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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:[Clostridium infections with and without manifest gas gangrene. Report on 77 infections in 76 patients]. 91 81

We have experienced a case of Fournier's gangrene which progressed rapidly after prostatic massage. The patient was a 70-year-old man who had poorly controlled diabetes mellitus, hemorrhoid, urethral stricture and benign prostatic hyperplasia. He visited an urologist complaining of pollakisuria and miction pain. Under the diagnosis of prostatitis, prostatic massage was performed. From that night, he developed a high grade fever. Simultaneously, redness, swelling and pain of the scrotum progressed rapidly, and 11 days later, he was admitted to our hospital. An X-ray examination revealed subcutaneous gas formation in the scrotum. Immediately, incision and drainage with extensive debridement of necrotic tissue were performed combined with chemotherapy using broad spectrum antibiotics and insulin therapy. About 3 months later, the gangrene and the wound were healed with granulation and scarring. Cultures of the pus and the necrotic tissue from the scrotum were positive for Bacteroides fragilis and several aerobes including Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus and Staphylococcus epidermidis. The case proved to be non-clostridial gas gangrene.
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PMID:[A case of Fournier's gangrene: was it triggered by prostatic massage?]. 223 20

Clostridium septicum is a major cause of spontaneous, nontraumatic gas gangrene. Unlike Clostridium perfringens, C. septicum is relatively aerotolerant and thus appears to be more capable of initiating infection in the absence of obvious damage to tissues. Six cases illustrate the clinical setting and fulminant nature of spontaneous gangrene caused by C. septicum. A lesion in the colon such as carcinoma is often present and is presumed to serve as a portal of entry to the bloodstream. Diabetes and leukopenia are also common predisposing conditions; compromise of vital host responses may facilitate proliferation of those organisms that settle out in the tissues. Acute lymphoma or leukemia during a course of chemotherapy is accompanied by damage to bowel mucosa and granulocytopenia, thus predisposing to spontaneous clostridial gangrene. Infection progresses in a fulminating manner; the majority of patients die within 24 hours of onset. Characteristic symptoms and signs include excruciating pain (although a sense of heaviness may be the only early symptom), swelling of tissues, crepitance, and bulla formation. A hallmark of C. septicum infection is the absence of acute inflammatory cells in involved tissues or in bulla fluid. A series of laboratory investigations demonstrated that fluid obtained from a bulla adversely affected the viability, morphology, and function of polymorphonuclear leukocytes (PMNs), which may explain the paucity of PMNs in involved tissues and may in part contribute to the fulminant progression observed in infection due to this organism.
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PMID:Spontaneous, nontraumatic gangrene due to Clostridium septicum. 233 Apr 82

Gas gangrene following scheduled orthopedic surgery is not uncommon. In order to assess its frequency and prognosis, identify possible predisposing factors and suggest preventive measures, we reviewed the records of 22 patients (14 males and 8 females, mean age 40 +/- 20 years) admitted between 1969 and 1987 who developed gas gangrene in the wake of orthopedic surgery. In all cases the lower limbs were the site of operation: the knee in 9, the hip in 4, the femur in 4 and the leg in 5 cases. Surgical procedures included on-site foreign material in 19 cases, pneumatic tourniquet in 6 and prolonged vascular stretch in 9. Infection was diagnosed within 1.4 +/- 1.1 days of surgery; local signs, especially crepitants and pain, were prominent for the diagnosis. Pathologic findings consisted of myonecrosis in 18 patients and cellulitis in 4. Local bacteriological studies, carried out in 19 patients, yielded organisms in 14, including 12 with Clostridia perfringens. Four patients (one despite surgical treatment) died within 24 hours of admission. The remainder were treated with a combination of surgery, antimicrobial therapy (18) and hyperbaric oxygen (17). Subsequently, 13 patients had severe functional disability, while 5 recovered without sequelae. In view of the poor prognosis of gas gangrene, several preventive measures are suggested during aseptic surgery of the lower limbs. Careful skin preparation, cleaning of the anal region and short-term prophylactic antibiotic therapy with cefamandole or amoxycillin-clavulanic acid, are among them.
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PMID:[Gas gangrene after aseptic orthopedic surgery]. 252 39

A case of gas gangrene is presented. The patient was a 78-year-old woman who was admitted with the diagnosis of vesico-vaginal fistula. Cystography revealed a vesico-intestinal fistula and leakage of contrast medium into the prevesical space, in addition to the vesico-vaginal fistula. Right ureterostomy was performed. Two weeks postoperatively, she complained of severe pain and swelling of her right thigh. The swelling grew rapidly and general condition became worse. A diagnosis of gas gangrene was made 8 days after her first complaint by demonstrating subcutaneous and intramuscular gas formation in X-ray. She died the next day. By the bacteriological examination, this case was non-clostridial gas gangrene.
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PMID:[A case of gas gangrene in a vesico-vaginal fistula]. 383 27

A 13-year-old girl incurred gas gangrene after intramuscular injection of adrenaline to the buttock. Clinical evidence of very severe pain at the site of injection with septicemia and collapse within 24 to 48 hours should arouse the suspicion of clostridial myositis rather than pyogenic infection. Early diagnosis and treatment by adequate excision of necrotic muscle (with a wide margin of normal-appearing muscle) can prevent loss of life or limb in these patients.
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PMID:Gas gangrene after intramuscular injection of adrenaline. 683 5

Gas gangrene is a rare complication of elective surgery. Caused by several species of Clostridia, it is an acute, highly invasive necrotizing infection of muscle and fascia often leading to coma and death. Gas gangrene should be suspected if the patient has unremitting pain, high temperature, tachycardia, and prostration. Edema, brown watery exudate emanating from he wound, evidence of gas in tissues, and gram-positive rods on smear support the clinical diagnosis. Rapid surgical decompression and debridement is the basis of treatment. Adjuvant antibiotic, hyperbaric oxygen, antitoxin, local, and supportive therapies aid in treatment. The authors review the literature and discuss etiologies, pathogenesis, clinical features, and treatment.
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PMID:Postoperative gas gangrene. 686 34

We describe a case of fatal gas gangrene of the uterus after an apparently normal term pregnancy in a 22-year-old woman. The patient died less than 15 h after the onset of symptoms, which consisted of a single episode of vomiting and increasing hypogastric pain. Hypotension, tachycardia and renal failure were the dominant clinical features. The pathogenesis, diagnosis and treatment of uterine gas gangrene are discussed.
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PMID:Fatal Clostridium perfringens infection after normal term pregnancy. 707 37

Clostridial myonecrosis is a complication associated with contaminated traumatized wounds. Presented is the case of an elderly female with pain in her right hip, radiographic evidence of gas in the soft tissues, and no history of trauma. Evaluation of this patient revealed Clostridial myonecrosis. Culture results identified the organism as Clostridium septicum. Due to the association between Clostridium septicum and occult malignancies, colonoscopic evaluation was performed. A colonic lesion was discovered, biopsied, resected, and staged, using the Modified Duke Classification, as a well differentiated adenocarcinoma, C2 lesion. Myonecrosis and its associated malignancies carry high morbidity and mortality, but early diagnosis, appropriate treatment, and awareness of the association with occult malignancies may avert unnecessary mortality.
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PMID:Clostridium septicum gas gangrene of the gluteus maximus and an ascending colon malignant tumor. A case report. 795 80

A 36-year-old male was admitted because of swelling and pain in the lower left limb. He had been diagnosed as having non-insulin dependent diabetes mellitus 4 years previously and had been treated unsuccessfully with insulin. Since gas formation was radiographically demonstrated in the soft tissue of the left foot, we treated him with antibiotics and hyperbaric oxygen under the diagnosis of gas gangrene. Despite this therapy, the gangrenous lesions progressed. Amputation of the left foot was necessary. Peptstreptococcus was isolated from the gangrenous area and identified as such on the seven hospital day. Nine cases of diabetic patients with non-clostridial gas gangrene who were treated with hyperbaric oxygen therapy have been reported in Japan. The results indicated that hyperbaric oxygen therapy is ineffective in the treatment of non-clostridial gas gangrene in diabetic patients.
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PMID:[A case of NIDDM with non-clostridial gas-producing infection in the lower limb--the effects of hyperbaric oxygen therapy]. 815 Nov 55


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