Fournier's gangrene: clinical, biochemical, bacteriologic, immunologic study and treatment outcome

Identify Fournier's disease associations, outcome and survival factors. Fournier's gangrene patients [34] were treated between 2003 to 2006. Data were collected about medical history, physical findings, metabolic test, bacteriologic typing, immunologic screening for T cell function, serum IL-2, ICAM-I and gamma IFN with their management. The disease had age range 3-67 years, polymicrobial nature, and low serum albumin [3.3 +/- 0.6mg/dl]. Inadequate T-cell function [18255.3 +/- 1641 CPM] and high ICAM-I, IL-2, gamma IFN [10.5 +/- 0.7, 93.3 +/- 1.6, 131 +/- 2 pg/ml] were detected in Fournier's disease but serum IL-2 was relevant to outcome [P=0.0001]. The survival factors were patients' age [P=0.0001], presentation timing [P=0.001], both disease extent [P=0.0001], septic shock [P=0.01], severe SIRS [P=0.001], serum albumin [P=0.0001] and IL-2. Fournier's disease is consistent with deviated metabolic status and immunologic dissonance, inciting local gangrenous process, these parameters are significant for disease outcome

Early jejunal tube feeding after repair of congenital tracheo-esophageal fistula

The role of postoperative enteral feeding has been well documented. The objective of this study was to assess the benefits of early feeding via a transgastric jejunal tube after primary repair of congenital esophageal atresia [EA] with tracheo-esophageal fistula [TEF]. Thirty patients were treated at Mansoura University Children's Hospital during the period from July 2002 and January 2005. Following thoracotomy and primary esophageal anastomosis, Stamm's gastrostomy was constructed, through which a jejunal tube was passed. Twenty four patients survived, six cases died. Four patients developed esophageal leaks, which were treated conservatively, one of them developed anastomotic stricture later and another developed a recurrent fistula. We observed improved infant's weight profile and increases IL-12 levels. Diminished glutathione peroxidase levels were detected postoperatively. Early enteral feeding improves the survival, decreases the morbidity, maintains the body weight and the hydroelectrolytic equilibrium and builds up the immunologic response