Simple Excision Research Articles

Deep Penetrating Nevus and Borderline-Deep Penetrating Nevus: A Literature Review.

Deep penetrating nevi (DPN) are rare melanocytic nevi, which can exhibit atypical histological features hampering the differentiation from malignant melanoma. DPN are considered benign melanocytic lesions, but rare spread to lymph nodes and unfavorable clinical outcomes associated with borderline/atypical DPN (B-DPN) has been reported. Since no guidelines are available for DPN and B-DPN, we aimed to review the literature on DPN and B-DPN to assess the management and prognosis. We screened 3,513 references from EMBASE, Scopus and Medline databases, and included 15 studies with a total of 355 DPN patients and 48 B-DPN patients. Therapeutic interventions ranged from simple excision to wide excisions and sentinel lymph node biopsy (SLNB), with block lymph node dissection in some positive SLNB cases. Follow-up periods ranged from 3 months to 23 years during which a total of five recurrences, two in DPN and three in B-DPN group, and three metastases, in B-DPN group, were reported. While some of the included studies comprised clinical and histopathological correlation, few included genetic assessment. The present review highlights the need for prospective cohort studies applying composite measures to identify effective regimens of diagnostic workup and treatment in DPN and B-DPN.

Merkel Cell Carcinoma Treatment in Finland in 1986-2016-A Real-World Data Study.

Merkel cell carcinoma (MCC) is a rare cutaneous carcinoma that has gained enormous interest since the discovery of Merkel cell polyoma virus, which is a causative oncogenic agent in the majority of MCC tumours. Increased research has focused on effective treatment options with immuno-oncology. In this study, we reviewed the real-world data on different treatments given to MCC patients in Finland in 1986–2016. We used the Finnish Cancer Registry database to find MCC patients and the Hospital Discharge Register and the Cause-of-Death Register to obtain treatment data. We identified 376 MCC patients and 33 different treatment entities and/or combinations of treatment. An increase was noted in the incidence of MCC since 2005. Therefore, the cohort was divided into two groups: the “early“ group with time of diagnosis between years 1986 and 2004 and the “late” group with time of diagnosis between 2005 and 2016. The multitude of different treatment combinations is a relatively new phenomenon; before the year 2005, only 11 treatments or treatment combinations were used for MCC patients. Our data show that combining radiation therapy with simple excision provided a survival advantage, which was, however, lost after adjustment for stage or age. Our registry study serves as a baseline treatment efficacy comparison as we move into the age of immunotherapy in MCC. Standardizing the treatment of MCC patients in Finland requires more work on awareness and multidisciplinary co-operation.

Ocular surface squamous neoplasia: a case series

Purpose: This study was conducted to show diverse clinical presentation of ocular surface squamous neoplasia with a rare presentation of caruncle squamous cell carcinoma (SCC).
 Methods: All cases that had suspicious ocular lesion were included in the treatment study. A detailed history including demographic data was obtained. Clinical features regarding the type of lesion, location, and the involvement of cornea were evaluated. For all patients, excisional biopsy following “Shield’s no-touch technique” with 3 to 4 mm margins of uninvolved tissue and cryotherapy at excisional margins was done. All specimens were sent for a histopathological evaluation. Topical chemotherapy (mitomycin C, 0.02%) was used as an adjunctive therapy following surgical excision for large and diffuse ocular surface tumors. All patients were subjected to long-term regular follow-ups.
 Results: Twenty-six patients (18 men and 8 women) with a mean age of 54.2 years were enrolled in this study. The results showed that the most common localization was bulbar conjunctiva (92%). Nodular lesions (46.5%) and SCC (57.5%) were the most common clinical and histopathological features, respectively. We observed one rare case of primary SCC of the left caruncle in a 68-year-old man who had an asymptomatic medial canthal mass. Recurrence was found in two patients with SCC, one of them having an orbital extension.
 Conclusion: The early suspicion of ocular surface neoplasia will be accomplished with a simple excision in most cases, leading to a favorable outcome except in severe progressive cases.

