Treatment of pilonidal sinus by phenol application and factors affecting the recurrence.

BACKGROUND: Phenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods. METHODS: In this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined. RESULTS: The mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05). CONCLUSIONS: Injection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.

Diagnostic features and treatment modalities in solitary rectal ulcer syndrome.

Solitary rectal ulcer syndrome (SRUS) is a traumatic lesion of the anterior or circular rectal wall caused by straining due to functional disorders of defecation. Defecography, transrectal ultrasonography or anorectal manometry are suitable procedures that may be used to detect the causative disorder and should, therefore, be performed in patients with solitary rectal ulcer syndrome. Histopathological features of SRUS are characteristic and pathognomonic, nevertheless the endoscopic and clinical presentations may be confusing. The lesions may mimic other rectal pathologies and lead to wrong diagnosis. We retrospectively evaluated 34 patients with SRUS who had various treatments. Rectosigmoidoscopy, defecography, transrectal ultrasonography and anorectal manometry were performed for evaluation of cases. The operative management was rectopexy in 26 patients, rectal mucosectomy in 4 patients, segmental colonic resection in 2 patients, local excision in 1 patient and colostomy in 1 patient. Total regression and healing of the ulcer occurred in 32 of 34 patients. Partial regression of symptoms in 2 patients, who underwent rectopexy and rectal mucosectomy, occurred, but we could not get complete healing.

The effect of hyperbaric oxygen treatment on oxidative stress in experimental acute necrotizing pancreatitis.

Various protocols may be used for acute pancreatitis treatment. Recently, the benefit of hyperbaric oxygen (HBO) has been demonstrated. To clarify the mechanism of HBO on the process of the acute pancreatitis, we determined the levels of antioxidant enzymes in an acute pancreatitis model. Forty-five Sprague-Dawley rats were randomly divided into three groups: Group I: sham group (n=15), Group II: pancreatitis group (n=15), Group III: pancreatitis group undergoing HBO therapy (n=15). HBO was applied postoperatively for 5 days, two sessions per day at 2.5 fold absolute atmospheric pressure (ATA) for 90 min. Superoxide dismutase (Cu/Zn-SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH Px) activity were measured in pancreatic tissue and erythrocyte lysate. MDA and GSH Px were also determined in plasma. In addition, amylase levels were measured in the serum. While serum amylase levels and MDA values in erythrocyte, plasma and pancreatic tissue were decreased, the levels of GSH Px and SOD were found to be significantly increased in the Group III as compared to those of the Group II. The findings of our study suggest that HBO has beneficial effects on the course of acute pancreatitis and this effect may occur through the antioxidant systems.

[Gastrointestinal hemorrhage due to traumatic superior mesenteric artery aneurysm (case report)]. / Travmatik süperior mezenterik arter anevrizmasina bagli gastrointestinal kanama (olgu sunumu).

We report the case of a 21-year-old male patient with superior mesenteric artery aneurysm due to missed arterial injuries, its complications of enteric fistula and results of surgical treatment. The aneurysm was excised, enteric fistula was closed and aorta-mesenteric bypass using saphenous vein graft was performed. The hemorrhage became masked because of the tamponade in the mesentery during penetrating abdominal injury and initial surgery, and the late complication of false aneurysm came on the scene in follow up. Aorta-mesenteric bypass by a transmesenteric approach provides successful result in surgical treatment of superior mesenteric artery aneurysm.

Hypoganglionic megacolon associated Chiliaditi's syndrome treated by subtotal colectomy: a case report.

In 1910, Chiliaditi described hepatodiaphragmatic interposition of the colon (Chiliaditi's syndrome). The condition is easily recognised on an antero-posterial chest radiograph. The interposed segment of bowel is usually the hepatic flexure of the colon. The degree of interposition varies from simple wedging to complete occupation of the right subdiaphragmatic space. The management is usually conservative and surgical intervention is rarely indicated. We present a patient with hepatodiaphragmatic interposition of the colon, associated with megacolon, requiring subtotal colectomy and ileosigmoid anastomosis for severe chronic constipation.

Surgical treatment of rectal prolapse. A retrospective analysis of 94 cases.

METHODS: A retrospective analysis evaluating 94 patients who underwent posterior rectopexy in 48 patients (51%), resection with or without rectopexy in 19 patients (20%) and Delorme's procedure in 27 patients (29%) was carried out for rectal prolapse in the last 15 years. The surgical procedures are described in detail. Postoperative evaluation was possible in all patients and mean observation time was 3.2 years. RESULTS: Mortality rate was zero. Recurrence was seen in 4 cases (4.2%), only after Delorme's procedures. The proportion of continent patients increased from 69.2% preoperatively to 91.6% postoperatively. Defecation difficulties and incomplete evacuation did not change beneficially after the surgery. Important postoperative complications, retrograde ejaculation and impotence were seen in 5 male patients (17.2) after posterior rectopexy, and were a major cause of dissatisfaction. CONCLUSIONS: In conclusion, Delorme's procedure, posterior rectopexy and resection procedures are effective surgical operations for treatment of rectal prolapse but extensive pelvic dissection during the posterior rectopexy may create serious sexual problems in male patients.

The results of surgical treatment and percutaneous drainage of hepatic hydatid disease.

BACKGROUND: Hydatid disease of the liver remains an important and challenging problem in rural areas. Although, surgery is considered the treatment of choice for hydatid disease of the liver, percutaneous drainage is an alternative treatment method for selected cases. The purpose of this study was to evaluate the results of percutaneous drainage and surgery. METHODS: A total of 66 patients underwent surgery; 36 cases had percutaneous drainage and were evaluated preoperatively for treatment choice according to localization, multiplicity, echographic type and size of the cysts in the liver. The patients were also evaluated postoperatively for systemic complications, e.g. fistula formation, infection of residual cyst, recurrence and hospitalization period for each group. RESULTS: Two groups, those with multiple cysts and cysts bigger than 5 cm, were treated by surgery. At the end of two treatment modalities, systemic complications, biliary fistulizations, recurrence and infection of cyst's cavity were seen more frequently in the surgery group and caused a longer hospital stay. CONCLUSIONS: Percutaneous drainage plus medical treatment can be successfully done for type I, type II and some selected type III hydatid cysts of the liver giving less complications, lower recurrence and shorter hospitalization periods. But, surgery is the primary treatment for big, multiple, complicated and recurrent hydatid cysts of the liver.