Background: Pilonidal sinus is a common chronic disease of thesacrococcygeal region. The treatment for a pilonidal sinus varies according to the clinical presentation of the disease.Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrencerates. Setting: Surgical Unit-II, Allied Hospital, PMC, Faisalabad. Material and Methods: This prospective studyincludes 30 patients who were treated with the use of a rhomboid excision and Limberg flap closure for chronic andrecurrent sacrococcygeal pilonidal sinus. The follow-up period ranged from 04 to 08 months. Results: The meanhospital stay was 03 days (range, 03-08 days) and the mean time to return to work was 15 days (range, 12-26 days).Early wound complications were encountered in 03 patients. No recurrence was noted on maximum of 08 months offollow-up. Nine patients had numbness at the operation site and 10% were not pleased with cosmetic appearance ofthe scars. Conclusions: The results favor rhomboid excision and Limberg flap closure in the treatment ofsacrococcygeal pilonidal sinus, especially in recurrent cases and in patients with extensive involvement. Low recurrencerates, shorter hospital stay, and time off from work may outweigh the disadvantages related to unfavorable cosmeticappearance.

With the advent of new generations of chemotherapeutic agents andadvances in radiation therapy in the management of malignancies, an understanding of tumor markers is becomingincreasingly important. These soluble molecules in the blood are usually glycoproteins detected by monoclonalantibodies. Each tumor marker has a variable profile of usefulness for screening, determining diagnosis and prognosis,assessing response to therapy, and monitoring for cancer recurrence. Monoclonal antibodies are used to detect serumantigens associated with specific malignancies. These tumor markers are most useful for monitoring response totherapy and detecting early relapse. With the exception of Prostate-Specific Antigen (PSA), tumor markers do not havesufficient sensitivity or specificity for use in screening. Cancer Antigen (CA) 27.29 most frequently is used to followresponse to therapy in patients with metastatic breast cancer. Carcinoembryonic antigen is used to detect relapse ofcolorectal cancer, and CA 19-9 may be helpful in establishing the nature of pancreatic masses. CA 125 is useful forevaluating pelvic masses in postmenopausal women, monitoring response to therapy in women with ovarian cancer,and detecting recurrence of this malignancy. Alpha-fetoprotein (AFP), a marker for hepatocellular carcinoma,sometimes is used to screen highly selected populations and to assess hepatic masses in patients at particular riskfor developing hepatic malignancy. Testing for the beta subunit of human chorionic gonadotropin (b-hCG) is an integralpart of the diagnosis and management of gestational trophoblastic disease. Combined AFP and b-hCG testing is anessential adjunct in the evaluation and treatment of nonseminomatous germ cell tumors, and in monitoring theresponse to therapy. AFP and b-hCG also may be useful in evaluating potential origins of poorly differentiatedmetastatic cancer. PSA is used to screen for prostate cancer, detect recurrence of the malignancy, and evaluatespecific syndromes of adenocarcinoma of unknown primary. This review article describes the use of common tumormarkers in primary care practice. Particular emphasis is given to when these tests should be ordered and to commonfactors that influence the interpretation of tumor marker levels.

Background: Anastomotic leak after gastrointestinal surgery is animportant postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequentlyused as an indicator of the quality of surgical care provided. Objective:(1).To define factors associated with leakageof small gut anastomosis. (2) To find technique of small gut anastomosis associated with lowest risk of anastomoticdehiscence. Study Design: Retrospective, Descriptive Duration: 02 Years (May 2003 to May 2005) Material andMethods: This study was conducted at Surgical Unit-II, Allied Hospital, Punjab Medical College, Faisalabad from Dec2003 to May 2005. A total number of 36 cases were included in this study comprising of both adult male and femalepatients developing anastomotic dehiscence following resection and end to end anastomosis of small gut. Results:Peritonitis was the risk factor identified in 69% of the patients. Hypovolemic shock both preoperatively and in theimmediate postoperative period was noted in 56% cases while 83% of the patients with anastomotic dehiscence hadhaemoglobin concentration less than 10g%. High concentration of blood urea was noted in 42% of the cases. It turnedto normal as soon as the hypovolemia was corrected in these cases. Small gut anastomosis done in emergency setting(75% cases) was associated with increased risk of anastomotic dehiscence as compared to the dehiscence noted in09 cases (25%) operated on elective list. Three different techniques were used for small gut anastomosis. The rate ofanastomotic leakage ranged from 19-45%. Conclusion: Peritonitis, hypovolaemia and low hemoglobin alone or incombination are associated with increased risk of small gut anastomotic leakage especially after emergency surgery.Single layered extramucosal interrupted anastomosis was associated with less risk of dehiscence than the full thicknessand continuous extramucosal anastomosis.