The Limberg flap procedure is a good treatment choice for pilonidal sinus because of its low complication rate, the short time to return to normal activity, and good long-term results. This procedure has good postoperative results and is a comfortable surgical method for the patient.

AIM:To investigate the roles of the adipocytokines, ghrelin and leptin in gastric cancer cachexia. METHODS: Resistin, ghrelin, leptin, adiponectin, insulin and insulin-like growth factor (IGF-Ⅰ), were measured in 30 healthy subjects, and 60 gastric cancer patients of which 30 suffered from cancerinduced cachexia and 30 served as a control group. The relationships between hormones, body mass index (BMI) loss ratio, age, gender, and Glasgow Prognostic Score (GPS) were investigated. RESULTS: Cachexia patients had higher tumor stage and GPS when compared with non-cachexia patients (P < 0.05). Ghrelin, resistin, leptin, adiponectin and IGF-Ⅰ, showed a significant correlation with BMI loss ratio and GPS (P < 0.05). A strong correlation was seen between GPS and BMI loss (R = -0.570, P < 0.0001). Multivariate analysis indicated that BMI loss was significantly independent as a predictor of ghrelin, resistin, leptin and IGF-Ⅰ (P < 0.05). Existence of an important significant relationship between resistin and insulin resistance was also noted. CONCLUSION: These results showed that serum ghrelin, leptin, adiponectin, and IGF-Ⅰ play important roles in cachexia-related gastric cancers. No relationship was found between resistin and cancer cachexia. Also, because of the correlation between these parameters and GPS, these parameters might be used as a predictor factor.

The mlF is a more effective treatment than cLF for the surgical management of PSD.

The Limberg flap procedure is effective and has a low complication rate, short time for returning to normal activity and short hospitalization.

The purpose of this study is to evaluate the operative outcomes of a gastric pull-up and free jejunal graft reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma. Records of all patients who underwent esophageal resection for carcinoma of the hypopharynx and cervical esophagus were reviewed. Reconstruction after esophagectomy was performed using the gastric pull-up (n = 38) or free jejunal graft (n = 14) techniques. The hypopharynx was the most common primary tumor site for the free jejunal graft group, whereas the gastric pull-up group had lesions more frequently in the cervical esophagus (P < 0.05). Both operative time and blood loss in the gastric pull-up group were significantly longer and excessive than those of the free jejunal graft group (P < 0.05). The graft survival rate was 95% (32/34) in the gastric pull-up group and 93% (13/14) for the free jejunal transfer group. The overall leakage rate was 1.9% (1/52). Three patients died (6%) in the postoperative period. There was no significant difference with regard to operative morbidity and mortality between the gastric pull-up group and free jejunal graft group. In conclusion, both free jejunal graft and gastric pull-up are safe and effective methods for the immediate restoration of alimentary continuity.

An unusual case of Fournier's gangrene after hemorrhoidectomy and drug-induced agranulocytosis, as the predisposing condition, is described. The patient had severe granulocytopenia that was attributed to the recent use of dipyrone. Together with hemodynamic resuscitation, broad-spectrum antibiotic and recombinant human granulocyte colony-stimulating factor were started. Wide surgical excision of all the gangrenous tissues, in addition to laparoscopic formation of a defunctioning sigmoid loop colostomy, was performed. The white blood cell count rose steadily and the patient experienced a rapid recovery. We emphasize that radical surgery must be accompanied by pharmacologic interventions for a successful outcome in such cases.

The role of extended lymphatic dissection on the prognosis and outcome of thoracic esophageal carcinoma is still controversial. The aim of this study was to determine the impact of three-field lymphatic dissection on the survival and recurrence rates of patients with thoracic carcinoma of the esophagus. Forty-six patients with primary squamous cell carcinoma of the thoracic esophagus underwent esophagectomy with three-field lymphatic dissection between 1992 and 2003. Recurrence and survival rates were examined as well as complications. Overall survival for the patients was 45.6 months and 5-year survival rate was 56%. Five-year survival rates for patients with Stage 2A, 2B, 3 and 4 were 68%, 0%, 53% and 33%, respectively. There was no Stage 1 patient. Mean disease-free survival was 41.4 months. Sixty three percent of patients had node-negative disease (5-year survival rate, 68.9%) and 37% had nodal metastases (5-year survival rate, 33.7%) (P = 0.002). Surgical morbidity was seen in 35 patients (76.1%). Conclusively, lymph node involvement in patients with thoracic esophageal carcinoma is the major determinant of prognosis and survival. Extended lymphatic dissection provides higher disease-free and overall survival rates and our study revealed the highest survival rate for thoracic esophageal carcinoma, to best of our knowledge.

Many antineoplastic agents alter the reduced glutathione (GSH) status of liver and tumor tissue by inhibiting cellular GSH-linked enzymes. Thus, intracellular GSH plays an important role in a wide variety of antineoplastic interventions regarding therapeutic efficacy and toxicity. Mean GSH values were 0.791 +/- 0.072 mg/m wet weight (ww) and 0.719 +/- 0.047 mg/g ww in gastric cancer tissue and nontumorous glandular mucosa, respectively. Whereas, the average GSH level of normal gastric mucosa was 1.709 +/- 0.135 mg/g, the mean GSH level of normal liver biopsies was 2.378 +/- 0.260 mg/g. The GSH values of normal liver tissue were higher than the hepatocellular GSH concentrations of patients with gastric adenocarcinoma and of another group of tumor-bearing patients who had received chemotherapy preoperatively. These results suggest that the GSH levels of tumor and liver may influence the efficacy and/or toxicity of chemotherapeutic agents.