The interval from the onset of clinical symptoms to the initial surgical intervention seems to be the most important prognostic factor with a significant impact on outcome. Given the significantly high mortality rate among diabetics, diabetes is also an independent prognostic factor. Despite the decreased number of idiopathic cases and extensive therapeutic efforts, Fournier's gangrene remains a surgical emergency, and early recognition with prompt radical debridement is the mainstays of management.

Objective: Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented. Methods: In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed. Results: The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n = 11) and left-sided in 83.8% (n = 57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n = 62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n = 9) and 16.2% (n = 11) patients, respectively. Conclusions: Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture. #

No abstract

To avoid the risk of nerve damage during thyroid surgery, a good knowledge of the variations of the inferior laryngeal nerve is essential. This is important to achieve an undisturbed quality of life for the thyroid patient.

Abstract. We report three cases of squamous cell carcinoma of the thyroid, which is an unusual malignant tumor that needs to be distinguished from other thyroid pathologies due to its aggressive behaviour. Three men, with an average of 63 years old, presented with progressive enlargement in the neck, hoarse voice or weight loss. Physical and radiological examinations revealed clues where malignancy was suspected and surgical resections were performed. Histopathological examination of the specimens was diagnosed as squamous cell carcinoma. Proper workup excluded the possibility of any primary site of SCC other than the thyroid. All patients died within 5 months. Adjuvant therapy evaluation is still inconclusive. Complete surgical resection still remains the primary choice for cure. We believe that radical resection with clear surgical margins followed by adjuvant chemo-radiation therapy is a curative strategy for achieving any chance of long-term survival.