Gangrene

In the past, hyperbaric oxygenation as a medical procedure has received considerable attention. In this treatment the patient is given pure oxygen and may be placed in a pressurized chamber. In effect, the patient may thus receive >400 kPa (>4 atm) of pure oxygen. Beneficial results in cases of carbon monoxide poisoning, gangrene, severe bums, and other difficulties are often achieved as a result of this treatment. 

Brammen, n., Brammen-. (Metal.) slabbing. Brand, m. burning (combustion, calcination, etc.) Are charge (of a kiln or oven) blight, smut gangrene, slough brand. 

Brand-messer, tn. pyrometer. -mittel, n. escharotic remedy for burns remedy for gangrene. -81, n. empyreumatic oil (obtained by d tructive distillation), -pilz, tn. smut fungus, -probe, /. Are test. Are assay, -riss, tn. Are crack, -salbe,/. salve for burns, -satz, tn. (Mil.) an incendiary composition, -schsden, tn. damage from Are. -schiefer, tn. bituminous shale, -silber, n. reAned silver, -stein, m. brick, brandstiftend, a. incendiary. 

Although Mg is generally considered non-toxic, the inhalation of fumes of freshly sublimed Mg oxide may cause metal fume fever. There is no evidence that Mg produces, true systemic poisoning. Particles of metallic Mg or Mg alloy which perforate the skin of gain entry thru cuts and scratched rilay produce a severe local lesion characterized by the evolution of gas and acute inflammatory reaction, frequently with necrosis. The condition Has been called a chemical gas gangrene . Gaseous blebs may develop within 24 hrs of the injury. The lesion is very slow to heal (Ref 23)... 

Distant site reactions Gangrene, vascular spasm ... 

Clostridium septicum, Cl. perfringens (welchii) and Cl. novyi (oedematiens) eause serious damage to tissue if they are able to develop in wounds where the oxygen supply is limited. Tissue may be destroyed, and earbon dioxide produeed from musele glyeogen gives rise to the eondition known as gas gangrene. 

Figure 12.2 Diabetic macroangiopathy severe peripheral vascular disease and gangrene of the foot.

Thrombolytic therapy should be reserved for patients who present with shock, hypotension, right ventricular strain, or massive DVT with limb gangrene... 

The earliest recorded attempts at organ transplant date back thousands of years.1 More than a few apocryphal descriptions exist from ancient Egypt, China, India, and Rome documenting experimentation with transplantation. For example, an Indian text from the second century bc describes a procedure for nasal reconstruction surgery with the use of autografted skin. Also, Roman Catholic lore has saints Damian and Cosmas replacing the gangrenous leg of a man with the leg of a recently deceased man in the third century ad.1... 

Late The skin becomes violaceous and progressively gangrenous hemorrhagic bullae may be present. Septic shock may ensue. 

Another important necrotizing skin and soft tissue infection is clostridial myonecrosis (gas gangrene). Clostridial myonecrosis can develop spontaneously but most often occurs after trauma. Clostridium perfringens is the most common causative pathogen. 

Moderate 3 Infection (as above) in a patient who is systemically well and metabol-ically stable but who has at least 1 of the following characteristics cellulitis extending greater than 2 cm, lymphangitic streaking, spread beneath the superficial fascia, deep tissue abscess, gangrene, and involvement of muscle, tendon, joint, or bone... 

Primary peritonitis is treated with antimicrobials and rarely requires drainage. Secondary peritonitis requires surgical removal of the inflamed or gangrenous tissue to prevent further bacterial contamination. If the surgical procedure is sub-optimal, attempts are made to provide drainage of the infected or gangrenous structures. 

Gangrenous or Imipenem/cilastatin, meropenem, ertapenem, 1. Aztreonam with clindamycin or metronidazole... 

If, at operation, the appendix were normal or inflamed, postoperative antimicrobials would not be required. If the appendix is gangrenous or perforated, a treatment course of 5 to 7 days with the agents listed in Table 74—2 is appropriate. 

Onychomycosis is a chronic infection that rarely remits spontaneously. Adequate treatment is essential to prevent spread to other sites, secondary bacterial infections, cellulitis, or gangrene. Due to the chronic nature and impenetrability of nails, topical agents have low efficacy rates for treating onychomycosis. Oral agents that can penetrate the nail matrix and nail base, such as itraconazole and terbinafine, are more effective than ciclopirox lacquer. Itraconazole and terbinafine demonstrate mycological cure rates of 62%37 and 76%,38 respectively, while ciclopirox has a cure rate of 29% to 36%.39... 

McClean, Rogers and Williams7 79 have devised a most timely use for hyaluronic acid, viz., its use as an early diagnostic test in gas gangrene infections. 

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