Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease

Background

The purpose of the study was to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary sacrococcygeal pilonidal disease (SPD).

Methods

Two hundred consecutive patients with SPD were randomly allocated to undergo either excision and primary closure (group 1, n = 100) or rhomboid excision and the Limberg flap procedure (group 2, n = 100). Duration of operation, postoperative pain, time to first mobilization, length of hospital stay, postoperative complications, time to resumption of work, recurrence and time to recurrence were recorded for all patients.

Results

Duration of operation was longer in group 2 than in group 1 (P = 0·001). However, postoperative pain was less (P < 0·001), mobilization earlier (P < 0·001), duration of hospital stay shorter (P < 0·001), time to resumption of work shorter (P < 0·001) and postoperative complications fewer (P < 0·001) in group 2. During a median follow-up of 28 months, no recurrence was detected in patients in group 2 versus 11 patients in group 1 (P = 0·001).

Conclusion

Because of its low complication rate and acceptable long-term results, rhomboid excision and the Limberg flap procedure is preferable to simple excision and primary closure in the treatment of SPD.

Signet ring cell carcinoma of the breast as a source of pelvic floor metastatic mass. A case report

Primary signet ring cell carcinoma of the breast is a very rare tumour. We present a case with pure signet ring cell carcinoma of the breast, which was recognized as metastasis on the pelvic floor, before developing breast symptoms and signs. A 40-year old woman was admitted with abdominal pain. First diagnostic effort revealed a cystic mass on the pelvic floor, compressing the colon and other neighbouring organs. A biopsy of the pelvic mass was performed. The histopathological examination revealed metastatic signet-ring cell carcinoma. At the time of the first operation, the mammary glands were not suspicious. No other sources of primary tumour were evidenced. An inflammatory sign developed in right breast two months after biopsy of the pelvic metastasis. The histopathology of the breast incisional biopsy revealed primary pure signet ring cell carcinoma of the breast. Because the oestrogen and progesterone receptor were negative in the tumoral tissue, the patient underwent chemotherapy followed by modified radical mastectomy, chemotherapy, and palliative resection of the metastatic mass. The patient was followed up for eight months. To our knowledge, in English literature, we believe that this case is the first report of signet ring cell carcinoma of the breast presenting with pelvic floor metastasis without breast sign.

Efficacy and safety of reuse of disposable laparoscopic instruments in laparoscopic cholecystectomy: a prospective randomized study

BACKGROUND

The aim of this prospective randomized study was to investigate the efficacy and safety of the reuse of disposable laparoscopic instruments (DLI) in laparoscopic cholecystectomy.

METHODS

A total of 125 consecutive patients with symptomatic cholelithiasis were randomly assigned to undergo laparoscopic cholecystectomy with single-use DLI (group 1, n = 62) or DLI that were reused (group 2, n = 63) after high-level disinfection by alkalinized 2% glutaraldehyde. Operative and postoperative outcomes were investigated.

RESULTS

There was no significant difference between group 1 and group 2 in mean operating time, linear analogue pain scale score, duration and amount of analgesic administration, or hospital stay. Total incidence of complications (3.2% vs 4.8%, p = 0.50) and infection rates (1.6% vs 3.2%, p = 0.57) were also similar when group 1 was compared to group 2.

CONCLUSION

This study showed that reusing DLI did not change the operative and postoperative outcomes or the infection rate for laparoscopic cholecystectomy when strict rules for disinfection were followed.

Bond strength of a self-etching adhesive system to caries-affected dentin

This in vitro study evaluated the microtensile bond strengths of sound versus caries-affected dentin using a self-etching adhesive system, Clearfil SE Bond, with or without additional acid pre-conditioning. Extracted human mandibular molars with occlusal caries extending halfway through the dentin were used. In the first group, the teeth were bonded with the self-etching adhesive Clearfil SE Bond according to the manufacturer's instructions. In the second group, prepared dentin surfaces were etched with 37% phosphoric acid prior to applying the same self-etching adhesive. After the bonding procedure, all specimens were built up with composite resin and stored in water for 24 hours. The teeth were serially sectioned vertically into 0.7-mm slabs and trimmed into an hourglass shape for measuring microtensile bond strength. Each specimen was attached to a Bencor device and stressed in tension at a crosshead speed of 1 mm/minute. Statistical analysis was performed using two-way ANOVA and the Tukey HSD test (p<0.05). The microtensile bond strengths of Clearfil SE Bond to sound dentin (32.9) were significantly higher than to caries-affected dentin (15.9). In the second group where acid etching was performed prior to applying Clearfil SE Bond, there were no statistically significant differences between the microtensile bond strengths of sound (19.2) and caries-affected dentin (16.3). While bond strengths to sound dentin were decreased by using additional acid etching prior to applying Clearfil SE Bond, this procedure revealed no statistically significant differences in bond strengths for the caries-affected dentin.