The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease (SPSD) who underwent Karydakis procedure at our centre with reference to the perioperative findings, early and late postoperative results and recurrence.
Materials and Methods:
A total of 103 patients presenting with SPSD at our centre underwent Karydakis flap repair from January 2001 to December 2010. These patients were then followed-up and evaluated with respect to operative time, drain use, hospital stay, suture removal, complications, and recurrence.
Results:
The mean operative time was 74.9 min with a median hospital stay of 5 days. Drains were removed at a median of 7 days and sutures at a median of 15 days. Twenty-one patients presented with serous collection in the wound. Six patients had wound infection. Patients were followed-up for a median of 29 months. No recurrences were noted in any of the cases.
Conclusion:
Karydakis flap procedure is a relatively simple procedure for SPSD with reproducible low recurrence rates.KEY WORDS: Complications, Karydakis flap repair, recurrence, sacrococcygeal pilonidal sinus disease相似文献
Adult Still's disease (ASD) is not uncommon disease. It is recognized as multi-systemic inflammatory disease of unknown aetiology. There is no significant racial and geographical distribution of the disease. In most of the cases-onset of disease course occur before the age of 35. Its main feature is the combination of symptoms, such as fever higher than 39°C, cutaneous rash during fever peak, polyarthritis, lymphadenopathy, raised white blood cell count, abnormalities of liver metabolism, raised serum ferritin etc. None of these signs is significant to establish the diagnosis. Some diagnostic criteria have been developed for diagnosis of ASD. Among them Yamaguchi criteria is superior to others in respect of its sensitivity and specificity. Some bacterial and viral infections, other rheumatic diseases, malignancy and drug hypersensitivity can also mimic ASD. The aim of treatment of ASD is to limit the intensity of the symptoms and to control disease evolution. Various types of drugs including biological agents are now promising to treat ASD. 相似文献
In observational studies on cancer patients, progression of performance status over time can be described by using a multistate model in which state-to-state transitions represent changes in a patient's health condition. Although a patient experiences transitions in continuous time, assessments on the patient are often made at irregularly spaced time points. In this paper, the authors formulate a Markov 4-state model for examining longitudinal data on performance status collected under intermittent observation. The cohort consisted of 11,342 patients diagnosed with cancer in Ontario, Canada, from 2007 to 2009. The authors extend the model to estimate the predicted probability of reaching the absorbing state, death, over various time intervals. The authors also illustrate what happens to the estimated transition intensities if the true observational scheme is overlooked. Methods for multistate analysis should be used by epidemiologists, since they prove particularly useful for examining the complexities of disease processes. 相似文献
Hierarchical lattices are structures composed of self-similar or dissimilar architected metamaterials that span multiple length scales. Hierarchical lattices have superior and tunable properties when compared to conventional lattices, and thus, open the door for a wide range of material property manipulation and optimization. Using finite element analysis, we investigate the energy absorption capabilities of 3D hierarchical lattices for various unit cells under low strain rates and loads. In this study, we use fused deposition modeling (FDM) 3D printing to fabricate a dog bone specimen and extract the mechanical properties of thermoplastic polyurethane (TPU) 85A with a hundred percent infill printed along the direction of tensile loading. With the numerical results, we observed that the energy absorption performance of the octet lattice can be enhanced four to five times by introducing a hierarchy in the structure. Conventional energy absorption structures such as foams and lattices have demonstrated their effectiveness and strengths; this research aims at expanding the design domain of energy absorption structures by exploiting 3D hierarchical lattices. The result of introducing a hierarchy to a lattice on the energy absorption performance is investigated by varying the hierarchical order from a first-order octet to a second-order octet. In addition, the effect of relative density on the energy absorption is isolated by creating a comparison between a first-order octet lattice with an equivalent relative density as a second-order octet lattice. The compression behaviors for the second order octet, dodecahedron, and truncated octahedron are studied. The effect of changing the cross-sectional geometry of the lattice members with respect to the energy absorption performance is investigated. Changing the orientation of the second-order cells from 0 to 45 degrees has a considerable impact on the force–displacement curve, providing a 20% increase in energy absorption for the second-order octet. Analytical solutions of the effective elasticity modulus for the first- and second-order octet lattices are compared to validate the simulations. The findings of this paper and the provided understanding will aid future works in lattice design optimization for energy absorption. 相似文献
Goal To ascertain outcomes of surveillance mammography (SM) following treatment of early stage unilateral primary breast cancer
(PBC) in a population based case series. Methods Random samples from all 12,279 women having breast surgery within 4 months after diagnosis of PBC, between July 1991and December
1993 in Ontario, were drawn from a database created by deterministic linkage of PBC files from the Ontario Cancer Registry
(OCR) with episodes of breast surgery extracted from the hospital Discharge Abstract Database (DAD), and mammography from
the Ontario physician billings database (OHIP). Among women having ≥1 episode(s) of breast surgery subsequent (SBS) to the
date of diagnosis up to December 2000, a sample of 1,200/5,064 (23.7%) was drawn, and among women with no SBS, a sample of
400/7,215 (5.5%). Among these two samples, operative, pathology, and mammography reports were abstracted from original charts.
