Primary invasive aspergillosis of the hand.

Primary invasive aspergillosis of the hand is an unusual manifestation of an opportunistic fungal infection that affects children who receive induction chemotherapy for acute leukemia. The surgeon should maintain a high index of suspicion when evaluating even the most innocuousappearing hand lesion in an immunocompromised patient. Early diagnosis, intravenous amphotericin B, and radical surgical debridement may prevent angioinvasion and subsequent fatal widespread dissemination.

Surgical management of massive perianal hidradenitis suppurativa.

Hidradenitis suppurativa of the perineum and buttocks is a devastating disease often causing patients years of pain, discomfort, and eventual social isolation. The chronic form of the disease results from a lack of aggressive surgical intervention when the patient is first seen. It is characterized by a malodorous drainage from multiple sinus tracts encased in marked scarred and fibrotic tissue. In contrast to axillary involvement, the perianal form of hidradenitis suppurativa is associated with an increased frequency of anemia, fistulous communications with bowel and urinary tract, and the development of carcinomas. Several cases illustrating the debilitating nature of the disease and its optimal management are presented. This report illustrates that (1) a well-planned preoperative and postoperative bowel regimen can eliminate the need for a diverting colostomy, even in the most extensive forms of perianal disease, (2) radical excision is expedited and blood loss is minimized by the use of a Shaw hot knife (Oximetrix, Mountain View, CA), (3) the quilted application of meshed split-thickness skin grafts as a primary procedure provides rapid closure of the surgical defect and minimizes patient discomfort, and (4) aggressive surgical intervention in severe cases provides a chance for a rapid recovery from this crippling disease.

A simple technique for securing a loop colostomy.

The common methods used to stabilize a loop colostomy can be fraught with patient dissatisfaction. Presented is an effective and convenient means of securing a loop colostomy by use of a skin bridge fixed by a single heavy suture.

Hypothyroidism following removal of a "thyroglossal duct cyst".

This case demonstrates how a midline ectopic thyroid gland can be misdiagnosed as a thyroglossal duct cyst. Awareness of this clinical entity is critical if the diagnosis is to be made preoperatively. Thyroid function tests and a 99mTc or 123I scintiscan of the neck should be performed when evaluating a patient with a midline anterior cervical mass. Although thyroid replacement will often cause regression of the enlarged ectopic thyroid gland, surgical intervention is required if a solid mass persists. When an ectopic thyroid gland has been excised and is subsequently found to be the child's only thyroid tissue, thyroid replacement is necessary. If biopsy of the mass established the diagnosis at the time of surgery, effective treatment consists of longitudinally dividing the tissue and placing each half laterally beneath the strap muscles. When this is done, long-term follow-up and periodic thyroid function tests are advised. If this tissue should become hypoactive, thyroid replacement is then required.