Integrative bioinformatics approaches to map key biological markers and therapeutic drugs in Extramammary Paget's disease of the scrotum.

Extramammary Paget's disease (EMPD) is an intra-epidermal adenocarcinoma. Till now, the mechanisms underlying the pathogenesis of scrotal EMPD is poorly known. This present study aims to explore the knowledge of molecular mechanism of scrotal EMPD by identifying the hub genes and candidate drugs using integrated bioinformatics approaches. Firstly, the microarray datasets (GSE117285) were downloaded from the GEO database and then analyzed using GEO2R in order to obtain differentially expressed genes (DEGs). Moreover, hub genes were identified on the basis of their degree of connectivity using Cytohubba plugin of cytoscape tool. Finally, GEPIA and DGIdb were used for the survival analysis and selection of therapeutic candidates, respectively. A total of 786 DEGs were identified, of which 10 genes were considered as hub genes on the basis of the highest degree of connectivity. After the survival analysis of ten hub genes, a total of 5 genes were found to be altered in EMPD patients. Furthermore, 14 drugs of CHEK1, CCNA2, and CDK1 were found to have therapeutic potential against EMPD. This study updates the information and yields a new perspective in the context of understanding the pathogenesis of EMPD. In future, hub genes and candidate drugs might be capable of improving the personalized detection and therapies for EMPD.

Incorporating Simplified Fournier's Gangrene Severity Index with early surgical intervention can maximize survival in high-risk Fournier's gangrene patients.

OBJECTIVES: To determine the optimal surgical timing in high-risk patients with Fournier's gangrene by the Simplified Fournier's Gangrene Severity Index. METHODS: From 1989 to 2018, 118 male patients diagnosed with Fournier's gangrene with complete medical records were retrospectively reviewed. Patients' demographics, laboratory parameters at initial diagnosis, Fournier's Gangrene Severity Index and Simplified Fournier's Gangrene Severity Index, and the time interval from emergency room arrival to surgical intervention were collected. The Fournier's gangrene patients were categorized into low-risk (Simplified Fournier's Gangrene Severity Index ≤2) and high-risk groups (Simplified Fournier's Gangrene Severity Index >2). Differences between the variables within the two groups were analyzed. The optimal surgical timing was analyzed with the receiver operating characteristic curve in high-risk Fournier's gangrene patients. RESULTS: The overall mortality of 118 Fournier's gangrene patients was 14.4%. After risk stratification with the Simplified Fournier's Gangrene Severity Index scoring system, the mortality of low-risk and high-risk Fournier's gangrene patients was 1.3% and 41.0%, respectively. In the high-risk group, the time interval from emergency room arrival to surgical intervention was the only variable with a significant difference between survivors and non-survivors (P = 0.039). The optimal surgical timing was determined at 14.35 h, which allowed the highest sensitivity (0.688) and specificity (0.762) to affect mortality. The mortality was significantly lower in high-risk Fournier's gangrene patients with early surgical intervention compared with late intervention (23.8% vs 68.8%, P = 0.007). CONCLUSIONS: The Simplified Fournier's Gangrene Severity Index is a quick and reliable screening tool for first-line physicians to identify high-risk patients with Fournier's gangrene (Simplified Fournier's Gangrene Severity Index >2) who have poor survival outcomes. We recommended early surgical intervention within 14.35 h to maximize the survival of high-risk Fournier's gangrene patients.

Hazardous effects of chemical pesticides on human health-Cancer and other associated disorders.

Poisoning from pesticides is a global public health problem and accounts for nearly 300,000 deaths worldwide every year. Exposure to pesticides is inevitable; there are different modes through which humans get exposed to pesticides. The mode of exposure is an important factor as it also signifies the concentration of pesticides exposure. Pesticides are used extensively in agricultural and domestic settings. These chemicals are believed to cause many disorders in humans and wildlife. Research from past few decades has tried to answer the associated mechanism of action of pesticides in conjunction with their harmful effects. This perspective considers the past and present research in the field of pesticides and associated disorders. We have reviewed the most common diseases including cancer which are associated with pesticides. Pesticides have shown to be involved in the pathogenesis of Parkinson's and Alzheimer's diseases as well as various disorders of the respiratory and reproductive tracts. Oxidative stress caused by pesticides is an important mechanism through which many of the pesticides exert their harmful effects. Oxidative stress is known to cause DNA damage which in turn may cause malignancies and other disorders. Many pesticides have shown to modulate the gene expression at the level of non-coding RNAs, histone deacetylases, DNA methylation patterns suggesting their role in epigenetics.

