RESUMO
Investigation of ultrastructural peculiarities of morpho-functional changes of macrophages have been studied with the purpose of determining the dynamics and thrust of destructive-necrotic processes in these cells when the ischemic-gangrenous form of diabetic foot syndrome develops show what under the influence of intravenous ozone therapy stimulant effect on functional activity and beneficial effect on elimination, mainly due to genetically programmed cell death (apoptosis), playing a significant role in the regulatory mechanisms of the inflammatory process. The stimulation of macrophages functional activity under the influence of ozone, as well as the presence of destructive changes in such cells without necrotizing lesions, is explained by the inclusion of the mechanism of apoptosis as a positive factor in the regulation of local homeostasis at the completion of the inflammatory (exudative) stage of the wound process.
Assuntos
Complicações do Diabetes/terapia , Macrófagos/ultraestrutura , Ozônio/uso terapêutico , Administração Intravenosa , Apoptose , Estudos de Casos e Controles , Complicações do Diabetes/patologia , Pé Diabético/patologia , Pé Diabético/terapia , Gangrena/patologia , Gangrena/terapia , Humanos , Inflamação/patologia , Inflamação/terapia , Mitocôndrias/ultraestrutura , Necrose , Ozônio/administração & dosagem , Solução Salina/administração & dosagem , Solução Salina/uso terapêuticoRESUMO
This article presents the case of a 5-month-old infant, who survived a fulminant meningococcal sepsis with purpura fulminans, septic shock and severe DIC with gastrointestinal bleeding. Amputation and reconstructive surgery were considered to treat the multiple skin and limb necroses at high risk of superinfection, but the surgical intervention was delayed due to the extremely doubtful outcome. On Day 10 after the onset of the disease, a hemodynamic improvement was achieved. The baby overcame early critical period, but was still in poor general condition. The hyperbaric oxygenation (HBO2) as adjuvant therapy was started in the monoplace chamber using the following protocol: from first through fifth day 45 minutes twice a day on 1.5 atmosphere absolute (ATA); after a two-day break, once a day on 1.8 ATA for 60 minutes. During 52 HBO2 treatments multiple areas of necrotic skin and subcutaneous tissue, together with fingertips and toes, detached spontaneously. All wounds healed without reinfections. An increased oxygen concentration during HBO2 therapy promoted spontaneous wound healing. Bacterial superinfection was not observed in numerous low-perfused lesions. Since repeated anesthesia and surgical interventions were not needed, a final invalidity was minimized. To the best of our knowledge, this is the first report on the successful conservative surgical treatment of this mutilating disease without aggressive reconstructive surgery in an infant with the help of HBO2.
Assuntos
Oxigenoterapia Hiperbárica/métodos , Infecções Meningocócicas/complicações , Púrpura Fulminante/terapia , Sepse/complicações , Protocolos Clínicos , Pé/patologia , Gangrena/patologia , Gangrena/terapia , Mãos/patologia , Humanos , Lactente , Masculino , Infecções Meningocócicas/terapia , Neisseria meningitidis Sorogrupo Y , Púrpura Fulminante/etiologia , Púrpura Fulminante/patologia , Sepse/terapia , Choque Séptico/etiologia , Choque Séptico/terapia , Pele/patologia , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
The treatment of diabetic patients with pyonecrotic lesions in the lower extremities requires prolonged reflexo-segmental balneophysiotherapy to normalize functions of the nerve centres. Curative volcanic mud solutions (15-24 g/l) enriched with organic and nonorganic biologically active compounds from volcanic deposits in Azerbaijan were used for the first time to treat such patients. Peloids were applied to the lumbar region (location of sympathetic nerve nodes) and the lower legs above and beneath the affected sites. The patients were subjected to 12-15 seances of peloidotherapy (at 40-41 degrees Celsius) each lasting 20-30 minutes. The treatment was preceded by wound sanation using the standard procedure and a course of antibiotic therapy based on individual antibiotocograms. A total of 86 daibetic patients with leg gangrene underwent rheovasographic thermovision examination that revealed enhanced blood supply to the affected extremities under the action of the applied peloids. Peloidotherapy resulted in the normalization of blood and urine glucose levels in 53 (63%) of the patients. Simultaneously, the doses of medicamentous therapy could be lowered. Wound and ulcer healing was completed in the majority of the patients (86%) by the end of balneophysiotherapy when fresh granulation tissue began to develop and signs of oedema to disappear. These patients no longer needed amputation.
