Choice of operation for treatment of patients with pilonidal sinus

An analysis of early postoperative complications and recurrences of the disease was made in 136 patients with epithelial coccygeal canal. A simple method of suturing the wounds was used in 96 patients, in 40 patients Z-plasty was used. The results were estimated by the degree of the pathological process and the individual features of the structure of the sacro-coccygeal area. The results did not differ in patients with simple forms of the disease. In patients with complex form of the coccygeal canal wound abscesses were noted in 9 (34.6%) patients with simple stitching and in 2 (8%) after using Z-plasty. Recurrent diseases appeared in 6 (23.1%) patients after traditional methods of surgery and in 1 (4%) patients after Z-plasty.     

Suture granuloma mimicking a recurrent sacro‐coccygeal pilonidal sinus after Limberg flap

Sacro‐coccygeal pilonidal sinus disease is classified as an asymptomatic, acutely abscess‐forming or chronic subcutaneous inflammation in the sacro‐coccygeal region featuring characteristic pits in the bottom cleft. Due to high rates of recurrence, two flap techniques have been established in the course of the past three decades. One of them is the Karydakis operation, the other option is a rotation flap named Limberg procedure. We report about a case of suture granuloma in the area of a Limberg flap after recurrent pilonidal sinus with extrusion of the suture material, thus mimicking recurrence. In case of recurrent pilonidal sinus following plastic coverage or primary closure, respectively, the differential diagnosis of suture granuloma should be considered.     

Glomus tumours of the coccygeal body associated with coccydynia. A preliminary report

Two cases of coccydynia are presented. Their definitive treatment was excision of the coccyx and the pericoccygeal tissues. The histology in both cases revealed a glomus tumour of the coccygeal body and the symptoms were completely relieved after operation. Glomus tumours of the coccygeal body may be the cause of some cases of coccydynia.     

Treatment of pustular lesions of the perineum and sacrococcygeal region

The results of treatment of 316 patients with chronic pustular lesions of the perineum and sacrococcygeal region are discussed. It is shown that the only radical measure in this category of patients is total excision of the involved tissues and, in combined variants, simultaneous performance of typical operations for rectal fistula or coccygeal pilonidal fistula. In localized and mostly in regional forms of the disease one-stage surgical interventions are expedient. Many-stage operations are indicated in extensive and, less frequently, in regional forms. Postoperative complications occurred in 5.3% of cases and were associated with wound suppuration. The late-term results were studied in 71.7% of patients who underwent operation: recurrences developed in 3.7% of cases.     

Treatment of epithelial coccygeal fistula

Analysis of treatment of 822 patients with epithelial coccygeal fistula has demonstrated that purulent complication is indication for primary radical surgery. Number of complications and recurrences decreases if the first focus of inflammation is treated and epithelial fistula is resected after healing of the wound. Anaerobic inflammation is seen in 0.4% patients with purulent epithelial coccygeal fistula. These patients require radical resection of affected tissues and general intensive therapy. There were no lethal outcomes after treatment of inflammatory complications. Hospital stay was 7.7 bed-days. All the surgical methods have disadvantages. Proposed method demonstrates the best results. Suppuration of the wounds was seen in 0.7% cases, recurrences -- in 1.1% patients.     

Diagnosis and surgical management of diaphragmatic agenesis in an adult: Report of a case

Unilateral diaphragmatic agenesis is a rare finding in adult patients. We herein present the case of a 24-year-old male patient who was diagnosed and surgically treated for the complete absence of the left hemidiaphragm. His symptoms included acute respiratory distress, ipsilateral absence of breath sounds, and vague abdominal discomfort. A neodiaphragm was created via a left thoracotomy using synthetic material. The postoperative course was uneventful, and the patient is in satisfactory condition 9 months after the operation. This is only the seventh known case of unilateral diaphragmatic agenesis reported in the literature.     

Instability of the coccyx in coccydynia

Coccygectomy is a controversial operation. Some authors have reported good results, but others advise against the procedure. The criteria for selection are ill-defined. We describe a study to validate an objective criterion for patient selection, namely radiological instability of the coccyx as judged by intermittent subluxation or hypermobility seen on lateral dynamic radiographs when sitting. We enrolled prospectively 37 patients with chronic pain because of coccygeal instability unrelieved by conservative treatment who were not involved in litigation. The operation was performed by the same surgeon. Patients were followed up for a minimum of two years after coccygectomy, with independent assessment at two years. There were 23 excellent, 11 good and three poor results. The mean time to definitive improvement was four to eight months. Coccygectomy gave good results in this group of patients.     

