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Artigo cientifico modelo, Esquemas de Física

Explica como se faz um artigo cientifico

Tipologia: Esquemas

2024

Compartilhado em 10/04/2024

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Baixe Artigo cientifico modelo e outras Esquemas em PDF para Física, somente na Docsity! Original Article Management of Fournier's gangrene: experience of a university hospital of Curitiba Manejo da gangrena de Fournier: experiência de um hospital universitário de Curitiba Apriano Antonio Met"; Dorvam CeLso Nogueira FitHo ACBC-PR?; Lucas Marques MANTOVANÊ; MicHeLE MaMpRiM GRiPPAZ, Rair Bencer 2, Denise Krauss, Denise Rigas* ABSTRACT Objective: To analyze the results obtained in the Department of General Surgery, Cajuru University Hospital - PUCPR, with the treatment of Fournier's gangrene. Methods: We reviewed the charts of 40 patients diagnosed with Fournier's gangrene admitted to the Cajuru University Hospital from November 1999 to April 2006, analyzing gender, age, predisposing factors, etiology, lesion location, laboratory tests, surgical procedures, antibiotic use and hyperbaric oxygen therapy. Results: The most common etiology was the anorectal origin. The most prevalent etiological agent was E. coli The predominant predisposing factor was diabetes mellitus. The majority of patients were male. The location and extent of injury was usually in the perineum. All undenwent surgical debridement, 17 with associated colostomy and two with combined cystostomy. All patients received antibiotics, the most used being metronidazole and gentamicin. Twenty-six patients underwent hyperbaric therapy. The overall mortality was 20%. Conclusion: Fournier's syndrome, despite all the advances in treatment today, continues to show high mortality rates. Early recognition of infection associated with invasive and aggressive treatment are essential for attempting to reduce these prognostic indices Key words: Fournier's gangrene. Hyperbaric Oxygenationvutilization. Therapy. INTRODUCTION ean Alfred Fournier, a French virologist (venerologist), described, in 1883, five cases of gangrene of the scrotum in young healthy patients without an apparent cause!2, Fournier's Syndrome or Gangreneis a rare condition characterized by acute onset and progression to fulminant sepsis with high levels of morbidity and mortality. Fournier's Syndrome (FS) was classified as primary when a cause was not identified and secondary when causing factors were discovered?. The disease is not exclusive to men, as there have been cases of vulvar necrosis*s. Contemporary series indicate that FS tends to affect patients between the third and sixth decade of life, with predisposing comorbidities, and in most cases, a present etiologic factor”. Despite the controversy in the description of the syndrome, it is characterized by a polymicrobial infection (aerobic and anaerobic bacteria) with an identifiable cause in 95% of cases, beginning in the genital or perineal regions*. It is characterized by an obliterative endarteritis, followed by ischemia and thrombosis of subcutaneous vessels, resulting in necrosis of the skin and adjacent subcutaneous tissue?º, even before evidence of erythema, crepitus and blistering formation. Microbial factors can activate the coagulation cascade directly or indirectly by inducing production of proinflammatory cytokines and subsequent tissue factor expression in endothelial cells and monocytes, which activate the clotting cascade"!, evolving to thrombosis of blood vessels, the main characteristic of this syndrome. Predisposing factors include: diabetes mellitus, local trauma, urine leakage, perirectal or perineal surgery", extention of a periuretral/anal infection'?"3, anorectal abscess, genitourinary infection!41s, alcoholism, immunosuppression and renal or hepatic disease's'º. The male gender has a high prevalence (10:1) of Fournier's Gangrene. Work done at the General Surgery Service and at the Hyperbaric Oxygen Therapy Service, Hospital Universitário Cajuru — PUCPR — Curitiba, Paraná, Brazil 1. Head, Hyperbaric Oxygen Therapy Service, Hospital Universitário Cajuru - PUCPR - Curitiba, Paraná, Brazil; 2. Former Resident, General Surgery Service, Hospital Universitário Cajuru - Curitiba, Paraná, Brazil; 3. Resident, Otorhinolaryngology, HSCM — Paraná, Brazil; 4. Resident, Gynecology and Obstetrics, HSCM — Paraná, Brazil Rev. Col. Bras. Cir. 2010; 376): 435-441