Sonnabend O, Sonnabend W, Rauh G, Bezzegh T, Gloor F, Amgwerd R, Krech U
Schweiz Med Wochenschr. 1977 Sep 3;107(35):1209-24.
Systematic microbiological research and correlation of the histopathological findings obtained from random autopsies revealed 23 hitherto undetected clostridial infections including 11 cases of gas gangrene, 4 of septicemia, 3 of bacteremia, and 5 other clostridial infections. The knowledge gained from this study led to clinical diagnosis of several cases of gas gangrene which were confirmed bacteriologically and histologically. Of 8 hospital patients who were thus diagnosed in this surgical clinic, 7 recovered, including a case of gas gangrene of the abdominal wall. The problem in gas gangrene is timely clinical diagnosis. Little is known about gas edema illnesses which are not traumatically conditioned. Recognition of the local and general symptoms (local, violent, yet inappropriate pain in the wound, "unexplained" postoperative secondary bleeding, appearance of tachycardia wholly unrelated to the patient's temperature, sudden shock, rapid deterioration of patient's general condition, jaundice and rise in CPK) makes it possible to diagnose postoperative gas edema in time. 77 infections with isolation of clostridia, seen in 76 patients, are reported. On the basis of clinical and histopathological criteria they have been classified as follows: 22 cases with gas gangrene (clostridial myonecrosis), 16 cases with anaerobic cellulitis, 20 wound infections, 8 cases of septicemia, 5 of bacteriemia, 1 of tetanus, and 5 other clostridial infections.
系统的微生物学研究以及对随机尸检所获组织病理学结果的相关性分析显示，发现了23例此前未被检测到的梭菌感染，其中包括11例气性坏疽、4例败血症、3例菌血症以及5例其他梭菌感染。从这项研究中获得的知识使得临床上诊断出了几例气性坏疽病例，这些病例经细菌学和组织学证实。在这家外科诊所被如此诊断出的8名住院患者中，7人康复，其中包括1例腹壁气性坏疽。气性坏疽的问题在于及时进行临床诊断。对于非创伤性引发的气性水肿疾病了解甚少。识别局部和全身症状（伤口处局部剧烈但不适当的疼痛、“不明原因”的术后继发性出血、与患者体温完全无关的心动过速的出现、突然休克、患者全身状况迅速恶化、黄疸以及肌酸磷酸激酶升高）使得及时诊断术后气性水肿成为可能。报告了在76名患者中发现的77例分离出梭菌的感染病例。根据临床和组织病理学标准，它们被分类如下：22例气性坏疽（梭菌性肌坏死）、16例厌氧性蜂窝织炎、20例伤口感染、8例败血症、5例菌血症、1例破伤风以及5例其他梭菌感染。
