Tài liệu Gangrene – current concepts and management options - Edited by Alexander A. Vitin

GANGRENE – CURRENT CONCEPTS AND MANAGEMENT OPTIONS
Edited by Alexander A. Vitin

Contents
Preface IX


Part 1 Fournier’s Gangrene:
Current Concepts and Treatment Options 1
Chapter 1 Gangrene: The Prognostic Factors and Validation
of Severity Index in Fournier’s Gangrene 3
Ik Yong Kim
Chapter 2 Fournier’s Gangrene:
Diagnostic and Therapeutic Considerations 19
David Kearney
Chapter 3 Perineal Gangrene: Clinical and Therapeutic
Features and Pronostic Analysis of 35 Cases 29
Slim Jarboui, Ayoub Zoghlami and Dorsaf Othmani
Chapter 4 Fournier’s Gangrene 37
Ndubuisi Eke and John E. Raphael
Chapter 5 Fournier’s Gangrene –
Medical and Surgical Considerations 49
Oscar Estrada Ferrer


Part 2 Intestinal Ischemia and Bowel Gangrene 67
Chapter 6 Intestinal Ischemia and Gangrene 69
Vivek Srivastava, Vaibhav Pandey and Somprakas Basu
Chapter 7 Segmental Small-Bowel Gangrene Associated
with Yersinia pseudotuberculosis Infection 85
H Seddik, A El Khattabi, A Abouzahir,
O El Mansari, H En-Nouali and M Rabhi
Chapter 8 Gangrene of Large Bowel Due to
Volvulus-Etiopathogenesis, Management and Outcome 91
Norman Oneil Machado



Part 3 Diabetic Foot, Gangrenous Lung Disease
and HIV-Induced Gangrene 103
Chapter 9 Gangrene Associated
with Human Immunodeficiency Virus (HIV) 105
Malladi VSS, Abkari S and Srinivasan VR


Part 3 Diabetic Foot, Gangrenous Lung Disease
and HIV-Induced Gangrene 103
Chapter 9 Gangrene Associated
with Human Immunodeficiency Virus (HIV) 105
Malladi VSS, Abkari S and Srinivasan VR
Chapter 10 Gangrenous Lung Disease 113
Chih-Hao Chen
Chapter 11 Diabetic Foot and Gangrene 121
Jude Rodrigues and Nivedita Mitta


Part 4 Necrosis and Gangrene: Current Management Options 145
Chapter 12 Effect of Macrolide Antibiotics on Biological Activities
Induced by Clostridium perfringens Alpha-Toxin 147
Jun Sakurai and Masataka Oda
Chapter 13 Hyperbaric Oxygen Therapy
in the Treatment of Necrosis and Gangrene 165
Alexander A. Vitin




Preface
Medicine is the only profession that labours incessantly
to destroy the reason for its own existence.
~James Bryce, 1914
Success of public health programs and advances in modern medicine have
substantially increased longevity and survival of sick patients, suffering from various
maladies with increased potential of major complications, such as limb and various
tissues gangrene.
Gangrene is the term used to describe the necrosis or death of soft tissue due to
obstructed circulation, usually followed by decomposition and putrefaction, a serious,
potentially fatal complication, that has been well known to generations of physicians for
epochs. Despite the immense experience in this field, gained by medicine during its
centuries-long history, and impressive recent advances, management of gangrene still
presents a significant clinical problem, which is still far from being completely resolved.
With ever-growing body of evidence in favor of various treatment modalities, no
consensus has been reached so far in respect to superior efficiency of any of the
suggested methods. Indeed, even today, with the enormous contemporary
armamentarium of treatment methods and immediate access to information literally at
his fingertips, a physician, while treating various conditions leading to
gangrene/necrosis development, oftentimes faces more unanswered questions than
enjoys luxury of choice from plenty of ready-to-use solutions with well-proved efficacy.
In the presented book, the attempt has been made to explore the most important
aspects of such detrimental conditions, as are gangrene and necrosis. These included
etiology, predisposing factors, demography, pathologic anatomy and mechanisms of
development, molecular biology, immunology, microbiology and more. A variety of
management strategies, including pharmacological treatment options, surgical and
non-surgical solutions and auxiliary methods, are also extensively discussed in the
book's chapters. The main goal of this book is not only to provide an easy access to the
up-to-date information on the selected topics, but also to help reader to obtain a clear,
objective, bias-free and comprehensive picture of the problem.
The presented book lays no claim of encompassing the whole of the problem in all its
complexity. Such endeavor would likely have required a multi-volume manuscript.
Rather, the book offers a collection of carefully selected reports of original studies, case
presentations and comprehensive review articles, contributed by physicians, who have
conducted an extended research in the selected area, experts, who possess a vast,
sometimes exquisite experience in practical management of gangrene and necrosis of
different locations. The fact that contributors present a variety of clinical disciplines
and work in different countries certainly multiplies values of their shared opinions
and unique experience.
The presented book contains no unanimously approved recipes and offers no
guidelines for immediate implementation. More importantly, the book provides an
arena for expert opinions exchange and experience sharing, the approach we believe to
be mostly productive, and which we have been following through, while trying to
accomplish a task of this book composing and editing.
First part of the book discusses Fournier's gangrene, by far most lethal condition
within a spectrum of all maladies complicated by gangrene-necrosis development.
This part contains five chapters, discussing in details pathogenesis, diagnosis and
natural course of FG, and also treatment options, prognosis and outcome.
Second part, that includes three chapters, is dedicated to the management of intestinal
ischemia and bowel necrosis, still difficult-to-diagnose and treat conditions with very
high mortality.
Third part contains three chapters, discussing different aspects of diabetic foot
gangrene, lung necrosis and also human immunodeficiency-related gangrene.
Fourth part includes two chapters, discussing various aspects of gangrene
management, such as antibiotic treatment and hyperbaric oxygen therapy.
I would like to extend my special thanks to all contributors for their outstanding work
in putting together a group of such compelling articles, and also for responding to
entreaties for revisions and updates with admirable patience and promptness. In
particular, I would like to express my deepest appreciation and personal gratitude to
Ms. Viktorija Zgela, without whose devotion, tireless, incessantly intense work,
continuous help, support and valuable advise this book, most certainly, would never
make its way to readers.
We hope that this book will help readers in expanding their knowledge and provide
some new ideas for further improvement of care of the patients suffering from
conditions, involving gangrene and tissue necrosis, which constitute the very purpose
of this collective work.
Alexander A. Vitin, MD, Ph.D.
University of Washington
USA