| The continuing challenge of Fournier's gangrene in the 1990s. | |
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MedLine Citation:
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PMID: 10597065 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Fournier's disease is a potentially fatal acute, gangrenous infection of the scrotum, penis, or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia. Thrombosis of small subcutaneous arterioles with resultant ischemia contributes to the rapid extension of the infection. During a 12-year period, the clinical and operative records of 14 patients with Fournier's gangrene were analyzed. All patients were treated with broad spectrum antibiotics and serial surgical debridements. Nine patients had polymicrobial isolates from the initial wound culture; two patients had Group A Streptococcus species as the sole isolate. The etiology of the infection was identified in 12 patients. Five patients died for an overall mortality of 38 per cent. The mean age of survivors was 51 years compared with 75 years for nonsurvivors (P<0.05). The last six patients in this series survived. The mean hospital stay was 29 days. Four patients (31%) had a prior history of diabetes; however, 11 patients (85%) had elevated serum glucose levels (>120 mg/dL) on admission. All patients were hypoalbuminemic on admission. Survivors had an average serum creatinine on admission of 1.28 mg/dL compared with 3.1 mg/dL for nonsurvivors. Although supportive care is required in these patients, the mainstay for treatment of Fournier's gangrene entails an aggressive approach with frequent and extensive soft tissue debridements to control the invasive nature of the infection with delayed wound coverage once the infection has been controlled. Elderly patients with evidence of renal dysfunction on admission have a poor prognosis despite aggressive therapy. |
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Authors:
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J N Olsofka; E H Carrillo; D A Spain; H C Polk |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The American surgeon Volume: 65 ISSN: 0003-1348 ISO Abbreviation: Am Surg Publication Date: 1999 Dec |
Date Detail:
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Created Date: 1999-12-23 Completed Date: 1999-12-23 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370522 Medline TA: Am Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1156-9 Citation Subset: IM |
Affiliation:
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Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Age Factors Aged Aged, 80 and over Anti-Bacterial Agents / therapeutic use Blood Glucose / analysis Cause of Death Creatinine / blood Debridement Diabetes Complications Fournier Gangrene / diagnosis*, physiopathology, surgery Humans Ischemia / physiopathology Length of Stay Male Middle Aged Penile Diseases / diagnosis Perineum / pathology Prognosis Retrospective Studies Scrotum / pathology Serum Albumin / analysis Streptococcal Infections / diagnosis Streptococcus pyogenes Survival Rate Thrombosis / physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 0/Blood Glucose; 0/Serum Albumin; 60-27-5/Creatinine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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