Pterygium excision with suture-less and glue-free conjunctival autograft

Introduction: Pterygium excision is a commonly encountered surgery with different methods being used. These procedures range from simple excision to use of grafts. Limbal conjunctival autograft is currently the most popular surgical procedure. The most common method of autograft fixation is suturing. But it has its own drawbacks like increased operating time, post-operative discomfort, inflammation, buttonholes, necrosis, giant papillary conjunctivitis, scarring, and granuloma formation. Glue is widely used due to many advantages like easy fixation of the graft, shorter operation time, and reduction in complications and post-operative discomfort but at the same time has some disadvantages also like high cost, the risk of transmission of infectionsand inactivation by iodine preparations.
 Purpose: In the following study, we describe a simple method of accomplishing conjunctival autograft adherence during pterygium surgery avoiding possible complications associated with the use of fibrin glue or sutures.
 Design: Prospective study.
 Method: We used conjunctival autograft, which was not sutured or glued to the scleral bed. The fibrin formed from the oozing blood was used to get the graft adhesion to the scleral bed. This study was approved by institutional review board, and written consent form was taken from each participant.
 Results: The suture-less and glue-free conjunctival autograft was found to have excellent results in terms of surgical outcome as well as post-operative recovery. In addition, risk of side effects related to sutures and glue was eliminated.
 Conclusion: Suture-less and glue-free conjunctival autograft is a new, easy, and cheaper technique for the management of pterygium.

MP35-16 SURGICAL MANAGEMENT OF URETHRO-CUTANEOUS FISTULA ORIGINATING FROM THE ANTERIOR URETHRA IN ADULT MEN OVER A 10 YEAR PERIOD

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-16 SURGICAL MANAGEMENT OF URETHRO-CUTANEOUS FISTULA ORIGINATING FROM THE ANTERIOR URETHRA IN ADULT MEN OVER A 10 YEAR PERIOD Nikki Jeffery*, Anastasia Frost, Simon Bugeja, Stella Ivaz, Mariya Dragova, Angelica Lock, Daniela Andrich, and Anthony Mundy Nikki Jeffery*Nikki Jeffery* More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Simon BugejaSimon Bugeja More articles by this author , Stella IvazStella Ivaz More articles by this author , Mariya DragovaMariya Dragova More articles by this author , Angelica LockAngelica Lock More articles by this author , Daniela AndrichDaniela Andrich More articles by this author , and Anthony MundyAnthony Mundy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethro-cutaneous fistula (UCF) originating from the anterior urethra in adult men is an uncommon presentation. We describe our experience in managing this problem. METHODS: We reviewed our prospective database to identify all cases of UCF repair in adult men over a 10 year period (May 2009 to May 2019), where the UCF originated from the anterior urethra. RESULTS: Our unit performed 59 surgeries for UCF repair in 55 patients (n = 52 referred from elsewhere). Most patients had a single fistulous tract (n = 43). The UCF tracked to the following locations: glans (n = 6), corona/subcorona (n = 17), distal shaft (n = 15), mid shaft (n = 11), proximal shaft (n = 7), penoscrotal (n = 7), perineum (n = 7). The causes of UCF included: prior hypospadias repair (n = 33), Prince Albert piercing (n = 5), circumcision injury (n = 6), other iatrogenic trauma (n = 4), idiopathic bulbar stricture (n = 4), prior epispadias repair (n = 2), Fournier’s gangrene (n = 1). Lichen sclerosus was present in 10 patients. Urethral stricture was present in 22 patients. Prior attempts at UCF repair had been made elsewhere in 10 patients (n = 5 with > 1 prior attempt). The surgical technique used for UCF repair depended on: i) presence of concomitant urethral stricture; ii) status of hypospadias or epispadias repair; iii) UCF size; iv) UCF location; v) quality of local tissue. Patients with no concomitant urethral stricture and no hypospadias failure were usually suitable for simple UCF excision and layered closure with dartos interposition (n = 18). Other techniques were typically used for larger UCF associated with poor quality local tissue: reopening of circumcision scar with degloving to mobilise dartos for interposition (n = 2), scrotal dartos interposition (n = 1), penile skin onlay flap (n = 1), scrotal skin onlay flap (n = 1), right inner thigh skin flap (n = 1). Patients with associated urethral stricture or failed hypospadias or epispadias repair required urethroplasty to deal with their UCF and its underlying cause (n = 31). Follow-up was available for 48 patients (n = 5 lost to follow-up, n = 2 died). Surgery was successful in 42 patients (86%) with minimum 3 months follow-up (mean 19 months). A second attempt at UCF repair was made in 4 patients with 2 successes, 1 failure and 1 lost to follow-up), giving overall success in 44 patients (94%). CONCLUSIONS: UCF originating from the anterior urethra in adult men can be managed surgically with excellent outcomes, even in re-operative cases. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e518-e518 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikki Jeffery* More articles by this author Anastasia Frost More articles by this author Simon Bugeja More articles by this author Stella Ivaz More articles by this author Mariya Dragova More articles by this author Angelica Lock More articles by this author Daniela Andrich More articles by this author Anthony Mundy More articles by this author Expand All Advertisement PDF downloadLoading ...

