Simple and effective surgical treatment of pilonidal sinus

PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.Presented at the Turkish National Surgical Congress '98, zmir, Turkey, May 6 to 10, 1998.     

Management of Recurrent Pituitary Cysts with Pituitary-Nasal Drain

Pituitary cysts are usually craniopharyngiomas or remnants of Rathke's cleft. Histologically craniopharyngiomas are lined by stratified squamous epithelium whereas Rathke's cleft cysts are lined by cuboidal or columnar epithelium. The management of pituitary cysts remains difficult because of the risks associated with attempts at complete removal and the chances of recurrence after inadequate resection. We describe 3 cases of cystic craniopharyngiomas and one case of Rathke's cleft cyst which recurred after surgery and were subsequently managed successfully with pituitary-nasal drains.     

蕈状肾盂输尿管支架管在治疗脓肾中的应用

目的观察蕈状肾盂输尿管支架管治疗脓肾的效果。方法通过蕈状肾盂输尿管支架管,应用有效抗生素,经过肾盂、输尿管、膀胱进行持续性冲洗、引流脓液,解除梗阻。结果本组28例患肾的功能全部或部分肾功能恢复,切口I期愈合。结论能有效地控制感染,解除梗阻,保留患肾,降低了脓肾的切除率及Ⅱ期手术率。     

Evaluation of axillary lymphadenectomy without axillary drainage for patients undergoing breast-conserving therapy

Background: The routine use of drainage after axillary node dissection in patients undergoing breast-conserving therapy (BCT) is being questioned. To determine the value of routine drainage, we evaluated the postoperative course of patients with primary breast carcinoma who underwent axillary dissection with or without axillary drainage. Methods: A retrospective review of 69 patients prompted a prospective randomized trial of 46 patients undergoing BCT at our tertiary cancer center. Variables studied were age, treatment (drain or no drain), number and tumor status of excised lymph nodes, size of primary tumor, duration of drainage or aspiration, number and volume of aspirations, number of office visits, incidence of complications and degree of pain, change in arm or forearm circumference, and body mass index (BMI). Data from prospective and retrospective studies were pooled for analysis. Results: Of 115 patients, 72 were treated with a drain (Drain group) and 43 were not (No-drain group). Overall there was no difference in the number or tumor status of excised nodes, the size of the primary tumor, or the incidence of complications between the two groups. Aspiration was required in 50% of the No-drain patients and 8.3% of the Drain patients. The incidence of drain placement or replacement postoperatively was 9.3% for the No-drain patients and 4.2% for the Drain patients. The No-drain patients had more office visits (5.1±0.4 vs. 3.6±0.1;P=.0002) and a longer interval between operation and last aspiration or drain removal (16.2±1.4 days vs. 11.3±0.6 days;P=.0040). Findings were similar in the subgroup of 46 prospectively studied patients, who included 24 Drain patients and 22 No-drain patients. In this group, pain evaluation using a scale of 0 to 10 showed a mean rating of 4.2±2.6 in Drain patients and 2.7±0.4 in No-drain patients (P=.0062). Conclusions: Axillary node dissection can be managed with or without a drain. More office visits but less pain can be expected if a drain is not used.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, IL, March 20–23, 1997.The views expressed herein are those of the authors and do not necessarily reflect the views of the United States Army, United States Navy, Uniformed Services University of the Health Sciences, or the Department of Defense.     

Determinants of Dual Chamber Pulse Generators Longevity

The aim of tbis study was to investigate the effect of battery capacity, internal current drain, and stimulation energy on pulse generators longevity, and if battery impedance measurements can reliably predict pulse generators end-of-life. For this purpose, the records of 577 patients with a mean age of 65 ± 14 years who had undergone implantation of two different dual chamber pulse generators (PGl: 409; PG2:168) were retro-spectively reviewed. Battery capacity were 2.3 Ah (PGl) and 3.0 Ah (PG2) while current drain at compara-ble nominal settings was 20 μA (PGl) and 30 μA (PG2) indicating a higher internal current drain of PG2. After a mean follow-up of 46 ± 23 months, stimulation energy at reprogrammed output settings was significantly higher in PGl as compared to PG2 (17.1 ± 0.14 J vs 15.5 ± 0.24 f). Three PGl (0.7%) and 12 PG2 (7.1%) (P < 0.01) had to be exchanged after a mean of 77.3 ± 5.3 months (PGl) and 75 ± 13.5 months (PG2) (P = NS) due to end-of-life being reached. The difference in battery impedances of PGl and PG2 gained statistical significance 5 years after implantation (1.0 kΩ vs 2.4 ± 6.7 kΩ) preceding the significant difference in PG survival after 6 years (98.7 ± 1.3% vs 90.7 ± 4.8%). These results indicate that internal current drain is the most important determinant of the pulse generators longevity and that battery impedance can reliably predict end-of-life. Therefore, the essential information about internal current drain should be available for each pacemaker, since it is required for adequate pulse generator selection. Diagnostic functions of dual chamber pulse generators should include measurement of battery impedance.     

持续低负压引流在急性重症胰腺炎术后的应用研究

通过动物实验以探讨不同负压值在腹腔引流中的效果，进而应用于临床治疗急性重症胰腺术后病例。其方法是：向兔腹腔滴注生理盐水，运用不同负压值的主动引流方式回收液体。结果：低负压组兔（1．5kPa）液体回收率最高（70％），与其它3组（负压值分别为0、5及15kPa）比较，有显著性差异（P＜0．01）。在此基础上，将1．5kPa持续低负压引流用于急性重症胰腺炎术后20例，亦取得良好效果。本实验结果提示：腹腔持续低负压引流对于急性重症胰腺炎术后病例具有减少并发症、促进恢复和降低死亡率的作用。     

Bowel perforation caused by silicone drains: A report of two cases

(Received for publication on Apr. 7, 1997; accepted on Nov. 6, 1997)     

Clinical and Therapeutic Importance of Sentinel Node Biopsy of the Internal Mammary Chain in Patients with Breast Cancer: A Single-Center Study with Long-Term Follow-Up

Background We evaluated the incidence of sentinel lymph nodes (SLNs) in the internal mammary chain, calculated the lymphoscintigraphy and surgical detection rates, and evaluated the clinical effect on staging and the therapeutic approach in patients with breast cancer.Methods The study involved 741 women diagnosed with breast cancer eligible for the SLN technique. Lymphoscintigraphy was performed on the day before the operation by peritumoral injection of ^99mTc-labeled nanocolloid. During the operation, a gamma probe was used to detect the SLN, which was then removed.Results A total of 719 SLNs were found in the axillary chain and 72 in the internal mammary chain. Preoperative lymphoscintigraphy showed 107 hot spots in the internal mammary chain, but only 72 SLNs in 65 patients were identified by the gamma probe and then removed with no complications. Of these 65 patients, 10 had a positive internal mammary chain SLN on final pathologic examination, whereas 55 patients had ≥1 negative SLNs on final pathologic analysis. Thirty-five (53%) of 65 patients had also an axillary SLN, but only 5 patients (8%) had a positive SLN on pathologic analysis.Conclusions Evaluation of the SLNs in the internal mammary chain may provide more accurate staging in breast cancer patients. If an internal mammary sampling is not performed, patients may be understaged. This technique may allow better selection of those patients who will be submitted to adjuvant locoregional radiotherapy.     

Concepts of seroma formation and prevention in breast cancer surgery

BACKGROUND: Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast-conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined. METHOD: MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out. RESULT: The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive. CONCLUSION: Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low-pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.