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At least 19 recordsLinked to original sources
PubMed1976

Marlex mesh in gas gangrene.

Clostridial gas gangrene is a well recognized complication of traumatic and surgical wounds, and is associated with an overall mortality rate of 25% (5, 22). Gas gangrene of a limb results in a mortality rate approximately half that of gas gangrene of the trunk (4, 7, 8, 9, 11, 12, 13, 15, 16, 19, 24). Radical debridement and antibiotic therapy or high amputation of involved limbs are accepted traditional approaches to the problem. The role and value of hyperbaric oxygenation (OHP) remains controversial despite intense study over the past few decades. Patients with gas gangrene involving all layers of the abdominal wall as well as an extremity pose major resuscitative, operative, supportive, and rehabilitative problems. A report is presented of two such patients with comments on the therapeutic modalities employed.

Abdominal Injuries↗
PubMed1977

Monoplace hyperbaric oxygen therapy for gas gangrene.

Untreated gas gangrene is a fulminating infection that can lead to extensive tissue necrosis and death. Hyperbaric oxygen, when used with antibiotics and surgical debridement, can lead to decreased mortality. Nine patients with gas gangrene proven by positive clostridial cultures have been treated at St Luke's Hospital of Kansas City with a mortality of 11.1%. A case of gas gangrene developing from a perirectal abscess is presented.

Abscess↗
PubMed1977

[Hyperbaric oxygenation in gas gangrene therapy].

Gas gangrene which is caused by gram-negativ rod-shaped bacilli appeared longtime in war only. Now an increase of infection is noted by heavy traffic accidents. Reporting about 18 patients and treatment results we suggest for therapeutic proceeding: excision of wounds without primary amputation followed by hyperbaric oxygenation. In our opinion, surgical intervention and hyperbaric oxygenation should not be rival but complementary treatment of equal value.

Adolescent↗
PubMed1976

[Gas gangrene panophthalmitis (author's transl)].

Gas gangrene panophthalmitis is a rare condition of penetrating injury to the globe. The infecting organism is usually Clostridium perfringens. Characteristic symptoms are a brawny swelling of the lids, marked chemosis, coffee-coloured discharge, hypopyon, ring abscess of the cornea, formation of gas bubbles in the anterior chamber, rise of intraocular tension and early amaurosis. Treatment consists in the evisceration or enucleation of the globe, rarely in the exenteration of the orbit. Antibiotics along (Penicillin, Tetracyclines) are insufficient. Administration of antiserum is almost completely abandoned, it is probably more dangerous than helpful. The use of hyperbaric oxygen is not indicated in cases of gas gangrene panophthalmitis. Extraocular extension of the infection and its danger for the individual is prevented by well-times surgical procedure.

Adult↗
PubMed1979

[Gas gangrene (author's transl)].

Gas gangrene which is due to clostridial contamination of a wound is a rare disease. The clinical picture is quite characteristic. Untreated the disease has a near 100% mortality for which reason treatment should be started as early as possible. Surgical debridement remains the therapeutic cornerstone. Administration of antibiotics is recommended and the efficacy of treatment with hyperbaric oxygen is beyond doubt. The only proven prophylactic means consists in the proper surgical management of wounds.

Anti-Bacterial Agents↗
PubMed1977

[Current aspects of gas gangrene, apropos of 47 cases collected over a 3-year period (1974-1976)].

On the basis of 47 cases of gas gangrene collected over the three year period between 1974 and 1976, the authors review the circumstances surrounding its development, the clinical features and the prognosis of the disorder which remains grave despite a well-defined therapeutic protocol combining surgery, antibiotics and hyperbaric oxygen. There would appear to be a real resurgence of the disease at the present time. Post-traumatic and surgical aetiologies predominate, giving rise to two types of gangrene: clostridial gas gangrene secondary to contamined wounds, with a quasi-constant vascular element, affecting predominantly the limbs, and nonclostridrial gangrene, the increasing prevalence of which involves essentially spetic abdomino-pelvic surgery. In the light of this study, prognosis would appear to be related to the underlying terrain in which the gangrene occurs, to certain features of the clinical picture and, above all, to the possibilities of early application of the complete therapeutic protocol. Strict prophylactic measures would alone seem capable of preventign the worrying increase in the number of cases of gas gangrene.

Adult↗
PubMed1975

Nonclostridial gas gangrene. Report of 48 cases and review of the literature.

