Treatment of pilonidal disease with laser epilation.

Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.

Hemodialysis access operations performed upon patients with human immunodeficiency virus.

Hemodialysis in known patients infected with human immunodeficiency virus (HIV) has been a subject of controversy. During a 60 month period, 28 hemodialysis access operations were performed upon 22 HIV infected patients. The indication for all procedures was need of dialysis access secondary to end-stage renal failure (ESRF). Operations included 24 arteriovenous dialysis grafts and four Cimino arteriovenous fistulas. All patients had a diagnosis of acquired immunodeficiency syndrome (AIDS) (five), AIDS related complex (six) or were HIV-positive (11) at the time of the operations. All of these patients were intravenous drug abusers. Follow-up study ranged from nine days to 13 months. During the course of this study, two patients died of the progression of AIDS for a mortality rate of 9 per cent. There were nine perioperative complications for a rate of 32 per cent. These results led us to conclude that hemodialysis access operations have application in HIV infected patients with ESRF, and hemodialysis should be considered an appropriate modality in those patients requiring long term dialysis.

Abdominal pain and anorectal disease in AIDS.

The diagnosis and treatment of abdominal pain and anorectal disease in AIDS patients are discussed. Emphasis is placed on the practical aspects of patient care.

Improved subclavian cannulation technique.

An improved subclavian cannulation technique using a 3 milliliter syringe attached to a No. 16 gauge needle and a guide wire is presented. Major complications, such as air embolism, vein laceration and retained catheter fragments, are eliminated by using this method of catheterization.

Improved house staff results with subclavian cannulation.

In the teaching hospital, insertion of subclavian lines is frequently the responsibility of the House Staff. This paper reviews 225 subclavian cannulations by the Surgical House Staff of St. Barnabas Medical Center over an eight-month period. Twenty-six complications were documented. The major complication rate was 1.8 per cent and minor complications, 9.8 per cent. No correlation could be found between age, sex, or side of the catheter insertion with regard to complications. The overall complication rate was highest in the postgraduate year I (PGY) and PGY II levels, and this decreased with the more experienced residents. These results were statistically significant (P less than 0.05). The literature is reviewed, and recommendations concerning subclavian cannulation techniques are made.

Subclavian cannulation. Valuable dialysis access alternative.

The subclavian vein was used for temporary dialysis access in 67 patients. There were 733 dialysis treatments performed using a total of 87 catheters during the study period. The catheters were left in place for an average of 24.5 days per patient and 18.9 days per catheter. A mean of 10.9 dialysis treatments per patient, and 8.4 dialysis treatments per catheter were performed. Seven patients expired with their catheters indwelling. None of these deaths were related to the catheter. There were 21 associated catheter complications. Twelve of these catheter complications were corrected by changing the catheter over a guide wire. The technique for catheter insertion, proper catheter care including home care, and complications due to the catheters are discussed. Subclavian catheter dialysis access appears to be a valuable adjunct for dialysis and has replaced the use of Scribner shunts and repeated femoral catheterizations for temporary access in our institution.