Prognostic factors and outcome of spermatic cord sarcoma.

PURPOSE: To evaluate management and outcome in a large series of patients with spermatic cord sarcomas (SCS), a rare malignancy. METHODS: Eighty-two patients with localized SCS treated at two dedicated sarcoma units between 1992 and 2013 were included. Disease-specific survival (DSS) and crude cumulative incidence of local recurrence and distant metastases (DM) were estimated by Kaplan-Meier plots and log rank tests. RESULTS: Median follow-up was 33 months (interquartile range 13-72 months). Sixty-one patients presented with primary disease. Liposarcoma was the most common histotype, but surprisingly, 37 % of tumors were of high grade. Seventeen patients (21 %) received radiotherapy and 12 patients (15 %) chemotherapy. Five-year DSS for the whole series was 92 % [95 % confidence interval (CI) 83-97]. Five-year rates of local recurrence and DM were 26 % (95 % CI 15-42) and 24 % (95 % CI 15-38), respectively. Tumor grade was found to be a significant predictor of both DSS and DM (both p < 0.001). Quality of surgical margins was proved to affect the local outcome (p = 0.025), while the rates of distant metastases were found to differ significantly by histology (p = 0.010). Exclusively in the liposarcoma subgroup, quality of surgical margins was also directly associated with DSS (p = 0.043). CONCLUSIONS: Wide excision of the tumor is critical for cure, especially in the liposarcoma subgroup. The role of radiotherapy and chemotherapy is not established.

Validation and simplification of Fournier's gangrene severity index.

OBJECTIVES: To validate the predictive value of Fournier's Gangrene Severity Index in patients with Fournier gangrene and to facilitate patient mortality risk-stratification by simplifying the Fournier's Gangrene Severity Index. METHODS: From January 1989 to December 2011, 85 male patients with clinically-documented Fournier's gangrene undergoing intensive treatment and with complete medical records were recruited. The demographic information and nine parameters of Fournier's Gangrene Severity Index were compared between survivors and non-survivors. The parameters that showed a significant difference between the two groups were selected to generate a simplified scoring index. RESULTS: Of the 85 patients recruited, 16 patients died of the disease with mortality rate of 18.8%. The Fournier's Gangrene Severity Index score at initial diagnosis was significantly higher in non-survivors than in survivors. Of the nine parameters of Fournier's Gangrene Severity Index, the scores of serum creatinine level, hematocrit level and serum potassium level were significantly different between the two groups. However, the mean body temperatures, heart rate, respiration rate, white blood cell count, serum sodium and bicarbonate levels were non-significantly different. Of the 12 patients with chronic kidney disease or end-stage renal disease, 10 died of severe sepsis. A simplified scoring index including parameters of creatinine, hematocrit and potassium was generated, which provided sensitivity and specificity of 87% and 77% in predicting patient mortality, respectively. The predictive values of this simplified Fournier's Gangrene Severity Index were shown to be non-inferior to Fournier's Gangrene Severity Index in our patients. CONCLUSIONS: The simplified Fournier's Gangrene Severity Index is easy to use at initial diagnosis, and offers a way to compare outcomes in different clinical populations.

Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases.

