Sinotomy technique versus surgical excision with primary closure technique in pilonidal sinus disease

Pilonidal disease is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Many surgical treatment modalities have been suggested, but an ideal and widely accepted treatment has yet to be established. The aim of this study was to compare quality of life of patients treated with the sinotomy technique with quality of life of patients treated with surgical excision plus primary closure technique by means of quality of life questionnaire. The data of patients who had been treated for pilonidal sinus in our clinic from September 2010 to June 2012 were analyzed retrospectively. Forty patients were treated with sinotomy technique and 40 patients were treated with surgical excision plus primary closure technique. Time to return to work and to time to complete wound healing were evaluated. All patients were asked to fill the questionnaire after complete healing occurred. Postoperative complications were bleeding in 2.5%, infection in 3.75% and fever in 2.5% patients. There were no significant differences between the two groups in terms of complete healing (p=0.1) and sport times (p=0.1). There were significant differences between the groups in terms of length of hospital stay (p ≤ 0.001), time off work (p ≤ 0.001),times to sitting on toilet and walking without pain (p=0.002 and p ≤ 0.001,respectively). The mean postoperative VAS scores were 5.2 ± 3.2 and 2.8 ± 2.2, respectively (p=0.02). The technique of sinotomy with good wound and surrounding skin care seems to be an ideal approach with high chance of cure. The patients returned to their routine in a short period of time.

Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.

Investigation of the relationship between serum hormones and pilonidal sinus disease: a cross-sectional study

AIM

The aim of this cross-sectional study was to determine whether pilonidal sinus is influenced by hormones that stimulate body hair growth. Currently, there are insufficient data on the presence of hormonal abnormalities in pilonidal sinus disease.

METHOD

Hormone levels (including those of thyroid-stimulating hormone, follicular-stimulating hormone, luteinizing hormone, prolactin, progesterone, oestradiol, testosterone, cortisol and dehydroepiandrosterone) were measured in 39 patients with pilonodal sinus presenting between February 2013 and March 2013. The results were compared with those of 39 volunteers without this disease.

RESULTS

There was no statistically significant difference between men with pilonidal sinus disease (P > 0.05). The prolactin levels of women with pilonoidal sinus were significantly higher than those of women in the control group (P < 0.05).

CONCLUSION

Raised serum prolactin levels in women may be related to the development of pilonidal sinus disease.

The efficacy of fibrin glue to control hemorrhage from the gallbladder bed during laparoscopic cholecystectomy

OBJECTIVE

The aim of the study is to report our experience with fibrin glue application in the management of bleeding from the gallbladder bed during laparoscopic cholecystectomy, which could not be controlled by conventional methods.

MATERIAL AND METHODS

Three hundred eighty-two patients underwent laparoscopic cholecystectomy. Fourteen patients with bleeding from the gallbladder bed, which could not be controlled by conventional methods, were analyzed retrospectively.

RESULTS

Fibrin glue was used in 10 patients. Six (71%) were female and 4 were (29%) male. The mean age was 55.7 years. Fourteen patients were operated for the presence of symptomatic gallstones. Thirteen patients (92%) had a concomitant pathology. The mean time spent to maintain hemostasis was 23.9 minutes (15-35). Blood products were used in two patients with hemoglobin values under 8 mg/dL. Hemostasis could not be achieved in a patient despite fibrin glue application, and the operation was converted to open surgery.

CONCLUSION

The application of fibrin glue for bleeding from the gallbladder bed during laparoscopic cholecystectomy can reduce conversion rates, further studies including more patients are required.

Diagnostic challenge in papillary thyroid carcinoma with cervical lymphadenopathy, metastasis, or tuberculous lymphadenitis

Papillary thyroid carcinoma (PTC) is the most frequent histological subtype of thyroid cancer. Total thyroidectomy with neck dissection is recommended for treatment. Tuberculous adenitis is a common cause of lymphadenopathy in endemic areas. Therefore, tuberculous lymphadenitis should be considered in the etiology of enlarged lymph nodes when PTC patients with risk factors such as tuberculosis present with cervical lymph node enlargement. Detailed evaluation of the neck metastasis of patients with PTC is necessary to avoid postoperative complications due to neck dissection. We present a 55-year-old female patient with tuberculous lymphadenitis mimicking metastatic lymph nodes from PTC.

Effects of trimetazidine in acute pancreatitis induced by L-arginine

BACKGROUND

In acute pancreatitis, oxygen free radicals (OFRs) and cytokines have been shown to play a role in the failure of pancreatic microcirculation and the development of local tissue damage. We studied the effects of trimetazidine (TMZ), a potent antioxidant and anti-ischemic agent, on acute pancreatitis.

METHODS

Rats were randomized into 3 groups: a control group (n = 15), a study group (n = 15) in which acute pancreatitis was induced with with L-arginine, and a treatment group (n = 15) in which pancreatitis was induced and treated with TMZ intraperitoneally. The rats were followed for 24 hours. At the 24th hour we determined serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lactate dehydrogenase (LDH), interleukin 1-β (IL-1β), interleukin 6 (IL-6) and tumour necrosis factor-α (TNF-α), and the pancreatic tissues were analyzed histopathologically.

RESULTS

The AST (p < 0.001), ALT (p < 0.01), amylase (p < 0.001), LDH (p < 0.01), TNF-α (p < 0.01), IL-1β (p < 0.001) and IL-6 (p < 0.001) levels, and pancreatic tissue edema (p < 0.01), hemorrhage (p < 0.05), acinar cell necrosis (p < 0.001) and level of perivascular inflammation (p < 0.01), were significantly lower in the treatment group than the study group.

CONCLUSION

Trimetazidine markedly decreases biochemical and histopathologic changes during the early stages of acute pancreatitis, thus preserving the pancreas histologically.

Mullerian inhibiting substance expression in papillary thyroid cancer

OBJECTIVE

To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer.

MATERIALS AND METHODS

The MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records (n = 23).

RESULTS

In all the cases studied, 50% (n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining.

CONCLUSION

The MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis.

The effects of different prosthetic materials on the formation of collagen types in incisional hernia

OBJECTIVE

The aim of this study was to determine the rate of collagen Type I/Type III for different meshes.

METHOD

Fifty rats were used. Five groups were formed: prolene (n = 10), mersilene (n = 10), parietex (n = 10), e PTFE (n = 10) and control group (n = 10). In all animals, laparotomy was performed using a midline incision. After that four different kinds of meshes are placed into the retro-rectus plane and fixed with a non-absorbable suture. Rectus superficial fascia and skin are closed. In the control group, repairment is done primarily. Thirty days later, meshes are found through the incisions that were done previously. Scar tissues above and near by meshes and also in the control group are taken, and in these tissue samples, the ratio of Type I/III is evaluated histochemically.

RESULTS

The Prolene mesh was found to contain more collagen fibers than e PTFE. As a result of the histopathologic evaluation, it was seen that Group I contained statistically significantly more collagen density than the other four groups (p < 0.05). Moreover, the collagen Type I/III ratio in the specimen taken from the top part and the surrounding area of Group I was found significantly higher than the collagen Type I/III ratios of the rest of the groups (p < 0.05).

CONCLUSION

As a conclusion, the ratio of collagen Type I/III is the highest in the prolene group.

The results of a one-time crystallized phenol application for pilonidal sinus disease

The aim of this study was to investigate the cure rate after a one-time phenol application for pilonidal sinus disease. Forty-eight patients diagnosed with pilonidal sinus from May 2006 to September 2009 were retrospectively reviewed. They were all managed under the same polyclinic conditions in different hospitals by the same surgeon under local anesthesia. Crystallized phenol was applied a total of 97 times on 48 patients. The median follow-up was 22 months (range, six to 38 months). Two patients (4 %) could not participate in the follow-up. One of these patients had 12 sinuses and didn't continue treatment after eight applications of phenol, and the other had nine sinuses and didn't continue treatment after five applications of phenol. The one-time application cure rate was 64.5 %, and the rate of success was 95 % with two or more applications. Recurrence did not occur during this period. A one-time phenol application is an effective treatment for pilonidal sinus disease. Hence, it can be an alternative to surgical treatment.

[Incidentally diagnosed liver and right iliac muscle hydatid disease]

Hydatid cyst disease is localized in the liver and lungs in most of the cases, but also can exist throughout the body. In this article, we present a 20-year-old male patient who was diagnosed with hydatid cyst of the liver and iliac muscle, who presented because of respiratory problems. Especially in endemic areas, in patients who are detected as having hydatid cyst in the liver, systemic examinations must be cattied out and investigated regarding any involvement of other organs.