Founrnier's gangrene: review of thirteen cases

Founrnier's gangrene is a synergistic necrotizing fascitis of the perineum and external genitalia. The process was belived to be idiopathic in initial descriptions. Thirteen patients were treated from Fournier's gangrene between 2000 and 2006 in the departments of surgery in El Helal and General Transport Organization hospitals. The common predisposing factors in all our cases were uncontrolled diabetes and sever anaemia. Escherichia coli and Sterptococcus aureus were identified most commonly in cultures of necrotic tissues. Our strategy in management of these cases was simultaneous control of the bad general condition of the patients with serial depridment of the necrotic tissues. Reconstructive operations to cover the raw areas were delayed till complete improvement of the medical status of the patients and till the affected areas were covered by healthy granulation tissues. There was no mortality among our cases

Management of civilian colon injuries

Over the past three decades, primary repair of colonic injuries has become more accepted and there has been a trend toward using this procedure for repairing civilian colonic injures. However, the best procedure remains controversial. Forty patients with colonic injuries alone or associated with other organ injuries were included in the present study over a 44 months period Benha University Hospital. After resuscitation, exploratory laparotomy was done and other organ injuries were appropriately managed. Colonic injuries were dealt with either by primary repair, age, blood transfusion, mechanism and site of injury and injury severity indices. The mechanism of injury was stab injury in 37.5% gunshout in 32.5% iatrogenic in 17% and blunt trauma in 13%. Isolated colon injuries were found in 27.5% and associated with small intestinal injury in 47%. The left colon injuries were found in 40% followed by transverse colon in 37.5%. Primary repair, either by debridement and simple closure in 2 layers or by segmental resection and primary anastomosis was done in 65% of patients while diversion procedures were carried out for 35% of patients. There were 3 mortalities and complications occurred in 30% of the studied patients. From this study we can conclude that there is no single policy for management of colon injuries either by diversion or primary repair. Good results can be obtained by proper decision of an experienced surgeon according to the individual circumstances of each case rather than following solid scheme by less experienced surge Primary suture should be limited to early cases induced by sharp agents or iatrogenic injury. For most severely traumatized patients diversion remains the most dependable method of treatment as it is followed by the least morbidity and mortality

Comparative study between vascular clips and traditional suture closure in vascular anastomosis

One of the most challenging problems which takes a lot of research is to reduce the time of vascular clamping specially in some critical surgical situations e.g. carotid surgery. revascularization of the brain [superficial temporal- middle cerebral artery anastemosts] coronary bypass. organ transplantation. critically threatened loss organ or limb. A new type of vascular closure is clamed to solve this problem that is the use of vascular clips in vascular anastomosis. The aim of this work is to evaluate the use of this new method of vascular ariastomosis in comparison with the traditional suture method. Cephalo-radial end to side arterio-venous fistulae for hemodialysis were done by the use of two types of vascular closures, titanium clips and traditional sutures, ten patients from each group were randomly chosen. The suture line anastomosis in all the patients was 1.5 cm. Apart from the times of tissue dissection the times of vascular anastomosis were only calculated. Then we randomly chosed 10 patients from each group in whom their fistulae done 5 months later. Their fistulae were examined by duplex apparatus. We could conclude from this work that the time required for clip vascular anatomosis is considerably shorter than for anastmosis are nearly equal as regard the patency and degree of narrowing at the site of vascular anatomosis

Surgical outcome of acute traumatic intracranial hematomas in pediatric age group

Fifty patients had traumatic intracranial hematomas in pediatric age group were treated surgically. The surgical outcome was evaluated for survivals during 12 months after injury. They constituted 6% of all pediatric head injuries required hospital admission. 32 patients had acute epidural hematoma, 10 had acute subdural, hematoma, and 8 had acute intracerebral hematoma. Good recovery was achieved in 84% of patients who had acute epidu ral hematoma, while high mortality was reported in those who had acute subdural and acute intracerebral hematomas [50% and 3 7.5% respectively]. Correlation between post resuscitation GCS scores and outcome was parallel together, as good recovery was achieved in 89% with no mortality in patients presented with G.C.S scores of 13-15, while good recovery was 13% with 53% mortality in those presented with GCS scores of 3-8. Presence of systemic injuries and shock had adverse influence on the outcome, as mortality was higher in patients who had systemic injuries than in those had head injury alone [40% and 17.5% respectively] and mortality was also higher in. patients who had shock on admission than in those had head injury alone [44% and 17% respectively]