Minerva chirurgica
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Case Reports
[Clinical evaluation and therapeutic strategy in necrotizing fasciitis or Fournier's syndrome. 2 case reports].
Fournier's syndrome or necrotizing fasciitis is a rare infection with high mortality rate. Old patients especially with diabetes mellitus, liver and renal failure are more affected. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support and immediate extensive surgical debridement are necessary. Two clinical cases are presented.
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Meckel's diverticulum is a pathology not rarely found everyday clinical medicine especially when it present with one of its complications. The specific diagnosis is a bit difficult to put because of the low sensibility and specificity of symptoms of diagnostic and instrumental techniques used. The reported case shows a rare type of complication constituted by the phlogosis of Meckel's diverticulum, itself due to an extraneous thing ingested by the patient. The authors discuss the entity of the manifestations of this pathology and highlight every aspects.
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Disturbances of anal continence and evacuation are frequent. Numerous techniques are now available to measure anorectal function. There is also a better understanding of the anatomy and physiology of the pelvic floor which has a major role in anorectal function. ⋯ CONCLUSION. All these tests provide extremely useful information on the pelvic floor and are reproducible. They can be of great help in evaluating patients with pelvic floor disorders but they are no substitute for clinical judgement.
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Intractable intra-abdominal sepsis occurring in eight patients was managed by the authors with planned abdomen reexploration. Only the severity of illness can justify such aggressive surgical treatment. Mortality is still high.
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The authors describe a series of 139 over-eighty patients (M = 53, F = 86), who underwent emergency surgery between 1-1-1987 and 30-6-1993. They consider diagnosis, copathology, type of surgical procedures, postoperative complications and final results. ⋯ They performed 74 mayor surgical procedures with 48% of postoperative complications and exitus in 24% of cases, due overall to exacerbation of coexisting diseases. The authors underline the direct between mortality rate and number of copathologies, and analyze the basic rules to follow in surgical indications and during the postoperative period.