1,721,373 research outputs found
Fourniers Gangrene: Approaches to the Diagnosis and Treatment
No full textBackground: Fourniers gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum.Objective: The main aim of this study was to observe comprehensively the disease profile of Fourniers gangrene, with a specific intent to observe the proportion of patient presenting with Fourniers gangrene.Materials and method: This cross sectional study was done in Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh. By purposive sampling from the admitted patients of department of Surgery 22 patients were finalized according to the eligibility criteria. Patients were thoroughly evaluated and managed and all relevant data were recorded. Data were managed, edited and plotted in tabular and figure form. Data analysis was done by chi square test. p value was significant at <0.05.Results: The mean ±SD age of the patients was 43.9±14.82 years. Among the study subjects 68.2% showed insidious onset whereas remaining showed abrupt onset. Both cutaneous and anorectal factors claimed the highest (36.4%) of etiology. Pain and Oedema were the prime manifestation. In 59% cases testes were not exposed. In 36.4% cases only scrotum was involved whereas in 22.7% cases both scrotum and perineum were involved. After provision of aggressive treatment in 72.7% cases no complication was observed. During treatment 9.1% subjects expired.Conclusion: Elderly and low economic profile people are frequently affected with Fourniers gangrene. To reduce the significant morbidity and mortality aggressive medical and surgical management is mandatory.Delta Med Col J. Jul 2017 5(2): 68-75</jats:p
Fournier\'s Gangrene: Irrua Teaching Hospital, Nigeria, Experience.
No full textFournier\'s gangrene can no longer be considered idiopathic or a disease of
young adult males in apparent good health. This work aims to highlight the changes in the knowledge of the epidemiology vis-à-vis current management recommendations. This study is retrospective. Case files of seventeen patients seen within the ten-year period of 1997-2006 were retrieved, relevant information extracted. All were males who had easily identifiable aetiological factors. Perianal sepsis was the most common (23.53%) followed by diabetes mellitus (17.64%). The disease was fulminating in 2 (11.76%) with over all mortality of 2 (11.76%), one a diabetic and the other an HIV positive patient. Epidemiology
of Fournier\'s gangrene is better understood now. There is an a etiology in most of the cases. All our patients were males, a finding similar to other authors from the region and casting doubt on the existence of female genital gangrene. The prognosis is worse when it is associated with immune suppression from diabetes mellitus and HIV infection. Keywords: Fournier\'s gangrene. Changing epidemiology. Female genital gangrene. eponym. AfricansSudanese Journal of Dermatology Vol. 6 (1) 2008: pp. 34-4
Fournier′s gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient
No full textFournier′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
Fistula-in-Ano complicated by Fournier′s gangrene our experience in North-Eastern region of Nigeria
No full textBackground: 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
Medial thigh flap: An eminent method of reconstruction of scrotal defect following fournier′s gangrene
No full textBackground and Objectives: Fournier′s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal, and perineal regions. It is characterized by progressive spread of necrosis in the skin and subcutaneous tissue which results in defects of various sizes in perineal region. Various techniques have been described for the reconstruction of these defects such as split thickness skin grafts, muscle flaps (e.g., Gracilis flap), and fasciocutaneous flaps (e.g., pudendal flap), perineal flap, anterolateral thigh flap, deep inferior epigastric perforator flap, and anteromedial thigh flap. We intend to study the results of medial thigh flap procedure in patients with scrotal defect following Fournier′s gangrene. Materials and Methods: Medial thigh flap was performed in eight patients with Fournier′s gangrene. The patients were selected consecutively from December 2016 to December 2017. All patients were followed for 3-6 months postoperatively. Results: All flaps survived well. However, in two cases, there was partial distal necrosis. Both cases were managed conservatively. In all cases, donor site healed well except for one case in which infection of the donor site suture line occurred. It was managed by frequent dressing. Interpretation and Conclusions: The medial thigh flap is a reliable fasciocutaneous flap which can be done in reasonably short operative time to cover difficult defects with excellent results
Prospective evaluation of risk factors for mortality in patients of Fournier′s gangrene: A single center experience
No full textIntroduction: 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 >55 years, total leukocyte count >15000 cumm, extent of the area involved, septic shock at admission, visual analog scale (VAS) >7 at admission, and Fournier gangrene severity index (FGSI) score >8 at admission were significantly associated with increased mortality.
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
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Clinical & Microbiological profile of Fourniers Gangrene in a Tertiary Care Hospital in Bangladesh : A prospective observational study
No full textBackground: Fourniers gangrene is the necrotising fasciitis of the genitalia and perineum, with associated poly microbial infection. Evidence based data in the very recent years suggest that it is associated with significant and potential risk of organ failure or death.Aim: This study was designed to be conducted among the patients suffering from Fourniers gangrene with a view to assess the probable prevalence rate of potentially adverse clinical consequences during course of treatment, overall mortality and to observe the microbiological pattern in our surgical practice.Method & materials: This cross sectional study was conducted among the 69 patients of Fourniers gangrene in BIRDEM General Hospital, Dhaka, Bangladesh from Jan 10.2013 to Sept 01 .2016, using the purposive sampling method.Results: The results of this study reflects that majority (43.4%) of the study population were in 51 to 60 years age group( Mean age 43±1.7 years) in study population. By using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, it was found that in most of the patients (approx 56.5%), a suspicious score ranging 06-08 was observed and only in 10.1% patients, a specific score of ?08 was observed. In 27.5% patients systemic complications like DIC, ARDS, MODS, MSOF and severe sepsis were observed in 1.4%, 4.3%, 10.1%, 4.3% and 5.7% cases respectively. Mortality rate was approximately 4.3%. Majority (84.1%) of the patients were associated with type 1 (Polymicrobial) bacterial infection, whereas in case of 15.9% patients, it was associated with type 2 (Monomicrobial) infection. Escherichia coli was the most frequently observed micro-organisms associated with approximately 39.1% of all cases. S. aureus, Staphylococcus pyogenes, Enterococci species, E.coli and Pseudomonas species were recorded to be associated with 17.4%, 27.5%, 21.7%, 39.1 and 10.1% cases respectively.Conclusion: This study suggests that Fourniers gangrene is associated with significant systemic complications. Poly microbial infections are most predominant and E coli infection was commonest organism involved.Bangladesh Crit Care J March 2017; 5(1): 28-32</jats:p
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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