Caracterización clínica de pacientes con gangrena de Fournier del Hospital General Docente "Dr. Agostinho Neto", 2008-2018 / Clinical characterization of patients with Fournier's gangrene at the Hospital General Docente "Dr. Agostinho Neto", 2008-2018 / Caracterização clínica de pacientes com gangrena de Fournier no Hospital Geral de Ensino "Dr. Agostinho Neto", 2008-2018

RESUMEN Introducción: La gangrena de Fournier se define como una forma específica de fascitis necrotizante Tipo I, que constituye una emergencia urológica, poco frecuente y de elevada mortalidad. Objetivo: Caracterizar la gangrena de Fournier en los pacientes atendidos en el servicio de Urología del Hospital General Docente "Dr. Agostinho Neto" en el periodo enero 2008 - diciembre 2018. Método: Se realizó un estudio descriptivo de variables demográficas y clínicas (edad, sexo, mortalidad, comorbilidad, causas desencadenantes, sitio primario de la infección, sitio de extensión de la infección, estadía hospitalaria) en 20 pacientes. La historia clínica fue la fuente de información primaria. Los datos fueron procesados mediante el programa estadístico SPSS versión 20.0, y se utilizó la estadística descriptiva para determinar las frecuencias absolutas y relativas (porcentajes) y media. Resultados: El 100 % correspondió a varones con un promedio de edad de 64,0 años (27-92); la mortalidad fue del 40 %. La diabetes mellitus fue la comorbilidad más frecuente en 10 pacientes (50,0 %), 12 (60,0 %) tenían más de un proceso comórbido. Las lesiones cutáneas constituyeron la causa primaria en 11 (55,0 %), y los escrotos fueron el principal sitio de origen de la infección en el 55,0 %. El promedio de estadía hospitalaria fue de 37,7 días (7-75 días). Conclusiones: La correcta evaluación de las variables demográficas y clínicas es necesaria para establecer un correcto diagnóstico y plan de tratamiento.

ABSTRACT Introduction: Fournier's gangrene is defined as a specific form of Type I necrotizing fasciitis, which constitutes a rare urological emergency with high mortality. Objective: To characterize Fournier's gangrene in patients treated in the Urology service of the Hospital General Docente "Dr. Agostinho Neto" in the period from January 2008 to December 2018. Method: A descriptive study of demographic and clinical variables (age, gender, mortality, comorbidity, triggering causes, primary site of infection, site of extension of the infection, hospital stay) was carried out in 20 patients. The medical history was the primary source of information. The data were processed using the statistical program SPSS, version 20.0, and descriptive statistics were used to determine the absolute and relative frequencies (percentages) and mean. Results: 100% corresponded to men with an average age of 64.0 years (27-92); mortality made a 40%. Diabetes mellitus was the most frequent comorbidity, in 10 of the patients (50.0%); 12 patients (60.0%) had more than one comorbid process. Skin lesions were the primary cause in 11 (55.0%), and the scrotum was the main site of origin of infection in 55.0%. The mean hospital stay was 37.7 days (7-75 days). Conclusions: The correct evaluation of the demographic and clinical variables is necessary to establish a correct diagnosis and treatment plan.

RESUMO Introdução: A gangrena de Fournier é definida como uma forma específica de fasceíte necrosante tipo I, que se constitui em uma rara emergência urológica com alta mortalidade. Objetivo: Caracterizar a gangrena de Fournier em pacientes atendidos no serviço de Urologia do Hospital Geral Universitário "Dr. Agostinho Neto" no período de janeiro de 2008 a dezembro de 2018. Método: Estudo descritivo de variáveis demográficas e clínicas (idade, sexo, mortalidade, comorbidade, causas desencadeantes, sítio primário de infecção, extensão do sítio de infecção, internação) em 20 pacientes. O histórico médico foi a principal fonte de informação. Os dados foram processados no programa estatístico SPSS versão 20.0, e a estatística descritiva foi utilizada para determinar as frequências absolutas e relativas (percentuais) e a média. Resultados: 100% corresponderam a homens com idade média de 64,0 anos (27-92); a mortalidade foi de 40%. Diabetes mellitus foi a comorbidade mais frequente em 10 pacientes (50,0%), 12 (60,0%) apresentaram mais de um processo comórbido. Lesões cutâneas foram a causa primária em 11 (55,0%), e o escroto foi o principal sítio de origem da infecção em 55,0%. O tempo médio de internação foi de 37,7 dias (7-75 dias). Conclusões: A correta avaliação das variáveis demográficas e clínicas é necessária para estabelecer um correto diagnóstico e plano de tratamento.

