Text Available Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  1. Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

    Science.gov (United States)

    Oguz, Abdullah; Gümüş, Metehan; Turkoglu, Ahmet; Bozdağ, Zübeyir; Ülger, Burak Veli; Agaçayak, Elif; Böyük, Abdullah

    2015-01-01

    We aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary. PMID:25859652

  2. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report.

    Science.gov (United States)

    Zgraj, Oskar; Paran, Sri; O'Sullivan, Maureen; Quinn, Feargal

    2011-12-12

    Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  3. Fournier's gangrene of the penis in a 12-year-old patient secondary to phimosis.

    Science.gov (United States)

    Ward, Luther; Eisenson, Daniel; Fils, Jean-Louis

    2016-12-01

    We report a case of Fournier's gangrene in a 12-year-old boy from St. Boniface Hospital in Fond-des-Blancs, Haiti. Fournier's gangrene, a fulminant necrotizing fasciitis of the penis and scrotum, is a rare and life-threatening infection that requires hospitalization, broad-spectrum antibiotics, and surgical debridement.1-3 It is usually associated with impaired cellular immunity due to systemic disorders such as diabetes and liver disease.4,5 This patient had none of those risk factors, but had severe, longstanding phimosis, for which circumcision had been recommended many years before. This case illustrates how lack of access to basic surgical care for an easily treatable condition leads to advanced presentation of a severe disease process. [Full article available at http://rimed.org/rimedicaljournal-2016-12.asp].

  4. Management of a young female patient with Fournier's gangrene and Lemierre's syndrome

    OpenAIRE

    Aslanidis, Theodoros; Myrou, Athena; Giannakou-Peftoulidou, Maria

    2014-01-01

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present ...

  5. Fournier Gangrene in a patient receiving chemo-radiation for rectal cancer.

    Science.gov (United States)

    Pittaka, Maria; Georgiou, Chrysanthos; Polyviou, Petros; Kountourakis, Pantelis; Loizou, Panayiotis; Constantinou, Ifigenia; Andreopoulos, Demetris; Vassiliou, Vassilios P

    2018-02-01

    We herein present a case of a 24-year-old patient with a cT4N+ rectal cancer who developed Fournier's gangrene (FG) 1 week after the completion of preoperative chemoradiotherapy. The patient was promptly referred to the surgical department where she was treated with antibiotics and repeated surgical debridement. FG is a rare and life-threatening situation that needs to be managed aggressively with no delay. The clinical image above is unique and characteristic of this clinical entity.

  6. Fournier gangrene from a thirty-two-centimeter rectosigmoid foreign body.

    Science.gov (United States)

    Abate, Getahun; Shirin, Mazumder; Kandanati, Vivek

    2013-02-01

    Medical and surgical problems associated with rectal foreign bodies are rare. Although most rectal foreign bodies can be removed without subsequent sequelae, they pose significant risk of infection. We report a patient with a 32-cm rectosigmoid foreign body and subsequent development of Fournier gangrene despite successful removal of the foreign body. A 63-year-old Caucasian man with past medical history of diabetes mellitus and depression presented with a chief complaint of "something stuck in my intestine." He admitted that he placed a foreign body in the rectum. Abdominal X-ray study and computed tomography of the abdomen/pelvis showed a conical-shaped 32-cm rectosigmoid foreign body. The foreign body was removed manually and follow-up colonoscopy was done. The patient's condition deteriorated in the first 2 days of hospital stay and he was diagnosed with Fournier gangrene. He required multiple surgeries and received broad-spectrum antibiotic coverage for mixed bacterial flora grown from deep tissue. Rectal foreign bodies can cause Fournier gangrene. A close observation and follow-up is important after removal of rectal foreign bodies. Published by Elsevier Inc.

  7. Manejo de la Gangrena de Fournier: Nuestra experiencia / Fourniers Gangrene Management: Our Experience

    Directory of Open Access Journals (Sweden)

    Etcheverry MG

    2015-11-01

    Full Text Available Fournier ‘s gangrene (GF is an infection that rapidly expands and affects the perineum, perianal region and the external genitalia. Without early treatment, based on life support, antibiotics and surgery it has a high mortality, even today. A retrospective, observational study was performed. All patients treated for GF in General Surgery third level hospital for the period between January 2002 and April 2014 were included. 23 patients are described and several variables regarding the diagnosis, treatment and monitoring of these patients were analized.

  8. Reconstruction of Defects After Fournier Gangrene: A Systematic Review.

    Science.gov (United States)

    Karian, Laurel S; Chung, Stella Y; Lee, Edward S

    2015-01-01

    Reconstruction of scrotal defects after Fournier gangrene is often achieved with skin grafts or flaps, but there is no general consensus on the best method of reconstruction or how to approach the exposed testicle. We systematically reviewed the literature addressing methods of reconstruction of Fournier defects after debridement. PubMed and Cochrane databases were searched from 1950 to 2013. Inclusion criteria were reconstruction for Fournier defects, patients 18 to 90 years old, and reconstructive complication rates reported as whole numbers or percentages. Exclusion criteria were studies focused on methods of debridement or other phases of care rather than reconstruction, studies with fewer than 5 male patients with Fournier defects, literature reviews, and articles not in English. The initial search yielded 982 studies, which was refined to 16 studies with a total pool of 425 patients. There were 25 (5.9%) patients with defects that healed by secondary intention, 44 (10.4%) with delayed primary closure, 36 (8.5%) with implantation of the testicle in a medial thigh pocket, 6 (1.4%) with loose wound approximation, 96 (22.6%) with skin grafts, 68 (16.0%) with scrotal advancement flaps, 128 (30.1%) with flaps, and 22 (5.2%) with flaps or skin grafts in combination with tissue adhesives. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. There is no conclusive evidence to support flap coverage of exposed testes rather than skin graft. A reconstructive algorithm is proposed. Skin grafting or flap reconstruction is recommended for defects larger than 50% of the scrotum or extending beyond the scrotum, whereas scrotal advancement flap reconstruction or healing by secondary intention is best for defects confined to less than 50% of the scrotum that cannot be closed

  9. [Two Cases of Fournier's Gangrene That Occurred during Chemotherapy for Rectal Cancer].

    Science.gov (United States)

    Koyama, Makoto; Kitazawa, Masato; Ehara, Takehito; Yamamoto, Yuta; Suzuki, Akira; Miyagawa, Yusuke; Miyagawa, Shinichi

    2017-02-01

    Two cases of Fournier's gangrene occurred during chemotherapy for advanced rectal cancer. Patients were treated using surgical debridement and antibiotic therapy. Case 1: A 66-year-old man had advanced rectal cancer with para-aortic and inguinal lymph node metastases. He received a sigmoid colostomy and chemotherapy(capecitabine, oxaliplatin, bevacizumab). Due to progression of the rectal mass, we performed radiotherapy(30 Gy)and chemotherapy(irinotecan, S-1, bevacizumab). After 14 days, he was hospitalized with a diagnosis of Fournier's gangrene with anal pain and fever. Case 2: A 63-year-old man had mucinous rectal carcinoma with sacrum invasion. He received a sigmoid colostomy and chemotherapy. Sixteen days after regorafenib therapy, as a fifth-line of chemotherapy, he was hospitalized with a diagnosis of Fournier's gangrene with hip pain, swollen perineum, and fever. There have been no reports of Fournier's gangrene occurring during chemotherapy for rectal cancer. We report 2 cases with a review of literature.

  10. Fournier's gangrene caused by Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi.

    Science.gov (United States)

    Tena, Daniel; Losa, Cristina; Medina-Pascual, María José; Sáez-Nieto, Juan Antonio

    2014-06-01

    We report the first case of Fournier's gangrene caused by three unusual anaerobic organisms: Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi. The infection occurred in a 73-year-old man without typical risk factors for the development of Fournier's gangrene. Clinical outcome was good after prolonged antibiotic treatment and extensive debridement of the perineum. The case suggests that A. funkei, F. gonidiaformans and C. hathewayi should be considered as potential pathogens of Fournier's gangrene. Human infections caused by these organisms are very rare but can be underestimated because correct identification is very difficult, especially in polymicrobial infections such as Fournier's gangrene. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Fournier gangrene: a review of 41 patients and strategies for reconstruction.

    Science.gov (United States)

    Chen, Shih-Yi; Fu, Ju-Peng; Wang, Chih-Hsin; Lee, Tzu-Peng; Chen, Shyi-Gen

    2010-06-01

    Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.

  12. Fournier's gangrene syndrome in a chimpanzee (Pan troglodytes).

    Science.gov (United States)

    Okeson, Danelle M; Marrow, Judilee; Carpenter, James W; Armbrust, Laura J; Ragsdale, John M; Klocke, Emily

    2010-03-01

    A 37-yr-old male chimpanzee (Pan troglodytes) was evaluated for intermittent diarrhea, scrotal swelling, and lethargy of 2 days duration. Physical examination revealed marked swelling of the scrotum and perineal tissues with mild pitting edema and crepitus. Computed tomography revealed a mixed gas and soft-tissue density extending from the caudal ventral subcutaneous tissues caudally to the scrotum and perineal tissues. Surgical exploration and castration were performed to establish drainage, and culture revealed a polymicrobial infection. A diagnosis of scrotal and fascial plane abscessation consistent with Fournier's gangrene was made. Although castration with open drainage was performed, the animal died 36 hr after surgery. Postmortem examination and histopathology revealed necrotizing fasciitis of the penis, vaginal tunic, and subcutaneous perineal and perianal tissues.

  13. Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

    Directory of Open Access Journals (Sweden)

    Ioannis Papaconstantinou

    2011-01-01

    Full Text Available A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

  14. Predictive factors for mortality in Fournier' gangrene: a series of 59 cases.

    Science.gov (United States)

    García Marín, Andrés; Turégano Fuentes, Fernando; Cuadrado Ayuso, Marta; Andueza Lillo, Juan Antonio; Cano Ballesteros, Juan Carlos; Pérez López, Mercedes

    2015-01-01

    Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department. Retrospective analysis study between 1998 and 2012. Of the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P=.023), hemoglobin (S 13; D 11; P=.014), hematocrit (S 37; D 31.4; P=.009), white blood cells (S 17,400; D 23,800; P=.023), serum urea (S 58; D 102; PFournier's gangrene severity index score (FGSIS) (S 4; D 7; P=.002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P=.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760-0.973), higher than FGSIS (0.746 [0.601-0.981]) and UFGSI (0.760 [0.617-0.904]). FG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Fournier's gangrene followed by intestinal involvement

    African Journals Online (AJOL)

    (FG) is a rapidly progressive, necrotizing fasciitis of the genital and perineal regions with high morbidity and mortality. FG is usually seen in immunocompromised patients and may be triggered by local factors such as trauma, trombosis, and vasculitis. Here, we present a adolescent, male patient with juvenile-onset BD who.

  16. Importance of repeated CT scan in Fournier gangrene treatment: clinical case

    International Nuclear Information System (INIS)

    Ignatenco, Sergiu

    2011-01-01

    A patient of 53 years presented fever, swelling and erythema in the perineal region. After computed tomography (CT) was diagnosed Fournier gangrene. After aggressive surgical debridement postoperative evolution was unfavorable. Repeated CT scan trace spread of infection to new areas that led to new surgical debridement on time. Use of CT scan in the postoperative period allows assessment of the effectiveness of surgical debridement and spread of infection. This article presents CT scan images and the most important periods of intraoperative surgical intervention. (authors)

  17. Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report.

    Science.gov (United States)

    Schulz, Dietmar; Mohor, Georgiana Simona; Solovan, Caius

    2015-01-01

    Fournier gangrene (FG) is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.

  18. Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene.

    Science.gov (United States)

    Tattersall, Timothy Lee; Thangasamy, Isaac A; Reynolds, Jamie

    2014-10-14

    We present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8-11 days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration. 2014 BMJ Publishing Group Ltd.

  19. Solitary Candida albicans Infection Causing Fournier Gangrene and Review of Fungal Etiologies.

    Science.gov (United States)

    Perkins, Tiffany A; Bieniek, Jared M; Sumfest, Joel M

    2014-01-01

    Polymicrobial bacterial infections are commonly found in cases of Fournier gangrene (FG), although fungal growth may occur occasionally. Solitary fungal organisms causing FG have rarely been reported. The authors describe a case of an elderly man with a history of diabetes who presented with a necrotizing scrotal and perineal soft tissue infection. He underwent emergent surgical debridement with findings of diffuse urethral stricture disease and urinary extravasation requiring suprapubic tube placement. Candida albicans was found to be the single causative organism on culture, and the patient recovered well following antifungal treatment. Fungal infections should be considered as rare causes of necrotizing fasciitis and antifungal treatment considered in at-risk immunodeficient individuals.

  20. Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene.

    Science.gov (United States)

    Chang, Feng-Shu; Chou, Chieh; Hu, Chuan-Yu; Huang, Shu-Hung

    2018-01-01

    The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing. The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0-10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study. The median age of the patients was 62 (38-76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage. The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.

  1. Computed Tomography findings in Fournier's gangrene; Hallazgos en tomografia computarizada de la grangrena de Fournier

    Energy Technology Data Exchange (ETDEWEB)

    Isusi, M.; Campo, M.; Oleaga, L.; Grande, J.; Grande, D. [Hospital de Barsurto. Bilbao (Spain)

    2000-07-01

    To assess the utility of computed tomography (CT) as an imaging technique in the diagnosis and determination of the extension of Fournier's gangrene (FG). We report the cases of six patients who had been clinically diagnosed as having FG, CT, enhanced by oral and intravenous contrast media, was performed in all the patients. All six patients presented soft tissue masses and gas in the scrotal region, which were also detected in the perineal region in five. In two patients, the gas extended toward anterior abdominal wall and in one of them, it also observed in anterior and posterior para renal space. The major predisposing factors were diabetes and alcoholism and the most common triggering factor was urologic disease. CT confirms the existence of FG and aids in assessing its extension and, in some cases, in identifying the underlying cause. (Author) 15 refs.

  2. [Different scoring systems to evaluate the prognosis of Fournier's gangrene: A comparative study].

    Science.gov (United States)

    Zhu, Xiao-dong; Ding, Fei; Wang, Guo-dong; Shao, Qiang

    2015-08-01

    To sum up the experience in diagnosis and treatment of Fournier's gangrene and find an optimal evaluation tool for its prognosis by comparing currently used prognostic scoring systems. We retrospectively analyzed 16 cases of Fournier's gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), Age-Adjusted Charlson Comorbidity Index (ACCI), and Surgical Apgar Score (sAPGAR) , we obtained the prognostic scores of the patients and made comparisons among different scoring systems. FGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score. Both ACCI and UFGSI are useful for evaluating the prognosis of Fournier's gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.

  3. Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene

    Science.gov (United States)

    Wang, Tao; Zhao, Gang; Rui, Yong-Jun; Mi, Jing-Yi

    2017-01-01

    Abstract Rationale: Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG. Patient concerns: A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th. Diagnoses: He was diagnosed with FG and chronic bronchitis. Interventions: The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment. Outcomes: One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now. Lessons: FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory. PMID:29145312

  4. Extended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.

    Science.gov (United States)

    Sugimoto, Motokazu; Matsuura, Kenji; Takayama, Hiroshi; Kayo, Munefumi; Ie, Tomotsugu

    2010-10-01

    Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge. In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully. Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.

  5. Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier's gangrene severity index for predicting the number of debridements in Fourner's gangrene?

    Science.gov (United States)

    Kahramanca, Sahin; Kaya, Oskay; Özgehan, Gülay; Irem, Burak; Dural, Ibrahim; Küçükpınar, Tevfik; Kargıcı, Hülagü

    2014-03-01

    Fournier's gangrene (FG) is a rapidly progressive and necrotizing infection of the subcutaneous and fascial tissues with a high mortality rate. In the present study, we aimed to investigate prognostic factors and analyze the outcomes of 68 patients in a tertiary reference hospital. Patients admitted to the emergency department were investigated retrospectively between January 2006 and January 2013 and divided into two groups. The patients in Group I (G1) required one debridement, and Group II (G2) patients required more than one. Patient demographic and clinical characteristics were encoded. Fournier's Gangrene Severity Index (FGSI) scores, neutrophil-lymphocyte ratios (NLR), and platelet-lymphocyte ratios (PLR) were calculated. Prognostic factors were compared between the groups. There were no statistically significant differences between the groups in terms of mean age, female-male ratio, or duration of symptoms on admission; however, there were more infection sources, predisposal factors, and positive culture results in G2. Additionally, hospital stay, total cost, and mortality rate values were high in G2. We found statistically higher NLR and PLR ratios in G2, but there was no significant difference in FGSI scores between the groups. The FGSI scoring system was not found to be valuable in determining prognosis. However, NLR and PLR were valuable, and previous use of NLR and PLR for determining Fournier's gangrene prognosis could not be found in the English literature.

  6. Fournier gangrene: description of 37 cases and analysis of associated health care costs.

    Science.gov (United States)

    Jiménez-Pacheco, A; Arrabal-Polo, M Á; Arias-Santiago, S; Arrabal-Martín, M; Nogueras-Ocaña, M; Zuluaga-Gómez, A

    2012-01-01

    Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. All the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

  7. [Fournier gangrene: description of 37 cases and analysis of associated health care costs].

    Science.gov (United States)

    Jiménez-Pacheco, A; Arrabal-Polo, M Á; Arias-Santiago, S; Arrabal-Martín, M; Nogueras-Ocaña, M; Zuluaga-Gómez, A

    2012-01-01

    Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

  8. Fournier gangrene associated with hyper IgE syndrome (Job syndrome).

    Science.gov (United States)

    Hori, Junichi; Yamaguchi, Satoshi; Watanabe, Masaki; Osanai, Hiroaki; Hori, Masako

    2008-04-01

    We report a case of a 32-year-old man with hyper IgE syndrome (Job syndrome) who developed Fournier gangrene due to infectious multiple atheromas of the scrotal skin that progressed to the right groin and thigh. The patient required surgical debridement and subsequent skin grafting. This is a rare case of Fournier gangrene associated with hyper IgE syndrome (Job syndrome). When a patient without diabetes mellitus has repeated infections and atopic-like dermatitis, Job syndrome should be considered.

  9. Magnetic resonance imaging in the diagnosis of Fournier's gangrene

    Energy Technology Data Exchange (ETDEWEB)

    Kickuth, R.; Adams, S.; Kirchner, J.; Simon, S.; Liermann, D. [Dept. of Radiology, Marienhospital Herne, University of Bochum, Herne (Germany); Pastor, J. [Dept. of Urology, Marienhospital Herne, University of Bochum, Herne (Germany)

    2001-05-01

    Magnetic resonance imaging and ultrasound are the imaging modalities recommended in the early diagnosis of Fournier's gangrene. Because of the high mortality of this inflammatory disease early diagnosis is essential to initiate adequate surgical and medical treatment. In the clinical literature only a handful of cases, in which diagnosis of Fournier's gangrene is based on MRI findings, have been reported; therefore, we report another case which shows the ability of MRI especially to determine the point of origin and extension of disease. (orig.)

  10. A case of Fournier's gangrene following local radiation for the recurrence of rectal carcinoma

    International Nuclear Information System (INIS)

    Ohashi, Hideyuki; Okuno, Tetsuo; Mizuo, Toshiyuki

    1993-01-01

    A case of Fournier's gangrene in a 69-year-old man was reported. He had diabetes mellitus and had received 30 Gy radiation for local recurrence of rectal carcinoma. Immediately after the irradiation the disease of scrotum began as redness and swelling, and developed ulcer and necrosis. Antibiotics and local drainage were not of benefit, so we performed debridement and obtained good result. We described our experience of the gangrene from the early phase to recovery. (author)

  11. Emergence of antibiotic-resistant bacteria in patients with Fournier gangrene.

    Science.gov (United States)

    Lin, Wei-Ting; Chao, Chien-Ming; Lin, Hsin-Lan; Hung, Ming-Chran; Lai, Chih-Cheng

    2015-04-01

    This study was conducted to investigate the bacteriology and associated patterns of antibiotic resistance Fournier gangrene. Patients with Fournier's gangrene from 2008 to 2012 were identified from the computerized database in a medical center in southern Taiwan. The medical records of all patients with Fournier's gangrene were reviewed retrospectively. There were 61 microorganisms, including 60 bacteria and one Candida spp, isolated from clinical wound specimens from 32 patients. The most common isolates obtained were Streptococcus spp. (n=12), Peptoniphilus spp. (n=8), Staphylococcus aureus (n=7), Escherichia coli (n=7), and Klebsiella pneumoniae (n=7). Among 21 strains of gram-negative bacilli, five (23.8%) were resistant to fluoroquinolones, and three isolates were resistant to ceftriaxone. Two E. coli strains produced extended-spectrum beta-lactamase. Four of the seven S. aureus isolates were methicillin-resistant. Among 15 anaerobic isolates, nine (60%) were resistant to penicillin, and eight (53.3%) were resistant to clindamycin. Four (26.7%) isolates were resistant to metronidazole. The only independent risk factor associated with mortality was inappropriate initial antibiotic treatment (p=0.021). Antibiotic-resistant bacteria are emerging in the clinical setting of Fournier gangrene. Clinicians should use broad-spectrum antibiotics initially to cover possible antibiotic-resistant bacteria.

  12. Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report.

    Science.gov (United States)

    Yang, Bo Kyu; Yi, Seung Rim; Lee, Ye Hyun; Kim, Hyun See; Nam, Seok Woo; Ahn, Young Joon; Kim, Seong Wan; Yang, Sung Wook; Im, Se Hyuk

    2014-12-01

    As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

  13. A rare case of juvenile-onset Behçet's disease: Fournier's gangrene ...

    African Journals Online (AJOL)

    Behçet's disease (BD) is a multisystemic, inflammatory disease with still unknown etiology and rarely seen in childhood. BD has worse prognosis in young, male patients. BD exacerbations may be triggered by viral, bacterial, and other undefined antigenic stimuli in genetically predisposed individuals. Fournier's gangrene ...

  14. Prognostic Factors of Fournier's Gangrene in the Elderly: Experiences of a Medical Center in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Feng Kuo

    2016-09-01

    Conclusion: The core principles to manage Fournier's gangrene in geriatric patients are early diagnoses, aggressive resuscitations, use of broad-spectrum antibiotics, and prompt and repeated surgical intervention. Medical teams can save their lives by applying aggressive treatment with longer hospitalization.

  15. [Primary cutaneous T-cell lymphoma of the penis complicated by Fournier gangrene: a case report].

    Science.gov (United States)

    Zhou, Zun-lin; Wang, Chuan-yun; Xu, Zhi-shun; Zheng, Bao-zhong

    2008-06-01

    To explore the clinical presentation, pathologic characteristics, diagnosis and treatment of cutaneous T-cell lymphoma of the penis. A 49-year-old man presented with painful swelling and inflammation of the foreskin, failed to respond to antibiotic treatment and dorsal incision, and was instead complicated by Fournier gangrene. Then he underwent debridement and pathological examination. Pathological results indicated cutaneous T-cell lymphoma of the penis. Immunohistochemistry showed CD3 and CD45 RO to be positive, but CD30, CD79a, CD20 and HMB negative. The patient was treated by interferon alpha and ultraviolet B for 2 weeks, followed by total removal of the external genitalia because of necrosis of the corpus spongiosum, which involved the scrotum and right testis on pathological examination. Cutaneous T-cell lymphoma of the penis is a rare condition and easily mis diagnosed in the early phase. Definitive diagnosis depends on pathological study.

  16. Experience in management of Fournier's gangrene: a report of 24 cases.

    Science.gov (United States)

    Wang, Longwang; Han, Xiaomin; Liu, Mei; Ma, Yan; Li, Bing; Pan, Feng; Li, Wencheng; Wang, Liang; Yang, Xiong; Chen, Zhaohui; Zeng, Fuqing

    2012-10-01

    Fournier's gangrene (FG) is an extremely aggressive and rapidly progressive polymicrobial soft tissue infection of the perineum, anal area or genitalial regions with a high mortality rate. The objectives of this study were to share our experience with the management of this serious infectious disease over the last 15 years. This retrospective study examined 24 patients diagnosed as having FG who were admitted to our hospital between March 1996 and December 2011. The gender, age, etiology, predisposing factors, laboratory findings, treatment modality, hospitalization time and spread of gangrene of the subjects were all recorded and analyzed. The results showed that the mean age of the patients was 48.33 years, the male-to-female ratio was 5:1 and the mortality rate was 20.8% (5/24). The most common predisposing factor was diabetes mellitus in 10 patients (41.6%), followed by alcohol abuse, obesity, neoplasms and immunosuppression. The most common etiology was peri-anal and peri-rectal abscesses (45.8%), followed by lesions of urogenital origin (33.3%) and cutaneous (8.3%) origin. No local pathologies could be identified in 3 (12.5%) patients. The most commonly isolated microorganisms were Escherichia coli (62.5%), followed by Enterococcus, Pseudomonas aeruginosa and Staphylococcus aureus. The median admission Fournier's gangrene severity index (FGSI) score for survivors was 5.63±1.89 against 13.6±3.64 for non-survivors which was designed for predicting the disease severity in the series. Early diagnosis and immediate extensive surgical debridement were significant prognostic factors in the management of Fournier gangrene. Individualized reconstructive modalities for wound coverage were useful in that they repaired the tissue defect and improved the quality of life. We are led to conclude that Fournier's gangrene is a severe condition with a high mortality. The Fournier's gangrene severity index (FGSI) score at admission serves as a good predictor for the disease

  17. Fournier gangrene: report of three cases, computed tomography imaging findings and literature review

    International Nuclear Information System (INIS)

    Judici, Paola Lima Pasini; Christofoli, Maria Olivia Jacques de Medeiros; Oliveira, Paulo Cesar Rocha; Teles, Ilailson de Goes; Najjar, Yana Senna Jeronimo

    2010-01-01

    The authors report three cases of patients with Fournier gangrene. This is a polymicrobial infectious disease that affects the perineum and genitalia, especially in males, whose source is most commonly genitourinary, colorectal or cutaneous and may also not have a clearly defined focus. Potentially lethal, requires immediate clinical and surgical treatment. The purpose of this report is to describe the main findings of imaging on computed tomography in this disease and to briefly review the literature on the subject. (author)

  18. Treatment, outcome and quality of life after Fournier's gangrene: a multicentre study.

    Science.gov (United States)

    Czymek, R; Kujath, P; Bruch, H-P; Pfeiffer, D; Nebrig, M; Seehofer, D; Guckelberger, O

    2013-12-01

    The object of this study was to describe the course of Fournier's gangrene and assess quality of life in a group of affected patients. We evaluated patients who received inpatient treatment for Fournier's gangrene at five hospitals in northern Germany from 1995 to 2010. Surviving patients were asked to take part in a clinical follow-up and complete the Short-Form 36 (SF-36) quality-of-life questionnaire and a disease-specific questionnaire including a physical examination. Of the 86 patients, 72 (83.7%) were men. The mean age of the patients was 57.9 ± 13.9 (25-89) years. The mean length of hospital stay was 52.0 ± 54.0 (1-329) days. Fourteen (16.3%) patients (eight men) died primarily from Fournier's gangrene. The most common aetiological event was anogenital abscess formation (n = 24; 27.9%). Seventy-one (82.5%) patients had a mixed polymicrobial infection. SF-36 physical role functioning (P = 0.010), physical functioning (P = 0.008), general health (P = 0.010) and physical health summary (P = 0.006) scores were significantly lower than those of the normal population. Deterioration in sexual function was reported by 65% of the patients. Patients with Fournier's gangrene experience persistent physical and mental health problems for a long period of time following their primary hospital stay and must receive long-term care from a variety of specialists, otherwise the disease leads to an increase in the duration of morbidity and a decrease in quality of life. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  19. Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion.

    Science.gov (United States)

    Eray, Ismail Cem; Alabaz, Omer; Akcam, Atilgan Tolga; Ulku, Abdullah; Parsak, Cem Kaan; Sakman, Gurhan; Seydaoglu, Gulsah

    2015-12-01

    In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

  20. Hyperbaric Oxygen Therapy as an Adjuvant Therapy for Comprehensive Treatment of Fournier's Gangrene.

    Science.gov (United States)

    Li, Chao; Zhou, Xu; Liu, Long-Fei; Qi, Fan; Chen, Jin-Bo; Zu, Xiong-Bing

    2015-01-01

    To compare simple conventional treatment with the addition of hyperbaric oxygen therapy (HBOT) to conventional therapies in the treatment of Fournier's gangrene (FG). A retrospective study of clinical data was performed by reviewing 28 cases of FG from January 2004 to December 2013 at Xiangya Hospital, Central South University. Among them, 12 patients were treated with the conventional therapy (non-HBOT group) and the other 16 cases were combined with hyperbaric oxygen therapy besides conventional therapy (HBOT group). All patients were followed up for 2 months to assess the therapeutic effect. The analyzed data included age, Fournier gangrene severity index (FGSI) score, number of surgical debridement, indwelling drainage tube time, length of stay (LOS), effective time, and curative time. The mortality rate was lower in the HBOT group at 12.5% (2/16) compared to the non-HBOT group, which was 33.3% (4/12). The difference in the number of surgical debridement, indwelling drainage tube time, and curative time between were significantly lower in the HBOT group compared to the non-HBOT group. Our preliminary research suggests that the effect of combining hyperbaric oxygen therapy with conventional therapy offers considerable advantage in the management of Fournier's gangrene. Multicenter studies with a larger sample size are required to confirm these observations. © 2015 S. Karger AG, Basel.

  1. Pressure sores significantly increase the risk of developing a Fournier's gangrene in patients with spinal cord injury.

    Science.gov (United States)

    Backhaus, M; Citak, M; Tilkorn, D-J; Meindl, R; Schildhauer, T A; Fehmer, T

    2011-11-01

    Retrospective chart review. The aim of our study was to evaluate the mortality rate and further specific risk factors for Fournier's gangrene in patients with spinal cord injury (SCI). Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. All patients with a SCI and a Fournier's gangrene treated in our hospital were enrolled in this study. Following parameters were taken form patients medical records: age, type of SCI, cause of Fournier's gangrene, number of surgical debridements, length of hospital and intensive care unit stay, co morbidity factors and mortality rate. In addition, laboratory parameter including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score and microbiological findings were analyzed. Clinical diagnosis was made via histological examination. A total of 16 male patients (15 paraplegic and one tetraplegic) were included in the study. In 81% of all cases, the origin of Fournier's gangrene was a pressure sore. The median LRINEC score on admission was 6.5. In the vast majority of cases, a polybacterial infection was found. No patient died during the hospital stay. The mean number of surgical debridements before soft tissue closure was 1.9 and after a mean time interval of 39.1 days wound closure was performed in all patients. Pressure sores significantly increase the risk of developing Fournier's gangrene in patients with SCI. We reported the results of our patients to increase awareness among physicians and training staff working with patients with a SCI in order to expedite the diagnosis.

  2. Fournier's gangrene – analysis of management and outcome in ...

    African Journals Online (AJOL)

    (1832 - 1914) in 1883 when he described the occurrence of a con- dition characterised by sudden onset in previously healthy young men, rapid progression to gangrene and absence of a definite cause, as quoted by Stephens et al.2 and Laor et al.3 The Persian physician. Avicenna (980 - 1037) had earlier described the ...

  3. Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient.

    Science.gov (United States)

    Yoshino, Hiroshi; Kawakami, Kyoko; Yoshino, Gen; Sawada, Katsuhiro

    2016-03-01

    A 64-year-old man was admitted to Shin-suma General Hospital, Kobe, Japan, complaining of a 3-day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5 °C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/μL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density of subcutaneous tissue and elevated air density. Thus, he was diagnosed with Fournier's gangrene. On the fourth hospital day, the patient underwent debridement of gangrenous tissue. Seton surgery was carried out for anal fistula on the 34th hospital day. He responded to the treatment very well. He was discharged on the 33rd postoperative day. Once Fournier's gangrene has been diagnosed, considering the association of anal fistula and perianal abscess is important.

  4. Is hemoglobin A1c level effective in predicting the prognosis of Fournier gangrene?

    Science.gov (United States)

    Sen, Haluk; Bayrak, Omer; Erturhan, Sakip; Borazan, Ersin; Koc, Mustafa Nihat

    2016-01-01

    To evaluate the effect of immune failure and/or diabetes mellitus (DM) association on the mortality and morbidity of the Fournier's Gangrene (FG), and interrelatedly, the usability of HbA1c level in the prediction of prognosis. The data of 38 patients with the diagnosis of FG were investigated retrospectively. The patients were divided into two groups as patients with DM (Group 1, n = 18) and non-diabetics (Group 2, n = 20). The patients in group 1 were also divided into two subgroups as patients with HbA1c value ≥7 (Group 1a) and HbA1c value 38°C) (n = 22, 57.8%), purulent discharge from genital or perineal areas (n = 13, 34.2%), skin bruises (n = 11, 28.9%) and general state disorder in five patients that were admitted from day care center (13.1%). DM, as the most often comorbid disease, was detected in 18 patients (47.3%). Six patients (15.7%) were deceased during the follow-up period. In the present study, the researchers determined that diabetic patients with HbA1c level of 7 or higher had worse prognosis, and increased mortality.

  5. Use of photodynamic inactivation for in vitro reduction of prevalent bacteria in Fournier's Gangrene

    Directory of Open Access Journals (Sweden)

    Nalisson Marques Pereira

    Full Text Available ABSTRACT Fournier's Gangrene (FG is an infectious disease caused by several synergic microbes, with high morbidity and mortality rates; therefore, the search for new less invasive and mutilating treatments, with faster recovery, has been proposed. Surgical intervention, the use of several systemic and topic antibiotics, and hyperbaric oxygen therapy are currently the best approach for the treatment of these patients. The use of Photodynamic Inactivation (PDI aims to lower morbidity and mortality, by reducing bacterial microbiota and speeding wound healing. In the present study, viable bacteria were separated in four groups: Group L-/F- (no irradiation with red laser and absence of methylene blue photosensitizer, Group L-/F+ (no irradiation with red laser and presence of methylene blue, Group L+/F- (irradiation with red laser and absence of methylene blue and L+/F+ (irradiation with red laser associated to methylene blue. In all groups, exposure time to treatment was 5, 10 and 15 minutes. The concentration of methylene blue photosensitizer was 0.1mg/L, and the dose of red laser (660nm wave length was 176.9mW/cm2. Following irradiation, the reduction of number of bacteria was evaluated, and the results were expressed in colony forming units (CFU and as exponential reduction. As the main results, in the L+/F+ group, there were no Clostridium perfringens and Staphylococcus aureus CFUs and there was a reduction of Escherichia coli that was not observed in the other groups.

  6. [A Case of Pyoderma Gangrenosum of the Penis Difficult to Distinguish from Fournier Gangrene].

    Science.gov (United States)

    Taguchi, Makoto; Inoue, Takaaki; Nishida, Teruhisa; Kawabata, Takashi; Kawakita, Shigenari; Muguruma, Kouei; Murota, Takashi; Kinoshita, Hidefumi; Matsuda, Tadashi

    2015-11-01

    Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes and treated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited our department following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/μl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated but proved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made.

  7. Fournier\\'s Gangrene in a Tertiary Health Facility in Nigeria | Edino ...

    African Journals Online (AJOL)

    Trois des patients (12.5%) sont décédés de septicémie. Conclusions: La gangrène de Fournier est rarement idiopathique, une cause sous-jacente est retrouvée habituellement dans la majorité des cas. La prise en charge chirurgicale et médicale agressive peut réduire la mortalité. African Journal of Urology Vol.11(1) 2005: ...

  8. Fournier's Gangrene Complicating Hematologic Malignancies: Literature Review and Treatment Suggestions

    Directory of Open Access Journals (Sweden)

    Giovanni D'Arena

    2013-11-01

    Full Text Available Fournier’s gangrene (FG is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease.

  9. Fournier's gangrene in a patient receiving treatment for idiopathic thrombocytopenic purpura.

    Science.gov (United States)

    Yuda, Junichiro; Honma, Riko; Yahagi, Tomoyasu; Omoto, Eijiro

    2011-01-01

    We report the case of a 68-year-old man who was diagnosed with Fournier's gangrene (FG), which developed during immunosuppresive treatment for idiopathic thrombocytopenic purpura (ITP). The patient was administered steroids for ITP but on the 36th day, he developed FG and septic shock. We initiated antibiotic treatment and drained a periproctal abscess immediately. On day 53, extensive drainage to progressive FG and a splenectomy was performed, following which both FG and thrombocytopenia improved. This is the first case of FG has developing in a ITP patient. It appears that high-dose immunoglobulin therapy and splenectomy should be considered earlier especially for a patient complicated with FG.

  10. A case of Fournier's gangrene following local radiation for the recurrence of rectal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ohashi, Hideyuki; Okuno, Tetsuo; Mizuo, Toshiyuki (Tokyo Rosai Hospital (Japan))

    1993-02-01

    A case of Fournier's gangrene in a 69-year-old man was reported. He had diabetes mellitus and had received 30 Gy radiation for local recurrence of rectal carcinoma. Immediately after the irradiation the disease of scrotum began as redness and swelling, and developed ulcer and necrosis. Antibiotics and local drainage were not of benefit, so we performed debridement and obtained good result. We described our experience of the gangrene from the early phase to recovery. (author).

  11. A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report.

    Science.gov (United States)

    Sawayama, Hiroshi; Miyanari, Nobutomo; Sugihara, Hidetaka; Iwagami, Shiro; Mizumoto, Takao; Kubota, Tatsuo; Haga, Yoshio; Baba, Hideo

    2017-12-01

    Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene. A 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued. Surgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.

  12. Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

    Directory of Open Access Journals (Sweden)

    Ania Sliwinski

    2014-06-01

    Full Text Available Introduction Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier’s gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion Penile skin recovery following Fournier’s gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall.

  13. Using negative pressure therapy for improving skin graft taking on genital area defects following Fournier gangrene.

    Science.gov (United States)

    Orhan, Erkan; Şenen, Dilek

    2017-09-01

    Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital and perianal regions. Treatment includes aggressive surgical debridement that often results in extensive loss of genital skin. Skin grafts may be used for reconstruction but skin grafting of the male genitalia is diffucult because the penis and scrotum are mobile and deformable. A variety of methods are used to secure skin graft to recipient beds. We used negative pressure therapy (NPT) to secure skin grafts and improve skin graft taking. We used negative pressure therapy for graft fixation in 13 male patients who underwent debridements with the indication of Fournier gangrene, and whose defects formed were reconstructed with grafts between January 2009, and January 2014. Information about age of the patients, sessions of negative pressure therapy applied before, and after reconstruction, duration of hospital stay, and graft losses during postoperative period were recorded. Median age of the patients was 56.15 (46-72) years. NPT was applied to patients for an average of 6.64 sessions (4-12) before and 1 sessions after graft reconstruction. Patients were hospitalized for an average of 26.7 (20-39) days. Any graft loss was not seen after NPT. Because of the peculiar anatomy of the genital region, anchoring of grafts is difficult so graft losses are often encountered. Use of NPT for ensuring graft fixation on the genital region prevents skin graft shearing.

