Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

PURPOSE: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.METHODS: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.RESULTS: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.CONCLUSION: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Inferior vena cava reconstruction by gallbladder patch: An experimental design

Objective: To evaluate the efficacy of the gallbladder for reconstruction of the inferior vena cava in a canine model

Methods: The experimental study was conducted on 5 dogs; an oval window with a diameter of [4×1 cm] was made in the inferior vena cava and then repaired using the autologous gallbladder patch with preservation of gallbladder function. The patency and functionality of the graft were assessed macroscopically and microscopically at 2 months postoperatively

Results: All the dogs were euthanized at 2 months, showing excellent patency of the vena cava macroscopically. In the microscopic examination, all the patches were completely endothelialized. No evidence of infection and inflammation and thrombosis was noted

Conclusion: The gallbladder patch is an available and safe alternate for reconstruction of the inferior vena cava at least in animal model. However, further well designed prospective studies are needed to confirm this hypothesis

Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems

PURPOSE: Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population. METHODS: We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined. RESULTS: The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores. CONCLUSION: The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.

Incidentally Solitary, Synchronous, Metastatic Left Adrenal Mass From Colon Cancer

The authors report the case of a 63-year-old man who underwent an open adrenalectomy for a synchronous, malignant, metastatic left adrenal tumor and a total colectomy for T3N0M1 (stage 4) primary, malignant colon cancer. Two polypoid lesions, one measuring 40 mm × 30 mm × 30 mm and the other measuring 20 mm × 10 mm × 10 mm, were found in the ascending colon and rectosigmoid (RS) junction, respectively, and a synchronous, malignant, left adrenal gland lesion measuring 70 mm × 50 mm × 30 mm was incidentally found on abdominal computed tomography scan. Histological examination revealed a metastatic, necrotic adenocarcinoma of the left adrenal mass, an adenocarcinoma of the cecal mass, and an adenomatous polyp (tubulovillous type) of the smallest polypoid lesion in RS junction that had invaded deeply into the submucosal layer. The patient recovered uneventfully, and his condition is now stable, with no evidence of local recurrence or metastatic disease, 2 years after the surgery. To the best of our knowledge, only 25 cases of an adrenalectomy for treating metastatic adrenal gland tumors have been reported to date; physicians should be aware of the possibility of this event.

Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial

PURPOSE: Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. METHODS: This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. RESULTS: Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). CONCLUSION: After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.

Late Presentation of Anal Canal Duplication in Adults: A Series of Four Rare Cases

Anal canal duplication (ACD) is a very rare condition, especially in adults. Four cases in adults are reported. In three cases, the orifice of duplication was located behind the native anus, and in one case, it was located anteriorly. In all cases, no communication between the anal canal and the tract of duplication was noted. Complete removals of the duplications were done through a perineal approach. Histology showed fibro-muscular tissue lined with a squamous epithelium. The postoperative courses were uneventful.

Outcome of AO external fixator for open tibial fractures

The purpose of the study was to evaluate the outcome of open tibial shaft fiactures [Gustilo IIWB] with A0 External Fixator and to document complications. Perspective study. This study was conducted at DHQ teaching Hospital, Gujranwala and at Fazil Memorial Hospital, Gujranwala from November 2010 to November 2012. 50 patients with open tibial shaft fractures were treated with AO External Fixator. Open fractures were classified according to Gustilo Anderson Criteria and wounds with EIA and IIIB were selected. Outcome was determined by the rate of union, while nonunion, pin tract infection, pin loosening and osteomylitis were recorded as complications. The follow up period was 08 months. Out of fifty cases of open tibial shaft fractures, 38 [76%] were men and 12 [24%] were Ladies. Mean age was 35.2 [8-67], 22 [44%] had Gustilo IIIB wound while 28 [56%] had Gustilo IIIA injuries. Pin tract infection and pin loosening rate were 12% and 16% respectively. Nonunion was seen in 10% of the cases. In 41 [82%] of the cases fracture united and average union time was about 26.5 weeks. No case of osteomylitis seen. External Fixator is simple and effective treatment for open tibial fractures

