ABSTRACT
The Fournier Gangrene (FG) is a synergistic, polymicrobial, necrotizing fasciitis with infectious origin that produces gangrene of the perineal, genital or perianal skin. The number bigger than cases happens between 20 at 50 years, the males are affected more than the females in proportion 10:1 and the mortality rate is high yet. The clinical manage of the GF must be fast and opportune with intravenous application of fluids, electrolytes and systemic broad-spectrum antibiotic therapy; and avoid the hemodynamic stabilization of the patient before the surgery. The precocious surgery with debridement of the necrotizing tissues constitutes the main objective of the treatment.
Subject(s)
Fournier Gangrene , Adult , Age Factors , Anti-Bacterial Agents/therapeutic use , Debridement , Diagnosis, Differential , Female , Fournier Gangrene/diagnosis , Fournier Gangrene/drug therapy , Fournier Gangrene/epidemiology , Fournier Gangrene/mortality , Fournier Gangrene/surgery , Fournier Gangrene/therapy , Humans , Hyperbaric Oxygenation , Male , Middle Aged , Prognosis , Sex FactorsABSTRACT
La Gangrena de Fournier (GF) es una fascitis necrotizante sinérgica, multimicrobiana, de origen infeccioso, que produce gangrena de piel de región genital, perineal, o perianal. Su mayor frecuencia se observa en pacientes de 20 a 50 años, los varones se afectan más que las hembras en proporción 10:1 y la tasa de mortalidad aún es alta. El manejo clínico debe ser rápido y oportuno, con aplicación intravenosa de líquidos, electrolitos y antibióticos de amplio espectro; a fin de lograr la estabilización hemodinámica del paciente antes de la intervención quirúrgica. La cirugía precoz con debridamiento extenso de tejidos desvitalizados, constituye la base principal del mismo
The Fournier Gangrene (FG) is a synergistic, polymicrobial, necrotizing fasciitis with infectious origin that produces gangrene of the perineal, genital or perianal skin. The number bigger than cases happens between 20 at 50 years, the males are affected more than the females in proportion 10:1 and the mortality rate is high yet. The clinical manage of the GF must be fast and opportune with intravenous application of fluids, electrolytes and systemic broad-spectrum antibiotic therapy; and avoid the hemodynamic stabilization of the patient before the surgery. The precocious surgery with debridament of the necrotizing tissues constitutes the main objective of the treatment
Subject(s)
Male , Female , Adult , Middle Aged , Child , Humans , Fournier Gangrene/diagnosis , Fournier Gangrene/epidemiology , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/diagnosis , Electrolytes/therapeutic use , Hyperbaric Oxygenation/methods , Hyperbaric Oxygenation/trends , Diagnosis, Differential , Metronidazole/therapeutic use , Clindamycin/therapeutic use , Proctoscopy/methods , Scrotum/pathology , Scrotum , Cephalosporins/therapeutic use , Penicillin G Benzathine/therapeutic useABSTRACT
A 3-month-old male infant was admitted to the University Hospital of Los Andes with a history of constipation, weak crying, poor feeding, flaccidity and later bilateral ptosis and hyporeflexia. The admission diagnosis was septicaemia until an electrophysiological study reported postetanic facilitation with 50 Hz/seg stimulations four days later. The Clostridium botulinum toxin type B was isolated from the infant's stool samples and the organism grew in anaerobic cultures. The patient recovered completely and was discharged 2 months later. Although infant botulism is an uncommon disease in our environment, this diagnosis must be suspected in all afebrile infants with constipation, affected cranial nerves and generalized hypotonia. The principal differential diagnoses are Landry-Guillain-Barré syndrome, poliomyelitis, myasthenia gravis and infant muscular atrophy.
Subject(s)
Botulism/diagnosis , Clostridium botulinum , Paralysis/microbiology , Botulism/microbiology , Botulism/physiopathology , Clostridium botulinum/isolation & purification , Diagnosis, Differential , Electrophysiology , Feces/microbiology , Humans , Infant , Male , Paralysis/physiopathologyABSTRACT
Se describe el caso clinico de un recien nacido con sindrome nefrotico congenito y seudohermafroditismo asociado con displasia coxofemoral congenita. Esta triple asociacion no parece haber sido descrita previamente en la literatura; sugiere anormalidades embriogenicas basicas, antes de la diferenciacion de las estructuras renales y genitales. La lesion glomerular observada en la biopsia renal practicada al mes de edad, consistio en esclerosis mesangial difusa retractil con depositos capilares de IgM y complemento (C3). El paciente evoluciono a insuficiencia renal cronica y fallecio por hipervolemia a los 3 meses de edad
