[Fournier's gangrene in an HIV-positive patient. Therapeutic options]. / Gangrena di Fournier in paziente HIV positivo: considerazioni terapeutiche.

Fournier's gangrene is a life-threatening necrotising infection of the perineal and genital regions. The case presented here refers to an HIV-positive 42-year-old man, admitted in emergency to our department with clinical signs and symptoms of sepsis related to gangrene of the perineum and scrotum. An early wide surgical necrosectomy was performed under epidural anaesthesia. Treatment was completed by intensive care, broad-spectrum antibiotics and hyperbaric oxygen therapy. The wound was managed with advanced dressing (AQUACEL Hydrofiber) until complete healing was obtained, and the scrotum was reconstructed with skin flaps. The disease did not involve the testes, spermatic cord or anorectal canal. The satisfactory aesthetic and functional outcome prompts the authors to stress a number of features of the therapeutic approach adopted: (i) the advantages of epidural anaesthesia with an indwelling catheter that allows further necrosectomy and wound dressing to be performed totally painlessly; (ii) the possibility of avoiding faecal diversion by means of synthetic opioid drugs which are useful to reduce the frequency of defecation; and (iii) the positive impact of advanced dressing on the wound healing process in relation to patient satisfaction and cost management.

Efficacy of intravenous tramadol treatment for reducing pain during office diagnostic hysteroscopy.

OBJECTIVE: To assess whether IV tramadol before outpatient hysteroscopy could reduce procedure-related pain. DESIGN: A randomized double-blind placebo controlled trial. SETTING: Outpatient Hysteroscopy Centre in the Department of Obstetrics and Gynaecology of Cagliari University. PATIENT(S): Fifty healthy, parous, women who underwent outpatient diagnostic hysteroscopy and endometrial biopsy. INTERVENTION(S): Random IV infusion of tramadol or placebo before hysteroscopy and endometrial biopsy were performed. MAIN OUTCOME MEASURE(S): Visual analogue scale of pain was measured both immediately after and 15 minutes after the procedure. Stress hormones (ACTH, cortisol), blood pressure, and heart frequency were evaluated before, during, and 15 minutes after the procedure. RESULT(S): In the tramadol group, the visual analogue scale of pain was significantly lower than in the placebo group both immediately after the procedure and 15 minutes later. Basal levels of ACTH and cortisol did not differ between the groups. In both groups, the ACTH levels remained unchanged during the study, and the cortisol levels were higher 15 minutes after the procedure than before the procedure. Procedure time, heart frequency, blood pressure, and adverse effects did not differ between the groups. CONCLUSION(S): In parous women without uterine malformations, a treatment with tramadol before hysteroscopy and endometrial biopsy appears to be capable of reducing the pain and discomfort that are associated with this procedure.