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Pereira de Godoy JM, Guerreiro Godoy MDF. Gas gangrene, diabetes and amputations of upper extremities. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:44-46. [PMID: 32191653 PMCID: PMC7569588 DOI: 10.23750/abm.v91i1.7287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 11/23/2019] [Indexed: 11/23/2022]
Abstract
PURPOSES The aim of the current study was to evaluate epidemiological data on amputations of upper extremities. METHODS The main causes of upper extremity amputations performed in the period from January 1998 to January 2008 in Hospital de Base, São José do Rio Preto were retrospectively evaluated in a descriptive and quantitative cross-sectional study. Data, including the age of the patient, gender and the reason for surgery, were obtained from hospital records identified by the international classification of diseases (ICD) code for amputation. RESULTS A total of 2919 amputations were performed in the period of this study with only 23 involving the upper extremities; thus 22 patients were included in this study as one was submitted to amputation of both arms. Fifteen patients (65.21%) were male with ages that ranged between 18 and 84 years old (mean = 41.6 years old). Seven patients (34.79%) were women with ages from 24 to 87 years old (mean = 58.8 years old). The causes for amputation were: accidents (14), gas gangrene (4), malignant neoplasms (3), arterial thrombosis (1) and unidentified cause (1). CONCLUSION Gas gangrene of the upper extremities is associated to diabetes mellitus which highlights the severity of the disease.
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Affiliation(s)
- Jose Maria Pereira de Godoy
- Cardiology and Cardiovascular Surgery Department of the Medicine School in São José do Rio Preto-FAMERP-Brazil and CNPq (National Council for Research and Development)-Brazil.
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Contou D, Lecronier M, Bitot V, Hersant B, Zakine A, Hua C, de Prost N. Fatal Clostridium septicum multifocal myonecrosis in a previously healthy 25-year-old man: Role of NSAIDs? Med Mal Infect 2017; 47:432-434. [PMID: 28705640 DOI: 10.1016/j.medmal.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/03/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- D Contou
- Service de réanimation médicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; UPEC-Université Paris-Est Créteil Val de Marne, faculté de médecine de Créteil, CARMAS Research Group, 94010 Créteil, France.
| | - M Lecronier
- Service de réanimation médicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - V Bitot
- Service d'anesthésiologie et réanimation chirurgicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - B Hersant
- Service de chirurgie plastique, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - A Zakine
- Service des urgences, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Hua
- Service de dermatologie, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - N de Prost
- Service de réanimation médicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; UPEC-Université Paris-Est Créteil Val de Marne, faculté de médecine de Créteil, CARMAS Research Group, 94010 Créteil, France
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Tocco I, Lancerotto L, Pontini A, Voltan A, Azzena B. "Synchronous" multifocal necrotizing fasciitis. J Emerg Med 2013; 45:e187-91. [PMID: 24063873 DOI: 10.1016/j.jemermed.2013.05.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/11/2012] [Accepted: 05/01/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Necrotizing fasciitis (NF) is an infection of the soft tissue, and is fatal if not promptly and aggressively treated. Although it is rare, it is not exceptional; nevertheless, its presentation may be misleading and may delay the diagnosis. We highlight the possible synchronous development of NF in multiple noncontiguous areas. CASE REPORT A 44-year-old diabetic man with no history of trauma complained of nonspecific lower back pain, which he treated with analgesics and oral antibiotics. Erythema at the left arm appeared, and the general condition worsened. The patient was admitted to the Emergency Department, and NF was diagnosed at the right gluteus and left arm. CONCLUSION "Synchronous" multifocality is not an expected presentation of NF, and it complicates the diagnosis and delays treatment, with a potentially negative impact on outcome.