Imaging of gastrointestinal endometriosis: what the radiologist should know.

Deep invasive gastrointestinal endometriosis (DIGIE) is a frequent and severe presentation of endometriosis. Although most cases invade the rectosigmoid colon, DIGIE can involve any portion of the gastrointestinal tract from the stomach to the rectum, and is commonly multifocal and multicentric. Although histopathologic confirmation with surgery remains the gold standard for diagnosis, ultrasound (US) and magnetic resonance imaging (MRI) are the key non-invasive imaging modalities for initial assessment. US may be preferred as a screening study because of its easy availability and low-cost. Pelvic MRI and magnetic resonance enterography (MRE) provide substantial advantages for disease mapping in the pre-operative period, particularly in extensive bowel endometriosis. Although medical management of DIGIE with hormonal therapy can help control symptoms, disease course can be relentless and require surgical intervention. Surgical options depend on, the location; length; depth; circumference; multicentric or multifocal disease. With procedures including simple excision, fulguration of superficial lesions, shaving, disc excision, and segmental resection. A successful treatment outcome is largely dependent on good communication between the treating surgeon and the radiologist, who can provide vital information for effective surgical planning by reporting the key elements that we elaborate upon in this paper.

Reconstruction of Thumb Polydactily: A Case Report

Background: Polydactyly is the most common hand congenital abnormality found, next after syndactyly. The presence of these extra fingers is not merely duplication but is accompanied by abnormal hypoplastic structures, abnormal joints, tendon anomalies, and anomly of the insertion of ligaments. There are many tehniques proposed to reconstruct polydactyly, from simple excision of bones, ligaments, and tendons to complex reconstructions. We report a case of polydactily, the patient had bone exicision of the duplicates when the patient was four-month-old, but that extra metacarpal with no phalanges resulted in a greater space of finger 1 and 2.
 Patient and Method: A 21-year-old woman complaining of difficulty in grasping because the space between first and second fingers is too far away, and the extra metacarpal bone is protruding that causes snagging and stumbling on other objects. She had a history of surgical removal of polydactyl when she was 4-month-old. The patient has a limitation in hand activities.
 Result: Six months after surgery, the patient was satisfied with the results. The fingers has better mobility, good appearance. No more prominent bone, and neuropathic problems, or other disorders were found.
 Conclusion: Polydactyly is a common congenital hand occurrence. Understanding the anatomy to guide the reconstructive actions is important. It is not only about which digit would be preserved, but we have to concern about what our patient need, improving the quality, patient's hand function, and the aesthetic aspect. 

Comparative analysis on the effect of Z‐plasty versus conventional simple excision for the treatment of sacrococcygeal pilonidal sinus: A retrospective randomised clinical study

Sacrococcygeal pilonidal sinus is one of common diseases in general department. However, it is characterised, for surgeons, by high post‐surgical recurrence and high incidence of post‐surgical wound complications. Due to that fact, this retrospective randomised clinical study was designed to evaluate the surgical procedure effect of Z‐plasty (ZP), compared with convention simple excision (SE). A total of 67 patients from May 2015 to May 2019 in our department were studied into two groups randomly, the group of ZP and the group of SE. The patients' characteristics, surgical data, hospital length of stay (LOS), and post‐surgery complications were recorded. Statistical approaches were proceed with P‐value analysis. The results are as follows. No significant differences were found between these two groups of the ages, gender distribution, Body Mass Index (BMI), smoking history, diabetes mellitus, and blood hypertension. The estimated blood loss, specimen volume, distance to anus, and drain output on the first day of post‐surgery between the two groups were not statistically significant, either. However, surgical time in the ZP group was longer than that in the SE group (P < .0001). LOS in the ZP group was obviously shorter than that in the SE group (P = .0051). Furthermore, the patients of the ZP group were tending to suffer from fewer post‐surgical complications than the ones of the SE group. In a conclusion, we hold the point view that the surgical procedure of ZP can lead a better outcome than SE because it demonstrated shortened LOS and fewer post‐surgical complications.