UNLABELLED: Study Type - Prognosis (outcome) Level of Evidence 2b. What's known on the subject? and What does the study add? Reportedly, Fournier's gangrene has a high mortality rate, ~7.5-40%, and experts recommend early surgical debridement. This study examines 379 patients and shows that an early intervention, i.e. within 2 hospital days could halve the mortality rate compared with later intervention. OBJECTIVE: • To examine how early surgical intervention influenced cases of Fournier's gangrene (FG) fatality. PATIENTS AND METHODS: • Patients with FG (defined as an International Classification of Diseases-10 code of M72.6 [necrotizing fasciitis] at the perineum or external genitalia), who received surgical intervention ≤ 5 days after admission, were identified from the Diagnosis Procedure Combination database for the 6-month period July to December, in the years 2007-2010. • Data included age, sex, comorbidities, ambulance use, operations and debridement ranges. • Multivariate logistic regression analysis of mortality was performed to show whether early (≤ 2 hospital days) or delayed (3-5 hospital days) surgical treatment affected FG outcomes. RESULTS: • A total of 302 male and 77 female patients with FG were identified for which the overall case fatality rate was 17.1% (65 cases). • There were no significant differences in patient characteristics between the early operation group (n = 327) and the delayed operation group (n = 52), with the exception of ambulance use (33.3% vs 17.3%, P = 0.020). • Cystostomy, colostomy, orchiectomy/penectomy (male patients only), or debridement ≥ 3000 cm(2) were performed on 42 (8.8%), 56 (11.5%), 46 (10.8%) and 17 (4.4%) patients, respectively. • Multivariate analysis showed that there was a significantly lower case fatality rate among the early operation group (odds ratio [OR] = 0.38; P = 0.031). • Older age (OR 1.80, for 10-year increments), Charlson comorbidity index score (OR = 1.33, for 1-point increments), sepsis or disseminated intravascular coagulation at admission (OR 4.01), and debridement range ≥ 3000 cm(2) (OR 5.22, compared with other operations) were significantly associated with a higher case fatality rate. CONCLUSION: • Early (≤ 2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3-5 hospital days) action.

Is there a need for the Fournier's gangrene severity index? Comparison of scoring systems for outcome prediction in patients with Fournier's gangrene.

UNLABELLED: Study Type - Prognosis (prospective cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Fournier's gangrene (FG) is a rare but life-threatening disease challenging the treating medical staff. Despite the fact that antibiotic therapy combined with surgery and intensive care surveillance are performed as standard treatment, mortality rates remain high. There have been efforts to develop a reliable tool to predict severity of the disease, not only to identify patients at highest risk of major complications or death but also to provide a target for medical teams and researchers aiming to improve outcome and to gather information for counselling patients. Laor et al. published the FG severity index (FGSI) in 1995 presenting a complex prediction score solely for patients with FG. Fifteen years later, Yilmazlar et al. suggested a new and supposedly more powerful scoring system, the Uludag FGSI (UFGSI), adding an age score and an extent of disease score to the FGSI. In the present study population we applied two scoring systems for outcome prediction that are solitarily applicable in patients with FG (FGSI, UFGSI), as well as two general scoring systems such as the established age-adjusted Charlson Comorbidity Index (ACCI) and the recently introduced surgical Apgar Score (sAPGAR) to compare them and to test whether one system might be superior to the other. In addition, we identified potential prognostic factors in the study population. By contrast to many earlier studies, we performed a combined prospective and retrospective analysis and provided a 30-day follow up. In the cohort of the present study, older patients with comorbidities as well as a need for mechanical ventilation and blood transfusion are at higher risk of lethal outcome. All scores are useful to predict mortality. Despite including more variables, the UFGSI does not seem to be more powerful than the FGSI. In daily routine we suggest applying ACCI and sAPGAR, as they are more easily calculated, generally applicable and well validated. OBJECTIVE: • To compare four published scoring systems for outcome prediction (Fournier's gangrene severity index [FGSI], Uludag FGSI [UFGSI], age-adjusted Charlson Comorbidity Index [ACCI] and surgical Apgar Score [sAPGAR]) and evaluate risk factors in patients with Fournier's gangrene (FG). PATIENTS AND METHODS: • In all, 44 patients were analysed. The scores were applied. • A Mann-Whitney U-test, Fisher's exact test, receiver operator characteristic (ROC) analysis and Pearson correlation analysis were performed. RESULTS: • The results of the present study show a significant association among FGSI (P= 0.002), UFGSI (P= 0.002), ACCI (P= 0.004), sAPGAR (P= 0.018) and death. • The differences between the area under the receiver operating characteristic curve of the scores were not significant. • Non-survivors were older (P= 0.046), had a greater incidence of acute renal failure (P < 0.001) and coagulopathy (P= 0.041), were treated more often with mechanical ventilation (P= 0.001) and received more packed red blood cells (RBCs; P= 0.001). CONCLUSION: • Older patients with comorbidities and need for mechanical ventilation and RBCs are at higher risk for death. • In the present cohort, scores calculated easily at the bedside, such as ACCI and sAPGAR, seemed to be as good at predicting outcome in patients with FG as FGSI and UFGSI.

