Explore the vast range of titles available.

A variety of systemic illnesses can be associated with limb gangrene with preservation of arterial pulses. Many such disorders involve venous thrombosis caused by a procoagulant–anticoagulant imbalance often related to low levels of protein C. There is a common misconception that ischemic limb necrosis results only from thrombosis or thromboembolism involving limb arteries, with loss of arterial pulses. Yet ischemic limb gangrene can also result from thrombosis involving the microcirculation, including small venules. In this situation, arterial pulses are palpable or identifiable with the use of Doppler signals. This review focuses on limb gangrene caused by microthrombosis that results from disseminated intravascular coagulation and the loss of natural anticoagulant mechanisms. Syndromes of Microthrombosis-Associated Limb Ischemia There are two distinct syndromes of microthrombosis-associated ischemic limb injury (Table 1). Venous limb gangrene can complicate thrombocytopenic disorders that . . .

Clostridium perfringens uses its arsenal of >16 toxins to cause histotoxic and intestinal infections in humans and animals. It has been unclear why this bacterium produces so many different toxins, especially since many target the plasma membrane of host cells. However, it is now established that C. perfringens uses chromosomally encoded alpha toxin (a phospholipase C) and perfringolysin O (a pore-forming toxin) during histotoxic infections. In contrast, this bacterium causes intestinal disease by employing toxins encoded by mobile genetic elements, including C. perfringens enterotoxin, necrotic enteritis toxin B-like, epsilon toxin and beta toxin. Like perfringolysin O, the toxins with established roles in intestinal disease form membrane pores. However, the intestinal disease-associated toxins vary in their target specificity, when they are produced (sporulation vs vegetative growth), and in their sensitivity to intestinal proteases. Producing many toxins with diverse characteristics likely imparts virulence flexibility to C. perfringens so it can cause an array of diseases.

Background Fournier’s Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier’s Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives. Methods This study included 46 hospitalized patients diagnosed with Fournier’s Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher’s exact test. Differences between numerical variables were compared using Student’s t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier’s Gangrene. Results Among the 46 Fournier’s Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age ( P <0.05), extension to the abdominal wall ( P <0.01), hematocrit ( P <0.01), albumin ( P <0.01), SFGSI ( P <0.01), and SFGSI>2 ( P <0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier’s Gangrene patients. Conclusion This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier’s Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates.

Fournier's gangrene (FG) is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital, or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin. It is believed that the occurrence of the disease in women is underreported and may be unrecognised by some clinicians. Fournier's gangrene is a life-threatening condition, constituting an urological emergency. Many patients with Fournier's gangrene have medical or surgical conditions, which are predisposing factors to this disease or its more severe or fatal course. These comprise diabetes mellitus, hypertension, alcoholism and advanced age. Recent reports in the literature point to changes in the epidemiology of FG, comprising an increasing age of patients. Several authors reported that the mean age of FG patients is at present 53-55 years. Prognosis in FG patients is based on FGSI (Fournier's gangrene severity index) score. Despite the progress in medical care for FG patients, the mortality rate reported in the literature remains high--most often 20-40%, but ranges from 4% to 80%. The most common isolates cultured from FG lesions are both Gram-positive and Gram-negative, as well as strictly anaerobic bacteria. Recently community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an etiological agent of FG with severe clinical course and even fulminant sepsis. Rarely FG may have a fungal etiology, being caused by yeast-like fungi Candida spp. or by moulds. Antibiotics should be administered parenterally and in doses high enough to reach an effective concentration in the infected tissues.

Fournier's gangrene (FG) is a rare, rapidly progressing necrotizing fasciitis of the external genitalia and perineum, with mortality rates ranging from 20 % to 50 %. Early identification of high-risk patients is essential for timely intervention. The quick Sequential Organ Failure Assessment (qSOFA) and the Fournier Gangrene Severity Index (FGSI) are commonly used prognostic tools, but their comparative performance in FG remains unclear. This study evaluates their predictive accuracy in a large FG cohort and explores their complementary roles in clinical decision-making. A retrospective cohort study was conducted on 153 FG patients admitted to Hasan Sadikin General Hospital, Indonesia, from January 2013 to December 2023. Clinical and laboratory data, including qSOFA and FGSI scores, were analyzed to assess in-hospital mortality. The predictive performance of both scoring systems was evaluated using receiver operating characteristic (ROC) curve analysis, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Multivariate logistic regression estimated adjusted odds ratios (ORs) for mortality while accounting for age and comorbidities. The overall mortality rate was 30 %. Non-survivors were significantly older and had higher rates of comorbidities, including acute kidney injury and cardiovascular disease. Both qSOFA and FGSI demonstrated strong predictive capabilities (AUC = 0.818). qSOFA had a specificity of 94.6 % but lower sensitivity (62.2 %), making it effective for identifying low-risk patients. FGSI demonstrated higher sensitivity (70.3 %) and specificity (85.9 %), making it more suitable for high-risk patient identification. Combining qSOFA's rapid bedside utility with FGSI's comprehensive risk assessment offers a powerful strategy for timely intervention and resource allocation. This study is among the first to compare qSOFA and FGSI in a large FG cohort, highlighting their complementary roles in clinical decision-making. A combined approach can enhance early risk stratification, optimize critical care resource allocation, and improve patient outcomes. Future research should explore integrating biomarkers such as lactate and procalcitonin to refine predictive accuracy, particularly in resource-limited settings. •qSOFA and FGSI scores can predict mortality in Fournier's gangrene effectively.•qSOFA excels in specificity; FGSI shows higher sensitivity for mortality risk.•Combining qSOFA and FGSI could enhance risk stratification and clinical decision-making.

