ObjectivesMany conservative methods have been applied in the treatment of pilonidal sinus disease (PSD). The most commonly used conservative treatment is 80% phenol solution. Our observations demonstrated that 80% phenol solution caused much destruction in the sacrococcygeal region.DesignIn this study low concentrations of phenol were used with the aim of reducing the unwanted side-effects of high-concentration phenol without reducing the therapeutic effects.ParticipantsWe treated 112 patients (18 women, 94 men) with PSD using phenol solution. Patients were divided into two groups: Group A was treated with a 40% solution of phenol solution, and Group B was treated with an 80% solution of phenol solution.SettingAll patients were treated on an outpatient basis. One mL of low (40%) or high (80%) concentration phenol solution was injected into the main sinus orifice. During the check it was observed and noted whether there was skin necrosis, fatty tissue necrosis or abscesses.Main outcome measuresThe mean age was 27.4 years (6–44). The median length of symptoms was seven months (0.5–132). In the 2.8 years (1–6) of mean follow-up period, the disease recurred in 13 (11.6%) patients.ResultsThis treatment procedure was well-tolerated by all the patients except for those who had unwanted results. No patients in group A had skin necrosis, and only one had abscesses. In group B two patients had abscesses, and three had skin necrosis. Fatty tissue necrosis was seen in one patient in Group A and in five patients in Group B. Recurrence rates were four (7.4%) cases in Group A and nine (15.5%) cases in Group B.ConclusionsIt is possible to treat patients in a shorter time with a considerably smaller loss of working time, since the destruction of peripilonidal adipose tissue and skin is less. Therefore, the use of low-concentration phenol solution is an option to be considered in the treatment of PSD.
A liver from a donor with brain death due to a ruptured cerebral aneurysm was transplanted. The liver had multiple bilobar simple cysts; the largest was less than 3 cm in diameter. The noncystic liver volume was greater than 50%, and the liver had neither fibrosis nor venous congestion. The donor surgery was performed in accordance with the standard protocol without rupture of the cysts. The recipient was a 40-year-old man with cirrhosis associated with hepatitis B. The recipient operation was done by using the piggyback method with no complications. Excessive drainage of chylous ascites (10 000 mL/d) started in the first days after surgery and continued, gradually decreasing until the end of the second month. The patient was discharged with no complications at the end of the third month. No growth in the cysts was observed on follow-up computed tomography scans. Excluding this particular case, a total of 7 other patients have received a polycystic liver transplant. In all 7 cases, the fact that the donor had polycystic liver disease was not known but was encountered by coincidence during procurement. The case reported here is the first case where the polycystic liver disease was diagnosed before procurement and the transplant was still carried out. It appears that, if the donor liver has enough healthy noncystic volume, polycystic livers can be transplanted.
Ö ÖZ ZE ET T A Am ma aç ç: : Bariatrik cerrahi uygulamalarında anestezi, riskli ve komplikedir. Bariatrik cerrahi uygulanmış hastaların pre, intra ve postoperatif özelliklerini retrospektif olarak araştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Etik Kurulu onayı ile hastanemizde 2006-2008 yıllarında bariatrik cerrahi uygulanan 60 hastanın dosyası incelendi. Bu hastaların demografik özellikleri, mallampati skoru, yandaş hastalık, zor entübasyon, anestezi/operasyon süresi, laparotomiye geçilmesi, anestezi yönetimi, hastaların bulantı-kusma yakınmaları ve postoperatif analjezik ilaçları kaydedildi. Ayrıca hastaların derlenme ünitesinde/hastanede kalış süresi, yoğun bakım gereksinimi, mekanik ventilatör gereksinimi, postoperatif komplikasyon varlığı (erken/geç), tekrar operasyon gereksinimi kaydedildi. B Bu ul lg gu ul la ar r: : Olguların %78,3'ü kadındı. İntraoperatif 4 hastada laparotomi gerekti. Anestezi indüksiyonunda barbitürat kullanılanların hastanede yatış süresi uzundu (p= 0,034). Kas gevşetici ek doz gereksinimi ile operasyon süresi (p= 0,003) arasında doğru orantı vardı. Peroperatif metilprednizolon uygulanan kronik bronşit ve astımlı hastaların, derlenme ünitesinde kalış süresinin kısaldığı görüldü (p= 0,033). Postoperatif %6,7 (n= 4) hastada yoğun bakım ihtiyacı vardı. Bu hastalardan 1'i mekanik ventilatör desteği aldı. Olguların %13,3 (n= 8)'ünde hastada erken dönemde komplikasyon gelişti. Bu komplikasyonlar sistemik enfeksiyon, port enfeksiyonu, akut karın, intraabdominal abse, pulmoner emboli, pnömotoraks ve hatalı trokar yerleşimiydi. Olguların %11,6 (n= 7)'sı tekrar operasyona alındı. İkinci operasyon gereksinimi ile Beden Kitle İndeksi (BKİ) arasında ters korelasyon (p= 0,013), komplikasyon varlığı ve sigara kullanma arasında ise doğru orantı vardı (p= 0,008). S So on nu uç ç: Cerrahi tedavi yöntemlerindeki artan başarı ve azalan komplikasyon oranları sayesinde daha fazla hasta ameliyat edilmektedir. Bariatrik cerrahi için anestezi uygulaması başlı başına bir sorundur ve dikkat edilmesi gereken pek çok özellik vardır.A An na ah ht ta ar r K Ke el li im me el le er r: : Obezite, morbit; şişmanlık cerrahisi; anestezi A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Anesthesia in bariatric surgery practise carries high risk and is complicated. We retrospectively analysed pre, intra and postoperative characteristics of patients who underwent bariatric surgery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Records of 60 patients who underwent bariatric surgery between 2006-2008 with the approval of the Ethics Committee were analysed. Demographic features of these patients, mallampati score, comorbidities, difficult intubation, anesthesia/operation time, switching to laparatomy, anesthesia management, emesis, vomiting and postoperative analgesic drugs of the patients were recorded. Additionally, duration of recovery unit/hospital stay, need for intensive care and mechanical ventilator, presence of postoperative complications (early/late), and reoperation requireme...
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