  14. Fournier gangrene: a rare case of necrotizing fasciitis of the entire right hemi-pelvis in a diabetic female.

    Science.gov (United States)

    Taylor, Gregory M; Hess, David V

    2018-02-01

    Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death. We present the case of a 58-year-old diabetic female presenting febrile, hypoxic, with severe respiratory distress and evidence of septic shock, found to have necrotizing fasciitis of the entire right hemi-pelvis. Despite rapid recognition, IV antibiotics and operative management, the patient went to the intensive-care unit on multiple pressors and died 24 h later.

  15. Fournier gangrene: report of three cases, computed tomography imaging findings and literature review;Gangrena de Fournier: relato de tres casos, achados tomograficos e revisao da literatura

    Energy Technology Data Exchange (ETDEWEB)

    Judici, Paola Lima Pasini; Christofoli, Maria Olivia Jacques de Medeiros; Oliveira, Paulo Cesar Rocha; Teles, Ilailson de Goes; Najjar, Yana Senna Jeronimo, E-mail: paolajudice@sarah.b [Rede Sarah de Hospitais de Reabilitacao, Brasilia, DF (Brazil)

    2010-08-15

    The authors report three cases of patients with Fournier gangrene. This is a polymicrobial infectious disease that affects the perineum and genitalia, especially in males, whose source is most commonly genitourinary, colorectal or cutaneous and may also not have a clearly defined focus. Potentially lethal, requires immediate clinical and surgical treatment. The purpose of this report is to describe the main findings of imaging on computed tomography in this disease and to briefly review the literature on the subject. (author)

  16. Síndrome de Fournier: análise dos fatores de mortalidade Analysis of mortality in Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Paulo de Azeredo Passos Candelária

    2009-06-01

    Full Text Available A fascite necrótica perineal (Síndrome de Fournier é infecção grave dos tecidos moles, de etiologia não totalmente esclarecida, porém associada a procedimentos urológicos, proctológicos ou ginecológicos, além de diabetes melito, alcoolismo, desnutrição grave e outros estados de imunodepressão. Trata-se de situação grave, exigindo antibioticoterapia de amplo espectro, desbridamentos cirúrgicos e por vezes derivação do trânsito fecal e/ou urinário. OBJETIVO: Avaliar os fatores relacionados com mortalidade. CASUÍSTICA: Foram avaliados retrospectivamente 43 doentes (39 masculinos com média de idade de 54,8 anos, no período de 1998 a 2005, na Santa Casa de São Paulo. MÉTODO: foram analisados sexo, idade, sinais e sintomas, tempo de evolução e de internação, doenças associadas, sepse, broncopneumonia, exames laboratoriais, área comprometida, cirurgias realizadas, índice fisiológico Apache II e causa de óbito. RESULTADOS: Sobreviveram 33 doentes e houve 10 (23,2% ��bitos. A letalidade relacionou-se a pacientes mais velhos, tempo de evolução longo, internações curtas, índice fisiológico Apache II elevado, sepse e broncopneumonia . Não houve relação com sexo, diabetes melito, desnutrição, culturas e antibioticoterapia, local de início, extensão da necrose, número de desbridamentos, bem como com colostomias e cistostomias. CONCLUSÃO: a letalidade relaciona-se à disseminação da infecção e retardo do tratamento. Não é relacionada com diabete nem cirurgias como colostomia ou cistostomia.BACKGROUND: Necrotizing fasciitis is a severe infection of soft tissues, and when it affects the perineum it is called Fournier's gangrene. Some controversy exists over the origin of the disease, but all studies identified correlations between infection and proctologic, urologic, gynecologic origin procedures or trauma. In addition, many other causes are commonly associated, such as diabetes mellitus, abuse of

  17. Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report

    Directory of Open Access Journals (Sweden)

    Schulz D

    2015-03-01

    Full Text Available Dietmar Schulz,1 Georgiana Simona Mohor,2 Caius Solovan2,3 1Sana Kliniken Leipziger Land, Klinik fur Urologie, Borna, Leipzig, Germany; 2University Clinic of Dermatology and Venereology, Timisoara, Romania; 3Department of Dermatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Abstract: Fournier gangrene (FG is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment. Keywords: pancreatic stent, wound debridement, vacuum-assisted closure, transplanted skin, necrotizing infection

  18. The Pattern of Penile Gangrene in Sokoto, Nigeria | Ntia | African ...

    African Journals Online (AJOL)

    Early presentation, aggressive antibiotic therapy and urinary diversion can prevent or minimize penile loss. Some patients with partial penile loss require surgical reconstruction of the urethra and penis. Keywords: Penile gangrene, Fournier's gangrene, necrotizing fasciitis, phalloplasty, urethroplasty, neomeatoplasty

  19. Abdominal implantation of testicles in the management of intractable testicular pain in Fournier gangrene.

    Science.gov (United States)

    Chan, Cyrus C; Shahrour, Khaled; Collier, Ronald D; Welch, Marlene; Chang, Shiliang; Williams, Mallory

    2013-01-01

    Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative.

  20. Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy

    Directory of Open Access Journals (Sweden)

    Giovanni Zagli

    2011-01-01

    Full Text Available Fournier's gangrene is a rare process which affects soft tissue in the genital and perirectal area. It can also progress to all different stages of sepsis, and abdominal compartment syndrome can be one of its complications. Two patients in septic shock due to Fournier gangrene were admitted to the Intensive Care Unit of Emergency Department. In both cases, infection started from the scrotum and the necrosis quickly involved genitals, perineal, and inguinal regions. Patients were treated with surgical debridement, protective colostomy, hyperbaric oxygen therapy, and broad-spectrum antibacterial chemotherapy. Vacuum-assisted closure (VAC therapy was applied to the wound with the aim to clean, decontaminate, and avoid abdominal compartmental syndrome development. Both patients survived and were discharged from Intensive Care Unit after hyperbaric oxygen therapy cycles and abdominal closure.

  1. Fournier′s Gangrene

    Directory of Open Access Journals (Sweden)

    Sayal S. K

    1997-01-01

    Full Text Available A 55 year old male presented with insidious onset of redness and swelling of the penis and scrotum which progressed to gangrene. He was diagnosed and managed as a case of Fournier’s gangrene.

  2. Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: a case of Fournier's gangrene caused by fish bone.

    Science.gov (United States)

    Shimizu, Takae; Harada, Kazutoshi; Akazawa, Satoshi; Yamaguchi, Miyuki; Inozume, Takashi; Kawamura, Tatsuyoshi; Shibagaki, Naotaka; Momosawa, Akira; Shimada, Shinji

    2014-06-01

    Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74-year-old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed. Intraoperative findings showed dirty necrosis of soft tissue, and a splinter-shaped foreign body was found in the perirectal region. The foreign body was thought to be the cause of the condition, and it was analyzed using Fourier transform infrared spectroscopy. We found that the foreign body was a mixture of calcium phosphate and protein, suggesting that the splinter was a bone. Moreover, during the medical interview, the patient mentioned about intake of fish around the time of onset of symptoms. Therefore, to confirm the results of the analysis, DNA was extracted from the foreign body, and genomic PCR with subsequent sequence analysis was performed. The DNA sequence was identical to that of Oncorhynchus kisutch, a salmon that is a very popular food in Japan. On the basis of these findings, we concluded that FG in this case was caused by the penetration into the rectum of an accidentally ingested fish bone. Although some cases of intra-abdominal abscess due to accidental ingestion of fish bone have been reported, FG caused by fish bone is extremely rare. © 2014 Japanese Dermatological Association.

  3. Xenogenic (porcine) acellular dermal matrix promotes growth of granulation tissues in the wound healing of Fournier gangrene.

    Science.gov (United States)

    Zhang, Zhaoxin; Lv, Lei; Mamat, Masut; Chen, Zhao; Zhou, Zhitao; Liu, Lihua; Wang, Zhizhong

    2015-01-01

    This article investigates the application values of Xenogenic (porcine) acellular dermal matrix (XADM) in preparation of a Fournier gangrene wound bed. Thirty-six consecutive cases of patients with Fournier gangrene between 2002 and 2012 were enrolled in our department of our hospital. The patients were divided into two groups according to different methods of wound bed preparation after surgical débridement, including the experimental group (17 cases) and the control group (19 cases). The wounds in the experimental group were covered with XADM after surgical wound débridement, whereas the wounds were cleaned with hydrogen peroxide and sodium hypochlorite solution (one time/day) in the control group. The wound bed preparation time and hospital stay were then compared in the two groups. The wound preparation time was 13.64 ± 1.46 days and hospitalization period was 26.06 ± 0.83 days in the experimental XADM group. In the control group, the wound bed preparation time and hospitalization period were 22.37 ± 1.38 and 38.11 ± 5.60 days, respectively. The results showed statistical differences between these two groups. When used in wound débridement after Fournier gangrene, XADM protects interecological organizations, promotes the growth of granulation tissues, and maximally retains function and morphology of the perineum and penis.

  4. Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene

    Science.gov (United States)

    Ye, Junna; Xie, Ting; Wu, Minjie; Ni, Pengwen; Lu, Shuliang

    2015-01-01

    Abstract Fournier gangrene is a rare but highly infectious disease characterized by fulminant necrotizing fasciitis involving the genital and perineal regions. Negative pressure wound therapy (NPWT; KCI USA Inc, San Antonio, TX) is a widely adopted technique in many clinical settings. Nevertheless, its application and effect in the treatment of Fournier gangrene are unclear. A 47-year-old male patient was admitted with an anal abscess followed by a spread of the infection to the scrotum, which was caused by Pseudomonas aeruginosa. NPWT was applied on the surface of the scrotal area and continued for 10 days. A split-thickness skin graft from the scalp was then grafted to the wound, after which, NPWT utilizing gauze sealed with an occlusive dressing and connected to a wall suction was employed for 7 days to secure the skin graft. At discharge, the percentage of the grafted skin alive on the scrotum was 98%. The wound beside the anus had decreased to 4 × 0.5 cm with a depth of 1 cm. Follow-up at the clinic 1 month later showed that both wounds had healed. The patient did not complain of any pain or bleeding, and was satisfied with the outcome. NPWT before and after split-thickness skin grafts is safe, well tolerated, and efficacious in the treatment of Fournier gangrene. PMID:25654376

  5. 2-octyl-cyanoacrylate glue for fixation of STSG in genitourinary tissue defects due to Fournier gangrene: a preliminary trial.

    Science.gov (United States)

    Sivrioğlu, Nazan; Irkören, Saime; Ceylan, Ender; Sonel, Ali Murat; Copçu, Eray

    2013-05-01

    In these reported cases, we observed the outcomes of skin take and wound healing using 2-octyl-cyanoacrylate glue, which was used as tissue glue in the reconstruction of complex genital skin loss due to fournier gangrene. Fifteen patients with Fournier's gangrene were treated in this study. After initial surgical debridement, all defects were repaired using STSG. In this method a thin layer of 2-octyl-cyanoacrylate was dripped on the recipient site immediately before graft application. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Patient and physician satisfaction were also determined. Grafts were completely accepted in all fifteen patients. None of the patients had wound infection, seroma, hematoma, or other complications. Use of 2-octyl-cyanoacrylate glue (Glueseal) for STSG fixation in complex genital skin defects after Fournier gangrene may be an acceptable alternative to conventional surgical closure with a good cosmetic outcome. Further studies are needed to confirm our initial success with this approach.

  6. [Fournier's gangrene-variety of clinical model of critical states in surgery].

    Science.gov (United States)

    Aliev, S A; Aliev, E S; Mirzoev, R A; Mirzoeva, K A

    2015-01-01

    The investigation based on a retrospective analysis of the treatment results of Fournier's gangrene (FG) in 27 patients aged from 34 till 82 years old. There were 27 patients. Diseases of colorectal zone were the nosological reasons of FG in 15 patients. Diseases of urogenital tract had 10 patients with FG. The development of FG was determined by closed trauma (1 patient) and a gunshot wound of the perineum and the scrotum in one patient. The slowly progressive (limited) forms of the disease were noted in 15 patients, although the rapid progressive (extensive) forms were in 12 patients.All the patients had the clinical manifestations of the disease and at the same time laboratory indices indicated a presence of generalized infection and they were characterized by symptoms of systemic inflammatory response syndrome (SIRS). There were 6 patient, who died out of 27.The lethality consisted of 22.2%. The reasons of the death were an infection-toxic shock (1 case), a progressive endotoxicosis (3 cases) and a pulmonary artery thromboembolism (2 cases). The results obtained testified that early diagnostics and the active strategy with radical surgical d-bridement of necrotic suppurative foci combined with programmed (staged) sanitation necrosectomy, complex system of local wound treatment, the rational antibacterial therapy, a task-specific and syndrome correction of dyscrasia could be the actual ways to improve the treatment results in patients with FG.

  7. Favorable outcome of Fournier gangrene in two patients with diabetes mellitus on continuous peritoneal dialysis.

    Science.gov (United States)

    Vigil, Darlene; Regmi, Anil; Last, Reuben; Wiggins, Brenda; Sun, Yijuan; Servilla, Karen S; Fair, Joanna R; Massie, Larry; Tzamaloukas, Antonios H

    2014-01-01

    Fournier gangrene (FG), a form of necrotizing fasciitis of the perineum and genitals, with high morbidity and mortality in the general population, carries the additional risk of involvement of the peritoneal catheter tunnel and peritoneal cavity in patients on chronic peritoneal dialysis (PD). We describe two men with diabetes who developed FG in the course of PD. Computed tomography showed no extension of FG to the abdominal wall, and spent peritoneal dialysate was clear in both patients. Broad-spectrum antibiotic therapy with anaerobic coverage and early aggressive debridement followed by negative-pressure wound therapy and repeated debridement led to improvements in clinical status in both cases. Surgical closure and healing of the wound was achieved in one patient; the wound of the second patient is healing, but remains open. Both patients experienced prolonged hospitalization, with a serious decline in nutrition status. In patients on PD, FG can be treated successfully. However, additional measures are required to evaluate for potential involvement of the PD apparatus and the peritoneal cavity in the infectious process; and prolonged hospitalization, worsening nutrition, and multiple surgical interventions can result.

  8. Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene: A case report.

    Science.gov (United States)

    Wang, Tao; Zhao, Gang; Rui, Yong-Jun; Mi, Jing-Yi

    2017-11-01

    Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG. A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th. He was diagnosed with FG and chronic bronchitis. The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment. One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now. FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory.

  9. Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients.

    Science.gov (United States)

    Tuncel, Altug; Keten, Tanju; Aslan, Yilmaz; Kayali, Mustafa; Erkan, Anil; Koseoglu, Ersin; Atan, Ali

    2014-08-01

    The aim of this study was to evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and compare three different validated scoring systems for outcome prediction: Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) and age-adjusted Charlson Comorbidity Index (ACCI). Fifty men who underwent surgery for FG between July 2005 and August 2012 were included in the study. Data were collected on medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. The FGSI, UFGSI and ACCI were evaluated stratified by survival. Admission and final parameters were measured using the Mann-Whitney test. The results were evaluated for two groups: survivors (n = 43) and non-survivors (n = 7). Survivors were younger than non-survivors (median age 58 vs 68.5 years, p = 0.017). The median extent of body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.04). No significant differences in laboratory parameters were found between survivors and non-survivors at the time of admission, except for haemoglobin, haematocrit, serum urea and albumin levels. Only UFGSI, but not FGSI or ACCI, had any meaning or predictive value in disease severity or patients' survival. Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation.

  10. Fournier gangrene with extensive necrosis of urethra and bladder mucosa: A rare occurrence in a patient with advanced prostate cancer

    Directory of Open Access Journals (Sweden)

    Somorendro S Paonam

    2015-01-01

    Full Text Available Fournier gangrene (FG is polymicrobial necrotizing infection of subcutaneous tissues and deep fascia, commonly involving the perineum, external genitalia, anterior abdominal wall and medial aspect of thighs. Urethral pathology, although often the inciting factor for FG, extensive involvement with urethral necrosis is very rare. This is the first report in English literature, describing complete sloughing of the bulbar urethra with ischemic necrosis of the bladder mucosa from FG. Such extensive disease is associated with high mortality, despite higher antibiotics, through debridement and intensive care. Urethral involvement needs extensive debridement and temporary or permanent urinary diversion.

  11. Fournier gangrene with extensive necrosis of urethra and bladder mucosa: A rare occurrence in a patient with advanced prostate cancer.

    Science.gov (United States)

    Paonam, Somorendro S; Bag, Sananda

    2015-01-01

    Fournier gangrene (FG) is polymicrobial necrotizing infection of subcutaneous tissues and deep fascia, commonly involving the perineum, external genitalia, anterior abdominal wall and medial aspect of thighs. Urethral pathology, although often the inciting factor for FG, extensive involvement with urethral necrosis is very rare. This is the first report in English literature, describing complete sloughing of the bulbar urethra with ischemic necrosis of the bladder mucosa from FG. Such extensive disease is associated with high mortality, despite higher antibiotics, through debridement and intensive care. Urethral involvement needs extensive debridement and temporary or permanent urinary diversion.

  12. FDG PET/CT images demonstrating Fournier gangrene with bilateral pelvic muscle extension in a patient with recurrent rectosigmoid cancer.

    Science.gov (United States)

    Hsu, Chia-Tien; Kao, Pan-Fu; Huang, Chi-Chou; Huang, Hsin-Hui; Lee, Jong-Kang

    2014-01-01

    A 71-year-old male patient with Parkinsonism was referred for an F-FDG PET/CT scan for suspicious recurrence of rectosigmoid adenocarcinoma. The FDG PET/CT scan revealed increased FDG uptakes in the lower pelvic region around the wall of the rectal stump, with extension to the bilateral pelvic sidewalls and the right gluteous minimus muscle. In addition, multiple small air bubbles were noted in the lesions on the attenuation CT images. Fournier gangrene was diagnosed. After treatment with intravenous antibiotics and debridement with sigmoidoscopic irrigation, the patient was discharged and remained uneventful during clinical follow-up for 50 days.

  13. A contemporary analysis of Fournier gangrene using the National Surgical Quality Improvement Program.

    Science.gov (United States)

    Kim, Stanley Y; Dupree, James M; Le, Brian V; Kim, Dae Y; Zhao, Lee C; Kundu, Shilajit D

    2015-05-01

    To determine a nationwide contemporary description of surgical Fournier gangrene (FG) and necrotizing fasciitis of the genitalia (NFG) outcomes because historically reported mortality rates for FG and NFG are based on small single-institution studies from the 1980s and the 1990s. The National Surgical Quality Improvement Program is a risk-adjusted surgical database used by nearly 400 hospitals nationwide, which tracks preoperative, intraoperative, and 30-day postoperative clinical variables. Data are extracted from patient charts by an independent surgical clinical reviewer at each hospital. Using the National Surgical Quality Improvement Program data from 2005 to 2009, we calculated 30-day mortality rates and identified preoperative factors associated with increased mortality. A total of 650 patients were identified with surgery for FG or NFG. Fourteen patients with do not resuscitate orders placed preoperatively were excluded from analyses. For the remaining 636 patients, the overall 30-day mortality was 10.1% (64 of 636). Fifty-seven percent of patients (360 of 636) were men, 70% (446 of 636) were white, and 13% (81 of 636) were African American. Multivariate logistic regression indicated that increased age (odds ratio [OR], 1.041; P = .004), body mass index (OR, 1.045; P <.001), and preoperative white blood cell count (OR, 1.061; P = .001), and decreased platelet count (OR, 0.993; P <.001) were all associated with increased risk of death. We determined a surgical mortality rate for FG-NFG of 10.1%. This rate is about half of historically published estimates and similar to recent studies. The lower rate may indicate improvements in therapy. Increased age, body mass index, and white blood cell count, and decreased platelet count were all associated with an increased risk of 30-day mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Congenital Duplex Gallbladder Anomaly Presenting as Gangrenous ...

    African Journals Online (AJOL)

    Valued eMachines Customer

    A 43 year old female patient, Mrs. M.S, presented with a three week history of .... they develop gangrenous calculus cholecystitis as they may simulate a liver abscess ... Congenital anomalies of the gallbladder and anatomical variations of their ...

  15. Evaluation of LRINEC Scale Feasibility for Predicting Outcomes of Fournier Gangrene.

    Science.gov (United States)

    Kincius, Marius; Telksnys, Titas; Trumbeckas, Darius; Jievaltas, Mindaugas; Milonas, Daimantas

    2016-08-01

    Fournier gangrene (FG) is a fulminant necrotizing infection of the perineal, perianal, and periurethral tissues. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scale is used for diagnosis of necrotizing fasciitis. However, data on its relevance and usefulness in FG are lacking. The aim of this study was to evaluate the utility of the LRINEC scale in predicting the outcome of FG. This retrospective case study included 41 patents with FG treated at our institution from 2000 to 2013. The patients were divided into survivors and non-survivors. The mortality rate was 22%. The median age (75 vs. 62.5 y; p = 0.013), rate of co-existing diabetes mellitus (66.7% vs. 3.1%; p < 0.001), and median affected skin surface (4% vs. 1%; p < 0.001) were greater in the non-survivors. Seven of nine patients (77.8%) who did not survive (compared with 37.5% who survived) had a polymicrobial infection (p = 0.032). Of all the causative pathogens isolated, Proteus mirabilis was more common in non-survivors (55.6% vs. 6.3%; p = 0.001). The median calculated LRINEC score for survivors was 5 compared with 10 for the non-survivors (p < 0.001). Regression analysis showed that all the aforementioned variables, except for polymicrobial culture, were significant risk factors for predicting death. The area under the receiver operating characteristic curve for the LRINEC score was the highest, 0.976 (95% confidence interval 0.872-0.999; p < 0.0001), and the cut-off value was ≥9 with 93.7% specificity and 100% susceptibility for the prediction of a lethal outcome. The LRINEC score could be used for prediction of disease severity and outcomes. A threshold of 9 could be a high-value predictor of death during the initial evaluation of patients with FG.

  16. Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients.

    Science.gov (United States)

    Wagner, Sigrid; Greco, Francesco; Hoda, M Raschid; Kawan, Felix; Heynemann, Hans; Fornara, Paolo

    2011-10-01

    To evaluate the effect of surgical wound debridement, antibiotics, and hyperbaric oxygen (HBO) in the treatment of Fournier gangrene (FG). Forty-one patients with a mean age of 54.3±14.6 years were referred to our department with a diagnosis of FG. To calculate a Fourier Gangrene Severity Index (FGSI), nine factors were assessed (temperature; heart rate; ventilatory rate; serum sodium, potassium, creatinine, and bicarbonate concentrations; hematocrit; and leukocyte count). After clinical stabilization, extensive debridement of the necrotic tissue was performed, and a surgical vacuum-assisted closure (V.A.C.®) device was applied. Hyperbaric oxygen was administered; medical therapy consisted of intravenous antibiotics, electrolyte replacement, and parenteral nutrition. Intraoperative cultures revealed Escherichia coli in 27 patients (66%), Pseudomonas aeruginosa in 28 (68%), gram-positive cocci in 24 (59%), and mixed flora (aerobic and anaerobic bacteria) in 39 (95%). One month after primary debridement, wound granulation was sufficient for plastic surgical reconstruction in all patients. Because of the rapid worsening of FG, early diagnosis and immediate, aggressive multi-modality therapy with surgical debridement and broad-spectrum empiric antibiotics is crucial. The utility of HBO remains unproved.

  17. Negative pressure wound therapy applied before and after split-thickness skin graft helps healing of Fournier gangrene: a case report (CARE-Compliant).

    Science.gov (United States)

    Ye, Junna; Xie, Ting; Wu, Minjie; Ni, Pengwen; Lu, Shuliang

    2015-02-01

    Fournier gangrene is a rare but highly infectious disease characterized by fulminant necrotizing fasciitis involving the genital and perineal regions. Negative pressure wound therapy (NPWT; KCI USA Inc, San Antonio, TX) is a widely adopted technique in many clinical settings. Nevertheless, its application and effect in the treatment of Fournier gangrene are unclear. A 47-year-old male patient was admitted with an anal abscess followed by a spread of the infection to the scrotum, which was caused by Pseudomonas aeruginosa. NPWT was applied on the surface of the scrotal area and continued for 10 days. A split-thickness skin graft from the scalp was then grafted to the wound, after which, NPWT utilizing gauze sealed with an occlusive dressing and connected to a wall suction was employed for 7 days to secure the skin graft. At discharge, the percentage of the grafted skin alive on the scrotum was 98%. The wound beside the anus had decreased to 4 × 0.5 cm with a depth of 1 cm. Follow-up at the clinic 1 month later showed that both wounds had healed. The patient did not complain of any pain or bleeding, and was satisfied with the outcome. NPWT before and after split-thickness skin grafts is safe, well tolerated, and efficacious in the treatment of Fournier gangrene.

  18. Splenic flexure volvulus presenting with gangrene

    International Nuclear Information System (INIS)

    Machado, Norman O; Chopra, Pradeep J; Subramanian, Sureshkannan K

    2009-01-01

    Volvulus of the splenic flexure is very rare cause of colonic obstruction constituting 2% of cases of colonic segmental volvulus. Primary splenic flexure volvulus (SFV) is due to congenital absence or laxity of the phrenocolic, gastro colic, and splenocolic ligaments while secondary volvulus is due to other causes including some prior surgery releasing these ligaments. A preoperative diagnosis can be established based on the characteristic radiological findings on plain x-ray abdomen and CT scan. We present a case of SFV in a young man who presented with acute abdominal pain, and distension, and illustrate the usefulness of CT scan, and plain x-ray of the abdomen in making a preoperative diagnosis. Laparotomy revealed a gangrenous SFV, which was resected and primary anastomosis was carried out. Literature is reviewed with regards to predisposing factors, presentation, investigation, and management among the more than 32 cases reported so far. (author)

  19. Fistula-in-Ano Complicated by Fournier fs Gangrene Our Experience ...

    African Journals Online (AJOL)

    Background: Fistula-in-ano when complicated by Fournierfs gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and ...

  20. Factores de riesgo para mortalidad en gangrena de Fournier

    OpenAIRE

    Azolas M,Rodrigo

    2011-01-01

    Introducción: La Gangrena de Fournier fue descrita por Fournier en 1883, es una fasceitis necrotizan-te que afecta la región perianal y genital. El objetivo del presente trabajo es analizar los factores de riesgo de mortalidad en pacientes portadores de Gangrena de Fournier y su relación con el score pronóstico FGSI (Fournier Gangrene Severity Index Score). Material y Método: Estudio prospectivo entre enero de 2000 y diciembre de 2007 en el Hospital Barros Luco Trudeau, que incluyó 31 pacient...

  1. Is hemoglobin A1c level effective in predicting the prognosis of Fournier gangrene?

    Directory of Open Access Journals (Sweden)

    Haluk Sen

    2016-01-01

    Materials and Methods: The data of 38 patients with the diagnosis of FG were investigated retrospectively. The patients were divided into two groups as patients with DM (Group 1, n = 18 and non-diabetics (Group 2, n = 20. The patients in group 1 were also divided into two subgroups as patients with HbA1c value ≥7 (Group 1a and HbA1c value 38°C (n = 22, 57.8%, purulent discharge from genital or perineal areas (n = 13, 34.2%, skin bruises (n = 11, 28.9% and general state disorder in five patients that were admitted from day care center (13.1%. DM, as the most often comorbid disease, was detected in 18 patients (47.3%. Six patients (15.7% were deceased during the follow-up period. Conclusion: In the present study, the researchers determined that diabetic patients with HbA1c level of 7 or higher had worse prognosis, and increased mortality.

  2. Temporary Relocation of the Testes in Anteromedial Thigh Pouches Facilitates Delayed Primary Scrotal Wound Closure in Fournier Gangrene With Extensive Loss of Scrotal Skin-Experience With 12 Cases.

    Science.gov (United States)

    Okwudili, Obi Anselm

    2016-03-01

    To share our experience on the use of temporary testicular thigh pouches to facilitate scrotal wound closure in Fournier gangrene with extensive loss of scrotal skin. Patients seen over a 10-year period who had extensive (>50%) loss of scrotal skin precluding delayed primary closure of the residual scrotal skin over the testes were documented. Patients had serial debridement as required with scrotal wound dressing until healthy granulation tissue was achieved. The testes were placed temporarily in anteromedial thigh pouches to allow for scrotal wound closure. In the postoperative period, the testes were gradually massaged back into the residual scrotal pouch, thus acting as natural tissue expanders. Mean patient age was 38.1 ± 10.0 years. Mean duration of admission was 24.4 ± 4.7 days. Identified predisposing factors were ischiorectal fossa abscess in 2 patients and urethral stricture in 1 patient. The rest were idiopathic. Mean Fournier gangrene severity index was 6.0 ± 1.3. Mean number of debridements was 2.3 ± 0.5. There was no mortality. The residual scrotal pouches expanded sufficiently over time (3-8 months) to accommodate the testes. Normal testicular volume was maintained in all patients. Mean testicular volume was 19.0 ± 3.2 cm. Follow-up was for 14.8 ± 9.7 months. Temporarily relocating the testes in anteromedial thigh pouches facilitates scrotal wound closure in Fournier gangrene with extensive loss of scrotal skin and obviates the need for specialized reconstructive surgery.

  3. Fournier’s Gangrene: Clinical Presentation of 13 Cases

    Science.gov (United States)

    Kuzaka, Bolesław; Borkowski, Tomasz; Kawecki, Dariusz; Kuzaka, Piotr; Młynarczyk, Grażyna; Radziszewski, Piotr

    2018-01-01

    Background Fournier’s gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis. Material/Methods This study is a retrospective analysis of the management of 13 cases of Fournier’s gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. All patients with Fournier’s gangrene underwent adequate surgical debridement of the necrotic tissues. Additional procedures (suprapubic cystostomy and orchiectomy) were necessary in 10 out of 13 (77.0%) patients. Seven out of 13 (53.8%) patients required subsequent reconstructive surgery of the scrotum. Results All 13 patients were males, with a median age of 59.6 years (range: 42–68 years). The average hospital stay was 31.9 days (range: 16–46 days). None of our patients died due to Fournier’s gangrene. Bacteriological cultures of samples from the wounds showed polymicrobial flora, including the following genera of aerobes and anaerobes: Escherichia, Proteus, Klebsiella, Moraxella, Gemella, Enterococcus, Streptococcus, Staphylococcus, Bacteroides, Pseudoflavonifractor, Parabacteroides, Porphyromonas, Prevotella, Peptoniphilus, Peptostreptococcus, Actinomyces, Collinsella, and Lactobacillus. Conclusions Favorable outcome of FG treatment with low morbidity and no mortality can be achieved with rapid diagnosis, urgent surgical debridement of all necrotic tissues, and broad-spectrum empirical antimicrobial therapy, usually with combined antibiotics, against aerobic and anaerobic bacteria. Prevention of uroseptic shock by treating localized infection is compulsory. PMID:29374769

  4. Breast Gangrene

    Directory of Open Access Journals (Sweden)

    Husasin Irfan

    2011-08-01

    Full Text Available Abstract Background Breast gangrene is rare in surgical practice. Gangrene of breast can be idiopathic or secondary to some causative factor. Antibiotics and debridement are used for management. Acute inflammatory infiltrate, severe necrosis of breast tissue, necrotizing arteritis, and venous thrombosis is observed on histopathology. The aim of was to study patients who had breast gangrene. Methods A prospective study of 10 patients who had breast gangrene over a period of 6 years were analyzed Results All the patients in the study group were female. Total of 10 patients were encountered who had breast gangrene. Six patients presented with breast gangrene on the right breast whereas four had on left breast. Out of 10 patients, three had breast abscess after teeth bite followed by gangrene, one had iatrogenic trauma by needle aspiration of erythematous area of breast under septic conditions. Four had history of application of belladonna on cutaneous breast abscess and had then gangrene. All were lactating female. Amongst the rest two were elderly, one of which was a diabetic who had gangrene of breast and had no application of belladonna. All except one had debridement under cover of broad spectrum antibiotics. Three patients had grafting to cover the raw area. Conclusion Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement.

  5. [Septic shock in a patient with the Fournièr gangrene with fatal outcome].

    Science.gov (United States)

    Zonca, P; Mrázek, T; Matusek, A; Hajek, M; Stiglerová, S; Jurytko, A; Kucera, C; Nieslanik, M

    2009-07-01

    The authors present a case of a patient with developed Fournièr gangrene and septic shock. Fournièr gangrene belongs to the group of local non-specific infection of soft tissues (NSTI). Its incidence is relatively low, but the infection is extraordinary aggressive with a possible lethal end. 39 years old patient with 4 days history of Fournier gangrene's development was admitted in irreversible septic shock. The initial APACHE II score was 36. The delay in treatment was an important factor in the further course of illness with lethal end. Above the mentioned 39 years old patient died because of septic shock. The hemorrhagic cystitis was the original source of infection with further development of Fournièr gangrene according to the pathological record. We often come across all different kinds of stages of sepsis from the MODS to the septic shock for patients with Fournièr gangrene. Causal treatment should be started early. The local surgical excision and wide broad antibiotic administrations are basic treatments in the context of other treatment modalities according to the current patient's needs. The adjuvant hyperbaric oxygen treatment takes place in patients with Fournièr gangrene as well and is beneficial. The following factor even worsens the illness prognosis: delay in diagnostic, higher age, anorectal origin of infection, the amount of organ with dysfunction or failure, diabetes mellitus and significant immunodeficiency.

  6. Indian tick typhus presenting with gangrene: a case report from an urban slum of Delhi.

    Science.gov (United States)

    Kumar, Manish; Singh, Raghvendra; Yadav, Mukesh

    2014-01-01

    Indian Tick Typhus has been rarely reported in children from Delhi. A 10-y-old male child from Delhi presented with fever, non specific gastrointestinal symptoms, petechial rash and gangrene of all the toes. Possibility of rickettsial infection was entertained after the child failed to improve with best of the antibiotics. Sample for serology for rickettsial infection was sent and Doxycycline was started empirically. He became afebrile within 72 h of starting Doxycycline. Later, diagnosis of Indian Tick Typhus was confirmed on the basis of IgM positivity against Rickettsia conori. Possibility of rickettsial infection should be entertained in children with history of fever and skin rash, especially if the child fails to improve with a course of antibiotics and common infectious etiologies have been ruled out.

  7. Paediatric Gangrenous Caecal Volvulus

    African Journals Online (AJOL)

    Caecal volvulus though common in adults is rare in children. A 10-year-old boy presented with abdominal pain, distension, vomiting and obstipation of acute onset. An exploratory laparotomy revealed a gangrenous caecal volvulus due to an elongated and mobile right colon. This was treated by a right hemicolectomy and ...

  8. Fournier's ganrene in the HIV era

    African Journals Online (AJOL)

    Only patients whose files could be traced were used in the study. One hundred and fourty six patients were listed as having been treated for Fournier's gan- grene during the period under review. The questionnaire sought information on patients demographic data, the presenting symptoms, primary source and anatomical.

  9. Fournier's gangrene in the HIV era | Ngugi | African Health Sciences

    African Journals Online (AJOL)

    African Health Sciences. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 4 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...

  10. Varicella and Fournier′s gangrene

    Directory of Open Access Journals (Sweden)

    Arcot Rekha

    2007-01-01

    Full Text Available Fournier′s gangrene is the necrotizing fasciitis of the scrotum and the perineum. The treatment involves early recognition, aggressive resuscitation, radical debridement and appropriate antibiotics. Even though its association with varicella is known to occur in children, it is found to be uncommon in adults. We present our findings and review literature regarding the associations, clinical presentations and management of Fournier′s gangrene.

  11. [Fournier syndrome: the perception of the patient].

    Science.gov (United States)

    Cavalini, Fernanda; Moriya, Tokico Murakawa; Pelá, Nilza Teresa Rotter

    2002-06-01

    The purpose of the present investigation was to identify the perception of the Fournier syndrome's patients about their disease and caregivers. Data was collected by means of interviews with a structured routine and the analysis was based on the André's analysis of prose. According to the patients, the syndrome causes intense pain, edema, fever and wounds, demanding surgical treatment, dressings and bringing physical, economical and familiar problems. The caregivers' attitudes and behaviors were described as having more negative aspects than good ones. The necessity of a better training of the caregivers in the cognitive, psychomotor and affective sense is evident.

  12. Gangrena de Fournier

    Directory of Open Access Journals (Sweden)

    Edelberto Fuentes Valdés

    Full Text Available Introducción: la gangrena de Fournier es una enfermedad rara y grave, caracterizada por fasciitis necrotizante, sinergística y polimicrobiana, que mantiene alta mortalidad. Objetivo: contribuir a un mayor conocimiento del diagnóstico, tratamiento y pronóstico individual de esta rara enfermedad. Métodos: fueron estudiados siete pacientes tratados entre febrero de 2010 y abril de 2011. Se evaluaron datos demográficos, enfermedades asociadas, etiología, tratamiento, complicaciones y mortalidad, así como tiempo con sonda y estadía hospitalaria. Resultados: Los pacientes fueron hombres con edad media de 43,3 años; el más joven tenía 30 años y el mayor 49. Enfermedades asociadas: síndrome de inmuno deficiencia adquirida (2, diabetes mellitus (1, hipertensión arterial (1. El origen perineal (4 y escrotal (3. Tres pacientes referían fístulas o abscesos perineales. El tiempo de evolución fluctuó entre 6 y 30 días. Las manifestaciones clínicas se caracterizaron por dolor, aumento de volumen en regiones perineal, escrotal o ambas y secreción fétida. Se encontró crepitación cuando la enfermedad invadió regiones inguinales y pared abdominal. El tratamiento quirúrgico comprendió desbridamiento y derivaciones digestivas (colostomía, urológicas (cistotomía o ambas. El número de intervenciones varió entre tres y siete. Se practicó la reconstrucción quirúrgica del periné y escroto con el uso de injertos de piel a los sobrevivientes. Tres enfermos (42,9 % tuvieron complicaciones: shock séptico, fallo orgánico múltiple y estenosis uretral tardía (1. Falleció un enfermo (14,3 %, que había ingresado con manifestaciones de shock séptico. Conclusiones: El éxito del tratamiento se logra con el diagnóstico temprano, desbridamiento quirúrgico precoz, agresivo y antibioticoterapia de amplio espectro.

