Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate.

BACKGROUND: Treatment of pilonidal sinus disease is controversial. Many claim policy of marsupialisation and healing by secondary intention. This is demanding in terms of nursing care and time lost from work. AIMS: To examine outcome of excision and primary closure of chronic pilonidal disease on recurrence rate and patient's daily activities. PATIENTS AND METHODS: One hundred and fourteen consecutive elective patients who had excision and primary closure of pilonidal sinus disease were reviewed. The demographic data and the post-operative outcome were studied. RESULTS: The recurrence of pilonidal sinus was noted in 9% of patients, wound breakdown occasioning delayed healing in 9%, patients able to drive by day 16 on average. The mean time to return to work was 20.5 days; duration of analgesia, 2.4 days; and duration of antibiotic treatment, 4.7 days. CONCLUSION: Excision and primary closure of chronic pilonidal sinus has low recurrence rate with early return to activities. Primary closure appears to be a cost-effective option for uncomplicated pilonidal sinus disease.

Collins' sign: validation of a clinical sign in cholelithiasis.

BACKGROUND: Cholelithiasis typically presents with right upper quadrant pain, as can pain from other right upper quadrant organs. Pain of cholelithiasis is often referred to tip of scapula. Professor Paddy Collins drew attention to fact that patients with gallstone pain would attempt to demonstrate this by placing their hand behind the back and thumb pointing upwards. This became known amongst his students as Collins' sign. AIM: To evaluate accuracy of Collins' sign as indicator of cholelithiasis. PATIENTS AND METHODS: Case-control study performed on 202 patients with symptomatic cholelithiasis and 200 control patients (with oesophagitis, gastritis or duodenal ulcer). Questionnaire examined pain pattern in both groups. The results analysed using t test and χ(2) test. RESULTS: Collins' sign was positive in 51.5% of gallstone patients and 7.5% of control group (P < 0.001). CONCLUSIONS: Collins' sign was positive in over half of all patients with cholelithiasis and was useful discriminator in diagnosis of gallstones.

Antipyretic studies on some indigenous Pakistani medicinal plants: II.

Eight Pakistani medicinal plants were investigated for antipyretic activity in rabbits receiving subcutaneous yeast injections. Hexane- and chloroform-soluble extracts of Aconitum napellus stems, Corchorus depressus whole plant and Gmelina asiatica roots exhibited prominent oral antipyretic activity while insignificant antipyretic effects were found in the hexane- and chloroform-soluble portions of Melia azadirachta seeds, Tinospora cordifolia stems and Vitex trifolia seeds. No antipyretic actions whatsoever were produced by extracts of A. heterophyllum roots and Hedysarum alhagi aerial parts. Toxicity studies revealed no noteworthy toxic or adverse effects for any of the above plant extracts up to the highest oral doses of 1.6 g/kg except in the case of A. napellus.

Antipyretic studies on some indigenous Pakistani medicinal plants.

Significant oral antipyretic activity in rabbits was exhibited by hexane-, chloroform- and water-soluble extracts of Artemisia absinthium, Viola odorata, Melia azadirachta and Fumaria parviflora comparable in potency aspirin. Pyresis was induced by subcutaneous yeast injections. Antipyretic activity was more prominent in the hexane-soluble portions of these plants. Insignificant to no antipyretic effects were produced by extracts of Butea frondosa, Berberis lycium and Sisymbrium irio. No obvious toxic effects were noted for any of the plant extracts up to doses of 1.6 g/kg.