1/13. Nontraumatic clostridial myonecrosis.We describe three cases of nontraumatic clostridial myonecrosis seen at the Victorian Institute of forensic medicine. Nontraumatic clostridial myonecrosis is an uncommon and often fatal condition that requires immediate institution of appropriate medical and surgical therapy. It is most commonly caused by clostridium perfringens and clostridium septicum and is associated with gastrointestinal and hematologic malignancies, diabetes mellitus, and peripheral vascular disease. The clinical features include a rapidly evolving acute illness with severe pain, marked tachycardia, and brawny discoloration of the skin with bullae formation and crepitus, followed by hypotension and acute renal failure. Features at autopsy include reddish brown skin discoloration with bullae formation and necrotic skeletal muscle. Radiographs may be of use prior to the postmortem in detecting gas within the soft tissues. Gram stain and microbiologic culture are important in establishing a definitive diagnosis; although the major factors in suggesting the diagnosis are the recognition of the typical clinical history and macroscopic autopsy findings.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/13. Perforated viscus presenting with gas in the soft tissues (subcutaneous emphysema).We have reviewed the spectrum of gaseous densities in the soft tissues secondary to a perforated viscus. All patients presented late and most were elderly. The most common surgical procedure was diversion of the fecal stream proximal to the perforation. In our series 4 of 7 patients died in the immediate postoperative period. knowledge of the mechanism and differential diagnosis of this entity will prevent overlooking this possibility, as occurs too frequently, particularly with subcutaneous emphysema of the leg.- - - - - - - - - - ranking = 5keywords = soft (Clic here for more details about this article) |
3/13. gas gangrene due to clostridium perfringens in two injecting drug users in Vienna, austria.We describe two cases of severe myonecrotic infections caused by clostridium perfringens in injecting drug users (IDUs) in Vienna, austria. Clostridial myonecrosis, or gas gangrene, is a clostridial infection primarily of muscle tissue. C. perfringens is isolated in 90% of these infections. Other clostridial species isolated are C. novyi, C. septicum, C. histolyticum, C. fallax, and C. bifermentans. Classically, clostridial myonecrosis has an acute presentation and a fulminant clinical course. It is diagnosed mainly on a clinical basis. The infection may be so rapidly progressive that any delay in recognition or treatment may be fatal. The onset is sudden, often within 4 to 6 hours after an injury. An early clinical finding is sudden severe pain in the area of infection. Swelling and edema in the area of infection is pronounced. At surgery, the infected muscle is dark-red to black, is noncontractile, and does not bleed when cut. Crepitus, although not prominent, is sometimes detected. We were able to demonstrate spores that were morphologically indistinguishable from spores of C. perfringens in a drug sample obtained from case 2. general practitioners and accident and emergency staff should be aware of the possibility of C. perfringens infection in IDUs, especially if injection into soft tissue is suspected.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
4/13. gas gangrene in a diabetic after intramuscular injection.A 47 year old male insulin-dependent diabetic developed two synchronous life-threatening clostridium perfringens infections under unusual circumstances. Numerous sterile abscesses were also present, being the result of regular pentazocine intramuscular injections. Extensive surgical debridement and parenteral antibiotic therapy proved effective in treating the septicaemia and the large soft tissue abscesses in the buttock and thigh. The patient made an excellent functional recovery. The pathogenesis of gas gangrene after injection is discussed with particular reference to the diabetic patient.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
5/13. gas gangrene in traumatic hand injuries. Report of three cases.Gaseous gangrene is an infection with anaerobies germs characterized by gaseous infiltration of soft tissues with quick and serious damage to the general state. Known in war time, it rages also in civilian practice. Two etiologies are dominating: post-trauma gaseous gangrenes, post-surgery gaseous gangrenes. Among post-trauma gaseous gangrenes, the ones on departure of inferior members are the most frequent arising from fractures or from luxations open or closed. Localisation on superior limbs is scarce, specially after soft parts' trauma. We report three cases of superior limbs' gaseous gangrene after seemingly benign trauma. Diagnosis has been set by the clinical surgery, and the presence of gas bubbles at soft tissues' radiography. It didn't exist any favorising agent such as diabetes, arterial insufficiency, intercurrent disease treated with corticoides or with immuno-depressors. Bacteriological levyings have not put the causal germ in evidence, this is due to levying conditions. Evolution of gaseous gangrene depends on quickness of diagnosis and treatment. This one includes surgical flattening, discharge's incisions and excisions of devitalized tissues, as well as antibiotherapy with 20 000 to 60 000 U penicilline by parenteral way. We didn't need appeal to hyperbare oxygenotherapy. Simple procedures of secondary repair surgery were sufficient to restoration of a normal function. Gaseous gangrene is a real surgical urgency, even without bacteriological proof.- - - - - - - - - - ranking = 3keywords = soft (Clic here for more details about this article) |
6/13. "Cold spot" imaging with gas gangrene in three phase skeletal scintigraphy.A photon deficient "cold spot" was noted in all three phases of a three phase bone study in a patient with gas gangrene of the foot. The scintigraphic findings correlated with the area of soft tissue gas noted in radiographs.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
7/13. Usefulness of computerized tomography in evaluating necrotizing fasciitis.A 54-year-old man was seen with what appeared to be cellulitis of the left lower extremity. Roentgenograms showed no evidence of gas in soft tissues. Two days later films revealed gas in soft tissues of the leg, but not in the thigh. Computerized tomography showed pockets of gas in the lateral fascial planes of both leg and thigh. Surgical exploration revealed extensive necrotizing fasciitis. CT scanning provided a much more accurate picture of the extent of infection than did standard radiographs.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
8/13. aeromonas hydrophila wound infection of the hand initially presenting as clostridial myonecrosis.A traumatic hand laceration in a previously health 17-year-old boy resulted in a rapidly progressive palmar space infection, with gas formation, in the soft tissues caused by aeromonas hydrophila. Typically associated with aquatic injuries, A. hydrophila was not initially suspected since the injury did not occur near water. physicians treated trauma-related soft tissue infections, particularly when the initial Gram stain shows many polymorphonuclear leukocytes and gram-negative bacilli, must consider the possibility of an Aeromonas infection even if the injury occurred in a nonaquatic environment. Appropriate therapy, including vigorous wound debridement and an aminoglycoside antibiotic, will be curative in an immunologically normal host.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
9/13. Medical hyperbaric oxygen therapy: 22 cases.Between 1976 and 1979, 22 patients had hyperbaric oxygen therapy at Wright-Patterson air Force Base Medical Center. Seventeen patients benefited and five did not--one of two carbon monoxide poisoning patients, both gas gangrene patients, and four of five osteomyelitis victims were greatly helped while 10 of 13 soft tissue wounds were healed with the hyperbaric oxygen treatment. This local series exemplifies the range and limitations of the medical application of hyperbaric oxygen.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/13. clostridium septicum gas gangrene of the gluteus maximus and an ascending colon malignant tumor. A case report.Clostridial myonecrosis is a complication associated with contaminated traumatized wounds. Presented is the case of an elderly female with pain in her right hip, radiographic evidence of gas in the soft tissues, and no history of trauma. Evaluation of this patient revealed Clostridial myonecrosis. culture results identified the organism as clostridium septicum. Due to the association between clostridium septicum and occult malignancies, colonoscopic evaluation was performed. A colonic lesion was discovered, biopsied, resected, and staged, using the Modified Duke classification, as a well differentiated adenocarcinoma, C2 lesion. Myonecrosis and its associated malignancies carry high morbidity and mortality, but early diagnosis, appropriate treatment, and awareness of the association with occult malignancies may avert unnecessary mortality.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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