The clinical presentation of pilonidal sinus and selection of the appropriate minimally invasive approach. A retrospective evaluation of 5338 cases.

OBJECTIVE: Pilonidal Sinus is a considerably problematic disease due to its recurrences which tend to become chronic and are exacerbated by abscess formation. There is little consensus regarding treatment - most probably due to limited understanding of its pathophysiology and progression. Despite this, it is accepted that accurate identification of pathogenesis and the clinical grade of PS are crucial for the determination of surgical approach. METHOD: This study presents the surgical treatment techniques we employed for Pilonidal Sinus disease with retrospective analysis of management and follow-up data of 5338 outpatient cases from 16 years of practice. RESULTS: At the follow-up period of 16 years, recurrence was 12.5%. All recurrences were also treated with an individualized minimally invasive surgical approach, which was proportional to the clinical presentation. CONCLUSION: The importance of designing surgical technique according to the needs of the patient and the condition of the disease is clear. Our results with over 5000 patients indicate that effective treatment for PS is individualized minimally invasive surgery. KEY WORDS: Classification, Grade, Minimally invasive surgery, Pilonidal sinus, Pilonidal cyst.

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging.

OBJECTIVE: Diagnosis of axillary nodal involvement is significant in the management of breast cancer as well as in predicting prognosis. In this prospective study, we evaluated the efficiency of US-guided fine needle aspiration biopsy (FNAB) in preoperative axillary staging of early breast cancer. MATERIAL AND METHODS: Between January 2011 and July 2013, 46 women were prospectively enrolled in the study. Ultrasound guided-FNABs for axillary assessment were performed preoperatively. Cytology results were compared with histopathology reports to determine its sensitivity, specificity, negative and positive predictive value and accuracy. RESULTS: Nineteen cases that had malignant cytology on FNAB also had axillary involvement in axillary lymph node dissection (ALND) without any false-positive results. The sensitivity and specificity of US-guided FNAB were 63.3% and 100%, respectively. US-guided FNAB was accurate in predicting the status of the axilla in 76.1% of patients. CONCLUSION: Although this technique is favorable due to its minimally invasive nature, it is not as effective as sentinel lymph node biopsy (SLNB) in terms of detecting axillary metastasis preoperatively. The low sensitivity and low accuracy rates decrease the usefulness of the technique. Therefore, it seems that US-guided FNAB alone could not replace SLNB. Nevertheless, combining some other molecular studies may be useful in increasing the technique's sensitivity. These issues should be determined by comprehensive clinical trials.

Perforated double appendicitis: Horseshoe type.

Appendix vermiformis duplex is an infrequent malformation. However if it is missed out, there might be some complications and medicolegal troubles. A surgeon must be aware of any other appendix during appendectomy. Therefore, the possible locations and shapes described in the Cave-Wallbridge classification should be considered by the surgeon. In this case report, we present a patient with a horseshoe-type dupplication of appendix in a perforated appendicitis diagnosed during an emergency laparotomy.

Coefficient Estimates for New Subclasses of Meromorphic Bi-Univalent Functions.

We introduce and investigate two new subclasses ℳ σ (α, λ) and ℳ σ (ß, λ) of meromorphic bi-univalent functions defined on Δ = {z : z ∈ ℂ, 1 < |z | <∞}. For functions belonging to these classes, estimates on the initial coefficients are obtained.

Release of NT-pro brain natriuretic peptide in children before and after adenotonsillectomy.

OBJECTIVES: To measure serum B-type natriuretic peptide, especially N-terminal segment of its prohormone (NT-proBNP) and pulmonary arterial pressure levels and to determine whether NT-proBNP concentrations correlate with pulmonary arterial pressure levels in children before and after adenotonsillectomy. METHODS: Twenty children with adenoid and tonsil hypertrophy and 20 healthy subjects were included in the study. Transthoracic echocardiography was performed in all patients to assess pulmonary artery systolic and diastolic pressure with cardiac dysfunction. The NT-proBNP was analyzed for correlation with pulmonary artery pressure. RESULTS: Our results showed that prohormone serum concentrations and pulmonary arterial pressures were significantly higher in the study group than in the control group at the preoperative evaluation. A significant decrease was detected among patients after surgery (p<0.05). There was no significant difference between the study and control groups for prohormone serum concentration and pulmonary arterial pressure at the postoperative evaluation (p>0.05). CONCLUSION: We found increased serum prohormone levels and height pulmonary artery pressures in the children with adenoid and tonsil hypertrophy when comparing with healthy subjects. Our study supported that increased serum prohormone levels and pulmonary artery pressures as a result of adenoid and tonsil hypertrophy are reversible. Pediatric cardiologs and otolaryngologs should keep in mind an increased pulmonary artery pressure during management of children with adenoid and tonsil hypertrophy. Furthermore, Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of surgical outcome of children with adenoid and tonsil hypertrophy.