Treatments were abstracted and categorized. Women with complete data for Stages 1 and 2 unilateral PBC were included. From
the subsequent surgery sample, 609/1,200 (50.8%) were excluded because of simultaneous or sequential bilateral breast cancers
or mastectomies within 6 months, missing stage information, Stage 3 or 4 PBC, or missing primary charts. From the no subsequent
surgery sample, 90/400 (22.5%) were excluded by the same criteria. Episodes of bilateral 2-view X-ray mammography, beginning
≥6 months after the diagnosis of unilateral PBC, and if multiple, at least 11 months apart, and not prompted by a clinical
concern or symptom, were classified as SM. We confirmed episodes of cancer recurrence within the ipsilateral conserved breast
(CRICB) and metachronous contralateral primary breast cancer (CPBC) ≥6 months after the diagnosis of the unilateral PBC from
original operative and pathology reports. We used Cox models to describe the association of exposure to ≥1 episode(s) of SM
with the risk of death from breast cancer among the study population, and separately among women experiencing CRICB or CPBC.
Results Eligible women comprising 591/1,200 and 310/400 produced a combined case series of 901/1,600 (56.3%). Women with ≥1 episode(s)
of SM numbered 721/901 (80.0%). We confirmed 84 CRICB events among 584 women initially treated by lumpectomy (14.4%), and
49 CPBC events among all 901 women in the study population (5.4%). Among women having ≥1 episode(s), the 25th percentile of
observed follow up was 1,631 days, the 50th, 4,287 days, and the 75th 5,011 days. Among women without any SM, the 25th percentile
of observed follow-up was 440 days, the 50th, 891 days, and the 75th, 1,849 days. Hazard ratio (HR) for death due to breast
cancer associated with ≥1 episode of SM was 0.28 (95% CI 0.22–0.37), adjusted for age, stage, type of surgery, adjuvant chemotherapy,
and tamoxifen. Among 84/584 women with CRICB, unadjusted HR = 0.36 (95%CI 0.13, 1.00) and among 49/901 women with CPBC, unadjusted
HR = 0.86 (0.20–3.77). Conclusion SM was associated with a significant reduction in the hazard for breast cancer death. Among women who experienced CRICB,
the reduction was of borderline significance, and the reduction was not significant among women who experienced CPBC. 相似文献
There is no doubt that controlled and pulsatile drug delivery system is an important challenge in medicine over the conventional drug delivery system in case of therapeutic efficacy. However, the conventional drug delivery systems often offer a limited by their inability to drug delivery which consists of systemic toxicity, narrow therapeutic window, complex dosing schedule for long term treatment etc. Therefore, there has been a search for the drug delivery system that exhibit broad enhancing activity for more drugs with less complication. More recently, some elegant study has noted that, a new type of micro-electrochemical system or MEMS-based drug delivery systems called microchip has been improved to overcome the problems related to conventional drug delivery. Moreover, micro-fabrication technology has enabled to develop the implantable controlled released microchip devices with improved drug administration and patient compliance. In this article, we have presented an overview of the investigations on the feasibility and application of microchip as an advanced drug delivery system. Commercial manufacturing materials and methods, related other research works and current advancement of the microchips for controlled drug delivery have also been summarized. 相似文献
