Background: Pilonidal sinus disease is a chronic condition of adolescents and young adults and is rare after the age of 40 years with a reported incidence rate of 26/10.000 people per year. Over the years many surgical approaches have been proposed but to date an ideal treatment has not yet been developed. The aim of this prospective observational study was to evaluate the short and long-term results obtained with this minimally surgical trephine technique for the treatment of pilonidal disease. Material and Methods: From November 2017 to November 2019 we treated 70 consecutive patients with minimally trephines technique. All patients were evaluated in terms of operation time, perioperative and postoperative complications, postoperative pain, patient satisfaction and recurrence at 6 months. Results: We prospectly observed 49 males and 21 females with an average age of 27.86 years (range: 17-36), finding a low operative time, a high cure rate (95.71%) and a low recurrence rate (4.28%). Differently from the Gips technique we suture the trephine-made openings, and this in our opinion reduces even more the healing time (19.14 days). Conclusion: Trephine operation is a simple outpatient approach for treating pilonidal sinus disease, with quick recovery, and appealing aesthetic outcome. Patients undergoing minimal excision with trephines had reduced number of sick days, shorter time to activity and fewer days requiring analgesia, and in cases of recurrence, the same treatment can be repeated as needed.

Background: We investigated the prognostic value of tumor size (TS) and tumor ratio (TMR) (length of bowel resected/tumor size) in patients with colorectal cancer (CRC). Material and Method: A total of 332 patients operated for stage 1-3 CRC between 2012 and 2017 were investigated retrospectively. Age, tumor location, operation type, pathological features of the tumor, lymph node ratio (LNR), TS, length of bowel resected, TMR , number of pathological lymph nodes removed (Np), overall survival (OS) were recorded for each case and analyzed by SPSS program. Results: Age, Np, and LNR were found to be effective factors on survival (p 0.05) . Conclusion: TS and TMR had no significant role in survival, whereas TS, length of bowel resected, N positivity, LNR, operation type were found to be effective factors in terms of survival. A correlation was observed between TS and T, N2 lymph node involvement and tumor stage.

Background Fecal peritonitis is caused by bacterial contamination from fecal material in a perforation of the bowel. A surgical approach is still a cornerstone in fecal peritonitis management, which includes the control and alleviation of the infection source. It has been controversial, over the years, whether peritoneal lavage, with or without antibiotics, is an essential step in the management of fecal peritonitis.Methods (Study A and Study B) Study A contained a total of 15 healthy Sprague-Dawley rats that were randomly divided into three groups. Cecal ligation and puncture were performed on all groups to establish sever fecal peritonitis. After a six-hour period, relaparotomy was performed, and swab cultures were taken before and after peritoneal lavage. The peritoneum was lavaged with normal saline 0.9% in Group A, with gentamicin in Group B, and with gentamicin and clindamycin in Group C. None of the groups was given any intramuscular or intravenous antibiotics.Study B contained a total of 20 healthy Sprague-Dawley rats that were randomly divided into four groups. The cecum was ligated, and punctures were performed with an 18-gauge needle through the ligated cecum. After a six-hour period, the rats were re-anesthetized for a relaparotomy, and the punctured cecum was resected, followed by peritoneal lavage. Group A was treated with a normal saline peritoneal lavage. Group B was treated with antibiotic (gentamicin and clindamycin) peritoneal lavage. Group C was treated with antibiotic (gentamicin and clindamycin) peritoneal lavage and an intramuscular (IM) antibiotic (Rocephin) injection. Group D was treated with a normal saline peritoneal lavage and an IM antibiotic (Rocephin) injection.Results The microbiological examination results of the pre- and post-lavage cultures in Study A revealed no change in bacterial colonization in Group A, whereas there was a significant reduction of bacterial contamination in Group B and no growth of bacteria in Group C. However, the mortality rate of all groups was 100% within 24 to 48 hours.In Study B, the mortality rate of Group A was 5/5 (100%). The use of normal saline in a peritoneal lavage did not affect mortality. The use of antibiotic peritoneal lavage had some effect on mortality rate, as the mortality rate of Group B was 2/5 (40%). There was a significant effect upon mortality rate when combining IM injection and antibiotic peritoneal lavage, such that all rats in Group C survived the procedure (0/5; 0%). Group D had results similar to those of Group C, with a 0% mortality rate.Conclusion Peritoneal lavage with intraperitoneal gentamicin and clindamycin can reduce the bacterial contamination caused by bowel perforation. This study showed that antibiotic peritoneal lavage alone reduces mortality rate when compared to a normal saline peritoneal lavage. However, systemic antibiotics in the management of fecal peritonitis are still superior to intraperitoneal antibiotics used in addition to a peritoneal lavage. Further studies are needed to investigate peritoneal lavage with antibiotics.