Risk factors for mortality in fournier's gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI)

ABSTRACT Objective To evaluate risk factors for mortality in patients with Fournier's gangrene (FG), with emphasis in the Simplified Fournier Gangrene Severe Index Score (SFGSI). Materials and Methods This was a cross-sectional study that was carried out from January 2010 to December 2014, with 124 patients treated for FG in a General Hospital. Several clinical and laboratory variables, including SFGSI, were evaluated and correlated with mortality through univariate analysis and logistic regression. Results Of the 124 patients, 99 were men (79.8%), the mean age was 50.8±19.5 years and the main comorbidity was diabetes mellitus (51.6%). The mortality rate was 25.8%. Variables that presented independent correlation with mortality were the extension of the lesion to the abdomen (OR=4.0, CI=1.10-14.68, p=0.03), hematocrit (OR=0.81, CI=0.73-0.90, p<0.0001), potassium (OR=2.41, CI=1.13-5.10, p=0.02) and creatinine (OR=2.15, CI= 1.04-4.41, p=0.03). When hematocrit, potassium and creatinine were tested together, as part of the SFGSI, a >2 result was the largest of the independent predictors of mortality (OR=50.2; CI=13.18-191.47; p<0.0001). Conclusion The SFGSI >2 presented a higher correlation with mortality than any variable tested alone. It seems to be a promising alternative to evaluate predictors of mortality in Fournier's gangrene. The main advantage is easy applicability because it contains only three parameters and can be used immediately after patient's admission.

Fournier's gangrene: outcome analysis and prognostic factors

Background: Fournier's gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes.Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier's gangrene. Methods: A prospective hospital based observational study on 51patients with a clinical diagnosis of Fournier's gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival.Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin(p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival.Conclusion: Fournier's gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction

Gangrena de Fournier: revisión de factores determinantes de mortalidad / Mortality risk factors in Fournier gangrene: a literature review

La gangrena de Fournier es una fascitis necrosante polimicrobiana que afecta el periné, el escroto y/o el área perianal con una tasa de mortalidad actual del 20% al 40%. El objetivo de esta revisión es describir los factores pronósticos de mortalidad reportados en la literatura mundial, para lo cual se realizó la búsqueda de artículos indexados en Medline, utilizando los respectivos términos MeSH para la búsqueda, así como una búsqueda manual de las referencias encontradas en los artículos primarios. Se reportan diversos factores con significación estadística; sin embargo, el índice de Laor predomina como herramienta de mayor significación a la hora de determinar la mortalidad de los pacientes.

Fournier gangrene is a necrotizing fasciitis caused by facultative microorganisms that affects the perineal area, the scrotum or the perianal area. It has a 20% to 40% mortality. We performed a literature review to determine its determinants of mortality. Among all factors, the Laor index (which includes temperature, heart rate, respiratory rate, serum sodium, potassium and creatine, blood leukocyte count, packed red cell volume and bicarbonate) predominates as the best tool to assess mortality risk.