Giant papillary carcinoma arising in the ectopic buccal thyroid tissue.

BACKGROUND: Ectopic thyroid tissue very rarely occurs in the buccal region. Even more rarely encountered is the papillary carcinoma arising in the ectopic tissue. METHODS AND RESULTS: We herein present a 78-year-old female patient admitted with a giant, buccal mass that developed within the previous 2 years. Physical examination revealed a vegetative mass on the left buccal region without any cervical lymphadenopathy. Magnetic resonance imaging scan showed an 8- × 6-cm solid mass with cystic components in the left buccal region and thoracic computed tomography scanning revealed pulmonary metastasis. A successful surgery including lower lip splitting was performed, and the mass was totally excised with its surrounding capsule. Histopathologic examination revealed follicular variant of papillary carcinoma of the ectopic thyroid tissue. CONCLUSIONS: To our knowledge, our case is the first case of papillary carcinoma arising from ectopic thyroid tissue in the buccal region in the literature.

Coefficient estimates for initial Taylor-Maclaurin coefficients for a subclass of analytic and bi-univalent functions defined by Al-Oboudi differential operator.

We introduce and investigate an interesting subclass NP(λ,δ)(Σ) (n, ß; h) of analytic and bi-univalent functions in the open unit disk U. For functions belonging to the class NP(λ,δ)(Σ) (n, ß; h), we obtain estimates on the first two Taylor-Maclaurin coefficients |a2| and |a3|.

Cervical thymic cyst mimicking laryngocele.

Cervical thymic cysts are nearly 0.3% of all congenital cervical cysts. Thymic cysts are asymptomatic, but they rarely complain of dysphagia or tracheal obstruction symptoms. A soft, mobile, and painless mass increasing with valsalva maneuver directs the diagnosis of laryngocele. There has not been any study in the literature in which thymic cyst presenting like laryngocele. We hereby present a case of thymic cyst mimicking laryngocele that has not been reported so far.

Is the use of topical fluorescein helpful for management of CSF leakage?

OBJECTIVES/HYPOTHESIS: We aimed to evaluate the effectiveness of topical intranasal fluorescence application together with high-resolution computed tomography and magnetic resonance imaging and/or magnetic resonance cisternography for the preoperative diagnosis of cerebrospinal fluid (CSF) leakage and for intraoperative localization of CSF fistulas. We also assessed postoperative recurrence. STUDY DESIGN: Descriptive study. METHODS: Twenty-four cases underwent endonasal endoscopic repair for CSF leakage. Following intranasal topical application of fluorescein 10% to the middle turbinate-cribriform plate region and anterior wall of the sphenoid sinus, a color change of the fluorescein from yellow-brown to green was accepted as evidence of CSF leakage. A nasoseptal flap, collagen matrix, or fascia lata and septal cartilage graft were used for reconstruction of the CSF fistula. RESULTS: The use of topical fluorescein application was helpful in diagnosing CSF rhinorrhea preoperatively and locating the CSF fistula intraoperatively. One case had both ethmoid roof and sphenoid sinus defects, and this case underwent a second operation for closure of the sphenoid defect. All CSF leakages were successfully repaired by endoscopic endonasal surgery using a nasoseptal flap. CONCLUSIONS: Cases with traumatic CSF leakage pose a higher risk of meningitis than the cases with spontaneous CSF leakage. Topical application of fluorescein is highly specific and sensitive in identifying preoperative, intraoperative, and postoperative CSF leakage. It is a simple, quick, and sensitive technique. The surgeon should be vigilant for multiple defects.