  13. Breast Gangrene in an HIV-Positive Patient

    Science.gov (United States)

    Venkatramani, V; Pillai, S; Marathe, S; Rege, SA; Hardikar, JV

    2009-01-01

    Introduction Breast gangrene has been reported as a complication following puerperal sepsis, breast surgery, nipple piercings, warfarin toxicity, etc. We report a case of primary breast gangrene in an HIV-positive individual which, to the best of our knowledge, is the first of its kind. Case report A 40-year-old previously healthy woman presented with fulminating left breast gangrene. She was detected to be HIV positive. Mastectomy was performed. The detailed management of the condition is discussed. Conclusion Severe necrotising infections may be initial manifestations of HIV infection and patients with such infections should be screened for HIV. PMID:19622255

  14. Síndrome de Fournier

    Directory of Open Access Journals (Sweden)

    Bruna Ramirez

    2014-10-01

    Full Text Available Introdução: A gangrena de Fournier é uma infecção polimicrobiana, causado por bactérias aeróbias e anaeróbias.É destrutiva e rapidamente progressiva do tecido subcutâneo e fáscia superficial, caracterizando, portanto, uma fasciite necrosante, acometendo principalmente as regiões perineal,perianal e genital. Caracterizada pela rápida evolução, se não tratada pode evoluir para sepse e falência múltipla dos órgãos. A gangrena de Fournier pode ser idiopática, ou estar relacionada com fatores de risco como: trauma mecânico,procedimentos cirúrgicos,pacientes imunossuprimidos, infecções urinárias ou perianais, diabetes mellitus, entre outras. Objetivo: Relatar o caso de paciente que manifestou a Síndrome de Fournier no Conjunto Hospitalar de Sorocaba. Contribuir com o meio cientifico através da ilustração do caso e seu manejo. Metodologia: As informações contidas nesse trabalho foram obtidas por meio de análise de prontuário, registros fotográficos de métodos diagnósticos, e revisão de literatura. Relato de Caso: Paciente do sexo masculino, 34 anos, diagnosticado com Síndrome de Fournier, iniciada com quadro de dor e edema em testículo esquerdo. Identificada no exame uma lesão ulcerada de 2cm, necrótica, com saída de secreção purulenta em períneo e necrose em escroto. Atualmente, o paciente encontra-se REG, corado, hidratado, AAA, normotenso, eupnéico e com colostomia rósea funcionante. Conclusão: A síndrome descrita acima foi de grande relevância clínica devido à sua rápida evolução no paciente, que culminou com o debridamento das bordas da ferida e a posterior melhora da secreção purulenta, com início de tecido de degranulação sobre a região lesada.

  15. A Novel Case of Penile Gangrene in a Patient Treated with Ibrutinib for Chronic Lymphocytic Leukemia

    OpenAIRE

    Skelton IV, William Paul; Akhavan, Neeka N.; Taylor, Zachary A.; Nguyen, Thu-Cuc; Hassan, Hassan; Townsend, Tabitha N.; Pathak, Prajwol; Trikha, Gaurav; Dang, Nam H.; Dang, Long H.; Ali, Azka

    2016-01-01

    Introduction. Ibrutinib is commonly used for the treatment of patients with CLL in either first-line or relapsed/refractory settings. Case Presentation. We present the case of a 74-year-old Caucasian man with CLL who presented with penile gangrene upon initiation of ibrutinib treatment. Our case is the first showing the complication of penile gangrene associated with ibrutinib use. The gangrene was self-limited upon discontinuing ibrutinib. Conclusion. Our finding describes a very rare yet im...

  16. Autoamputation of diabetic toe with dry gangrene: a myth or a fact?

    Directory of Open Access Journals (Sweden)

    Al Wahbi A

    2018-06-01

    Full Text Available Abdullah Al Wahbi Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia Abstract: Diabetes is associated with various complications and reduced quality of life. Of the many complications, some are life-threatening. Among these, foot complications remain an important concern. The major foot complications include foot ulceration, cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis, with different pathophysiological concepts behind each of them. Gangrene occurs due to reduced blood supply in the body tissues that leads to necrosis. This condition may arise because of an injury, infection, or other health conditions, majorly diabetes. Gangrene is classified as dry, wet, and gas gangrene. In case of wet and gas gangrene, surgical amputation is usually performed to prevent the spread of infection to other tissues. In dry gangrene, due to the presence of clear demarcation, autoamputation is preferred in certain parts of the globe. The present review aims to analyze the mode of dry gangrene management in diabetic patients based on previous evidence and plans to highlight various management strategies available for dry gangrene and the advantages/disadvantages of different treatments with special consideration to autoamputation. Keywords: dry gangrene, amputation, surgical amputation, diabetic foot, diabetic toe, foot care

  17. Gangrena de Fournier numa Mulher

    OpenAIRE

    Murinello, A; Figueiredo, AM; Athayde, M; Grima, B; Ribeiro, V; Lourenço, S; Fernandes, C; Goja, M; Coleho, JF

    2009-01-01

    A fasceíte necrotizante dos tecidos infra-diafragmáticos (gangrena de Fournier) é uma grave infecção sinergística por agentes aeróbicos/anaeróbicos, com uma evolução clínica súbita e rápida de gangrena da fascia e sepsis generalizada, associada a elevada mortalidade. Trata-se de uma emergência médico-cirúrgica necessitando de tratamento intensivo englobando a correcção das anomalias hemodinâmicas, hidroelectrolí- ticas e metabólicas, antibioterapia dupla/tripla de largo espectro por ...

  18. IMPACT OF AGGRESSIVE SURGICAL INTERVENTION IN FOURNIER’S GANGRENE AND ITS CORRELATION TO THE OUTCOME IN PATIENTS AT A RURAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Shaikh MH, Singh Puneet, Kamal Tausif Syed, Shaikh Simran

    2015-01-01

    Full Text Available Background: Fournier’s gangrene is rare and rapidly spreading aggressive and progressive infection of the perineum in which fascial necrosis is more extensive than the visible gangrene.Early surgical debridement prompt antibiotic administration, are essential for a better prognosis. Delay in diagnosis or treatment increase the mortality rate. This could be because of the multi factorial and poly microbial association of the disease. Aim: We attempt to describe the importance of early radical debridement and its effect on the outcome of the disease. Methodology: We conducted an analytical study on 26 patients of Fournier gangrene admitted in the rural hospital from July 2011 to July2014. On admission their Fournier gangrene severity index was calculated. The broad spectrum antibiotics were started and radical debridement was done in all patients on the same day within 6 hours of admission. Daily dressing was done till the wound showed healthy granulation tissue. The scrotal skin was mobilized and suturing was done. Result: In our studies there was no mortality. This indicates that early aggressive resuscitation to correct the dehydration and early radical debridement improves the outcome in this rare and fatal disease.

  19. Jean-Alfred Fournier - the founder of the European venereology and dermatology (on the one hundredth death anniversary

    Directory of Open Access Journals (Sweden)

    O. A. Kisteneva

    2014-01-01

    Full Text Available The article presents a life story of a great French dermatologist and venereologist, one of the founders of the theory of syphilis Jean-Alfred Fournier (1832-1914. It provides data on the published works by Jean-Alfred Fournier, some of which earned him a doctoral degree. It also provides data on Fournier’s election as a member of the French Academy of Medicine in 1879 as well as on the founding of the French Society of Dermatology and Syphiligraphy by Fournier and other French dermatologists in 1889. The article defines the contribution made by Fournier to the development of venereology and practical medicine in the second half of the 19th century and early 20th century.

  20. CANINE GANGRENOUS MASTITIS : A CASE REPORT

    OpenAIRE

    Egyptien, Sophie; Lefebvre, Michaël; Guieu, Liz-Valéry; Robiteau, Guillaume; Deleuze, Stefan

    2017-01-01

    This report describes the treatments and discusses the cost effectiveness of a Negative Pressure Wound Therapy (NPWT) device on a gangrenous mastitis case. Mastitis is an inflammation of the mammary gland found mainly in lactating females. Coliforms (Escherichia coli), Staphylococcus spp (Staphylococcus aureus) and, to a lesser extent, Streptococcus spp are the most commonly isolated organisms in bitches. The bitch can be presented because of local signs of inflammation, puppies failing to th...

  1. Prognostic Factors for Fournier’s Gangrene; A 10-year Experience in Southeastern Iran

    Science.gov (United States)

    Sabzi Sarvestani, Amene; Zamiri, Mehdi; Sabouri, Mehdi

    2013-01-01

    Objectives: To describe the characteristics and prognostic factors of 28 patients with Fournier’s Gangrene (FG) referred to our medical center at Southeastern Iran. Methods: This was a cross-sectional study including 28 cases of FG that were operated in Surgery department of Zahedan University of Medical Sciences during a 10-year period from April 2002 to March 2012. The study analyzed 9 parameters including the body temperature, heart rate, respiratory rate, hematocrit, white blood count (WBC), and serum levels of sodium, potassium, creatininee (twice for 2 for acute renal failure), and bicarbonate for Fournier Gangrene Severity Index (FGSI) score. The aspects taken into account were age, gender, predisposing factors, duration of symptoms, hospitalization period, and number of debridements, disease outcome and the FGSI. Results: All patients were males, aged from 26 to 68 years, with mean age 44.6 ±8.49 years. Statistically significant differences in age (p<0.001), duration of symptoms (p=0.001), number of debridements (p=0.006), hospitalization duration (p<0.001) and FGSI (p<0.001) were found between surviving and dead patients. The mortality rate was 35.7%, and the most common presentation was perianal/scrotal pain (78.6%). Perianal and primary scrotal abscesses were most common causes of FG and were found in 57.14% and 21.42% of patients respectively. The most prevalent predisposing factor was diabetes mellitus in 12 (42.85%) patients. With respect to laboratory findings, statistically significant differences in WBC (p=0.002), creatinine (p<0.001), albumin (p<0.001), calcium (p<0.001) and serum sodium (p=0.035) were found between the surviving and dead patients. Conclusion: Serious outcome of FG was associated with old age, delayed diagnosis and treatment, inadequate surgical debridement, shorter hospitalization and higher FGSI scores. In addition higher WBC, higher creatininee and serum sodium and lower albumin and calcium levels implicated worse prognosis

  2. [Fournier syndrome: report of a clinical case].

    Science.gov (United States)

    La Torre, F; Otti, M; Ruggeri, E; Taglienti, D; Bonanno, L; Bianchini, G P; Veneroso, S; Tintisona, O; Monti, M

    2001-01-01

    The case of a Fournier's syndrome in a 58 years old patient is reported from the Authors that describe the ethiopathogenetic and therapeutic aspects. They analyse the importance of an early surgical treatment associated with antibiotic therapy and later a riparation of the lesions with a myocutaneous skin flap of TLF.

  3. unusual urological presentations of hiv/aids at king edward viii hospital

    African Journals Online (AJOL)

    Extensive scrotal and lower abdominal Fournier's gangrene. FIG. 1. erscon showing bilateral renal abscesses. THE SOUTHEIlN AFRICAN JOUIlNAL Of HIV MEDICINE -----------HBIlUAIlY 200 I. DIAGNOSIS OF OPPORTUNISTIC INFECTIONS. DIAGNOSIS OF UTI IN AIDS. TREATMENT OF UTls. • A high index of suspicion ...

  4. Improved vacuum sealing drainage in the treatment of gas gangrene: a case report.

    Science.gov (United States)

    Liu, Zhaofa; Zhao, Dewei; Wang, Benjie

    2015-01-01

    In this case, improved vacuum sealing drainage was used for gas gangrene treatment, which is different from traditional therapies of gas gangrene and this is the first report of using improved vacuum sealing drainage to treat gas gangrene. The patient was a 12-year-old Asian Male who was presented to the Emergency Department with a one-day history of left femoral progressing swelling, paining and fevering. Four days ago, rusty iron bars were plugged into the muscle of the left femoral when he played. Then he was taken to the local clinic and injected with tetanus antitoxin. A diagnosis of gas gangrene was made and modified vacuum sealing drainage device was used after thorough debridement. After two weeks' treatment, left femoral was kept and gas gangrene was cured successfully.

  5. Diabetic gangrene of the foot

    International Nuclear Information System (INIS)

    Tanaka, Junji; Hoshi, Makoto; Shinozaki, Tatsuyo; Kimura, Masakata; Ichinohe, Hitomoto.

    1983-01-01

    A case of severe diabetic gangrene was reported. Angiography showed no evidence of ischemic changes in the foot, except for mild atherosclerosis in the femoral and popliteal arteries. Tc-99m labelled macroagglugated albumine (MAA) was injected transcatheterally into the abdominal aorta to see the blood perfusion of the lower extremities, which showed increased blood flow of the foot as well as the presence of micro arteriovenous shuntings shown by the appearance of both lungs. Damages of the microcirculation are thought to have much influences on the formation of diabetic gangrene. Histopathological findings supported above. (author)

  6. Spontaneous occurrence of synergistic bacterial gangrene following external pelvic irradiation

    International Nuclear Information System (INIS)

    Husseinzadeh, N.; Nahhas, W.A.; Manders, E.K.; Whitney, C.W.; Mortel, R.

    1984-01-01

    A case of spontaneous synergistic bacterial gangrene occurring after external pelvic irradiation is presented in a 25-year-old woman with invasive cervical cancer. Treatment consisted of aggressive antibiotic therapy and extensive excision and debridement followed by split-thickness skin grafting. Both recovery and cosmetic results were satisfactory. The pathophysiology, predisposing factors, and treatment modalities are presented

  7. A Novel Case of Penile Gangrene in a Patient Treated with Ibrutinib for Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    William Paul Skelton IV

    2016-01-01

    Full Text Available Introduction. Ibrutinib is commonly used for the treatment of patients with CLL in either first-line or relapsed/refractory settings. Case Presentation. We present the case of a 74-year-old Caucasian man with CLL who presented with penile gangrene upon initiation of ibrutinib treatment. Our case is the first showing the complication of penile gangrene associated with ibrutinib use. The gangrene was self-limited upon discontinuing ibrutinib. Conclusion. Our finding describes a very rare yet important adverse event associated with ibrutinib use.

  8. Alain-Fournier. El eterno adolescente

    Directory of Open Access Journals (Sweden)

    Manuela SAN MIGUEL

    2009-11-01

    Full Text Available Ejerce ahora la escuela rural una innegable atracción, recuperándose del injusto olvido en que durante muchos años se hallaba sumida. Su renacimiento pone de manifiesto la vigencia y validez de una historia escrita otrora y en otro lugar por un joven que nació en 1886 y murió, cual héroe mítico de cuento o narración infantil, antes de llegar a la madurez, en plena acción de armas, durante la primera Guerra Mundial. Su nombre: Henri Fournier, más conocido como Alain-Fournier en el mundo literario.

  9. The role of hyperbaric oxygen therapy in treating extensive Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Ming-Chan Hung

    2016-09-01

    Conclusion: Bacteremia and sepsis are major indicators of the mortality rate for FG. The cornerstones of treatment are early diagnosis, aggressive resuscitation, broad-spectrum antibiotic therapy, early colostomy, and prompt and repeated surgical intervention. Adjuvant HBO therapy led to higher survival rates.

  10. Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene.

    Science.gov (United States)

    Sliker, Clint W; Steenburg, Scott D; Archer-Arroyo, Krystal

    2013-06-01

    An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.

  11. Gangrene of the limb complicating Salmonella typhi Septicaemia in ...

    African Journals Online (AJOL)

    We report an unusual case of lower limb gangrene in a pubertal boy following a typical clinical presentation of septicaemia due to Salmonella typhi. After an initial response to presumed appropriate antibiotic and supportive therapy, the patient developed tissue ischaemia in both feet. There were no clinical or laboratory ...

  12. [Anesthetic management of four patients with Fournier syndrome].

    Science.gov (United States)

    Sato, Rui; Tomioka, Toshiya; Orii, Ryo; Yamada, Yoshitsugu

    2008-03-01

    We experienced anesthetic managements of four patients with Fournier syndrome. In the anesthetic management of the patients with Fournier syndrome the following three points should be kept in mind; (a) the necessity of careful preoperative examination, (b) the better anesthesia, and (c) the careful postoperative care.

  13. RAINFALL AGGRESSIVENESS EVALUATION IN REGHIN HILLS USING FOURNIER INDEX

    Directory of Open Access Journals (Sweden)

    J. SZILAGYI

    2016-03-01

    Full Text Available Aggressiveness erosive force of rainfall is the express of kinetic energy and potential energy of rain water runoff on slopes. In the absence of a database for the analysis of parameters that define the torrencial rainfall, the rainfall erosivity factor was calculated by Fournier Index, Modified Fournier Index based on the monthly and annual precipitation.

  14. Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis

    Directory of Open Access Journals (Sweden)

    Mayank Mohan Agarwal

    2007-01-01

    Full Text Available Penile gangrene associated with chronic renal failure is very uncommon. A 52-year-old man with diabetes mellitus, diffuse atherosclerosis, ischemic cardiomyopathy and end-stage renal disease presented with blackening of distal penis for 10 days. His general condition was poor and gangrene of prepuce and glans was noted. Doppler and magnetic-resonance angiography revealed bilateral internal iliac artery obstruction. He underwent trocar suprapubic cystostomy and was planned for partial penectomy. But he died of severe diabetic complications in the interim period. Penile gangrene is a manifestation of widespread vascular calcifications associated with end-stage renal disease and is a marker of poor prognosis.

  15. Fatal liver gas gangrene after biliary surgery

    Directory of Open Access Journals (Sweden)

    Yui Miyata

    2017-01-01

    Discussion: Liver gas gangrene is rare and has a high mortality rate. This case seems to have arisen from an immunosuppressive state after major surgery with biliary reconstruction for bile duct cancer and subsequent gastrointestinal bleeding, leading to gas gangrene of the liver.

  16. Feline gangrenous mastitis

    OpenAIRE

    Wilson, Courtney R.

    2013-01-01

    A 3.7-kg, 3-year-old intact female domestic shorthaired cat was presented with the chief complaint of anorexia and lethargy of 3 days duration with a noticeable decrease in body condition and a large open wound on her ventral caudal abdomen. A diagnosis of acute mastitis with gland abscessation was made. The patient was successfully treated with oral antibiotics and open wound management using surgical debridement and lavage followed by wound dressings using honey.

  17. Feline gangrenous mastitis.

    Science.gov (United States)

    Wilson, Courtney R

    2013-03-01

    A 3.7-kg, 3-year-old intact female domestic shorthaired cat was presented with the chief complaint of anorexia and lethargy of 3 days duration with a noticeable decrease in body condition and a large open wound on her ventral caudal abdomen. A diagnosis of acute mastitis with gland abscessation was made. The patient was successfully treated with oral antibiotics and open wound management using surgical debridement and lavage followed by wound dressings using honey.

  18. Penile gangrene in a HIV patient

    African Journals Online (AJOL)

    L.E. Mubenga

    2016-11-16

    Nov 16, 2016 ... Abstract. Introduction: The good vascularization of penis protects this organ from necrosis. .... An unusual delayed complication of paraffin self-injection for ... B, Paradysz A. Gangrene of the penis, scrotum, and perineum,.

  19. Pulmonary gangrene as a complication of mucormycosis

    International Nuclear Information System (INIS)

    Zagoria, R.J.; Choplin, R.H.; Karstaedt, N.

    1985-01-01

    Pulmonary gangrene, a rare complication of pneumonia occurs when vascular thrombosis leads to necrosis of a large portion of lung. The devitalized lung is then sloughed into a cavity, resulting in a characteristic radiographic appearance. The previously reported cases of pulmonary gangrene have been associated with either bacterial or tuberculous pneumonia; the authors describe a case resulting from mucormycosis. In addition to the plain-film findings, the computed tomographic (CT) appearance is described

  20. Gangrenous Appendicitis in a Boy with Mobile Caecum

    Science.gov (United States)

    Keskin, Suat; Keskin, Zeynep; Gunduz, Metin; Sekmenli, Taner; Kivrak, Hatice Yazar

    2015-01-01

    A mobile caecum and ascending colon is an uncommon congenital disorder, and it is even rarer as the cause of an acute abdomen during childhood. This report presents the case of a 6-year-old boy with acute gangrenous appendicitis with a mobile caecum and ascending colon. Data from the surgical course, as well as laboratory and imaging studies, were acquired and carefully examined. Emergency ultrasound (US) was performed and revealed no signs of appendicitis in the right lower quadrant. Serial imaging study, including non-enhanced computed tomography (CT), was performed. An imaging study identified epigastric appendicitis with mobile caecum. Surgery was executed under general anesthesia with a median incision extending from the epigastrium to the suprapubic region. The caecum was mobile and placed in the right epigastric area, next to the left lobe of the liver and gallbladder. The gangrenous appendix was discovered posterior to the caecum and transverse colon, enlarging to the left upper quadrant. Appendectomy was executed, the gangrenous appendix was confirmed pathologically, and the patient was released 4 days later. In the US, if there are unusual clinical findings or no findings in patients with abdominal pain, CT is beneficial in determining the location of the caecum and appendix and preventing misdiagnosis in children. PMID:26060548

  1. Fournier′s gangrene of the penis

    Directory of Open Access Journals (Sweden)

    Tauro Leo

    2005-01-01

    Full Text Available Fournier′s gangrene is a rare, fulminant, though generally localized disease of the scrotum and penis with occasional extension up the abdominal wall. The usual organism is an anaerobic streptococcus synergistic with some second organism. Our case was unusual in that only the penis was involved without involving the scrotum or abdominal wall. Early therapy is the key, including hospitalization, debridement of entire shaft of the penis distal to the devasted area without excising the normal skin, parenteral broad-spectrum antibiotics & skin grafting. Only few cases of Fournier′s gangrene of the penis have been reported.

  2. Fournier′s gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Georgios Papadimitriou

    2015-01-01

    Full Text Available Fournier′s gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier′s gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified. Subsequently, the patient underwent scheduled cecostomy closure (right hemicolectomy, while the scrotum trauma healed with tertiary intention. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier′s gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development.

  3. Intrauterine extremity gangrene and cerebral infarction at term

    DEFF Research Database (Denmark)

    Tanvig, M; Jørgensen, J S; Nybo, M

    2011-01-01

    Intrauterine extremity gangrene in combination with cerebral infarction is a serious and rare event. We present a case with a healthy mother who gave birth to a child with this condition. At term, the mother presented at the antenatal clinic with decreased fetal movements. Cardiotocography (CTG...... resonance imaging (MRI). At one year of age the boy was doing well and had prosthesis as a left arm. He had no signs of further complications. Despite thorough examination of the parents and the child, the reason for the thrombosis is still unknown....

  4. Síndrome de Fournier: a percepçao do seu portador Síndrome de Fournier The perception of the Fournier syndrome's patient: la percepción de su portador

    Directory of Open Access Journals (Sweden)

    Fernanda Cavalini

    2002-06-01

    Full Text Available O propósito da presente investigação foi identificar a percepção dos pacientes que tiveram Síndrome de Fournier (SF sobre esta afecção, bem como sobre seus cuidadores. Os dados foram coletados através de entrevista com roteiro estruturado e a análise baseada na Análise de Prosa de André. Segundo os entrevistados, a SF causa dor intensa, edema, febre e ferida, necessitando tratamento cirúrgico, curativos e que traz problemas físicos, econômicos e familiares. Sobre seus cuidadores descreveram demonstração de atitudes e comportamentos mais negativos que positivos. A necessidade de melhor treinamento de seus cuidadores tanto nos aspectos cognitivos e psicomotor quanto afetivo, ficou evidente.El propósito de la presente investigación fue identificar la percepción de los pacientes que tuvieron el Síndrome de Fournier (SF sobre esa afección, así como acerca de sus cuidadores. Los datos fueron colectados a través de entrevista con formulário estructurado y análisis basado en el Análisis de Prosa de André. Según los entrevistados, el SF causa dolor intenso, edema, fiebre y heridas, que necesitan de tratamiento quirúrgic y curativos ocasionando problemas físicos, económicos y familiares. Sobre sus cuidadores, describieron la demostración de actitudes y comportamientos más negativos que positivos. La necesidad de un entrenamiento mejor de sus cuidadores tanto en los aspectos cognitivos y psicomotores como afectivos, fue evidente.The purpose of the present investigation was to identify the perception of the Fournier syndrome's patients about their disease and caregivers- Data was collected by means of interviews with a structured routine and the analysis was based on the Andres analysis of prose. According to the patients, the syndrome causes intense pain, edema, fever and wounds, demanding surgical treatment, dressings and bringing physical, economical and familiar problems. The caregivers' attitudes and behaviors were

  5. Fournier′s gangrene of the penis: A rare entity

    Directory of Open Access Journals (Sweden)

    Ashutosh Talwar

    2010-01-01

    Full Text Available Fournier′s gangrene is a rare, fulminant, but and usually a localized disease of the scrotum and penis, with an occasional extension up to the abdominal wall. The usual organism is an anaerobic streptococcus synergistic with other organisms. A 45-year-old male presented with fever and pain and a brownish-black discolouration of the penis, of four days. Our case was unusual in that the penis was involved, which is very rare. Early therapy is the key, including hospitalization, debridement of the entire shaft of the penis distal to the devastated area, without excising the normal skin, parenteral broad-spectrum antibiotics, and skin grafting.

  6. Successful combined approach to a severe Fournier′s gangrene

    Directory of Open Access Journals (Sweden)

    Tommaso Agostini

    2014-01-01

    Full Text Available We present a case of a successful reconstruction of a severe Fournier′s gangrene (FG involving the scrotum, the perineum, the right ischial area and extended to the lower abdomen. There are many different surgical techniques to repair and reconstruct the defect following debridement in FG. The authors treated this complex wound using negative pressure wound therapy (NPWT, dermal regeneration template and a split-thickness skin graft. Complete recovery was achieved and no major complications were observed. The patient showed a satisfying functional and aesthetic result.

  7. Bilataral Peripheral Gangrene Following Malaria Parasitaemia At ...

    African Journals Online (AJOL)

    ADMIN

    malaria& falciparum), are prevalent in E Africa, it is the Plasmodium falciparum that is most aggressive and rampant. In this region ... In both cases several investigations were carried out to rule out other possible causes of limb ischemia and gangrene. ... He had never smoked cigarettes, and there was no history of trauma.

  8. Fournier’s gangrene. A clinical review

    Directory of Open Access Journals (Sweden)

    Ariana Singh

    2016-10-01

    Full Text Available Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available

  9. Preliminary chronostratigraphy of the Tetagouche and Fournier groups in northern New Brunswick

    International Nuclear Information System (INIS)

    Sullivan, R.W.; VanStaal, C.R.

    1996-01-01

    Seven U-Pb zircon ages of volcanic rocks from northern New Brunswick are reported and a preliminary stratigraphy of the middle Ordovician Tetagouche and Fournier groups is presented. Deposition of the Tetagouche Group started with calcareous rocks of the Vallee Lourdes Formation in the Late Arenig (>470 Ma). Quartz- and feldspar-phyric felsic volcanic rocks of the immediately overlying Nepisiquit Falls Formation yielded U-Pb zircon ages between ca. 471 and 469 Ma. These volcanic rocks are time stratigraphic equivalents of the feldspar-phyric dacites of the Spruce Lake Formation, which yielded a U-Pb zircon age of ca. 470 Ma, and tholeiitic and alkalic pillow basalts of the structurally overlying Canoe Landing Lake Formation. The final phase of rhyolitic to dacitic volcanism is marked by the emplacement of distinct quartz- and feldspar-phyric dacitic porphyries at ca. 465 Ma, thus limiting silicic volcanism to the Late Arenig and llanvim. During the Ilandeilo and Caradoc (ca. 464-457 Ma) volcanic activity in the Tetagouche Group was characterized by extrusion of alkali basalts and minor comendites, interlayered with dark shales and siltstones of the Boucher Brook Formation. Oceanic crust of the Fournier Group was also formed during this period. (author). 29 refs., 1 tab., 10 figs

  10. Preliminary chronostratigraphy of the Tetagouche and Fournier groups in northern New Brunswick

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, R W; VanStaal, C R [Geological Survey of Canada, Ottawa, ON (Canada)

    1997-12-31

    Seven U-Pb zircon ages of volcanic rocks from northern New Brunswick are reported and a preliminary stratigraphy of the middle Ordovician Tetagouche and Fournier groups is presented. Deposition of the Tetagouche Group started with calcareous rocks of the Vallee Lourdes Formation in the Late Arenig (>470 Ma). Quartz- and feldspar-phyric felsic volcanic rocks of the immediately overlying Nepisiquit Falls Formation yielded U-Pb zircon ages between ca. 471 and 469 Ma. These volcanic rocks are time stratigraphic equivalents of the feldspar-phyric dacites of the Spruce Lake Formation, which yielded a U-Pb zircon age of ca. 470 Ma, and tholeiitic and alkalic pillow basalts of the structurally overlying Canoe Landing Lake Formation. The final phase of rhyolitic to dacitic volcanism is marked by the emplacement of distinct quartz- and feldspar-phyric dacitic porphyries at ca. 465 Ma, thus limiting silicic volcanism to the Late Arenig and llanvim. During the Ilandeilo and Caradoc (ca. 464-457 Ma) volcanic activity in the Tetagouche Group was characterized by extrusion of alkali basalts and minor comendites, interlayered with dark shales and siltstones of the Boucher Brook Formation. Oceanic crust of the Fournier Group was also formed during this period. (author). 29 refs., 1 tab., 10 figs.

  11. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

    Science.gov (United States)

    2013-01-01

    Introduction Fournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality. Methods The medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Results Ten males and five females were enrolled in the study. The mean age was 54 years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality. Conclusions Fournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices. PMID:23547796

  12. [Maggot therapy for gangrene and osteomyelitis].

    Science.gov (United States)

    Mumcuoglu, K Y; Lipo, M; Ioffe-Uspensky, I; Miller, J; Galun, R

    1997-03-02

    5 patients with diabetic-foot were treated by maggot therapy. The most serious case was in a 75-year-old man who had gangrene and osteomyelitis of the right foot. Proteus mirabilis, Enterococcus sp., Providencia stuartii and Staphylococcus spec. (coagulase positive) were isolated from lesions which did not respond to antibiotic therapy. The patient had twice refused amputation but agreed to maggot therapy. Larvae of the sheep blowfly Phoenicia (Lucilia) sericata were used for twice-weekly treatment over a period of 7 months. Sterile larvae were applied to the wound and replaced every 3-4 days. After 4 months of treatment, the necrotic tissue around the toes and on the sole of the foot detached from the healthy tissue. During the last 3 months of treatment the larvae removed the remaining infected tissue. As therapy progressed, new layers of healthy tissue covered the wound. The offensive odor associated with the necrotic tissue and the intense pain in the foot decreased significantly. At the end of therapy, during which there were no complaints of discomfort, he was able to walk. In the 4 other patients who had relatively superficial gangrene, the maggots debrided the wounds within 2-4 weeks. Thereafter treatment was continued with antibiotics. Maggot therapy can be recommended in cases of intractable gangrene and osteomyelitis, when treatment with antibiotics and surgical debridement have failed.

  13. Síndrome de Fournier secundária a adenocarcinoma de próstata avançado: relato de caso Fournier's syndrome secondary to advanced prostatic adenocarcinoma: case report

    Directory of Open Access Journals (Sweden)

    Rodrigo Rocha Batista

    2010-06-01

    Full Text Available A Síndrome de Fournier é uma fasciite necrotizante rapidamente progressiva que acomete a genitália e região perineal. Mesmo com os avanços na terapêutica, a morbidade e a mortalidade desta afecção permanecem elevadas. É relatado caso de paciente masculino, 70 anos, com diagnóstico de adenocarcinoma de próstata avançado. Há um dia com dor e aumento de volume escrotal associado a febre. Ao exame físico, paciente séptico com gangrena gasosa do pênis e escroto; ao toque retal, lesão ulcero-vegetante em parede anterior do reto estendendo-se de 3 a 7 cm da borda anal. Realizado desbridamento cirúrgico, com identificação de fístula reto-escrotal transtumoral. Estudo histo-patológico da lesão retal confirmou infiltração por adenocarcinoma de próstata. Recebeu alta hospitalar no vigésimo dia de internação, atualmente em acompanhamento oncológico ambulatorial.Fournier's syndrome is a rapidly progressive necrotizing fasciitis affecting the genitalia and perineal region. Even with the advances in therapy, morbidity and mortality of this disease remain high. We report the case of male patient, 70 years old, diagnosed with advanced adenocarcinoma of the prostate. A day with pain and swelling near scrotum associated with fever. The physical examination revealed septic patient with gas gangrene of the penis and scrotum; on digital rectal examination, a vegetative and ulcerated lesion on the anterior wall of the rectum extending from 3 to 7 cm from the anal edge. Performed surgical debridement, with identification of scrotal-rectal fistula transtumoral. Histo-pathological study of the lesion confirmed rectal infiltration by adenocarcinoma of prostate. Was discharged from the hospital on the twentieth day of hospitalization, outpatient cancer currently monitoring.

  14. Peripheral gangrene in a case of severe dengue | Nair | Nigerian ...

    African Journals Online (AJOL)

    We report the case of a 10.year.old male who developed gangrene of his fingers and toes following severe dengue fever complicated by disseminated intravascular coagulation (DIC). Child developed bilateral dry gangrene of fingers and toes. All the peripheral pulses of the affected limbs were palpable. The child had no ...

  15. Laboratory studies on the outbreak of Gangrenous Ergotism ...

    African Journals Online (AJOL)

    Objectives: The objective of this study was to investigate consumption of cereal grains grown locally as the most likely cause of the outbreak of gangrenous ergotism so that control measures could be applied. Methods: During June to August, 2001, there were reports of a large number of cases of gangrene in Arsi Zone, ...

  16. Digital gangrene associated with anticentromere antibodies: a case report

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    Nair Bindu

    2010-06-01

    Full Text Available Abstract Introduction Anticentromere antibodies have been associated with peripheral vascular occlusive disease, most frequently accompanied by sclerodactyly in the context of a connective tissue disorder. We report a case of digital gangrene with no other clinical associations except positive anticentromere antibodies. Case presentation Our patient, a 53-year-old Caucasian woman, non-smoker, presented with progressive pain and blackening of the distal right third finger over the preceding five weeks. No sclerodactyly was evident. She was anticentromere antibody positive at greater than 100 U/mL. Angiography revealed diffuse distal vasculopathy in both upper extremities. Other investigations were unremarkable. Conclusions It is rare for anticentromere antibody-associated digital necrosis to develop without concomitant sclerodactyly. However, this patient's case illustrates the need to consider an autoimmune contribution to the pathogenesis of digital ischemia even in the absence of a recognizable connective tissue disease.

  17. Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

    Science.gov (United States)

    Hu, Ning; Wu, Xing-Huo; Liu, Rong; Yang, Shu-Hua; Huang, Wei; Jiang, Dian-Ming; Wu, Qiang; Xia, Tian; Shao, Zeng-Wu; Ye, Zhe-Wei

    2015-08-01

    Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

  18. Gangrena de Fournier: infección necrotizante de los genitales externos y del perine, a propósito de 5 casos

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    Haydee Wong Arocha

    1995-12-01

    Full Text Available La gangrena de Fournier es una forma de gangrena sinergística y frecuente del revestimiento cutáneo de los órganos genitales externos y del periné. Esta afección descrita por Fournier en 1884 recibe varias denominaciones como: gangrena escrotal y fulminante. La incidencia de esta entidad es poco frecuente, no obstante, dentro de las urgencias urológicas de nuestro Servicio de Urología, hemos apreciado que en los últimos 6 meses se han detectado un total de 5 casos para el 18,5 %. En los casos reportados hemos conocido los factores locales desencadenantes de ésta, con una puerta de entrada bien definida. Se precisan los microorganismos más frecuentes que estuvieron presentes y que demandaron un tratamiento quirúrgico agresivo de inmediato para lograr una evolución satisfactoria

  19. Fournier’s Gangrene in a Heterosexual Man: A Complication of Neisseria meningitidis Urethritis

    Directory of Open Access Journals (Sweden)

    Tariq A. Khemees

    2012-01-01

    Full Text Available A 55-year-old heterosexual male presented to the emergency department with a symptomatology consistent with urethritis and Fournier’s gangrene. Urethral swab and operative tissue cultures were positive for coagulase-negative Staphylococcus and an intracellular Gram-negative diplococcus. The latter was initially thought to be Neisseria gonorrhea; however, DNA sequencing technique confirmed it to be Neisseria meningitidis. The patient required three separate surgical debridements to control widespread necrotizing infection. Following documentation of sterile wound healing with appropriate antibiotics, four reconstructive surgeries were necessary to manage the resultant wound defects. To our knowledge, Neisseria meningitidis as a causative organism in Fournier’s gangrene has not been reported in the literature.

  20. Peripheral gangrene in a case of severe dengue

    African Journals Online (AJOL)

    ergot alkaloids or other related medications. ... The spectrum of disease manifestations in dengue fever is wide. ... dengue shock syndrome and multiorgan failure. .... McGouran RC, Emmerson GA. Symmetrical peripheral gangrene. Br Heart J.

  1. Safe Resection and Primary Anastomosis of Gangrenous Sigmoid ...

    African Journals Online (AJOL)

    %) of the sigmoid volvulus was gangrenous and 85.2% of all the sigmoid volvulus was managed by resection and primary anastomosis. Complications seen after resection and primary anastomosis were anastomotic leak at 4.5%, resection.

  2. Avoidable birth injury complicated with limb gangrene: a reflection of ...

    African Journals Online (AJOL)

    2015-11-10

    Nov 10, 2015 ... this recommendation and existence of modern health facilities in Nigeria ... gangrene from poor management of the fracture and eventual .... done for logistic reasons and financial constraint. Al- .... with time trends since 2000.

  3. X-ray examination of patients with gangrenous pulmonary abscesses

    International Nuclear Information System (INIS)

    Palamarchuk, V.P.; Gordeeva, T.Ya.

    1980-01-01

    Analysis of variability of some signs in the process of roentgenological dynamic observation of 31 patients with gangrenous pulmonary abscess who received conservative treatment is carried out. On the basis of the results of statistical processing of roentgenological data on the changes of the expansion of inflammatory infiltration, the cavity diameter, thickness of its walls and sizes of sequester optimum time of roentgenological study in the dynamics during conservative treatment of gangrenous abscess are suggested

  4. Fournier’s Gangrene in  a Patient with Obesity and B-lymphoma

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    Christos Komninos

    2013-01-01

    Full Text Available We present a  case of Fournier’s gangrene disease in  a young obese patient with coexistent B-lymphoma. It remains controversial if obesity constitutes a  predisposing factor for an individual to develop necrotizing fasciitis. On the other hand, only few cases of patients with coexistence of B-lymphoma and Fournier’s gangrene disease have been reported.  A 30-years-old obese man was admitted to emergency department with fever (38.7 °C, pain, erythema and swelling extended from the left scrotum to the left lower abdominal quadrant. He was confused, with low urinary excretion and septic shock’s signs. The clinical findings were characteristics of Fournier’s gangrene disease. Furthermore during physical examination a  massive, painless and motionless mass in  the left breast was revealed. The patient required urgent surgical debridement of the affected area and pus drainage. Biopsies of the breast mass were received by excision. Pus and blood cultures yielded Staphylococci coagulase(–, Klebsiella and Proteus sp. Intravenous antibiotic treatment with Meropeneme and Clindamycine started immediately. Repeated debridement was often performed. Pathology examination of the massive tissue revealed a  diffuse B-lymphoma of large cells (Germinal center B-cell like-GCB. The patient was discharged from the hospital 35 days later.  Afterwards, he was treated with chemotherapeutic agents for malignant lymphoma at the oncological department. The aim of this case’s presentation is to mention that young obese patients with Fournier’s gangrene disease should be particularly investigated due to the possible occurrence of another not obvious predisposing factor, such as a  malignant disease.

