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...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.展开更多
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 ...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 severity.Early diagnosis,surgical debridement and aggressive fluid th展开更多
Background: Fournier gangrene is an acute and rapidly progressive necrotizing fasciitis of the scrotum, perianal and perineal region of the body. It is a polymicrobial infection having an interplay of both anaerobic a...Background: Fournier gangrene is an acute and rapidly progressive necrotizing fasciitis of the scrotum, perianal and perineal region of the body. It is a polymicrobial infection having an interplay of both anaerobic and aerobic orgasms in a soup of microbial disaster. Fournier’s gangrene was also initially thought to be an idiopathic condition but a lot of risk factors have been associated now with this condition, both systemic risk factors and local. Systemic risk factors include diabetes mellitus, HIV/AIDS, cancers, chronic liver disease, chronic steroid use etc. The local risk factors include perineal injuries, watering can perineum, perianal abscess, chronic perineal itching etc. Purpose: The swiftly flourishing bacteria orgasms cause a similar disruptive event in the body of the patients both clinically and biochemically and these can be used to create a predictive score or index for patients in order to assess the disease severity and guide in the management and prognostication of this condition. Materials and Method: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Folders were retrieved and the medical records were reviewed. Results: Of the 50 patients reviewed, Male to female ratio is 24:1. The mean age is 56 years (2 weeks to 97 years). Mortality rate was 34%. There is a significant difference between delayed presentation/initial use of unorthodox treatment with mortality (p = 0.002). Of the 17 patients that died, 15 had FGSI > 9 and of the 33 patients that survived 29 had FGSI 9 is 88.2% while the mortality rate for those with FGSI Conclusion: knowledge of the predictors of its mortality is necessary in other to help stratify patients and ensure the best response by the caregivers. FGSI, delayed presentation/initial patronage of unorthodox care, and polymicrobial infection are impor展开更多
Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving...Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .展开更多
Little is known about the toxic activity of the atrazine (a herbicide, commonly used in agricultural production) on the thyroid gland. In this study the compound was administered orally in female albino rats at sublet...Little is known about the toxic activity of the atrazine (a herbicide, commonly used in agricultural production) on the thyroid gland. In this study the compound was administered orally in female albino rats at sublethal exposure equivalent to 0.2 LD50 doses for 6 and 12 days. At termination of dosing the anesthetized animals were killed and blood was drawn for the determination of serum triiodothyronine (T3) and thyroxin (T4). A dose-dependent decrease of serum T3 concentration was observed in all the groups (control: 0.57 nmol·L-1; 6 days: 0.35 nmol·L-1; 12 days: 0.21 nmol·L-1). The thyroid gland was examined light-microscopically. Bouin's solution-fixed thyroids were embedded in paraffin and sections cut at 6 μm, stained separately with toluidine blue according to Slinchenko's method. Histologically in experimental groups epithelium featured small cuboidal cells and occasional structures of the follicles confluence within epitheliomers. A dose-dependent changes of the following parameters were observed: (a) increasing of number of follicle-building thyroid cells; (b) increasing of follicular volume, (c) decreasing of nucleus volume. Investigation of the whole population of thyroid mast cells disclosed no change in degranulation intensity. By contrast, degranulation intensity was decreased in perifollicular mast cells from groups treated with atrazine in dose-dependent manner.There are no changes observed in degranulation of stromal mast cells. These results suggesting that differences in response to the atrazine might account for an aspect of the functional heterogeneity within the rat thyroid mast cell population.展开更多
Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following...Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.展开更多
Despite being in arid and semi-arid areas,erosion is largely a result of infrequent but heavy rainfall events; therefore,rainfall erosivity data can be used as an indicator of potential erosion risks.The purpose of th...Despite being in arid and semi-arid areas,erosion is largely a result of infrequent but heavy rainfall events; therefore,rainfall erosivity data can be used as an indicator of potential erosion risks.The purpose of this study was to investigate the spatial distribution of annual rainfall erosivity in North Jordan.A simplified procedure was used to correlate erosivity factor R values in both the universal soil loss equation (USLE) and the revised universal soil loss equation (RUSLE) with annual rainfall amount or modified Fournier index (F mod ).Pluviometric data recorded at 18 weather stations covering North Jordan were used to predict R values.The annual values of erosivity ranged between 86-779 MJ mm ha ?1 h ?1 year ?1 .The northwest regions of Jordan showed the highest annual erosivity values,while the northeastern regions showed the lowest annual erosivity values.展开更多
Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The m...Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The mainstay of treatment is swift open drainage and early aggressive surgical debridement of all necrotic tissue, followed by targeted antibiotic therapy. The authors report on two patients who were admitted to the surgical ward. Both presented with initial perianal sepsis complicated by painful swollen scrotum with rapid progression of gangrene of the scrotal skin and subcutaneous tissue, extensive cellulitis of the perineum, and in one patient crepitation of the anterior abdominal wall. A diagnosis of Fournier’s Gangrene was made and they were both managed by prompt resuscitation, broad-spectrum antibiotics, extensive debridement of all necrotic tissue in theatre, daily wound dressing, and repeated neurectomy on the ward. One of the patients had a colostomy done and the other a cystostomy to divert feces and relieve chronic urinary retention respectively. These patients were successfully treated despite the severity of their conditions which was complicated by severe sepsis in the face of limited diagnostic capabilities and resources, using a multidisciplinary approach and basic clinical monitoring as a guide.展开更多
Background: Fournier's gangrene is a rapidly spreading necrotizing gangrene affecting the perineum, Perianal and genital regions but remarkably sparing the testicles, bladder and rectum due to their separate blood...Background: Fournier's gangrene is a rapidly spreading necrotizing gangrene affecting the perineum, Perianal and genital regions but remarkably sparing the testicles, bladder and rectum due to their separate blood supply which is directly from the aorta. The aim of this study is to share our experience with the management of 46 cases. Patients and method: We retrospectively analysed the medical records of 46 patients admitted with Fournier's gangrene between April 2005 and December 2011 in the urology unit of Aminu Kano Teaching Hospital. Data extracted from these include age, sex, hospital stay, premorbid diseases, mobility, mortality, laboratory investigations and treatments carried out. Results: Fourty six patients were admitted and managed for Fournier's gangrene during the study period. All the patients were male and mean age was 50 years (range 20 - 80 years). Five patients died (10.90%) mortality, 41 (89.10%) patients survived. The shortest hospital stay was 13 days and longest was 120 days. 45.7% of the patients had urethral stricture with watering can perineum as predisposing factor, 16 (34.80%) had diabetes mellitus, 7 (15.2%) had perineal injuries as the predisposing factors while 5 (10.90%) patients had uraemia and one patient (2.20%) each had bladder tumour and scrotal abscess as their predisposing factors, in 3 patients (6.50%) it was idiopathic. Only 34 (73.90%) patients had wound swab microscopy culture and sensitivity on admission. The culture grew Klebsiella spp. in 9 (26.50%), Staph aureus and E. coli in 5 (10.90%) of cases each, while Gram positive rod and Gram negative Cocci with 4 (11.80%) and 6 (17.60%) respectively. Conclusion: Fournier's gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals, is now changing pattern. Extensive surgical debridement and broad spectrum intravenous antibiotics remain the mainstay of treatment.展开更多
<strong>Introduction:</strong> Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortalit...<strong>Introduction:</strong> Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortality remains high despite advances in resuscitation. We report the experience of the surgery department of the Regional University Hospital Center (CHUR) of Ouahigouya in order to describe the epidemiological profile and the therapeutic aspects of GOGE. <strong>Patients and</strong> <strong>methods:</strong> We carried out a descriptive and analytical retrospective study collecting 41 cases of Fournier’s gangrene treated over 63 months (from March 2013 to July 2018) in the surgical department of the Ouahigouya regional university hospital center. Ethical clearance was taken from the institutional ethics committee. <strong>Results:</strong> The mean age of the patients was 65.02 ± 17.92 years with extremes of 23 years and 95 years. All patients were male. Urologic causes were the most common with 36.58% of cases. The average consultation time was 15.44 ± 16.04 days with extremes of 1 day and 60 days. All patients received resuscitation, bi or triantibiotherapy and surgical debridement. The mortality rate was 24.39%. The mean duration of hospitalization was 10.83 ± 6.257 days with extremes of 1 day and 60 days. <strong>Conclusion:</strong> The Fournier’s gangrene always has a very high lethality. Improving the prognosis requires fast and effective management.展开更多