Background: Violence towards healthcare staff occurs most commonly in emergency rooms. The purpose of this study is to answer the question what the source of violence against healthcare staff in emergency is rooms and evaluate the role of good communication on preventing violence. Material and Methods: This is a survey research involving 320 subjects which were selected randomly. It was performed in the Emergency Room of a Teaching and Research Hospital. One study subgroup involved patients and the family members (n: 160), and second subgroup involved the healthcare staff (n: 160). Results: The rate of verbal and/or physical offenses that healthcare staff was opposed was 77.5%. There was no significant difference between two groups in terms of communication skill, and their views regarding work environment of the healthcare staff. High level of education of healthcare staff showed a high level of correlation with positive perception of social relation by patients/patients’ relatives. An attempt to communicate mutually resulted in a positive manner between two groups. Among healthcare staff there was no statistical significance in terms of whether they were exposed to violence according to both communication skills (greeting and addressing patient/patient’s relatives by their first name; p: 0.625 and 0.505, respectively). Among patient/patient’s relatives there was no statistical significance in terms of whether they had quarrel with healthcare staff according to both communication skills (greeting healthcare staff and knowing healthcare staff identity; p: 0.417 and 0.189, respectively). Conclusion: There is no doubt that good communication result in a positive manner between healthcare staff and patient/patient’s relatives. Hence, significance of communication training should be emphasized. However, good communication alone is not enough on preventing violence. There must be more to do on preventing violence.

Background and aim : The gag reflex has been a hindrance for instrumentation of pharyngeal area. Hence a better method to reduce the gag reflex is investigated. This study aimed to look at the feasibility of chewing lignocaine soaked gauze to reduce gag reflex besides identifying the optimum dosage of lignocaine.Patients and method: This is phase two, 3 arms, double-blinded, randomized control trial where participants were divided into three groups that received either gauze soaked with 160 mg or 320 mg lignocaine or with water base on computer-generated block randomization and were assessed by two assessors at the end of 3 minutes.Result: 30 participants were recruited and divided into three groups with 1:1:1 ratio according to block randomization. Gag reflex reduction was seen highest in group B (M = 2.3, SD = 0.67) and no statistically significant changes in the control group (p = 0.343, 95% CI = -0.126, 0.326). Significant difference in gag reflex score were seen between group A and B with group C (p = 0.000, 95% CI = -2.90, 1.30) and (p = 0.000, 95% CI = -2.70, -1.10) respectively. There was no significant difference between group A and group B (p = 1.00, 95% CI = -1.00, 0.60). No difference were seen in vital signs for all groups during the study.Conclusion: Chewing lignocaine soaked gauze is a feasible method to reduce gag reflex and 320 mg lignocaine is not superior to 160 mg of lignocaine in gag reflex reduction.

Background: Acute appendicitis (AA) remains the most common emergent abdominal pathology and appendectomy is the most often operation in children. The routine placement of a surgical drain to prevent intraabdominal abscess (IAA) after an appendectomy for complicated appendicitis is controversial and has been questioned.Aim of this study was to compare the results after laparoscopic appendectomy (LA) in cases of complicated acute appendicitis with and without abdominal drainage.Material and Methods: From January 2009 to December 2018, all charts of consecutive patients who underwent LA were revised. All patients with complicated AA were divided into two groups: the group without drains (123 patients) and the group (71 patients) with the applying of abdominal drainage. Both groups were compared by the postoperative outcomes: duration of antibiotic use and paralytic ileus, timing of oral refeeding, length of hospital stay, and complications, such as wound infection, IAA and early bowel obstruction.Results: The complicated AA was noted in 194 patients. The duration of postoperative ileus, time of refeeding, and length of hospital stay was longer in drainage group. The rate of all postoperative complications in both groups of patients had no significant statistical difference.Conclusion: The prophylactic use of abdominal drainage after laparoscopic appendectomy for complicated appendicitis in children does not prevent postoperative complications and associated with the prolonged paralytic ileus and length of hospital stay. The abdominal drainage may increase time of antibiotic treatment and refeeding. Combination of all these factors tilts the risk-benefit balance in favor to abandoning abdominal drains in pediatric appendicitis except cases of generalized peritonitis. However, prospective randomized studies will be necessary to verify this question