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Affiliation(s)
- Ilaria Tocco
- Institute of Plastic Surgery, University Hospital of Padova, Padova, Italy
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Wright WF. Clostridium septicum myonecrosis presenting as an acute painful foot. Am J Emerg Med 2012; 30:253.e3-5. [DOI: 10.1016/j.ajem.2010.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 11/28/2022] Open
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El-Khani U, Nehme J, Darwish A, Jamnadas-Khoda B, Scerri G, Heppell S, Bennett N. Multifocal necrotising fasciitis: an overlooked entity? J Plast Reconstr Aesthet Surg 2011; 65:501-12. [PMID: 21945063 DOI: 10.1016/j.bjps.2011.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/01/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study is to report a case of multi-focal necrotising fasciitis, review research on this subject to identify common aetiological factors and highlight suggestions to improve management. CONTEXT Necrotising fasciitis is a severe, life-threatening soft tissue infection that typically arises from a single area, usually secondary to a minor penetrating injury. Multi-focal necrotising fasciitis, where there is more than one non-contiguous area of necrosis, is much less commonly reported. There are no guidelines specific to the management of multi-focal necrotising fasciitis, and its under-reporting may lead to missed management opportunities. DESIGN A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. DATA SOURCES A search of MEDLINE, OLD MEDLINE and the Cochrane Collaboration was performed from 1966 to March 2011 using 16 search terms. DATA EXTRACTION All articles were screened for genuine non-contiguous multi-focal necrotising fasciitis. Of the papers that met this criterion, data on patient demographics, likely inciting injury, presentation time-line, microbial agents, sites affected, objective assessment scores, treatment and outcome were extracted. DATA SYNTHESIS A total of 31 studies met our inclusion criteria and 33 individual cases of multi-focal necrotising fasciitis were included in the quantitative analysis. About half (52%) of cases were type II necrotising fasciitis; 42% of cases had identifiable inciting injuries; 21% of cases developed multi-focal lesions non-synchronously, of which 86% were type II. Nearly all (94%) of cases had incomplete objective assessment scores. One case identified inflammatory imaging findings prior to clinical necrosis. CONCLUSIONS Multifocality in necrotising fasciitis is likely to be associated with type II disease. We postulate that validated objective tools will aid necrotising fasciitis management pathways that will identify high-risk groups for multifocality and advise early pre-emptive imaging. We recommend the adoption of regional multi-focal necrotising fasciitis registers.
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Affiliation(s)
- Ussamah El-Khani
- Mountbatten Department of Plastic and Reconstructive Surgery, Queen Alexandra Hospital, Curie Road, Cosham, Portsmouth PO6 3LY, UK.
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Leaning DJ, Dixon L, Fisher P. Non-traumatic gas gangrene presenting as left buttock and thigh pain in a patient with metastatic non-small cell lung cancer. BMJ Case Rep 2010; 2010:2010/oct27_1/bcr0320102839. [PMID: 22791722 DOI: 10.1136/bcr.03.2010.2839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of Clostridium septicum myonecrosis in a patient with metastatic non-small cell lung cancer receiving palliative chemotherapy. This is a rare but important differential diagnosis in patients with known malignancy presenting with acute pain. It is critical that the diagnosis is considered and confirmed promptly due to rapid deterioration and a potentially fatal outcome in the absence of aggressive treatment.
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Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, Weil LS, Zlotoff HJ, Bouché R, Baker J. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg 2010; 49:S1-19. [PMID: 20439021 DOI: 10.1053/j.jfas.2010.01.001] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Indexed: 02/03/2023]
Abstract
Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
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Affiliation(s)
- James L Thomas
- Chair, Clinical Practice Guideline Heel Pain Panel (2001), Morgantown, WV, USA
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Schade VL, Roukis TS, Haque M. Clostridium septicum necrotizing fasciitis of the forefoot secondary to adenocarcinoma of the colon: Case report and review of the literature. J Foot Ankle Surg 2009; 49:159.e1-8. [PMID: 19945301 DOI: 10.1053/j.jfas.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Indexed: 02/03/2023]
Abstract
Clostridium septicum accounts for 1% of all reported clostridial infections. C septicum infections are most often nontraumatic in nature and associated with either an occult colonic or hematologic malignancy. The initial presentation of a C septicum infection can be relatively benign with rapid progression to fatality without emergent treatment. Presented is a case of necrotizing fasciitis of the forefoot caused by C septicum associated with an occult adenocarcinoma of the colon in a patient with uncontrolled diabetes. The process we used to achieve successful functional limb preservation based on rapid surgical intervention and use of a multidisciplinary approach to medical and surgical management of this patient is discussed in detail, as well as a through review of the literature regarding the association between malignancies and C septicum infections.
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Affiliation(s)
- Valerie L Schade
- Limb Preservation Complex Lower Extremity Surgery, Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Tiong W, Butt F. Subcutaneous emphysema of the upper extremity following penetrating blackthorn injury to the wrist. J Plast Reconstr Aesthet Surg 2009; 62:e29-32. [PMID: 19177641 DOI: 10.1016/j.bjps.2007.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hermsen JL, Schurr MJ, Kudsk KA, Faucher LD. Phenotyping Clostridium septicum infection: a surgeon's infectious disease. J Surg Res 2008; 148:67-76. [PMID: 18570933 DOI: 10.1016/j.jss.2008.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/05/2008] [Accepted: 02/12/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clostridium septicum infection is associated with malignancy. Whether disease phenotype is affected by malignant status is not known. Surgical treatment is used frequently but its impact on survival has not been examined in a cohort >30 patients. METHODS A PubMed search of English language journal articles yielded 320 cases. Full information (infection location, cancer type, operative intervention, and survival) was available for 224 cases + 7 at our institution not previously reported. RESULTS Seventy-two percent of patients had malignancy or malady of the gastrointestinal (GI) or hematologic (HEME) organ systems. HEME survival was inferior to GI survival (35% versus 55%, P = 0.03). Overall, patients who underwent operation had improved survival (57% versus 26%; P < 0.0001) and this association was maintained within GI and HEME cohorts (P = 0.002 and 0.005, respectively). More GI than HEME patients underwent operation (81% versus 51%, P < 0.001). GI patients were more likely than HEME patients to experience infection of skin and soft tissues (SSTI, P = 0.006). Diabetics were more likely to experience SSTI than nondiabetics (77% versus 45%, P < 0.001). CONCLUSIONS C. septicum infectious phenotype varies with host milieu. The SSTI phenotype is more common in GI and diabetic patients. This recognition may aid in directing the search for occult malignancy, which must be performed given the >70% incidence of concomitant cancer. This infection is more fatal in HEME versus GI patients, perhaps due in part to less HEME group operative intervention. Primary surgical therapy should be considered in GI or HEME patients as operative intervention benefits both groups.