Assuntos
Glicemia/análise , Complicações do Diabetes , Gangrena , Glicosúria/urina , Peloterapia , Antibacterianos/administração & dosagem , Glicemia/metabolismo , Complicações do Diabetes/sangue , Complicações do Diabetes/patologia , Complicações do Diabetes/terapia , Complicações do Diabetes/urina , Feminino , Gangrena/sangue , Gangrena/patologia , Gangrena/terapia , Gangrena/urina , Glucose/metabolismo , Glicosúria/sangue , Glicosúria/patologia , Glicosúria/terapia , Temperatura Alta , Humanos , Extremidade Inferior/patologia , Masculino , CicatrizaçãoAssuntos
Nefropatias Diabéticas/complicações , Febre/etiologia , Gangrena/etiologia , Hiperparatireoidismo/complicações , Dermatopatias/etiologia , Pele/patologia , Uremia/complicações , Adulto , Nefropatias Diabéticas/diagnóstico , Progressão da Doença , Feminino , Febre/patologia , Gangrena/patologia , Humanos , Oxigenoterapia Hiperbárica , Hiperparatireoidismo/diagnóstico , Hiperplasia/complicações , Hiperplasia/cirurgia , Necrose/etiologia , Necrose/patologia , Glândulas Paratireoides/cirurgia , Diálise Renal , Dermatopatias/patologia , Uremia/diagnósticoRESUMO
Tropical idiopathic lower limb gangrene is a rare disease. It was first described by Gelfand amongst the indigenous inhabitants of present day Zimbabwe. It is a bilateral and simultaneous gangrene of both lower extremities due to no obvious cause and usually seen in men during the second and fourth decade of life. The onset is always sudden and the first sign is oedema of both feet accompanied by pain. The patients are usually people who have been previously healthy. This is a report of a clinical variant of the disease.
Assuntos
Gangrena/patologia , Perna (Membro)/irrigação sanguínea , Adolescente , Gangrena/cirurgia , Humanos , Perna (Membro)/cirurgia , Masculino , Medicinas Tradicionais AfricanasRESUMO
The purpose of this study was to investigate the characteristics of arachidonic acid-induced peripheral vascular disease in rats. Injecting arachidonic acid (2 mg/leg) into the femoral artery caused hind limb gangrene. Histopathological examination revealed occlusive thrombi and marked vascular injury, including denudation of the endothelium and degeneration of the media in the paw arteries. Arachidonic acid injection markedly enhanced the platelet response to both U-46619 and collagen. Although the number of circulating platelets did not differ between sham-operation rats and arachidonic acid-injected rats, the numbers of circulating white blood cells and red blood cells were raised 10 d after arachidonic acid injection. Thrombocytopenia, induced before arachidonic acid injection, markedly suppressed arachidonic acid-induced hind limb gangrene in rats. In addition, the combined administration of aspirin (100 mg/kg/d, p.o.) and ticlopidine (300 mg/kg/d, p.o.) prevented the progression of arachidonic acid-induced hind limb gangrene. These results suggest that platelets are involved in the progression of arachidonic acid-induced hind limb gangrene. This experimental rat model may be suitable for developing novel drugs for the treatment of peripheral vascular disease.