Fournier's gangrene: an analysis of 80 patients and a novel scoring system.

BACKGROUND: To create a better scoring system for outcome prediction for patients with Fournier's gangrene in order to design more appropriate and feasible management strategies. METHODS: Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier's gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with the Fournier's gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score. RESULTS: The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P < 0.001). The receiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002). CONCLUSIONS: The power of the novel scoring system introduced in this study proves that in patients with Fournier's gangrene, the extent of the gangrene as well as the patient's age and physiological status have a significant effect on the outcome.

Genitourinary infections caused by nontuberculous mycobacteria at a university hospital in Taiwan, 1996-2008.

Genitourinary infections caused by nontuberculous mycobacteria (NTM) are rarely reported. The medical records of all patients with genitourinary NTM infections treated at National Taiwan University Hospital from 1996-2008 were retrospectively reviewed. Fifteen patients were identified, of whom 10 (67%) were male. More than two-thirds of patients had underlying conditions, the most common of which was chronic renal disease. Only one patient had AIDS. Acid-fast smears of urine were negative in all patients. Eleven isolates were available for further confirmation by sequencing of the 16S rRNA gene. Mycobacterium avium complex was the most common (n = 5, 33%), followed by both Mycobacterium abscessus (n = 2; 13%) and Mycobacterium fortuitum (n = 2; 13%). Of the 12 patients receiving anti-NTM treatment, only four received adequate prescribed regimens and none died of NTM infections. Two patients died of refractory urosepsis before the urinary NTM infections were diagnosed. The clinical characteristics of the 15 patients were also compared with 43 previously reported patients with genitourinary tuberculosis. Patients with genitourinary NTM infections were more likely to report constitutional symptoms, seek medical help within 1 month after the onset of symptoms and develop leukocytosis. Patients with genitourinary tuberculosis were more likely to have ureteral strictures and abnormal chest radiographs associated with active or inactive tuberculosis. Although rare, genitourinary NTM infections pose a significant threat to life and should be considered in the differential diagnosis of genitourinary infections, especially when patients are unresponsive to conventional antibiotic treatment.

Validation of the Fournier's gangrene severity index in a large contemporary series.

PURPOSE: In this study we identified prognostic factors for survival and validated the accuracy of the Fournier's gangrene severity index in patients with Fournier's gangrene. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients diagnosed with Fournier's gangrene between 1996 and 2006. Fournier's gangrene severity index scores were assessed using a receiver operating characteristic curve. Using an outcome variable of inpatient mortality, univariate analyses were performed using the Mann-Whitney U, chi-square and Fisher exact tests. RESULTS: A total of 68 patients (79.4% male, mean age 55.8 +/- 15.2 years) diagnosed with Fournier's gangrene met the criteria for review. The inpatient mortality rate was 10% (7 patients). The mean Fournier's gangrene severity index score for survivors was 5.4 +/- 3.5 vs 10.9 +/- 4.7 for nonsurvivors (p = 0.006). Isolated Fournier's gangrene severity index and individual laboratory parameters associated with mortality included heart rate (p = 0.05), respiratory rate (p = 0.02), serum creatinine (p = 0.03), serum bicarbonate (p = 0.001), serum lactate (p = 0.001) and serum calcium (p = 0.03). Although mean total body surface area was only suggestive of an association (p = 0.169), abdominal wall (p = 0.004) or lower extremity (p = 0.005) involvement was associated with increased mortality. Using a Fournier's gangrene severity index score threshold of 9 (sensitivity 71.4%, specificity 90%) there was a 96% survival rate in patients with a Fournier's gangrene severity index of less than 9 and a 46% mortality rate in those with a Fournier's gangrene severity index of 9 or greater (p = 0.001, OR 22, 95% CI 3.5-139.7). CONCLUSIONS: The Fournier's gangrene severity index remains an objective and simple method to quantify the extent of metabolic aberration at presentation in patients with Fournier's gangrene. A Fournier's gangrene severity index threshold value of 9 is sensitive and specific for predicting mortality in this patient population.

