Fournier's gangrene: analysis of prognostic variables in 34 patients.

INTRODUCTION: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area. The objective of this study was to assess risk factors for mortality. MATERIALS AND METHODS: We conducted an analytic and retrospective study of the patients with FG treated at our institution between 1998 and 2008. Statistical analysis was performed with the Statistical Package for Social Science for Windows, version 15.0, using the Mann-Whitney test for quantitative variables, and the chi-square and Fisher exact tests for qualitative variables, in univariate analyses. RESULTS: Of the 34 patients treated, 25 survived (74%) and 9 died (26%) with a median timing of 29 days (13, 60). Statistically significant differences were not found in age, sex and predisposing factors, except heart disease (p = 0.034). Admission laboratory parameters and severity criteria showed significant differences in serum urea (p = 0.007), potassium (p = 0.008), alkaline phosphatase (p = 0.014) and Fournier's gangrene severity index score (FGSIS) (p = 0.008). Others factors such as duration of symptoms before hospital admission, extent of body surface area, number of surgical debridements, additional surgical manoeuvers (supra-pubic catheterization or colostomy), microbiological cultures and ICU stay did not show significant differences. CONCLUSIONS: FG is a life-threatening necrotizing fasciitis with a high mortality rate. In our study, prognostic variables were heart disease, admission serum urea, potassium, alkaline phosphatase, and FGSIS. More studies are needed to validate these findings.

[Lower gastrointestinal bleeding secondary to rectal gastrointestinal stromal tumor]. / Hemorragia digestiva baja secundaria a tumor del estroma gastrointestinal rectal.

Gastrointestinal stromal tumors are the most frequent mesenchymal digestive tract neoplasms, but represent only 1 to3% of all GI tract neoplasms. We report an uncommon case of stromal rectal tumor because of its atypical location.

[Local resection and radiofrequency hepatic epithelioid hemangioendothelioma]. / Resección local y radiofrecuencia en hemangioendotelioma epitelioide hepático.

Epithelioid hemangioendothelioma is an uncommon tumor of vascular endothelial cell origin with a clinical course between hemangioma and angiosarcoma. Clinical manifestations and radiological findings are nonspecific, and histopathologic examination is required to establish a definitive diagnosis. Currently, hepatic resection or liver transplantation is the best therapeutic options. Because of its unknown biological behavior, local resection and radio-frequency ablation, although an uncommon treatment method, can be performed in the absence of extrahepatic or diffuse involvement.

[Low back pain as a manifestation of an intra-abdominal desmoplastic small round cell tumor]. / Dolor lumbar como manifestación de un tumor intra-abdominal desmoplásico de células pequeñas y redondas.

The desmoplastic small round cell tumor is infrequent.That mainly affects male youngsters and is normally located at the abdomino-pelvic cavity, being its clinic unspecific. The diagnosis is confirmed by the presence of a specific chromosomal translocation: t (11; 22), (p13; q12). As to its treatment, it is mostly recommended to follow a multimodal aggressive one. We present the case of a man, whose atypicality is due to his advanced age (63 years old) and the symptoms he presents (lumbar ache).