  5. A case of anal canal cancer which developed fournier's syndrome after chemoradiotherapy

    International Nuclear Information System (INIS)

    Momma, Tomoyuki; Kikuchi, Daiki; Watanabe, Yohei; Onozawa, Hisashi; Suzuki, Satoshi; Nakamura, Izumi; Ohki, Shinji; Takenoshita, Seiichi; Yoshida, Noriyuki

    2013-01-01

    Fournier's syndrome is an acute necrotizing fasciitis of the perineum which progresses rapidly, resulting in poor prognosis if not treated appropriately at an early stage. Here we report a case of anal canal cancer which developed Fournier's syndrome after chemoradiotherapy (CRT). A 79-year-old man with anal canal cancer received a double-barrel sigmoid colostomy followed by concurrent CRT (50.4 Gy) with S-1 (100 mg/body). Although the patient was discharged after CRT, he developed a fever at 10 days after discharge and visited our hospital complaining of pain in the anal region. He was hospitalized with a diagnosis of Fournier's syndrome. Extensive drainage, administration of antibiotics, additional drainage and continuous irrigation of the affected region improved the symptoms of Fournier's syndrome. Multiple liver metastases were found on a CT scan at 3 months after onset of Fournier's syndrome, and the patient was transferred to another hospital for systemic chemotherapy. There have been no reports on the onset of Fournier's syndrome after CRT for rectal cancer with anal canal involvement; we report this case with a review of the literature. (author)

  6. Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

    Science.gov (United States)

    Tarchouli, Mohamed; Bounaim, Ahmed; Essarghini, Mohamed; Ratbi, Moulay Brahim; Belhamidi, Mohamed Said; Bensal, Abdelhak; Zemmouri, Adil; Ali, Abdelmounaim Ait; Sair, Khalid

    2015-01-01

    Introduction: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality. Methods: We carried out a retrospective study of 72 patients treated for Fournier’s gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and non-survivors and potential prognostic factors were analyzed. Results: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier’s Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002). Conclusion: Fournier’s gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival. PMID:26600888

  7. A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

    Directory of Open Access Journals (Sweden)

    Heon Ju Lee

    2013-06-01

    Full Text Available Variceal bleeding and hepatorenal syndrome (HRS are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

  8. Fournier′s gangrene: Evaluation of 68 patients and analysis of prognostic variables

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    Unalp H

    2008-01-01

    Full Text Available Context: Fournier′s gangrene (FG is a rapidly progressing acute gangrenous infection of the anorectal and urogenital area. Aims: The objectives of this study were to investigate patients with FG and to determine risk factors that affect mortality. Settings and Design: Retrospective clinical study. Materials and Methods: Clinical presentations and outcomes of surgical treatments were evaluated in 68 patients with FG. Statistical Analysis Used: Chi-square, Student′s t -test, and logistic regression test. Results: Mean age of patients was 54 and female-to-male ratio was 9:59. Among the predisposing factors, diabetes mellitus (DM was the most common ( n =24, 35.3%, and sepsis on admission was detected in 31 (45.6% and 15 (22.1% patients, respectively. Seven (10.3% patients died. Using logistic regression test, Fournier′s Gangrene Severity Index (FGSI> 9, DM and sepsis on admission were found as prognostic factors. Conclusions: FG has a high mortality rate, especially in patients with DM and sepsis. An FGSI value> 9 indicates high mortality rate.

  9. Le traitement de la gangrène de fournier : à propos de 64 cas ...

    African Journals Online (AJOL)

    Objective: to describe and to analyze the therapeutic modalities of the gangrene of the genital rea treated in Tokoin Teaching Hospital of Lome. Patients and Method: sixty four patients having a gangrene of the genital area and treaty of 1993 to 2008 have been taken in charge by a resuscitation followed of a necrosectomy ...

  10. Comprehensive treatment for gas gangrene of the limbs in earthquakes.

    Science.gov (United States)

    Wang, Yue; Lu, Bo; Hao, Peng; Yan, Meng-ning; Dai, Ke-rong

    2013-10-01

    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. 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. Of 226 patients with limbs open injuries sustained during the earthquake, 53 patients underwent smear analysis of wound exudates and gas gangrene was diagnosed in 19 patients. The average elapsed time from injury to arrival at the hospital was 72 hours, from injury to definitive diagnosis was 4.3 days, and from diagnosis to conversion of negative findings on wound smear analysis to positive findings was 12.7 days. Anaerobic cultures were also obtained before wound closure. The average elapsed time from completion of surgery to recovery of normal vital signs was 6.3 days. Of the 19 patients, 16 were treated with open amputation, two with closed amputation, and 1 with successful limb salvage; 18 patients were successfully treated and one died. In earthquakes, rapid, accurate screening and isolation are essential to successful treatment of gas gangrene and helpful in preventing nosocomial diffusion. Early and thorough debridement, open amputation, and active supportive treatment can produce satisfactory therapeutic results.

  11. Gangrene of the oesophago-gastric junction caused by strangulated hiatal hernia: operative challenge or surgical dead end.

    Science.gov (United States)

    Schweigert, M; Dubecz, A; Ofner, D; Stein, H J

    2014-06-01

    Gangrene of the oesophago-gastric junction due to incarcerated hiatal hernia is an extremely uncommon emergency situation which was first recognized in the late nineteenth century. Early symptoms are mainly unspecific and so diagnosis is often considerably delayed. Aim of the study is to share experience in dealing with this devastating condition. We encountered three male patients with gangrene of the oesophago-gastric junction caused by strangulated hiatal hernia within the last years. Clinical symptoms, surgical procedures and outcomes were retrospectively analyzed. Furthermore, we provide a history outline on the evolving surgical management from the preliminary reports of the nineteenth century up to modern times. Early symptoms were massive vomiting accompanied by retrosternal and epigastric pain. Hiatal hernia was already known in all patients. Nevertheless, clinical presentation was initially misdiagnosed as cardiovascular disorders. Upon emergency laparotomy gangrene of the oesophago-gastric junction was obvious while in one case even necrosis of the whole stomach occurred after considerable delayed diagnosis. Transmediastinal esophagectomy with resection of the proximal stomach and gastric pull up with cervical anastomosis was performed in two cases. Oesophago-gastrectomy with delayed reconstruction by retrosternal colonic interposition was mandatory in the case of complete gastric gangrene. Finally all sufferers recuperated well. Strangulation of hiatal hernia with subsequent gangrene of the oesophago-gastric junction is a life-threatening condition. Straight diagnosis is mandatory to avoid further necrosis of the proximal gastrointestinal tract as well as severe septic disease. Surgical strategies have considerably varied throughout the last 100 years. In our opinion transmediastinal oesophagectomy with interposition of a gastric tube and cervical anastomosis should be the procedure of choice if the distal stomach is still viable. Otherwise oesophago

  12. Strangulated small bowel gangrene due to torsioned gangrenous appendix in an old man: a case report

    Directory of Open Access Journals (Sweden)

    Ardavan Shahbazi

    2016-11-01

    Full Text Available Background: Torsion of the appendix is a rare entity and divided into two categories: primary and secondary. The primary mode is due to an abnormality in either appendix anatomy or its meso or both and is more common in children. The secondary forms happen in adults which can be associated with appendiceal tumor, appendiceal mucocele, fecal impaction, volvulus of ovarian cyctadenoma. Adynamic small bowel obstruction or ileus is seen frequently with all forms of peritoneal inflammation. However, Anatomical small intestinal obstruction or gangrene due to torsioned appendix is a rare condition and few cases reported in the literature. Method: Here we have a 83-year-old man patient with small bowel obstruction and localized right lower quadrant peritonitis who undergo emergency laparotomy to eliminate small bowel obstruction and peritonitis. Preoperative abdominal radiography showed multiple dilated small bowel loops with empty colon. Results: During exploration necrosis of the terminal 40cm of the ileum due to a twisted and gangrenous appendix was discovered. Other parts were normal. Conclusion: it may be useful to recommend early midline exploratory laparotomy for patients with small bowel obstruction even in the presence symptoms of local appendicitis. This operation can be both diagnostic and therapeutic.

  13. Case Report: Multiple Myeloma with Gangrene of Extremities

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    N Gharahi

    2009-07-01

    Full Text Available Introduction: Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia and hypercalcemia. The hyper viscosity syndrome is rare. Cryoglobulins are immunoglubulins that precipitate at temperatures less than 37degrees Celsius. Monoclonal cryoglobulins are usually present along with a specific hematologic disorder and are often asymptomatic. We report a second case of multiple myeloma with gangrene of all four extremities. Case: The Patient was a 77 year–old farmer with a 2 weeks history of coldness, pain and discoloration of the fingers of both the extremities which had extended to the mid forearm and shin regions. It was accompanied by skin erosions of the lower extremities, dark spots on the ear auricles and discoloration of the tip of the nose. On physical examination, quadrigangrene associated with ischemia of the auricles and tip of nose was seen. Serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin, Bone marrow study showed neoplastic plasma cells infiltration. The patient was diagnosed as cryoglobulinemia based on multiple myeloma and treated accordingly.

  14. Contemporary diagnosis and management of Fournier’s gangrene

    Science.gov (United States)

    Khourdaji, Iyad; Burks, Frank; Killinger, Kim A.

    2015-01-01

    Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing fasciitis of the external genitalia. Mainly associated with men and those over the age of 50, Fournier’s gangrene has been shown to have a predilection for patients with diabetes as well as people who are long-term alcohol misusers. The nidus for the synergistic polymicrobial infection is usually located in the genitourinary tract, lower gastointestinal tract or skin. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. The diagnosis is often made clinically, although radiography can be helpful when the diagnosis or the extent of the disease is difficult to discern. The Laboratory Risk Indicator for Necrotizing Fasciitis score can be used to stratify patients into low, moderate or high risk and the Fournier’s Gangrene Severity Index (FGSI) can also be used to determine the severity and prognosis of Fournier’s gangrene. Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. In cases of severe perineal involvement, colostomy has been used for fecal diversion or alternatively, the Flexi-Seal Fecal Management System can be utilized to prevent fecal contamination of the wound. After extensive debridement, many patients sustain significant defects of the skin and soft tissue, creating a need for reconstructive surgery for satisfactory functional and cosmetic results. PMID:26445600

  15. Diabetic gangrene of the foot. Report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Junji; Hoshi, Makoto; Shinozaki, Tatsuyo; Kimura, Masakata (Hirosaki Univ., Aomori (Japan). School of Medicine); Ichinohe, Hitomoto

    1983-08-01

    A case of severe diabetic gangrene was reported. Angiography showed no evidence of ischemic changes in the foot, except for mild atherosclerosis in the femoral and popliteal arteries. Tc-99m labelled macroagglugated albumine (MAA) was injected transcatheterally into the abdominal aorta to see the blood perfusion of the lower extremities, which showed increased blood flow of the foot as well as the presence of micro arteriovenous shuntings shown by the appearance of both lungs. Damages of the microcirculation are thought to have much influences on the formation of diabetic gangrene. Histopathological findings supported above.

  16. Lethal pneumatosis coli in a 12-month-old child caused by acute intestinal gas gangrene after prolonged artificial nutrition: a case report

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    Kircher Stefan

    2008-07-01

    Full Text Available Abstract Introduction Pneumatosis coli is a rare disease with heterogeneous symptoms which can be detected in the course of various acute and chronic intestinal diseases in children, such as necrotizing enterocolitis, intestinal obstruction and intestinal bacteriological infections. Case presentation We report the case of a 12-month-old boy who died of pneumatosis coli caused by an acute intestinal gas gangrene after prolonged artificial alimentation. Conclusion While intestinal gas gangrene is a highly uncommon cause of pneumatosis coli, it is important to consider it as a differential diagnosis, especially in patients receiving a prolonged artificial food supply. These patients may develop intestinal gas gangrene due to a dysfunctional intestinal barrier.

  17. Perforated Duodenum – An Unusual Etiology of Fournier's Disease: A Case Report

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    Yung-Chin Lee

    2003-12-01

    Full Text Available Fournier's disease, a form of necrotizing fasciitis, is a rapidly progressing subcutaneous infection of the male genitalia. We report a case of Fournier's disease with the unusual etiology of a perforated duodenum. This patient suffered from progressive right scrotal swelling after percutaneous transhepatic cholangeal drainage. Scrotal exploration revealed a large abscess with muscle necrosis that had spread up to the right retroperitoneal space. Radiologic studies and second abdominal exploration documented the origin as a perforated duodenum. The pus distribution in this case suggested that the infection process differed from that in previous reports. In future cases of Fournier's disease involving previous abdominal events, we recommend that abdominal origins be carefully surveyed before scrotal exploration.

  18. IDIOPATHIC SCLEROSING ENCAPSULATING PERITONITIS CAUSING ACUTE INTESTINAL OBSTRUCTION AND GANGRENE: A CASE REPORT

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    Nava

    2016-04-01

    Full Text Available INTRODUCTION Sclerosing encapsulating peritonitis (SEP is a relatively rare cause of intestinal obstruction resulting from encasement of variable lengths of bowel by dense fibro-collagenous membrane. It is more common in young females, and shows tropical and sub-tropical distribution. The idiopathic cases of SEP, which lack any identifiable cause from clinical, radiological and histopathological findings, are also reported under the descriptive term “abdominal cocoon syndrome”. SEP presents with acute or sub-acute intestinal obstruction with or without a mass. In the era of laparoscopic surgery, inadvertent damage to the small bowel at insertion of the trocar and cannula can occur by being unaware of this condition resulting in unnecessary bowel resection. Persistent untreated SEP may advance to bowel gangrene or intestinal perforation, representing life threatening conditions. We report the clinical presentation of a 75-year-old female presenting with signs of intestinal obstruction whose imaging findings revealed abdominal cocoon with bowel gangrene leading to perforation and the same confirmed at surgery. Surgical excision of the fibrotic sac encasing the bowel, resection of gangrenous bowel segment and end ileostomy was performed. Histopathology of the excised membrane confirmed sclerosing encapsulating peritonitis. To our knowledge, only a few cases of abdominal cocoon with perforation have been reported in literature so far. Radiologists should be aware of this relatively rare cause of intestinal obstruction, its imaging findings and complications, as preoperative diagnosis will prevent delay and aid in treatment planning to the surgeon. Identification of soft tissue density membrane encasing congregated small bowel loops into a single area on computed-tomography gives diagnostic clue. Surgical excision of sac, release of bowel loops and adhesions with partial intestinal resection when necessary is the treatment.

  19. Evidências científicas brasileiras sobre gangrena de Fournier

    OpenAIRE

    Érick Igor dos Santos; Amanda Luiza Vasconcellos Vertulli Vale; Isabel Cristina Peixoto Marinho dos Reis; Priscila Benevides Neves; Cristiane Marinho Pontes; Sarita Gonçalves de Campos Camara

    2014-01-01

    El objetivo fue describir producciones brasileñas publicadas en los últimos veinte años acerca de la gangrena de Fournier. Revisión integradora realizada en las bases de datos LILACS, MEDLINE, BDENF y Colecciona SUS, con el descriptor “Gangrena de Fournier”. Se seleccionaron textos publicados entre enero de 1994 y julio de 2014, en portugués y disponibles gratuitamente en Internet. Según los 14 artículos encontrados, los principales síntomas de la gangrena de Fournier incluyen malestar, con s...

  20. Marcel Fournier, Charles Kraemer (dir.), Durkheim avant Durkheim. Une jeunesse vosgienne

    OpenAIRE

    Béra, Matthieu

    2016-01-01

    Cet ouvrage restitue un grand nombre de recherches, souvent pointues, communiquées au public il y a maintenant sept ans (en mai 2008) à Épinal, à l’occasion des 150 ans de la naissance de Durkheim dans cette ville en 1858. La biographie d’Émile Durkheim par Marcel Fournier venait alors de paraître (Durkheim, 2007, Fayard) ; le projet de Fournier, co-organisateur des trois journées, était de reconstituer le cadre social de la « prime jeunesse » de Durkheim, de remonter aux sources, d’immerger ...

  1. Rare Cause of Seizures, Renal Failure, and Gangrene in an 83-Year-Old Diabetic Male

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    Stalin Viswanathan

    2013-01-01

    Full Text Available We report an 83-year-old diabetic male who presented with acute-onset renal failure, seizures, psychosis, pneumonia, and right foot gangrene. Investigations revealed thrombocytopenia, CSF lymphocytosis, ANA and dsDNA positivity, hypocomplementemia, and pneumonitis following which he was treated with pulse methylprednisolone. He was treated for Pseudomonas-related ventilator-associated pneumonia, candiduria, and E. coli-related bedsore infection prior to discharge. He was discharged at request and died 17 days later due to a respiratory infection.

  2. Platelet abnormalities in a dog suffering from gangrenous mastitis by Staphylococcus aureus infection.

    Science.gov (United States)

    Hasegawa, T; Fujii, M; Fukada, T; Tsuji, C; Fujita, T; Goto, Y; Shinjo, T; Ogawa, H

    1993-02-01

    Severe gangrenous mastitis due to Staphylococcus aureus infection was diagnosed in a 7 year-old intact female beagle which was presented with swelling of mammary glands after dystocia. Leukocytosis (25,200-48,600/microliters), decreased platelets (107,000-179,000/microliters), and abnormal platelet pattern continued during the critical condition. Consistent with platelet pattern, large platelets were observed in the blood smear. The number of leukocytes and platelets rapidly returned to normal during treatment, and the platelet pattern was also restored. The number and pattern of platelet may provide a clue for the evaluation of the clinical condition and/or severity of the lesions in the dog with mastitis.

  3. Bone setter's gangrene | Nwadiaro | Nigerian Journal of Medicine

    African Journals Online (AJOL)

    Abstract. Background: Gangrene usually supervenes following prolonged pressure of tight splintage by traditional bone setters (TBS) in the process of treating fractures. However, various complications such as blisters, pressure sores, Volkmann's ischaemia/ contracture, Crush syndrome and pregangrene occur by the same ...

  4. Primary omental gangrene mimicking appendicular perforation peritonitis-A case report.

    Science.gov (United States)

    Kumar, A; Shah, J; Vaidya, P

    2016-01-01

    Primary omental torsion is a rare cause of acute abdomen in adults and presents with variable signs and symptoms. Establishing a preoperative diagnosis may be difficult in the emergency setting. It is rarely diagnosed preoperatively as it mimics common surgical emergencies such as acute appendicitis, appendicular perforation, acute cholecystitis and perforated peptic ulcers and can lead to the clinical deterioration of patient if missed A 47 years old male was taken to the operating room with a diagnosis of appendicular perforation peritonitis and during surgery was found to have a primary omental gangrene with pyoperitoneum, for which omentectomy and peritoneal lavage was performed. Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Omental torsion can be primary (idiopathic) or secondary, depending on an underlying cause. Primary omental torsion was first described by Eitel in 1899. However, very few cases have been reported. Our case was a rare case presenting with omental gangrene with pyoperitoneum mimicking appendicular perforation peritonitis. Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Fistula-in-Ano complicated by Fournier′s gangrene our experience in North-Eastern region of Nigeria

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    Abubakar A Bakari

    2013-01-01

    Full Text Available Background: Fistula-in-ano when complicated by Fournier′s gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. Results: A total of 10 men with a mean age of 50.5 years (35-60 were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70% of these patients presented with Fournier′s gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40% of these patients had inadequate drainage of their perianal abscess and 2 (20% had incision and drainage. Another 4 (40% had spontaneously rupture of the perianal abscess. 6 (60% of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50% and fistulotomy in 3 (30% patients. Another 30% had fistulotomy and continuing sitz bath. Conclusion: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier′s gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier′s gangrene.

  6. Brazilian scientific evidence on Fournier’s gangrene

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    Érick Igor dos Santos

    2015-02-01

    Full Text Available The objective of this study was to describe the Brazilian scientific reports published over the past twenty years on Fournier’s gangrene. It is an integrative review conducted through incursions in the LILACS, MEDLINE, BDENF and Coleciona SUS databases with the descriptor ‘Fournier’s Gangrene’. Texts published between January 1994 and July 2014, in Portuguese, and freely available online were selected. According to the 14 articles found, the main symptoms of Fournier’s gangrene include discomfort with painful sensations, high fever, edema, malaise, and sweating. In most cases erythema and blistering are observed, evolving into a wound. The clinical profile assists in the selection of empirical antimicrobial therapy even before the culture results. It was concluded that early diagnosis and appropriate and aggressive treatment are crucial in patient prognosis. There is still a shortage of Brazilian scientific production with a high power of evidence on the subject.

  7. Amputation of extremity in patients with atherosclerotic gangrene

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    Tsareva Yu.O.

    2011-12-01

    Full Text Available Aim of investigation — to analyze the results of treatment of patients with atherosclerotic gangrene of a limb, to identify the causes of adverse outcomes amputation. Materials and methods: We analyzed the results of examination and treatment of 218 patients with atherosclerotic gangrene of the limb. Good outcome of amputation was considered the primary surgical wound healing of the stump. Suppuration, secondary healing, re-amputation and death we attributed to the adverse results of amputation. Results: The adverse outcomes of amputation due to technical errors in surgery, properly chosen level, inadequate drainage of the wound stump, an unsuccessful operation on the arteries of a limb, inadequate empirical antibiotic therapy, patient's age, functional capabilities of myocardium, the duration of critical ischemia, as well as the lack of psychological adaptation of patients before amputation. Conclusion: To decide the need for amputation in patients with atherosclerotic gangrene follows the assessment of possible vascular reconstructive surgery. In determining the level of amputation is necessary to objectively assess the degree of disruption of regional blood flow using multilevel manometry and laser Dopplerflowmetry. In preparation for amputation should be paid special attention to the correction of rheological and coagulation properties of blood, normalization of the functional state of the myocardium, as well as specialized psychotherapeutic training for timely and adequate psychological adaptation of the patient

  8. USING THE FOURNIER INDEXES IN ESTIMATING RAINFALL EROSIVITY. CASE STUDY - THE SECAŞUL MARE BASIN

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    M. COSTEA

    2012-03-01

    Full Text Available Using the Fournier Index in Estimating Rainfall Erosivity. Case Study - The Secaşul Mare Basin. Climatic aggressiveness is one of the most important factors in relief dynamic. Of all climatic parameters, rainfall is directly involved in versant dynamic, in the loss of soil quality and through pluvial denudation and the processes associated with it, through the erosivity of torrential rain. We analyzed rainfall aggressiveness based on monthly and annual average values through the Fournier's index (1970 and Fournier's index modified by Arnoldus (1980. They have the advantage that they can be used not only for evaluating the land susceptibility to erosion and the calculation of erodibility of land and soil losses, but also in assessing land susceptibility to sliding (Aghiruş, 2010. The literature illustrates the successful use of this index which provides a summary assessment of the probability of rainfall with significant erosive effects. The results obtained allow observation of differences in space and time of the distribution of this index.

  9. Fournier′s gangrene in Mansoura Egypt: A review of 74 cases

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    Ghnnam W

    2008-01-01

    Full Text Available Background: Fournier′s gangrene (FG, caused by synergistic aerobic and anaerobic organisms, is a life-threatening disorder in which infection of the perineum and scrotum (can affect penis alone spreads along fascial planes, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. Materials and Methods: We analyzed 74 patients admitted to our institution′s emergency surgical unit presenting with FG between January 2002 and January 2007, considering the anatomical site of infective gangrene, predisposing factors, etiological agents, and outcomes. Results: All the 74 patients included in this study were males; their mean age was 51±10.8 years (21-72 years. The mean duration from the onset of symptoms to admission to the hospital was 3.74±2.09 days (1-8 days. The mean hospitalization time was 9.2± 6.6 days (1-31. Forty patients (54.05% had FG secondary to anorectal conditions. No etiologic factors for FG were found in 27 patients (36.5%. Diabetes mellitus as a predisposing factor was found in 38 patients (51.35%. There was no definite predisposing factor in 24 patients (32.43%. The microbiological finding was polymicrobial in 48 patients (64.8% and monomicrobial in 26 patients (35.1%. The most frequent bacterial organisms were Escherichia coli (75.6%. Simple sigmoid loop colostomy was done in one patient (1.4%. Unilateral orchidectomy was done in one case (1.4%. The overall mortality rate was 16 patients (21.6%. Conclusion: FG is a rapidly progressive, fulminant infection. Even with aggressive surgical and medical treatment, mortality of the disease is high. In the present cases, such a high ratio of 21.6% means that this disease is still serious and fatal in Egypt.

  10. Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    The presented materials consist of presentations of international workshop which held in Warsaw from 4 to 5 October 2007. Main subject of the meeting was progress in manufacturing as well as research program development for neutron detector which is planned to be placed at GANIL laboratory and will be used in nuclear spectroscopy research

  11. Manejo da gangrena de Fournier: experiência de um hospital universitário de Curitiba

    OpenAIRE

    Mehl,Adriano Antonio; Nogueira Filho,Dorivam Celso; Mantovani,Lucas Marques; Grippa,Michele Mamprim; Berger,Ralf; Krauss,Denise; Ribas,Denise

    2010-01-01

    OBJETIVO: Analisar os resultados obtidos no Serviço de Cirurgia Geral do Hospital Universitário Cajuru - PUCPR, com o tratamento da gangrena de Fournier. MÉTODOS: Foram revisados os prontuários de 40 pacientes com diagnóstico de Gangrena de Fournier internados no hospital universitário Cajuru de Novembro de 1999 a Abril de 2006, analisando-se as variáveis: sexo, idade, fatores predisponentes, etiologia, localização da lesão, exames laboratoriais, procedimentos cirúrgicos realizados, antibioti...

  12. LE PÈRE INVISIBLE ET SILENCIEUX CHEZ GISÈLE FOURNIER (The Invisible and Silent Father by Gisèle Fournier

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    Julie Crohas Commans

    2015-06-01

    Full Text Available The game of visible and invisible led by the paternal character in the novel Non-dits (2000 of Gisèle Fournier betrays the threat which presses on the story of a family torn by the secrets of the past. The father keeps out of the oppressive closed world he is sentenced to, using silence. Far from losing him, this attitude allows him to be marked out. And actually in the slow succession of the novel’s monologues, his image and his presence persist even after his suicide. The look of both character and reader is thus headed towards this paternal figure. Once narrativized, this vision allows us to question the contemporary illness which affects the transmission.

  13. Gangrène de Fournier : Aspects diagnostiques et thérapeutiques au ...

    African Journals Online (AJOL)

    Le but de ce travail était d' évaluer la prise en charge des patients présentant une gangrène de Fournier, la morbi-mortalité et formuler des recommandations. Les auteurs rapportent une série de 22 cas de gangrène périnéoscrotale colligés sur 5 ans d'octobre 2005 à février 2010. Pour chaque patient l'âge, les aspects ...

  14. Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    The PARIS meeting held in Cracow, Poland from 14 to 15 May 2007. The main subjects discussed during this meeting were the status of international project dedicated to gamma spectroscopy research. The scientific research program includes investigations of giant dipole resonance, probe of hot nuclei induced in heavy reactions, Jacobi shape transitions, isospin mixing and nuclear multifragmentation. The mentioned programme needs Rand D development such as new scintillations materials as lanthanum chlorides and bromides as well as new photo detection sensors as avalanche photodiodes - such subjects are also subjects of discussion. Additionally results of computerized simulations of scintillation detectors properties by means of GEANT- 4 code are presented

  15. Presentation

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    Eduardo Vicente

    2013-06-01

    Full Text Available In the present edition of Significação – Scientific Journal for Audiovisual Culture and in the others to follow something new is brought: the presence of thematic dossiers which are to be organized by invited scholars. The appointed subject for the very first one of them was Radio and the invited scholar, Eduardo Vicente, professor at the Graduate Course in Audiovisual and at the Postgraduate Program in Audiovisual Media and Processes of the School of Communication and Arts of the University of São Paulo (ECA-USP. Entitled Radio Beyond Borders the dossier gathers six articles and the intention of reuniting works on the perspectives of usage of such media as much as on the new possibilities of aesthetical experimenting being build up for it, especially considering the new digital technologies and technological convergences. It also intends to present works with original theoretical approach and original reflections able to reset the way we look at what is today already a centennial media. Having broadened the meaning of “beyond borders”, four foreign authors were invited to join the dossier. This is the first time they are being published in this country and so, in all cases, the articles where either written or translated into Portuguese.The dossier begins with “Radio is dead…Long live to the sound”, which is the transcription of a thought provoking lecture given by Armand Balsebre (Autonomous University of Barcelona – one of the most influential authors in the world on the Radio study field. It addresses the challenges such media is to face so that it can become “a new sound media, in the context of a new soundscape or sound-sphere, for the new listeners”. Andrew Dubber (Birmingham City University regarding the challenges posed by a Digital Era argues for a theoretical approach in radio studies which can consider a Media Ecology. The author understands the form and discourse of radio as a negotiation of affordances and

  16. Evidências científicas brasileiras sobre gangrena de Fournier

    Directory of Open Access Journals (Sweden)

    Érick Igor dos Santos

    2014-01-01

    Full Text Available El objetivo fue describir producciones brasileñas publicadas en los últimos veinte años acerca de la gangrena de Fournier. Revisión integradora realizada en las bases de datos LILACS, MEDLINE, BDENF y Colecciona SUS, con el descriptor “Gangrena de Fournier”. Se seleccionaron textos publicados entre enero de 1994 y julio de 2014, en portugués y disponibles gratuitamente en Internet. Según los 14 artículos encontrados, los principales síntomas de la gangrena de Fournier incluyen malestar, con sensaciones dolorosas, fiebre alta, edema, malestar general, sudoración. En la mayor parte de los casos, son observados eritema y formación de bollas, surgiéndose una herida. El cuadro clínico ayuda en la selección de la terapia antimicrobiana empírica antes del resultado de la cultura. En conclusión, el diagnóstico precoz y el tratamiento apropiado y agresivo son cruciales en el pronóstico del paciente. Aún, hay escasez de producciones científicas brasileñas con gran poder de evidencia sobre el tema.

  17. Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

    Science.gov (United States)

    Bruketa, Tomislav; Majerovic, Matea; Augustin, Goran

    2015-01-01

    Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects. PMID:26290629

  18. Oro-facial gangrene (noma/cancrum oris): pathogenetic mechanisms.

    Science.gov (United States)

    Enwonwu, C O; Falkler, W A; Idigbe, E O

    2000-01-01

    Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from 1 to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of micro-organisms, with Fusobacterium necrophorum (Fn) and Prevotella intermedia (Pi) as the suspected key players. Additional to production of a growth-stimulating factor for Pi, Fn displays a classic endotoxin, a dermonecrotic toxin, a cytoplasmic toxin, and a hemolysin. Without appropriate treatment, the mortality rate from noma is 70-90%. Survivors suffer the two-fold afflictions of oro-facial mutilation and functional impairment, which require a time-consuming, financially prohibitive surgical reconstruction.

  19. Clostridium septicum Gas Gangrene in Colon Cancer: Importance of Early Diagnosis

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    Sowmya Nanjappa

    2015-01-01

    Full Text Available The Clostridia species are responsible for some of the deadliest diseases including gas gangrene, tetanus, and botulism. Clostridium septicum is a rare subgroup known to cause atraumatic myonecrosis and is associated with colonic malignancy or immunosuppression. It is a Gram-positive, anaerobic, spore-forming bacillus found in the gastrointestinal tract and can lead to direct, spontaneous infections of the bowel and peritoneal cavity. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring germination of clostridial spores. Tumor-induced mucosal ulceration allows for translocation of sporulated bacteria from the bowel into the bloodstream, leading to fulminant sepsis. C. septicum bacteremia can have a variable presentation and is associated with greater than 60% mortality rate. The majority of deaths occur within the first 24 hours if diagnosis and appropriate treatment measures are not promptly started. We report a case of abdominal myonecrosis in a patient with newly diagnosed colon cancer. The aim of this study is to stress the importance of maintaining a high suspicion of C. septicum infection in patients with underlying colonic malignancy.

  20. Fournier’s Gangrene in a Two Year Old Child: A Case Report

    Science.gov (United States)

    Bains, Satinder Pal Singh; Singh, Vikram; Jain, Amit; Arry, Vivek

    2014-01-01

    Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any age but it is relatively uncommon in children. Here, we report a case of Fournier’s gangrene in a two year old male child who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gave good results. PMID:25302233

  1. Penile gangrene associated with chronic renal failure - report of 2 cases and review of literature

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    Arvind Goyal

    2001-01-01

    Full Text Available Penile gangrene associated with chronic renal failure, is a rare entity. Patients usually have associated diseases like diabetes, hypertension. Gangrene occurs because the dystrophic calcific infiltration causes huninal obstruction. This is an accompaniment of generalized soft tissue calcification and bony abnormality resulting. from secondary hyperparathyroidism. Calcium phosphate product exceeds plasma solubility causing precipitation of calcium phosphate. Medical treatment may maintain the product below precipitation levels. Mortality in these patients remains high due to the severity of the associated systemic illnesses. Conservative surgical treatment is advocated in view of short life span.

  2. Dal carnalis concubitus all’heretica pravitate. Sesso, matrimonio ed eresia nel tribunale di Jacques Fournier (1318-1325

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    Irene Bueno

    2009-07-01

    Full Text Available Amore, sessualità e matrimonio sono tematiche ricorrenti nei documenti inquisitoriali due-trecenteschi ed entrano con forza nel registro di Jacques Fournier, vescovo-inquisitore di Pamiers (1318-1325. Il significato di questi racconti non si può comprendere senza chiarire quale interesse essi rivestissero agli occhi dell’autorità ecclesiastica: i rapporti adulterini, incestuosi, omosessuali di imputati e imputate sono in effetti mediati dalla figura di Fournier nell’ambito di una corte che sovrappone competenze vescovili e inquisitoriali. Collegando condotte ed affermazioni licenziose alle posizioni antimatrimoniali dei catari, il vescovo stabilisce in sede processuale un nesso fra carnalis concubitus extraconiugale ed heretica pravitate. Ogni trasgressione allo spazio sacro del matrimonio diventa indizio di eresia e contribuisce a disegnare un ritratto dissoluto e vizioso di eretici ed eretiche, funzionale al successo e alla popolarità della repressione.Love, sex, and marriage are recurring themes in inquisition records of the thirteenth and fourteenth centuries, and especially in the register of Jacques Fournier, bishop-inquisitor of Pamiers from 1318 to 1325. The significance of these confessions cannot be  understood without indicating the ecclesiastical authority’s interest: adultery, incest and homosexual relations of the accused are in fact mediated by Fournier within a court that superimposes episcopal and inquisitorial competences. Linking licentious conducts and libertine statements to the anti-matrimonial tenets of the Cathars, the bishop establishes, during the trial, a connection between sexual sin and heretical crime. Any transgression of the sacred space of marriage is understood to be an indication sign of heresy and contributes to depict a dissolute and vicious portrait of the heretical believers, which is ultimately functional to the success and popularity of repression.

  3. Immunopathology and Cytokine Responses in Commercial Broiler Chickens with Gangrenous Dermatitis

    Science.gov (United States)

    Gangrene dermatitis (GD) is an emerging disease of increasing economic importance in poultry that results from infection by Clostridium septicum and C. perfringens (CP) type A. Lack of a reproducible disease model has been a major obstacle in understanding the immunopathology of GD. To gain better u...

  4. GENOME-WIDE DIFFERENTIAL GENE EXPRESSION PROFILES IN BROILER CHICKENS WITH GANGRENOUS DERMATITIS

    Science.gov (United States)

    Gangrenous dermatitis (GD) is a disease of poultry associated with the infection of Clostridium septicum (CS) and/or C. perfringens (CP) type A. While GD causes significant morbidity, mortality, and economic loss to the poultry industry, the fundamental mechanisms underlying this host-pathogen inte...

  5. Benefits of an abridged antibiotic protocol for treatment of gangrenous appendicitis.

    Science.gov (United States)

    Shbat, Layla; Emil, Sherif; Elkady, Sherif; Baird, Robert; Laberge, Jean-Martin; Puligandla, Pramod; Shaw, Kenneth

    2014-12-01

    We previously reported a validated, objective definition of gangrenous, nonperforated appendicitis. In this study, we compared a cohort of children with gangrenous appendicitis treated with abridged antibiotics (AA) to another treated with prolonged antibiotics (PA). In 2012, our service changed its standard of care for gangrenous appendicitis from PA to AA. In PA, patients received postoperative triple antibiotics until ileus resolved, they were afebrile (antibiotics. A PA cohort during a 12-month period (February 2010-January 2011) was compared to an AA cohort during another 12-month period (April 2012-March 2013). Twenty patients were treated with AA and 38 patients with PA. AA patients had a significantly shorter overall length of stay (2.1±1.58 vs. 3.18±1.09days, p=0.003), as well as a significantly shorter postoperative stay (1.85±1.42 vs. 2.95±1.14days, p=0.002). There were no differences between the AA and PA cohorts in wound infections (0%), intraabdominal infections (0%), or appendicitis-related readmissions (0%). Abridged postoperative antibiotics for gangrenous appendicitis significantly shorten hospital stay without increasing complications. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Profile of patients with Fournier’s gangrene and their clinical evolution

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    DJONEY RAFAEL DOS-SANTOS

    2018-02-01

    Full Text Available ABSTRACT Objective: to analyze the profile of patients with Fournier’s gangrene treated in a public tertiary hospital in western Paraná State. Methods: we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier’s gangrene treated between January 2012 and November 2016. Results: there were 40 patients with Fournier’s gangrene treated in the period, 29 (72.5% men and 11 (27.5% women. The mean age was 51.7±16.3 years. The mean time of disease progression, from the initial symptom to hospitalization, was 10.5±1.2 days. All patients had clinical signs such as pain, bulging, erythema, among others, and 38 (95% had associated comorbidities, the most common being type 2 diabetes mellitus and systemic arterial hypertension. The majority (30 patients - 75% had perianal abscess as the probable etiology. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 1.8±1.1 surgeries per patient. Nine (22.5% patients died. There was a strong correlation between the presence of sepsis on admission and mortality. Conclusion: Fournier’s gangrene patients in this series had a long disease duration and a high prevalence of comorbidities, with a high mortality rate.

  7. Prospective evaluation of risk factors for mortality in patients of Fournier′s gangrene: A single center experience

    Directory of Open Access Journals (Sweden)

    Hari Gopal Vyas

    2013-01-01

    Conclusion : In patients of Fournier′s gangrene, increased age, total leukocyte count, extent of the area involved, septic shock at admission, VAS score, and FGSI score at admission have a significant association with mortality.

  8. Analysis of Evapotranspiration and Modified Fournier Index in the municipality of Ahuacatlan, Nayarit, Mexico.

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    García-Ramírez, E.I.

    2016-01-01

    Full Text Available There is a global concern to know the trends on climate variables to prevent natural disasters and adapt measures in diverse productive activities. The objective of this work was to analyze the effect that potential evapotranspiration (ETo and modified Fournier index (MFi have on soil erosion, in the municipality of Ahuacatlan Nayarit during the period 1980-2009. Climatological records of precipitation and maximum and minimum temperatures were taken from the official website of the National Meteorological Service; a data cleaning and data quality control was performed using RClimdex software; data processing and variable calculation was carried by the Moclic software. Regarding the ETo variable, no significant changes were observed annually but a considered increasing trend in the months of july and august. A significant trend towards an increase was observed annually for the MFi. It was found that july, august, june and september were the months that most affect such trend. An increase in the ETo and MFi variables was found during july, which can cause higher damage on the soil.