[Fournier gangrene: evaluation of prognostic factors in 90 patients]. / Gangrena de Fournier: estudio de los factores pronósticos en 90 pacientes.

INTRODUCTION: This study evaluates the risk factors and prognostic variables that affect survival of patients with gangrene of Fournier. MATERIAL AND METHODS: The study retrospectively analyzed 90 consecutive patients with gangrene of Fournier treated in our institution between 1975 and 2008. We evaluated the average age, associated systemic diseases, and the source, time of evolution and extent of necrotizing fasciitis. The outcomes were assessed according to whether the patient survived or died. All patients had aggressive surgical debridement, and received parenteral antibiotic therapy. RESULTS: The mortality rate was 34.4%. The mean age was 63.0 years (range 33-95), a statistically significant difference was found between the age of the survivors (median age, 59.84 years) and those who died (median age, 70.20 years) (p = 0.001). Medical comorbidities were identified in 51 patients; the death rate was higher in patients who had any medical disease, especially those who suffered from cancer. Although diabetes mellitus was the most common associated pathology, it was not related to a statistically significant worst prognosis. The source of the infection was identified in 62 patients, who showed a higher mortality (p = 0.015), the mortality rate when a urological source is identified was 50%. Moreover, patients suffering from a more extensive necrotizing infection showed a worst prognosis. CONCLUSIONS: The gangrene of Fournier has a high mortality rate. Large series are required to study prognostic variables of this disease. The patient age, the presence of systemic risk factors, especially cancer, a urological source of infection and the extent of the disease have impact on the prognosis of Fournier's gangrene.

Genital and nongenital nonmelanoma skin cancer: more epidemiological studies are needed.

Although black men in the United States have a lower mortality of nongenital nonmelanoma skin cancer (NMSC) than white men, they have a higher mortality of genital NMSC than white men. Mortality of NMSC has declined over time. Ethnicity-specific incidence and survival analyses of NMSC can be used to determine to what degree earlier detection and/or more efficient therapies have contributed to these observations.

Trends in nonmelanoma skin cancer mortality rates in the United States, 1969 through 2000.

The purpose of this population-based study was to assess trends in mortality rates for nonmelanoma skin cancer (NMSC) in the United States. Particular emphasis was placed on the subgroup of malignancies arising on genital skin. Nearly 75,000 deaths in the United States were attributed to NMSC from 1969 to 2000. The age-adjusted US mortality rate for NMSC arising on nongenital skin from 1969 to 2000 was 0.69/10(5)/year; the rate among men was twice that among women. Mortality rates among white men exceeded that of black men by a factor of two; the same was observed among women, but by a smaller multiple. Corresponding mortality rates for malignancies arising from genital skin (penis, scrotum, vulva) were higher in women (0.54) than in men (0.30). In contrast to nongenital NMSC, mortality rates among black men were twice that of white men; however, rates for white and black women were similar. These results suggest that greater emphasis could be placed on reducing mortality from genital NMSC while continuing to stress reduction of excess sun exposure.

Hyperbaric oxygen for the treatment of fournier's gangrene.

