Pilonidal sinus is a frequently encountered condition in young adults. It is commonly found in the mid-line skin that covers sacrum and coccyx. Sinus can be found elsewhere, sometimes between the fingers in hair dressers, and in the umbilicus. It is characterized by chronic inflammation in one or more sinuses in the mid-line of the natal cleft that contain hairs and debris. Pilonidal disease is a significant social and economic problem affecting predominantly young males in the second decade of life. This study aimed to compare the results of excision and midline closure with those of lateral approach (Modified Bascom's procedure) in the treatment of sacro-coccygeal pilonidal sinus in regard to the duration of the procedure and wound complication. This prospective randomized study was performed on 53 patients operated upon for a pilonidal sinus between June 2014 and December 2015 in Al-Sadir Teaching Hospital in Basrah. Patients were divided into two groups randomly. Group A (25) patients underwent modified Bascom procedure and group B (19) patients underwent excision and midline closure. The modified Bascom technique showed a significantly short wound healing time (30±10 days) compared to primary closure (55±25 days), p<0.01. The duration of this procedure was significantly longer(50±15 minute) in comparison with excision and midline closure (30±15 minutes) p< 0.01. No significant differences between the two groups regarding bleeding, wound infection, seroma formation and recurrence were recorded. In conclusion, modified Bascom procedure is feasible, effective and applicable for all patients with pilonidal sinus. It is of particular advantages in the treatment of complex, recurrent and chronic non-healing pilonidal sinuses when wound healing remains an important dilemma in the surgical treatment.
Introduction About 50% of acute appendicitis cases are atypical in their presentation. The objectives of this study was to assess and compare the feasibility of clinical scores [Alvarado and Appendicitis Inflammatory Response (AIR)] and imaging [ultrasound and abdominopelvic computed tomography (CT) scan] in the evaluation of equivocal cases of acute appendicitis in a clinical trial to identify that subset of patients who really need and will benefit from imaging, mainly CT scan. Methods: A total of 286 consecutive adult patients with suspected acute appendicitis were included. The clinical scores, including Alvarado and AIR scores and ultrasound, were done for all patients. Abdominal and pelvic CT scans were done for 192 patients to resolve the diagnosis of acute appendicitis. The sensitivity, specificity, positive and negative predictive values, and accuracy rate of both clinical scores and imaging (ultrasound and CT scan) were compared. The final histopathology was used as the gold standard for which the diagnostic feasibility of the clinical score and imaging were compared. Results: Out of 286 total patients who presented with right lower quadrant abdominal pain, a presumptive diagnosis of acute appendicitis was made in 211 patients (123 males and 88 females) after thorough clinical evaluation, clinical scores, and imaging, and they were submitted to appendicectomy. The overall prevalence of acute appendicitis proved by histopathology as a gold standard was 89.1% (188 patients) with a negative appendectomy rate of 10.9%. Simple acute appendicitis was reported in 165 (78.2%) patients and perforated appendicitis in 23 (10.9%) patients. For patients with equivocal clinical scores (≥4 to ≤6), the sensitivity, specificity, predictive values, and accuracy rate of CT scan were significantly higher than those of Alvarado and AIR scores. Patients with low clinical scores (≤4) and high clinical scores (≥7), the sensitivity, specificity, predictive values, and accuracy rate of clinical scores and imaging were comparable. The diagnostic feasibility of AIR scores was significantly higher than the Alvarado score, and the clinical scores were associated with significantly higher diagnostic accuracy than ultrasound. CT scan is unlikely to be needed and will add little to the diagnosis of acute appendicitis for patients with high clinical scores (≥7). The sensitivity of the CT scan for perforated appendicitis was lower than that for nonperforated appendicitis. The use of CT scans for query cases did not change the negative appendectomy rate. Conclusion: CT scan evaluation is beneficial only for patients with equivocal clinical scores. For patients with high clinical scores, surgery is recommended. AIR score was superior to the Alvarado score in terms of sensitivity, specificity, and predictive values. A CT scan is usually not required for patients with low scores since acute appendicitis is unlikely; in such cases, ultrasound co...
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