  9. Fournier′s gangrene developing secondary to infected hydrocele: A unique clinical scenario

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    Umran Sarwar

    2012-01-01

    Full Text Available We report the first case of Fournier′s gangrene (FG developing secondary to an infected hydrocele worldwide. We present a case report with a brief overview of the literature relating to FG and its aetiology, diagnosis and management. A 70 year-old male was referred by his General Practitioner with a 2 week history of worsening symptoms of scrotal discomfort and swelling. Following clinical examination, an initial diagnosis of an infected right-sided hydrocele was made and treatment, consisting of antibiotics, was initiated. Despite showing good clinical improvement, several days later, necrotic areas were observed over the right hemiscrotum with spreading cellulitis. A diagnosis of FG was made. The patient was started on triple-therapy antibiotics and taken to the operating room for urgent surgical debridement. Necrotic skin and subcutaneous tissue extending over the perineum and lower anterior abdomen was debrided down to healthy tissue. A further debridement took place 2 days later. The patient continued to improve and was eventually discharged under the care of Plastic Surgeons for reconstruction of the soft tissue defect. FG is a type of necrotising fasciitis predominantly affecting the male perineal, perianal, genital and anterior abdominal wall regions. It has a significant mortality rate, and the key to survival is early detection and treatment consisting of antibiotics and surgical debridement of the affected area. To the best of our knowledge, this is the first reported case of FG developing secondary to an existing hydrocele without any prior urological intervention. The case highlights the important clinical diagnostic and therapeutic interventions required to prevent complications associated with this, potentially fatal, condition.

  10. A multistep approach to manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report

    Directory of Open Access Journals (Sweden)

    Pastore Antonio Luigi

    2013-01-01

    Full Text Available Abstract Introduction Fournier’s gangrene is an infectious necrotizing fasciitis of the perineum and genital regions and has a high mortality rate. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms and predisposing factors, including diabetes mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a case of Fournier’s gangrene in a patient with unknown type II diabetes submitted to 24-hour catheterization 15 days before gangrene onset. Case presentation The patient, a 60-year-old Caucasian man, presented with a swollen, edematous, emphysematous scrotum with a crepitant skin and a small circle of necrosis. A lack of resistance along the dartos fascia of the scrotum and Scarpa’s lower abdominal wall fascia combined with the presence of gas and pus during the first surgical debridement also supported the diagnosis of Fournier’s gangrene. On the basis of the microbiological culture, the patient was given multiple antibiotic therapy, combined hypoglycemic treatment, hyperbaric oxygen therapy, and several surgical debridements. After five days the infection was not completely controlled and a vacuum-assisted closure device therapy was started. Conclusions This report describes the successful multistep approach of an immediate surgical debridement combined with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted closure is a well-known method used to treat complex wounds. In this case study, vacuum-assisted closure treatment was effective and the patient did not require reconstructive surgery. Our report shows that bladder catheterization, a minimally invasive maneuver, may also cause severe infective consequences in high-risk patients, such as patients with diabetes.

  11. Gangrena de Fournier: infección necrotizante de los genitales externos y del perine, a propósito de 5 casos

    OpenAIRE

    Haydee Wong Arocha; Alberto Elejalde Hernández; Armando Fleites Castro

    1995-01-01

    La gangrena de Fournier es una forma de gangrena sinergística y frecuente del revestimiento cutáneo de los órganos genitales externos y del periné. Esta afección descrita por Fournier en 1884 recibe varias denominaciones como: gangrena escrotal y fulminante. La incidencia de esta entidad es poco frecuente, no obstante, dentro de las urgencias urológicas de nuestro Servicio de Urología, hemos apreciado que en los últimos 6 meses se han detectado un total de 5 casos para el 18,5 %. En los casos...

  12. [Vacuum sealing drainage as an adjuvant treatment of penile and scrotal gangrene: Clinical analysis of 4 cases].

    Science.gov (United States)

    Zhu, Tong; Liao, Liang-Gong; Li, Yan-Feng; Liu, Xu-Dong; Hu, Ming; Zhang, Yong; Li, Zhong-Tai; Cao, Quan-Fu; Jiang, Jun

    2017-03-01

    To search for an optimal strategy for the treatment of penile and scrotal gangrene by analyzing the clinical effect of vacuum sealing drainage (VSD) as an adjuvant treatment on this disease. We retrospectively analyzed the clinical data about 4 cases of penile and scrotal gangrene treated by VSD as an adjuvant treatment from January 2015 to June 2016. The 4 patients all underwent early extensive and radical debridement of gangrene of the scrotum and penis and received intravenous injection of two broad-spectrum antibiotics, followed by VSD for wound drainage and irrigation. Adequate wound drainage was achieved in all the 4 cases, the gangrene range rapidly localized and testicular necrosis avoided. The wound surface healed satisfactorily after cleansing and suturing. The patients were followed up for 3 months after discharged from the hospital and none experienced recurrence. VSD combined with early adequate debridement can effectively localize the gangrene range, significantly reduce the frequency of changing dressings and shorten the hospitalization time of the patient, and therefore is a very effective adjuvant treatment of penile and scrotal gangrene.

  13. Manejo da gangrena de Fournier: experiência de um hospital universitário de Curitiba

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    Adriano Antonio Mehl

    Full Text Available OBJETIVO: Analisar os resultados obtidos no Serviço de Cirurgia Geral do Hospital Universitário Cajuru - PUCPR, com o tratamento da gangrena de Fournier. MÉTODOS: Foram revisados os prontuários de 40 pacientes com diagnóstico de Gangrena de Fournier internados no hospital universitário Cajuru de Novembro de 1999 a Abril de 2006, analisando-se as variáveis: sexo, idade, fatores predisponentes, etiologia, localização da lesão, exames laboratoriais, procedimentos cirúrgicos realizados, antibioticoterapia e utilização de câmara hiperbárica. RESULTADOS: A etiologia mais comum foi de origem anorretal. O agente etiológico mais prevalente foi a E. coli. O fator predisponente predominantes foi a diabetes mellitus, A maioria dos pacientes eram do sexo masculino. A localização e extensão da lesão mais freqüente foi a perineal. Todos foram submetidos à desbridamento cirúrgico, 17 à colostomia e dois à cistostomia. Todos os pacientes utilizaram antibiótico, sendo os mais usados: metronidazol e gentamicina. Vinte e seis pacientes submeteram-se à terapia hiperbárica. A mortalidade global foi de 20%. CONCLUSÃO: A Síndrome de Fournier, apesar de todos os avanços terapêuticos atuais, continua apresentando altos índices de mortalidade. O reconhecimento precoce da infecção associado a tratamento agressivo e invasivo são medidas essenciais para se tentar diminuir esses índices prognósticos.

  14. [A case of freeze-dried gas gangrene antitoxin for the treatment of Clostridium perfringens sepsis].

    Science.gov (United States)

    Yoshida, Juichiro; Nakamura, Hideki; Yamada, Shinya; Sekoguchi, Satoru; Suzuki, Takahiro; Tomatsuri, Naoya; Sato, Hideki; Okuyama, Yusuke; Kimura, Hiroyuki; Yoshida, Norimasa

    2015-02-01

    A 66-year-old man was admitted to our hospital with high fever. We diagnosed a gas-containing liver abscess and performed percutaneous abscess drainage. However, 15 hours after admission, he developed massive intravascular hemolysis and acidosis. Sepsis due to Clostridium perfringens was suspected and we treated the patient intensively with multidisciplinary approaches, including antibiotics, mechanical ventilation, and renal replacement therapy. Furthermore, we administered freeze-dried gas gangrene antitoxin. Despite intensive care, the patient died 43 hours after admission.

  15. Fulminant gas gangrene in an adolescent with immunodeficiency. Case report and literature review

    Directory of Open Access Journals (Sweden)

    Edna Karina García

    2016-07-01

    Full Text Available Immunity defects are important predisposing factors to aggressive infections with high risk of mortality. The case of a teenager with a history of immunodeficiency, who developed gas gangrene infection originated in the left lower limb is reported here. The disease progressed in less than 24 hours, developed systemic involvement and led to multiple organ failure and death. Pathophysiological aspects and features of the agent are reviewed here, highlighting the importance of high index of clinical suspicion and immediate handling.

  16. Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

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    Orestis Ioannidis

    2017-07-01

    Full Text Available BackgroundFournier’s gangrene (FG is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4% and 4 females (16.6%. In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%. All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and

  17. Unilateral mastectomy as an alternative treatment for gangrenous mastitis in a Saanen goat

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    Ahmet Sabuncu

    2015-06-01

    Full Text Available A four-year-old Saanen goat, weighing 52 kg, was referred to the Department of Obstetrics and Gynaecology clinic with black discoloration of the left mammary gland. The goat’s general condition was not good upon initial examination. The goat was anorexic, lethargic, and febrile (rectal temperature of 40 °C with a palpably cold left mammary gland on which there was an accumulation of pus. Somatic cell count (SCC was measured as 820,000/ml in the milk sample collected from the infected gland, and Staphylococcus aureus was isolated. Gangrenous mastitis was diagnosed on the left mammary gland of the goat based on the clinical findings. To treat the condition, a unilateral mastectomy was performed successfully. The goat was fully recovered a week after surgery. This case aimed to establish a surgical approach of unilateral mastectomy as a treatment option for goats with gangrenous mastitis while allowing the other mammary gland to continue lactation. Thus, it can be concluded that unilateral mastectomy is a viable alternative treatment of goats with gangrenous mastitis.

  18. Download this PDF file

    African Journals Online (AJOL)

    ÿþU s e r

    Chemical debridement, Acriflavine, honcrivine, honey. INTRODUCTION. Dead and devitalized wounds such as found in crush injury, contused wound Fournier's gangrene, cancrum oris, decubitus ulcer, diabetic gangrene, diabetic neuropathic ulcer and chronic non-healing ulcers encourage growth and multiplication of.

  19. Presentation And Management Of Gastroschisis: Experience In 8 ...

    African Journals Online (AJOL)

    Eleven were operated between 4 and 8 hours on presentation. Of the Six that had digital stretching of abdominal cavity, gastric suctioning/rectal irrigation and primary abdominal closure, three died and three survived. The two who had bowel gangrene for which resection/anastomosis and primary abdominal closure were ...

  20. Evaluation of the utility of the Fournier′s gangrene severity index in the management of Fournier′s gangrene in North India: A multicentre retrospective study

    Directory of Open Access Journals (Sweden)

    Satyajeet Verma

    2012-01-01

    Full Text Available Objective: To study the utility of Fournier′s Gangrene Severity Index (FGSI with mortality predictive value in our tertiary institutes in North India. Materials and Methods: A retrospective study of 95 cases of Fournier′s Gangrene (FG, admitted from 2009 to 2011, was carried out. We analysed clinical and laboratory findings, various prognostic factors, surgical treatments and their outcomes in FG patients. FGSI was used as individual variable to estimate the severity of FG; the effects of these factors on mortality were also evaluated. Results: The overall mean age was 46.5 ± 15.6 (range 24-82 years. Anorectal and urological regions were the main sites of the infection. The most common site of infection origin was scrotum in 81.3% in group A and 41.2% in group B. One or more predisposing factors such as diabetes mellitus (DM; 55% malignancies (4.6%, chronic renal failure (4.5% and previous surgery (9.2% were detected. We observed mortality in 26.5% cases (17/65. The FGSI calculated averaged 5.95 ± 365 in group A and 9.44 ± 2.56 in group B, at the time of admission ( P > 0.05. Conclusion: In FG, an early diagnosis and early surgical debridement are essential. The FGSI seems to be an excellent tool for the outcome prediction.

  1. Foudroyant Course of an Extensive Clostridium septicum Gas Gangrene in a Diabetic Patient with Occult Carcinoma of the Colon

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    Maximilian Hartel

    2013-01-01

    Full Text Available Background. Spontaneous gas gangrene is a rare disease in which Clostridium septicum frequently can be detected. After an incubation period of 5–48 hours, a very painful swelling is accompanied by a rapidly spreading toxic-infectious clinical picture ultimately leading to septic shock and multiple organ failure. We present a case of a completely documented rare infectious disease with triage findings including initial vital signs, initial medical findings, and the emergency lab., radiological, intraoperative, histopathological, microbiological, and postmortem results. After initial diagnosis of the underlying disease, the patient has been immediately transferred to the operating theatre. The laboratory findings reflect the devastating effect of toxin α which is a toxin typically produced by C. septicum. The patient presented both an anaemia and a manifest coagulopathy as well as an onset of multiple organ failure. Despite the aggressive medical and surgical measures that have been taken, this patient could not be saved. Discussion. The case presented vividly emphasises the difficulty to identify these cases early enough to save a patient. This documentation may help health care providers to identify this life threatening disease as early as possible in future cases.

  2. Male gender and sonographic gall bladder wall thickness: important predictable factors for empyema and gangrene in acute cholecystitis

    International Nuclear Information System (INIS)

    Khan, M.L.U.; Jawed, M.; Shaikh, U.; Abbassi, M.R.

    2014-01-01

    Objective: To underline the status of male gender and gall bladder wall thickness as significant risk factors for acute cholecystitis complications. Methods: The retrospective study, with purposive sampling of the patients of acute cholecystits in age above 18 years, who were operated within 10 days of onset of symptoms, was conducted at the Department of Surgery, Dow University Hospital, Karachi, by reviewing the patients' medical record from March 2010 to August 2012. Correlation of incidence of acute cholecystitis complications (empyema and gangrene) to male gender and to the sonographic gall bladder wall thickness more than 4.5mm was analysed using SPSS 16. Result: Out of 62 patients, 8 (13%) patients had gangrene while 10 (16.12%) had empyema. Overall, there were 21 (33.87%) males in the study. Ten (47.6%) of the male patients developed empyema or gangrene of the gall bladder as a complication of acute cholecystitis. Of the 41 (66.12%) female patients, only 8 (19.5%) developed these complications. There were 22 (35.48%) cases of gall bladders with sonographic wall thickness more than 4.5mm who were operated for acute cholecystitis. Of them, 16 (72.7%) had empyema or gangrene. Conclusion: Male gender and sonographic gall bladder wall thickness more than 4.5mm were statistically significant risk factors for suspicion of complicated acute cholecystitis (empyema/gangrene) and by using these risk factors, we can prioritise patients for surgery in the emergency room. (author)

  3. Abordaje quirúrgico combinado como alternativa mínimamente invasiva en el tratamiento de la Gangrena de Fournier

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    Juan C. Larsson

    Full Text Available Introducción y Objetivo: La Gangrena de Fournier es una fascitis necrotizante del perineo y genitales externos que presenta una morbi-mortalidad elevada debido a su diagnóstico tardío y a las comorbilidades comúnmente asociadas en estos pacientes. Terapias adyuvantes como la presión negativa y los sustitutos dérmicos, han mostrado eficacia en el tratamiento de pacientes con defectos complejos de tejidos blandos y forman parte de nuestro protocolo de tratamiento actual. El objetivo de este estudio es describir la utilidad de nuestro abordaje quirúrgico combinado en la Gangrena de Fournier. Material y método. Presentamos un trabajo retrospectivo en el que describimos 3 pacientes varones tratados por defectos complejos de tejidos blandos secundarios a Gangrena de Fournier mediante nuestro protocolo de tratamiento quirúrgico que comprende: una primera etapa de control de la herida mediante desbridamientos agresivos y terapia de presión negativa, seguido de una etapa de contemporización que combina la utilización de matriz dérmica y terapia de presión negativa, y por último una etapa de reconstrucción para dar cobertura final al defecto. Resultados. Los 3 pacientes presentaron compromiso extenso de la región perineal y de las regiones adyacentes incluyendo genitales externos y miembros inferiores. Todos fueron tratados con éxito mediante el abordaje que describimos, sin secuelas funcionales y manteniendo el contorno a la región. Conclusiones. El abordaje utilizado en nuestros 3 casos representó una alternativa terapéutica eficaz. La combinación de terapia de presión negativa y matriz dérmica nos permitió un manejo simplificado de la herida y una reconstrucción con mayor seguridad y mínima morbilidad mediante cierre primario de las heridas y avance de colgajos locales.

  4. Síndrome de Fournier secundária a adenocarcinoma de próstata avançado: relato de caso Fournier's syndrome secondary to advanced prostatic adenocarcinoma: case report

    OpenAIRE

    Rodrigo Rocha Batista; Paulo Roberto Ramacciotti Filho; Carlos Alberto Torres de Castro; Marcus Fábio Magalhães Fonseca; Idblan Carvalho de Albuquerque; Galdino José Sitonio Formiga

    2010-01-01

    A Síndrome de Fournier é uma fasciite necrotizante rapidamente progressiva que acomete a genitália e região perineal. Mesmo com os avanços na terapêutica, a morbidade e a mortalidade desta afecção permanecem elevadas. É relatado caso de paciente masculino, 70 anos, com diagnóstico de adenocarcinoma de próstata avançado. Há um dia com dor e aumento de volume escrotal associado a febre. Ao exame físico, paciente séptico com gangrena gasosa do pênis e escroto; ao toque retal, lesão ulcero-vegeta...

  5. Modified Fournier and rainfall concentration indices, as estimators of soil erosion factors, Sinaloa, Mexico; Indices de Fournier modificado y de concentracion de la precipitacion, como estimadores del factor de riesgo de la erosion, en Sinaloa, Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Velasco, I.; Costes, G.

    2009-07-01

    Some of the parameters which characterize the climatic zones, identified as Hydric Regime Indices are the rainfall concentration index ICP), and the Modified Fournier index (IFM), which allow to evaluate, in terms of the rainfall behavior, the risk of soil erosion. The conventional ICP rank of variation foes from uniforms to irregular (8 to 100%). The calculation of this index must be done for every year and then the average is the value to use. IFM considers the monthly rainfall of the most humid month of the year in relation to the other months. This index characterizes the rainfall aggressiveness, and their conventional values go from very low (0 to 60), until very high (more than 160), and mainly mean the vulnerability and risk to soil loss. (Author) 2 refs.

  6. Severe Hypernatremic Dehydration and Lower Limb Gangrene in an Infant Exposed to Lamotrigine, Aripiprazole, and Sertraline in Breast Milk.

    Science.gov (United States)

    Morin, Caroline; Chevalier, Isabelle

    Hypernatremic dehydration is well described in exclusively breastfed neonates, although life-threatening complications are rarely reported. The present article describes a case of severe hypernatremic dehydration in a previously healthy term neonate. Other published cases of severe complications of hypernatremic dehydration are discussed. The exclusively breastfed neonate described had severe hypernatremic dehydration because of inadequate milk intake, with disseminated intravascular coagulation and right lower limb gangrene that required amputation of all five toes and surgical debridement of the metatarsals. The usual etiology of hypernatremic dehydration in this age group is insufficient breast milk intake. Here, the infant's mother was treated for bipolar disorder with lamotrigine 250 mg orally once daily, aripiprazole 15 mg orally once daily, and sertraline 100 mg orally once daily. Awareness of these complications should prompt close follow-up of the infant with poor weight gain. The role of maternal medication as a risk factor for hypernatremic dehydration among exclusively breastfed infants needs to be further explored.

  7. Fournier’s Gangrene after Open Hemorrhoidectomy without a Predisposing Factor: Report of a Case and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Guldeniz Karadeniz Cakmak

    2009-05-01

    Full Text Available Fournier’s gangrene (FG is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and vulva in women. An unpredictable case of FG two weeks after open hemorrhoidectomy in a previously healthy 55-year-old male is described. Full-thickness patchy skin necrosis of the perianal, perineal and scrotal region associated with rectal perforation was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Because of rectal involvement, diverting sigmoid colostomy was fashioned. The patient survived after two additional local debridements. Nevertheless, loss of sphincter function due to massive muscle destruction led to permanent colostomy. Our case together with others reported in the literature illustrates that, although rare, FG after open hemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. The development of fever and urinary retention should draw the attention of the surgeon, even if the presentation is delayed. The current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than anticipated. This disastrous complication without predisposing factor is discussed along with a literature review.

  8. Manual Aspiration Thrombectomy with Stent Placement: Rapid and Effective Treatment for Phlegmasia Cerulea Dolens with Impending Venous Gangrene

    International Nuclear Information System (INIS)

    Oguzkurt, Levent; Tercan, Fahri; Ozkan, Ugur

    2008-01-01

    Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene

  9. Saddle-nose and bilateral cauliflower ear deformities with pyoderma gangrenosum-like ulcers, cavitary pulmonary lesions, digital gangrene and pulselessness in a young female.

    Science.gov (United States)

    Subhadarshani, Sweta; Gupta, Vishal; Chahal, Anurag; Verma, Kaushal K

    2017-06-15

    We report a young female who presented with saddle-nose and bilateral cauliflower ear deformities along with pyoderma gangrenosum-like ulcers, digital gangrene and pulselessness. Subsequently, she was found to have bilateral conductive hearing loss, a corneal opacity, mild aortic regurgitation and radiological evidence of cavitary changes in lungs and aortoarteritis. Our patient had a constellation of symptoms which posed a diagnostic challenge. Finally, a diagnosis of relapsing polychondritis with several unusual features was made. Overlap with Takayasu's arteritis and granulomatosis with polyangitis, which has been reported rarely in the literature, cannot be excluded. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Amyand’s hernia with acute gangrenous appendicitis and cecal perforation: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    William Kromka

    Full Text Available Introduction: An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. Presentation of case: A 46-year-old male with a right inguinal hernia of 2–3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain. The patient was diagnosed with an incarcerated right inguinal hernia and underwent emergent surgical repair. Intraoperatively a reactive fluid was found within the hernia sac that prompted an exploratory laparotomy for suspected bowel perforation. The hernia was then found to contain an inflamed gangrenous appendix with an inflamed and perforated cecum. An ileocecectomy and enteroenterostomy was performed and the hernia defect was repaired without mesh. Discussion: With an estimated incidence of only 1%, Amyand's hernias are rare and lack a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. To avoid potential morbidity and mortality, the surgeon must consider an Amyand's hernia on his or her differential when operating on inguinal hernias and be aware of the associated presentations, complications, and management schemes. Conclusion: There is a paucity of reports describing simultaneous appendicitis and cecal perforation within an Amyand's hernia. In our case, ileocecectomy and Bassini hernia repair with close follow-up led to a favorable outcome. Keywords: Amyand, Hernia, Appendicitis, Surgery, Case report, Ileocecectomy

  11. [Mucormycosis cutanea- clinical case presentation souvenir etiopatogenia diagnosis and treatment].

    Science.gov (United States)

    Frey Gutierrez, Miguel Enrique; Martinez, Gabriel W; Alvarez Milan, Lorena; Acuña Vassallo, Juan P; Trinajstic, Eduardo M

    2016-01-01

    Mucormycosis is serious emerging infection, caused by saprophytic fungi of the order Mucorales, which mainly affects immunocompromised patients. Presentation forms can be rinosinusal, pulmonary, gastrointestinal, disseminated and localized wounds and burns. The cutaneous presentation is caused by inoculation of spores into the dermis with the subsequent development compatible with gangrenous ecthyma. Our patient was treated with surgical lesion and antifungal cleaning. Presenting hemodynamic complication secondary to the administration of posaconazole.

  12. Leptospirosis complicating with acute large bowel gangrene: a case report.

    Science.gov (United States)

    Zamri, Z; Shaker, A H; Razman, J

    2012-01-01

    Leptospirosis is a zoonosis with worldwide distribution. It is often referred to as swineherd's disease, swamp fever or mud fever. In recent years there is increase incidence in leptospirosis in human. The incidence varies from sporadic in temperate zones to endemic in the tropical countries. Leptospirosis generally present with features of bacterial infection in acute phase following with multi organs complications. Acute bowel ischaemia with perforation following leptospirosis is a rare presentation . To the best of our knowledge, this is the first case report of such condition. The surgical management of this rare incidence will be discussed.

  13. Penile Gangrene: An Unusual Complication of Priapism in a Patient ...

    African Journals Online (AJOL)

    3. 13. Badmus TA, Adediran IA, Adesunkanmi AR, Katung IA. Priapism in southwestern Nigeria. East Afr Med J 2003;80:518-24. 14. Ajape AA, Kuranga IS, Babata AL, Abiola OO, Obiano SK, Sanni MA, et al. Priapism as an initial presentation of ...

  14. Heroin addict with gangrene of the extremities, rhabdomyolysis and severe hyperkalemia

    Directory of Open Access Journals (Sweden)

    Radovanović Milan R.

    2012-01-01

    Full Text Available Introduction. Long-time consumption of narcotics leads to altered mental status of the addict. It is also connected to damages of different organic systems and it often leads to appearance of multiple organ failure. Excessive narcotics consumption or abuse in a long time period can lead to various consequences, such as atraumatic rhabdomyolysis, acute renal failure and electrolytic disorders. Rhabdomyolysis is characterized by injury of skeletal muscle with subsequent release of intracellular contents, such as myoglobin, potassium and creatine phosphokinase. In heroin addicts, rhabdomyolysis is a consequence of the development of a compartment syndrome due to immobilization of patients in the state of unconsciousness and prolonged compression of extremities, direct heroin toxicity or extremities ischemia caused by intraluminal occlusion of blood vessels after intraarterial injection of heroin. Severe hyperkalemia and the development of acute renal failure require urgent therapeutic measures, which imply the application of either conventional treatment or a form of dialysis. Case report. We presented a male patient, aged 50, hospitalized in the Emergency Center Kragujevac due to altered mental status (Glasgow Coma Score 11, partial respiratory insufficiency (pO2 7.5 kPa, pCO2 4.3 kPa, SpO2 89 %, weakness of lower extremities and atypical electrocardiographic changes. Laboratory analyses, carried out immediately after the patient’s admission to the Emergency Center, registered the following disturbances: high hyperkalemia level (K+ 9.9 mmol/L, increased levels of urea (30.1 mmol/L, creatinine (400 μmol/L, creatine phosphokinase - CK (120350 IU/L, CK-MB (2500 IU/L and myoglobin (57000 μg/L, with normal levels of troponin I (< 0.01 μg/L, as well as signs of anemia (Hgb 92 g/L, Er 3.61 x 1012/L, infection (C-reactive proteine 184 μg/mL, Le 16.1 x 109/L and acidosis (base excess - 18.4 mmol/L, pH 7.26. Initial examination of the patient revealed

  15. Diabetic foot gangrene patient with multi-drug resistant Pseudomonas putida infection in Karawaci District, Indonesia

    Directory of Open Access Journals (Sweden)

    Nata Pratama Hardjo Lugito

    2015-01-01

    Full Text Available Pseudomonas putida is a rod-shaped, non fermenting Gram-negative organism frequently found in the environment that utilizes aerobic metabolism, previously thought to be of low pathogenicity. It had been reported as cause of skin and soft tissue infection, especially in immunocompromised patients. A female green grocer, 51 year-old came to internal medicine out-patient clinic with gangrene and osteomyelitis on her 1 st , 2 nd and 3 rd digit and wound on the sole of the right foot since 1 month prior. The patient had history of uncontrolled diabetes since a year ago. She was given ceftriaxone 2 grams b.i.d, metronidazole 500 mg t.i.d empirically and then amikacin 250 mg b.i.d, followed by amputation of the digits and wound debridement. The microorganism′s culture from pus revealed multi drug resistant Pseudomonas putida. She recovered well after antibiotics and surgery.

  16. Gas Gangrene

    Science.gov (United States)

    ... Editor & Contributors Sponsors Sponsorship Opportunities Spread the Word Shop AAP Find a Pediatrician Health Issues Conditions Abdominal ... rate may increase (tachycardia), along with rapid breathing, sweating, paleness, and fever . If untreated, her condition can ...

  17. [Urological emergencies at the Dakar university teaching hospital: epidemiological, clinical and therapeutic features].

    Science.gov (United States)

    Fall, B; Diao, B; Fall, P A; Diallo, Y; Sow, Y; Ondongo, A A M; Diagana, M; Ndoye, A K; Ba, M; Diagne, B A

    2008-11-01

    To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa. The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar). There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier's gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%). The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier's gangrene) and priapism are not rare there.

  18. Severe necrotizing infection of the perineum: beyond necrosectomy ...

    African Journals Online (AJOL)

    ... a mean arterial pressure of 65 – 90 mmHg, a urine output of > 0.5mls/kg/hr, a hematocrit of >30% and a central venous oxygen saturation of > 70% in a patient who is intubated, sedated and paralysed.We present an illustrative case of the management of severe Fournier's gangrene and how a series of misadventures at ...

  19. Download this PDF file

    African Journals Online (AJOL)

    GB

    Gangrenous sigmoid. 6. 46.2. Colorectal cancer. 3. 23.1. Anorectal cancer. 1. 7.7. Ileosigmoid knotting. 1. 7.7. Penetrating abdominal injury. 1. 7.7. Intussusceptions. 1. 7.7. Total. 13 62.0%. Myocardial infarctions. Gangrenous sigmoid. 2. 66.7. Fournier's gangrene. 1. 33.3. Total. 3. 14.3. Respiratory failure. Colorectal cancer.

  20. Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene

    Directory of Open Access Journals (Sweden)

    Soo Yeon Lim

    2018-01-01

    Full Text Available Symmetrical peripheral gangrene (SPG is rare but devastating complication which is characterized by symmetrical ischemic change of the distal extremities. In this report, we describe our management protocol for SPG, focusing on surgical approaches. Between January 2007 and February 2016, 10 thoracodorsal artery perforator (TDAP free flaps were performed in 6 patients with SPG. Three patients were male and mean age was 56 (range, 44–69 years. All the patients were in shock. The causes of shock were sepsis in 4 cases, respiratory arrest in 1 case, and hypovolemia in 1 case. Eight transmetatarsal amputations and 2 Lisfranc amputations were performed. Flap sizes ranged from 7 × 11 cm to 25 × 15 cm. There were 3 cases of partial necrosis of the flap: two healed conservatively with dressings and one required skin graft. Three of the patients were later able to walk independently at Functional Ambulation Classification (FAC level 6, one patient could walk independently on level surfaces at FAC level 5, and 2 could walk independently using walking aids, classified at FAC level 4. The average follow-up period was 18 (range, 6–54 months. In patients with SPG, minimal bone amputation and foot salvage with TDAP flaps were successful. Separate reconstruction of bone and soft tissue had good outcomes.

  1. Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene: a prospective parallel cohort study.

    Science.gov (United States)

    Keyl, Cornelius; Held, Tanja; Albiez, Georg; Schmack, Astrid; Wiesenack, Christoph

    2013-07-01

    Peripheral neuropathy may affect nerve conduction in patients with diabetes mellitus. This study was designed to test the hypothesis that the electrical stimulation threshold for a motor response of the sciatic nerve is increased in patients suffering from diabetic foot gangrene compared to non-diabetic patients. Prospective non-randomised trial with two parallel groups. Two university-affiliated hospitals. Patients scheduled for surgical treatment of diabetic foot gangrene (n = 30) and non-diabetic patients (n = 30) displaying no risk factors for neuropathy undergoing orthopaedic foot or ankle surgery. The minimum current intensity required to elicit a typical motor response (dorsiflexion or eversion of the foot) at a pulse width of 0.1 ms and a stimulation frequency of 1 Hz when the needle tip was positioned under ultrasound control directly adjacent to the peroneal component of the sciatic nerve. The non-diabetic patients were younger [64 (SD 12) vs. 74 (SD 7) years] and predominantly female (23 vs. 8). The geometric mean of the motor stimulation threshold was 0.26 [95% confidence interval (95% CI) 0.24 to 0.28] mA in non-diabetic and 1.9 (95% CI 1.6 to 2.2) mA in diabetic patients. The geometric mean of the electrical stimulation threshold was significantly (P diabetic compared to non-diabetic patients. The electrical stimulation threshold for a motor response of the sciatic nerve is increased by a factor of 7.2 in patients with diabetic foot gangrene, which might hamper nerve identification.

  2. A forgotten biliary stent for 17 years: Presented with perforated gallbladder and stentolith

    Directory of Open Access Journals (Sweden)

    Tejas J Patel

    2014-01-01

    Full Text Available Endoscopic biliary stent placement is a well-established, safe, and minimally invasive modality for the treatment of choledocholithiasis and other biliary diseases. Over the past decade, there has been an increase in its prevalence and use. We present an unusual case of forgotten biliary stent for 17 years who presented now with gangrenous cholecystitis and sealed the perforation. A large stentolith had also developed which was cleared with endoscopic retrograde cholengiography and re-stenting followed by laparoscopic cholecystectomy.

  3. Mode of action of plectasin-derived peptides against gas gangrene-associated Clostridium perfringens type A.

    Directory of Open Access Journals (Sweden)

    Xueling Zheng

    Full Text Available NZ2114 and MP1102 are novel plectasin-derived peptides with potent activity against Gram-positive bacteria. The antibacterial characteristics and mechanism of NZ2114 and MP1102 against gas gangrene-associated Clostridium perfringens were studied for the first time. The minimal inhibitory concentration and minimal bactericidal concentration of NZ2114 and MP1102 against resistant C. perfringens type A strain CVCC 46 were 0.91 μM. Based on the fractional inhibitory concentration index (FICI result, an additive or synergic effect was observed between NZ2114 (FICI = 0.5~0.75 or MP1102 (FICI = 0.375~1.0 and antibiotics. The flow cytometry, scanning and transmission electron microscopy analysis showed that both NZ2114 and MP1102 induced obviously membrane damage, such as the leakage of cellular materials, partial disappearance of the cell membrane and membrane peeling, as well as retracting cytoplasm and ghost cell. The gel retardation and circular dichroism (CD detection showed that NZ2114 and MP1102 could bind to C. perfringens genomic DNA and change the DNA conformation. Moreover, NZ2114 also interfered with the double helix and unwind the genomic DNA. The cell cycle analysis showed that C. perfringens CVCC 46 cells exposed to NZ2114 and MP1102 were arrested at the phase I. These data indicated that both NZ2114 and MP1102 have potential as new antimicrobial agents for gas gangrene infection resulting from resistant C. perfringens.

  4. RARE PRESENTATION OF SYMPTOMATIC BILATERAL PROXIMAL POPLITEAL ARTERY ANEURYSM

    Directory of Open Access Journals (Sweden)

    Thulasikumar Ganapathy

    2016-07-01

    Full Text Available True Popliteal artery aneurysm is the most common of all the peripheral artery aneurysms. We present a case of proximal popliteal artery aneurysm involvement both lower limb presented with gangrene in one lower limb and incapacitating claudication pain on the other lower limb. We have successfully repaired both sides aneurysm in the same sitting with Poly Tetra Fluro Ethylene (PTFE graft, as the patient also had multiple venous perforators’ involvement on both sides, which left us only with synthetic graft repair option rather than venous graft repair.

  5. South African Journal of Surgery - Vol 50, No 1 (2012)

    African Journals Online (AJOL)

    Fournier's gangrene – analysis of management and outcome in south-eastern Nigeria · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. FO Ugwumba, II Nnabugwu, OFN Ozoemena ...

  6. Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies.

    Science.gov (United States)

    Mills, Joseph L

    2016-01-01

    The confluence of several chronic conditions--in particular ageing, peripheral artery disease, diabetes, and chronic kidney disease--has created a global wave of lower limbs at risk for major amputation. While frequently asymptomatic or not lifestyle limiting, at least 1% of the population has peripheral artery disease of sufficient severity to be limb threatening. To avoid the critical error of failing to diagnose ischaemia, all patients with diabetic foot ulcers and gangrene should routinely undergo physiologic evaluation of foot perfusion. Ankle brachial index is useful when measurable, but may be falsely elevated or not obtainable in as many as 30% of patients with diabetic foot ulcers primarily because of medial calcinosis. Toe pressures and skin perfusion pressures are applicable to such patients. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Browse Title Index

    African Journals Online (AJOL)

    Items 1 - 50 of 88 ... Vol 6, No 1 (2008), Fournier\\'s Gangrene: Irrua Teaching Hospital, Nigeria, Experience. Abstract. E Irekpita, TAT Salami, AE Dongo, KC Eze, MO Momoh, SA Okogbenin. Vol 3, No 3 (2005), Giant condylomata acuminata of buschke and löwenstein - single case report & review, Abstract. Adil HH Bashir.

  8. Author Details

    African Journals Online (AJOL)

    Salami, TAT. Vol 6, No 1 (2008) - Articles Fournier\\'s Gangrene: Irrua Teaching Hospital, Nigeria, Experience. Abstract. ISSN: 1815-3941. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact ...

  9. Author Details

    African Journals Online (AJOL)

    Eze, KC. Vol 6, No 1 (2008) - Articles Fournier\\'s Gangrene: Irrua Teaching Hospital, Nigeria, Experience. Abstract. ISSN: 1815-3941. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL ...

  10. Scrotal metastases from colorectal carcinoma: a case report.

    LENUS (Irish Health Repository)

    McWeeney, Doireann M

    2012-01-31

    ABSTRACT: A 72-year-old man presented with a two month history of rectal bleeding. Colonoscopy demonstrated synchronous lesions at 3 cm and 40 cm with histological analysis confirming synchronous adenocarcinomata. He developed bilobar hepatic metastases while undergoing neoadjuvant chemoradiotherapy. Treatment was complicated by Fournier\\'s gangrene of the right hemiscrotum which required surgical debridement. Eight months later he re-presented with an ulcerating lesion on the right hemiscrotum. An en-bloc resection of the ulcerating scrotal lesion and underlying testis was performed. Immunohistological analysis revealed metastatic adenocarcinoma of large bowel origin. Colorectal metastasis to the urogenital tract is rare and here we report a case of rectal carcinoma metastasizing to scrotal skin.

  11. Pneumoscrotum: report of two different cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Cochetti G

    2015-04-01

    Full Text Available Giovanni Cochetti,1 Francesco Barillaro,1 Emanuele Cottini,1 Francesco D’Amico,1 Alberto Pansadoro,1 Solajd Pohja,1 Andrea Boni,1 Roberto Cirocchi,2 Veronica Grassi,2 Rosa Mancuso,1 Elisa Silvi,1 Katifenia Ioannidou,1 Maria Giulia Egidi,1 Giulia Poli,1 Ettore Mearini1 1Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy; 2Department of Surgical Sciences, University of Perugia, Terni, Italy Abstract: Pneumoscrotum is the term used to describe the presence of air within the scrotum and includes scrotal emphysema as well as pneumatocele. The etiology varies; in some cases, pneumoscrotum may be due to life-threatening disease like pneumothorax or Fournier gangrene. Despite this, pneumoscrotum is a rarely debated issue. We present two different cases of pneumoscrotum and a review of the literature. The first case report is about a 29 year old male patient affected by Duchenne syndrome who showed pneumoscrotum after cardiopulmonary resuscitation that was performed for asphyxic crisis and cardiovascular arrest. We carried out local puncture with an 18-gauge needle, and the pneumoscrotum was successfully solved. The second case report is about a 56 year old male with pneumoscrotum due to Fournier gangrene who underwent radical exeresis of all necrotic tissues and drainage. This is why most of the scrotal skin and all of the penis skin were removed; as a result, the testicles, epididymis, and cavernosa corpora were externalized. On postoperative day one, the patient was feverless and underwent hyperbaric chamber therapy. No postoperative complications occurred. Accurate evaluation of the pneumoscrotum is always needed. Despite the benign course of most of the clinically evident pneumoscrotum cases, this condition should never be underestimated. Keywords: cardiopulmonary resuscitation, Fournier gangrene, pneumoscrotum, spontaneous causes

  12. A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult

    Directory of Open Access Journals (Sweden)

    Rajamanickam Saravana

    2010-01-01

    Full Text Available A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult.

