Treatment outcome of Fournier's gangrene and its associated factors: A retrospective study.

INTRODUCTION: Fournier's gangrene (FG) is a rapidly progressive necrotizing infection that affects the perineal and abdominal regions and is known for its high mortality rate. This study aims to present the practical experience of managing FG patients and identify factors that may affect their clinical outcomes. MATERIALS AND METHODS: A retrospective study was conducted from April 2009 to December 2020 at General Military Hospital in Sana'a, Yemen including 26 patients who were diagnosed with FG and treated on. Data on demographic characteristics, time to admission, surgical intervention, and treatment outcomes were collected. Univariate analysis was performed to determine factors that affect patient outcomes. RESULT: The mean age of the patients was 65.77 ± 5.04 years, and 65.4% of them were over the age of 65. Most patients (57.7%) presented after five days of experiencing symptoms, and 65.4% were in septic conditions. Of the patients, 17 (65.4%) survived, and the total mortality rate was 34.6%. Univariate analysis showed that delayed presentation (p = 0.001), a history of diabetes mellitus (p < 0.001), end-stage renal disease (p < 0.001), heart failure (p < 0.001), cerebrovascular accident (p = 0.032), liver cirrhosis (p < 001), presence of multiple comorbidities (p < 001), involvement of lager area (p < 001), septic conditions (p = 0.009), advanced age (p = 0.018), and intensive care unit admission (p = 0.002) were found to be risk factors for mortality in patients with FG. CONCLUSIONS: FG is a potentially life-threatening medical condition, even with aggressive and specialized treatment. Our study revealed a mortality rate of 34.6%. Factors such as older age, the presence of multiple comorbidities, septic conditions, the abdominal spread of the disease, intensive care unit admission, and delayed presentation contribute to higher mortality rates.

The surgical treatment of renal tumors - a 30-month evaluation of the post operative period at a secondary center. / Tratamiento quirúrgico de tumores renales- evaluación postoperatoria a 30 meses en un centro secundario.

OBJECTIVES: Our aim was to compare nephrectomies with kidney resections in terms of their influence on renal function and blood loss. We compared laparoscopic nephrectomies with open nephrectomies in terms of the length of the procedure and the hospital stay. METHODS: We retrospectively included patients who were operated for renal tumors (n=148) between January 2016 to July 2018 in a single secondary center. We considered the type of operation (nephrectomies versus kidney resections), the approach to the kidney (open or laparoscopic) and compared the following outcomes: the length of the operation, perioperative blood loss, the changes in hemoglobin concentrations, in creatinine levels and in the estimated glomerular filtration rate (eGFR). RESULTS: Kidney resections when compared to nephrectomies resulted in a significantly smaller decline in the estimated glomerular filtration rates (ß=38.78 ml/min;p<0.001). When compared to baseline values, there was a significant drop in the eGFR on both day 1 and 3-6 months after the operation in the nephrectomy group (p<0.001 for both intervals); this drop was not present in the resection group. The decline in hemoglobin levels was bigger in the resection than in the nephrectomy group. However, during a follow up evaluation 3-6 months after the procedures, the values did not differ between the groups. We then compared open nephrectomies with laparoscopic nephrectomies. Laparoscopy involved more time (ß=38.6 minutes; p<0.001), was used for early stage tumors and involved a shorter hospital stay (ß=3 days;p<0.001) in comparison to open surgeries. CONCLUSIONS: Data from our center confirmed the findings from other literature that nephron-sparing surgeries lead to a lower decline in kidney function than with nephrectomies. This benefit for kidney function also remained during the follow-up. When performing a nephrectomy, the laparoscopic approach offers a shorter hospital stay for the patient than with an open surgery.

