Evaluation of Karydakis Technique for the management of chronic pilonidal sinus in obese patients

This study was conducted to evaluate Karydakis technique for the management of chronic pilonidal sinus in obese patients. The study included 40 patients divided according to their body mass index [BMI] into two groups: Group I included obese patients and Group II included non-obese patients. There was no significant difference between obese and non-obese patients regarding their clinical presentation in terms of symptoms, duration of the disease and number of sinus openings. It was concluded that Karydakis technique for management of chronic pilonidal sinus was easy to perform, had a fast healing time, short hospital stay and low recurrence rate. The results were similar between obese and non-obese patients with a BMI< 30.5 and no recurrence seen in these patients. Complications occurred in obese patients had a BMI > 30.5. In such patients, a dietary regimen before operation was advisable and inserting a suction drain during the operation was recommended to avoid seroma formation

Minimaly invasive therapy for localized infiltrating bladder cancer in comparison with radical cystectomy

Purpose: We analyzed the long-term results of aggressive transurethral resection plus intravesical B.C.G. for the treatment of patients with localized muscle infiltrating bladder cancer in comparison to radical cystectomy regarding its efficacy, recurrence rate, survival rate, quality of life and patient satisfaction. Patients and A total of 118 patients with locally invasive transitional cell carcinoma T2 and T3A were included in the study. Seventy two patients [group I] underwent radical cystectomy, while 46 patients [group II] treated by aggressive repeated iransurethral resection until negative biopsies of the muscle layer of the depth and periphery of the tumer bed were obtained. B.C. G. was intravesically instilled in single 6-week course [150 mg/ instillation] then monthly for one year. The avenge follow-up period of group I was 60.5 months [36 - 70] and for group II was 62 months [42 - 65]. Patients were evaluated postoperatively every 3 momhs for 2 years and then every 6 months thereafter by urine cytology, cystescopy, biopsy, ultrasonography and metastatic evaluation. A comparative non-randomized study was performed for both groups, At 5-years average follow-up, cause specific survival rates were 72.4%, 66.6%, 61.1% and 60% in group I according to the stage and grade of the tumer, while it was 68.8%, 66.4%, 58.3% and 50% in group II with no statistical significant differences [p > 0.05]. The recurrence rates ranged from 24.4% to 36.3% in group I according to the stage and grade of the tumor, while it was ranged from 26.3% to 50% in group II which an apparent increase in the recurrence rates in group II which was not significant. Bladder preservation in group II ranged from 78.9% to 66.6% at average 5-year follow-up postoperativelly. Aggressive repeated transurethral resection and B.C.G. intravesical instillation is justified when the tumor is clinically limited to the muscle layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. This modality of treatment is effective and comparable to radical cystectomy In some selected patients with small localized infiltrating transitional cell carcinoma stage T2, T3 A. moreover, it avoids the morbidity and change in quality of lif associated with radical cystectomy