Η μείωση της χρήσης των αντιβιοτικών αποτελεί δείκτη καταλληλόλητας της περίθαλψης, ενώ η μη ορθολογική κατανάλωσή τους αυξάνει τα κοστολογικά δεδομένα της φροντίδας και είναι υπεύθυνη για την αύξηση της μικροβιακής αντοχής.Σκοπός : H σύγχρονη βιβλιογραφική τεκμηρίωση της σημασίας και αναγκαιότητας μείωσης της χρήσης αντιβιοτικών στην Ελλάδα και ο εντοπισμός των εμπλεκόμενων φορέων που επηρεάζουν την κατανάλωσή τους.Μέθοδος: Η επιστημονική τεκμηρίωση και ο εντοπισμός των εμπλεκομένων μερών στηρίχθηκε στην αναζήτηση και παράθεση πληροφοριών τόσο από ελληνική όσο και από ξένη βιβλιογραφία.Αποτελέσματα: Η ανεξέλεγκτη χρήση των αντιβιοτικών στην Ελλάδα, την κατατάσσει ως πρώτη ανάμεσα στις χώρες του ΟΟΣΑ τόσο σε κατανάλωση, όσο και σε επίπεδα μικροβιακής αντοχής, η οποία αποτελεί σημαντικό κίνδυνο δημόσιας υγείας.Συμπεράσματα: Η Πολιτεία μέσω των θεσμών της, το ιατρικό προσωπικό, οι πολίτες, οι φορείς παροχής πρωτοβάθμιας και δευτεροβάθμιας φροντίδας υγείας και οι υπόλοιποι φορείς που επηρεάζουν την κατανάλωση αντιβιοτικών, οφείλουν να συμβάλουν στον ορθολογική χρήση τους σε ένα πλαίσιο συνέργειας και υιοθέτησης δράσεων. Στα Νοσοκομεία η άμεση και απρόσκοπτη λειτουργία των Ομάδων Επιτήρησης της Κατανάλωσης και της Ορθής Χρήσης των Αντιβιοτικών, αποτελεί προαπαιτούμενο για οποιαδήποτε προσπάθεια ορθολογικής χρήσης των αντιβιοτικών στη παρεχόμενη φροντίδα υγείας.

Thyroid malignancy poses a challenge especially when diagnosed during pregnancy. Although in papillary thyroid carcinoma, surgery can be safely delayed until the post-partum period, in medullary thyroid carcinoma, there is more urgency to treat.Here, we present a case of a 31-year-old female was diagnosed with medullary thyroid carcinoma during her third trimester. Diagnosis was made by aspiration cytology. Due to the patient’s condition, a CT scan was contraindicated and thus we were unable to make a complete assessment. A decision was made that the surgery was done after delivery, and when a complete assessment can be done. The surgery was successful and there were no complications both for the patient and her baby.In patients whom diagnosis of medullary thyroid carcinoma is made during the third trimester, it appears to be safe for mother and baby that surgery is done during the postpartum period.

Jejunal diverticulum are rare and usually asymptomatic. However, it may present with a wide spectrum of chronic non-specific symptoms and rarely lead to an acute presentation. We report a case of 83-year-old Malay women, presented with 1-week history of generalized cramping abdominal pain with distension and watery stool. Clinical examination revealed abdomen was peritonitis. Erect chest x-ray shows pneumoperitoneum. Patient underwent an emergency laparotomy with findings of multiple jejunal diverticula with single perforation. Affected small bowel was resected with end to end anastomosis done. Histopathological examination showed evidence of acute diverticulitis with background of diverticular disease. Unfortunately, patient succumbed to death post-operative because of cardiac complications. Jejunal diverticulosis in elderly can lead to significant morbidity and mortality. Thus, it should be suspected in elderly patients presenting with chronic cramping abdominal pain and altered bowel habits.

