[Septic shock in a patient with the Fournièr gangrene with fatal outcome]. / Septický sok u pacienta s Fournièrovou gangrénou s fatálním koncem.

AIM: The authors present a case of a patient with developed Fournièr gangrene and septic shock. Fournièr gangrene belongs to the group of local non-specific infection of soft tissues (NSTI). Its incidence is relatively low, but the infection is extraordinary aggressive with a possible lethal end. MATERIAL AND METHOD: 39 years old patient with 4 days history of Fournier gangrene's development was admitted in irreversible septic shock. The initial APACHE II score was 36. The delay in treatment was an important factor in the further course of illness with lethal end. RESULTS: Above the mentioned 39 years old patient died because of septic shock. The hemorrhagic cystitis was the original source of infection with further development of Fournièr gangrene according to the pathological record. CONCLUSION: We often come across all different kinds of stages of sepsis from the MODS to the septic shock for patients with Fournièr gangrene. Causal treatment should be started early. The local surgical excision and wide broad antibiotic administrations are basic treatments in the context of other treatment modalities according to the current patient's needs. The adjuvant hyperbaric oxygen treatment takes place in patients with Fournièr gangrene as well and is beneficial. The following factor even worsens the illness prognosis: delay in diagnostic, higher age, anorectal origin of infection, the amount of organ with dysfunction or failure, diabetes mellitus and significant immunodeficiency.

Do we really apply fast-track surgery?

AIM: The aim of this study is to show the current view on fast-track programs optimizing the perioperative care. METHODS: Authors searched Medline databases and identified current trials regarding all factors of fast-track programs. They analyzed these trials and identified the most important principles of fast-track programs based on trial analysis. RESULTS: The most important principles are consistent in all individual trials. Most of authors recommend 10-12 issues. All authors emphasize early mobilization of patients after surgery and early introduction of peroral nutrition. Fast-track programs shorten the duration of hospitalisation and decrease morbidity. CONCLUSION: The perioperative care is characterized by a range of trussing traditions. Fast-track surgery optimizes the perioperative care. It is a safe method according to the trials. The implementation of single fast-track surgery factors is very slow (Tab. 2, Ref. 49).