In the year has been indexed in the Medlinedatabase, and has become a vehicle for expressing the most current Spanish medicine and modern. All articles are subjected to a rigorous process of revision in pairs, and careful editing for literary and scientific style. CiteScore measures average citations received per document published. Read more.
|Published (Last):||13 January 2005|
|PDF File Size:||5.90 Mb|
|ePub File Size:||16.82 Mb|
|Price:||Free* [*Free Regsitration Required]|
In the year has been indexed in the Medlinedatabase, and has become a vehicle for expressing the most current Spanish medicine and modern. All articles are subjected to a rigorous process of revision in pairs, and careful editing for literary and scientific style. CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Fournier gangrene is a urological emergency associated with a high mortality.
It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department.. We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January and October All the patients were men, Statistically significant differences were observed between the age of surviving patients and that of patients who died The mean hospital stay was Etiology was unknown in Polymicrobial infection was observed in Mortality was Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay..
Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented..
El estudio analiza retrospectivamente 37 pacientes diagnosticados de gangrena de Fournier en el periodo de tiempo comprendido entre enero del a octubre de Fournier gangrene is a urological emergency that was first reported in by Baurienne, 1 although it was not until that the French venereologist Jean Fournier described the clinical characteristics of the disease in a series of 5 cases with no apparent cause.
Fournier gangrene is defined as necrotizing fasciitis resulting from a rapidly progressive polymicrobial infection involving aerobes and anaerobes acting synergistically.
The disease originates in the anorectal and genitourinary areas and can reach the groin, legs, anterior wall of the abdomen, and even the thorax, given its ability to progress across the fasciae of Buck, Dartos, Colles, and Scarpa. Progression results from thrombosis of the small subcutaneous vessels secondary to endarteritis obliterans, which produces tissue hypoxia and limited vascular supply, thus facilitating overgrowth of anaerobic microorganisms and making it difficult for antibiotics to reach these areas.
Although there have been reports in women and even in children as young as 2 months, 7,8 the disease mainly affects men aged 50—70 years. The overall incidence of the disease is 1. Many patients have underlying systemic diseases e. Using data from the patients treated in our department, we analyzed the clinical and epidemiological characteristics of Fournier gangrene to compare them with the findings of previous reports.
We also analyzed those variables that affected outcome and mortality. The disease was coded according to the International Classification of Diseases, Ninth Revision as Fournier gangrene Clinical diagnosis was based on the patient's medical history and physical examination, which included as diagnostic criteria the presence of foul-smelling necrotic slough in the anogenital area associated with crepitus in the context of sepsis.
The variables studied were as follows: 1. Personal details: age and sex. Personal history, including mainly presence of diabetes mellitus, chronic alcoholism, obesity, perianal abscess or fistula, and urethral stricture. Presence or absence of previous multiple conditions. We defined multiple conditions as the presence of 2 or more chronic diseases that can affect normal performance of activities of daily living and require close follow-up by a clinician.
Urinary catheterization before diagnosis of Fournier gangrene. Identification of causal agents monomicrobial or polymicrobial. Need for reconstructive surgery: secondary suture, placement of skin grafts or flaps.
Outcome mortality attributable to infection. Admission to and length of stay in the intensive care unit ICU. Mean overall health care costs arising mainly from the hospital stay and the use of an operating room for wound care. Each unit cost was multiplied by the mean stay in the ICU, the mean stay on the urology ward, and the mean time in the operating room. Data were analyzed in a purpose-designed database using SPSS version We analyzed 37 patients diagnosed with Fournier gangrene during the study period.
Mean SD age was As for personal history, Local involvement of the genital and perineal areas was as follows: urethral stricture, Multiple conditions were recorded in None of the patients analyzed had a urinary catheter before diagnosis. The sites involved on admission were as follows: scrotum, All patients had some degree of edema on the penis or scrotum, Characteristic necrotic plaques and blisters.
Once diagnosis had been confirmed by the presence of symptoms and the results of imaging tests, all patients required at least 1 surgical intervention, and The mean stay in the ICU was 7. Only chronic alcoholism had a statistically significant association with ICU stay P Exposure of the penis and testicles after extensive debridement. Healthy tissue is visible. Exposure of the penis and testicles after extensive debridement.