  13. Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Samuel B. Weimer

    2017-01-01

    Full Text Available Introduction. Necrotizing fasciitis (NF is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV infection. Case Report. A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Conclusion. NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.

  14. Septic Shock following Prostate Biopsy: Aggressive Limb Salvage for Extremities after Pressor-Induced Ischemic Gangrene

    Directory of Open Access Journals (Sweden)

    Jocelyn Lu, BS

    2017-09-01

    Full Text Available Summary:. Vasopressors used to treat patients with septic shock can cause ischemic necrosis of appendages such as the ears and nose, as well as the extremities. Cases of quadruple-extremity necrosis have high morbidity and mortality, and a profound negative impact on quality of life. This case report details the successful limb salvage and return to function using free tissue transfer as a means to salvage bilateral lower extremities in a patient who suffered vasopressor-induced ischemia of upper and lower extremities after prostate biopsy–induced septic shock. Septic shock following transrectal ultrasound–guided prostate biopsy is a rare, yet life-threatening complication. Successful treatment included thorough planning and staging of therapies such as awaiting tissue demarcation and serial surgical debridement to adequately prepare the tissue bed for free tissue transfer. Adjunctive treatments such as hyperbaric oxygen therapy, negative-pressure wound therapy, and meticulous wound care played a crucial role in wound healing. This vigilant planning and coordinated care resulted in the successful lower extremity salvage, consisting of bilateral transmetatarsal amputations and free tissue transfer to both limbs. We present our long-term follow-up of a functional ambulatory patient after catastrophic, life-threatening infection and appropriate multidisciplinary care.

  15. Delivery presentations

    Science.gov (United States)

    Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation ... The mother can walk, rock, and try different delivery positions during labor to help encourage the baby ...

  16. Lecture Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    The Heavy-Ion Collisions in the LHC workshop held in Cracow from 18 to 18 May 2007. The main subject of the workshop was to present the newest results of research provided at CERN LHC collider. Additionally some theoretical models and methods used for presented data analysis were discussed

  17. CATCHY PRESENTATIONS

    DEFF Research Database (Denmark)

    Eriksen, Kaare; Tollestrup, Christian; Ovesen, Nis

    2011-01-01

    An important competence for designers is the ability to communicate and present ideas and proposals for customers, partners, investors and colleagues. The Pecha Kucha principle, developed by Astrid Klein and Mark Dytham, has become a widely used and easy format for the presentation of new concepts...

  18. Workshop presentations

    International Nuclear Information System (INIS)

    Sanden, Per-Olof; Edland, Anne; Reiersen, Craig; Mullins, Peter; Ingemarsson, Karl-Fredrik; Bouchard, Andre; Watts, Germaine; Johnstone, John; Hollnagel, Erik; Ramberg, Patric; Reiman, Teemu

    2009-01-01

    An important part of the workshop was a series of invited presentations. The presentations were intended to both provide the participants with an understanding of various organisational approaches and activities as well as to stimulate the exchange of ideas during the small group discussion sessions. The presentation subjects ranged from current organisational regulations and licensee activities to new organisational research and the benefits of viewing organisations from a different perspective. There were more than a dozen invited presentations. The initial set of presentations gave the participants an overview of the background, structure, and aims of the workshop. This included a short presentation on the results from the regulatory responses to the pre-workshop survey. Representatives from four countries (Sweden, Canada, Finland, and the United Kingdom) expanded upon their survey responses with detailed presentations on both regulatory and licensee safety-related organisational activities in their countries. There were also presentations on new research concerning how to evaluate safety critical organisations and on a resilience engineering perspective to safety critical organisations. Below is the list of the presentations, the slides of which being available in Appendix 2: 1 - Workshop Welcome (Per-Olof Sanden); 2 - CSNI Working Group on Human and Organisational Factors (Craig Reiersen); 3 - Regulatory expectations on justification of suitability of licensee organisational structures, resources and competencies (Anne Edland); 4 - Justifying the suitability of licensee organisational structures, resources and competencies (Karl-Fredrik Ingemarsson); 5 - Nuclear Organisational Suitability in Canada (Andre Bouchard); 6 - Designing and Resourcing for Safety and Effectiveness (Germaine Watts); 7 - Organisational Suitability - What do you need and how do you know that you've got it? (Craig Reiersen); 8 - Suitability of Organisations - UK Regulator's View (Peter

  19. CERN presentations

    CERN Multimedia

    CERN. Geneva

    2011-01-01

    Presentation by CERN (10 minutes each) Rolf Landua - Education and Outreach Salvatore Mele - Open Access Jean-Yves Le Meur - Digital Library in Africa Francois Fluckiger - Open Source/Standards (tbc) Tim Smith - Open Data for Science Tullio Basiglia - tbc

  20. Delivery presentations

    Science.gov (United States)

    ... has entered the pelvis. If the presenting part lies above the ischial spines, the station is reported ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  1. Information Presentation

    Science.gov (United States)

    Holden, K.L.; Boyer, J.L.; Sandor, A.; Thompson, S.G.; McCann, R.S.; Begault, D.R.; Adelstein, B.D.; Beutter, B.R.; Stone, L.S.

    2009-01-01

    The goal of the Information Presentation Directed Research Project (DRP) is to address design questions related to the presentation of information to the crew. The major areas of work, or subtasks, within this DRP are: 1) Displays, 2) Controls, 3) Electronic Procedures and Fault Management, and 4) Human Performance Modeling. This DRP is a collaborative effort between researchers at Johnson Space Center and Ames Research Center.

  2. Voting Present

    Directory of Open Access Journals (Sweden)

    James Lo

    2013-12-01

    Full Text Available During his time as a state senator in Illinois, Barack Obama voted “Present” 129 times, a deliberate act of nonvoting that subsequently became an important campaign issue during the 2008 presidential elections. In this article, I examine the use of Present votes in the Illinois state senate. I find evidence that Present votes can largely be characterized as protest votes used as a legislative tool by the minority party. Incorporating information from Present votes into a Bayesian polytomous item-response model, I find that this information increases the efficiency of ideal point estimates by approximately 35%. There is little evidence of significant moderation by Obama when Present votes are accounted for, though my results suggest that Obama’s voting record may have moderated significantly before his subsequent election to the U.S. Senate. My results also suggest that because legislative nonvoting may occur for a variety of reasons, naive inclusion of nonvoting behavior into vote choice models may lead to biased results.

  3. Lecture Presentations

    International Nuclear Information System (INIS)

    2008-01-01

    The Symposium on Physics of Elementary Interactions in the LHC Era held in Warsaw from 21 to 22 April 2008. The main subject of the workshop was to present the progress in CERN LHC collider project. Additionally some satellite activities in field of education, knowledge and technology transfer in the frame of CERN - Poland cooperation were shown

  4. Presentation Technique

    International Nuclear Information System (INIS)

    Froejmark, M.

    1992-10-01

    The report presents a wide, easily understandable description of presentation technique and man-machine communication. General fundamentals for the man-machine interface are illustrated, and the factors that affect the interface are described. A model is presented for describing the operators work situation, based on three different levels in the operators behaviour. The operator reacts routinely in the face of simple, known problems, and reacts in accordance with predetermined plans in the face of more complex, recognizable problems. Deep fundamental knowledge is necessary for truly complex questions. Today's technical status and future development have been studied. In the future, the operator interface will be based on standard software. Functions such as zooming, integration of video pictures, and sound reproduction will become common. Video walls may be expected to come into use in situations in which several persons simultaneously need access to the same information. A summary of the fundamental rules for the design of good picture ergonomics and design requirements for control rooms are included in the report. In conclusion, the report describes a presentation technique within the Distribution Automation and Demand Side Management area and analyses the know-how requirements within Vattenfall. If different systems are integrated, such as geographical information systems and operation monitoring systems, strict demands are made on the expertise of the users for achieving a user-friendly technique which is matched to the needs of the human being. (3 figs.)

  5. Technical presentation

    CERN Document Server

    FI Department

    2008-01-01

    RADIOSPARES, the leading catalogue distributor of components (electronic, electrical, automation, etc.) and industrial supplies will be at CERN on Friday 3 October 2008 (Main Building, Room B, from 9.00 a.m. to 3.00 p.m.) to introduce its new 2008/2009 catalogue. This will be the opportunity for us to present our complete range of products in more detail: 400 000 part numbers available on our web site (Radiospares France, RS International, extended range of components from other manufacturers); our new services: quotations, search for products not included in the catalogue, SBP products (Small Batch Production: packaging in quantities adapted to customers’ requirements); partnership with our focus manufacturers; demonstration of the on-line purchasing tool implemented on our web site in conjunction with CERN. RADIOSPARES will be accompanied by representatives of FLUKE and TYCO ELECTRONICS, who will make presentations, demonstrate materials and answer any technical questio...

  6. Technical presentation

    CERN Document Server

    FP Department

    2009-01-01

    07 April 2009 Technical presentation by Leuze Electronics: 14.00 – 15.00, Main Building, Room 61-1-017 (Room A) Photoelectric sensors, data identification and transmission systems, image processing systems. We at Leuze Electronics are "the sensor people": we have been specialising in optoelectronic sensors and safety technology for accident prevention for over 40 years. Our dedicated staff are all highly customer oriented. Customers of Leuze Electronics can always rely on one thing – on us! •\tFounded in 1963 •\t740 employees •\t115 MEUR turnover •\t20 subsidiaries •\t3 production facilities in southern Germany Product groups: •\tPhotoelectric sensors •\tIdentification and measurements •\tSafety devices

  7. Patterns of presentation and outcome in critical limb ischemia

    International Nuclear Information System (INIS)

    Tariq, S.; Imtiaz, N.; Kiani, F.; Malik, Z.U.

    2013-01-01

    Introduction: The threatened limb due to peripheral occlusive arterial disease, embolism or trauma requires early recognition and urgent treatment if the limb is to be saved. Objective: To determine the pattern of presentation and outcome of surgery in cases of critical limb ischemia. Study Design: Descriptive study. Place and Duration of Study: This study was conducted at surgical ward, Combined Military Hospital, Rawalpindi, from Dec 2006 to Dec 2007. Subject and Methods: A sample size of 30 patients was taken by convenience sampling. Informed written consent was obtained from all patients. Patients suffering from rest pain with ischemia features, trophic lesions, extensive gangrene , ulcers and demonstrable presence of occlusive arterial disease were included in the study. Moribund patients, extensive cardiopulmonary disease or advanced malignancy were not included in the study. Results: Thirty patients were included in the study. The mean age was 56 +-13. There were 28 males (93.3%) and 2 females (6.7%). They were all married and belonged to middle and low middle social economic class. Out of 30, there were 2 (6.7%) cases of trauma while 28 (93.3%) had peripheral vascular involvement secondary to thromboembolism. Vessels involved were femoral artery in 9 (30%) cases, popliteal artery in 18 (60%) cases and brachial artery in 2 (6.7%) cases. Rest pain was present as a primary feature in all the patients (100%), while tissue loss or gangrene was seen in 22 (73.33%) cases. A total of 14 (46.7%) amputations, 6 (20%) bypass procedures, 4 (13.3%) lumbar sympathectomies, and 2 (6.7 %) embolectomies, were carried out, whereas 4 (13.3%) patients were managed conservatively. Of the patients having rest pain 46.7 % were amputated, whereas of patients having ischemic tissue loss 73.3% were amputated. 13 patients who underwent primary amputation had ankle brachial pressure index (ABPI less than 0.4 (86.7%). ABPI was more than 0.4 in 4 (13.3%) patients whereas it was less

  8. Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene.

    Science.gov (United States)

    Elsherif, Mohamed; Tawfick, Wael; Canning, Patrick; Hynes, Niamh; Sultan, Sherif

    2018-04-01

    Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetatarsal amputation group ( P = 0.974). 29.9% of digital amputations and 15.7% of transmetatarsal amputations in diabetic patients, required minor amputations or revision procedures ( P = 0.04). Median length of hospital stay was (20 days, IQR 27) in the digital group and (17 days, IQR17) in the transmetatarsal amputation group ( P = 0.17). Need for re-admission was 48.1% in digital patients compared to 50% in transmetatarsal amputation patients ( P = 0.81). Quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) was (315 days, IQR 45) in digital group and (346 days, IQR 48) in the transmetatarsal amputation patients ( P = 0.099). Conclusion Despite the lack of statistical significance, transmetatarsal amputation offered better outcome in the diabetic patients, with less re-intervention rate, shorter hospital stays, less theatre trips, and longer time without toxicity (TWiST).

  9. Acute irritant reaction to an antiseptic bath emollient

    OpenAIRE

    Saw, N; Hindmarsh, J

    2005-01-01

    Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients.

  10. Acute irritant reaction to an antiseptic bath emollient

    Science.gov (United States)

    Saw, N; Hindmarsh, J

    2005-01-01

    Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients. PMID:15701748

  11. Browse Title Index

    African Journals Online (AJOL)

    Items 101 - 150 of 406 ... Vol 50, No 1 (2012), Fournier's gangrene – analysis of management and outcome in south-eastern Nigeria, Abstract PDF. FO Ugwumba, II Nnabugwu, OFN Ozoemena. Vol 54, No 2 (2016), Gallbladder duplication masquerading as a dilated common bile duct with choledocholithiasis, Abstract PDF.

  12. The 'purple urine bag syndrome': Where indigo and indirubin meet!

    African Journals Online (AJOL)

    A. Adam

    occurring [5]. Close surveillance amongst immune-compromised patients with. PUBS is advised, since the life-threatening complication of. Fournier's gangrene has been previously reported amongst this sub- set of patients [6]. Consent. Written consent had been obtained from the patient. Conflict of interest. None declared.

  13. Author Details

    African Journals Online (AJOL)

    Balumuka, D. Vol 90, No 11 (2013) - Articles Scrotal Reconstruction with a Pedicled Gracilis Muscle Flap after Debridement of Fournier's Gangrene: A Case Report Abstract PDF. ISSN: 0012-835X. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  14. Browse Title Index

    African Journals Online (AJOL)

    Items 251 - 300 of 366 ... S N Anyanwu. Vol 63, No 4-6 (2017), Stepwise minimal debridement in Fournier's gangrene: a technical note, Abstract. M.C. Kabeya, A Danso, L Gwanzura. Vol 46, No 9 (2000), Storage of breast milk: effect of temperature and storage duration on microbial growth, Abstract. E O Igumbor, R D Makura, ...

  15. East African Medical Journal - Vol 90, No 11 (2013)

    African Journals Online (AJOL)

    Scrotal Reconstruction with a Pedicled Gracilis Muscle Flap after Debridement of Fournier's Gangrene: A Case Report · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. LJ Katusabe, D Balumuka, A Hodges, 375-378 ...

  16. Browse Title Index

    African Journals Online (AJOL)

    Items 51 - 61 of 61 ... Vol 1, No 2 (2005), Tetanus following Fournier's gangrene: case report and literature review, Abstract. II Lawal. Vol 2, No 2 (2006), The Evolution Of Human Resource Management In Reforming The Health Sector In Nigeria, Abstract. K Sabitu. Vol 1, No 2 (2005), The pattern of distribution of ABO blood ...

  17. East and Central African Journal of Surgery http://www.bioline.org.br ...

    African Journals Online (AJOL)

    Patrick

    This increases the chances of misdiagnosis with resultant complications and sometimes need-less surgery. The causes of scrotal pain include epididymitis, epididymo- orchitis, testicular torsion, appendicular torsion, trauma, Fournier's gangrene, testicular vasculitis, testicular tumor with tumor necrosis or haemorrhage into it ...

  18. La Gangrène Périneo-Scrotale. Etiologies et Thérapeutiques. A ...

    African Journals Online (AJOL)

    13 cases were considered as primitive and classified as Fournier's Gangrene. All patients were admitted to the emergency unit and underwent a large debridement with urinary diversion. A colostomy was done in 25 cases. A hyperbaric oxygenotherapy was administered in 30 cases. Results Ten patients died after a week ...

  19. Author Details

    African Journals Online (AJOL)

    Lema, VM. Vol 80, No 9 (2003): - Articles Fournier's gangrene complicating vasectomy. Details PDF · Vol 86, No 6 (2009) - Articles Therapeutic misconception and clinical trials in sub-saharan Africa: A review. Abstract PDF · Vol 86, No 11 (2009) - Articles HIV/AIDS and pregnancy-related deaths in Blantyre, Malawi

  20. Browse Title Index

    African Journals Online (AJOL)

    Vol 24, No 1 (2016), Formes hémorragiques graves de la fièvre de la vallée du Rift: à propos de 5 cas, Abstract. Mohamed Lemine Ould Salem, Sidi El Wafi Ould Baba, Fatimetou Zahra Fall-Malick, Boushab Mohamed Boushab, Sidi Mohamed Ghaber, Abdelwedoud Mokhtar. Vol 20, No 1 (2015), Fournier gangrene: Rare ...

  1. Cefepime Associated With Phenytoin Induced Stevens-Johnson Syndrome.

    Science.gov (United States)

    Marco-Del Río, José; Domingo-Chiva, Esther; Cuesta-Montero, Pablo; Valladolid-Walsh, Ana; García-Martínez, Eva María

    We describe a recent case of Stevens-Johnson Syndrome. A 49-year-old man was admitted to the Intensive Care Unit of an Anaesthesia and Resuscitation Department because of a Fournier gangrene that derived in a sepsis, ventilator-associated pneumonia, and renal failure. He was under treatment with cefepime and suffered a generalized status epilepticus, so started treatment with phenytoin. The next day he developed a "maculous cutaneous eruption in trunk and lower limbs" compatible with a Stevens-Johnson Syndrome. Stevens-Johnson Syndrome is a very severe and potentially fatal multiorganic disease, especially when present in critically ill patients, with a strong drug-related etiology, especially with antiepileptic drugs.

  2. A surprising cause of wheezing in a morbidly obese patient: a case report

    Directory of Open Access Journals (Sweden)

    Kurnutala LN

    2014-10-01

    Full Text Available Lakshmi N Kurnutala, Minal Joshi, Hattiyangadi Kamath, Joel Yarmush Department of Anesthesiology, New York Methodist Hospital, Brooklyn, NY, USA Abstract: A typical patient with chronic obstructive pulmonary disease has small airway disease, which often responds to bronchodilators. If the patient is obese, he or she may be further compromised and not tolerate being in the supine position. We present a case of a patient with history of chronic obstructive pulmonary disease and obstructive sleep apnea with acute renal failure and urosepsis scheduled for an emergent debridement of Fournier's gangrene. In this patient, the fiberoptic intubation was performed in semi-Fowler's position, and tracheomalacia was observed. Keywords: tracheomalacia, difficult airway, fiberoptic intubation, COPD

  3. Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-06-01

    Full Text Available Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84% and dyspnea (53%. Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%. In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases, and the mean length of hospital stay was 6 days (5-8 days which was longer (1-2 months in patients with gangrenous bowel (3 patients. Furthermore, no mortality was reported during the course of hospitalization in these

  4. Virtual Presenters: Towards Interactive Virtual Presentations

    NARCIS (Netherlands)

    Nijholt, Antinus; Cappellini, V.; Hemsley, J.

    2005-01-01

    We discuss having virtual presenters in virtual environments that present information to visitors of these environments. Some current research is surveyed and we will look in particular to our research in the context of a virtual meeting room where a virtual presenter uses speech, gestures, pointing

  5. Making your presentation fun: creative presentation techniques

    Energy Technology Data Exchange (ETDEWEB)

    KEENEN,MARTHA JANE

    2000-05-18

    What possesses someone to volunteer and go through hoops and red tape to make a presentation at a conference? For that matter, why does anyone ever present anything to anyone? Actually, presentations are a fact of life and there are many reasons for doing a presentation and doing it well. New and existing staff need training and orientation to the way things are done here. Handing all of them a manual and hoping they read it is pretty much a waste of paper. On the other hand, an effective, entertaining and upbeat presentation on the relevant topics is more likely to stick with those people. They will even have a name and face to remember and seek out when they have an issue on or with that topic. This can be a very effective beginning for networking with new peers. The presenter is seen as knowledgeable, as a source of information on company topics and possibly evaluated as a potential mentor or future manager. Project staff and/or peers benefit from clear, concise, presentations of topical knowledge. This is one way that a group working on various aspects of the same project or program can stay in touch and in step with each other. Most importantly, presentations may be the best or only door into the minds (and budgets) of management and customers. These presentations are a wonderful opportunity to address legal and compliance issues, budget, staffing, and services. Here is a chance, maybe the only one, to demonstrate and explain the wonderfulness of a program and the benefit they get by using the services offered most effectively. An interactive presentation on legal and compliance issues can be an effective tool in helping customers and/or management make good risk management decisions.

  6. Clinical and hematological presentation of children and adolescents with polycythemia vera

    Science.gov (United States)

    McMullin, Mary Frances; Pahl, Heike L.

    2014-01-01

    Polycythemia vera (PV) in children and adolescents is very rare. Data on clinical and laboratory evaluations as well as on treatment modalities are sparse. Here, we report the long-term clinical course of a PV patient first diagnosed more than 40 years ago at age 12. In addition, after a systematic review of the scientific medical literature, clinical and hematological data of 35 patients (19 female and 17 male) from 25 previous reports are summarized. Three patients developed PV following antecedent hematological malignancies. Budd–Chiari syndrome was diagnosed in seven patients indicating a particular risk of young patients of developing this disorder. One patient presented with ischemic stroke, one patient with gangrene, and three patients with severe hemorrhage. Three patients died from disease-related complications. Hematocrit levels and platelet counts were not correlated with disease severity. Leukocytosis >15×109/L was present in 9/35 patients and associated with a thromboembolic or hemorrhagic complication in seven patients. The few available data on molecular genetics and endogenous erythroid colony growth indicate changes comparable to those detectable in adult patients. Treatment varied enormously. It included aspirin, phlebotomy, hydroxycarbamide, busulfan, melphalan, pyrimethamine, and interferon-alpha. Two patients successfully underwent stem cell transplantation. Currently, it is impossible to treat an individual pediatric PV patient with an evidence-based regimen. PMID:19468728

  7. The socio-demografic characteristics of enuresis nocturna in childhood

    Directory of Open Access Journals (Sweden)

    Serhan Ci and #775;men

    2016-09-01

    Full Text Available Background: Fournier's gangrene (FG is a rapidly progressive, destructive, necrotizing fasciitis of the perianal, perineal, and genital regions. Common clinical symptoms include sudden intense pain in the scrotum, prostration, fever, and pallor. In this study, the aim was to assess FG through a wider lens. Methods: 60 patients that presented with FG at the authors' hospital over a 6-year period between April 2008 and March 2014 were retrospectively reviewed. Age, gender, site of gangrene, risk factors, symptoms, microbiology, treatment modalities, Fournier's Gangrene Severity Index score (FGSI, and mortality data were evaluated. Results: 60 male patients with a mean age of 55 (ranging between 48-62 were included in the study. 50 patients survived and the mortality rate was 16.6%. Septic shock (n: 4, cardiogenic shock (n:4, and pneumonia (n:2 were the official causes of death. As a risk factor, 45 (75% patients had diabetes mellitus (DM, 40 (66.6% had hypertension (HT, and 35 (58.3% had both DM and HT. There were no other co-morbidities in the 10 (16.6% remaining patients. All the surviving 50 patients were suitable for surgical reconstruction. A split thickness skin grafting procedure was performed for 46 (76.6% patients and flap reconstruction was performed for 4 (6.6%. None of the patients had hyperbaric oxygen therapy (HBO. The mean length of hospitalization was 16 days (ranging from 5-58 for all patients. A mean FGSI score at admission was 5.02 +/- 2.45 for survivors compared with 13.8 +/- 4.53 for non-survivors. A mean FGSI score was 4.56 +/- 2.28 for survivors and 11.50 +/- 2.63 for non-survivors during hospitalization. Conclusion: Although FG has a high mortality rate, appropriate management of the disease can reduce it. Early diagnosis, surgical debridement, vacuum-assisted closure application, and antibiotherapy are essentials for treating FG. [Arch Clin Exp Surg 2016; 5(3.000: 134-137

  8. Mesenteric defect with internal herniation in the pediatric emergency department: an unusual presentation of acute abdomen.

    Science.gov (United States)

    Hu, Mei-Hua; Huang, Go-Shine; Chen, Jeng-Chang; Wu, Chang-Teng

    2014-04-01

    Internal herniation is a rare cause of intestinal obstruction, especially in the emergency department. We report a child with acute abdomen resulting from transmesenteric internal herniation of the small bowel. Radiographic findings revealed gaseous distension of the bowel loops in the upper abdominal area with a paucity of gas in the lower abdomen. Operative finding showed gangrenous small bowel due to mesenteric defect with an internal herniation. The gangrenous bowel was resected and the patient was discharged with an uneventful outcome. We emphasize that early recognition of internal herniation warrants further evaluation and appropriate management. Copyright © 2012. Published by Elsevier B.V.

  9. Develop your presentation skills

    CERN Document Server

    Theobald, Theo

    2016-01-01

    Going beyond handling nerves and presenting PowerPoint slides, the third edition of "Develop Your Presentation Skills "offers practical advice on developing a captivating presentation, constructing compelling content, and boosting self-confidence. The book includes three new chapters on delivering a "stripped down"presentation, using new media to engage with the audience, and handling being asked to present on short notice."

  10. Subpart DD Training Presentations

    Science.gov (United States)

    EPA has produced the following training presentation(s) for reporters subject to this subpart. Generally, these presentations explain the rule or show how to use the reporting system e-GGRT to submit annual GHG reports to EPA.

  11. Subpart AA Training Presentations

    Science.gov (United States)

    EPA has produced the following training presentation(s) for reporters subject to this subpart. Generally, these presentations explain how to use the reporting system e-GGRT to submit annual GHG reports to EPA.

  12. Subpart W Training Presentations

    Science.gov (United States)

    EPA has produced the following training presentation(s) for reporters subject to this subpart. Generally, these presentations explain the rule or show how to use the reporting system e-GGRT to submit annual GHG reports to EPA.

  13. Rotating Poster Presentations

    Science.gov (United States)

    Lagares, Manuel; Reisenleutner, Sandra

    2017-01-01

    Oral presentations are a common practice in foreign language classes, often used to assess students' speaking skills. Usually, the presentations are delivered by students in front of the class, often with PowerPoint slides or Prezi as support. However, frequently the audience does not engage with the presentation and thus, the benefits of this…

  14. Presenting Food Science Effectively

    Science.gov (United States)

    Winter, Carl K.

    2016-01-01

    While the need to present food science information effectively is viewed as a critical competency for food scientists by the Institute of Food Technologists, most food scientists may not receive adequate training in this area. Effective presentations combine both scientific content and delivery mechanisms that demonstrate presenter enthusiasm for…

  15. Innovative presentations for dummies

    CERN Document Server

    Anthony, Ray

    2014-01-01

    Be the speaker they follow with breakthrough innovative presentations Innovative Presentations For Dummies is a practical guide to engaging your audience with superior, creative, and ultra-compelling presentations. Using clear language and a concise style, this book goes way beyond PowerPoint to enable you to reimagine, reinvent, and remake your presentations. Learn how to stimulate, capture, and hold your audience in the palm of your hand with sound, sight, and touch, and get up to speed on the latest presentation design methods that make you a speaker who gets audiences committed and acting

  16. Alarm filtering and presentation

    International Nuclear Information System (INIS)

    Bray, M.A.

    1989-01-01

    This paper discusses alarm filtering and presentation in the control room of nuclear and other process control plants. Alarm generation and presentation is widely recognized as a general process control problem. Alarm systems often fail to provide meaningful alarms to operators. Alarm generation and presentation is an area in which computer aiding is feasible and provides clear benefits. Therefore, researchers have developed several computerized alarm filtering and presentation approaches. This paper discusses problems associated with alarm generation and presentation. Approaches to improving the alarm situation and installation issues of alarm system improvements are discussed. The impact of artificial intelligence (AI) technology on alarm system improvements is assessed. (orig.)

  17. Behavioural present value

    OpenAIRE

    Krzysztof Piasecki

    2013-01-01

    Impact of chosen behavioural factors on imprecision of present value is discussed here. The formal model of behavioural present value is offered as a result of this discussion. Behavioural present value is described here by fuzzy set. These considerations were illustrated by means of extensive numerical case study. Finally there are shown that in proposed model the return rate is given, as a fuzzy probabilistic set.

  18. Conns' syndrome - atypical presentations

    International Nuclear Information System (INIS)

    Kumar, K V S Hari; Modi, K D; Jha, Sangeeta; Jha, Ratan

    2009-01-01

    Primary hyperaldosteronism (Conns' syndrome) commonly presents with a combination of clinical features of hypokalemia and hypertension. Atypical presentations like normotension, normokalemia and neurological ailments are described in few cases. We encountered two such cases, the first presenting with acute neurological complaint and second case having insignificant hypertension. Both the patients had a characteristic biochemical and imaging profile consistent with primary hyperaldosteronism and responded to surgical resection of adrenal adenoma. (author)

  19. CERN Electronics Pool presentations

    CERN Multimedia

    2011-01-01

    The CERN Electronics Pool has organised a series of presentations in collaboration with oscilloscope manufacturers. The last one will take place according to the schedule below.   Time will be available at the end of the presentation to discuss your personal needs. The Agilent presentation had to be postponed and will be organised later. -     Lecroy: Thursday, 24 November 2011, in 530-R-030, 14:00 to 16:30.

  20. Presentation skills for nurses.

    Science.gov (United States)

    Foulkes, Mark

    2015-02-20

    This article emphasises the importance of effective presentation skills. Such skills allow nurses to share knowledge and expertise and to communicate clearly in a range of workplace scenarios. Nurses are increasingly being asked to present in formal and informal situations, such as conferences, poster presentations, job interviews, case reports and ward-based teaching. This article explores the principles underpinning the development of these skills, discusses the situations in which they could be applied and demonstrates how nurses might improve and develop as presenters.

  1. Creating meaningful multimedia presentations

    NARCIS (Netherlands)

    Hardman, H.L.; Ossenbruggen, van J.R.

    2006-01-01

    Finding relevant information is one step in the chain of understanding information. Presenting material to a user in a suitable way is a further step. Our research focuses on using semantic annotations of multimedia elements to increase the "presentability" of retrieved information. We investigate

  2. Unusual presentation of sunburn.

    Science.gov (United States)

    Verma, Gopalkrishna G; Dave, Dhaval; Byrne, Eileen

    2008-10-01

    We present three cases of sunburn to the head, presenting with oedema of the face in children aged 6, 9 and 13 years. Oedema was predominantly on the forehead and temporal region; a direct effect of gravity was associated with erythema of the scalp. Sunburn healed without any complications.

  3. Presentation to the symposium

    International Nuclear Information System (INIS)

    Goodhead, D.

    1997-01-01

    A novel theory, the Second Event theory, advanced by Chris Busby, suggested that certain man-made radioisotopes could bypass cellular genetic repair mechanisms and cause cancer at very low dose. The present paper, after some introductory comments on the effects of particle tracks on cells, goes on to present the author's own perception of this Second Event theory. (UK)

  4. Conjugando el presente

    Directory of Open Access Journals (Sweden)

    Héctor Rojas Herazo

    1968-06-01

    Full Text Available La añoranza suele ser, casi siempre, la línea critica de menor resistencia. El lema de que "todo tiempo pasado fue mejor" tiene un poco la culpa. En cualquier orden del conocimiento el pasado sigue el verdadero presente. Ese presente en que nos gusta respirar y vivir. Nada de compromiso circundante. Nada de inmediatez.

  5. The presentation and treatment

    African Journals Online (AJOL)

    user

    tion of single collocations proposals are made for an implicit presentation of complex ... function lexicographers often include items to illustrate the typical use of the ... they have no items explicitly addressed at them to elevate them to treatment.

  6. PRESENT STATUS IN INDIA

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. PRESENT STATUS IN INDIA. FIXED LINES – 36 MILLION. MOBILE CONNECTIONS – 14 MILLION. TELEDENSITY APPROXIMATELY 5. INTERNET CONNECTIONS – 5 MILLION. INTERNET USERS NEARLY – 25 MILLION.

  7. Fostering oral presentation performance

    NARCIS (Netherlands)

    Ginkel, van Stan; Gulikers, Judith; Biemans, Harm; Mulder, Martin

    2017-01-01

    Previous research revealed significant differences in the effectiveness of various feedback sources for encouraging students’ oral presentation performance. While former studies emphasised the superiority of teacher feedback, it remains unclear whether the quality of feedback actually differs

  8. Present status of dibaryons

    International Nuclear Information System (INIS)

    Locher, M.P.

    1981-01-01

    In the present notes the author tries to assess the situation regarding dibaryons in the various channels with baryon number two, emphasizing the problems and discussing in greater detail the most recent developments since the Versailles Conference. One of the motivations for the present search of B=2 states is the possibility of colored subclusters for systems with six quarks which cannot occur for ordinary baryons or mesons. (Auth.)

  9. Presenting New Grammar

    Institute of Scientific and Technical Information of China (English)

    WU Cai-ling; WANG Xi

    2015-01-01

    More and more researchers have now agreed upon the necessity of teaching grammar, but it still remains controversial as how to teach the forms, with the central consideration of not to harm the meaning-focused communicative teaching method. In this essay, one of the issues in grammar teaching will be discussed as how to present new grammar to learners, through evaluating and modifying a particular presentation activity in a grammar-teaching textbook.

  10. Stellar Presentations (Abstract)

    Science.gov (United States)

    Young, D.

    2015-12-01

    (Abstract only) The AAVSO is in the process of expanding its education, outreach and speakers bureau program. powerpoint presentations prepared for specific target audiences such as AAVSO members, educators, students, the general public, and Science Olympiad teams, coaches, event supervisors, and state directors will be available online for members to use. The presentations range from specific and general content relating to stellar evolution and variable stars to specific activities for a workshop environment. A presentation—even with a general topic—that works for high school students will not work for educators, Science Olympiad teams, or the general public. Each audience is unique and requires a different approach. The current environment necessitates presentations that are captivating for a younger generation that is embedded in a highly visual and sound-bite world of social media, twitter and U-Tube, and mobile devices. For educators, presentations and workshops for themselves and their students must support the Next Generation Science Standards (NGSS), the Common Core Content Standards, and the Science Technology, Engineering and Mathematics (STEM) initiative. Current best practices for developing relevant and engaging powerpoint presentations to deliver information to a variety of targeted audiences will be presented along with several examples.

  11. Milk: Past and Present

    Science.gov (United States)

    Bulajić, S.; Đorđević, J.; Ledina, T.; Šarčević, D.; Baltić, M. Ž.

    2017-09-01

    Although milk/dairy consumption is part of many cultures and is recommended in most dietary guidelines around the world, its contribution to overall diet quality remains a matter of controversy, leading to a highly polarized debate within the scientific community, media and public sector. The present article, at first, describes the evolutionary roots of milk consumption, then reviews the milk-derived bioactive peptides as health-promoting components. The third part of the article, in general, presents the associations between milk nutrients, disease prevention, and health promotion.

  12. Book Presentation | 27 February

    CERN Multimedia

    The CERN Library

    2013-01-01

    "A caccia del bosone di Higgs. Magneti, governi, scienziati e particelle nell'impresa scientifica del secolo" by Luciano Maiani and Romeo Bassoli, published by Mondadori. On Wednesday 27 February Luciano Maiani will present the book "A caccia del bosone di Higgs. Magneti, governi, scienziati e particelle nell'impresa scientifica del secolo". More information here. The presentation will take place in the Council Chamber at 16.00 and will be followed by a debate and book signing. The book will be on sale. You are cordially invited.

  13. Renewable Electricity Futures (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Mai, T.

    2012-08-01

    This presentation library summarizes findings of NREL's Renewable Electricity Futures study, published in June 2012. RE Futures investigated the challenges and impacts of achieving very high renewable electricity generation levels in the contiguous United States by 2050. It was presented at the 2012 RE AMP Annual Meeting. RE-AMP is an active network of 144 nonprofits and foundations across eight Midwestern states working on climate change and energy policy with the goal of reducing global warming pollution economy-wide 80% by 2050.

  14. Hera presentation generator (Poster)

    NARCIS (Netherlands)

    Frasincar, F.; Houben, G.J.P.M.; Barna, P.; Ellis, A.; Hagino, T.

    2005-01-01

    Semantic Web Information Systems (SWIS) are Web Information Systems that use Semantic Web technologies. Hera is a model-driven design methodology for SWIS. In Hera, models are represented in RDFS and model instances in RDF. The Hera Presentation Generator (HPG) is an integrated development

  15. Creating Meaningful Multimedia Presentations

    NARCIS (Netherlands)

    L. Hardman (Lynda); J.R. van Ossenbruggen (Jacco)

    2006-01-01

    textabstractFinding relevant information is one step in the chain of understanding information. Presenting material to a user in a suitable way is a further step. Our research focuses on using semantic annotations of multimedia elements to increase the ”presentability” of

  16. AECL present and future

    International Nuclear Information System (INIS)

    Foster, J.S.

    The history and present activities of the Crown corporation AECL are described. AECL owns limited interests in nuclear power plants and a Manitoba transmission system. AECL is the world's foremost producer of heavy water, and exports CANDU type reactors and radiation processing equipment. AECL backs up the Canadian nuclear power program wherever there is no conflict with private enterprise. (E.C.B.)

  17. Econophysics: Past and present

    Science.gov (United States)

    de Area Leão Pereira, Eder Johnson; da Silva, Marcus Fernandes; Pereira, H. B. B.

    2017-05-01

    This paper provides a brief historical review of the relationship between economics and physics, beginning with Adam Smith being influenced by Isaac Newton's ideas up to the present day including the new econophysics discipline and some of the tools applied to the economy. Thus, this work is expected to motivate new researchers who are interested in this new discipline.

  18. Present State Examination

    DEFF Research Database (Denmark)

    Pedersen, Kamilla; Bertelsen, Aksel

    Present State Examination (PSE) 5. udgave er en revideret version af speciallæge i psykiatri Aksel Bertelsens oprindelige materiale. Aksel Bertelsen er ophavsmand til PSE og til den danske udgave af ICD-10. Revisionen omfatter et forbedret layout, en modernisering af sproget, tilføjelse af...

  19. Presentation of CEA

    International Nuclear Information System (INIS)

    Graf, J.J.

    1976-01-01

    The organization of the CEA, its missions and means are presented. Its activities in the field of light water reactors, fast neutron reactors and PWR reactors of small and medium power for electricity and/or heat generation are emphasized [fr

  20. Going beyond methodological presentism

    DEFF Research Database (Denmark)

    Schmidt, Garbi

    2017-01-01

    Denmark is an example of a country where the idea of historical ethnic homogeneity stands strong. This article challenges this historical presentism: the scholarly and societal tendency to understand social phenomena within a limited contemporary framework, neglecting possible effects and similar...