Renal anomalies in family members of infants with bilateral renal agenesis/adysplasia

Renal agenesis/adysplasia is the leading etiology of end stage renal disease in children. The etiology for renal agenesis/adysplasia has not been identified. The purpose of the present study was to determine if renal agenesis/adysplasia occur in a familial pattern. Twenty seven cases of bilateral renal agenesis/adysplasia were identified by review of autopsy records, and four were excluded. A male excess of 2.8:1 was noted with a mean gestation of 35 weeks. Prenatal and family histories were obtained on 11/23 families. Potential embryologic stressors were identified in 8/11 pregnancies. Thirty-four 1st and 2nd degree relatives from five families participated in a renal ultrasound exam. An increased prevalence of congenital renal anomalies was identified in the relatives of index patients with bilateral renal agenesis/adysplasia (14.7%) compared to controls (2.2%), with a recurrence risk of 6.2 for 1st degree relatives. The most frequently identified renal anomalies in the family members were solitary kidneys and duplicated collecting systems. The increased prevalence of a range of renal anomalies within affected families raises the possibility that isolated renal malformations result from unidentified gene-environment interactions.     

尾骨痛105例临床分析

作者对收治的105例尾骨痛进行分析,结果表明:(1)尾骨疼痛者女性(84/105—80%)比男性(21/105—20%)多.(2)与无尾骨痛者相比较,特发性尾骨痛者外偏角变大,骶尾间角和第1、2尾椎间角变小;而外伤性尾骨痛者外偏角不变,其它两角也变小.(3)保守治疗87例,治愈率92.94%,好转率7.06%;手术治疗18例,治愈率100%.总有效率100%.     

Mechanism leading to the development of pressure ulcers based on shear force and pressures during a bed operation: Influence of body types, body positions, and knee positions

Surface pressures and shear forces were measured in order to clarify the mechanism leading to the development of a pressure ulcer at five sites on the body during the operation of a bed (bed) using a device for simultaneously measuring pressure and shear force. Changes of shear force and pressure when three body types adopted different supine positions, with or without raising/bending the knees (raising the knees), were investigated and analyzed. The results are as follows: a slender body type tends to have the highest shear force at the coccygeal bone site and also has a higher surface pressure at the coccygeal and at the lateral sacral bone sites than an obese body type. On the other hand, an obese body type has a higher surface pressure at the other sites than the slender type. Shear forces at the sacrum and coccygeal bone sites can be reduced during a bed operation by raising the knees. Furthermore, shear forces can be reduced during a bed operation in a supine position by matching the body's bending points with those of the bed or by shifting the subjects 10 cm toward the head of the bed. These new findings are clinically useful in the treatment and the prevention of the onset of pressure ulcers.     

先天性胆囊缺如2例并文献复习

目的探讨先天性胆囊缺如的诊断方法。方法分析我科诊治的2例和1994年以来国内文献报道76例先天性胆囊缺如病人的临床资料,结合文献进行讨论。结果术前B超和(或) CT检查:5例先天性胆囊缺如确诊。1例未手术,其余77例均手术证实先天性胆囊缺如。总共有34例(诊为萎缩性胆囊炎2例,诊为胆囊结石32例)进行了不必要的手术。先天性胆囊缺如可分为Ⅰ型:有症状型,Ⅱ型:无症状型;Ⅰ型再可分为Ⅰa型:伴其它先天多发致死畸形,Ⅰb型:不伴致死性畸形。结论术前确诊胆囊缺如非常困难,对这一先天畸形的认识有助于医生对可疑病例的鉴别,从而避免不必要的手术。     

Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma

STUDY DESIGN: A total of 208 consecutive coccydynia patients were examined with the same clinical and radiologic protocol. OBJECTIVES: To study radiographic coccygeal lesions in the sitting position, to elucidate the influence of body mass index on the different lesions, and to establish the effect of coccygeal trauma. SUMMARY OF BACKGROUND DATA: A protocol comparing standing radiographs and radiographs subsequently taken in the painful sitting position in coccydynia patients and in controls has shown two culprit lesions: posterior luxation and hypermobility. Obesity and a history of trauma have been identified as risk factors for luxation. METHODS: Dynamic radiographs were obtained. The body mass index was compared with the coccygeal angle of incidence, sagittal rotation of the pelvis when sitting down, and the presence and time of previous trauma. The patients with the newly described lesions were examined after an anesthetic block under fluoroscopic guidance. RESULTS: Two new coccygeal lesions are described (anterior luxation and spicules). Obesity was found to be a risk factor. The body mass index determines the way a subject sits down, and lesion patterns were different in obese, normal-weight, and thin patients (posterior luxation: 51%, 15.2%, 3.7%; hypermobility: 26.5%, 30.3%, 14.8%; spicules: 2%, 15.9%, 29.6%; normal: 16.3%, 32.6%, 48.1%, respectively; P < 0.0001). Trauma affected the type of lesion only if it was recent (<1 month before the onset of coccydynia), in which case the instability rate increased from 55.6% to 77.1%. Backward-moving coccyges were at greatest risk of trauma. CONCLUSIONS: This protocol allows identification of the culprit lesion in 69.2% of cases. The body mass index determines the causative lesion, as does trauma sustained within the month preceding the onset of the pain.     

The current practice of paediatric surgery in Malaysia.

This 10-year review of surgical conditions in infants at the University Hospital, Kuala Lumpur, highlights some of the more common problems encountered and outlines their management. Anorectal agenesis and Hirschsprung's disease were seen relatively more frequently than other anomalies of the gastrointestinal tract. The management of these two conditions and the operation of colostomy and its complications are singled out and presented in some detail.     

