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.     

Mediastinal Seroma Post Laparoscopic Repair of Type IV Paraesophageal Hernia

Laparoscopic repair of paraesophageal hernia is safe and feasible and can provide comparable results for patients with type IV paraesophageal hernia. We report a rare case of mediastinal seroma in an 80-year-old gentleman who had a giant type IV paraesophageal hernia and was eventually admitted to our hospital for elective laparoscopic repair and recovered very well after surgery with resolution of the atelectatic lungs and air-fluid collection in his chest.     

Retroperitoneal aspergilloma

We report a previously healthy 8-year-old boy who presented to the hospital with a palpable abdominal mass, fever and abdominal pain. CT and MRI scans confirmed a large mass that was centered in the retroperitoneum. The lesion was biopsied and the histology showed branching hyphae. Tissue cultures grew Aspergillus fumigatus and a diagnosis of aspergilloma was made. The immunological work-up did not reveal an immunodeficiency. This case is a unique presentation of aspergilloma presenting in an unusual location and in an immunocompetent patient.     

Effects of supplemental thyme extract (Thymus vulgaris L.) on growth performance,intestinal microbial populations,and meat quality in Japanese quails

The aim of the current study was to investigate the effects of dietary supplementation with thyme extract as growth promoter agent on growth performance, intestinal microbial populations, and thigh meat quality of Japanese quail. A total of one hundred eighty 1-day-old Japanese quails were randomly allocated to three treatments with four replicates per treatment and 15 quail chicks per pen. The dietary treatments consisted of basal control diet (CO) without any added compounds, virginiamycin (VM, 200 mg/kg), and thyme extract (TH, 100 mg/kg). Daily feed intake for each pen was recorded. The average body weight gain (BWG) and feed intake (FI) adjusted for mortality to 21 and 35 days of age were used to calculate the feed conversion ratio (FCR). At day 35, two birds per replicate were slaughtered for determination of intestinal weights and also for thigh meat quality. Supplementing VM significantly decreased the FCR of quails at day 35. The results showed that the count of lactobacillus bacteria increased in birds fed the TH diet compared to VM and CO treatments. Also, supplemental TH decreased the number of coliforms in the ileum compared to the CO diet. Japanese quails fed the TH diet had significantly lower 2-thiobarbituric acid-reactive substances (TBARS) than the VM and CO treatments. Water holding capacity (WHC) was significantly increased in quails fed the TH diet. In conclusion, TH can increase the number of beneficial bacteria (lactobacillus bacteria) and decrease harmful ones (coliforms). Also, TH has good effects on thigh meat quality as indicated by the decrease in TBARS and the increase in WHC, but it has not affected the growth performance.     

Prevalence of phonatory symptoms in patients with type 2 diabetes mellitus

To look at the prevalence of phonatory symptoms in patients with type 2 diabetes mellitus. The correlation between these symptoms with duration of the disease, glycemic control, and neuropathy will be described. A total of 105 consecutive patients diagnosed with type 2 diabetes mellitus by their primary endocrinologist were evaluated. A control group consisting of 33 healthy subjects was recruited for this study. Demographic data included: age, gender, allergy, smoking, duration of the disease, glycemic control, and presence or absence of neuropathy. Subjects were also asked about the presence or absence of the following symptoms: hoarseness, vocal tiring or fatigue, vocal straining, and aphonia or complete loss of voice. Patients were also asked to fill out the Voice Handicap Index 10. The mean age of patients with diabetes was 53.21 + 9.68 years with male-to-female ratio of 2/3. The most common phonatory symptoms were vocal tiring or fatigue and hoarseness (34.3 and 33.3 %). There was a significant difference in the prevalence of hoarseness and vocal straining (p value 0.045 and 0.015, respectively) compared to controls. There was a significant correlation between glycemic control, neuropathy, and hoarseness (p value 0.030 and 0.001, respectively). Vocal straining and aphonia also correlated significantly with the presence of neuropathy. Close to 16 % of diabetic patients had a VHI-10 above or equal to 7. Diabetic patients are more likely to have phonatory symptoms compared to controls, namely straining and hoarseness. One out of seven patients with diabetes has reported that phonatory symptoms had a significant impact on their quality of life. The presence of neuropathy and poor glycemic control should alert the treating physician to these vocal complaints.