Esophageal perforation has high risk of mortality. With the non-specific nature of the presentation, high clinical suspicious is important in its detection so that appropriate treatment can be given.We presented a case of unfortunate young lady who accidentally swallowed a piece of her denture during an episode of seizures. Esophagogastroduodenoscopy (OGDS) was performed in an attempt to retrieve the fragmented denture but unsuccessful and she was discharged home allowing spontaneous passage. However she presented back with sepsis associated with massive left pleural effusion and pneumomediastinum. Contrast study confirmed intrathoracic esophageal perforation which was managed non-operatively. Pleural collection was managed with chest drain insertion and subsequently video-assisted thoracoscopy and decortication. Esophageal perforation healed with non-operative approach, without primary closure.

Buttonhole tears of the vagina wall during labour are rare and stressful lesions, in addition to being a severe complication with serious impact in the quality of a woman’s life. Although the diagnosis of the entity is not difficult, treatment remains a challenge in need of emergency surgery. Surgical repair is the appropriate solution but needs a skillful surgical team with appropriate knowledge of the anatomy of the pelvic floor and the necessary surgical maneuvers to reconstruct it. Prevention can also play a central role, provided that existing recommendations during labour are followed closely.We present a case of a 26-year-old female, who presented to us with a large skip lesion in the rectovaginal septum after vaginal labour. During the second stage of labour the obstetrician noticed rectal bleeding and a digital examination revealed a gap at the posterior vaginal wall without external anal sphincter involvement. The patient was under spinal anaesthesia and after the completion of the vaginal labour she was moved to the operating room and treated with a primary repair. After 3 days she was discharged with a normal follow-up three months later.Rectovaginal lesions often happen during obstetrical events and they can have severe consequences. They represent an emergency situation. Surgical repair with interrupted closure of the rectovaginal septum in two layers with absorbable suture or a running closure, offers the best results, reducing long term risks. Prevention includes appropriate episiotomy, support of the perineum and avoiding pressure on the fundus.

Laparoscopic adjustable gastric banding (LAGB) is considered a safe and effective restrictive bariatric surgery to assist weight loss and morbidities associated with obesity. However, it is associated with possible complications of port dysfunction, band erosion or migration, oesophageal dilatation or dysmotility and infection. Classically, removal of gastric banding subjects the patient to another surgery, either open or laparoscopically, when they present with complications. We present a case of successful retrieval of an eroded gastric band which was inserted laparoscopically 13 years ago.A 40-year-old male presented to our outpatient clinic with complains of intermittent epigastric pain aggravated by oral intake for a month. He has a background history of an adjustable gastric band implanted laparoscopically 13 years ago. Physical examinations showed a previous 3cm scar correlating with the port system location, otherwise unremarkable. Oesophagogastroscopy (OGDS) showed a partially eroded gastric band with more than 50% of the band into the gastric lumen at cardia. The port system was removed after local anaesthesia under aseptic technique. The eroded gastric band was then removed endoscopically using a 3.5mm guidewire and emergency lithotripter device. Contrast study done post removal shows no leak. Patient was discharged well the day after.Erosion of gastric band into the gastric cavity is a rare complication of LAGB. Some possible cause of the erosion includes chronic inflammation due to the foreign body effect, constriction of the band causing stomach ischaemia, and injury to the stomach wall during insertion.Endoscopic removal of eroded gastric band is a feasible and safe procedure, provided there is no evidence of perforation or peritonitis.

Cytomegalovirus (CMV) is a common opportunistic pathogen in patients infected with Human Immunodeficiency Virus (HIV), especially in those with CD4+ lymphocyte count less than 50 cells/μL. Esophageal involvement usually causes lower esophageal ulcers. The endoscopic feature of an esophageal pseudotumour is a rare occurrence.A 27 year old man presented with fever, diarrhea and vomiting for 1 week. He had a background history of retroviral disease. Examination revealed severe pallor with hemoglobin level of 2.4 g/dL. Oesophagogastroduodenoscopy (OGDS) showed a polypoidal mass at lower esophagus. Histopathogical examination reported presence scattered epithelial and endothelial cells with intranuclear inclusion bodies which also stained positive for CMV immunostain. This led to a final diagnosis of CMV esophagitis. He initiated on intravenous Ganciclovir for three weeks and a repeat OGDS showed resolution of the lower esophageal polypoidal lesion.Although CMV pseudotumors are rare, they are unlikely to remain this way as the length of survival of patients with Acquired Immune Deficiency Syndrome (AIDS) increases. It should be included in the differential diagnosis of gastrointestinal mass lesions in AIDS patients and other immunocompromised patients. The pseudotumor often responds well to antiviral therapy.