  1. Analyzing in the present

    DEFF Research Database (Denmark)

    Revsbæk, Line; Tanggaard, Lene

    2015-01-01

    The article presents a notion of “analyzing in the present” as a source of inspiration in analyzing qualitative research materials. The term emerged from extensive listening to interview recordings during everyday commuting to university campus. Paying attention to the way different parts of vari...

  2. Presentation on ecoenergetic assessment

    International Nuclear Information System (INIS)

    Fournelle, C.

    1998-01-01

    The development of a tool to assess the quality of indoor air for buildings in the residential and commercial sector was presented. The computer software program was designed to allow a building operator to set an optimal target to reflect the greatest economies in energy consumption. Air quality was assessed in terms of carbon dioxide, volatile organic compounds, and other common indoor pollutants

  3. Keynote presentation : SAR systems

    NARCIS (Netherlands)

    Halsema, D. van; Otten, M.P.G.; Maas, A.P.M.; Bolt, R.J.; Anitori, L.

    2011-01-01

    Synthetic Aperture Radar (SAR) systems are becoming increasingly important sensors in as well the military environment as in the civilian market. In this keynote presentation an overview will be given over more than 2 decades of SAR system∼ and SAR application development at TNO in the Netherlands.

  4. Agriculture Oral Presentations

    International Nuclear Information System (INIS)

    1997-01-01

    This publication contains 23 papers related to the use of nuclear techniques in plant breeding in Turkey, effect of gamma irradiations on growing various plants, mutations and soil chemistry, etc., presented at 4. International Congress of Nuclear Agriculture and Animal Science in Bursa, Turkey, 25-27 Sep 1996. A separate abstract was prepared for each paper

  5. Imagined futures, present lives

    DEFF Research Database (Denmark)

    Dalsgaard, Anne Line; Wildermuth, Norbert

    2006-01-01

    is discussed centrally in this attempt to contribute to an empirically grounded understanding of the role that media play for youth in their striving to ‘find a place in life'. In the empirical context presented in the article, imaginations, expanded and circulated by a globalized media circuit...

  6. Presentation of 2004 earnings

    International Nuclear Information System (INIS)

    2005-03-01

    This presentation offers financial information on the AREVA Group earnings for the year 2004. With manufacturing facilities in over 40 countries and a sales network in over 100, Areva offers customers technological solutions for nuclear power generation and electricity transmission and distribution. The Group also provides interconnect systems to the telecommunications, computer and automotive markets. (A.L.B.)

  7. Summary of the presentations

    International Nuclear Information System (INIS)

    2002-01-01

    This part summarizes the content of the six following presentations: 1. IAEA requirements/guidance for the decommissioning safety case (Mike Bell, IAEA); 2. Safety case in an EIA context (Patrick O'SULLIVAN, The Netherlands); 3. Plant configuration and the D and D licensing process (Eugenio GIL LOPEZ and Pedro CARBONERAS, Spain); 4. Accident assessment (Ivo TRIPPUTI, Italy; Ingmar LUND, Sweden); 5. Balancing radiological and industrial risk in the safety case (Pascal DEBOODT, Belgium); 6. The safety case for safe store and dormancy periods (Paul WOOLLAM, UK). Following the six presentations, the WPDD members discussed the safety case in an open discussion led by the Topical Session Chair, Frances Taylor. The discussion was wide-ranging, and topics varied from the standards that apply to releases to the environment during safe store, to decommissioning parallels with other major processing industries and facilities (such as oil rigs). Frances Taylor steered the discussion toward addressing the questions that the WPDD Core Group had proposed for the topical session. The Chair, the Rapporteur, and some members of the group sensed that the presentations had covered such an wide variety of issues, and that the content of the presentations themselves differed so greatly, that it would be difficult to distill a position paper from the information gathered, as had been the mandate from the Core Group. In addition, the meaning of the term 'Safety Case' differed greatly among participants in the topical session. Some took the term to mean the analysis and document that the implementor provides to the regulator, describing how operations will be performed safely. Others considered the term to mean the overall safety and risk conditions inherent in a nuclear facility during operations or decommissioning. With the differences in presentations and with the meaning of the terminology remaining unclear, the WPDD participants did not reach consensus conclusions on December 5, 2001

  8. [Metachromatic Leukodystrophy. Case Presentation].

    Science.gov (United States)

    Espejo, Lina María; de la Espriella, Ricardo; Hernández, José Fernando

    Metachromatic leukodystrophy (MLD) is a rare demyelinating disease (prevalence 1:40 000), also called arylsulfatase A deficiency (ARS-A), which may present with neurological and psychiatric symptoms. Clinical assessment may be difficult, due to unspecific signs and symptoms. A case is presented of a 16 year-old female patient seen in psychiatry due to behavioural changes, psychosis, and with impaired overall performance. She was initially diagnosed with schizophrenia, but the Nuclear Magnetic Resonance (NMR) scan and laboratory tests lead to the diagnosis of MLD. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  9. Sirenomelia: A Rare Presentation

    Science.gov (United States)

    Srinivas, S; Kumar, Shiva; Reddy, Surweshwar; Prasad, Hari; Irfan, G M

    2012-01-01

    We are presenting two cases of Sirenomelia (Mermaid Syndrome), which is an extreme example of the caudal regression syndrome. It invariably presents with lower limb fusion, sacral and pelvic bony anomalies, absent external genitalia, imperforate anus, and renal agenesis or dysgenesis. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation. One of our cases survived for 12 days after birth. This new born had an unusually high anorectal anomaly in which the colon was ending at the level of mid transverse colon, fused lower limbs and genital anomalies. Ultrasound of the abdomen revealed horseshoe kidney. Colostomy was performed on day 2 of life. The second case encountered was a stillborn baby on whom an autopsy was performed. PMID:26023366

  10. Sirenomelia: a rare presentation.

    Science.gov (United States)

    Reddy, K Ramesh; Srinivas, S; Kumar, Shiva; Reddy, Surweshwar; Prasad, Hari; Irfan, G M

    2012-01-01

    We are presenting two cases of Sirenomelia (Mermaid Syndrome), which is an extreme example of the caudal regression syndrome. It invariably presents with lower limb fusion, sacral and pelvic bony anomalies, absent external genitalia, imperforate anus, and renal agenesis or dysgenesis. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation. One of our cases survived for 12 days after birth. This new born had an unusually high anorectal anomaly in which the colon was ending at the level of mid transverse colon, fused lower limbs and genital anomalies. Ultrasound of the abdomen revealed horseshoe kidney. Colostomy was performed on day 2 of life. The second case encountered was a stillborn baby on whom an autopsy was performed.

  11. Organising and presenting information.

    Science.gov (United States)

    Kankanady, Raghavendra; Wells, Marilyn

    2013-01-01

    Information management can be a daunting process for clinicians, health care providers and policy makers within the health care industry. This chapter discusses the importance of information classification and information architecture in the information economy and specific challenges faced within the health care industry. The healthcare sector has industry specific requirements for information management, standards and specifications for information presentation. Classification of information based on information criticality and the value in the health care industry is discussed in this paper. Presentation of information with reference to eHealth standards and specifications for healthcare information systems and their key requirements are also discussed, as are information architecture for eHealth implementation in Australia. This chapter also touches on information management and clinical governance since the importance of information governance is discussed by various researchers and how this is becoming of value to healthcare information management.

  12. Atypical Presentations of Tularemia.

    Science.gov (United States)

    Odegaard, Karah; Boersma, Beth; Keegan, James

    2017-05-01

    Francisella tularensis is a gram-negative coccobacillus that causes a condition commonly referred to as tularemia. There has been a dramatic increase in tularemia cases reported in South Dakota, many of which were challenging to diagnose due to atypical clinical manifestations. We describe an interesting case of pneumonic tularemia and summarize six similar cases, several of which presented with lung nodules suggestive of malignancy. According to the literature, this is only the third outbreak of pneumonic tularemia reported in the U.S. We believe it is important for clinicians to be aware of the increased incidence of tularemia in the area and to be vigilant in the diagnosis and management of these atypically presenting cases. Copyright© South Dakota State Medical Association.

  13. Presentation = Speech + Slides

    Directory of Open Access Journals (Sweden)

    Derik Badman

    2008-12-01

    Full Text Available Back in October, Aaron Schmidt posted “HOWTO give a good presentation” to his blog walking paper. His second bullet point of “thoughts” on good presentations is: Please don’t fill your slides with words. Find some relevant and pretty pictures to support what you’re saying. You can use the pictures to remind yourself what you’re going [...

  14. Abscesso perineal por ingestão acidental de palito de dente

    Directory of Open Access Journals (Sweden)

    Roberto Iglesias Lopes

    2006-06-01

    Full Text Available Palitos de dente são itens domésticos comuns e a maioria das pessoas subestima a gravidade das lesões que podem ocorrer com a ingestão acidental de palitos. Nós apresentamos um caso de abscesso perineal causado pela ingestão de um palito de dente. Um homem de 55 anos apresentou-se com quadro de dor perianal há um mês. Ao exame físico, notou-se abscesso perineal. Leucocitose com desvio à esquerda foi observada e a tomografia pélvica demonstrou um corpo estranho na região perineal. A remoção cirúrgica do corpo estranho e a drenagem adequada do abscesso foram realizadas, revelando um palito de dente. O paciente evoluiu bem após a abordagem cirúrgica. O abscesso perineal pode progredir para gangrena de Fournier e, portanto, a abordagem de abscessos perineais deve ser agressiva, com drenagem adequada e remoção do corpo estranho (sempre que presente.Toothpicks are a common household item and most people underestimate the seriousness of injuries that can occur with accidental ingestion. We report a case of a perineal abscess caused by an ingested toothpick. A 55-year-old man was admitted to the hospital with a 30-day history of perianal pain. Physical examination was unremarkable, except for a perineal abscess. Leucocytosis with 10% bands was present and pelvic tomography demonstrated a foreign body located in the perineal area. Surgical removal of the foreign body with adequate abscess drainage was performed revealing a toothpick. Perineal abscess may progress to Fournier's gangrene and as a consequence the management of a perineal abscess should be aggressive with adequate drainage and removal of the foreign body (if present.

  15. EPMA present and future

    International Nuclear Information System (INIS)

    Love, G.

    2002-01-01

    In electron probe microanalysis the objective has always been to gain the maximum information from a sample. To this end efforts have been directed at increasing detection efficiency, reducing the size of the excitation volume, analysing more difficult specimens and improving the accuracy of quantitative measurements whilst, at the same time, attempting to minimize the complexity of the analysis. The present paper comments on the progress that has been made in this areas, focuses on the latest hardware and software developments taking place and looks forward to how these may impact on the technique of EPMA. (author)

  16. Sarcoidosis Presenting Addison's Disease.

    Science.gov (United States)

    Takahashi, Kentaro; Kagami, Shin-Ichiro; Kawashima, Hirotoshi; Kashiwakuma, Daisuke; Suzuki, Yoshio; Iwamoto, Itsuo

    2016-01-01

    We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.

  17. Radwaste - Multimedia presentation

    International Nuclear Information System (INIS)

    2000-01-01

    Radioactivity is a part of the Nature since the creation of the Earth. We have learned how to use radioactivity in medicine, power industry, and in other areas of life. Similarly as in other activities, waste is generated. We offer you basic information about radioactivity and radioactive waste (radwaste) in four films: Radioactivity, Source of radwaste, Management of radwaste. In the glossary are video presentations: Container (Castor) for radioactive waste; Deep underground repository; Transport vehicle; WWER type reactor. Encyclopedic part of the program contains detailed theoretical and practical information about use of radioactivity and radioactive waste. You will find the explanation in the part Glossary. (authors)

  18. Presenting Newtonian gravitation

    International Nuclear Information System (INIS)

    Counihan, Martin

    2007-01-01

    The basic principles of the Newtonian theory of gravitation are presented in a way which students may find more logically coherent, mathematically accessible and physically interesting than other approaches. After giving relatively simple derivations of the circular hodograph and the elliptical orbit from the inverse-square law, the concept of gravitational energy is developed from vector calculus. It is argued that the energy density of a gravitational field may reasonably be regarded as -g 2 /8πG, and that the inverse-square law may be replaced by a Schwarzschild-like force law without the need to invoke non-Euclidean geometry

  19. Presentation to the symposium

    International Nuclear Information System (INIS)

    Busby, C.

    1997-01-01

    This paper proposes that there is a major error in the present perception of cancer risk from exposure to low level radiation from internal man-made fission products like strontium-90. The author's Second Event theory is discussed which advances the basis that fission products are different in radiation risk terms. Since the scientific community has been so ready to dismiss this idea out of hand, the author also explores scientific culture and scientific revolutions. The evidence that the idea is broadly right is surveyed and finally some studies that could be undertaken to prove or disprove the author's contention are outlined. (UK)

  20. Radiation myelopathy (case presentation)

    International Nuclear Information System (INIS)

    Sangheli, M.; Lisnic, V.; Plesca, S.; Odainic, O.; Chetrari, L.

    2009-01-01

    The radiotherapy is one of the most widely spread and commonly used method in treating tumors of different localization. A detailed analysis of benefits and possible side effects along with evaluation of the risk factors allows preventing one of the most difficult complication, and namely the radiation myelopathy. The delayed form of such a disease is distinguished by a pronounced unfavorable prognosis. The presented case provoked the discussion of difficulties in performing differential diagnosis, as well as the importance of determining the localization of vulnerable tissues as regards the target organ exposed to radiotherapy. (authors)

  1. DOE financial assurance presentation

    International Nuclear Information System (INIS)

    Huck, R.

    1990-01-01

    The presentation topic is California's approach to license application review in meeting financial assurances for the proposed Ward Valley site. The purpose of the presentation is to provide information on specific financial assurance provisions contained in 10 CFR Part 61 and how California intends to satisfy those requirements. Also, as rate setter, California intends to demonstrate how it will assure allowable costs to the rate base though a financial prudency review. The key provisions of financial assurance are: 10 CFR Section 61.61 - This provision requires an applicant to demonstrate its ability to finance licensed activities; 10 CFR Section 61.62 - This provision requires an applicant to provide assurance that sufficient funds will be available for site closure and stabilization; and 10 CFR Section 61.63 - This provision requires an applicant to provide 'a copy of a binding arrangement, such as a lease, between the applicant and the disposal site owner, so that sufficient funds will be available to cover the costs of the institutional control period.' To assist California in its determination of financial assurance compliance to be demonstrated by the applicant for Part 61 requirements, is NUREG guidance document 1199 'Standard Format and Content of a License Application for a Low-Level Radioactive Waste (LLRW) Disposal Facility.' The detailed financial assurance provisions of NUREG 1199 are then embodied in NUREG 1200, 'Standard Review Plant for the Review of a License Application for a LLRW Disposal Facility.'

  2. Rett syndrome: EEG presentation.

    Science.gov (United States)

    Robertson, R; Langill, L; Wong, P K; Ho, H H

    1988-11-01

    Rett syndrome, a degenerative neurological disorder of girls, has a classical presentation and typical EEG findings. The electroencephalograms (EEGs) of 7 girls whose records have been followed from the onset of symptoms to the age of 5 or more are presented. These findings are tabulated with the Clinical Staging System of Hagberg and Witt-Engerström (1986). The records show a progressive deterioration in background rhythms in waking and sleep. The abnormalities of the background activity may only become evident at 4-5 years of age or during stage 2--the Rapid Destructive Stage. The marked contrast between waking and sleep background may not occur until stage 3--the Pseudostationary Stage. In essence EEG changes appear to lag behind clinical symptomatology by 1-3 years. An unexpected, but frequent, abnormality was central spikes seen in 5 of 7 girls. They appeared to be age related and could be evoked by tactile stimulation in 2 patients. We hypothesize that the prominent 'hand washing' mannerism may be self-stimulating and related to the appearance of central spike discharges.

  3. Bad (Re)Presentations

    CERN Multimedia

    Computer Security Team

    2013-01-01

    This time, we would like to address copyright violations (again) - but with a twist. While previous articles focussed on “Music, videos and the risk for CERN” or on software licences, the focus is now on using photos, music and images “found” on the Web for presentations, publications and web pages…   Just recently, a video produced for CERN and published on YouTube and Facebook used background music from a contemporary popular artist. However, the people responsible failed to obtain the appropriate permission to actually use that music. They thought that having bought it on iTunes was sufficient. But it was not: “buying” means you have the right to listen, but not the right for further distribution or re-publication. As a result, the videos were pulled from YouTube and Facebook. Similarly, how many of us integrate graphics and images “found” on the Web into our presentations?  How many of us...

  4. Film Presentation: Die Urknallmaschine

    CERN Multimedia

    Carolyn Lee

    2010-01-01

    Die Urknallmaschine, an Austrian film by Gerd Baldauf, narrated by Norbert Frischauf (Alpha Österreich - ORF, 2009).  In CERN’s gigantic complex particles are accelerated to almost the speed of light, brought to collision and made to divide into even smaller particles. Public opinion of CERN’s research is also divided. Sceptics fear that black holes may be created. Might the goal to study the origin of the world lead to its destruction? The Austrian researcher Norbert Frischauf worked at CERN for many years. With his guidance it is possible to explore the world’s largest research centre, get a glimpse of the fascinating work the scientists do there and take a crash course in particle physics. Die Urknallmaschine will be presented on Friday, 25 June from 13:00 to 14:00 in the Main Auditorium. Language: German

  5. Abdominal pregnancy - Case presentation.

    Science.gov (United States)

    Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, I A; Bohiltea, C

    2015-01-01

    Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated.

  6. Trichinosis - case presentation

    Directory of Open Access Journals (Sweden)

    Rajko Saletinger

    2007-03-01

    Full Text Available Background: Trichinosis is a widespread zoonosis acquired by ingestion of undercooked meat infected with the larvae of Trichinella parasites. The disease has variable clinical manifestations ranging from asymptomatic to fatal. Majority of infections is caused by Trichinella spiralis, although there are some cases caused by other species. The dramatic decline of trichinosis reflects changes in industrial practices and increased public awareness. The majority of human cases are now associated with wild game meat and noncommercial pork. The case of previously healthy, young man with trichinosis is presented. The disease was determined with serologic testing and cured with albendazole. The source of infection has not been determined.Conclusions: In patients with fever, mialgias and eosinophilia infection with tissue nematodes should always be taken in consideration. In those who have recently consumed raw or undercooked pork and wild game meat we should think about trichinosis. The disease is rare in Slovenia.

  7. Imagined futures, present lives

    DEFF Research Database (Denmark)

    Dalsgaard, Anne Line; Wildermuth, Norbert

    2006-01-01

    The article is focused thematically on the uses and meanings of media for (some) young people in Recife, a million-inhabitant city in the northeast of Brazil. The article brings together the perspective of Anne Line Dalsgaard, a long-term anthropological field researcher who is familiar with the ......The article is focused thematically on the uses and meanings of media for (some) young people in Recife, a million-inhabitant city in the northeast of Brazil. The article brings together the perspective of Anne Line Dalsgaard, a long-term anthropological field researcher who is familiar...... is discussed centrally in this attempt to contribute to an empirically grounded understanding of the role that media play for youth in their striving to ‘find a place in life'. In the empirical context presented in the article, imaginations, expanded and circulated by a globalized media circuit...

  8. Presenting practice financial information.

    Science.gov (United States)

    Webster, Lee Ann H

    2007-01-01

    Medical practice leadership teams, often consisting primarily of physicians with limited financial backgrounds, must make important business decisions and continuously monitor practice operations. In order to competently perform this duty, they need financial reports that are relevant and easy to understand. This article explores financial reporting and decision-making in a physician practice. It discusses reports and tools, such as ratios, graphs, and comparisons, that practices typically include in their reports. Because profitability and cash flow are often the most important financial considerations for physician practices, reports should generally focus on the impact of various activities and potential decisions upon these concerns. This article also provides communication tips for both those presenting practice financial information and those making the decisions. By communicating effectively, these leaders can best use financial information to improve decision-making and maximize financial performance.

  9. Presentation of Canada

    International Nuclear Information System (INIS)

    Hedley, Dianne E.

    1997-01-01

    In contingency of a nuclear emergency event, requiring application of intervention measures on a federal scale, Canada has of a plan ensuring the compatibility of the plans of different provinces and serving as interface between federal and provincial authorities. Exclusive of a nuclear attack against North America, by nuclear emergency it is understood an accident resulting in radionuclide release. This is called the Plan of federal intervention in case of nuclear emergency. 'Sante Canada' is the federal authority responsible for intervention in case of nuclear emergency and it has the task of preparing and coordinating the actions on a federal scale.Should the plan be set in action and if the emergency has repercussions upon the agricultural sector, the sustaining organism will be 'Agriculture and agroalimentaire Canada' which in case of emergency acts through the channels of the National System of intervention in the agro-alimentary sector (SNIUA). The paper presents the objectives, the principles of organization and operation, the responsibilities and the plans which SNIUA has in its charge to implement in case of emergency

  10. STS-69 postflight presentation

    Science.gov (United States)

    1995-10-01

    A postflight conference of the STS-69 mission is presented. The flightcrew ('The Dog Team') consisted of Cmdr. David Walker, Pilot Kenneth Cockrell, Payload Cmdr. James Voss, and Mission Specialists James Newman and Michael Gernhardt. The mission's primary objective was the deployment and retrieval of the SPARTAN-201 satellite, which investigated the interaction between the Sun and it's solar wind. Other secondary experiments and shuttle payloads included the Wake Shield Facility (WSF), which grew several layers of semiconductor films, the International Extreme Ultraviolet Hitchhiker (IEH-1), the Capillary Pumped Loop-2/Gas Bridge Assembly (CAPL-2/GBA), several Get Away Specials (GAS) experiments, the Electrolysis Performance Improvement Concept Study (EPICS), the Thermal Energy Storage (TES-2) experiment, the Commercial Generic Bioprocessing Apparatus-7 (CGBA-7), the National Institutes of Health-Cells 4 (NIH-C4) experiment, and the Biological Research in Canister-6 (BRIC-6) experiment. Earth views consisted of Saudi Arabia water wells, uncommon vortices over Oman, the Amazon River, the Bahamas, Somalia, a sunset over the Earth's horizon, and two hurricanes, Luis and Marilyn.

  11. Present energy status

    Energy Technology Data Exchange (ETDEWEB)

    Desprairies, P

    1988-04-01

    This paper reviews the past and present situation of the World Oil Market and assumes future trends and possible future evolution. Low oil prices between 1950 and 1973 have contributed to an exceptional growth of oil demand during more than 20 years which was more and more supplied by OPEC. The oil shocks of 1973 and 1979 have dramatically changed this situation. Some of the most important changes have been the emergence of non-OPEC new oil producers, the growth of substitute energies, especially natural gas and nuclear power, on the supply side; and substantial decrease of energy consumption in many industrialized countries which has greatly reduced oil demand to OPEC on the demand side. Today this situation seems somewhat stabilized (after the reversal of world oil prices in 1986) and OPEC is producing around 18 million b/day as against a producing capacity of about 30 million b/day. It is generally considered that in coming years oil prices will remain relatively low (or occasionally even become lower than today) due to excess oil production capacity and relative abundance of other types of energy. However, many experts think that these trends can be reversed when oil supply will more and more concentrate again in the Middle East; but it is hard to say if this will begin in 1995, 2000, 2010.

  12. The laryngocele; case presentation

    Directory of Open Access Journals (Sweden)

    Gabriel V. Berteșteanu

    2016-05-01

    Full Text Available Laryngocele is a rare pathology, but because of their clinical evolution and the symptoms they generate, they should always be considered as a differential diagnosis when investigating neck masses. A laryngocele is basically a herniation of the mucosa of the laryngeal ventricle (Morgagni's ventricle arising usually from the saccular region. This herniation may remain confined to the larynx - in which case the laryngocele is internal- or expand through the thyro-hyoid membrane into the structures of the neck - thus being called an external laryngocele. Usually the laryngocele has both an internal and external component thus being a mixed laryngocele. Diagnosis of laryngoceles still relies heavily on clinical signs such as tympanism, easily depressible neck mass, indirect laryngoscopy, but is now simplified by imagistic investigations (ultrasound, CT and MRI. However, the treatment of this condition is exclusively surgical and consists of total excision of the laryngocele, as well as proper identification of the point of origin from the saccule and also the final suture of the breach in order to prevent recurrence. Investigation of possible causes of obstruction of the laryngeal ventricle should always be performed (because of the possibility of an underlying malignancy as well as a follow-up protocol of the patient, given the risk of relapse. We present a recently diagnosed case of a 32 year old man with mixed laryngocele, which we have operated in our clinic.

  13. [Antibiotics: present and future].

    Science.gov (United States)

    Bérdy, János

    2013-04-14

    The author discuss the up to date interpretation of the concept of antibiotics and antibiotic research, as well as the present role of various natural, semisynthetic and synthetic antibiotic compounds in various areas of the human therapy. The origin and the total number of all antibiotics and applied antibiotics in the practice, as well as the bioactive microbial metabolites (antibiotics) in other therapeutical, non-antibiotic fields (including agriculture) are also reviewed. The author discusses main problems, such as increasing (poly)resistance, virulence of pathogens and the non-scientific factors (such as a decline of research efforts and their sociological, economic, financial and regulatory reasons). A short summary of the history of Hungarian antibiotic research is also provided. The author briefly discusses the prospects in the future and the general advantages of the natural products over synthetic compounds. It is concluded that new approaches for the investigation of the unlimited possibilities of the living world are necessary. The discovery of new types or simply neglected (micro)organisms and their biosynthetic capabilities, the introduction of new biotechnological and genetic methods (genomics, metagenom, genome mining) are absolutely required in the future.

  14. IKONOS: future and present

    Science.gov (United States)

    Schaap, Niek

    2003-04-01

    The IKONOS satellite has been operational since January 2000 and was the first commercial satellite collecting imagery with 1 meter resolution. The current life expectancy of the satellite is 10 years. Since the launch, Space Imaging Inc. (the owner of the satellite) supplied IKONOS imagery to users in many vertical markets, such as: agriculture, defense, oil & gas and telecommunications. This oral presentation will give comprehensive information about IKONOS and the future: * Block II, the successor of IKONOS. Space Imaging expects to launch in 2004 a new high-resolution satellite, ensuring both continuity and (for some years) a tandem operation with IKONOS, greatly improving the availability of imagery. * Space Imaging affiliates. IKONOS imagery collected, processed and sold by regional affiliates. These regional affiliates are strategically located around the world, like Japan Space Imaging (Tokyo), Space Imaging Middle East (Dubai) and Space Imaging Eurasia (Ankara, Turkey). * Technical briefing IKONOS. IKONOS (compared to other commercial high-resolution satellites) has superior collection capabilities. Due to, the higher orbit altitude, local reception of the imagery, bi-directional scanning and the high agility of the satellite, is the IKONOS satellite capable to collect the imagery relative quickly.

  15. Presentation of Pydio

    CERN Multimedia

    CERN. Geneva

    2014-01-01

    **Pydio is an open-source platform for file sharing and synchronisation.** It is wildly used by enterprises and organizations worldwide, including major universities. Pydio comes with a rich web-based interface, native clients for both iOS and Android mobile devices, and lately a new sync client for desktop platforms. Pydio v6 is of great useability and introduces many new features that makes it the ultimate sharing machine. Its architecture makes it a perfect fit for either easily deploying an on-premise dropbox solution, or building more complicated solutions where the box feature is integrated as OEM. Storage-agnostic, Pydio is a simple layer that can be deployed on top of any storage backend, thus providing scalability and high-availability out-of-the-box. Charles du Jeu is the lead developer of the solution and will briefly present its feature and how it can fit for research and engineering purpose. See https://pyd.io/ for more information.

  16. THE UPSIDE OF PRESENTISM

    Directory of Open Access Journals (Sweden)

    Lynn Fendler

    2009-01-01

    Full Text Available El presentismo es visto generalmente como un mal necesario en historiografía. Este artículo explora lo positivo de esta inevitabilidad. Aplicando un enfoque filosófico al análisis discursivo en la tradición de la nueva historia cultural, se distingue -de una parte-¿ entre un uso estratégico del presentismo, y -de otra- un enfoque racionalista en historia. El artículo concluye considerando algunas implicaciones políticas en historiografía de las explicaciones racionalistas y de las explicaciones estratégicamente presentistas. Los modos de comprensión racionalistas inscriben las expectativas del pasado en las visiones del futuro; asignando al historiador el papel de profeta; y perpetuando nociones de agentes ahistóricos. En contraste, las historias estratégicamente presentistas incorporan una orientación que deliberadamente emplea las lentes y perspectivas del presente en orden a tener en cuenta supuestos y perspectivas actuales. Cuando las asunciones son examinadas en relación a las perspectivas presentistas, dichos presupuestos sueltan su rienda en el pensamiento. Dado que el presentismo es inevitable, no debe ser desestimado por completo, sino que debe ser una cuestión sondeada y examinada críticamente. Con dicho foco, el presentismo estratégico en la historiografía debe posibilitar una reflexión sobre los límites de lo que es posible pensar.

  17. Texts of presentation

    Energy Technology Data Exchange (ETDEWEB)

    Magnin, G.; Vidolov, K.; Dufour-Fallot, B.; Dewarrat, Th.; Rose, T.; Favatier, A.; Gazeley, D.; Pujol, T.; Worner, D.; Van de Wel, E.; Revaz, J.M.; Clerfayt, G.; Creedy, A.; Moisan, F.; Geissler, M.; Isbell, P.; Macaluso, M.; Litzka, V.; Gillis, W.; Jarvis, I.; Gorg, M.; Bebie, B.

    2004-07-01

    Implementing a sustainable local energy policy involves a long term reflection on the general interest, energy efficiency, distributed generation and environmental protection. Providing services on a market involves looking for activities that are profitable, if possible in the 'short-term'. The aim of this conference is to analyse the possibility of reconciling these apparently contradictory requirements and how this can be achieved. This conference brings together the best specialists from European municipalities as well as important partners for local authorities (energy agencies, service companies, institutions, etc.) in order to discuss the public-private partnerships concerning the various functions that municipalities may perform in the energy field as consumers and customers, planners and organizers of urban space and rousers as regards inhabitants and economic players of their areas. This document contains the summaries of the following presentations: 1 - Performance contracting: Bulgarian municipalities use private capital for energy efficiency improvement (K. VIDOLOV, Varna (BG)), Contracting experiences in Swiss municipalities: consistent energy policy thanks to the Energy-city label (B. DUFOUR-FALLOT and T. DEWARRAT (CH)), Experience of contracting in the domestic sector (T. ROSE (GB)); 2 - Public procurement: Multicolor electricity (A. FAVATIER (CH)), Tendering for new green electricity capacity (D. GAZELEY (GB)), The Barcelona solar thermal ordinance (T. PUJOL (ES)); 3 - Urban planning and schemes: Influencing energy issues through urban planning (D. WOERNER (DE)), Tendering for the supply of energy infrastructure (E. VAN DE WEL (NL)), Concessions and public utility warranty (J.M. REVAZ (CH)); 4 - Certificate schemes: the market of green certificates in Wallonia region in a liberalized power market (G. CLERFAYT (BE)), The Carbon Neutral{sup R} project: a voluntary certification scheme with opportunity for implementation in other European

  18. Crystallography: past and present

    Science.gov (United States)

    Hodeau, J.-L.; Guinebretiere, R.

    2007-12-01

    structure (chemical order, anisotropy, charge transfer, magnetic order) versus an external parameter like temperature, pressure, magnetic or electric field. Modern crystallography is also extended to the study of very small crystals, powders, ill-ordered or non-crystallized materials. Thus presently, crystallography is concerned with any solid that “scatters” an incident beam. Nevertheless, as quoted by A. Guinier, “the problems facing crystallographers have only changed, ... new ones have appeared which require reflection and imagination, ... and which in turn may still bring much joy to all those who like crystallography” [4]. Such developments open up crystallography to modern materials like artificial ones and nanostructures with low- and/or multi-scaled-periodicities and/or extremely small “crystal size” and to materials of the “real world”, with mixtures of phases and/or amorphous contribution and/or defects, a common characteristic of ancient materials analysed in patrimonial research. In our contribution we will show by selected examples that these improvements were allowed (i) by the use of powerful sources, apparatus and detectors which allow micro-diffraction, in-situ diffraction, spectroscopy, resonant scattering, inelastic scattering, coherent scattering, (ii) by the development of methods like diffraction anomalous fine structure (DAFS), pair distribution function (PDF), simulated annealing, single object reconstruction, (iii) by combination of scattering and spectroscopy and by combination of scattering and microscopy. Such combination of different approaches is very efficient and, as said by H. Curien at the IUCr Bordeaux Congress in 1990, “in crystallography, there is a constant alternation between the crystal space and its associated reciprocal space, ... the alternation between experiment and model building is another feature of crystallography activity ..., the crystallographer relies both on his computer and on his diffractometer

  19. Transcutaneous oxygen tension in imminent foot gangrene

    DEFF Research Database (Denmark)

    Tønnesen, K H

    1978-01-01

    Transcutaneous oxygen tension at 44 degree C and maximal isotope clearance (90m Tc-pretechnetate + histramine) just proximal to the 1st toe and systolic toe blood pressure (strain gauge) were studied on a tilt table in patients with various degrees of obstructive arteriosclerotic disease. In legs...

  20. Penile gangrene due to calcific uremic arteriopathy

    African Journals Online (AJOL)

    2011-06-15

    Jun 15, 2011 ... 2Department of Medicine, Nephrology Unit, 3Department of Medicine, Infectious Disease Unit, King Fahad. Medical City, Riyadh, Kingdom of Saudi Arabia. Correspondence to: Dr. .... Russell R, Brookshire MA, Zekonis M, Moe SM. Distal calcific uremic arteriolopathy in a hemodialysis patient responds to ...

  1. present

    African Journals Online (AJOL)

    as medium of instruction enhances concept formation, especially in science subjects as ... The study, on which this paper is based, was conducted to evaluate Malawi's ... corrected in the wake of information flowing from the evaluation phase (Kaplan .... concerning the background information and suggested activities (Thodi,.

  2. PRESENTATION

    OpenAIRE

    Editors, The

    2017-01-01

    To plan and to implement academic projects remain a systematic challenge for the team and the collaborators of the Electronic Journal. Each study published is an opportunity to strengthen the proposed goals and to add more value to the community involved and interested.

  3. Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    The aim of the Exploratory Workshop is to encourage informal discussion and the exchange of expertise between scientists using random matrix theory in various areas of research ranging from fundamental physics: string theory, gravity, quantum chaos, information theory, complexity theory, combinatorics to applied research: biophysics, econophysics, quantitative finance and telecommunication. Such a discussion would be a first step towards creating a common European environment for researchers using this powerful theory

  4. Clinical characteristics and outcomes of bacteraemic melioidosis in a teaching hospital in a northeastern state of Malaysia: a five-year review.

    Science.gov (United States)

    Deris, Zakuan Zainy; Hasan, Habsah; Siti Suraiya, Mohd Noor

    2010-08-04

    Melioidosis is an important public health problem causing community acquired sepsis in the northeastern part of Malaysia. From January 2001 to December 2005, we reviewed case reports of all bacteraemic melioidosis admitted to a tertiary teaching hospital, Hospital Universiti Sains Malaysia. Thirty-five patients had positive blood culture for meliodosis and 27 case reports were traceable for further analysis. The mean age was 46.8 + 20.0 years. Twenty patients (74.1%) were male. The main clinical presentation was fever that occurred in 23 (85.2%) patients. Eighteen patients (66.7%) had lung involvement and three patients had liver abscess. Two patients presented with scrotal swelling, one of whom further developed Fournier's Gangrene. Nineteen (70.4%) patients had underlying diabetes, five of whom were newly diagnosed during the admission. Thirteen (48.1%) patients were treated with high-dose ceftazidime and six (22.2%) patients were treated with imipenem. Eight (29.6%) patients were not given anti-melioidosis therapy because the causative agents were not identified until after the patients died. The patients were admitted 16.8 days + 18.1. Seventeen patients (63.0%) died in this series, 13 patients of whom died within four days of admission. The wide range of clinical presentations and the fatal outcomes of melioidosis require a high level of suspicion among physicians to develop an early appropriate therapy and reduce the mortality rate.

  5. Anorectal emergencies

    Science.gov (United States)

    Lohsiriwat, Varut

    2016-01-01

    Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. PMID:27468181

  6. Tips for Good Electronic Presentations.

    Science.gov (United States)

    Strasser, Dennis

    1996-01-01

    Describes library uses of presentation graphics software and offers tips for creating electronic presentations. Tips include: audience retention; visual aid options; software package options; presentation planning; presentation showing; and use of text, colors, and graphics. Sidebars note common presentation errors and popular presentation…

  7. Punch up your podium presentations.

    Science.gov (United States)

    Wood, Tim J; Hollier, Amelie

    2017-08-01

    The goal of most presentations is to engage audience participants. Effective presenters go beyond content expertise to connect with audiences through various techniques, formats, and presentation styles. Mayer's theory of multimedia learning, neurocognitive factors, and the assertion-evidence approach are essential elements that presenters can use if they have not had formal training in creating presentations. Tips are offered on how to connect with the audience and how to avoid known pitfalls. ©2017 American Association of Nurse Practitioners.

  8. Put Power into Your Presentations: Using Presentation Software Effectively

    Science.gov (United States)

    Safransky, Robert J.; Burmeister, Marsha L.

    2009-01-01

    Microsoft PowerPoint, Apple Keynote, and OpenOffice Impress are relatively common tools in the classroom and in the boardroom these days. What makes presentation software so popular? As the Chinese proverb declares, a picture is worth a thousand words. People like visual presentations. Presentation software can make even a dull subject come to…

  9. Present market for nuclear energy

    International Nuclear Information System (INIS)

    Marzo, M.A.S.

    1987-01-01

    The present market for nuclear energy is present since nuclear production and electric power generation to the utilization of radioisotopes in medicine and biology. Some data about the main world suppliers to this market are shown. (E.G.) [pt

  10. Integral Presentations of Catalan Numbers

    Science.gov (United States)

    Dana-Picard, Thierry

    2010-01-01

    We compute in three different ways the same definite parametric integral. By-products are the derivation of a combinatorial identity and two integral presentations of Catalan numbers. One of them leads to a presentation using the [gamma] function.

