Meges of Sidon: The "Most Learned" of Surgery's Founding Fathers.

This paper aims to bring back to life an underrated, even forgotten surgeon of the late first century B.C.E., Meges of Sidon. He was an experienced surgeon of his time and was considered the most erudite Roman surgeon before Galen. He belonged to the Alexandria School of Medicine and later migrated to Rome to practice. Although most of his work did not survive, he was mentioned by notable ancient figures, such as Celsus and Galen. He excelled in various surgical specialties, not limited to neurosurgery, orthopedics, ophthalmology, and urology. Galen cited Meges in his surgical book on head injuries and cranial procedures. Meges was known to have invented a "double-edged" blade that he used to remove stones from the neck of the bladder. His treatment of anal fistulas was a reference through the Middle Ages. Celsus, a Roman encyclopedist of the first century, would later erroneously receive credit for ancient surgical innovations, such as the nonslipping cranial drill and the treatment of depressed skull fractures, even though he was not a surgeon. However, as Celsus was going over the history of surgery, he described Meges as the "most learned" of its prominent figures. Meges' neurosurgic techniques and teachings are deduced from Celsus, who shortly succeeded him, did not practice surgery, and acknowledged him as his primary source on surgical topics.

Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico / Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry

Introducción: La enfermedad de Crohn (EC) perianal fistulizante es un fenotipo de mal pronóstico. No existen estudios en nuestro medio. Nuestro objetivo es determinar las características clínicas, sociodemográficas y el tratamiento de la EC perianal fistulizante en un registro multicéntrico colombiano. Materiales y métodos: Se realizó un estudio observacional multicéntrico, retrospectivo, con recolección prospectiva de la información, en los principales centros de referencia de enfermedad inflamatoria intestinal (EII) del país. Las variables continuas se expresaron como medianas y rangos intercuartílicos. Las variables de resultado categóricas fueron comparados por la prueba de Chi-cuadrado. Resultados: Se documentaron 65 pacientes con EC perianal fistulizante, con una mediana de edad de aparición de fistula perianal de 31,0 años (rango: 24-42), predominando en hombres (61,5%; razón H:M: 1,4:1). Las fístulas perianales complejas fueron más frecuentes que las simples (75,35 vs. 24,6%). En cuanto al tratamiento médico, el 66,2% de los pacientes recibieron antibióticos, el 64,6% esteroides, el 78,5% terapia biológica, el 47,7% setones no cortantes y el 46,2% requirieron manejo quirúrgico, diferente a la colocación de setones. En solo el 29,2% se logró remisión completa de la fístula, y el 9,2% de los pacientes terminaron en colostomía definitiva. Los pacientes con EC con fístulas complejas recibieron más terapia biológica comparado con pacientes con EC y fístulas simples (84,8 vs. 56,3%; p: 0,038). Conclusiones: La EC perianal fistulizante es de mal pronóstico en nuestro medio, solo 3 de cada 10 pacientes logran la remisión completa a pesar del tratamiento. Un manejo multidisciplinario es fundamental para el manejo integral de esta difícil enfermedad.(AU)

Introduction: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. Materials and methods: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. Results: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). Conclusions: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.(AU)

Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry. / Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico.

INTRODUCTION: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. MATERIALS AND METHODS: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. RESULTS: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). CONCLUSIONS: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.

Application of surgical removal and setons abscess drainage management in patients with moderate and severe acne inverse at gluteal and perianal area / 中华医学美学美容杂志

Objective:To investigate the application value and effect of surgical removal and setons abscess drainage in moderate and severe acne inverse.Methods:A retrospective case study of 4 patients (3 males and 1 female with an average of onset of 28 years) with acne inverse at gluteal and perianal area in the Qixia Traditioal Chinese Medical Hospital of Shandong province between June 2016 and August 2020, The operative technique was based on the complete excision of the entire diseased skin and subcutaneous fatty tissue, down to the muscular fascia. The cavity was explored using a probe, two setons were placed in each of the fistula tracts, and the wound were covered with absorptive dressing.Results:All the wounds in 4 patients healed primarily and showed no recurrence after surgery, execpt for one patient who did not take supine position in time after operation which resulted in more bleeding in a short time. The other patients recovered well. The patients were followed up for 6 months without affecting the anal skin function, skin lesions and recurrence.Conclusions:The technique of wide surgical excision and setons abscess drainage is an effective method for moderate and severe acne inverse.