<span style="font-family:Verdana;">Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. </span><b><b><span sty...<span style="font-family:Verdana;">Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. </span><b><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> We report the experience of the service in the management of Fournier gangrene of the external genital organs by inguinal flap pediculated in front of the loss of significant substances of the scrotum.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">Patients and method: This was a mono-centric retrospective study from January 2008 to August 2021 in the General Surgery Department of the Bocar Sidi Sall University Hospital (CHU BSS) in Kati. It focused on patients treated for Fournier gangrene of external genitals.</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The variables studied were age, sex, blood count, germs encountered, the antibiogram, duration of evolution, reconstruction of the scrotum by pedicle flap, and morbidity. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">During the study period we collected 5 cases of Fournier gangrene of external genitals in the service. The average age was 57.6 years and all the patients were male. The average duration of evolution was 5 days for an average age of 57.6 years. All patients were male. <i></i></span><i><i><span style="font-family:Verdana;">Echerichia coli</span></i><span style="font-family:Verdana;"></span></i> (<i><i><span style="font-family:Verdana;">E.</span></i><i><span style="font-family:;" "=""> </span></i><i><span style="font-family:Verdana;">coli</span></i><span style="font-family:Verdana;"></span></i>)<span> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">was the frequently observed germ followed by <展开更多
BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated w...BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.展开更多
BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of ...BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.展开更多
Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify pa...Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.展开更多
Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary...Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary conditions such as anal fistulas and abscesses.Methods:A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals—the Sixth Affiliated Hospital of Sun Yat-sen University and People’s Hospital Affiliated to Fujian University of Traditional Chinese—over the period from May 2013 to April 2017.Results:Sixty FG patients were included in this study.The common causative microorganisms cultured were Escherichia coli species.Genital and perirectal regional involvement was evident in 52 and 59 cases,respectively,although the perineum was unaffected in 7 cases(12%),as confirmed by imaging examination and surgical exploration.Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality(1.7%).Ten patients underwent protective colostomy.No patient underwent an orchidectomy and required urinary diversion.Conclusions:FG originating from the anorectal region can be rapidly progressive and life-threatening.Infection can spread superiorly to the genital region without the involvement in perineal tissue.An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.展开更多
文摘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.
文摘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 severity.Early diagnosis,surgical debridement and aggressive fluid th
文摘Background: Fournier gangrene is an acute and rapidly progressive necrotizing fasciitis of the scrotum, perianal and perineal region of the body. It is a polymicrobial infection having an interplay of both anaerobic and aerobic orgasms in a soup of microbial disaster. Fournier’s gangrene was also initially thought to be an idiopathic condition but a lot of risk factors have been associated now with this condition, both systemic risk factors and local. Systemic risk factors include diabetes mellitus, HIV/AIDS, cancers, chronic liver disease, chronic steroid use etc. The local risk factors include perineal injuries, watering can perineum, perianal abscess, chronic perineal itching etc. Purpose: The swiftly flourishing bacteria orgasms cause a similar disruptive event in the body of the patients both clinically and biochemically and these can be used to create a predictive score or index for patients in order to assess the disease severity and guide in the management and prognostication of this condition. Materials and Method: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Folders were retrieved and the medical records were reviewed. Results: Of the 50 patients reviewed, Male to female ratio is 24:1. The mean age is 56 years (2 weeks to 97 years). Mortality rate was 34%. There is a significant difference between delayed presentation/initial use of unorthodox treatment with mortality (p = 0.002). Of the 17 patients that died, 15 had FGSI > 9 and of the 33 patients that survived 29 had FGSI 9 is 88.2% while the mortality rate for those with FGSI Conclusion: knowledge of the predictors of its mortality is necessary in other to help stratify patients and ensure the best response by the caregivers. FGSI, delayed presentation/initial patronage of unorthodox care, and polymicrobial infection are impor
文摘Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .
文摘Little is known about the toxic activity of the atrazine (a herbicide, commonly used in agricultural production) on the thyroid gland. In this study the compound was administered orally in female albino rats at sublethal exposure equivalent to 0.2 LD50 doses for 6 and 12 days. At termination of dosing the anesthetized animals were killed and blood was drawn for the determination of serum triiodothyronine (T3) and thyroxin (T4). A dose-dependent decrease of serum T3 concentration was observed in all the groups (control: 0.57 nmol·L-1; 6 days: 0.35 nmol·L-1; 12 days: 0.21 nmol·L-1). The thyroid gland was examined light-microscopically. Bouin's solution-fixed thyroids were embedded in paraffin and sections cut at 6 μm, stained separately with toluidine blue according to Slinchenko's method. Histologically in experimental groups epithelium featured small cuboidal cells and occasional structures of the follicles confluence within epitheliomers. A dose-dependent changes of the following parameters were observed: (a) increasing of number of follicle-building thyroid cells; (b) increasing of follicular volume, (c) decreasing of nucleus volume. Investigation of the whole population of thyroid mast cells disclosed no change in degranulation intensity. By contrast, degranulation intensity was decreased in perifollicular mast cells from groups treated with atrazine in dose-dependent manner.There are no changes observed in degranulation of stromal mast cells. These results suggesting that differences in response to the atrazine might account for an aspect of the functional heterogeneity within the rat thyroid mast cell population.
文摘Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.
基金Supported by the Deanship of Research, Jordan University of Science and Technology (No. 91/2004)
文摘Despite being in arid and semi-arid areas,erosion is largely a result of infrequent but heavy rainfall events; therefore,rainfall erosivity data can be used as an indicator of potential erosion risks.The purpose of this study was to investigate the spatial distribution of annual rainfall erosivity in North Jordan.A simplified procedure was used to correlate erosivity factor R values in both the universal soil loss equation (USLE) and the revised universal soil loss equation (RUSLE) with annual rainfall amount or modified Fournier index (F mod ).Pluviometric data recorded at 18 weather stations covering North Jordan were used to predict R values.The annual values of erosivity ranged between 86-779 MJ mm ha ?1 h ?1 year ?1 .The northwest regions of Jordan showed the highest annual erosivity values,while the northeastern regions showed the lowest annual erosivity values.
文摘Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The mainstay of treatment is swift open drainage and early aggressive surgical debridement of all necrotic tissue, followed by targeted antibiotic therapy. The authors report on two patients who were admitted to the surgical ward. Both presented with initial perianal sepsis complicated by painful swollen scrotum with rapid progression of gangrene of the scrotal skin and subcutaneous tissue, extensive cellulitis of the perineum, and in one patient crepitation of the anterior abdominal wall. A diagnosis of Fournier’s Gangrene was made and they were both managed by prompt resuscitation, broad-spectrum antibiotics, extensive debridement of all necrotic tissue in theatre, daily wound dressing, and repeated neurectomy on the ward. One of the patients had a colostomy done and the other a cystostomy to divert feces and relieve chronic urinary retention respectively. These patients were successfully treated despite the severity of their conditions which was complicated by severe sepsis in the face of limited diagnostic capabilities and resources, using a multidisciplinary approach and basic clinical monitoring as a guide.
文摘Background: Fournier's gangrene is a rapidly spreading necrotizing gangrene affecting the perineum, Perianal and genital regions but remarkably sparing the testicles, bladder and rectum due to their separate blood supply which is directly from the aorta. The aim of this study is to share our experience with the management of 46 cases. Patients and method: We retrospectively analysed the medical records of 46 patients admitted with Fournier's gangrene between April 2005 and December 2011 in the urology unit of Aminu Kano Teaching Hospital. Data extracted from these include age, sex, hospital stay, premorbid diseases, mobility, mortality, laboratory investigations and treatments carried out. Results: Fourty six patients were admitted and managed for Fournier's gangrene during the study period. All the patients were male and mean age was 50 years (range 20 - 80 years). Five patients died (10.90%) mortality, 41 (89.10%) patients survived. The shortest hospital stay was 13 days and longest was 120 days. 45.7% of the patients had urethral stricture with watering can perineum as predisposing factor, 16 (34.80%) had diabetes mellitus, 7 (15.2%) had perineal injuries as the predisposing factors while 5 (10.90%) patients had uraemia and one patient (2.20%) each had bladder tumour and scrotal abscess as their predisposing factors, in 3 patients (6.50%) it was idiopathic. Only 34 (73.90%) patients had wound swab microscopy culture and sensitivity on admission. The culture grew Klebsiella spp. in 9 (26.50%), Staph aureus and E. coli in 5 (10.90%) of cases each, while Gram positive rod and Gram negative Cocci with 4 (11.80%) and 6 (17.60%) respectively. Conclusion: Fournier's gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals, is now changing pattern. Extensive surgical debridement and broad spectrum intravenous antibiotics remain the mainstay of treatment.