PURPOSE: Fournier's gangrene is a necrotizing fasciitis of the genitalia that is associated with high morbidity and mortality. Groups at many institutions have initiated routine adjuvant hyperbaric oxygen (HBO) therapy. We examined whether HBO has made a difference in the morbidity, mortality and costs associated with treating this disease. We also analyzed predictors of extended hospital stay and mortality. MATERIALS AND METHODS: The records of patients with the hospital discharge diagnoses of Fournier's gangrene, necrotizing fasciitis, gangrene of the genitalia and scrotal gangrene from 1993 to 2002 were reviewed. Data concerning clinical presentation characteristics, hospital stay, complications, hospital charges and outcomes, including graft failure and death, were analyzed. RESULTS: A total of 42 patients were identified and followed a median 4.2 years. Of the patients 16 underwent surgical debridement and antibiotic therapy alone, and 26 were treated with HBO plus surgery and antibiotics. Overall disease specific mortality was 21.4%, that is 12.5% in the nonHBO group and 26.9% in the HBO group. Three or more complications occurred in 13% of nonHBO and in 19% of HBO cases, of which the most common was myocardial infarction. The skin graft failure rate was 6% (nonHBO) and 8% (HBO). Physical disability was a statistically significant predictor of extended hospital stay (p <0.01). There was a trend toward a correlation between known coronary artery disease and death (p = 0.2). A statistically significant difference was noted in average daily hospital charges in nonHBO vs HBO cases ($2,552 vs $3,384 daily, p <0.01). CONCLUSIONS: These data do not support routine HBO in the treatment of Fournier's gangrene. There was a trend toward higher morbidity and mortality in the HBO group, suggesting that treatment may have been given to patients who were more ill.

A life-threatening infection: Fournier's gangrene.

Fournier's gangrene is a life-threatening disorder in which infection of the perineum and scrotum spreads along fascial planes, causing soft tissue necrosis. If urgent surgery is delayed, the disease will soon result in septic shock, multiorgan failure, and death. In this study, we present 21 patients with Fournier's gangrene who were treated in period between 1994 and 2001. Patients' charts were reviewed retrospectively and are discussed in the light of literature. All patients received aggressive surgical debridment. Penicillin or Ceftriaxone, aminoglicoside and metronidazole were administered intravenously. Of the 21 patients, 5 had scrotal carbuncle, 1 had urethral stricture, 1 had chronic indwelling urethral catheterization, 2 had perirectal abscess, and 1 had hemorrhoidectomy. In eleven patients we couldn't identify any cause. Twelve patients had diabetes mellitus, and two had chronic alcoholism. Escherichia coli was isolated in 12 purulent tissue cultures, and Bacteroides fragilis in eight. Seventeen patients survived, whereas four died. Fourier's gangrene is considered a surgical emergency. Early surgical intervention is essential, as the gangrene can spread rapidly at rates reaching 2 mm per hour. So that Fournier's gangrene is an abrupt, rapidly progressive, gangrenous infection of the external genitalia and perineum and is a real urologic emergency.

Fournier's gangrene.

Fournier's gangrene can still be a life-threatening condition with a high mortality rate. Diagnosis and treatment should be prompt and adequate. Radiological studies may help to define the extent of the disease preoperatively in cases in which this is unclear. Surgery with extensive debridement of all necrotic tissue is the mainstay of treatment.

Fistulas complicating diverticulitis.

This study was undertaken to assess the appropriate management of patients with diverticulitis complicated by fistula formation. A retrospective chart review was conducted on patients with symptoms of a fistula who presented between 1975 to 1995. There were 42 patients (32 women, 76%; 10 men, 24%) who ranged in age from 46 to 89 years (mean 69.8 +/- 9.8). Six patients had multiple fistulas. The types of fistulas included colovesical (48%), colovaginal (44%), colocutaneous (4%), colotubal (2%), and coloenteric (2%). Operative procedures consisted of resection and primary anastomosis in 38 patients and a Hartmann's operation in one. Three patients were managed conservatively with antibiotics (two due to poor performance status, the third due to resolution of symptoms). There were no operative deaths. The postoperative course was uncomplicated in 69%, while 12 patients (31%) experienced 19 complications (40%). These consisted of urinary tract infection (9.5%), atelectasis (7.1%), prolonged ileus (4.8%), arrhythmias (4.8%) and renal failure, myocardial infarction, pseudomembranous colitis, peroneal nerve palsy, unexplained fever, pulmonary edema (2.4% each). There were no anastomotic leaks and no deaths. Hospital stay ranged from 6 to 31 days (mean 12.3 +/- 7.6). Fistulas due to diverticulitis were safely managed by resection and primary anastomosis without mortality and with acceptable morbidity in this series. Patients deemed to be poor operative risks can be managed with a course of nonoperative treatment.

