The natal cleft of patients with pilonidal sinus disease is deeper than the natal cleft of members of the volunteer group.
Active subdiaphragmatic gas aspiration after a laparoscopic cholecystectomy is a simple procedure that can effectively reduce postoperative abdominal and shoulder pain and as a result the need for analgesics.
Background Pilonidal disease is a common problem in primary health care which may require immediate surgical referral. Although various management options have been proposed, so far there is no gold standard treatment. The aim of the present study was to determine which of the following techniques was superior as regards postoperative complications and recurrence, midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. Methods A randomized clinical trial was conducted in the Department of General Surgery. Patients with noncomplicated pilonidal sinus were enrolled in the study from April 2009 to January 2012. All patients were randomized the day of surgery at the coordinating center by means of a computer program. Patients were randomized to receive midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. All procedures were performed under local anesthesia and patients were discharged 6 h after surgery. Demographic characteristics, skin color, body hair type, family history, preoperative complaints and duration of symptoms, cyst size, intraoperative iatrogenic cyst rupture, the presence of a tuft of hairs in the cyst, surgical techniques, duration of drainage, length of hospital stay, postoperative complications and recurrence were evaluated. Results One hundred and ninety-two patients with non-complicated pilonidal sinus were enrolled. Seventy-two patients were randomized to midline unshifted adipofascial turn-over flap, 67 patients to midline shifted adipofascial turn-over flap and 53 patients to Karydakis flap. The mean age was 25.66 ± 7.67 years. At 76-month follow-up, the overall complications and recurrence rates were not significantly different between groups (p [ 0.05). Conclusion In cases of non-complicated pilonidal sinus, we recommend surgical management using local anesthesia, outpatient surgery and the surgical approach with which the surgeon is most familiar.
A 52-year-old woman suffering from painful breast mass presented to general surgery department for evaluation of possible breast carcinoma. She had a history of painless slowly growing breast mass for 19 years, but she complained of breast pain for the last 2 months. Till this age, she had never before undergone ultrasonomammographic examination. On physical examination, approximately a 13-cm large mass was detected in the lower inner quadrant of the left breast.Ultrasonomammography revealed a 10-cm diameter well circumscribed anechoic lesion at 7-o'clock position and a 3 cm diameter heterogeneous calcified semi-solid lesion at 9-o'clock position (Fig. 1). On breast MRI, an 11-cm diameter cystic mass accompanying by a 4-cm diameter heterogeneous calcified cyst lesion were detected (Fig. 2). Ultrasound-guided cyst aspiration for the cystic lesion and core biopsy for the solid lesion were performed. Histological examination of (b) (c) (a) Figure 4. Histology of granular cell tumor of the breast. (a) Photomicrograph of the circumscribed tumor in Fig. 2b shows sheets of large polygonal cells with round to oval nuclei and abundant eosinophilic cytoplasmic granules (inset). Note the scant fibrous stroma. (Hematoxylin-eosin stain; original magnification 100·; inset 400·). (b) Photomicrograph of the spiculated tumor in Fig. 3 show cords of large polygonal cells on a background of dense stromal fibrosis, in contrast with the scant fibrous tissue in A. (Hematoxylin-eosin stain, original magnification 100·). (c) The cells stain positive for S-100 protein, a marker for cells of neural or neuroectodermal origin. Note the eccentrically located nuclei and cytoplasmic granules (S-100 stain; original magnification 400 ·).Figure 1. Breast MRI demonstrate a 11-cm diameter cystic mass accompanying by a 4-cm diameter heterogeneous calcified cyst lesion.
Objective: To analyse the gastrointestinal stromal tumours (GIST) patients' inter-demographics, histological type and association with secondary tumours. Study Design: A case series.
Aim: Lichtenstein inguinal hernia repair with local anesthesia as a day-case surgery is one of aspects of education in inguinal hernia surgery as a surgical training program. In this study, we aimed to present these surgery performed by residents. Material and Methods: Forty years and older male patients diagnosed as primary inguinal hernia were included prospectively between June 2009 and March 2011. Surgical outcomes with respect to recurrence and chronic postoperative pain were studied. Results: There were 151 patients with a mean age of 55.7±10.8. Intraoperative evaluation revealed direct in 84 (55.6%), indirect in 58 (38.4%) and combined hernia in nine (6.0%). Mean operation time was 51.2±13.2 minutes which was significantly higher in obese patients (p<0.05). Patients were discharged at postoperatively eight hours or less in 143 (94.7%). Most of the patients (90.7%) were reported to choose local anesthesia again. Eleven and four patients reported pain scores of 0.23±0.7 (range 0-4) and 0.07±0.4 (range 0-3) at 6th and 12th month evaluations, respectively. At the postoperative 1st day, 137 (90.7%) patients could return to daily activities. There were 28 (18.5%) hematoma and seroma formation, and 18 (11.9%) wound infection. There was no mesh reaction; however, two (1.3%) recurrences were detected after one year of the operation. Conclusion: Lichtenstein inguinal hernia repair under local anesthesia as a day case surgery should be chosen as a primary treatment method, and can be performed by surgical residents under supervision in a safe manner. Keywords: Hernia repair, Local anesthesia, Day-case surgery Öz Amaç: Lokal anestezi ile günü birlik cerrahi olarak uygulanan Lichtenstein inguinal herni onarımı, cerrahi eğitim programı kapsamın yapılan eğitimlerin başında gelmektedir. Bu çalışmada, asisten hekimlerin yaptığı bu ameliyatı incelemeyi amaçladık. Gereç ve Yöntemler: Primer inguinal herni tanısı alan 40 yaş ve üstü erkek hastalar, Haziran 2009-Mart 2011 arasında ileriye dönük olarak çalışmaya dahil edildi. Tekrarlama ve kronik postoperatif ağrı açısından cerrahi sonuçlar çalışıldı. Bulgular: Yaş ortalaması 55,7±10,8 olan 151 hasta vardı. İntraoperatif değerlendirme 84 (%55,6) direk fıtık, 58 (%38,4) indirekt ve dokuz (%6,0) direk-indirekt fıtık birlikteliği vardı. Ortalama operasyon süresi 51,2 ±13,2 dakikaydı ve bu obez hastalarda anlamlı derecede yüksekti (p<0,05). Postoperatif dönemde 143 (%94,7) hasta, ilk sekiz saat içinde taburcu edildi. Hastaların çoğu (%90,7) lokal anesteziyi tekrar seçeceğini ifade etti. Onbir hastanın ağrı skoru 6. ve 12. ay değerlendirmelerinde 0,23±0,7 (dağılım 0-4) ve 0,07±0,4 (dağılım 0-3) olarak tespit edildi. Postoperatif 1. günde, 137 (%90,7) hasta günlük aktivitelerine geri döndü. 28 (%18,5) hematom ve seroma oluşumu ve 18 (%11,9) yara enfeksiyonu vardı. Mesh reaksiyonu saptanmadı; Ancak bir yıl operasyondan sonra iki (%1.3) rekürrens tespit edildi. Sonuç: Lichtenstein inguinal herni onarımı, lokal anestezi altında günlük cerrahi girişim olarak birincil tedavi yön...
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