Clinical effects of excision and setons drainage management in treatment of early and medium-term perifolliculitis capitis abscedenset suffodiens / 中华医学美学美容杂志

Objective:To investigate the surgical management of perifolliculitis capitis abscedenset (PCAS).Methods:From June 2015 to October 2018, 8 patients with PCAS were treated, aged 13-26 years, with an average age of 23 years. Hypepigmented plaques in size were from 0.5-4.0 cm. The operative technique was based on the complete excision of the entire diseased skin and subcutaneous fatty tissue, the fistula was explored using a probe, the seton was inserted through the remaining tract in a double-strand fashion, this double-strand elastic seton was then tied over itself without excessive tension. The wound was covered with absorptive dressing.Results:All the wounds in 8 patients healed primarily. All patients were followed up for 6 months and showed no recurrence after surgery.Conclusions:Perifolliculitis capitis abscedens et suffodiens scalp is a rare chronic suppurative skin disease, its etiology and pathogenesis are unclear, but related with follicular atresia, bacterial infection, immune factors, sex hormones, smoking and obesity. The treatment is difficult, including antibiotics, vitamin A acid, biological agents, photodynamic, laser and surgery. The disease is stubborn and refractory. The technique of wide surgical excision and loose setons drainage is an effective method for PCAS.

Historical Surgical Treatments in Polish Veterinary Medicine.

Several methods of surgical treatments have been used in the history of Polish veterinary medicine, many of which have now been forgotten. In the present study, a review was conducted of Polish-language veterinary medicine books published from the 16th century (when the first books in Polish were printed) to the 20th century. The article contains a description of the most popular surgical methods used in animal treatment in Poland over the centuries including, among others, bloodletting, setons, fonticulus and cauterization. This article reviews historical veterinary methods and traces the development of Polish veterinary medicine from ancient cures often based on humoral theory to a modern branch of biologic science.

The results of seton drainage combined with anti-TNFα therapy for anal fistula in Crohn's disease.

AIM: Combined infliximab and sphincter-sparing surgery can be effective in perianal fistula associated with Crohn's disease (CD). This study aimed to assess the efficacy of local surgery combined with infliximab on sustained fistula closure and to identify predictive factors for response after this combined treatment. METHOD: Between 2000 and 2010, 81 patients with fistulising perianal CD were included in this observational study. Drainage with a loose seton was followed by infliximab therapy. The primary end-points were the rate of complete fistula closure and time required for this to occur. RESULTS: The fistula was complex in 71 (88%) of the 81 patients. Local proctological surgery was carried out in 77 (95%), including seton drainage in 62 (80.5%) of these. This was continued for a median duration of 3.8 months and the patient then received infliximab therapy. The median follow-up after treatment was 64 months (2-263). Initial complete closure of the fistula occurred in 71 (88%) cases at a median interval of 12.4 months (1-147) from the start of treatment. Recurrence was observed in 29 (41%) patients at a median interval of 38.5 months (2-48) from the start of treatment. They were treated again with combined treatment with successful closure in 19 (65.5%) patients. The total rate of closure of the fistula was 75.3%. Female gender, anal stenosis, rectovaginal and complex fistula formation were factors independently associated with failure of combined treatment. CONCLUSION: Seton drainage for several months combined with infliximab therapy is effective in closing the fistula in 75% of patients with complex perianal fistula formation associated with CD.

Partial fistulotomy and multiple setons in high anal fistulae.

Setons are employed in high perianal fistulae. Our study aimed to use multiple setons in addition to a partial fistulotomy in high perianal fistulae involving the sphincter complex to combine the effects of cutting and drainage of the fistulous tract. This prospective study included 16 patients over a period of 4 years who presented with high perianal fistulae. The internal opening was identified and tract laid open till the dentate line. Four prolene threads were passed along the remainder of the tract and taken out through the external opening. One was tied tightly while the others were tightened every 7 days. No patients developed major faecal incontinence. Fistula recurred in one patient within a year and one patient had occasional incontinence to flatus. Multiple setons after partial fistulotomy is an effective treatment for high anal fistulae with low incidence of incontinence and recurrence and adequate patient satisfaction.