  11. An Atypical Presentation on Insulinoma

    Science.gov (United States)

    2017-06-16

    PUBLICATIONS/ PRESENTATIONS 1. TO: CLINICAL RESEARCH 2. FROM: (Author’s Name, Rank, Grade, Office Symbol) 3. GME/GHSE STUDENT: 4. PROTOCOL NUMBER: Kluesner...PROCESSING OF PROFESSIONAL MEDICAL RESEARCH/TECHNICAL PUBLICATIONS/ PRESENTATIONS 1st ENDORSEMENT (59 MDW/SGVU Use Only) TO: Clinical Research Division 24...CAPT JOSEPH KLUESNER FROM: 59 MDW/SGYU SUBJECT: Professional Presentation Approval 1. Your paper, entitled An Atypical Presentation of Insulinoma

  12. Turning Scientific Presentations into Stories

    Science.gov (United States)

    Aruffo, Christopher

    2015-01-01

    To increase students' confidence in giving scientific presentations, students were shown how to present scientific findings as a narrative story. Students who were preparing to give a scientific talk attended a workshop in which they were encouraged to experience the similarities between telling a personal anecdote and presenting scientific data.…

  13. Dressed to Present: Ratings of Classroom Presentations Vary with Attire

    Science.gov (United States)

    Gurung, Regan A. R.; Kempen, Laura; Klemm, Kayla; Senn, Rebecca; Wysocki, Rosie

    2014-01-01

    This study investigates the effects of formality of dress on ratings of classroom presentations. Participants (N = 65, 66% women) from a Midwestern university in the United States rated three female students giving a presentation designed for a health psychology class in one of four outfits: casual, party, business casual, or business formal.…

  14. Isolated Torticollis May Present as an Atypical Presentation of Meningitis

    Directory of Open Access Journals (Sweden)

    Roger Chirurgi

    2012-01-01

    Full Text Available Background. Bacterial meningitis is a life-threatening medical emergency that requires urgent diagnosis and treatment. Diagnosis is infrequently missed if the patient presents with the classic symptoms of fever, headache, rash, nuchal rigidity, or Kernig or Brudzinski sign. However, it may be less obvious in neonates, elderly, or immunocompromised patients. Meningitis which presents as isolated torticollis, without any other signs or symptoms, is exceedingly rare. Objective. To identify an abnormal presentation of meningitis in an adult immunocompromised patient. Case Report. We present a case of an adult diabetic male who presented multiple times to the ED with complaint of isolated torticollis, who ultimately was diagnosed with bacterial meningitis. Conclusion. We propose that in the absence of sufficient explanation for acute painful torticollis in an immunocompromised adult patient, further evaluation, possibly including a lumbar puncture may be warranted.

  15. Discussion paper (presented during meeting)

    International Nuclear Information System (INIS)

    Allemand, R.

    1975-01-01

    A method of particle localization for gas chambers (backgammon game method) is presented. The cathode is geometrically cut in such a way that it is possible to establish a simple relation between the signal amplitude on the different parts of the cathode and the position of the nuclear event. The results obtained in the case of x-ray detectors are presented. The application of this method to the localization of neutrons is presently studied [fr

  16. Unusual presentation of Klinefelter syndrome

    Science.gov (United States)

    Das, Chanchal; Sahana, Pranab Kumar; Sengupta, Nilanjan; Roy, Mukut; Dasgupta, Ranen

    2013-01-01

    Introduction: Klinefelter syndrome usually presents in the puberty and adulthood with its characteristic features. We report a boy who had Klinefelter syndrome with hypospadias and hydrocele. Case Note: Six and half year old boy had complaints of genitourinary problem in the form of hypospadias, small phallus and hydrocele. Karyotyping showed 47,XXY. Conclusion: This case illustrates that Klinefelter syndrome was presented in the infancy with hypospadias and hydrocele which are very uncommon presentation of the disease PMID:24910838

  17. Retinoblastoma: a most unusual presentation

    African Journals Online (AJOL)

    Dr. C. Pedro-Egbe

    Although leukocoria and strabismus are the most common presenting signs of retinoblastoma, a retrospective study by Abramson et al. identified 32 distinct presenting signs of retinoblastoma.6-8. A few other studies have also noted some distinct characteristics exhibited by children whose conditions were diagnosed in the ...

  18. Present status of processing method

    Energy Technology Data Exchange (ETDEWEB)

    Kosako, Kazuaki [Sumitomo Atomic Energy Industries Ltd., Tokyo (Japan)

    1998-11-01

    Present status of processing method for a high-energy nuclear data file was examined. The NJOY94 code is the only one available to the processing. In Japan, present processing used NJOY94 is orienting toward the production of traditional cross section library, because a high-energy transport code using a high-energy cross section library is indistinct. (author)

  19. Uncommon presentation of neuro- cysticercosis

    African Journals Online (AJOL)

    Uncommon presentation of neuro- cysticercosis. Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system caused by the pork tapeworm Taenia solium. The clinical presentation of NCC in children includes generalised and partial seizures with or without features of raised intracranial pressure.

  20. Presentation Skills Workshops for Nurses.

    Science.gov (United States)

    Kinn, S.; Kenyon, M.

    2002-01-01

    Workshops were held to prepare nurses (n=87) to present results of professional activities. One year after the course, 20 had made oral and 30 written presentations. The workshops increased their confidence and were considered practical, informal, and nonthreatening. (Contains 31 references.) (SK)

  1. Castleman's disease, an unusual presentation

    Directory of Open Access Journals (Sweden)

    Shital Munde

    2015-01-01

    The present report describes a 30-year-old serving male who presented with pain abdomen and on and off episodes ofmelena, found to have peripancreatic lymphadenopathy on CECT abdomen. Ultrasound guided FN AC was done in private hospital revealed reactive lymphadenopathy. Excision biopsy was done in our institute and a diagnosis of Castleman's disease was made.

  2. Multiphasic presentation of Rasmussen's encephalitis

    NARCIS (Netherlands)

    Avbersek, A.; Miserocchi, A.; McEvoy, A.W.; Patel, A.V.; Aronica, E.; Blumcke, I.; Jacques, T.S.; Acheson, J.; Thom, M.; Sisodiya, S.M.

    2015-01-01

    Rasmussen's encephalitis is a rare, chronic inflammatory disorder of unknown cause, characterised by drug-resistant focal epilepsy that may rarely present in adolescence or adulthood. We present a case of Rasmussen's encephalitis with prominent recurrent fluctuation in symptoms and well-documented

  3. Creating an effective poster presentation.

    Science.gov (United States)

    Taggart, H M; Arslanian, C

    2000-01-01

    One way to build knowledge in nursing is to share research findings or clinical program outcomes. The dissemination of these findings is often a difficult final step in a project that has taken months or years to complete. One method of sharing findings in a relaxed and informal setting is a poster presentation. This method is an effective form for presenting findings using an interactive approach. The milieu of a poster presentation enables the presenters to interact and dialogue with colleagues. Guidelines for size and format require that the poster is clear and informative. Application of design helps to create visually appealing posters. This article summarizes elements of designing and conducting a poster presentation.

  4. Atypical presentations of Wolframs syndrome

    Directory of Open Access Journals (Sweden)

    S Saran

    2012-01-01

    Full Text Available Background: Wolfram syndrome is a rare hereditary or sporadic neurodegenerative disorder also known as DIDMOAD. The classically described presentation is of insulin-dependent diabetes, followed by optic atrophy, central diabetes insipidus, and sensory neural deafness. Also included are less well-described presentations of Wolframs syndrome. We here present three cases of atypical presentation of this syndrome. Case 1: A 15-year-old boy with insulin-dependent diabetes was presented for evaluation of depressive symptoms associated with suicidal tendency. Neuropsychiatric manifestations are described with Wolframs syndrome, and wolframin gene, in recessive inheritance, is associated with psychiatric illnesses without other manifestations of Wolframs syndrome. Case 2: A 17-year-old diabetic boy on insulin with good control of blood sugar presented for evaluation of delayed puberty. Central hypogonadism and other anterior pituitary hormone dysfunctions are the less publicized hormone dysfunctions in Wolframs syndrome. Case 3: A 23-year-old female who was on insulin for diabetes for the past 14 years, got admitted for evaluation of sudden loss of vision. This patient had developed a vitreous hemorrhage and, on evaluation, was found to have optic atrophy, sensory neural hearing loss, and diabetes insipidus, and presented differently from the gradual loss of vision described in Wolframs syndrome. Conclusion: Wolframs syndrome being a multisystem degenerative disorder can have myriad other manifestations than the classically described features. Neuropsychiatric manifestations, depression with suicidal risk, central hypogonadism, and secondary adrenal insufficiency are among the less well-described manifestations of this syndrome.

  5. An unusual presentation of sporotrichosis

    Directory of Open Access Journals (Sweden)

    S S Vaishampayan

    2013-01-01

    Full Text Available Sporotrichosis can mimic a few diseases. Sporotrichosis presenting as a hypoaesthetic plaque or plaque suggestive of leprosy has not been mentioned in literature. Herein we present a case of a 26 years old man who presented with hypoesthetic plaque on left ankle and was clinically diagnosed to have borderline tuberculoid leprosy who later developed few nodules in linear fashion on left leg, which ruptured to form non healing ulcers. Culture from ulcer grew Sporothrix schenckii. Patient was successfully treated with oral potassium iodide.

  6. Rhabdomyosarcoma presenting as acute leukemia.

    Science.gov (United States)

    Morandi, S; Manna, A; Sabattini, E; Porcellini, A

    1996-08-01

    We describe a case of a very unusual presentation of rhabdomyosarcoma. An 18-year-old woman presented with symptoms and signs compatible with acute leukemia. The bone marrow picture showed diffuse involvement sustained by undifferentiated blasts that turned out to be of striated muscle origin by immunochemistry. While it is well known that rhabdomyosarcoma may metastasize to the bone marrow, extensive marrow involvement with leukemic spread as a unique clinical manifestation is extremely rare. Our observation further confirms the need to consider rhabdomyosarcoma among the possible differential diagnoses in patients who present with a leukemic picture and atypical blasts lacking all hematopoietic markers.

  7. Clinical presentation of thyroid cancer

    International Nuclear Information System (INIS)

    Samuel, A.M.; Shah, D.H.

    1999-01-01

    The clinical manifestation of thyroid cancer (TC) as seen at the Nuclear Medicine Department, where the patients investigated prior to diagnosis of disease are clinically suspected to harbor malignancy and mostly referred for scintigraphic investigations are presented

  8. Hyperthyroidism: an unusual case presentation.

    Science.gov (United States)

    Scripture, D L

    1998-02-01

    Hyperthyroidism is the most common disorder of the thyroid. Patients typically present with complaints consistent with a hypermetabolic state, including nervousness, weight loss, heat intolerance, palpitations, irritability, and tremor. This case report reviews a 34-year-old woman who presented with unilateral upper extremity weakness, weight gain, and an episode of atrial fibrillation, the latter coinciding with a 36-hour lack of sleep and excess alcohol and caffeine intake. Although an extensive neurologic evaluation failed to identify any abnormality, the patient's laboratory analysis revealed elevations in thyroxine (T4) and triiodothyronine (T3) levels with unsuppressed thyroid-stimulating hormone levels. Subsequent treatment with the antithyroid drug methimazole (Tapazole) provided complete relief of symptoms. This case report illustrates how health care providers can be diverted to pursue a neurologic etiology when muscle weakness presents as a unilateral symptom. Plausible alternative causes for muscle weakness and other symptoms are presented.

  9. Thyrotoxic crisis presenting with jaundice.

    Science.gov (United States)

    Wickramasinghe, R D S S; Luke, W A N V; Sebastiampillai, B S; Gunathilake, M P M L; Premaratna, R

    2016-06-23

    Thyrotoxic crisis is a medical emergency requiring early diagnosis and urgent management, which can be challenging due to its diverse clinical presentations. While common presentations include fever, sweating, palpitations, tremors and confusion, presence of jaundice is rare. We report a 35-year-old male who presented with jaundice due to cholestasis along with other features of thyrotoxic crisis due to Graves' disease. He had a good clinical recovery with resolution of cholestasis following treatment for thyrotoxic crisis. Jaundice can be a rare manifestation of thyrotoxic crisis, and should be considered in the differential diagnosis when other clinical features of thyrotoxic crisis are present. However secondary causes of jaundice should be looked into and excluded.

  10. Presentation at FTP: A review

    International Nuclear Information System (INIS)

    Sheffield, J.

    1987-01-01

    This series of vugraphs presents some information concerning ORNL's involvement in the fusion energy research program. Recent and future experiments are named, and a rough estimate of funding is given

  11. Extradural lipomatosis presenting with paraplegia.

    Directory of Open Access Journals (Sweden)

    Deogaonkar M

    1995-07-01

    Full Text Available An unusual case with spinal extradural lipomatosis in a non-obese and otherwise healthy man is reported. The patient presented with a history of weakness of legs which progressed to paraplegia over a 40 day period.

  12. A centralized audio presentation manager

    Energy Technology Data Exchange (ETDEWEB)

    Papp, A.L. III; Blattner, M.M.

    1994-05-16

    The centralized audio presentation manager addresses the problems which occur when multiple programs running simultaneously attempt to use the audio output of a computer system. Time dependence of sound means that certain auditory messages must be scheduled simultaneously, which can lead to perceptual problems due to psychoacoustic phenomena. Furthermore, the combination of speech and nonspeech audio is examined; each presents its own problems of perceptibility in an acoustic environment composed of multiple auditory streams. The centralized audio presentation manager receives abstract parameterized message requests from the currently running programs, and attempts to create and present a sonic representation in the most perceptible manner through the use of a theoretically and empirically designed rule set.

  13. Hypertension presenting early in pregnancy

    OpenAIRE

    Melvin, Audrey; Kinsley, Brendan

    2015-01-01

    Key Clinical Message Paraganglioma in pregnancy is an exceedingly rare and potentially life?threatening diagnosis. It is important that the clinicians consider secondary causes when women present with hypertension in early pregnancy.

  14. HYDROGEOLOGIC CASE STUDIES (DENVER PRESENTATION)

    Science.gov (United States)

    Hydrogeology is the foundation of subsurface site characterization for evaluations of monitored natural attenuation (MNA). Three case studies are presented. Examples of the potentially detrimental effects of drilling additives on ground-water samples from monitoring wells are d...

  15. QCD machines - present and future

    International Nuclear Information System (INIS)

    Christ, N.H.

    1991-01-01

    The present status of the currently working and nearly working dedicated QCD machines is reviewed and proposals for future machines are discussed with particular emphasis on the QCD Teraflop Project in the US. (orig.)

  16. Unusual presentation of cutaneous leiomyoma

    Directory of Open Access Journals (Sweden)

    Sapnashree Bhaskar

    2014-01-01

    Full Text Available Herein, we report a case of leiomyoma cutis because of its rarity and unusual presentation. The case presented with a solitary leiomyoma lesion which was painless. However, the adjacent normal appearing area was tender. A biopsy of the lesion as well as of a portion of the adjacent normal appearing area was taken, which confirmed the diagnosis of cutaneous leiomyoma. This may suggest the dormant nature of the disease which has not yet become apparent.

  17. ECRIS 2010 - Proceedings and Presentations

    International Nuclear Information System (INIS)

    2012-01-01

    The workshop focussed on the latest developments in performance, modeling and applications of ECR ion sources along with the associated physics and technologies, including plasma physics, beam optics, beam diagnostics, magnet technology.... The presentations were organized around 8 topics: 1) status of ECRIS operation, 2) new developments, 3) ion beams and low energy beam transport (LEBT), 4) pulsed operation, 5) applications, and 6) plasma and beam investigations. Most papers are accompanied with the slides of their presentation

  18. AN UNUSUAL PRESENTATION OF DIC

    Directory of Open Access Journals (Sweden)

    Manish

    2015-10-01

    Full Text Available Placenta Praevia is a common obstetric problem which presents with antepartum H aemorrhage and is treated by the obstetrician. It is very rare to see a patient with placenta praevia treated in medical ward for post - partum H aemorrhage due to disseminated intravascular coagulation defect with the added complication of acute kidney injury, P ost - partum H ypertension and PRES (posterior reversible encephalopathy syndrome, hence the presentation

  19. Present and future superconducting cyclotrons

    International Nuclear Information System (INIS)

    Nolen, J.A. Jr.

    1987-01-01

    This paper begins with a brief review of the status of present superconducting (SC) cyclotron projects, including the two which are currently operating and the six which are under construction. The next section summarizes the main features shared by five of these machines, while the third section presents recent developments and new concepts introduced in the other three ''second generation'' SC cyclotrons. Projects in early stages of development are discussed in the fourth section

  20. Peripartum Cardiomyopathy Presenting as Bradycardia

    OpenAIRE

    Codsi, Elisabeth; Rose, Carl H.; Tweet, Marysia S.; Hayes, Sharonne N.; Best, Patricia J. M.; Blauwet, Lori A.

    2017-01-01

    Peripartum cardiomyopathy (PPCM) is a disease that typically affects young otherwise healthy women. As PPCM is associated with significant mortality, timely diagnosis is necessary to ensure appropriate care. To our knowledge, this represents the first reported case of PPCM presenting as symptomatic bradycardia. We describe the patient’s clinical presentation and relevant findings and review the potential etiology and ramifications of bradycardia in patients with PPCM.

  1. Presentation of the ASTRAL software; Presentation du logiciel ASTRAL

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    This report presents the ASTRAL software (ASTRAL means technical assistance in post-accidental radioprotection) which is aimed to be used as an aid-to-decision tool in the case of an important release of radionuclides in the environment by assessing radionuclide concentration in different environments and food products, determining the potential exposure to irradiation of concerned populations, foreseeing the evolution of the situation, and proposing different scenarios for the management of contaminated areas. The report describes the software general operation, presents the calculation module (main functionalities, concentration index calculation, dose calculation or radiological impact calculation, how countermeasures are taken into account), the data bases (contextual data, data for radio-ecological calculations and for radiological calculations), the software ergonomics (general principles, result selection and display, result printing and input data). Its briefly evokes the development quality assurance, and describes the software implementation architecture

  2. Dexmedetomidine overdosage: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Soumya S Nath

    2013-01-01

    Full Text Available We present a case of dexmedetomidine toxicity in a 3-year-old child. The case report describes the features and outlines the treatment strategy adopted. The child presented with bradypnoea, bradycardia, hypotension, deep hypnosis and miosis. He was successfully managed with oxygen, saline boluses and adrenaline infusion. He became haemodynamically stable with adrenaline infusion. He started responding to painful stimuli in 3 h and became oriented in 7 h. Dexmedetomidine, a selective α2 adrenoceptor agonist, is claimed to have a wide safety margin. This case report highlights the fact that dexmedetomidine administered in a toxic dose may be life-threatening may present with miosis and adrenaline infusion may be a useful supportive treatment.

  3. Neonatal hemophilia: a rare presentation

    Directory of Open Access Journals (Sweden)

    Nuno Ferreira

    2015-12-01

    Full Text Available Hemophilia A is a X-linked hereditary condition that lead to decreased factor VIII activity, occurs mainly in males. Decreased factor VIII activity leads to increased risk of bleeding events. During neonatal period, diagnosis is made after post-partum bleeding complication or unexpected bleeding after medical procedures. Subgaleal hemorrhage during neonatal period is a rare, severe extracranial bleeding with high mortality and usually related to traumatic labor or coagulation disorders. Subgaleal hemorrhage complications result from massive bleeding. We present a neonate with unremarkable family history and uneventful pregnancy with a vaginal delivery with no instrumentation, presenting with severe subgaleal bleeding at 52 hours of life. Aggressive support measures were implemented and bleeding managed. The unexpected bleeding lead to a coagulation study and the diagnosis of severe hemophilia A. There were no known sequelae. This case shows a rare hemophilia presentation reflecting the importance of coagulation studies when faced with unexplained severe bleeding.

  4. Graphical presentation of participants' results

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    The results obtained by 19 participating dosimetry systems are presented in this section. Section 3 of the preceding report, ''Evaluation of the Results of the First IAEA Coordinated Research Program on Intercomparison for Individual Monitoring'', explains the format and conventions used for the graphical presentation. The system number appearing in the upper left hand corner of each page can be used to correlate the dosimeter design information found in Table 2 of the preceding report with the results. However, care should be used in drawing inferences from this correlation, since system performance depends on a number of factors other than detector selection and design characteristics. (orig.)

  5. Technical presentation: Next Generation Oscilloscopes

    CERN Multimedia

    PH Department

    2011-01-01

      Rohde & Schwarz "Next Generation Oscilloscopes" - Introduction and Presentation Agenda: Wednesday 23 March  -  09:30 to 11:30 (open end) Bldg. 13-2-005 Language: English 09.30 Presentation "Next Generation Oscilloscopes" from Rohde & Schwarz RTO / RTM in theory and practice Gerard Walker 10.15 Technical design details from R&D Dr. Markus Freidhof 10.45 Scope and Probe Roadmap (confidential) Guido Schulze 11.00 Open Discussion Feedback, first impression, wishes, needs and requirements from CERN All 11.30 Expert Talks, Hands on All Mr. Dr. Markus Freidhof, Head of R&D Oscilloscopes, Rohde & Schwarz, Germany; Mr. Guido Schulze, ...

  6. DOE Collegiate Wind Competition (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Jones, J.

    2014-02-01

    This presentation for the January Stakeholder Engagement and Outreach webinar outlines the expanded need for workers in the wind industry and provides an overview of the DOE Wind Competition (to be held in May 2014) and the guiding principles of the competition.

  7. Press book presentation progress report

    International Nuclear Information System (INIS)

    2001-07-01

    This document presents four french sites of the ANDRA concerning the radioactive waste disposal. The concerned site are the underground research laboratory of Meuse/Haute-Marne, the Aube Center, the TFA Center and the Manche Center. For each sites, data and information on the geophysics, the capacity, the management or the research programs are analysed. (A.L.B.)

  8. Rose breeding: past, present, prospects

    NARCIS (Netherlands)

    Vries, de D.P.; Dubois, L.A.M.

    1996-01-01

    In this review the PAST, PRESENT and PROSPECT will be considered as three separate periods in the history of the breeding and development of rose cultivars. The recurring theme is the genetic variation. This theme was chosen because there is justified doubt as to sufficient genetic variation

  9. Understanding Algorithms in Different Presentations

    Science.gov (United States)

    Csernoch, Mária; Biró, Piroska; Abari, Kálmán; Máth, János

    2015-01-01

    Within the framework of the Testing Algorithmic and Application Skills project we tested first year students of Informatics at the beginning of their tertiary education. We were focusing on the students' level of understanding in different programming environments. In the present paper we provide the results from the University of Debrecen, the…

  10. Experiments in Multimodal Information Presentation

    NARCIS (Netherlands)

    van Hooijdonk, Charlotte; Bosma, W.E.; Krahmer, Emiel; Maes, Alfons; Theune, Mariet; van den Bosch, Antal; Bouma, Gosse

    In this chapter we describe three experiments investigating multimodal information presentation in the context of a medical QA system. In Experiment 1, we wanted to know how non-experts design (multimodal) answers to medical questions, distinguishing between what questions and how questions. In

  11. Clinical Presentations of Acute Leukemia

    International Nuclear Information System (INIS)

    Shahab, F.; Raziq, F.

    2014-01-01

    Objective: To document the clinical presentation and epidemiology of various types of acute leukemia with their respective referral source at a tertiary level centre in Peshawar. Study Design: An observational study. Place and Duration of Study: Department of Pathology, Hayatabad Medical Complex (HMC), Peshawar, from January 2011 to May 2012. Methodology: A total of 618 bone marrow biopsy reports were reviewed. All biopsy reports labeled as acute leukemia were reviewed for age, gender, address, referring unit, diagnosis on bone marrow examination, presenting complaints, duration of illness and findings of clinical examination. Results: Ninety-two patients were diagnosed as suffering from acute leukemias (15%). ALL was most prevalent (46%), followed by AML (38%) and undifferentiated acute leukemia (16%). Males were affected more compared to females (60% vs. 40%). ALL and AML were predominant in pediatric (64%) and adults (77%) patients respectively. Patients from Afghanistan accounted for 33% of all cases followed by Peshawar (14%). Fever (77%), pallor (33%) and bleeding disorders (23%) were the main presenting complaints. Enlargement of liver, spleen and lymph nodes together was associated with ALL compared with AML (p = 0.004). Conclusion: ALL-L1 and AML-M4 were the most common sub-types. Fever, pallor and bleeding disorders were the main presenting complaints. Enlargement of liver, spleen and lymph nodes was more frequently associated with ALL compared to AML. (author)

  12. Reninoma presenting as cardiac syncope

    Science.gov (United States)

    Tak, Shahid I; Wani, Mohd Lateef; Khan, Khursheed A; Alai, Mohd Sultan; Shera, Altaf Hussain; Ahangar, Abdul G; Khan, Yasir Bashir; Nayeem-ul-Hassan; Irshad, Ifat

    2011-01-01

    Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia. PMID:21677812

  13. Unusual Presentation of Maydl's Hernia

    African Journals Online (AJOL)

    Nikhil NBA, Natarajan K, Mohanty A, et al. An. Unusual Case of Maydl's Hernia. Int J Cur Res Rev. 2013;5(6):22-5. 11. Ganesaratnam M. Maydl's hernia: Report of a Series of Seven Cases and Review of Literature. Brit J Surg. 1985;72:737-8. 12. Weledji EP, Mokake M, Ngowe MN. A Rare. Presentation of Maydl's Hernia.

  14. Secondary syphilis presenting as vertigo

    International Nuclear Information System (INIS)

    Bari, A.U.; Mehmood, T.; Khan, B.; Malik, N.; Malik, K.Z.; Sukhera, A.M.

    2006-01-01

    Syphilis is a chronic, systemic and sexually transmitted infectious disease affecting most of the organs in the body. A young African man presented with vertigo, unsteadiness of gait and a skin rash suggestive of secondary syphilis. Diagnosis was confirmed on serology and was treated with two shots of long-acting penicillin, following which his symptoms settled. (author)

  15. Energy consumption: Past, present, future

    Science.gov (United States)

    1973-01-01

    The energy consumption history of the United States and the changes which could occur in consumption characteristics in the next 50 years are presented. The various sources of energy are analyzed to show the limitations involved in development and utilization as a function of time available. Several scenarios were prepared to show the consumption and supply of energy under varying conditions.

  16. Learning through Dramatic Story Presentation

    Science.gov (United States)

    Tindall, Evie

    2012-01-01

    The use of story with dramatic presentation approaches produces an engaging and powerful instructional choice for today's adult ESL educators. Two engaging and timed-tested approaches are Reader's Theater and Tableau Vivant. Both provide English language learners with content tailored to their abilities in addition to numerable opportunities to…

  17. Police, managerialization and presentational strategies

    NARCIS (Netherlands)

    Terpstra, J.; Trommel, W.A.

    2009-01-01

    Purpose - The managerialization of the police may be seen as an effort to restore the legitimacy of the police. This paper aims to show that the managerialist strategy presently occurring within police forces creates new pitfalls and unintended consequences. Design/methodology/approach - The paper

  18. Viewfoils for environmental capabilities presentation

    International Nuclear Information System (INIS)

    1992-01-01

    This document contains information about the environmental applications of aerial surveys. It discusses the accuracy, dependability, history, advantages, and sensitivity of aerial surveys. Also included, are a brief overview of in-situ gamma spectroscopy and samples of aerial surveys. This document contains entirely of an outline and viewfoils for the presentation

  19. Present Day Philosophies of Education

    Science.gov (United States)

    Ediger, Marlow

    2006-01-01

    Presently, there are competing philosophies of education which need comparison. Two philosophies will be compared which are at opposite ends of the continuum. They are distinctly different. And yet, both schools of thought have their disciples. Each of the two will be discussed in terms of its essential features and then there will be selected…

  20. MAMMARY TUBERCULOSIS PRESENTING AS CARCINOMA

    African Journals Online (AJOL)

    She was otherwise well wizh no symptoms referable to other systems. On examination .... cardiac failure. The other ... but chronic oedema of the right arm of moderate degree was present. .... a tuberculous ulcer on the dorsum of the hand, followed ... venous system may also lead to haematogenous dissemination, producing ...

  1. The Present State of Behaviorism

    Science.gov (United States)

    Mowrer, O. Hobart

    1976-01-01

    Assesses the present status of behaviorism by dividing this study into an evaluation of Behaviorism 1, based explicitly on Pavlov's conception of conditioned-response learning, and Behaviorism 11, single-handedly launched and almost completely dominanted by Professor B. F. Skinner. (Author/RK)

  2. Petroleum - its present and future

    Digital Repository Service at National Institute of Oceanography (India)

    SenGupta, R.; Qasim, S.Z.

    World's "published proved" reserve of oil by the end of 1984 was known to be of the order of 95,000 million tonnes. Of this, 57% lies buried in the middle eastern countries. At the present rate of growth in consumption and production of oil...

  3. Reactor enclosure. BRC meeting presentation

    International Nuclear Information System (INIS)

    Fisch, J.W.

    1975-01-01

    The latest status of key components of the Reactor Enclosure System of the Clinch River Breeder Reactor Plant is described. Areas where there have been notable design changes or significant design detail maturity in the six months since the last BRC presentation are highlighted. (auth)

  4. Slide Composition for Electronic Presentations

    Science.gov (United States)

    Larson, Ronald B.

    2004-01-01

    Instructors who use computer-generated graphics in their lectures have many options to consider when developing their presentations. Experts give different advice on which typefaces, background and letter colors, and background imagery improve communications. This study attempted to resolve these controversies by examining how short-term recall of…

  5. Hypervideos and interactive multimedia presentations

    NARCIS (Netherlands)

    B. Meixner (Britta)

    2017-01-01

    textabstractHypervideos and interactive multimedia presentations allow the creation of fully interactive and enriched video. It is possible to organize video scenes in a nonlinear way. Additional information can be added to the video ranging from short descriptions to images and more videos.

  6. Unusual presentation of gallbladder perforation

    Directory of Open Access Journals (Sweden)

    G. Jayasinghe

    2016-01-01

    Conclusions: Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified.

  7. Neutrino astronomy: Present and future

    Indian Academy of Sciences (India)

    Abstract. I briefly review the present and future status of the burgeoning field of neu- ... near future build upon previous results. ... novel radio and acoustic techniques utilized by, for example, experiments such as. GLUE ... Left: Schematic of νµ-induced muon track in detector. Right: .... an eye toward the galactic center).

  8. BVDV: past, present, and future

    Science.gov (United States)

    The term bovine viral diarrhea (BVD) has come to refer to a collection of diverse clinical presentations that include respiratory, enteric and reproductive diseases accompanied by immunosuppression. BVD may be caused by one of three different species of bovine pestivirus, bovine viral diarrhea viru...

  9. Clustering semantics for hypermedia presentation

    NARCIS (Netherlands)

    Alberink, M.J.; Rutledge, L.W.; Hardman, H.L.; Veenstra, M.J.A.

    2004-01-01

    Semantic annotations of media repositories make relationships among the stored media and relevant concepts explicit. However, these relationships and the media they join are not directly presentable as hypermedia. Previous work shows how clustering over the annotations in the repositories can

  10. Summary of presentations and discussions

    International Nuclear Information System (INIS)

    Takeuchi, Mitsuo

    2008-01-01

    In December 2007, the Forum on Stakeholder Confidence discussed its theme entitled 'Link between research, development and demonstration (RD and D) and stakeholder confidence'. It was remarked that regulators need a technical demonstration to aid in evaluating the safety case. Local stakeholders appreciate the opportunity to visualise technological arrangements. In both cases, demonstration adds to confidence in the feasibility of solutions. Some believe there is an important role for analogues in communication with stakeholders, if handled with integrity. To explore and benchmark current practices, it was decided to hold a topical session at the 9. regular meeting of the FSC on 4 June 2008 regarding the use of analogues for confidence building. The session opened with an introductory presentation by the session rapporteur. This incorporated input provided for the purpose by FSC members in cooperation with their country's representative to the NEA RWMC 'Integration Group on the Safety Case'. Three speakers then presented the various uses of analogues by implementers, regulators and scientists to build their own confidence; a fourth speaker dealt with the experience of using natural analogues in public information. The presentations addressed the use of analogues in the field of geological disposal of high-level waste (HLW) and long-lived intermediate level (ILW-LL) radioactive waste. Then the FSC participants split into two working groups for discussion. The outcome of these discussions was reported in plenary on 6 June 2008 and it was agreed to publish proceedings of the session. The present summary, prepared by the session rapporteur with input from the NEA Secretariat, captures the main points heard in the course of the event. It combines data from the formal presentations and remarks made in discussion. The latter represent viewpoints expressed by a group whose primary focus is not natural analogues but rather stakeholder interests. The summary and viewpoints

  11. Pulmonary hyalinizing granuloma presenting with dysphagia: a rare presentation.

    Science.gov (United States)

    Khan, Fazal; Hamid, Arsalan; Fatima, Benish; Hashmi, Shiraz; Fatimi, Saulat

    2017-01-01

    A 25-year-old man presented with a 2-month history of dysphagia and past history of pulmonary and intestinal tuberculosis. A barium swallow showed a point of constriction 42 mm above the gastroesophageal junction. Computed tomography revealed large opacities in bilateral lung fields, encroaching more on the esophagus. The lesion progressively compressed the esophagus as it moved inferiorly. A right posterolateral thoracotomy was performed for sub-anatomical resection of the mass. A biopsy revealed homogenous whirling hyalinized collagen fibers, highly suggestive of pulmonary hyalinizing granuloma, with no evidence of malignancy. Pulmonary hyalinizing granuloma should be considered in the differential diagnosis of longstanding dysphagia.

  12. An unusual presentation of presentation of a branchial cleft cyst.

    Science.gov (United States)

    Vemula, Rahul; Greco, Gregory

    2012-05-01

    Branchial cleft cysts are congenital anomalies that arise from the aberrant embryological development of the branchial apparatus. The location of a branchial cleft cyst is determined by which branchial cleft failed to obliterate during embryological development, with the second branchial cleft cyst being the most commonly recognized lesion. Although the most common location for branchial cleft cysts is between the external auditory canal and the level of the clavicle, the literature does describe unusual locations. We present a case a 15-year-old boy who had an enlarging lesion on his back that had been present since birth. A presumptive radiologic diagnosis of lymphangioma circumscriptum was made. Upon excision of the lesion and pathologic examination, it was determined to be a branchial cleft cyst. The patient had an uneventful postoperative course, and no recurrence was noted after a 2-year follow-up. Our clinical report demonstrates a lesion on the posterior thorax that proved to be a branchial cleft cyst and should always be part of the differential diagnosis for soft tissue masses of the thorax.

  13. Presentation of the ASTRAL software

    International Nuclear Information System (INIS)

    2011-01-01

    This report presents the ASTRAL software (ASTRAL means technical assistance in post-accidental radioprotection) which is aimed to be used as an aid-to-decision tool in the case of an important release of radionuclides in the environment by assessing radionuclide concentration in different environments and food products, determining the potential exposure to irradiation of concerned populations, foreseeing the evolution of the situation, and proposing different scenarios for the management of contaminated areas. The report describes the software general operation, presents the calculation module (main functionalities, concentration index calculation, dose calculation or radiological impact calculation, how countermeasures are taken into account), the data bases (contextual data, data for radio-ecological calculations and for radiological calculations), the software ergonomics (general principles, result selection and display, result printing and input data). Its briefly evokes the development quality assurance, and describes the software implementation architecture

  14. Presentation of economic evaluation results.

    Science.gov (United States)

    Chaikledkaew, Usa

    2014-05-01

    The first HTA guidelines for Thailand included a chapter outlining a set of guidelines on how best to report the findings of health economic evaluations, based on a review of best practice and existing guidelines on the presentation of economic evaluation results from around the world. In this second edition of HTA guidelines for Thailand, the recommendations build on the first edition by using a case study to illustrate how the guidelines can be applied in a real research context. The guidelines propose that all reporting include ten key elements: defining the scope of the study, selection of comparator(s), defining the type of economic evaluation, measurement of costs, measurement of clinical effects, handling time in economic evaluation studies, handling uncertainty and sensitivity analysis, presentation of the results, discussion of the results, and disclosure of funding and authors conflict of interest.

  15. RTNS-II: present status

    International Nuclear Information System (INIS)

    Heikkinen, D.W.; Logan, C.M.

    1980-10-01

    The present status of the RTNS-II facility is described and typical operating parameters are given. A brief discussion is given of the methods used in production of the TiT 2 targets as well as their performance and tritium handling at RTNS-II. The various types of non-interactive beam diagnostics presently in use at the neutron sources are outlined. The on-line computer system which provides a time history of an irradiation and records target performance is described. Examples are listed of several representative experimental programs which have been carried out thus far at RTNS-II. These include both active and passive experiments. Finally, several of the major improvements to the facility made since the beginning of the experimental program are given

  16. Presentation of TVO's visitor's centre

    International Nuclear Information System (INIS)

    Aemmaelae, V.M.

    1993-01-01

    There are four nuclear power plant units in Finland, two of which are PWR's owned by Imatran Voima Oy. The two BWR units are located at Olkiluoto and owned by Teollisuuden Voima Oy. This presentation tells about TVO's concept of informing the visitors at Olkiluoto. At the site there are located, in addition to the two nuclear power plant units, the intermediate storage for spent fuel, the repository for low and medium-active waste as well as the training centre. At the Olkiluoto Visitor's Centre all the activities of the company are presented using varied audio-visual aids. The centre has several exhibits and there are also different installations to show how the plant works. (author)

  17. Amebiasis Presenting as Pleuropulmonary Disease

    OpenAIRE

    Kubitschek, Kenneth R.; Peters, Jay; Nickeson, David; Musher, Daniel M.

    1985-01-01

    Seven patients with amebic liver abscess presenting as pleuropulmonary disease were admitted to hospital initially because of pulmonary symptoms and were found to have amebic liver disease. Three categories of pleuropulmonary involvement included reactive inflammation of the pleura or lung, rupture of a hepatic abscess into the pleural space and rupture of a hepatic abscess into the bronchial airways. The preferred medical treatment is with metronidazole, but rupture of hepatic amebic abscess...

  18. Computer training, present and future.

    Science.gov (United States)

    Smith, G. A.

    1972-01-01

    The products of educational firms today lead toward a multimedia approach to the education and training of commercial programmers and systems analysts. Computer-assisted instruction or CAI is a relatively new medium to augment the other media. The government use of computers is discussed together with the importance of computer pretests. Pretests can aid in determining a person's ability to absorb a particular instructional level. The material presented in a number of computer courses is listed.

  19. Sarcoidosis presenting as penile mass

    Directory of Open Access Journals (Sweden)

    Hüseyin Semiz

    2017-01-01

    Full Text Available Sarcoidosis is an inflammatory disease with unknown cause characterized by noncaseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, eye, and musculoskeletal system involvement. Rare involvement of the genital organs (prostate, testis, epididymis has also been reported. However, penile involvement is observed quite rare. In this paper, we report a patient with penile mass who was diagnosed with sarcoidosis on the basis of the laboratory, radiological, and pathological investigations.

  20. Carcinoma caecum - a rare presentation

    International Nuclear Information System (INIS)

    Ali, T.; Mudasser, S.; Mudsser, S.; Sarwar, M.

    2010-01-01

    Caecal and right sided colonic cancers mostly present with fatigue, weakness and iron deficiency anemia. Such tumours rarely perforate posteriorly and involve the retroperitoneum. We report a case of an old Omani lady who came with insidious sign and symptoms of perforated caecum leading to retroperitoneal collection and necrotizing fasciitis of abdominal wall due to carcinoma of caecum. She underwent surgery but despite active intervention, she died because of septicemic shock. (author)