Para-articular osteochondroma of the infrapatellar fat pad: A report of three cases

IntroductionPara-articular osteochondromas are not very common. We performed simple marginal excision for three cases. Presentation of caseWe encountered three cases of para-articular osteochondroma of the infrapatellar fat pad. All patients were men, with an average age of 43 years. The symptoms were very similar to those of anterior knee pain, which were increasing swelling and reduction of the range of motion. After simple marginal excision was performed, the symptoms improved and no recurrences or malignant transformation occurred during the mean postoperative period of 51 months. DiscussionForty-seven cases of para-articular osteochondroma have been reported, and excision is the standard treatment. Local recurrence has been reported in only one case, and malignant transformation has never been reported. However, in some reports there was no specification of the excision method, which was simply referred to as “excision.” Thus, we used a simple marginal excision for all three of our cases. ConclusionWe report three cases of para-articular osteochondroma of the infrapatellar fat pad that were effectively treated using simple marginal excision.

Pyogenic granuloma: Clinicopathological and treatment scenario

Background:Oral pyogenic granuloma is a soft-tissue lesion of the oral mucosa. This lesion has a tendency to reoccur after surgical excision.Materials and Methods:A total of 28 patients underwent surgical excision of pyogenic granuloma in the period from September 2014 to May 2016. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage.Results:Females (54%) were slightly more predominant than males (46%). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow-growing rate. Rural residents were more affected (57%) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8% and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion.Conclusion:Modified excision with deep curettage prevents the recurrence of the lesion after 1-year follow-up.

Multiple Hereditary Exostosis of Distal Ulna with Dislocation of Radial Head: A Case Report

Background: Multiple hereditary exostosis of the forearm is typically formed in the distal ulna causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exo­stosis inhibits the growth of the ulna leading to an acquisition of a varus deformity in the ra­dius which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cos­me­tic problems. This study aimed to report the mul­ti­ple hereditary exostosis of distal ulna with dis­location of radial head. Case Presentation: We present a case of a 14 year-old girl with main complaint of a bony prominence on her right elbow which limits the elbow flexion range of motion. 3D CT-Scan re­vealed a dislocation of radial head, shortening and posterior bowing of ulna. We performed excision of the prominent radial head, recons­truction, and temporary arthrodesis of the elbow. Results: The forearm deformity in patients with multiple hereditary exostosis related to the cross-sectional area of the distal ulnar physis was only one-quarter of the distal radius, the distal ulna is more involved in the condition. There was more longitudinal growth at the distal ulnar physis than at the distal radial physis, the distal ulnar physis contributed more total Ulnar Length than the distal radial physis did to Radial length. Known surgical interventions including simple excision, ulnar lengthening, corrective radial os­teo­­tomy, hemi-epiphyseal stapling of the distal radius, the Sauve-Kapandji procedure. Conclusion: Simple excision could improve the range of movement of the forearm but would not halt the progression of disease, particularly in younger patients. It was not effective in con­troll­ing progression of the deformity. Mature patients did not recur, but in patients that had been excis­ed before puberty the results were varied and unpredictable. Keywords: multiple hereditary exostosis, radial head dislocation, excision Correspondence: Pamudji Utomo. Department of Orthopaedics and Traumatology Prof. Dr. R.Soeharso Ortho­paedics Hospital, Surakarta. Email: utomodr­@yahoo.com. Indonesian Journal of Medicine (2020), 05(01): 63-69 https://doi.org/10.26911/theijmed.2020.05.01.10

Temporomandibular Joint Herniation: Review of the Literature

To define clear clinical characteristics and management strategies of herniation of temporomandibular joint (TMJ) into the external auditory canal (EAC). MEDLINE, PubMed, and EMBASE databases. A search was conducted using the keywords "temporomandibular joint" and "herniation" with all of their synonyms. Literature selection criteria included articles published in English, and articles dating back no further than 1970. Forty articles regarding 51 cases were eligible for critical appraisal. According to the previously published papers, TMJ herniation has following characteristics; symptoms are nonspecific, but a distinguishable feature is a protruding mass into the EAC that can be seen to appear and disappear as the mouth opens and closes. High-resolution computed tomography scans are sensitive to the bony defect and are helpful in diagnosing TMJ herniation. In the surgical treatment of TMJ herniation, wall reconstruction rather than simple mass excision could be a safe and long-lasting strategy. Herniation of TMJ into the EAC is a rare condition, but can be encountered in the clinic at any time. This literature review could be helpful in the diagnosis and treatment of TMJ herniation into the EAC.

