Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure.

OBJECTIVE: To study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. METHODS: A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A (37 patients) were treated by open method (excision and healing by secondary intention) and Group B (40 patients) for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years (mean 4.16) was through outpatient visits. RESULTS: The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups (p < 0.0001). The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference (p = 0.0401), while the differences were insignificant for each complication when analyzed separately. CONCLUSION: Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus.

Serosurvey of prevalence of human immunodeficiency virus amongst high risk groups in Port Sudan, Sudan.

During October, 1987, 593 sera were collected from risk groups in Sudan's only major deepwater port, Port Sudan. The risk groups included prostitutes, lorry drivers and prisoners. A large proportion of the study participants practised high risk behaviour which included sexual promiscuity, medical treatment by injection, scarification and tattooing. Despite high risk behaviour and evidence of a high prevalence of hepatitis B infection, a virus transmitted in a manner similar to HIV, no study participants were positive for HIV infection. This data suggests that the prevalence of HIV infection amongst high risk groups in Port Sudan is very low. These findings confirm a lack of clinical cases of AIDS in hospitalized patients in Port Sudan and the small number of reported cases in other areas of northern Sudan.

PIP: The high prevalence of hepatitis B markers in the Sudan (up to 80% of those surveyed) suggests the potential for a rapid spread of human immunodeficiency virus (HIV) since both viruses are transmitted in similar ways. Although clinical cases of acquired immunodeficiency syndrome (AIDS) have not been reported from Port Sudan, southern Sudan borders on several countries with a high prevalence of HIV infection. Sudan's National AIDS Committee plans a series of surveys to determine the prevalence of HIV infection in high risk groups and the general population in several geographic regions. The 1st such survey was conducted in Port Sudan in 1987 among 593 high-risk individuals (203 prostitutes, 103 lorry drivers, 118 prisoners, and 169 in mixed occupations). The study population included 330 males and 263 females. About half of the participants were married and in the 21-30-year age group. Over 75% had been exposed to hepatitis B and 76% had been treated for malaria, largely through injection. Overall, the incidence of non-sex-related risk factors for HIV infection among Port Sudan subjects was: injection, 48%; scarification, 40%; and tatoos, 38%. 32% reported a prior history of a sexually transmitted disease. 71% of the males had used prostitutes. Surprisingly, no study participants were positive for HIV infection. This finding presumably reflects Port Sudan's geographic isolation from other Central and East African countries with large numbers of HIV-positive individuals. On the other hand, Port Sudan is the site of importation of all goods by sea into the country and many people from other African and Arab countries are associated with the seaport. Thus, once the HIV virus is introduced by infected persons from other areas, the risk factors suggest the potential for rapid transmission.

A clinicopathologic study of Ki-67 proliferation index in colorectal carcinoma.

OBJECTIVES: To investigate Ki-67 immunoexpressions in colorectal cancer and analyze possible correlations with variable clinicopathological prognostic factors. METHODS: A cross-sectional study of tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined at the Histopathology Laboratory of Rezgary Teaching Hospital in Erbil, Iraq between January 2010 and July 2011. Ki-67 labeling index is calculated immunohistochemically using the monoclonal antibody MIB-1, and the standard streptavidin-biotin immunoperoxidase method. The clinicopathologic and prognostic features were statistically analyzed. RESULTS: Over-expression of Ki-67 proliferation protein was found in 31 (62%) cases. Statistical analyses revealed a significant relation between Ki-67 proliferation index and histologic type (p=0.005) and tumor grade (p=0.018); but no significant relation was calculated with the other clinicopathological parameters such as age, gender, tumor's size, site, depth, stage, nodal status, and vascular invasion (p>0.05). CONCLUSION: Ki-67 immune overexpression is a frequent finding in our colorectal cancer cases; but it is not enough to monitor Ki-67 proliferation index alone for prognosis in colorectal cancer.

Serum opacity factor of Staphylococcus epidermidis.

Three Staphylococcus epidermidis strains produced a factor giving rise to opacity in different sera but not in albumin. Serum opacity factor was resistant to age and heat and active in acidic media.

Streptococcal impetigo and acute glomerulonephritis in children in Cairo.

Impetigo contagiosa in Cairo affected young children of both sexes, the face being the main site. Post-impetigo nephritis, confirmed by a low serum C3 level and by urinalysis, occurred in only 11% of cases. Streptococcus pyogenes strains were recovered from 84% of the skin lesions. Sixteen types were identified according to their T-protein, and most infections were associated with T3/B3264, T13/B3264, T5, T11, T12, T8/25/Imp 19 and T14/49; the majority of these types were also recovered from houseflies. The types isolated from cases of post-impetigo nephritis were T4 (M 60), T14/49 (M49), T8/25/Imp 19 (mostly M 55) and T11. Seventy percent of the patients infected with T4 (M 60) and 40% of those infected with T14/49 (M 49) developed nephritis. Strains isolated from the skin bore a closer resemblance to those isolated from the nose than to those found in the throat. The ASO response was poor in uncomplicated impetigo but the titre rose more aften in post-impetigo nephritis.

HLA antigen frequencies in children with cardiac disease in Cairo.

The study of Histocompatibility Locus Antigen (HLA) frequencies in 48 cases with congenital heart disease (CHD) in children in Cairo showed high incidence of A10. Cases with atrial septal defect have shown a significant association with A3 besides A10. There is also a significant association between B12-45 and right loop anomalies (Fallot's and pulmonary stenosis) together with A10. On the other hand, children with rheumatic heart disease have shown strong positive association with HLA group B8 and negative association with A28.

HLA typing intestinohepatic schistosomiasis.

Patients with simple and/or complicated intestinal bilharziasis and normal controls were chosen for CBC, complete urine and stool analysis, liver function tests, liver biopsy, sigmoidoscopy and rectal biopsy. HLA typing was done by microcytotoxicity test. A statistically significant increased frequency of HLA-B8 antigen was present in with or without polyposis and with or without hepatosplenomegaly, as compared to controls (P less than 0.01). Also HLA-B8 showed a statistically significant increased frequency in those with or without polyposis and with hepatosplenomegaly and without polyposis (P less than 0.05). The HLA-A25 and A26 showed a significant increased frequency among all groups (P less than 0.05). HLA-A1, A9, B18 were variable in frequency among all groups. It was concluded that patients with bilharzial hepatosplenomegaly specially with intestinal polyposis have a high frequency of HLA-B8.