ABSTRACT
INTRODUCTION: Hidradenitis suppurativa is a chronic, recurrent inflammatory disease causing significant changes and damage to skin. Predilection sites are the axilla and the anogenital region. Chronic and severe forms of the diseases may cause both physical and psychological injury to the patient. PATIENTS: We present the cases of two female patients with severe hidradenitis suppurativa in the axillae and in the anogenital region. The patients had been unsuccessfully treated for eight and four years respectively with antibiotics and by limited surgery. Different methods of closing the defects following radical surgical excision (local flap reconstruction, healing by granulation) had to be used with respect to the extent of the disease and the site of involved skin. CONCLUSION: Radical wide excision of the skin area involved is the only appropriate surgical procedure which prevents recurrence of the disease. Selection of the therapeutic method must be done very carefully with respect to the individual characteristics of the disease and the patients attitude to therapy.
Subject(s)
Hidradenitis Suppurativa/diagnosis , Plastic Surgery Procedures/methods , Surgical Flaps , Adult , Axilla/surgery , Female , Hidradenitis Suppurativa/surgery , Humans , Middle Aged , Severity of Illness IndexABSTRACT
INTRODUCTION: Primary hyperparathyroidism (pHPT) is a general calcium, phosphate and bone metabolism malfunction due to increased secretion of the parathyroid hormone over a substantial period of time. Causal treatment is a surgical procedure - parathyroidectomy. MATERIAL AND METHODS: A retrospective study of patients who underwent surgery was conducted in the department of surgery at the Atlas Hospital in Zlín between 2005 and 2011. In this period, 2555 patients were operated on for thyroid and parathyroid gland disease. 182 of these patients (7.1%) had hyperparathyroidism. There were 80 standard parathyroidectomies, 82 MIVAPs and 20 MIRPs (minimally invasive radio-guided parathyroidectomy). RESULTS: In the study, 82 patients were operated on using the MIVAP technique. 78 (95.1%) had a parathyroid adenoma, 2 (2.4%) had hyperplasia, 2 (2.4%) had a standard body. Using the MIVAP technique, 75 parathyroid gland adenomas were found in 72 patients, 3 patients (3.6%) had a double adenoma. Conversion was performed in 10 patients (12.2%). During standard revision, an adenoma was found intraparenchymatously in 4 cases (4.9%), in 2 cases the adenoma was removed during standard revision. There was no permanent NRL paresis. 4 patients (4.9%) experienced temporary NLR paresis, MIVAP was successful in 72 patients (87.8%), 6 adenomas were removed during conversion; currently, all these patients have normal levels of calcium and parathyroid hormone. No parathyroid gland adenoma was found in 2 patients (2.4%), nor was it removed using persistent pHPT. 2 patients (2.4%) with hyperplasia are being monitored for their borderline calcium and parathyroid hormone levels. CONCLUSION: MIVAP is a complex endoscopic technique which can achieve 90% success rate in patients with the location of a parathyroid gland adenoma confirmed both by ultrasound and MIBI scanning.