Diagnóstico y manejo precoz de la gangrena de fournerr / Early diagnosis and management of fournier´s gangrene

Aim: The aim of this study is to report the results of a series of patients diagnosed with Fournier’s gangrene underwent surgical debridement plus broad-spectrum antibiotics in the emergency department of the Hospital Barros Luco-Trudeau (HBLT) between 2009 and 2013, in terms of mortality associated with the disease. Material and Methods: Between 2009 and 2013, a case series of patients with diagnosis of Fournier’s gangrene treated in the Emergency Department of the Hospital Barros Luco-Trudeau. The outcome variable was mortality attributed to the disease (MAD). Other variables were: age, sex, comorbidities, focus of origin, waiting time for antibiotic treatment and surgery to start, number of surgical debridement and agents isolated from cultures. Descriptive statistics were used, with calculation of measures of central tendency and dispersion. Results: During the study period, 56 patients were identified with diagnosis of Fournier’s gangrene (60.7 percent were male) with a mean age of 52 years (23-75 years old). The MAD was 48.2 percent. The most common comorbidity was diabetes (66.6 percent). The more prevalent focus of origin was anorectal pathology (42.9 percent). The average waiting time from diagnosis to initiation of antibiotic therapy and surgery was 40 minutes (15-80) and 580 minutes (20-4320), respectively. The required surgical debridement average was 4. Isolated on the intraoperative tissue cultures agent was E. coli (51.8 percent). Conclusion: Mortality attributable to Fournier’s gangrene is similar to that observed in the literature.

Objetivo: El objetivo de este estudio es comunicar los resultados observados en una serie de pacientes con diagnóstico de gangrena de Fournier sometidos a aseo quirúrgico con debridamiento más terapia antibiótica de amplio espectro, en el Servicio de Urgencias del Hospital Barros Luco Trudeau (HBLT), entre los años 2009 y 2013, en términos de mortalidad asociada a la enfermedad. Material y Método: Serie de casos de pacientes con diagnóstico de gangrena de Fournier tratados en el Servicio de Urgencias del Hospital Barros Luco-Trudeau entre 2009 y 2013. La variable resultado fue mortalidad atribuida a la enfermedad (MAE). Otras variables de interés fueron: edad, sexo, patologías asociadas, foco de origen, tiempo de espera para el inicio del tratamiento antibiótico y cirugía, número de aseos y agentes aislados en los cultivos. Se utilizó estadística descriptiva, con cálculo de medidas de tendencia central y dispersión. Resultados: En el período en estudio se identificaron 56 pacientes con diagnóstico de Gangrena de Fournier (60,7 por ciento eran masculinos), con un promedio de edad de 52 años (23-75 años). La MAE fue 48,2 por ciento. La patología asociada más frecuente fue la diabetes (66,6 por ciento). El foco de origen más prevalente fue la patología anorrectal (42,9 por ciento). El tiempo promedio de espera desde el diagnóstico hasta el inicio de la terapia antibiótica y la cirugía fue de 40 minutos (15-80) y 580 minutos (20-4320) respectivamente. El promedio de aseos requeridos fue de 4. El agente más aislado en los cultivos de tejido intraoperatorio fue Escherichia coli (51,8 por ciento). Conclusión: La mortalidad atribuible a la Gangrena de Fournier es similar a la observada en la literatura.

Clinical outcomes of Fournier's gangrene from a tertiary hospital

Fournier's gangrene is a progressive polymicrobial necrotizing fasciitis, caused by aerobic and anaerobic organisms. It causes an endarteritis obliterans leading to vessel thrombosis and subsequent cutaneous and subcutaneous necrosis of the perineal region. OBJECTIVE: It was to describe the clinical outcomes of Fournier's gangrene treated at the Hospital Santa Marcelina, São Paulo (SP), Brazil. METHODS: This was a retrospective study conducted at the Hospital Santa Marcelina, in São Paulo (SP), Brazil, with patients with necrotizing fasciitis from September 2008 to March 2011. RESULTS: We included 13 patients, most were males, and the mean age was 51.8 years old. Five of them presented with systemic inflammatory response syndrome, only two had no comorbidities and 23% were obese. The most prevalent etiologic agent was E. coli, and the most common antibiotic regimen consisted of a combination of metronidazole with ciprofloxacin. The average number of surgical procedures performed by patient was 2.07, and 7 patients (53.8%) underwent colostomy formation. The mortality rate was 30.8%. CONCLUSIONS: Fournier's gangrene is a severe disease, with high mortality rates. The physician should suspect its diagnosis early and have an aggressive treatment approach to achieve better outcomes. (AU)

