Conservative treatment of ingrown toenail

Ingrown toenail or onychocryptosis or unguis incarnates is a common health problem affecting generally young adults and result in a lot of discomfort and a significant morbidity. Though a variety of methods have been adopted including conservative treatment, nail excision and partial complete matrixectomy, but to date no ideal treatment exists. Although conservative management was first described in the eighteenth century and has been reported sporadically since, only a few doctors treat their patients in this way. There is, however, a distinct place for this highly effective, low cost method as the initial treatment of these patients without the need for hospital referral. The study was carried out on 25 patients with 29 ingrown toenails in whom there is over curvature of the nail plate as one of the etiological factors for that condition. The central portion of the nail is scrapped using a scalpel making it more pliable at edges and corners so could be lifted from heaped soft tissues over. After that the patients were instructed to cut their nail straight and to repeat the procedure of scrapping, they have been learned, when need supervenes. In patients not benefited from this simple technique wedge resection with phenol matrixectomy was performed for them. The patients' age ranged from 10 to 53 years with a mean age of 28 years In all patients it was the big toe that was affected. Four patients had bilateral ingrown toenail, so the sum was 29 ingrown toenails .Five patients of the twenty one with one toe affection did not satisfy by the conservative treatment and subjected to wedge excision and phenol matrixectomy. After 24 hrs, patients in whom conservative treatment was applied were able to move around. By the end of second week, they were able to attend to their normal work. Healing was complete by 4 weeks in the twenty patients. Success rate was 82.75% [24 of 29 ingrown toenails]. Conservative treatment is a worthy trial for patients with ingrown toe nail especially in the early stages of the disease in which the primary cause is increased curvature of the nail. Although it needs a highly cooperative patient, it is painless, requires no anesthesia and achieves a high success rate

Outcome of loupe assisted sub-inguinal varicocelectomy in infertile men

Sub-inguinal varicocelectomy has gained wide reputation among surgeons. The aim of this study was to evaluate outcome of varicocelectomy using a modified microsurgical method, specifically a loupe assisted one, and its effects on sperm parameters in infertile men. This study was carried out in 40 patients who presented with varicocele. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and confirmed with color Doppler ultrasound. Routine investigations as required preoperatively were done. Semen analysis and hormonal profile was also done and repeated postoperatively for follow up. Half of the patients [20 patients] were treated by subinguinal approach assisted with loupe magnification [Group-A] and the other half was treated by the same approach but without magnification [Group-B]. To facilitate the procedure, an x3.0 loupe was used during the spermatic cord dissection at the level of the external inguinal ring. During dissection, the dilated veins were ligated and divided including vassal veins and external spermatic veins. A total of 40 patients were followed up for more than 6 months. Age of the patients varied from 25 to 38 years [mean 32.5]. No intra-operative complications occurred in both groups. As regard post-operative complications, group [A] [loupe assisted] showed only one patient [5%] who developed scrotal hematoma and two [10%] developed wound infection, while in group [B] complication rate was higher, two cases [10%] developed scrotal hematoma, two cases [10%] developed wound infection, three cases [15%] developed hydrocele, two cases [10%] developed recurrence and two cases [10%] developed scrotal edema. As regard to seminal parameters there was much improvement in sperm count, sperm motility and decrease in abnormal forms after surgery with significant differences in Group A [patients treated with a modified microsurgical method] but in Group B [patients treated with sub-inguinal approach without loupe assistant] there was improvement in sperm count, sperm motility and decrease in abnormal forms but without significant differences. Loupe-assisted sub- inguinal varicocelectomy is a safe, simple, and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment and has significant improvement in sperm parameters