Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the gangrene is caused by an infectious agent, it may present with a fever or sepsis.Risk factors include diabetes, peripheral arterial disease, smoking, major trauma, alcoholism, HIV/AIDS, frostbite, influenza, dengue fever, malaria, chickenpox, plague, hypernatremia, radiation injuries, meningococcal disease, Group B streptococcal infection and Raynauds syndrome. It can be classified as dry gangrene, wet gangrene, gas gangrene, internal gangrene, and necrotizing fasciitis. The diagnosis of gangrene is based on symptoms and supported by tests such as medical imaging.Treatment may involve surgery to remove the dead tissue, antibiotics to treat any infection, and efforts to address the underlying cause. Surgical efforts may include debridement, amputation, or the use of maggot therapy. Efforts to treat the underlying cause may include bypass surgery or angioplasty. In certain cases, hyperbaric oxygen therapy may be useful. How commonly the condition occurs is unknown. Signs and symptoms
Symptoms may include a change in skin color to red or black, numbness, pain, skin breakdown, and coolness. The feet and hands are most commonly involved. Causes
Gangrene is caused by a critically insufficient blood supply (e.g., peripheral vascular disease) or infection. It is associated with diabetes and long-term tobacco smoking.
Other diagnostic tests are useful in excluding other similar conditions, but history, X-ray, and biopsy are essential. These other tests may include basic blood work, blood cultures, and bronchoalveolar lavage. The clinical picture is similar to ARDS, but AIP differs from ARDS in that the cause for AIP is not known. Treatment
Treatment is primarily supportive. Management in an intensive care unit is required and the need for mechanical ventilation is common. Therapy with corticosteroids is generally attempted, though their usefulness has not been established. The only treatment that has met with success to date is a lung transplant. Prognosis
Sixty percent of people with acute interstitial pneumonitis will die in the first six months of illness. The median survival is 1+1⁄2 months. However, most people who have one episode do not have a second. People who survive often recover lung function completely. Epidemiology
Acute interstitial pneumonitis occurs most frequently among people older than forty years old. It affects men and women equally. There are no known risk factors; in particular, smoking is not associated with increased risk. History
Acute interstitial pneumonitis was first described in 1935 by Louis Hamman and Arnold Rich, and given the name Hamman–Rich syndrome. References
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synd/3010 at Who Named It? 00181 at CHORUS