[Perineal gangrene. Analysis of 24 cases]. / Les gangrènes du périnée. Analyse de 24 observations.

Fournier's syndrome, characterised by anaerobic necrotising cellulitis of the soft tissues situated below the diaphragm, is a serous disease with an unpredictable course. From 1978 to 1991, we treated 24 men with a mean age of 57 years (27 to 90 years). Following the diagnosis of this disease, rigorous treatment was instituted immediately, consisting of a triple antibiotic combination, repeated surgical exposure, debridement and drainage with a frequent, almost systematic indication for faecal diversion (n = 16), hyperbaric oxygen therapy and classical intensive care measures. The mean interval between the first clinical signs and the diagnosis was 7.4 days. The lesions were limited to the perineum in 11 cases and extended to the abdomen, thighs and/or loins in 13 cases. The microorganisms responsible for the infection were identified in 19 cases and blood cultures were positive in 5 cases. This infection was of coloproctological origin in 12 cases, urogenital origin in 4 cases and postoperative in 2 cases, while no aetiology could be identified in 6 patients. There were 6 deaths and 18 cures without sequelae. 1. The prognosis of this disease is better in younger subjects (under the age of 60 years) with a localised clinical form, with no deterioration in the general status, sterile blood cultures and treated by a diversion colostomy. 2. A detailed aetiological work-up must be performed, looking for local or regional infection, cancer, haematological malignancy or arterial disease.

[Evolution and treatment of 8 patients with Fournier's perineal-scrotal gangrene]. / Evolution et traitement de huit malades atteints d'une gangrène périnéo-scrotale de Fournier.

The authors present eight cases of Fournier's gangrene treated from 1987 to 1989 (3 years). There was no discernable cause for 5 patients (62.5%). Immediate aggressive surgical debridement of all necrotic tissue was performed. Intravenous antibiotics and resuscitation fluid and hyperbaric oxygenation were also administered to all patients. Skin grafting was performed for 4 patients (40%), 3 weeks after surgical debridement. One patient died (12.5%) and 2 subsequently developed an urethral stricture. Etiology, treatment and outcome of Fournier's gangrene are discussed and the results of the study are compared to other studies. This disease is still serious, its pathogenesis is not completely elucidated, but when immediate adequate treatment is performed, the outcome is generally favourable.

[Postoperative morbidity and mortality of infectious complications of colonic diverticulosis: multifactorial study]. / Morbidité et mortalité post-opératoires des complications infectieuses diverticularies coliques: étude multifactorielle.

The objective of this study was to determine parameters influencing the mortality due to postoperative adverse events, by taking into account surgical techniques and many other perioperative parameters. From 1967 to 1989, 83 patients were operated for pericolic abscess (level 1, n = 22), pelvic abscess (level 2, n = 38) purulent peritonitis (level 3, n = 16) and fecal peritonitis (level 4, n = 7). Surgical techniques were: first colostomy with drainage (n = 21), first resection without immediate anastomosis (n = 34), and first resection with immediate anastomosis (n = 28). The overall complications were 51% (n = 42) with a mortality of 28% (n = 23). During univariate analysis, variables linked to postoperative complications were neurologic events (p < 0.0001), cirrhosis (p = 0.01), current treatment by steroids (p = 0.007), infectious level (p = 0.002), first colostomy (p = 0.005) and first resection with anastomosis (p = 0.007). Postoperative mortality was linked with neurologic events (p < 0.0001), age (p = 0.005), infectious level (p = 0.04), first colostomy (p = 0.005), and first resection with anastomosis (p = 0.0012). Logistic regression determined 3 independent variables influencing complications: neurologic events (p < 0.0001), first colostomy (p = 0.01), and infectious level (p = 0.002). The mortality determined by multivariate analysis was dependent on 3 variables: neurologic events (p < 0.0001) first colostomy (p = 0.007) and age (p = 0.01). The adjusted relative risk was 17 for neurologic events and 6 for first colostomy.