[LANGUAGE= \"English\"] BACKGROUND: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier’s gangrene (FG) and develop methods to increase the survival rate.METHODS: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taşçıoğlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species.RESULTS: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively.CONCLUSION: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.[LANGUAGE= \"Turkish\"] AMAÇ: Fournier gangreninde (FG) mortaliteyi etkileyen faktörleri araştırarak, sağkalımı arttırabilecek yöntemleri geliştirmek amaçlanmıştır. GEREÇ VE YÖNTEM: İstanbul Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi Cerrahi Kliniği’nde 01.02.2012–30.06.2021 tarihlerinde FG tanısıyla yatan 73 olgu geriye dönük incelendi. Sağkalanlar (Grup 1: 56), ölenler (Grup 2: 17) olarak ayrıldı. Gruplar cins, yaş, enfeksiyonun genişliği, Uludağ Fournier Gangreni Şiddet İndeksi (UFGSI), Fournier Gangreni Şiddet İndeksi (FGSI), enfeksiyonun kaynağı, yandaş hastalıklar, stoma varlığı, Vacuum Assisted Closure süresi, yattığı gün sayısı, yoğun bakım süresi (YBS), bakteri türleri açısından karşılaştırıldı. Sonuçlar, SPSS 21.0 programı kullanılarak değerlendirildi.BULGULAR: Mortalite %23’dü, 31 kadın, 42 erkek içeriyordu. Gruplar arasında cinsiyette anlamlı fark bulundu (p=0.001). Toplamda ortalama yaş 57.29±13.36, Grup 1’dekilerin ortalama yaşı (53.66±11.185) Grup 2’dekilerin ortalamasından (69.24±13.264) anlamlı küçüktü (p=0.000). Enfeksiyonun genişliği Grup 1’de anlamlı düşüktü (p=0.011). UFGSI ve FGSI skorları Grup 1’de Grup 2’den anlamlı düşüktü (sırasıyla p=0.00, p=0.009). Hematokrit, bikarbonat değerleri Grup 2’de anlamlı düşüktü (p=0.000, p=0.015). UFGSI ve FGSI, mortalitenin öngörülmesinde sırasıyla %100 ve %82 duyarlılık ve sırasıyla %68 ve %58 özgüllüğe sahipti. UFGSI ve FGSI eşik değerleri 8 ve 6 bulundu. Grup 1’dekilerin 29’unda, Grup 2’dekilerin tamamında yandaş hastalıklar vardı, anlamlı fark bulundu (p=0.000). YBS Grup 2’de anlamlı uzundu (p=0.000).TARTIŞMA: UFGSI 8’den küçük hastalarda sağkalım yüksek, nadiren yoğun bakım gerektirir. UFGSI 8’den büyük hastalarda mortalite yüksektir. Bu hastalar genel cerrahi, plastik cerrahi, yoğun bakım uzmanından oluşan deneyimli bir takım tarafından yoğun bakım ünitesinde tedavi edilmelidir.

PurposeTo compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).MethodsA comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.ResultsTen scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.ConclusionThis study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.

Fournier’s gangrene (FG) is a rare form of necrotizing fasciitis of the perineal, genital, or perianal region. It is characterized by an aggressive course and high mortality rate, over 20%. FG demands immediate treatment including resuscitation maneuvers, intravenous antibiotic therapy and early surgical debridement. Background/Objectives: The gold-standard treatment for FG is surgical reconstruction. However, up to date, no precise guidelines exist. Thus, we decided to systematically review the literature, focusing on FG contemporary approaches to reconstructive surgery, aiming to analyze the various reconstructive strategies and their specific indications. Methods: A systematic review was carried out according to the PRISMA statement by searching various databases from April 2014 to April 2024, using the terms ‘‘Fournier Gangrene OR Fournier Gangrene Reconstruction OR Fournier Gangrene Treatment OR Fournier Gangrene Plastic Surgery OR Necrotizing Fasciitis OR Necrotizing Fasciitis AND Reconstruction”. The eligibility criteria included original studies aimed at discussing FG reconstruction with at least three clinical cases. Results: The final synthesis included 38 articles, and 576 reconstructions were described. Of these, 77.6% were minimally invasive strategies (direct closure, secondary healing, grafts, and local random flaps), while more invasive reconstructions (loco-regional flaps based on known vascular anatomy) were adopted in 22.4%. No free flaps were reported. Conclusions: FG requires immediate medical interventions including broad-spectrum antibiotic therapy, surgical debridement, adjuvant therapies, and reconstructive surgeries. Taking into account the anatomical characteristics of the inguinal-crural region, skin grafts and local random flaps could offer versatile and effective reconstructions for most FG cases, while the more invasive strategies should be reserved for very few cases. Future research is warranted to define an FG dedicated reconstruction protocol.

Clostridium perfringens α-toxins are lethal, neurotoxic factors that play a critical role in the pathogenesis of gas gangrene and hemorrhagic enteritis. In this study, the full-length α-toxin protein and two multi-epitope tandem proteins, CPA1 and CPA2, were recombinantly expressed using a prokaryotic expression system, and their immunogenic effects were evaluated in a mouse model. Compared with the full-length α-toxin, CPA1 and CPA2 induced comparable lymphocyte proliferation and differentiation, as well as sustained high antibody levels. Additionally, significantly elevated serum levels of cytokines IL-2, IL-4, and IL-10 were observed in mice immunized with CPA1 and CPA2. Protective efficacy against lethal toxin challenge was 70 % for CPA1 and 80 % for CPA2, as assessed relative to the α-toxin protein control. These findings suggest that CPA1 and CPA2 represent promising subunit vaccine candidates against Clostridium perfringens type A infection in sika deer.