The aim of this study is to evaluate the effectiveness of lamivudine treatment in both precore mutant and wild type of chronic hepatitis B (CHB) patients. The study was done on sixty CHB patients of both sexes seeking treatment in the Outpatient Department and admitted patients of Mymensingh Medical College Hospital. The patients were divided into two groups. Group A included chronic hepatitis B patients with raised ALT (> 80 u/l ) with HBeAg positivity, and group B included precore mutant variety of CHB patients with raised ALT (> 80 u/l) with HBeAg negativity. In Group-A, after 1 year of completion of lamivudine therapy there was 86.67% normalization of ALT, 23.33% HBeAg loss, 16.67% anti-HBeAg development and 73.33% HBV DNA loss. In Group-B, there was 76.67% normalization of ALT and 73.33% HBV DNA loss after 1 year of completion of therapy. In the present study, it was observed that lamivudine is equally effective in both wild and precore mutant variety of CHB patients. This was reflected by normalization of ALT and loss of HBV DNA. This study also shows the reappearance of HBV DNA during the later half of Lamivudine therapy which is due to YMDD mutation. 相似文献
Association of serum Interleukin -2 (IL-2) levels with the activity of chronic hepatitis B (CHB) was evaluated in this study. We studied 45 subjects in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. They were divided into three groups. Group A consisted of 15 CHB patients with raised Alanine aminotrasferase (ALT) (> 80 iu/L), Group B consisted of 15 CHB carrier with normal ALT (< or =40 iu/L) and Group C consisted of 15 healthy subjects with normal ALT. Serum IL-2 level was measured in all groups. IL-2 level was detected in 14(93.33%) subjects in group A and 2(13.33%) subjects in group B. IL-2 level was undetectable in all the subjects in group C. The association between IL-2 level and activity of chronic hepatitis B was observed by statistical analysis (Z-test). There is significant difference between group A and group B (p<0.001) and also in group A and group C (p<0.001), but no significant difference between group B and group C (p>0.05). Our results support the observation that IL-2 level can be used as a marker of activity in CHB patients as IL-2 level was significantly detected in the patients of group A. 相似文献
Obesity is associated with increased breast cancer risk in women. Bariatric surgery induces substantial weight loss. However, the effects of such weight loss on subsequent breast cancer risk in women with obesity are poorly understood. To examine breast cancer incidence and related outcomes in women with obesity undergoing bariatric surgery.
Materials and Methods
This was a population-based matched cohort study of breast surgery outcomes utilizing linked clinical databases in Ontario, Canada. Women with obesity who underwent bariatric surgery were 1:1 matched using a propensity score to non-surgical controls for age and breast cancer screening history. The main outcomes were incidence of breast cancer after lag periods of 1, 2, and 5 years. Additional outcomes included tumor hormone receptor status, cancer stage, and treatments undertaken. Time-varying Cox proportional hazard models accounting for screening during follow-up were used to model cancer incidence.
Results
A total of 12,724 women per group were included, average age 45.09. After a 1-year lag, breast cancer incidence occurred in 1.09% and 0.79% of the control and surgery groups, respectively (adjusted hazard ratio, 0.81 [95%CI 0.69–0.95]; p = 0.01). This association was maintained after lag periods of 2 and 5 years. Women in the surgical cohort diagnosed with breast cancer were more likely to have low-grade tumors and less likely to have high-grade tumors (overall p < 0.01). No association was found for tumor hormone receptor status, although the surgical group was more likely to have her2neu-negative tumors (p = 0.01).
Conclusion
Bariatric surgery was associated with a lower incidence of breast cancer and lower tumor grade in women with obesity. Further evaluation of outcomes, including mortality, is required.
