RESUMO
Objective: To report our experience with Fournier's Gangrene [FG] over the past eight years and evaluate the predisposing factors which affect the mortality
Methods: Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed
Results: Our cases included 8 women and 57 men. The average age of men was 51 +/- 13.9 [range 19-75] and the average age of women was 63 +/- 10.5 [range 52-76]. Average hospitalization time was 9.2 +/- 6.6 days [range 5-25] days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 [12.3%] patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement
Conclusions: Fournier's gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity
RESUMO
To evaluate the efficacy and reliability of ureteroscopic pneumatic lithoripsy [URSPL] in patients with ureter calculi. A total of 612 patients who were treated with URS-PL in Medical school of Yuzuncu Yil University, Van State Hospital and Bingol State Hospital in the period between April 2005-May 2010 were studied. Diagnoses of ureter stones were made with intravenous pyelography [IVP] or computerize tomography [CT]. Ureteral balloon dilation was not performed on any patient. On the post-operative 1[st], 7[th] and 21[st] days, control direct urinary system graphic [DUSG] was taken. The rates of stone free and complication were analyzed with the ki-kare test. P < 0.05 was accepted as significant. The mean age of the patients was 39 +/- 10 [18-75]. There were 417 males [68.13%] and 195 females [31.86%]. The mean volume of calculi in patients was 10.1 +/- 2.3 mm. Of these patients, 121 had proximal ureter stone, 169 medial ureter stones and 322 had distal ureter stones. In the first session of URS-PL, the calculi of 96 patients in proximal ureter [80%], those of 143 patients in medial ureter [85%] and those of 305 patients [95%] in distal ureter were cracked successfully. The mean stone free rate was 92.4% [79.4% in upper ureter, 94.1% in middle ureter and 93.7% in distal ureter [P < 0.05]. Overall complication rate was 7.6% [7.7% in distal ureter, 3.9% in middle ureter and 11.8% in proximal ureter] [P>0.05]. Most common peroperative complications of the procedure were ureteral perforation 4,2% [n=26], infection 2.2% [n=14], and mucosal laceration 1.9% [n=12]. The most common late complication was ureteral stricture in 1.3% [n=8] of patients. Although URS-PL is a commonly used application for the treatment of patients with proximal and middle ureter stones, its common usage could also be extended to patients with distal ureter stones in the first stage of treatment, and it could be considered as an efficient and reliable procedure
RESUMO
Renal cell carcinoma [RCC] is rare neoplasm and rarely extends to IVC. Perinephric and venous system invasion is an important prognostic sign for RCC. The tumor may grow intraluminally into the renal vein and Inferior Vena Cava [IVC] as an extension of primary tumor. In this report, we present two unusual case of venous system involvement, invasion of RCC into SVC. RCC with tumor thrombus extension into the IVC remains a difficult operative challenge. However surgical intervention should be performed. Our cases were successfully operated and their post operative recovery was uneventful