Comparison of the classic limberg flap and modified limberg flap in the treatment of pilonidal sinus disease: A retrospective analysis of 416 patients

Purpose  

Pilonidal sinus disease (PSD) is usually seen on the sacrococcygeal region in adolescent patients. The current study analyzed the outcome of the rhomboid excision and the Limberg flap procedure (cLF) in comparison to the modified Limberg flap procedure (mlF) for PSD.     

A community-randomised controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh

Objectives To pilot two intensive hand hygiene promotion interventions, one using soap and one using a waterless hand sanitizer, in low‐income housing compounds in Dhaka, Bangladesh and assess subsequent changes in handwashing behaviour and hand microbiology. Methods Fieldworkers randomized 30 housing compounds: 10 received handwashing promotion with free soap, 10 received handwashing promotion with free waterless hand sanitizer and 10 were non‐intervention controls. Fieldworkers assessed handwashing behaviour by structured observation and collected hand rinse specimens. Results At baseline, compound residents washed their hands with soap 26% of the time after defecation and 30% after cleaning a child’s anus but <1% at other times. Compared with baseline, residents of soap intervention compounds were much more likely to wash their hands with soap after faecal contact (85–91%), before preparing food (26%) and before eating (26%). Compounds that received waterless hand sanitizer cleansed their hands more commonly than control compounds that used soap (10.4%vs. 2.3%), but less commonly than soap intervention compounds used soap (25%). Post‐intervention hand rinse samples from soap and sanitizer compounds had lower concentrations of faecal indicator bacteria compared with baseline and control compounds. Conclusions Waterless hand sanitizer was readily adopted by this low‐income community and reduced hand contamination but did not improve the frequency of handwashing compared with soap. Future deployments of waterless hand sanitizers may improve hand hygiene more effectively by targeting settings where soap and water is unavailable.     

Bone mineral density in patients with familial Mediterranean fever

This study was carried out to determine lumbar and femoral bone mineral density (BMD) in patients with familial Mediterranean fever (FMF), an autosomal-recessive disease characterized by recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. In patients with FMF and control subjects, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. BMD was determined at the lumbar spine (L1–4) and the femoral regions (neck and total) using dual energy X-ray absorptiometry. Twenty-eight FMF patients and 30 control subjects without a history of inflammatory disease participated in our study. The demographic variables, such as age, sex and body mass index were similar between patients and controls (P > 0.05). We found statistically significant difference in ESR and CRP between FMF patients and controls (P < 0.01, P < 0.05 respectively). There was statistically significant difference in lumbar spine, femoral neck, and total femur BMD between FMF patients and control groups (P < 0.001, P < 0.01, P < 0.01 respectively).Our study indicates that lumbar spine and femoral neck and total femur BMD in patients with FMF may be lower than in healthy subjects.     

DNA integrity in patients undergoing hyperbaric oxygen (HBO) therapy

Hyperbaric oxygen (HBO) therapy is successfully applied for a wide variety of diseases. However, recent studies in humans undergoing (HBO) therapy have revealed that HBO is able to induce oxidative DNA damage especially in lymphocytes while the biological significance of this outcome is still not clear. HBO mediated DNA damage in lymphocytes has been determined by using the alkaline version of the comet assay in order to detect DNA strand breakages in patients undergoing HBO therapy. Blood samples were obtained from 100 voluntary patients and were drawn by venipuncture before and immediately after the first session of HBO treatment. The DNA damaging effect of HBO has also been evaluated in the fifth session of HBO therapy. DNA strand breakages were significantly increased after the first session of HBO treatment. However the elevated DNA strand breaks returned to their normal levels in lymphocytes after two hours of in vitro incubation. The elevated DNA strand breaks consistently decreased and reached to the baseline levels after the fifth session of HBO therapy. The results of this study, conducted in patients undergoing HBO therapy, support the existence of the previously reported cellular adaptive response against HBO mediated oxidative DNA damage in experimental studies.     

The Importance of Early Carotid Endarterectomy in Symptomatic Patients

INTRODUCTION

Early carotid endarterectomy (CEA) in symptomatic patients may prevent repeat cerebral events. This study investigates the relationship between waiting time for CEA and the incidence of repeat cerebral events prior to surgery in symptomatic patients.

PATIENTS AND METHODS

A prospective database of consecutive patients undergoing CEA between January 2002 and December 2006 was reviewed. Repeat event rates prior to surgery were calculated using Kaplan–Meier analysis and predictive factors identified using Cox regression analysis.

RESULTS

A total of 118 patients underwent CEA for non-disabling stroke, TIA and amaurosis fugax. Repeat cerebral events occurred in 34 of 118 (29%) patients at a median 51 days (range, 2–360 days) after the first event. The estimated risk of repeat events was 2% at 7 days and 9% at 1 month after first event (Kaplan–Meier survival analysis). Age (HR 1.059; 95% CI 1.014–1.106; P = 0.009] was identified as a predictor of repeat events. Patients underwent surgery at median 97 days (range, 7–621 days) after the first event. Eleven of 60 (18%) patients waiting ≤?97 days for surgery and 23 of 58 (40%) patients waiting >?97 days had repeat events. (P = 0.011, chi-squared test).

CONCLUSIONS

Delays in surgery should be reduced in order to minimise repeat cerebral events in patients with symptomatic carotid stenosis, particularly in the elderly population.     

Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy

BACKGROUND: Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature. CASE DESCRIPTION: A 22-year-old woman in her 36th week of gestation presented with acute onset of upper back pain and progressive paraplegia. Imaging studies revealed a T4 vertebral hemangioma, which involved the vertebral body, pedincules, transverse, and spinous process with a focal extradural extension of soft tissue component. She underwent emergent cesarean delivery and endovascular embolization, respectively. Her symptoms and neurologic deficits improved quickly. Her complaints restarted 2 years after embolization. Surgical treatment which consists of intraoperative vertebraplasty and segmental fixation was performed. The patient's postoperative recovery was excellent. CONCLUSION: According to literature review and our patient's outcome, pregnancy may induce neurologic symptoms and signs in silent spinal hemangiomas. The way of management is decided by whether the neurologic deficits depend on the deformity caused by hemangioma or some other factors including vascular insufficiency.     

The protective effect of erythropoietin infusion on testicular torsion/detorsion: an experimental study

Introduction  The aim of the present study was to evaluate the effects of erythropoietin (EPO) on the histopathology of testes after unilateral testicular torsion and detorsion. Materials and methods  Twenty-five male Sprague–Dawley rats weighing 120 g were used in this study. The rats were randomly divided into three groups, a sham group consisting of five rats and the other two groups consisting of ten rats. In group 1 (sham group), right orchiectomy with no additional intervention was performed. In group 2 (T/D group), torsion was created by rotating the testis 720° in a clockwise direction for 4 h. After a 4-h torsion period, the right testis was detorted and replaced into the scrotum for 4 h. After the torsion, 0.5 cc 0.9% NaCl solution was injected once and three times in a week (total 12 doses). In group 3 (T/D + erythropoietin; EPO group), the same surgical procedure was done as in group 1, but EPO 1,000 IU/kg was injected just before the detorsion and three times in a week. At the end of each procedure, bilateral orchiectomies were performed for the histopathological examinations in all groups. Results  We examined the testes weight, vascularization of the region between the seminiferous tubules, percentage of necrotic seminipherous tubules, and maturation of spermatogenesis in terms of necrosis, sertoli cells, maturation arrest of spermatogenesis, hypospermatogenesis, and normal spermatogenesis of torsioned testis tissues with and without EPO treatment. Extremely significant differences in testicular weight were observed in group 1 compared to groups 2 and 3 (P < 0.001). Conclusion  Administration of EPO significantly influenced the rescue of testicular function by preserving the intact seminiferous tubular morphology, lowering the percentage of necrotic seminipherous tubules, and significantly reducing histological damage (P < 0.05).