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Join tens of thousands of doctors, health professionals and patients who receive our newsletters. A century since the First World War, gangrene remains a problem, albeit a less deadly problem, for many people. The distinctive smell of that "gas gangrene" was the only means to diagnose the condition in the trenches and on the battlefield. Use this page to learn about the modern-day factors that lead to different forms of gangrene, and how doctors today manage the conditions. Gangrene is a serious, sometimes life-threatening condition in which the skin, muscle and other tissues die as a result of lost blood supply. It is usually external, affecting the extremities, but it can also affect internal tissues. Gangrene is most commonly associated with chronic illness, such as a severe complication of diabetes, or acute causes, such as certain types of injury.
Dry gangrene is caused by chronic illness, while wet gangrene - including gas gangrene - is usually an acute form involving bacterial infection and caused by injury, for example.
Surgical complication can lead to internal gangrene, which presents with signs of toxic shock. Initial diagnosis is made based on the history leading up to the presentation, and a physical examination, including external appearance and smell. Urgent treatment is important to prevent further serious illness and death, and includes removal of dead tissue or even amputation.
Prevention of gangrene is an important part of living with certain chronic illnesses, including diabetes. Gangrene is a disease of the skin and soft tissues - and sometimes internal tissues and organs - that results in tissue death (necrosis).
Gas gangrene (also called clostridial myonecrosis) is a particularly virulent form of wet gangrene.2,3,6,7 This is the condition that is associated with poorly cleansed wounds of the kind suffered in war - deep crushing or penetrating wounds that become infected with bacteria, Clostridium in particular. The reasons behind necrosis and tissue death differ depending on the specific type of gangrene. Wet gangrene results from a sudden loss of perfusion, and is worsened by the involvement of bacteria. Dry gangrene is more likely to occur in older people with diabetic foot - a common complication of undiagnosed or uncontrolled diabetes.
Complications of diabetes affecting the extremities, especially the feet, are a risk factor for gangrene, partly because painless wounds can go unnoticed.
Surgery - an operation involving the ligation of an artery, as treatment of an aneurysm for example, can shut off blood supply in such a way as to cause gangrene. Mechanical constriction - for example, gangrene can be revealed when pressure splints are removed. Severe burns, scalds and cold - heat, chemical agents (especially carbolic acid, but also caustic potash, and nitric or sulphuric acid), and cold (including frostbite) can all lead to dry gangrene. Raynaud's disease - this condition, in which spasm of blood vessels causes impaired circulation to the ends of fingers and toes, especially in cold weather, is implicated in some cases of gangrene.
Eating large quantities of coarse rye bread - long-term intake of ergot, a fungus that can infect rye is implicated in gangrene development as ergotism involves vasoconstriction. Injury - deep, crushing or penetrating wounds that are sustained in conditions that allow bacterial infection to take hold can lead to gangrene.
Mechanical constriction - rarely, blood flow restriction caused by pressure from bandages, bone fractures, tumors, and so on, can lead to gangrene. Embolic gangrene - the sudden occlusion of an artery due to an embolism can lead to dry gangrene, but this can also increase the risk of infection and thus lead to wet gangrene. Any case of dry gangrene can progress to wet gangrene if there is an opportunity for bacterial infection. In addition to the features seen in more common types of gangrene, there are certain signs and symptoms peculiar to gas gangrene, a less common form of wet gangrene. Produce a foul-smelling brown-red or bloody fluid when the tissue affected tissue is drained or leaks (a serosanguineous discharge).
Initial suspicion of gangrene calls for physical examination by a doctor, who will also take medical history, asking questions about symptoms and potential exposure to infection or trauma.