OBJETIVOS: Nuestro objetivo fue comparar las nefrectomías en términos de resultados de función renal y perdida de sangre. Comparamos las nefrectomías laparoscópicas con las abiertas en términos de duración de la cirugía y estancia hospitalaria. MÉTODOS: Se incluyeron retrospectivamente pacientes que fueron operados por tumores renales (n=148) entre enero 2016 y julio 2018 en un único centro secundario. Consideramos el tipo de cirugía (nefrectomía vs resección renal), la técnica quirúrgica (abierta vs laparoscópica) y comparando sus resultados: tiempo de cirugía, perdida sanguínea, cambios en la concentración hemoglobina, niveles de creatinina y filtrado glomerular estimado. RESULTADOS: Las resecciones renales en comparación con las nefrectomías presentaron una caída estimada de FG menor (ß=38,78 ml/min; p<0,001). Al comparar con los valores basales, se mostro una caída significativa de FG en los días 1 y a los 3-6 meses después de la operación en el grupo nefrectomía (p<0,001 en ambos intervalos); esta caída no estaba presente en el grupo de resección renal. La caída de hemoglobina fue superior en las resecciones renales en comparación con las nefrectomías. Aunque durante el seguimiento de 3 a 6 meses después del procedimiento, el valor no cambio entre grupos. Comparamos también las nefrectomías abiertas con laparoscópicas. Las laparoscópicas implican más tiempo (ß=38,6 minutos; p<0,001), se usaron en estadíos más precoces e implicaron menos estancia hospitalaria en comparación con las abiertas (ß=3 días; p<0,00). CONCLUSIONES: Los datos de nuestro centro confirmanlos hallazgos que la cirugía de resección renal implica menos caída de FG que las nefrectomías. Este beneficio se mantuvo en el seguimiento. Cuando realizamos una nefrectomía, la laparoscopia aporta una menor estancia hospitalaria que la cirugía abierta.

The surgical treatment of renal tumors a 30 month evaluation of the post operative period at a secondary center / El tratamiento quirúrgico de los tumores renales: una evaluación de 30 meses del período postoperatorio en un centro secundario

Objetives: Our aim was to comparenephrectomies with kidney resections in terms of their influence on renal function and blood loss. We comparedlaparoscopic nephrectomies with open nephrectomiesin terms of the length of the procedure and the hospitalstay.Mmethods: We retrospectively included patients whowere operated for renal tumors (n=148) between January 2016 to July 2018 in a single secondary center. Weconsidered the type of operation (nephrectomies versuskidney resections), the approach to the kidney (open orlaparoscopic) and compared the following outcomes:the length of the operation, perioperative blood loss, thechanges in hemoglobin concentrations, in creatinine levels and in the estimated glomerular filtration rate (eGFR). Results: Kidney resections when compared to nephrectomies resulted in a significantly smaller decline in theestimated glomerular filtration rates (β=38.78 ml/min;p<0.001). When compared to baseline values, therewas a significant drop in the eGFR on both day 1 and3-6 months after the operation in the nephrectomy group(p<0.001 for both intervals); this drop was not presentin the resection group. The decline in hemoglobin levels was bigger in the resection than in the nephrectomy group. However, during a follow up evaluation 3-6months after the procedures, the values did not differbetween the groups.We then compared open nephrectomies with laparoscopic nephrectomies. Laparoscopy involved more time(β=38.6 minutes; p<0.001), was used for early stagetumors and involved a shorter hospital stay (β=3 days;p<0.001) in comparison to open surgeries.Conclusions: Data from our center confirmed thefindings from other literature that nephron-sparing surgeries lead to a lower decline in kidney function thanwith nephrectomies. This benefit for kidney function alsoremained during the follow-up. When performing...(AU)

Objetivos: Nuestro objetivo fue comparar las nefrectomías en términos de resultados de funciónrenal y perdida de sangre. Comparamos las nefrectomías laparoscópicas con las abiertas en términos deduración de la cirugía y estancia hospitalaria. Métodos: Se incluyeron retrospectivamente pacientes que fueron operados por tumores renales (n=148)entre enero 2016 y julio 2018 en un único centrosecundario. Consideramos el tipo de cirugía (nefrectomía vs resección renal), la técnica quirúrgica (abierta vs laparoscópica) y comparando sus resultados: tiempo de cirugía, perdida sanguínea, cambios en laconcentración hemoglobina, niveles de creatinina y filtrado glomerular estimado.Resultados: Las resecciones renales en comparación con las nefrectomías presentaron una caída estimada de FG menor (β=38,78 ml/min; p<0,001).Al comparar con los valores basales, se mostro unacaída significativa de FG en los días 1 y a los 3-6 meses después de la operación en el grupo nefrectomía(p<0,001 en ambos intervalos); esta caída no estabapresente en el grupo de resección renal. La caída dehemoglobina fue superior en las resecciones renalesen comparación con las nefrectomías. Aunque durante el seguimiento de 3 a 6 meses después del procedimiento, el valor no cambio entre grupos.Comparamos también las nefrectomías abiertas conlaparoscópicas. Las laparoscópicas implican mástiempo (β=38,6 minutos; p<0,001), se usaron en estadios más precoces e implicaron menos estancia hospitalaria en comparación con las abiertas (β=3 días;p<0,001). Conclusiones: Los datos de nuestro centro confirman los hallazgos que la cirugía de resección renalimplica menos caída de FG que las nefrectomías.(AU)