Human Bite Injuries of the Orofacial Region: An Analysis of 26 Cases in Port Harcourt, Nigeria

Study Design: A retrospective study of 26 cases of human bite injuries at the Government Dental and Maxillofacial Hospital (now Maxillofacial unit, Rivers State University Teaching Hospital), Port Harcourt, within September 2011 and August 2016. Objective: To analyze the pattern, presentation, management, and complications of human bite injuries in the orofacial region. Methods: Information was extracted from hospital records of all victims of human bites to the face between the study period. Facial bites resulting from animals were excluded. Data such as age, gender, time lag between the injury and time of presentation in the hospital, nature and the circumstances of the injuries, site of injuries, and treatment outcomes and complications were collected and analyzed. Results: A total of 26 patients within the ages of 18 and 60 years were seen during the period of study. They were all related to fights, which were all resolved out of court. There was a preponderance of females, and the lower lip was the most affected site ( p &lt; .05). In all, 14 patients presented within 24 hours of injury and all but 2 (7.6%) patients presented within 7 days of injury. No wound was overtly infected. Treatments of injuries were varied from simple wedge excision and primary closure to complex multistaged procedures and were uneventful with acceptable surgical outcomes. Conclusion: Human bite wounds reported in this study were all due to social conflicts without legal redress. Although human bite wounds are considered to be dirty or contaminated but with proper wound debridement, antimicrobial cover and primary or immediate surgical closure results in very favorable aesthetic outcomes in all cases.

Congenital Lacrimal Fistula in a Seven-Year-Old Female: A Rare Cause of Epiphora

Congenital lacrimal fistulas are rare epithelium-lined tracts that tend to have a direct communication between skin and the lacrimal drainage system. These are benign developmental abnormalities, that may require no treatment. This is a rare diagnosis since patients are usually asymptomatic and presents only when epiphora is associated. When symptomatic, congenital lacrimal fistula presents as epiphora, or mucoid discharge, rarely patients could develop nasolacrimal duct obstruction, which may present as recurrent dacryocystitis. Thorough clinical examination is the best way to diagnose the condition, where a fistula ostium may be found inferonasal to medial canthus of the eye. Further, lacrimal probing and irrigation is helpful. Surgical management of the fistula is advised only if the disease is symptomatic which ranges from simple excision to dacryocystorhinostomy. This is a report of one such patient with congenital lacrimal fistula which was treated surgically by fistulectomy.

Surgical Strategy to Reduce the Recurrence of Adventitial Cystic Disease after Treatment.

PurposeAdventitial cystic disease (ACD) is a rare condition that causes intermittent claudication and non-atherosclerotic disease without cardiovascular risk factors. The etiology and optimal treatment of ACD remain controversial. The purpose of this study was to analyze surgical treatment results for ACD and to elucidate optimal treatment options.Materials and MethodsWe retrospectively reviewed 30 patients with ACD who underwent surgery from 2006 to 2018. Twenty-two patients had arterial ACD, six had venous ACD, and two had combined venous and arterial ACD. We reviewed demographic and clinical characteristics, treatment details, and procedure outcomes.ResultsRecurrence occurred in 6 cases either after cyst excision alone (4/17) or patch angioplasty (2/2). There was no recurrence after vessel excision with interposition grafting (0/7). Therefore, vessel excision was a statistically significant factor in recurrence prevention (P=0.026). Among the six recurrences, joint connections of the cystic lesions were found in four of the six (66.7%).ConclusionAs a curative surgery for ACD, vessel excision with interposition grafting is a better strategy to prevent recurrence than simple cyst excision alone.