If gangrene is suspected, further diagnostic tests will be used to determine the type and extent of the necrosis, and to detect or rule out gas gangrene. Olfactory tests - to detect the unique, foul smell that can indicate gangrene, especially gas gangrene.
To reduce the risk of serious complication and death, gangrene requires emergency treatment. In all cases of dry gangrene caused by chronic disease, prevention is far better than cure - simply because cure is not possible after, for example, diabetic gangrene has set in, when amputation of an extremity becomes necessary.5 The same attention to prevention is also important in avoiding the acute risks of gangrene, such as from injury or extreme cold. Hyperbaric oxygen therapy6,9-11 is used in other tissue infections and, in particular, diabetic foot ulcers that have become infected and failed to heal. The idea behind this treatment is that a hyperbaric chamber of high-pressure oxygen creates a bactericidal and bacteriostatic effect and improves oxygen supply to the wounds by encouraging the formation of new blood vessels (angiogenesis), and causing greater dissolution of oxygen in plasma.
In certain settings, such as hospitals, healthcare professionals should practise measures that minimise the risk of infections such as gas gangrene. Frostbite can lead to gangrene, as can Reynaud's, a disease that usually affects the finger tips and tends to be worse in winter.
Routinely administering, for abdominal surgery, intravenous antibiotics - before, during, and after the operation.
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Since gestational diabetes affect the mother later in her pregnancy, it does not usually cause any severe birth defects like sometimes diabetes can do when a woman has it before she gets pregnant. The good news about gestational diabetes is that it is usually very easy to handle and control during pregnancy. All women are at risk for gestational diabetes, but some women have a greater risk than others.
The case: This 69-year-old obese diabetic man presented to the surgery with a long history of a rash affecting his groin. Assuming it was a fungal infection, the like of which he had in his younger, rugby playing days, he had treated it with topical clotrimazole for a number of weeks, but this had failed to help.
Diagnosis and managementThe diagnosis is erythrasma, a bacterial infection caused by Corynebacterium minutissimum. Diagnosis can be made by shining a Wood's light on the affected areas, which reveals a coral-red fluorescence caused by porphyrins produced by the bacteria.
Follow-up laboratory and imaging tests, and sometimes exploratory surgery may also be used to diagnose gangrene.
Doctors working in hospitals, especially those involved in abdominal surgery, also take steps to prevent gangrene. In such cases, the circulation of blood to the feet worsens, and there is a higher likelihood of any foot wounds going unnoticed by the patient. This can also occur in younger people with arteriosclerosis (arterial narrowing) caused by, for example, a combination of syphilis and alcohol dependency. If treatment involves wet or oily dressings and there are septic conditions, wet gangrene can develop. In gas gangrene the infected area of skin can quickly extend, with some changes visible in just a matter of minutes.
As such, it is important that anyone with suspected symptoms of gangrene seeks immediate medical attention. With treatment, there is a success rate of up to 60%7 (an improvement on the 50% rate achieved on battlefields for the soldiers serving in the World Wars1). However, the precise mechanism behind the effects of hyperbaric oxygen therapy remains unknown.

Chicago, Illinois, US: Encyclop?dia Britannica, published online by Encyclop?dia Britannica, Inc, accessed November 2014. It is a very common pregnancy complication, affecting up to almost ten percent of all pregnant women.
However, when a woman does have gestational diabetes that is uncontrolled, it can cause some sorts of problems with her baby. Most women who have gestational diabetes do not experience any long term complications from the condition. Women who are overweight before becoming pregnant have a higher chance of developing gestational diabetes, as do women who have had a history of sugar in the urine. Clinically proven to dramatically increase your chances of conception and help you get pregnant fast from the very first use. In between keeping up with a busy toddler, she enjoys blogging about parenting, cooking, crafting at The Accidental Wallflower. Closer inspection revealed an area of well demarcated red-brown macules with a wrinkled appearance to the skin and a fine scale.
Although resistance may occur, antibiotics, such as penicillin, erythromycin, cephalosporins and tetracyclines, are usually effective.
In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. This is because of diabetic neuropathy, which is a loss of sensation resulting from nerve damage caused by diabetes. Pregnant women who have never had diabetes before and who have high blood sugar levels are said to have gestational diabetes. One of the most common complications associated with gestational diabetes is having a baby with a high birth weight. Women who are members of a high risk ethnic group such as Hispanic, African American, Native American or Asian, will also have a greater risk.
And now for a limited time, Try a FREE starter pack today & receive 20 FREE pregnancy tests and a FREE Digital BBT Thermometer! Predisposing factors include excessive sweating, obesity, diabetes, poor hygiene, advanced age and other conditions which affect immunity. The prognosis is usually excellent but recurrence is common if underlying factors are not also addressed. In some women, the hormones from the placenta seem to affect the mom’s resistance to insulin in the body. Having a baby that is bigger than normal can have problems with diabetes and even obesity later in life. This means once a woman gives birth, she will no longer have to worry about gestational diabetes however, she will still have to worry about regular Type 2 Diabetes later in life.
It is also important to remember that a baby’s blood sugar can drop to dangerously low levels after being born because the baby will not be receiving the high blood sugars from the mother like it was used to.
If a woman has previously given birth to a baby over 9 pounds, or a stillborn baby are at a greater risk. Surprisingly, almost all women have some level of gluclose intolerance during their pregnancies, but not all women develop gestational diabetes.
Having a large baby will increase the risk of a c-section being needed, and can also increase the risk of trauma or other complications during childbirth. Having gestational diabetes with a previous pregnancy or too much amniotic fluid can increase the risk of having gestational diabetes.
However, it is important to remember that many women who develop gestational diabetes have no known risk factors at all.

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