The review highlights the issues of etiology, pathogenesis, clinical and laboratory picture, radiodiagnosis, treatment and prognosis of fulminant perineum gangrene, or Fournier’s gangrene. According to modern concepts, Fournier’s gangrene is one of the rare forms of necrotizing fasciitis of polymicrobial etiology with a primary lesion of the skin, subcutaneous tissue and superficial fascia of the scrotum, penis, and perineum. Fournier’s gangrene refers to acute surgical diseases of pyonecrotic nature and is characterized by rapid septic course, high mortality, reaching 80%, in spite of the modern antibiotic therapy advances. Over the last decade the Fournier’s gangrene incidence increased in 2.2-6.4 times, due to the increasing number of immunocompromised patients in the population. The disease most often occurs in older men with diabetes, alcoholism and obesity. The Fournier’s gangrene occurrence is preceded by different inflammatory diseases of the colon, urinary organs, scrotum and perineum skin. The disease diagnosis in full-scale stage usually is not difficult. In rare cases, namely in the disease early stages, various radiological methods of investigation, laboratory tests and exploratory surgery with affected soft tissues express biopsy are used with differential diagnosis purposes. The cornerstone in the Fournier’s gangrene treatment is an emergency surgical intervention in combination with a powerful anti-bacterial and anti-shock therapy. To improve the wound healing course and reduce the septic complications risk, new methods of adjuvant treatments such as hyperbaric oxygen therapy and vacuum therapy are used. Hospitalization duration in Fournier’s gangrene is usually lengthy, due to the need to use repeated sanitation necrectomy and reconstructive plastic surgery and are associated with considerable economic costs for treatment. The Fournier’s gangrene prognosis depends on the timing of specialized medical care provision and, above all, on the time interval between the disease onset and surgery performing.
The early diagnosis, prognosis, complications and mortality Fournier’s gangrene (FG) are discussed. The terms pre-hospital period with FG is amount of 8.0 ± 5.2 days. Cases of misdiagnosis are observed in 70% in the early stages of FG due to nonspecific clinical and laboratory picture, lack of awareness and alertness of doctors. Early diagnosis of FG is based on clinical and laboratory data of the picture. In order to timely diagnosis of FG is used scale laboratory indicators of necrotizing fasciitis (LRINEC), allowing suspect FG in doubtful cases. In diagnostically unclear cases FG used radiation methods. At the slightest suspicion on the FG made explorative operation, including express biopsy of soft tissues. The differential diagnosis is carried out in the early stages of FG with acute diseases anogenital region and is rarely used. As a prognostic criteria discussed the patient's age, the presence and nature of comorbid diseases, severity of the condition, the hospital admission dates, duration of preoperative period, necrosis area, metabolic parameters, the amount of remedial necrectomy, antibiotic regimen, hyperbaric oxygen therapy. For the systematic evaluation of the severity of the patient's condition and prognosis use different scoring systems. Many of the proposed prognostic criteria are controversial. The favorable prognosis in FG is entirely dependent on early diagnosis and timing of emergency surgery. Sepsis and its complications are the main causes of deaths. Mortality in the FG has been a steady downward trend, and is 22.3 ± 8.8%. Prevention of the FG is a timely treatment of infectious and inflammatory diseases of the urinary organs and their complications.
In the present literature review, modern view on etiology, pathogenesis, clinical course, diagnosis, treatment and prognosis of scrotal and penile epidermoid cysts is described. Such cysts are rare, refer to benign cystic tumors with slow growth and low malignant potential. Epidermoid cysts develop in different races representatives, mostly in the age range of 30-40 years. Causes of epidermoid cysts remain unclear. Their relationship with different chromosomal aberrations, vulgar acne, post-pubertal age hyperandrogenism, human papillomavirus infection, excessive sun exposure, external genital organs injury are discussed. Epidermoid cysts histogenesis is not completely understood. Preference is given to disembriogenetic theory of the cysts origin. Epidermoid cysts have a characteristic clinical and ultrasound picture, and in the absence of complications have latent and favorable course. Epidermoid cysts diagnosis usually is not difficult and based on cysts characteristic visual picture. In controversial cases, epidermoid cysts must be differentiated from the inguinal-scrotal hernia, lipoma, hematoma, primary malignant or metastatic tumors of the genital organs. In these cases, high resolution ultrasound examination and high-field magnetic resonance imaging are used. Epidermoid cysts complications occur rare. Among them, cases of cysts traumatic rupture with the scrotal hematoma and infection development are the most frequent. Isolated cases of epidermoid cysts blastomatous transformation in various types of skin cancer, T-cell lymphoma, carcinoid tumor, melanoma in situ are described. As the treatment of epidermoid cysts active follow-up in uncomplicated cysts, medication and surgical treatment are offered. Medication treatment is used for inflamed cysts. Surgical treatment is absolutely indicated for abscess formation and suspected malignancy in epidermoid cyst. The prognosis for epidermoid cysts surgical treatment is generally favorable. Cases of epidermoid cyst recurrence in case of their total excision were not observed.
Военно-медицинская академия им. С. М. Кирова, Санкт-Петербург, Россия Травматические повреждения определяют высокий уровень смертности и инвалидности в когорте трудоспособного населения� Легочные инфекционные осложнения у пострадавших при политравме вносят наибольший вклад в показатели летальности у пациентов данной группы� В статье рассмотрены факторы риска, возбудители, патофизиология и особенности диагностики нозокомиальной пневмонии у пострадавших при политравме� Отдельно изучены состояние и варианты иммунного ответа организма на политравму, а также связанные с этим вопросы возможности использования данных о полиморфизме генов цитокинов для улучшения диагностики и оценки прогноза течения и исхода нозокомиальной пневмонии у пациентов данной группы�
Chemotherapy combined with targeted therapy, radiofrequency and microwave ablation is able to increase resectability up to 35-40% in patients with colorectal cancer followed by liver metastases. Minimally invasive procedures (RFA, MWA) reduce surgical risk in critically ill patients.
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