Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. When the treatment is considered, there was a frequent lack of success of the surgical methods of excision regarding morbidity, healing, recurrence and cure. All these factors rendered the acquired thesis of pilonidal sinus disease to be more accepted. In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. Additional sinuses are frequent and have lateral openings. Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported. Pilonidal sinus disease consists in a symptoms complex with presentations ranging from asymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Asymptomatic pits do not require treatment. Options for treatment of acute abscess include aspiration, drainage without curettage, and drainage with curettage. The choice of a particular surgical approach depends on the surgeon's familiarity with the procedure and perceived result in terms of low recurrence of sinus and a quick healing of resulting cavity or surgical wound. Conservative nonoperative management, closed methods, laying of track, wide excision and open drainage, wide excision and primary closure, and limited excision are the methods currently used. From the profusion of studies, it is apparent that various methods are being tried and no one method is universally acceptable. Recurrence rates vary with the technique, operator and length of follow-up. Primary closure with a lateral approach appears to give the best results.

Gastrointestinal cancers are al eading cause of mortality,accounting for 23 %ofcancer-related deaths worldwide.Inorder to improve outcomes from these cancers,novel tissue characterization methods are needed to facilitate accurate diagnosis.R apid evaporative ionization mass spectrometry (REIMS) is at echnique developed for the in vivo classification of human tissue through mass spectrometric analysis of aerosols released during electrosurgical dissection. This ionization technique was further developed by utilizing surface induced dissociation and was integrated with an endoscopic polypectomy snare to allow in vivo analysis of the gastrointestinal tract. We tested the classification performance of this novel endoscopic REIMS method in vivo.Itwas shown to be capable of differentiating between healthy layers of the intestinal wall, cancer,and adenomatous polyps based on the REIMS fingerprint of each tissue type in vivo.Despite increasing incidence,m ortality from cancer has generally been decreasing over the last four decades. [1,2] Endoscopy represents ac ore diagnostic tool for the early detection of gastrointestinal (GI) tumors,a nd it is routinely deployed in national screening programs that have played an important role in reducing the burden of this disease. [3] Conventional white-light endoscopic investigation of the GI tract with tissue biopsy is the gold standard method for the diagnosis of GI cancers. [4] However,u pt o7 .8 %ofu pper-GI cancers may be missed by this technique in patients who are subsequently diagnosed with cancer. [5] Moreover,t here is as ignificant economic and service burden on histopathology specialists who have to report on benign polyps,which may be found in 13.5 to 75 %ofcolonoscopies. [6] Amajor advantage of endoscopic intervention is that it provides al ess invasive therapeutic option compared to conventional open surgical approaches.Early-stage cancers and premalignant conditions are now routinely treated using endoscopic mucosal resection (EMR) techniques that utilize electrosurgical diathermy and radiofrequencyablation (RFA). [7] However,re-intervention is necessary in up to 41 %o fp atients owing to incomplete excision. [8] Hence,t here remains an eed to develop accurate in situ techniques for improving the adenoma detection rate (ADR) and for real-time chemical biopsies that can detect dysplasia or cancer in vivo to increase the efficacy and safety of endoscopic therapies.Enhanced endoscopic imaging technologies are currently being developed to address these requirements,with aspecific emphasis on spectroscopic characterization using elastic scattering spectroscopy,o ptical coherence tomography,a nd multimodal imaging combining Raman spectroscopy,a utofluorescence,a nd narrow band imaging. [9] However,o ptical strategies do not provide detailed information on tumor biology or chemistry and cannot be deployed during therapeutic procedures to provide data on cancer-margin status. Mass spectrometry (MS)-based identification of tissues has been employed in the context of MS imag...

Wound infection rates are generally higher in patients undergoing surgery for spinal metastasis. Risk factors of wound infection in these patients are poorly understood. PurposeTo identify demographic and clinical variables that may be associated with patients experiencing a higher wound infection rate. Study designRetrospective study with prospectively collected data of spinal metastasis patients operated consecutively at a University teaching hospital, adult spine division which is a tertiary referral centre for complex spinal surgery. Patient sampleNinety eight patients were all surgically treated, consecutively from January 2009 to September 2011. Three patients had to be excluded due to inadequate data.Outcome measures Physiologic measure, with presence or absence of microbiologically proven infection. MethodsVarious demographic and clinical data were recorded, including age, serum albumin level, blood total lymphocyte count, corticosteroid intake, Malnutrition Universal Screening Tool (MUST) score, neurological disability, skin closure material used, levels of surgery and administration of peri-operative corticosteroids. No funding was received from any sources for this study and as far as we are aware, there are no potential conflict of interest-associated biases in this study. ResultsHigher probabilities of infection were associated with low albumin level, 7 or more levels of surgery, use of delayed/non-absorbable skin closure material and presence of neurological disability. Of these factors, levels of surgery was found to be statistically significant at the 5% significance level. ConclusionsRisk of infection is high (17.9%) in patients undergoing surgery for spinal metastasis. Seven or more vertebral levels of surgery increases the risk of infection significantly (p‹0.05). Low albumin level, and presence of neurological disability appear to show a trend towards increased risk of infection. Use of absorbable skin closure material,age, low lymphocyte count, peri-operative administration of corticosteroids and MUST score do not appear to influence the risk of infection.