A gangrena de Fournier representa uma fasceíte necrotizante e progressiva de origem polimicrobiana, causada por organismos aeróbios e anaeróbios. Tem como fisiopatologia a endarterite obliterante, que leva à trombose dos vasos cutâneos e subcutâneos e à consequente necrose da região perineal. OBJETIVO: Foi descrever os casos de gangrena de Fournier atendidos no Hospital Santa Marcelina, São Paulo (SP), Brasil. MÉTODOS: Este estudo retrospectivo foi realizado no Hospital Santa Marcelina, em São Paulo (SP), com pacientes portadores de fasceíte necrotizante no período de setembro de 2008 a março de 2011. RESULTADOS: Este estudo incluiu 13 pacientes, a maioria do sexo masculino, com média de idade de 51,8 anos. Cinco apresentavam síndrome da resposta inflamatória sistêmica e somente dois não tinham comorbidades, sendo 23% deles obesos. O agente etiológico mais prevalente foi a E.coli, e o esquema de antibiótico mais utilizado foi a associação de metronidazol e ciprofloxacina. A média foi de 2,07 cirurgias por paciente, com realização de ostomia derivativa em 7 dos 13 pacientes (53,8%). A taxa de mortalidade foi de 30,8%. CONCLUSÃO: A gangrena de Fournier é uma doença grave, com alto índice de mortalidade. O médico assistente deve suspeitar precocemente essa afecção e realizar conduta terapêutica agressiva visando a melhores resultados. (AU)

Factores de riesgo para mortalidad en gangrena de Fournier / Mortality prognostic factors in Fournier gangrene

Background: Fournier gangrene corresponds to a necrotizing fasciitis that affects the genital and perianal region. It has a high mortality and a special score, FGSI (Fournier Gangrene Severity Index Score), which includes nine laboratory and clinical parameters was devised to evaluate its prognosis. Aim: To determine predictors of mortality among patients with Fournier gangrene. Material and Methods: Prospective study of 31 patients aged 58 +/- 13 years (25 males) with Fournier gangrene. The inclusion criteria was the presence of perianal inflammation with redness, pain swelling and appearance of a rapidly progressing necrosis with fever, tachycardia and leukocytosis. Results: Eight patients died. Length of hospital stay ranged from 1 to 187 days and the number of required surgical procedures ranged from 1 to 17. The FGSI score was 7.1 +/- 4. These three factors had a prognostic value for mortality. Conclusions: Among patients with Fournier gangrene, length of hospital stay, number of required surgical procedures and FGSI are predictive of mortality.

Introducción: La Gangrena de Fournier fue descrita por Fournier en 1883, es una fasceitis necrotizante que afecta la región perianal y genital. El objetivo del presente trabajo es analizar los factores de riesgo de mortalidad en pacientes portadores de Gangrena de Fournier y su relación con el score pronóstico FGSI (Fournier Gangrene Severity Index Score). Material y Método: Estudio prospectivo entre enero de 2000 y diciembre de 2007 en el Hospital Barros Luco Trudeau, que incluyó 31 pacientes con gangrena de Fournier, el 80 por ciento de sexo masculino y una edad promedio de 58,2 años. Se analizaron los factores de riesgo y se calculó el índice de gravedad. Se realizó el análisis estadístico univariado y multivariado de cada uno de los factores y del índice de gravedad. Resultados: En el análisis univariado y multivariado los días de hospitalización, que variaron entre 1 y 187 (p = 0,055), el número de cirugías entre 1 y 7 (p = 0,031) y el score de gravedad que estuvo entre 1 y 17 (p = 0,017), fueron los factores significativos como factores de riesgo de mortalidad. Conclusiones: La Gangrena de Fournier presenta una alta mortalidad. El número de días hospitalizados y el número de cirugías realizadas son factores de riesgo para mortalidad y el score de gravedad es una herramienta importante y simple para predecir el riesgo de mortalidad.