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Affiliation(s)
- Joshua L Hermsen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
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Yeom JH, Son SI, Min HK, Shim JH, Cho SY, Shin WJ, Kim KH, Jeon WJ. Spontaneous, Fulminant Gas Gangrene Caused by Klebsiella Pneumoniae: An Unrecognized Small Air Bubbles in the Left Femoral, External and Common Iliac Vein, and Inferior Vena Cava - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.1.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jong Hoon Yeom
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Sung Il Son
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Hyoung Ki Min
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Sang Yoon Cho
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Woo Jong Shin
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Kyoung Hun Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
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Morshed S, Malek F, Silverstein RM, O'Donnell RJ. Clostridium cadaveris septic arthritis after total hip arthroplasty in a metastatic breast cancer patient. J Arthroplasty 2007; 22:289-92. [PMID: 17275650 DOI: 10.1016/j.arth.2006.02.158] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 02/20/2006] [Indexed: 02/01/2023] Open
Abstract
We report the first known case of septic arthritis in the setting of total hip arthroplasty caused by Clostridium cadaveris, a gas-forming anaerobic enteric organism usually considered a non-pathogen. This case occurred in a patient treated with total hip arthroplasty for metastatic breast cancer involving the acetabulum. The patient was managed successfully with debridement, prosthetic retention, and chronic antibiotic suppression. We propose this mode of care as a successful alternative for some patients with prosthetic joint infection and prohibitive comorbid conditions.
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Affiliation(s)
- Saam Morshed
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, UCSF Comprehensive Cancer Center, San Francisco, California 94115, USA
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Yildiz T, Gündeş S, Willke A, Solak M, Toker K. Spontaneous, nontraumatic gas gangrene due to Clostridium perfringens. Int J Infect Dis 2005; 10:83-5. [PMID: 16310394 DOI: 10.1016/j.ijid.2005.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 02/11/2005] [Accepted: 02/22/2005] [Indexed: 11/29/2022] Open
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Goon PKY, O'Brien M, Titley OG. Spontaneous Clostridium septicum septic arthritis of the shoulder and gas gangrene. a case report. J Bone Joint Surg Am 2005; 87:874-7. [PMID: 15805220 DOI: 10.2106/jbjs.d.02337] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- P K Y Goon
- Department of Plastic Surgery, University Hospital Birmingham, Selly Oak, Birmingham B29 6JD, United Kingdom.
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Tehrani H, Gillespie PH, Cormack GC. Fatal multifocal metastasis of Clostridium septicum: a case report. ACTA ACUST UNITED AC 2004; 57:673-5. [PMID: 15380701 DOI: 10.1016/j.bjps.2004.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Accepted: 04/23/2004] [Indexed: 11/25/2022]
Abstract
Clostridium septicum infection produces rapidly spreading tissue necrosis, often, but not exclusively, associated with trauma or large bowel malignancy. We present a unique case of atraumatic infection leading to multifocal metastatic spread in a neutropenic patient, emphasising the devastating potential of this disease.
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Affiliation(s)
- H Tehrani
- Department of Plastic Surgery, Norfolk and Norwich Hospital, Norwich NR4 7UF, UK
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Carron P, Tagan D. [Fulminant spontaneous Clostridium septicum gas gangrene]. ANNALES DE CHIRURGIE 2003; 128:391-3. [PMID: 12943837 DOI: 10.1016/s0003-3944(03)00120-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clostridium septicum gas gangrene is a rare fulminant infectious disease for which signs and symptoms like extreme pain, subcutaneous crepitus and violaceous necrotic bullae must be recognised. Early diagnosis followed by large surgical debridement are the only ways to ameliorate the bad prognosis. Here we describe a case of cervico-thoracic spontaneous gas gangrene.
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Affiliation(s)
- P Carron
- Division des soins intensifs, hôpital Riviera, site du Samaritain, boulevard Paderewsky 3, 1800 Vevey, Suisse
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