Efficiency analysis on functional protection of nerve plane-oriented laparoscopic total mesorectal excision

Objective: Using previous total mesorectal excision with pelvic autonomic nerve preservation (PANP+TME) and simple total mesorectal excision (TME) without emphasis on retained nerves as control, we explore the advantages of nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) on urinary and sexual function. Methods: A retrospective cohort study was carried out. Case inclusion criteria: (1) male patients with pathologically confirmed middle and low rectal adenocarcinoma (4 to 11 cm from the anus); (2) stage T1-2tumor; (3) normal sexual life before operation. Exclusion criteria: (1) no pathological diagnosis before surgery; (2) local recurrence or distant metastasis; (3) preoperative neoadjuvant chemoradiotherapy; (4) opensurgery and laparoscopic surgery conversionto open; (5) no follow-up data. According to the above criteria, clinical data of 173 male patients with low and middle rectal adenocarcinoma who underwent radical operation for laparoscopic rectal cancer from July 2003 to July 2018 at the Department of Gastrointestinal Surgery, Wuhan University People's Hospital were collected. According to different surgical methods, patients were divided into TME group (58 cases), PANP+TME group (63 cases) and NPO+LTME group (52 cases). There were no significant differences in the baseline data including age, body mass index and pathological examination between the 3 groups (all P>0.05). The nerve plane referred to the nerve, the adipose tissue, the extremely finecapillaries around the nerve with overlying fine membranous tissue. NPO+LTME referred to the process of laparoscopic TME guided by the nerve plane, performing in the loose connective tissue between the nerve plane and the rectal properfascia, in order to ensure the integrity of the nerve plane, and maximally protect the patient's urinary and reproductive functions. The operation time, intraoperative blood loss, urinary catheter removal time, urinary function grading, postoperative first erection time, and erectile function and ejaculation function were observed and compared among the 3 groups at 3- and 6-month after operation. Results: In the NPO+LTME group, the PANP+TME group and the TME group, the operation time was (181.9±24.5) minutes, (176.7±29.2) minutes and (137.7±16.2) minutes, respectively (F=54.868, P<0.001); the intraoperative blood lost was (6.0±1.4) ml, (6.5±1.8) ml and (12.8±4.6) ml, respectively (F=95.016, P<0.001); the time to postoperative removal of the catheter was (2.4±1.1) days, (3.7 ±1.7) days and (6.5±2.4) days, respectively (F=79.409, P<0.001); the first postoperative erection time was (1.6±0.6) days, (8.9±2.7) days and (15.9±6.8) days (F=177.677, P<0.001), respectively, whose differences were all statistically significant (all P<0.01). In comparison of urinary function grading, the proportion of grade I (normal function, no urinary dysfunction) in the NPO+LTME, the ANP+TME group and the TME group was 84.1% (53/63), 39.7% (23/58) and 19.2% (10/52), respectively, and the difference was statistically significant (H=52.915, P<0.001). At postoperative 3- and 6-month, proportion of patients with grade I erectile function (normal erectile function) was 77.8% (49/63) and 85.7% (54/63), 44.8% (26/58) and 53.4% (31/58), 28.8% (15/52) and 48.1% (25/52) in the NPO+LTME group, the PANP+TME group, and the TME group, respectively. The differences were statistically significant (H=91.709, P<0.001; H=79.692, P<0.001). The proportion of patients with grade I ejaculation function (with ejaculation, no abnormalities in routine semen examination before and after surgery) at 3- and 6-month after surgery in the NPO+LTME group, the PANP+TME group and the TME group was 82.5% (52/63) and 87.3% (55/63), 53.4% (31/58) and 60.3% (35/58), 28.8% (15/52) and 46.1% (24/52), respectively. The differences were statistically significant as well (H=86.543, P<0.001; H=78.667, P<0.001). Patients in the NPO+LTME group had no grade III erections and ejaculation disorders. Conclusion: The surgical procedure of NPO+LTME can promote the recovery of postoperative neurological function and preserve urination and sexual function better.

Clinico-Pathological Presentations of Cystic and Classic Adenomatoid Odontogenic Tumors.