文摘<strong>Introduction:</strong> Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortality remains high despite advances in resuscitation. We report the experience of the surgery department of the Regional University Hospital Center (CHUR) of Ouahigouya in order to describe the epidemiological profile and the therapeutic aspects of GOGE. <strong>Patients and</strong> <strong>methods:</strong> We carried out a descriptive and analytical retrospective study collecting 41 cases of Fournier’s gangrene treated over 63 months (from March 2013 to July 2018) in the surgical department of the Ouahigouya regional university hospital center. Ethical clearance was taken from the institutional ethics committee. <strong>Results:</strong> The mean age of the patients was 65.02 ± 17.92 years with extremes of 23 years and 95 years. All patients were male. Urologic causes were the most common with 36.58% of cases. The average consultation time was 15.44 ± 16.04 days with extremes of 1 day and 60 days. All patients received resuscitation, bi or triantibiotherapy and surgical debridement. The mortality rate was 24.39%. The mean duration of hospitalization was 10.83 ± 6.257 days with extremes of 1 day and 60 days. <strong>Conclusion:</strong> The Fournier’s gangrene always has a very high lethality. Improving the prognosis requires fast and effective management.
文摘<span style="font-family:Verdana;">Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. </span><b><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> We report the experience of the service in the management of Fournier gangrene of the external genital organs by inguinal flap pediculated in front of the loss of significant substances of the scrotum.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">Patients and method: This was a mono-centric retrospective study from January 2008 to August 2021 in the General Surgery Department of the Bocar Sidi Sall University Hospital (CHU BSS) in Kati. It focused on patients treated for Fournier gangrene of external genitals.</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The variables studied were age, sex, blood count, germs encountered, the antibiogram, duration of evolution, reconstruction of the scrotum by pedicle flap, and morbidity. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">During the study period we collected 5 cases of Fournier gangrene of external genitals in the service. The average age was 57.6 years and all the patients were male. The average duration of evolution was 5 days for an average age of 57.6 years. All patients were male. <i></i></span><i><i><span style="font-family:Verdana;">Echerichia coli</span></i><span style="font-family:Verdana;"></span></i> (<i><i><span style="font-family:Verdana;">E.</span></i><i><span style="font-family:;" "=""> </span></i><i><span style="font-family:Verdana;">coli</span></i><span style="font-family:Verdana;"></span></i>)<span> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">was the frequently observed germ followed by <
文摘BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.
文摘BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.
文摘Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.
基金supported by the National Key Clinical Discipline Medical Scientific Research Foundation of Guangdong Province,China(Grant number A2015180)the National Natural Science Foundation of China(Grant number 81603628)Sun Yat-Sen University Clinical Research 5010 Program(Grant number 2017017).
文摘Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary conditions such as anal fistulas and abscesses.Methods:A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals—the Sixth Affiliated Hospital of Sun Yat-sen University and People’s Hospital Affiliated to Fujian University of Traditional Chinese—over the period from May 2013 to April 2017.Results:Sixty FG patients were included in this study.The common causative microorganisms cultured were Escherichia coli species.Genital and perirectal regional involvement was evident in 52 and 59 cases,respectively,although the perineum was unaffected in 7 cases(12%),as confirmed by imaging examination and surgical exploration.Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality(1.7%).Ten patients underwent protective colostomy.No patient underwent an orchidectomy and required urinary diversion.Conclusions:FG originating from the anorectal region can be rapidly progressive and life-threatening.Infection can spread superiorly to the genital region without the involvement in perineal tissue.An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.
