[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

[Seroepidemiology of HIV, syphilis, hepatitis B and C in intravenous drug users at Loghman Hakim hospital]

Intravenous drug using is a main risk factor for getting infected with HIV, Hepatitis B and C viruses. The syphilis is a common infection. The aim of this study was to investigate the seroepidemiology of HIV, syphilis, hepatitis B and C among the intravenous drug users [IDUs] at Loghman Hakim hospital, Tehran. A descriptive [cross- sectional] study with observative-interview technique was conducted. 70 admitted IDUs patients in Loghman Hakim hospital during July- December 2007 were included in this study. The patients with mean of age 34.4 +/- 9.6 and mean of oral drug 66.15 +/- 82.5 months, mean of intravenous drug 48.94 +/- 48.46 months, mean of inhalation drug 87.05 +/- 84.14 months were studied. 74.5% of the patients had been in prison and 11.5% of them shared syringe. The positive results obtained for the serological tests of 70 patients were in the following order: Anti- HCV [36%], Anti-HIV [30%], HBsAb [11.5%] and HBsAg [6%]. None of the patients was positive in RPR test. There was no significant correlations between the routes of using drug, history in prison and results of serology. Importantly, a significant correlation was found between the sharing syringe and positivity for Anti-HCV by itself or co-infection of HCV with HIV. HCV is the most common infection among the intravenous drug users followed by HIV and Hepatitis B. A lack of RPR shows infection with syphilis is under control