ABSTRACT
Despite advances in diagnostic techniques, liver trauma management remains a challenging issue. To audit the 2 years resutls of liver traumas treated surgically. Retrospective analysis of patients who underwent surgery for liver injury were reviewed. Age, gender, type of trauma, haemodynamic parameters, preoperateive hemoglobin, number of injuries to the liver, coexisting organ injuries, type of surgery, duration of hospitalisation, health status on discharge were evaluated. A total of 30 patients underwent surgery for liver trauma, their median age was 35 +/- 17.14 [23 male, 7 female]. Blunt liver trauma was seen in 50% of the cases [n=15], while, remaining had penetrating trauma. Nine patients [30%] were haemodynamically unstable. Number of injuries to the liver were 1 in 13 patients [43.3%] 2 in 7 patients [23.33%] 3 in 4 patients [13.33%] and more than 3 in 6 patients [20%] Twenty two patients [73.3%] had co-existing injuries to other organs too. Among the surgical procedures used, 9 were damage controlling procedures and 9 were definitive repair, and one patient underwent living donor liver transplantion. Mortality was 10% [n=3]. Coexisting organ injuries and hemodynamically unstable status contributed to mortality
ABSTRACT
Liver and other solid organ transplant recipients are at an increased risk of developing several malignancies because of the immuno-suppressive treatment. Generally, patients who had a liver transplant have upper gastrointestinal tract complaints, which makes identification of gastric carcinoma symptoms in those patients difficult. A 58 years old liver transplant male patient presented to the hospital for his routine checkup and dyspeptic complaints. He had received a liver from a cadaver 18 months ago and his postoperative period had been uneventful. An esophagogastroduodenoscopy [EGD] revealed gastric cancer. A subtotal gastric resection with a D2 lymph node dissection was carried out. There was no recurrence during three years follow up. In order to make a timely identification of the occurrence of common malignancies such as gastric cancer, liver transplant recipients must be followed closely
Subject(s)
Humans , Male , Middle Aged , Liver Transplantation/adverse effects , Immunosuppression Therapy/adverse effects , Early Detection of CancerABSTRACT
To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus [DM] as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene. Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively. The mean age of the patients was 52.8 years. There were 8 female [30.8%] and 18 male [69.2%] patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus [DM] and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients. In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene