Gangrene Research Today is a free monthly online journal that collates and summarizes the latest research about Gangrene, including details on smoking, treatment, causes, amputation, necrosis. | ||||||
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Acute mesenteric venous thrombosis: improved outcome with early diagnosis and prompt anticoagulation therapy.Alvi AR, Khan S, Niazi SK, Ghulam M, Bibi S Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. rehman.alvi@aku.edu AIM: To analyze the clinical spectrum of acute mesenteric venous thrombosis (AMVT), to assess the factors affecting the outcome and to determine the optimal management of this disease. METHODS: We retrospectively reviewed the case records of 20 patients with acute mesenteric venous thrombosis confirmed on CT imaging or on laparotomy over a 23 year period. Patients were divided into two groups according to the duration of symptoms: group I with symptoms for up to 3 days duration and group II with symptoms for more than 3 days. RESULTS: The mean age was 50.55 year, with 15 male and five female patients. In all patients the diagnosis were confirmed on CT imaging preoperatively except two patients when the diagnosis was established on exploratory laparotomy in the period before 1998. There were six patients in group I and 14 in group II. Five patients underwent an operation and one received a non-operative treatment in group I. Three patients underwent laparotomy and 11 received non-operative treatment in group II (P-value 0.01, Fisher's exact test). There were three and one mortality in groups I (n=6) and II (n=14) respectively (P-value 0.061, Fisher's exact test). Most patients received preoperative therapeutic anticoagulation. Two patients in group II who underwent exploratory laparotomy, neither did receive preoperative anticoagulation. Both patients died in the postoperative period. Eighteen patients were investigated for thrombophilia. Eleven patients had one (n=6) or more (n=5) identifiable hypercoagulable state, these included protein S deficiency (n=1), both protein C and S deficiency (n=5), polycythemia (n=2), factor V Leiden deficiency (n=1) and malignancy (n=2). None had antithrombin III deficiency, hyperhomocystine urea and contraceptive pill intake. There were no statistical differences between thrombophilic and non-thrombophilic patients regarding duration of symptoms, indications for laparotomy and 30 days mortality rate. CONCLUSIONS: Patients with AMVT of rapid onset (<3 days duration) had poor outcome and more patients required laparotomy because of extensive thrombosis leading to bowel gangrene and peritonitis. Early diagnosis with CT scanning, prompt treatment with anticoagulation in all patients, surgical treatment in cases of peritonitis or failure of medical treatment can contain the mortality rate in these patients. Published 22 June 2009 in Int J Surg, 7(3): 210-3. Articles on Gangrene published 17 June 2009: Rectal diversion without colostomy in Fournier's gangrene. Tech Coloproctol, 13(2): 157-9. Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy. [Abstract] [Full-text] Clinical and hematological presentation of children and adolescents with polycythemia vera. Ann Hematol, 88(8): 713-9. 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 ... [Abstract] [Full-text] Articles on Gangrene published 15 June 2009: Symmetrical peripheral gangrene: a prospective study of 14 consecutive cases in a tertiary-care hospital in eastern India. J Eur Acad Dermatol Venereol. Abstract Background Symmetrical peripheral gangrene (SPG) is characterized by sudden onset of peripheral, frequently symmetrical gangrene in the absence of major vascular occlusive disease. SPG is associated with a wide range of underlying medical problems and usually has disseminated intravascular coagulation (DIC) in the background. Although sporadic cases and a few retrospective case series of SPG have been reported, lack of any prospective study on the profile and outcome of these patients ... [Abstract] [Full-text] Articles on Gangrene published 12 June 2009: Fatal Morganella morganii bacteraemia in a diabetic patient with gas gangrene. J Med Microbiol, 58: 965-7. We report a case of a 60-year-old lady with a history of a heel ulcer that had not responded to antibiotic therapy. This progressed to involve the right leg, which was swollen and erythematous. Radiological imaging revealed the presence of gas within the fascial planes. Blood cultures on admission yielded Morganella morganii. Due to the extent of the gas gangrene and her co-morbidities the patient was not suitable for surgical intervention and was treated conservatively with antibiotics. She ... [Abstract] [Full-text] Articles on Gangrene published 9 June 2009: Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int, 82(4): 426-31. BACKGROUND: Fournier's gangrene (FG) is a very aggressive necrotizing fasciitis involving subcutaneous fat and skin of scrotal and perineal regions. Vacuum-assisted closure (VAC) is a well-known method used to treat complex wounds. The authors for the first time enhance a multimodal strategy to treat the FG using VAC, reducing the number of surgical debridements, allowing a one-step surgical reconstruction with locoregional fasciocutaneous flap. METHODS: Six patients with the diagnosis of FG ... [Abstract] [Full-text] Articles on Gangrene published 5 June 2009: Predictors of limb loss despite a patent endovascular-treated arterial segment. J Vasc Surg, 49(6): 1440-5. OBJECTIVE: The goal of this study was to assess the frequency and predictors of major amputation with patent endovascular-treated arterial segments (PETAS) in patients with critical limb ischemia. METHODS: The study included 358 consecutive patients (412 limbs) who underwent endovascular (236 limbs) or open (176 limbs) revascularizations for critical limb ischemia from June 2001 through May 2007. Patients with limb loss despite PETAS were compared with the rest of the endovascular-treated group ... [Abstract] [Full-text] Articles on Gangrene published 3 June 2009: Clostridium histolyticum collagenase is responsible for extensive tissue destruction in gas gangrene, and its activity is enhanced by calcium ions. The collagen-binding domain is the minimal segment of the enzyme required for binding to insoluble collagen fibrils and for subsequent collagenolysis. The collagen-binding domain is joined to another binding module by a conserved 14-amino-acid linker. The linker undergoes secondary structural transformation from an alpha-helix to a beta-strand and ... [Abstract] [Full-text] Articles on Gangrene published 2 June 2009: Hydralazine-induced autoimmune disease: comparison to idiopathic lupus and ANCA-positive vasculitis. Mod Rheumatol, 19(3): 338-47. We report two cases of hydralazine-induced vasculitis with rare complications: pulmonary renal syndrome and digital gangrene. We also review 68 published cases of hydralazine-induced vasculitis. Hydralazine-induced vasculitis mimics idiopathic antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis. However, it also produces other autoantibodies, such as antinuclear antibodies, antihistone antibodies, anti-dsDNA antibodies, and antiphospholipid antibodies. Patients with ... [Abstract] [Full-text] © 2005-2009 Gangrene Research Today. All Rights Reserved. |
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