American family physician
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Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and penis, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of three mechanisms: local trauma, extension from a perianal, periurethral or ischiorectal infection. Fournier's gangrene is a urologic emergency that requires prompt recognition and aggressive hemodynamic stabilization, treatment with parenteral broad-spectrum antibiotics and surgical debridement. This disease is associated with a high mortality rate; a high index of suspicion is essential for early recognition whenever a patient presents with scrotal discomfort and swelling.
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American family physician · Nov 1995
Practice Guideline GuidelineTrial of labor vs. elective repeat cesarean section. AAFP Task Force on Clinical Policies for Patient Care.
A trial of labor after a previous low transverse cesarean section in the absence of ongoing contraindications is safe for most women. A comprehensive review and meta-analysis of the literature was conducted to determine outcomes, costs and women's preferences by method of delivery. About seven of 10 women who undergo a trial of labor after previous low transverse cesarean section can expect to deliver vaginally. ⋯ When given the opportunity, about two-thirds of eligible women choose a trial of labor over elective repeat cesarean section. The reasons underlying women's preferences for a trial of labor or elective repeat cesarean section were diverse and changed during pregnancy. As a consequence, women's preferences for the method of delivery must be explored and respected throughout pregnancy and during the delivery process.(ABSTRACT TRUNCATED AT 250 WORDS)