[Treatment of pilonidal disease with midline excision and primary repair]

Pilonidal sinus is a common disorder of the sacrococcygeal region, optimal treatment remain controversial and recent reports have advocated different surgical approaches. A prospective study was performed on 103 patients with non recurrent and without complication sinus; excision with primary closure was performed on all patients. Patients were subdivided into 2 groups; in group A the excision and repaired associated with overtie bandage; in group B the wound was not overtie bandage. Excision with primary closure and overtie bandage was perform in 53 patients. Overtie bandage omitted in so patients; minor wound complication occurred in 3 patients in A and in 36 patients in B. No complete dehiscence of the wound was observed in patient in group A and in 8 patient in group B. Complete healing was fastest in group A. recurrence occurred in 1 patient in group A and in 2 patient in group B. Short and long term result suggest that midline excision with primary closure and overtie bandage in patients with BMI < 35 is a simple and effective procedure in the surgical treatment of uncomplicated ps

Report of four cases of rhinocerebral mucormycosis in Loghman hospital in 1388

Rhinocerebral mucormycosis is an aggressive fungal disease that involves the nose, paranasal sinuses, orbit and central nervous system. It may rapidly be fatal. This infection usually occurs secondary to immune suppression, diabetic ketoacidosis, and prolonged use of antibiotics, steroids, and cytotoxic drugs. Management of the condition consists of treatment of the underlying disease and surgical debridement combined with intravenous amphotericin-B. We presented 4 cases of rhinocerebral mucormycosis with same presentation. They presented with coryza, erythema and swelling of periorbital area several days before admission. Symptoms progressed quickly and ptosis and chemosis developed. Paranasal CT scan showed opacification in ethmoid, frontal and maxillary sinuses. Diagnostic endoscope showed necrosis in orbit and nasal root. Orbital exenteration, necrotic tissue debridment was done. Smear of necrotic tissue showed branching nonseptated mycelium in favor of mucoral. Culture of necrotis tissue showed rhizopus. Amphotericin-B started for all the patients. Two patients expired in spit of extensive surgical debridment and medical therapy and two survived. The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome