The natal cleft of patients with pilonidal sinus disease is deeper than the natal cleft of members of the volunteer group.

Active subdiaphragmatic gas aspiration after a laparoscopic cholecystectomy is a simple procedure that can effectively reduce postoperative abdominal and shoulder pain and as a result the need for analgesics.

Background Pilonidal disease is a common problem in primary health care which may require immediate surgical referral. Although various management options have been proposed, so far there is no gold standard treatment. The aim of the present study was to determine which of the following techniques was superior as regards postoperative complications and recurrence, midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. Methods A randomized clinical trial was conducted in the Department of General Surgery. Patients with noncomplicated pilonidal sinus were enrolled in the study from April 2009 to January 2012. All patients were randomized the day of surgery at the coordinating center by means of a computer program. Patients were randomized to receive midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. All procedures were performed under local anesthesia and patients were discharged 6 h after surgery. Demographic characteristics, skin color, body hair type, family history, preoperative complaints and duration of symptoms, cyst size, intraoperative iatrogenic cyst rupture, the presence of a tuft of hairs in the cyst, surgical techniques, duration of drainage, length of hospital stay, postoperative complications and recurrence were evaluated. Results One hundred and ninety-two patients with non-complicated pilonidal sinus were enrolled. Seventy-two patients were randomized to midline unshifted adipofascial turn-over flap, 67 patients to midline shifted adipofascial turn-over flap and 53 patients to Karydakis flap. The mean age was 25.66 ± 7.67 years. At 76-month follow-up, the overall complications and recurrence rates were not significantly different between groups (p [ 0.05). Conclusion In cases of non-complicated pilonidal sinus, we recommend surgical management using local anesthesia, outpatient surgery and the surgical approach with which the surgeon is most familiar.

A 52-year-old woman suffering from painful breast mass presented to general surgery department for evaluation of possible breast carcinoma. She had a history of painless slowly growing breast mass for 19 years, but she complained of breast pain for the last 2 months. Till this age, she had never before undergone ultrasonomammographic examination. On physical examination, approximately a 13-cm large mass was detected in the lower inner quadrant of the left breast.Ultrasonomammography revealed a 10-cm diameter well circumscribed anechoic lesion at 7-o'clock position and a 3 cm diameter heterogeneous calcified semi-solid lesion at 9-o'clock position (Fig. 1). On breast MRI, an 11-cm diameter cystic mass accompanying by a 4-cm diameter heterogeneous calcified cyst lesion were detected (Fig. 2). Ultrasound-guided cyst aspiration for the cystic lesion and core biopsy for the solid lesion were performed. Histological examination of (b) (c) (a) Figure 4. Histology of granular cell tumor of the breast. (a) Photomicrograph of the circumscribed tumor in Fig. 2b shows sheets of large polygonal cells with round to oval nuclei and abundant eosinophilic cytoplasmic granules (inset). Note the scant fibrous stroma. (Hematoxylin-eosin stain; original magnification 100·; inset 400·). (b) Photomicrograph of the spiculated tumor in Fig. 3 show cords of large polygonal cells on a background of dense stromal fibrosis, in contrast with the scant fibrous tissue in A. (Hematoxylin-eosin stain, original magnification 100·). (c) The cells stain positive for S-100 protein, a marker for cells of neural or neuroectodermal origin. Note the eccentrically located nuclei and cytoplasmic granules (S-100 stain; original magnification 400 ·).Figure 1. Breast MRI demonstrate a 11-cm diameter cystic mass accompanying by a 4-cm diameter heterogeneous calcified cyst lesion.

Objective: To analyse the gastrointestinal stromal tumours (GIST) patients' inter-demographics, histological type and association with secondary tumours. Study Design: A case series.