Gangrena de Fournier: 10 años de experiencia / Fournier gangrene: a 10 year experience

Introducción: La gangrena de Fournier es una entidad infecciosa caracterizada por una fascitis necrotizante sinérgica rápidamente progresiva a punto de partida urinaria o colorrectal que amenaza la vida del paciente de no instaurarse un diagnóstico temprano y un tratamiento agresivo. Tiene alta prevalencia en pacientes diabéticos e inmunosuprimidos. El objetivo del trabajo es recabar la experiencia de nuestro Servicio y valorar el índice de severidad de gangrena de Fournier en un subgrupo de pacientes. Materiales y métodos: Se realizó un estudio retrospectivo descriptivo que incluyó 52 pacientes que fueron atendidos en el Servicio de Urología del Hospital Ramos Mejía en el período comprendido entre 2000-2009 con diagnóstico de gangrena de Fournier. Se evaluaron los factores predisponentes, el tiempo de evolución, el manejo quirúrgico y la mortalidad. El índice de severidad de gangrena de Fournier se realizó en el subgrupo de los últimos 20 pacientes. Todos los pacientes fueron sometidos a debridamiento quirúrgico y cobertura antibiótica. Resultados: La diabetes como factor predisponente fue identificada en 26/52 pacientes (50 por ciento). La tasa de mortalidad en nuestra serie fue del 11,5 por ciento (6/52). De los 52 pacientes incluidos, en los últimos 20 se utilizó el índice de severidad de gangrena de Fournier. De éstos, 4 presentaron un ISGF >9 puntos con 50 por ciento (2/4) de mortalidad. 49 pacientes fueron sometidos a un único y extenso debridamiento quirúrgico; los otros 3 pacientes requirieron 3 procedimientos quirúrgicos. Al 75 por ciento se les realizó derivación urinaria previo a la cirugía. Conclusión: La gangrena de Fournier es una urgencia urológica. El primer debridamiento quirúrgico debe ser el más agresivo de todos pudiendo disminuir la mortalidad y la necesidad de reintervenciones. Un índice de severidad de gangrena de Fournier >9 puntos se acompaña de una elevada tasa de mortalidad.

Introduction: Fournier gangrene is an infectious entity characterized by a necrotic fascytis or urinary or colonic origin that quickly spreads and may compromise the patient life if not timely treated. It has a high prevalence in diabetic and immunosuppressed patients.Objective: To review the experience gathered at our institution on Fournier gangrene and to evaluate the severity of this situation on a specific subgroup of patients. Material and method: Our retrospective study included 52 patients seen between the year 2000 and 2009 at the Ramos Mejía Hospital with Fournier Gangrene. Associated factors, time of evolution, surgical management and mortality were evaluated. Severity index (SI) was used on the last 20 patients. All patients underwent surgical exploration and antibiotic therapy. Results: Diabetes as predisposing factor was seen in 26 of 52 patients (50 percent). Mortality was 11.5 percent (6 patients). Out of the 20 patients in which SI was used, 4 had SI > 9 with 50 percent mortality. Of the 52 patients, 3 required more than one surgical procedure. All patients underwent urinary diversion prior to surgery. Conclusion: Fournier gangrene is a urological emergency. First surgical intervention should be very aggressive though it may decrease mortality and the need for further interventions. A SI > 9 is associated with higher mortality.

Relation between the area affected by Fournier's gangrene and the type of reconstructive surgery used: a study with 80 patients

OBJECTIVE: To assess the affected skin area and the reconstructive techniques used in 80 patients affected by Fournier's gangrene. MATERIALS AND METHODS: Eighty patients ranging in age from 19 to 85 years (mean = 51) affected by Fournier's gangrene were studied. When admitted to the emergency room the patients were submitted to clinical and laboratory examinations to analyze the gravity of the case. All patients were submitted to an extensive debridement of the lesion, urinary derivation by cystostomy and colostomy whenever necessary. RESULTS: Only 13 patients (16.25 percent) died. From the 67 remaining patients, in 44 (65.6 percent) debridement was restricted to the scrotum, in 10 (14.9 percent) there has been scrotum and penile lesions and in 13 (19.3 percent) there has been a debridement of the scrotum and the perineal region. In 11 cases (16.4 percent) there was no need for reconstructive surgery with wound closing by second intention, in 16 cases (23.8 percent) reconstructive surgery was performed with mobilization of local skin, in 19 (28.3 percent) we have used skin grafts, 20 patients (29.8 percent) needed reconstructive surgery with the use of skin flaps and in 1 case (1.4 percent) there has been the use of skin flaps and grafts simultaneously. CONCLUSIONS: Fournier's gangrene is a serious pathology and should be treated aggressively with an extensive debridement of the area with necrosis. The use of precocious reconstructive surgery of the genitals present good results and tends to greatly reduce the length of hospital stay and improve the psychological conditions of these patients.

