The use of nail enfolded flaps for reconstruction of full-thickness ala nasi defects: an early report of experience.

The most common etiology of nasal defects that require reconstruction is basal cell carcinoma, as well as squamous cell carcinoma and melanoma. In reconstructing full-thickness ala nasi defects following excision of basal cell carcinomas, we present our technique of the nail enfolded local flaps which involves the harvesting of the nail plate and placing it to serve as a supporting component. In four patients, the nail plate grafts are inserted into various local flaps, and used for reconstruction of full-thickness ala nasi defects. Lining deficiencies of the alar lobule were resurfaced with skin grafts. None of the cases experienced skin graft loss or nail plate exposure. The nail graft prevented alar collapse by supporting the nasal airway. This technique discards the need for a second operation.

Hypoganglionic megacolon associated Chiliaditi's syndrome treated by subtotal colectomy: a case report.

In 1910, Chiliaditi described hepatodiaphragmatic interposition of the colon (Chiliaditi's syndrome). The condition is easily recognised on an antero-posterial chest radiograph. The interposed segment of bowel is usually the hepatic flexure of the colon. The degree of interposition varies from simple wedging to complete occupation of the right subdiaphragmatic space. The management is usually conservative and surgical intervention is rarely indicated. We present a patient with hepatodiaphragmatic interposition of the colon, associated with megacolon, requiring subtotal colectomy and ileosigmoid anastomosis for severe chronic constipation.

Surgical treatment of rectal prolapse. A retrospective analysis of 94 cases.

METHODS: A retrospective analysis evaluating 94 patients who underwent posterior rectopexy in 48 patients (51%), resection with or without rectopexy in 19 patients (20%) and Delorme's procedure in 27 patients (29%) was carried out for rectal prolapse in the last 15 years. The surgical procedures are described in detail. Postoperative evaluation was possible in all patients and mean observation time was 3.2 years. RESULTS: Mortality rate was zero. Recurrence was seen in 4 cases (4.2%), only after Delorme's procedures. The proportion of continent patients increased from 69.2% preoperatively to 91.6% postoperatively. Defecation difficulties and incomplete evacuation did not change beneficially after the surgery. Important postoperative complications, retrograde ejaculation and impotence were seen in 5 male patients (17.2) after posterior rectopexy, and were a major cause of dissatisfaction. CONCLUSIONS: In conclusion, Delorme's procedure, posterior rectopexy and resection procedures are effective surgical operations for treatment of rectal prolapse but extensive pelvic dissection during the posterior rectopexy may create serious sexual problems in male patients.

The results of surgical treatment and percutaneous drainage of hepatic hydatid disease.

BACKGROUND: Hydatid disease of the liver remains an important and challenging problem in rural areas. Although, surgery is considered the treatment of choice for hydatid disease of the liver, percutaneous drainage is an alternative treatment method for selected cases. The purpose of this study was to evaluate the results of percutaneous drainage and surgery. METHODS: A total of 66 patients underwent surgery; 36 cases had percutaneous drainage and were evaluated preoperatively for treatment choice according to localization, multiplicity, echographic type and size of the cysts in the liver. The patients were also evaluated postoperatively for systemic complications, e.g. fistula formation, infection of residual cyst, recurrence and hospitalization period for each group. RESULTS: Two groups, those with multiple cysts and cysts bigger than 5 cm, were treated by surgery. At the end of two treatment modalities, systemic complications, biliary fistulizations, recurrence and infection of cyst's cavity were seen more frequently in the surgery group and caused a longer hospital stay. CONCLUSIONS: Percutaneous drainage plus medical treatment can be successfully done for type I, type II and some selected type III hydatid cysts of the liver giving less complications, lower recurrence and shorter hospitalization periods. But, surgery is the primary treatment for big, multiple, complicated and recurrent hydatid cysts of the liver.