Predictive factors of mortality in Fournier's gangrene

Background: Fournier's Gangrene is a rare but serious condition accounting for a high death rate. Several predictive factors of mortality have been reported from retrospective series but more often these factors vary from one study to another

Aim: The aim of this work is to assess the clinical and therapeutic characteristics of patients treated for Fournier's gangrene in order to determine the predictive factors of mortality

Methods: The study enrolled retrospectively all patients admitted in the surgery 'B' unit of Charles Nicolle hospital for Fournier's gangrene during the period ranging between January, 1st, 2000 and December, 31st, 2010. The diagnosis of Fournier's gangrene has been retained each time a tissue necrosis has been noted in perineum, whether during physical examination or intraoperatively. For all patients, clinical variables and treatments were collected. A comparative study was carried out between the group of survivors and deceased

Results: Forty one patients have been included. The univariate analysis identified the following predictive factors of mortality: extension of lesions outside the perineum [p=0,002], severe sepsis and/or a septic shock [p=0,006], heart rate greater than 90/min [p=0,001], white blood cell count higher than 20000/mm3 [p=0,043] and urea level higher than 7 mmol/l [p=0,009]. The multivariate analysis retained the extension of gangrene beyond the perineum as an independent predictive factor of mortality [p=0,004]

Conclusion: Improving prognosis of Fournier's gangrene requires early diagnosis ahead of the extension of lesions beside the perineum which is associated with a higher mortality risk despite optimal care and treatment

[Primary carcnoid hepatic tumour: a case report]

Primary carcinoid tumour of the liver is rare and poses a diagnostic and management dilemma. Report a new cases. A 48 year-old patient man, with a 8-months history of abdominal pain and weight loss, was operated on in December 2000, in another centre with the diagnosis of caudate pancreatic cancer. At laparotomy, Resection was deemed to be not feasible. Histological examination of biopsy was for carcinoid tumor. The patient underwent post operative radiotherapy and four courses of chemotherapy and he was referred to our hospital. Physical examination was normal. Based on radiological examination, the diagnosis was endocrine tumor of the pancreas. The patient underwent relaparotomy, the lesion was independent from the pancreas but linked to the liver; the caudate lobe. Complete macroscopic resection was performed. Histological examination of operative specimen concludes to carcinoid tumor with invasion of hepatic margins. The patient underwent adjuvant chemotherapy; he was free from disease 6 months after surgery. The diagnostic of primary carcinoid tumors is based principally in the histopathological confirmation of neuroendocrine origin and the exclusion of non hepatic primary tumour. This requires preoperative imaging but most importantly a thorough laparotomy and rigorous follow-up. Surgical resection if possible is recommended

[Impact of esophageal manometry before anti-reflux surgery]

Esophageal hypomotility is frequent in patients with gastroesophageal reflux disease [GERD]. To precise the frequency and the patterns of esophageal manometric abnormalities in GERD patients referred before anti-reflux surgery, to determine the frequency of post-operative dysphagia and to look for associated factors with high risk of dysphagia, with special interest on pre-operative esophageal manometric study. We conducted a retrospective study based on patients having anti-reflux surgery and pre-operative esophageal manometry. Post-operative dysphagia was prospectively assessed during the follow-up. We studied 33 patients [mean age: 46 years; sex ratio: 0.4]. Pre-operative esophageal manometry was abnormal in 1/3 of cases, with a high prevalence of non specific motor disorders and hypomotility. Nor epidemiological, clinical or pH metric factor was associated with the risk of motor esophageal abnormalities. Post-operative dysphagia was noted in 21% of the cases, with any correlation with results of pre-operative manometry. Esophageal hypomotility is frequent in patients with GERD; and not associated with a higher risk of post-operative dysphagia after anti-reflux surgery

Agenesie de la vesicule biliaire: a propos d'une cas.

Agenesis of the gall-bladder is a very rare affection. The pathogeny is correlated with abnormality affecting the embryogenesis of hepatic diverticulum which explain the frequent association with others malformations. The diagnosis is exceptionnaly made preoperatively. Laparotomy confirm the diagnosis and the surgeon must explore the habitual ectopic site by manual explorations, sonography and cholangiography before concluding at the diagnosis of agenesis of gallbladder

Deux cas de cancerisation des stenoses caustiques de l'oesophage

The incidence of carcinoma of the esophagus within patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than in the general population. Two patients developed carcinoma of the esophagus respectively 25 and 40 years after corrosive injury. One of these patients had initially gastrostomy and repeated esophagal dilation. Taking into account the high incidence of carcinoma in the site of esophageal stricture, we conclude that the resection of the esophagus is indicated in patients with chronic caustic stricture if there is any finding suggestive of malignancies such as a long duration of the lesions more than 20 years particulary when the ingested agent was caustic soda or sudden aggravation of preexisting dysphagia