Predictive value of modified severity index for fournier's gangrene

Fournier's gangrene is a rare but lethal disease initiating from minor local infection in the perineal viscera in susceptible individuals. It is the synergistic necrotizing fascitis of the genital, urinary and perianal tissues. The objective of this study was to determine if incorporating the skin loss and platelets count increases the predictive value of fournier's gangrene severity index described by Laor et al. This is an analysis of demographics, presentations, concomitant morbidities, management and outcome in 15 patients with fournier's gangrene managed during last fifteen years. Various clinical and para-clinical parameters were scored on the basis of Laor's index. The additional features of surface area and platelets count were also scored for the modified index. Then the relationships of these two indices with survival were evaluated. In this study of 15 patients, the mortality rate was 27%. Regarding Laor's index, the mean score for survived group was 6 with the range of 2 to 10 whereas that for dead group was 11.5 with the range of 8 to 13. There was 67% probability of death for the patients scoring more than "7" whereas the score of "7" or less was associated with 100% probability of survival. Regarding the modified index, the mean score for survived group was 8.5 with the range of 2 to 12 whereas that for dead group was 15 with the range of 14 to 17. There was 100% probability of survival for the patients having score of "12" or less whereas the score of more than "12" was associated with 100% probability of death. The proposed modification of Laor's index appears to be having better predictive value of outcome but needs to be evaluated in trials having statistical significance

Fournier's gangrene and its management

To find out major causes of Fournier's gangrene and evaluate its management. A retrospective study was done at Department of Urology JPMC, Karachi, and records of all 32 patients with Fournier's Gangrene over 4 years' period i.e. from December 2001 till 2005 were reviewed. Mean age was 48 years, all being male. All presented with an average delay of 2-10 days. Involvement was typical, with 70% extending to lower abdominal wall, and 10% to perianal region. 37.5% presented with septic shock. Cause being urological in most of the cases [78.13%], followed by anorectal in 6.2% and idiopathic in 15.6%. Associated diseases were diabetes mellitus in 37.5%, uraemia in 12.5% and hepatic failure in 6.25%. 25% patients died due to multiorgan failure in our study. Aggressive surgical debridment with supportive measures remained the key to success

Avaliação do efeito da oxigenoterapia hiperbárica no tratamento das infecções necrosantes pelviperineais / Evaluation of the effect of hyperbaric oxygen therapy in the treatment of pelviperineal necrotizing infections

As infecções necrosantes pelviperineais (INPPs) são infecções graves, pouco comum, com mortalidade aproximada em torno de 30 por cento de flora bacteriana mista e predomínio do sexo masculino. Objetivo: avaliar o efeito da oxigenoterapia hiperbárica (OHB) no tratamento das INPPs. Método: estudo clínico prospectivo randomizado realizado no Serviço de Cirurgia de Emergência do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / The pelviperineal necrotizing infecctions are serious infections, relatively rare, with mortality approached around 30 por cent of mixed bacterial flora and prevalence of masculine sex. Objective: to evaluate the effect of hyperbaric oxygn (HBO) therapy in the treatment of pelviperineal necrotizing infections. Method: prospective randomized clinical study accomplished in the Service of Emergency Surgery at the Clinical Hospital of the School of Medicine at the University of São Paulo in the period from July 2000 to November 2002...

Gangrena de Fournier: experiência de uma equipe cirúrgica em um Hospital Geral / Fournier's gangrene: surgical team experiences at General Hospital

A gangrena de Fournier foi primeiramente descrita em 1883, como fasciíte necrotizante do períneo ou genitália em pacientes de ambos os sexos. Neste estudo realizamos uma análise retrospectiva dos principais aspectos de 19 casos de gangrena de Fournier registrados no Hospital Nossa Senhora da Conceição, em Porto Alegre, entre janeiro de 1996 e maio 1997. Nove pacientes (47,4 por cento) eram do sexo feminino e 10 (52,6 por cento) do sexo masculino. Os fatores de risco mais freqüentes foram diabetes mellitus (31,5 por cento), abscesso perianal (31,5 por cento), alcoolismo (15,8 por cento) e imunossupressão (10,5 por cento). Obteve-se uma média de dois debridamentos por paciente. Foi realizada colostomia em dois pacientes (10,5 por cento) e cistostomia em três (15,8 por cento) A mortalidade compreendeu 31,5 por cento. A gangrena de Fournier consiste em uma patologia de etiologia variada, com sucesso terapêutico agressivo associado à antibioticoterapia de largo espectro e ao suporte clínico adequado

Fournier's gangrene a urological emergency

A retrospective study to collect data about Fournier's gangrene done in Surgical-IV Liaquat Medical College Hospital Jamshoro/Hyderabad. During five years period from January 1994 to December 1998, thirty cases were collected with median age of 53 years. Pain, fever, erythema and swelling of the genitalia were present in all cases. The crepitus was found in fifteen cases and 33.3 percent patients developed multiple organ failure. The cause of infection was urological in 90 percent cases and anorectal in 10 percent cases. Associated systemic diseases were diabetes mellitus in 66.7 percent, uraemia 86.7 percent, cardiac failure in 33.3 percent cases and hepatic failure in 10 percent cases. The operations done were debridements in all cases, cystostomy in 83.3 percent and colostomy in 6.7 percent cases. Twenty patients [67 percent] died due to multiple organ failure

Factores pronósticos en las infecciones severas del periné / Prognosis factors in severe infections of perineum

Se evaluaron los factores de riesgo en las infecciones severas del periné en 20 pacientes atendidos entre enero de 1984 y diciembre de 1995 en la Clínica Modelo de Lanús. Entre los múltiples factores evaluados al ingreso, consideramos como desfavorables: la diabetes, la edad avanzada, neoplasias, el tiempo de evolución de la enfermedad y la puntuación APACHE II mayor 30 puntos. En la evolución de la enfermedad consideramos que la sepsis, la progresión anatómica de la infección y el número de cirugías inciden desfavorablemente, aumentando el índice de mortalidad. Se concluye que la estadificación clínica de estos enfermos, la detección temprana de las complicaciones sistémicas, y el acto quirúrgico efectivo son los aspectos fundamentales que llevaran a obtener una menor morbimortalidad.

Gangrena perineal (Enfermedad de Fournier): nuestra experiencia / Perineal gangrene (Fournier syndrome): our experience

Se trata de una afección poco frecuente, de la que se han comunicado aproximadamente 500 casos, pero que puede tener suma gravedad. Descripta por Fournier en 1883, recibió distintas denominaciones y se modificó su descripción original. Su mayor incidencia se registra en adultos jóvenes de sexo masculino. Reconoce factores predisponentes como cáncer, diabetes, alcoholismo y neutropenia, que condicionan inmunodepresión y ensombrecen el pronóstico y factores desencadenantes como cirugía, procedimientos endoscópicos, traumatismos e infecciones locales, por lo que se recomienda, sobre todo para pacientes ambulatorios, que presenten algunas de las características antedichas, extremar la antisepsia y un estricto control de seguimiento. Su diagnóstico no ofrece dificultades, salvo quizás, la diferenciación con el abceso anorrectal simple. El tratamiento debe ser precoz, agresivo, basado en tres pilares: compensación del medio interno, antibióticos y cirugía amplia. Los resultados mejoraron con el advenimiento de los antibióticos y el mejor conocimiento del medio interno.