Patients were transferred to the ward after leaving the ICU. Once infection had been controlled and the surgical wound had healed, Secondary sutures were applied in Reconstruction of the genital area and covering with skin after debridement. Infection was monomicrobial in The most commonly isolated microorganism was Escherichia coli Other less commonly isolated agents were Enterococcus faecium Only 5 patients The association with stay in the intensive care unit or the hospital is measured in days.
When Fournier gangrene was first described, it was thought to affect men only. In a series of 39 women diagnosed with Fournier gangrene, Sorensen et al.
However, twice as many women required mechanical ventilation and dialysis, and hospital stay was longer and mortality greater than in men, although none of these findings was statistically significant. We recorded no cases in women or children in our series. Common predisposing factors for Fournier gangrene include chronic alcoholism, systemic disorders, diabetes mellitus, chronic renal insufficiency, malignant neoplasm, and human immunodeficiency virus infection 5,14 ; some series have reported an association between predisposing factors and mortality.
Most authors consider diabetes mellitus to be a risk factor for Fournier gangrene, although there is no agreement on whether it is associated with greater mortality.
In our study, We observed a statistically significant association between multiple conditions and mortality; however, of all the conditions analyzed only the association between ischemic heart disease and mortality was statistically significant.
Ischemic heart disease was also associated with longer hospital stay. There is no consensus on the variables that predict poor outcome in patients with Fournier gangrene. Some studies show that early and extensive debridement can significantly reduce mortality and that involvement of large areas is associated with greater mortality, since more interventions are necessary. Laor et al.
It is important to recognize Fournier gangrene in the early stages, when cutaneous manifestations are minimal. However, diagnosis is difficult. The first 24—48 hours are characterized by nonspecific symptoms associated with hardening of the perineal area, mild fever, and erythema of the affected tissue. If the condition is not diagnosed in the early stages and the process follows its normal course, hemorrhagic blisters appear and can quickly become necrotic.
Given the anatomical continuity between the fasciae, necrosis can spread to distant sites. The results of imaging tests are sometimes useful for confirming the clinical suspicion, determining the extension of the disease, and evaluating the response to treatment.
This is an important advantage, given that some patients are hospitalized in the ICU or may be hemodynamically unstable, thus making it difficult to move them to the radiology department for a computed tomography CT scan.
CT imaging does not usually show scrotal structures as well as ultrasound and often requires injection of contrast medium, which may not always be possible, as patients with Fournier gangrene often have renal failure. Fournier gangrene is usually considered a polymicrobial infection, although not all the microorganisms involved are necessarily detected in culture. Both aerobes and anaerobes are almost always present, although anaerobes are isolated less frequently.
These entities are present in normal gastrointestinal and perineal flora. According to the literature, treatment is based on early and extensive debridement to remove infected and necrotic tissue, hemodynamic stabilization, and broad-spectrum antibiotics. Recent studies recommend starting empirical therapy with third-generation cephalosporins for gram-negative agents and metronidazole for anaerobes, with the possibility of adding aminoglycosides.
Antibiotic resistance and the advent of agents with a broader spectrum, which are also easier to use, have led us to prescribe empirical carbapenems in monotherapy or combined with metronidazole, as this approach is effective in most patients. Reconstructive procedures were necessary in Of those who required a flap, 5.
When it was necessary to use grafts, we chose thick grafts owing to their reduced contractility. There is no consensus on predictors of the disease. In most cases, the anorectal or genitourinary area is affected.
2010, Número 1
Gray JA. Gangrene of the genitalia as seen in advanced periurethral extravasation with phlegmon. Idiopathic necrotizing fascii tis:recognition, incidence, and outcome of therapy. Ann Surg ;
Fournier's gangrene: Our experience in 5 years, bibliographic review and assessment of the Fournier's gangrene severity index. Department of Urology. Hospital Universitario Dr. It is potentially fatal, and affects any age and gender. The severity index for Fournier's gangrene has been described; it is useful for evaluating the prognosis of these patients. Our goal is to report our experience with this disease over the past 5 years and evaluate the index in retrospect. Methods: We analyzed medical records of patients with Fournier gangrene over the last 5 years at the University Hospital "Dr.