Objective To determine the relative effects of open healing compared with primary closure for pilonidal sinus and optimal closure method (midline v off-midline). Design Systematic review and meta-analyses of randomised controlled trials. Data sources Cochrane register of controlled trials, Cochrane Wounds Group specialised trials register, Medline (1950Medline ( -2007, Embase, and CINAHL bibliographic databases, without language restrictions. Data extraction Primary outcomes were time (days) to healing, surgical site infection, and recurrence rate. Secondary outcomes were time to return to work, other complications and morbidity, cost, length of hospital stay, and wound healing rate. Study selection Randomised controlled trials evaluating surgical treatment of pilonidal sinus in patients aged 14 years or more. Data were extracted independently by two reviewers and assessed for quality. Meta-analyses used fixed and random effects models, dichotomous data were reported as relative risks or Peto odds ratios and continuous data are given as mean differences; all with 95% confidence intervals. Results 18 trials (n=1573) were included. 12 trials compared open healing with primary closure. Time to healing was quicker after primary closure although data were unsuitable for aggregation. Rates of surgical site infection did not differ; recurrence was less likely to occur after open healing (relative risk 0.42, 0.26 to 0.66). 14 patients would require their wound to heal by open healing to prevent one recurrence. Six trials compared surgical closure methods (midline v off-midline). Wounds took longer to heal after midline closure than after offmidline closure (mean difference 5.4 days, 95% confidence interval 2.3 to 8.5), rate of infection was higher (relative risk 4.70, 95% confidence interval 1.93 to 11.45), and risk of recurrence higher (Peto odds ratio 4.95, 95% confidence interval 2.18 to 11.24). Nine patients would need to be treated by an off-midline procedure to prevent one surgical site infection and 11 would need to be treated to prevent one recurrence. Conclusions Wounds heal more quickly after primary closure than after open healing but at the expense of increased risk of recurrence. Benefits were clearly shown with off-midline closure compared with midline closure. Off-midline closure should become standard management for pilonidal sinus when closure is the desired surgical option.

Healing by primary versus secondary intention a er surgical treatment for pilonidal sinus.

Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

Summary The aim of this study was to see if antibiotic pastilles could reduce radiation mucositis, pain, dysphagia and weight loss in patients undergoing radical radiotherapy for head and neck cancer. A total of 275 patients with T -T4 tumours entered the study; 136 were allocated to suck four times daily a pastille containing amphotericin, polymyxin and tobramycin. The During treatment, cells in the basal layers of the mucous membranes within the irradiated volume are unable to replace adequately cells lost through inactivation or exfoliation. The resultant mucosal damage may then be exacerbated by colonisation of the affected area by abnormal microbial flora. Mucositis has a number of manifestations that may be seen at different times depending on the volume irradiated, the total dose and the fractionation schedule. Initially, there may be a transient white discolouration, followed by deepening erythema and later a white pseudomembrane which may be patchy or confluent. The most severe manifestation is ulceration of the mucosa.In health, the very diverse oropharyngeal flora contains a marked preponderance of anaerobic bacteria together with a near universal presence of lesser numbers of viridans streptococci and Neisseria species. Irradiation, local tumour and surgery can all interfere with the mucosal defences important for the maintenance of this ecological balance. In consequence, there is frequent overgrowth of organisms rarely seen in health and then only at low concentrations. Overgrowth of yeasts and aerobic Gram-negative bacilli (in particular Enterobacteriaceae, Pseudomonads and Acinetobacter) has attracted particular attention in the context of irradiation mucositis (van Saene and Martin, 1990).There are no established effective measures to prevent or treat mucositis. Standard therapy is to maintain good oral hygiene and prescribe analgesics if necessary. A small study by Spijkervert et al. (1991) described a novel approach to this problem. Lozenges containing polymyxin E, tobramycin and amphotericin B were used to eradicate selectively aerobic Gram-negative bacteria (AGNB) and yeasts from the oropharynx while retaining the normal anaerobic and aerobic flora. This selective decontamination regimen was given to 15 patients with head and neck cancer treated by radiotherapy. An excellent microbiological result was obtained and mucositis was confined to erythema in all patients. By contrast, matched historical controls treated with a placebo or chlorhexidene showed an 80% incidence of more severe mucositis with pseudomembrane formation.The aim of the study was to use a placebo-controlled double-blind trial to test the hypothesis that the more severe forms of irradiation mucositis are associated with abnormal carriage of AGNB and yeasts and that selective reduction of these microbial populations with non-absorbable antibiotics would reduce both the signs and symptoms of mucositis. Materials and methodsPatients receiving potentially curative radiotherapy for T-4 head and neck cancer were entered into th...

Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.