The objective of the study is to present the clinico-pathological features of cystic and classic adenomatoid odontogenic tumors (AOTs) in order to identify the differences between the two variants of AOT. Materials and method: The study sample comprised of 41 AOTs, which were categorized into cystic and classic AOTs. Cystic AOTs are diagnosed as such when macroscopic and microscopic evidence of a cyst is present together with histopathological criteria of AOT (WHO–2017). Results: The study sample comprised of eleven cystic and thirty classic AOTs. Eight cystic AOTs were regarded as arising from dentigerous cysts as these lesions were attached to the cemento-enamel junction of the impacted teeth. Though not statistically significant, in contrast to classic AOTs which showed female predilection, cystic AOTs were more prevalent in males. Cystic AOTs tend to present as significantly larger lesions compared to classic AOTs (p < 0.02). In both cystic and classic AOTs, duct-like structures and epithelial whorls were the two most prominent histopathological features present in the majority of tumors. Two AOTs with massive amounts of dentinoid occurred in the mandible and presented as large lesions that eroded cortical bone. None of the 12 patients with follow-up information presented with recurrences. Conclusion: Except for the size of the lesion, no significant clinico-pathological differences were observed between cystic and classic AOTs. Therefore the cystic AOTs can be considered as a variant of AOT with enucleation, simple excision, or radical excision as the treatment of choice depending on the extent of the lesion, similar to classic AOTs.

Excision and tension-free primary closure of pilonidal disease.

This study aimed to estimate simple excision and tension free primary closure and to study its effectiveness in terms of operating and healing time, duration of hospital stay, degree of post operation complications, and rate of recurrence. This is study included 78 patients, of whom 71 were (91%) males and 7 (9%) females, who underwent excision and tension free closure. The procedure was based on bilateral side flaps, which were released and dissected 2-3 cm from the edge of the wound. Patient's age, gender, body mass index, wound healing, operation, drain removal, length of hospital stay, and complications and recurrence were analysed. The study involved 78 patients, 71 (91%) males and 7 (9%) females. Median age of the patients was 28.5 years. Mean operation time was 44.6 minutes . Sixty-one patients (78.2%) had full primary healing without any complication. No one had hematoma or seroma, but five (6.4%) cases had a minor wound infection and three (3.8%) obese patients developed recurrence. Mean length of hospital stay was 2.5 days , most patients went back to their work within 3 weeks. Median follow-up period was in a 26.2 weak range (1-51.4 weak). Five (6.41%) cases had wound infection and three (3.85%) developed recurrence. Excision and tension free primary closure were found to be simple procedures associated with lower rates of wound infection, shorter hospital stay, lower recurrence, early wound recovery and short period of being absent from work. Surgery can be easily performed and preferred for cases of non-recurrent pilonidal sinus and cyst.

Early Prenatal Diagnosis of Congenital Ranula

Congenital ranula (CR) is a rare tumor. Few cases of prenatal diagnosis (PD) of CR have been reported in the literature and diagnosis usually is beyond 20 weeks of gestation. We report a case of a pregnant patient with 16 weeks of gestation, where ultrasound (US) visualized in her fetus, a cystic tumor protruding in his oral cavity. Basis and complementary studies, including fetal echocardiography, were normal. Serial two-dimensional (2D) and three-dimensional (3D) US studies monitored fetal growth, amniotic fluid, progressive changes in the cystic mass, and maxillary movements. At 38.5 weeks of gestation, a cesarean section was performed. At 17th neonate days old, the neonate was done the simple and complete excision. Early PD of CR is possible. In this case was done as early as at 16 weeks of gestation. This is the first CR reported case with the earliest PD (16 week of gestation). We recommend that during the first trimester US, the oral cavity must be well explored, to rule out tumors.

Evaluation treatment modalities of the pilonidal disease

Background: The pilonidal disease is a minor surgical pathology that has distressful complications. Many original and newer treatment modalities have been used in its management (including excisional and conservative surgical approaches). However, there is non-consensus on any one of them and the main reason is the significant recurrence rate. The objective of the study was to evaluate the excisional surgical modalities and conservative surgical approach in management the pilonidal disease.Methods: A prospective study enrolled 98 patients (80 males vs. 18 females) with chronic sacrococcygeal pilonidal disease. The ages range is 15-42 years. Group IA were treated by simple excision with primary closure, group IB by simple excision with Z- plasty and group II by conservative surgical approach. The wound complications (wound disruption and infection), length of hospital stays, recurrence rate, patients' satisfaction, and the cosmetic appearance were recorded.Results: The excision and Z-plasy has the least recurrence rate, wound complications rate and average time off work days. The simple excision with primary closure has the highest patient's cosmetic satisfaction. Conservative surgical approach has the worst results (recurrence rate 75%, wound infection rate 65%, 21 days average time off work and two days average length of hospital stay)..Conclusions: The Z-plasty is superior to other methods (has the least recurrence rate). The conservative treatment has non-encouraging results, we recommend it for patients unwilling excisional surgery.