Gangrenous lesions accompanied by evidence of subcutaneous gas usually are diagnosed as "clostridial gas gangrene." The occurrence of nonclostridial gas gangrene has been infrequently reported and is thought to be relatively rare. Review of 278 admissions of diabetic patients with orthopedic vascular problems disclosed a 17% (48 patients) incidence of nonclostridial gas infections and a 3% (one patient) occurrence of clostridial gas gangrene. Clinical characteristics ranged from severe to benign toxicity. Appreciation of the causative organisms (usually mixed Gram-negative rod and enterococcus) of this syndrome is essential, especially in the diabetic patient, since appropriate antibiotic therapy and surgery can result in a low mortality (4%) and a high incidence (80%) of ambulatory, independent patients.

Acute Disease↗
PubMed1979

Gas gangrene as a complication of burns.

Gas gangrene infection in burnt patients is a rare but often fatal complication. It may however, be successfully treated by the use of hyperbaric oxygen and later judicious amputation of dead tissues. Five cases of bacteriologically proven gas gangrene, three of whom survived, occurred out of a total of one thousand and sixty-four burns patients treated since 1964 in the McIndoe Burns Unit, and these we describe.

Adult↗
PubMed1977

[Clostridium infections with and without manifest gas gangrene. Report on 77 infections in 76 patients].

Systematic microbiological research and correlation of the histopathological findings obtained from random autopsies revealed 23 hitherto undetected clostridial infections including 11 cases of gas gangrene, 4 of septicemia, 3 of bacteremia, and 5 other clostridial infections. The knowledge gained from this study led to clinical diagnosis of several cases of gas gangrene which were confirmed bacteriologically and histologically. Of 8 hospital patients who were thus diagnosed in this surgical clinic, 7 recovered, including a case of gas gangrene of the abdominal wall. The problem in gas gangrene is timely clinical diagnosis. Little is known about gas edema illnesses which are not traumatically conditioned. Recognition of the local and general symptoms (local, violent, yet inappropriate pain in the wound, "unexplained" postoperative secondary bleeding, appearance of tachycardia wholly unrelated to the patient's temperature, sudden shock, rapid deterioration of patient's general condition, jaundice and rise in CPK) makes it possible to diagnose postoperative gas edema in time. 77 infections with isolation of clostridia, seen in 76 patients, are reported. On the basis of clinical and histopathological criteria they have been classified as follows: 22 cases with gas gangrene (clostridial myonecrosis), 16 cases with anaerobic cellulitis, 20 wound infections, 8 cases of septicemia, 5 of bacteriemia, 1 of tetanus, and 5 other clostridial infections.

Adolescent↗
PubMed1979

[Experiences in the treatment of gas gangrene in accident surgery (author's transl)].

It is reported on 105 patients with gas gangrene. 68 cases were caused by accident, 7 of them died. Only the gas chromatographic identification of toxin in blood was needed to assure diagnosis. In 46 cases of gas gangrene localized in the lower limbs, amputation was necessary in 12 cases; in 5 cases gangrene in the lower leg, in 7 cases in the thigh. In ten cases of disease in the upper limbs three amputations were necessary. If OHP is implicated as soon as possible in the therapy of gas gangrene, in most cases local necrectomy with maintenance of the limb will be sufficient, if amputation was necessary, it was localized in the region of infection.

Adolescent↗
PubMed1977

Clostridium-produced gas gangrene of the colon.

A case of radiologically demonstrable gas gangrene of the colon was proved pathologically to be caused by C. perfringens. The case was radiologically indistinguishable from that of bowel infarction. When intramural gas is seen in patients with the symptoms of toxemia but without the bloody diarrhea associated with bowel infarction, infectious gas gangrene should be considered.

Aged↗
PubMed1978

[Hyperbaric oxygen treatment in gas gangrene (author's transl)].

Among 100 patients with proven gas gangrene surgical treatment was undertaken in 34 who also received 30--60 mega-units of penicillin, in addition to appropriate shock treatment. Since 1967, additional treatment in a hyperbaric chamber was undertaken in 66 patients. There was no clear-cut advantage of hyperbaric oxygenation as far as the death-rate was concerned. There was merely a moderate decrease in the amputation rate after limb injuries. Wide incision of the wound and radical surgical excision of all tissue affected by gas gangrene continues to be an essential form of treatment.

