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Founier’s Gangrene: A Rare Life Threatening Story

Teaser: 

1William J. Watson, MSc, MD, CCFP, FCFP, 2D'Arcy Little MD CCFP FCFP FRCPC,

1Staff Physician (Retired), Honorary Consultant, Family Medicine, St. Michael’s Hospital, Associate Professor Emeritus, Department of Family and Community Medicine and the Dalla Lana School of Public Health, University of Toronto. 2Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

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Abstract:
A 45-year-old diabetic male developed Fournier’s gangrene requiring emergency surgery. His infectious disease specialist noted his rapid recovery was partly attributable to preserved antibiotic susceptibility from years of judicious prescribing by his family physician who avoided unnecessary antibiotics. This case highlights antibiotic stewardship’s critical role in maintaining treatment effectiveness for life-threatening infections.

Key Words: Fournier’s gangrene, antibiotic stewardship, necrotizing fasciitis, antibiotic resistance.
Fournier’s gangrene is a rapidly progressive necrotizing infection of the genitals and perineum with 40-50% mortality requiring emergency surgical debridement and broad-spectrum antibiotics.
The patient’s preserved antibiotic susceptibility, resulting from years of avoided unnecessary antibiotic use, contributed to his rapid recovery from this life-threatening infection.
CT imaging is the preferred diagnostic modality, detecting subcutaneous emphysema in soft tissues, though clinical diagnosis should never delay urgent surgical intervention.
Risk factors include diabetes mellitus, immunocompromise, alcohol misuse, and SGLT-2 inhibitor use, with early recognition being crucial to reducing mortality.
Time is tissue: Fournier’s gangrene progresses at 2-3 cm per hour—immediate surgical debridement is lifesaving and should never be delayed for imaging when clinical diagnosis is evident.
Antibiotic stewardship saves lives: Preserving antibiotic effectiveness through judicious prescribing for minor viral infections maintains therapeutic options for critical infections requiring immediate broad-spectrum coverage.
High index of suspicion: Scrotal or perineal pain with systemic toxicity (fever, tachycardia, hypotension) in diabetic or immunocompromised patients warrants urgent evaluation—systemic signs may be disproportionate to local findings.
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Related Terms: Radiology, Fournier’s gangrene, antibiotic stewardship, necrotizing fasciitis, antibiotic resistance
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Imaging the Past: The Application of Medical Imaging Technologies in the Examination of Cultural Artifacts and Art

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

D’Arcy Little, MD, CCFP, FCFP, FRCPC, Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

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Abstract:
The application of medical imaging technologies to cultural heritage has revolutionized our ability to examine, preserve, and understand artifacts from human history. This article reviews the use of radiological techniques—including digital radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound—in the non-destructive examination of cultural objects and works of art. From revealing hidden paintings beneath masterpieces to decoding ancient astronomical devices, these technologies have bridged the gap between medicine and archaeology, offering unprecedented insights into artistic techniques, construction methods, provenance, and conservation needs. As imaging technology continues to advance, the collaboration between radiologists and heritage scientists promises even greater discoveries.

Key Words: paleoradiology, heritage imaging, cultural heritage CT, non-destructive examination.
Medical imaging technologies have revolutionized cultural heritage examination: Digital radiography, CT, MRI, and ultrasound enable non-destructive analysis of artifacts, revealing hidden features, artistic techniques, construction methods, and conservation needs without physical alteration of irreplaceable objects.
CT imaging has transformed understanding of ancient remains and artifacts: The re-examination of the first X-rayed mummy (1896) using modern dual-source CT demonstrates extraordinary technological progress, revealing age, sex, pathological findings (hepatomegaly, pectus excavatum, Harris lines), and mummification practices with sub-millimeter resolution that was impossible with early radiography.
X-ray techniques provide crucial insights into artistic practices: Radiography and X-ray fluorescence spectroscopy reveal hidden compositions, pentimenti (artist’s changes), pigment analysis, and authentication information in paintings. Examples include discovering compositional changes in Rembrandt’s works and visualizing hidden portraits beneath Van Gogh paintings using synchrotron-based imaging.
Complex ancient mechanisms can be decoded through advanced imaging: CT examination of the Antikythera Mechanism (circa 200 BCE) using specialized 450 kV microfocus systems revealed 37 meshing bronze gears, previously illegible inscriptions comprising an estimated 15,000 characters, and demonstrated the device’s capability to track celestial movements and predict eclipses with remarkable accuracy.
Interdisciplinary collaboration is essential for accurate interpretation: While radiologists possess expertise in image analysis and three-dimensional reasoning, optimal interpretation of heritage scans requires consultation with archaeologists, art historians, bone pathologists, and conservators—most radiologists cannot independently identify ancient diseases or artistic techniques.
Artifacts require specialized handling protocols unlike living patients: Heritage objects cannot be repositioned, may be extremely fragile, and require protective measures for the object rather than the operator (staff wore masks and gloves during Tutankhamun’s CT scan to protect the mummy, and radiation dose was minimized despite no living tissue being present).
Standard clinical imaging equipment can be adapted for museum applications: Recent innovations demonstrate that accurate CT reconstructions can be achieved using two-dimensional radiography equipment already available in larger museums, combined with marker-based acquisition protocols and sophisticated algorithms, eliminating the need to transport fragile artifacts to external CT facilities.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Radiology, paleoradiology, heritage imaging, cultural heritage CT, non-destructive examination
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Disclaimer at the end of each page