Epoxidationof ferutinin by different fungi and antibacterial activity of its metabolite

Structural transformation of the sesquiterpene ester, ferutinin [1], by suspended fungal cultures of Aspergillus niger, Rhizopus stolonifer, and Fusarium lini, resulted in the formation of a metabolite. This metabolite was identified as ferutinin alpha-epoxide [2], by different spectroscopic techniques. Metabolite 2 showed a good antibacterial activity against Staphylococcus aureuscompared to ferutinin [1]

Fascioliasis - a cause of obstructive jaundice: a case report

A rare case of obstructive Jaundice in a 35 yrs old male from Afghanistan is presented with recurring attacks of upper abdominal pain and jaundice. Ultrasound examination revealed multiple gallstones with' dilated common bile duct. During exploration of common bile duct, five leaf like liver flukes [Fasciola Hepatica] were recovered and identified. Patient was treated with Albendazole and had an uneventful recovery. Biliary fascioliasis should be considered in the differential diagnosis of obstructive jaundice

[Typology of family parenting style [combination of maternal and paternal parenting styles] and its effect on male adolescents' anxiety and depression: a new approach to parenting]

Mothers and fathers are different in a variety of their parenting characteristics. The different combinations of maternal and paternal parenting styles are related to their adjustment, mental health and psycho-social development in adolescence. This study was conducted to evaluate the effect of combinations of mothers' and fathers' parenting styles on anxiety and depression in adolescents. Three hundred fifty six male students from governmental high schools in Isfahan [2009] were selected by cluster multistage sampling method. They fulfilled parenting style questionnaire, Beck anxiety inventory and Beck depression inventory. Parenting typology of families classified according to combination of maternal and paternal parenting styles and adolescents' depression and anxiety levels in different types were compared by ANOVAs regression analysis and Schefe's test. Findings of this study suggest that adolescents achieve the most positive outcomes when they have at least one authoritative parent or two indulgent parents [P<0/001], and worst outcomes when they are reared by both uninvolved parents [P<0/001], and in types with one uninvolved parent, mother's uninvolvement has more negative outcomes [P<0/001]. Low amounts of anxiety and depression are outcomes of high levels of warmth and control of both or at least one of the parents and/or congruency in maternal and paternal parenting styles. Low levels of warmth and control or incongruence in mother and father parenting had worst outcomes

Etiology, presentation and managment outcome of pneumothorax

This study was carried to determine etiology, presentation, complications and management outcomes of pneumothorax in patients presenting at two hospitals in NWFP province of Pakistan. Pneumothorax patients reporting at the chest unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, and Pulmonology unit of Ayub Teaching Hospital, Abbottabad from 1999 to 2002 were included in the study. Patients of all ages were included. They were admitted and followed up to the full recovery/late complications. A total of 146 pneumothorax patients reported during this period. Majority of the patients were diagnosed to have pneumothorax due to pulmonary tuberculosis making about 36.30%] of the total cases. Second most common cause was primary spontaneous pneumothorax [19.86%]. Bacterial infections were also sizeable at 16.43%. Other causes included COPD, Asthma, latrogenic, Interstitial lung disease, tuberous sclerosis and bronchiectasis. It was concluded from this study that pulmonary tuberculosis is the commonest cause of pneumothorax in our setup

Surgical treatment of spinal arachnoid cyst

Four patients with arachnoid cysts of the spine ages between 14 to 40 years were treated surgically during the last 5 years in the Department of Neurosurgery. Lahore General Hospital, Lahore. Three were extradural and one intradural; three were located in the dorsal region, and one in the cervical region. Male / Female ratio was 3:1. Postoperatively, the patients made a smooth rapid recovery and no recurrence has been noted in follow up which ranges from 3 months to 5 years