Amputation, Surgical↗
PubMedDate not supplied

Anesthetic considerations in patients with gas gangrene.

Anesthesia for a patient with gas gangrene presents a challenge for the anesthesiologist, since it is an uncommon disease requiring emergency treatment. The authors, faced with such a challenge and finding little guidance in the literature, have proposed modalities of anesthetic management based on pathophysiology, symptomatology, and the reported experience of others. In addition to choice of anesthetic agents, problems reviewed include shock, hypovolemia, tachycardia, fever, anemia, renal dysfunction, pulmonary insufficiency, and contamination. Factors relating to anesthesia during hyperbaric-O2 therapy are also reviewed.

Adjuvants, Anesthesia↗
PubMed1992

Effect of hyperbaric oxygen and surgery on experimental gas gangrene.

An experimental model of clostridial gas gangrene was developed in rats and the therapeutic value of surgical debridement alone versus a combination of surgery and hyperbaric oxygen (HBO) was assessed. The infection was produced by an intramuscular injection of Clostridium perfringens microorganisms. The mortality of untreated rats was 100%. The mortality of the rats treated only with surgery was 37.5% compared to 12.5% when HBO was added to the treatment protocol (p < 0.01). In the group treated with HBO and surgery 82.5% of the animals healed completely and were able to walk normally, whereas the corresponding figure in the rats treated with surgery alone was 12.5% (p < 0.001). In the present experimental setting HBO treatment was an important therapeutic adjunct to surgery reducing both mortality and morbidity.

Animals↗
PubMed1977

Treatment of gas gangrene. Interest of hyperbaric oxygen therapy.

We report 27 cases of gas gangrene treated at the University Hospital of Liège since the Anesthesiology Department has been using a caisson for hyperbaric oxygen therapy. Frequency of gas gangrene does not appear to have decreased during recent years. The etiologies now encountered are mainly of post-traumatic and post-operative origin (especially surgery on the digestive tract); arterial insufficiency is a predisposing factor. The prognosis depends on the speed with which an effectual treatment is started; the latter consists in intensive hyperbaric oxygen therapy, antibiotic therapy and resuscitation. Surgery should be as conservative as possible and is undertaken only when progress of the disease has been checked by hyperbaric oxygen therapy. The association of these various modes of treatment proves effectual despite a still significant mortality.

Adolescent↗
PubMed1978

[Gas gangrene. The files of the Swiss Accident Insurance Company 1963-1975].

The clinical histories of 28 cases registered as gas gangrene by the Swiss National Accident Insurance (Schweizerische Unfallversicherungsanstalt) from 1963 to 1975 are reviewed. According to the classification of Altemeier (1. gas gangrene, 2. clostridial cellulitis, 3. simple contamination of a wound by Clostridium, and 4. gaseous infection without Clostridium) only 5 cases were assignable to group one (1 survivor), 2 cases to group two, 9 to group three and 9 to group four. Typical cases from each group are discussed to illustrate the advantages of this classification, the dangers of treatment based on wrong diagnosis, and the necessary prophylaxis. The more serious prognosis in gas gangrene in comparison to the other groups is emphasized.

Accidents, Occupational↗
PubMed1977

Gas gangrene and related infection: classification, clinical features and aetiology, management and mortality. A report of 88 cases.

The clinical features of gas gangrene and related infection seen in 88 patients over a 10-year period are described. It is suggested that clostridial infection could be simply classified as either 'gas-forming' or 'non-gas-forming'. The gas-forming group represents the more severe form of infection. Non-clostridial gas gangrene may present in a variety of forms. The anaerobic streptococcus was the organism most frequently responsible, but these cases were indistinguishable from clostridial infection on clinical grounds. The treatment of gas gangrene in this series of patients is reported. Emphasis is laid on the importance of adequate prophylaxis with penicillin in patients at risk. The value of antibiotics in established infection remains equivocal. The evidence supporting the value of hyperbaric oxygen therapy is assessed and an attempt made to quantify the response to this treatment. Benefit was apparent in only a proportion of patients. A favourable response indicated clostridial infection and guaranteed immediate survival. Extensive debridement or amputation is unnecessary in this group. No response following hyperbaric oxygen therapy indicated widespread mixed clostridial and non-clostridial infection, or infection due to organisms other than clostridia. Urgent and extensive debridement and amputation remain the predominant measures in this group.

Adolescent↗