Gangrene from exposure to cold

Abstract

DUNNING : GANGRENOUS EFFECTS O F COLD 883 these were rare events, as his type of work did not attract much outside interest. As an illustration of his attitude, there was an occasion when a visiting surgical club proposed to spend a day in the hospital to watch the work in the operating theatres. The staff therefore arranged a programme of demonstration operations, but Gibbs refused to take part. He explained that to be watched by a group of surgeons might quite easily upset his judgement and interfere with his technique, to the great detriment of his patient. Furthermore, he believed it wrong for the rest of the surgical staff to take any part in this sort of publicity.As could be expected, he was a very skilled user of the cystoscope, both of the earliest models with poor light, small field, and inverted image, and of the subsequent greatly improved instruments; but it was, perhaps, in his masterly method of handling the then very common urethral strictures that his great manipulative ability and experience were best displayed. Cases where all previous attempts by others to pass a bougie had failed always seemed to yield to the many little 'tricks' which Gibbs would demonstrate to students and housemen. It might result only in the passage of a filiform bougie as a start to further dilatation, but this was practical knowledge for which they would be very grateful when they themselves were called upon to deal with similar cases.For many years he controlled the prosectors of the R.C.S., and here his precise knowledge of anatomy was of great value to the prosectors themselves and also to the examiners, who used the specimens thus provided.There can be no doubt that Gibbs was unique in his ability to convey information in the didactic manner so well suited to the state of surgical knowledge at the time. He is still regarded by the older generation of Charing Cross men as having been the finest teacher they knew.N. C. L.

Symmetrical peripheral gangrene.

“…The causes of this syndrome fall into three main groups: (1) vasospastic conditions such as Raynaud's syndrome (Raynaud, 1888), ergot poisoning (Cranley et al, 1963), and frostbite (Dunning, 1964); (2) conditions in which the small vessels are obstructed, such as disseminated intravascular coagulation (Goodwin and Berne, 1974), the presence of cold agglutinins, or primary thrombocythaemia (Preston et al, 1974) and Lloyd et al (1967) described 4 cases in children in which the presumptive diagnosis was polyarteritis nodosa; it has also been described in children after infectious diseases such as chickenpox (Gyde and Beales, 1970) and measles (Chaudhuri and McKenzie, 1970) where intravascular coagulation was probably responsible; and (3) conditions leading to a fall in cardiac output-our cases belong to this third group.…”

The diagnosis and management of gangrene from exposure to cold

“…ROYAL FREE HOSPITAL EXPOSURE of the extremities to cold, wet conditions is common in war time. Thus Larrey described the devastating effects of cold upon Napoleon's soldiers during the Russian campaign (Dunning, 1964). cases in their lifetime, wet conditions sufficiently severe to cause gangrene is rare in civil practice in this country, however, and not many surgeons are likely to see more than a few In this paper we report the cases of 3 patients who suffered gangrene from exposure to cold, we describe the pathology of cold injury, and we review the methods of treatment which have been employed in this condition.…”

Symmetrical Peripheral Gangrene in Disseminated Tuberculosis

“…Mechanisms and conditions leading to symmetrical peripheral gangrene Hypotension shock [3] cardiac failure of different origin [4] treatment with beta-blocking agents [11] Vasoconstriction shock [3] frostbite [9] treatment with vasoactive agents ergotamine [5], vasopressin [13], dopamine [14] and chloroquine [16] secondary Raynaud's phenomenon [15] Endothelial damage treatment with bleomycin [17] bacterial sepsis [10,18] rickettsiosis [19] viral diseases: hepatitis B [20], measles [21], chickenpox [22] vasculitis of different origin [23,24] arterial calcification: uremia [25], oxalosis [26] carbon monoxide poisoning [12] Kaposi's sarcoma [27] black foot disease [28] Obliteration thromboembolic occlusion disseminated intravascular coagulation [21,32,33,44,45] cholesterol embolism [7] septic embolism [29] malaria [30] sickle cell anemia [18,38] essential thrombocythemia [35] heparin-induced thrombosis [39] polycythemia vera [34] hyperviscosity states cryoglobulinemia [36] paraproteinemia [36,40] hypernatrémie dehydration [42] venous thrombosis …”