Assuntos
Ácido Araquidônico/toxicidade , Gangrena/induzido quimicamente , Membro Posterior/irrigação sanguínea , Doenças Vasculares/induzido quimicamente , Animais , Aspirina/uso terapêutico , Modelos Animais de Doenças , Progressão da Doença , Avaliação Pré-Clínica de Medicamentos , Artéria Femoral , Gangrena/patologia , Membro Posterior/patologia , Injeções Intra-Arteriais , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Ratos , Ratos Sprague-Dawley , Ticlopidina/uso terapêutico , Doenças Vasculares/patologiaRESUMO
BACKGROUND: Necrotizing fasciitis is a soft tissue gangrenous infection that is optimally treated by early diagnosis, radical surgical debridement of all involved necrotic tissue, broad spectrum antibiotics, and aggressive nutritional support. The early clinical diagnosis of an area of necrotizing fasciitis is difficult and frequently unreliable. We are reporting a series of cases in which an early, accurate diagnosis of necrotizing fasciitis was established by a frozen section tissue biopsy obtained at the bedside. METHODS: Over a 15-year period, a consecutive series of 43 patients had a bedside biopsy under local anesthesia with immediate frozen section evaluation. All patients were seen in the hospital or emergency room for treatment of an inflammatory process. RESULTS: These 43 patients had bedside biopsy and frozen section evaluation of an inflammatory process. Twelve patients were found to have necrotizing fasciitis. These patients were treated with immediate surgical debridement of all gross necrotic tissue, broad spectrum antibiotics, and adequate nutritional support. All of them survived. No cases of infectious gangrene occurred in the group of patients whose biopsy did not reveal necrotizing fasciitis. CONCLUSION: Frozen section tissue biopsy is a useful adjunct in establishing an early, accurate diagnosis of infectious gangrene.
Assuntos
Biópsia , Desbridamento , Fasciite Necrosante/terapia , Abscesso/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Antibacterianos/uso terapêutico , Celulite (Flegmão)/diagnóstico , Terapia Combinada , Diagnóstico Diferencial , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/cirurgia , Infecções por Escherichia coli/terapia , Fasciite Necrosante/patologia , Fasciite Necrosante/cirurgia , Feminino , Secções Congeladas , Gangrena/patologia , Gangrena/cirurgia , Gangrena/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Apoio Nutricional , Quartos de Pacientes , Infecções por Proteus/patologia , Infecções por Proteus/cirurgia , Infecções por Proteus/terapia , Reprodutibilidade dos Testes , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/cirurgia , Infecções Estafilocócicas/terapia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
A total of 1,265 patients with age-related diseases such as diabetes, arthritis, vascular disease and hypertension as well as 1,100 persons in diminished health without apparent disease, were treated with the metal chelator EDTA and antioxidants such as vitamin C, E, beta-carotene, selenium, zinc and chromium. Good results were observed in the majority of patients. This is encouraging for the initiation of controlled clinical trials.
Assuntos
Envelhecimento , Antioxidantes/uso terapêutico , Artrite/tratamento farmacológico , Quelantes/uso terapêutico , Doença das Coronárias/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Ácido Edético/uso terapêutico , Hipertensão/tratamento farmacológico , Oligoelementos/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Vitaminas/uso terapêutico , Adulto , Idoso , Artrite/patologia , Artrite/fisiopatologia , Doença das Coronárias/patologia , Doença das Coronárias/fisiopatologia , Feminino , Doenças do Pé/patologia , Gangrena/patologia , Humanos , Hipertensão/patologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/patologia , Doenças Vasculares/fisiopatologiaRESUMO
Fournier's gangrene of the external genitals is a complex entity characterized by acute onset, rapid progress to gangrene, toxemia and high mortality rate. The disease may be primary as described by Fournier or secondary with a detectable cause in the colo-rectal area, the lower urogenital tract or in the perineum. The disease may affect healthy young males (originally described by Fournier) or elderly subjects especially with general ill health, cancer, diabetes, liver or renal failure, immunosuppression, etc. The microbiology is as complex as the etiology. The nosiology is likewise complex. Because the mortality is high, it is important to be aggressive in therapy. Triple attack is necessary, viz.: antibiotic coverage for aerobes and anaerobes, general supportive measures and adequate surgical debridement. We, recommend Hyperbaric Oxygen Therapy (HBO) treatment in specialized centers as an adjunctive measure since we had no mortality in the cases we treated. In expert centers, HBO has very few complications which are outweighed by the benefit the patient gets. The one-man chamber is the commonest in use, but for a compromised patient the multiplace may be more appropriate. In the very early stage, HBO may avert gangrene or reduce it. It is important to have a high index of awareness of this disease amongst the medical profession. More work is needed for the more precise definition, classification and management of the complex syndrome of Fournier.