Percutaneous management of stones in a patient with sacral agenesis

We report a case of a patient with sacral agenesis and nephrolithiasis in whom percutaneous nephrostolithotomy was used to treat the stone disease. Sacral agenesis is an uncommon congenital anomaly involving the lower vertebral bodies and is associated with urinary tract dysfunction. Nephrolithiasis in a patient with sacral agenesis poses a problem in access for percutaneous nephrostolithotomy because of the associated presence of renal ectopia. We describe our technique and the special considerations necessary for successful access.     

Duodenal and jejunal atresia with agenesis of the dorsal mesentery: "apple peel" small bowel.

Two newborn infants with duodenal and jejunal atresia and agenesis of the dorsal mesentery represent our surgical experience with "apple peel" small bowel or "christmas tree" demormity. The first patient had the typical appearance of this condition. The postoperative course was complicated by hyperbilirubinemia, septicemia, and disseminated intravascular coagulation. The infant is in satisfactory condition 1.5 years after operation. The second patient had agenesis of the dorsal mesentery without spiraling of the bowel around its vascular stalk. The child died after 1 month, with complete absence of extrahepatic bile ducts as seen at a second laparotomy. Neither child had been subjected to gastrostomy.     

A case of juvenile vesical endometriosis with unilateral renal agenesis and bicornate uterus

A case of vesical endometriosis with unilateral renal agenesis is reported. A 13-year-old girl complained of difficulty in urination and lower abdominal pain during the menstruation. Detail urological examinations revealed left renal agenesis and intravesical cystic mass. The mass was located in the left vesical lateral wall, obstructing the vesical outlet and containing dark-brown-coloured fluid in it. She finally suffered from urinary retention following the menstruation and underwent a resection of the mass together with a part of the vesical wall. During the operation, the uterus was found to be a bicornate one. The resected mass was diagnosed as an endometriosis based on the histological findings. Eighteen months after the operation she is free from any symptoms during the menstruation and recurrence of endometriosis.     

Treatment of spontaneous pneumothorax in a patient with right pulmonary agenesis

Pulmonary agenesis is a rare congenital disease that is associated with many other congenital anomalies. We present the case of a patient, with right pulmonary agenesis and transmediastinal lung herniation, who presented with a spontaneous pneumothorax. This congenital anomaly and the treatment for this rare presentation is discussed in detail.     

Traitement d’un déficit congénital bilatéral de flexion du coude chez un enfant classé arthrogrypose

The authors report the case of a child presenting with bilateral upper limb arthrogryposis due to agenesis of the biceps. Physical examination revealed a bilateral deficit of active elbow flexion although passive flexion was possible. Echography confirmed bilateral biceps agenesis. The treatment was surgical, one side at a time. An ipsilateral pedicle latissimus dorsi muscle transfer was used to restore elbow function. The second procedure took place 7 months after the first. After each operation, the patient's limb was immobilised in plaster for 6 weeks before rehabilitation was commenced. Six months postoperatively, elbow flexion measured 100° on both sides. The functional sequelae at the donor site were negligible, apart from some persisting hypertrophic scars. Bilateral biceps brachii agenesis has not previously been reported in the literature. The surgical treatment undertaken enabled restoration of function with minimal sequelae.     

Reconstruction of vaginal agenesis by Singapore flap

Summary Various surgical methods for reconstruction of vaginal agenesis have been described in the past. One of these is the neurovascular pudendal thigh flap described by Wee and Joseph [20] after they studied the blood and nerve supply of upper thigh skin, medial groin, and perineum in fresh cadavers. This technique involves elevation of two flaps extending laterally to labia majora in the groin crease and suturing them to each other in the midline after bringing them through tunnels formed under the labia majora, thus, creating a new vagina. In our clinic, 24 cases of vaginal agenesis have been reconstructed with neurovascular pudendal thigh flaps in a period of 33 months. The patients were observed for eight months to three years following the operation, and only in three cases did necrosis of the distal flaps occur; hair grew in the vagina in five cases, and shrinkage was observed in only one case. This rather easy technique is the ideal reconstructive method in the vaginal agenesis. However, hair growth in the vagina must be prevented, since this is the main patient complaint.Presented at the 7th Congress of the European Section of the International Confederation for Plastic and Reconstructive Surgery, Berlin, Germany, June 2–5, 1993     

Vascularized autogenous canine coccygeal bone transfer.

Based on cadaver studies in dogs, the 8th, 9th, or 10th canine coccygeal vertebra with overlying skin was designed for free vascularized bone transfer. In six dogs the coccygeal osteocutaneous flap was transferred to fill a defect of the tibia, anastomosing the median caudal artery and one of the two caudal veins to the tibial vessels. The overlying skin provided a reliable monitoring system for the transferred tissue. The behavior of the vascularized coccygeal vertebrae was then evaluated with radiographic and histologic examination and compared with control vertebrae transferred without reconnection of the blood vessels. The results revealed that the canine coccygeal bone graft is a reliable vascularized osteocutaneous flap, which can be applied either in clinical veterinary surgery or in orthopedic microsurgical research.