Association of biochemical and clinical parameters with parathyroid adenoma weight. Turkish-Bulgarian endocrine and breast surgery study group, hyperparathyroidism registry study.

BACKGROUND: Primary hyperparathyroidism (pHPT) caused by a single benign parathyroid adenoma is a common endocrine disorder that is affected by regional differences. Living in different geographical regions reveals differences in the laboratory results and pathological findings, but studies on this subject are not sufficient. The article focuses on biochemical and pathological effects of geographical differences in parathyroid adenoma. In addition, the present study seeks to elaborate on treatment methods and effectiveness of screening in geographical area of Bulgaria and Turkey. METHOD: In this prospective study, 159 patients were included from 16 centres. Demographic characteristics, symptoms, biochemical markers and pathologic characteristics were analysed and compared between 8 different regions. RESULTS: Patients from Turkish Black Sea had the highest median serum calcium (Ca) level, whereas patients from Eastern Turkey had the lowest median serum phosphorus (P) level. On the other hand, there was no significant difference between Ca, parathormone (PTH) and P levels according to regions. Patients from Eastern Turkey had the highest adenoma weight, while patients from Bulgaria had the lowest adenoma weight. The weight of adenoma showed statistically significant differences between regions (p < 0.001). There was a correlation between adenoma weight and serum PTH level (p = 0.05) and Ca level (p = 0.035). CONCLUSION: This study has provided a deeper insight into the effect of the regional differences upon clinicopathological changing and biochemical values of pHTP patients with adenoma. Awareness of regional differences will assist in biochemical screening and treatment of this patient group.

Identification of irisin immunoreactivity in porcupine (Hystrix cristata) adrenal glands and kidneys.

Irisin, a novel peptide, was initially been shown to be expressed explicitly in the muscle tissues. We studied the presence of irisin immunoreactivity in porcupine adrenal glands and kidneys. Immunocytochemistry showed that irisin was localised both in the adrenal cortex and adrenal medulla. In organs, irisin immunoreactivity was found in the tubular and collecting system of the nephron. The functional role of irisin in the adrenal gland and kidney has not been precisely yet. However, irisin might have a paracrine and autocrine function as do other locally produced peptides.

An unusual case of hematemesis and epistaxis caused by a pheochromocytoma.

Pheochromocytoma is a rare catecholamine-secreting neoplasm that is the cause of hypertension in <0.2% of patients with hypertension. We encountered an unusual case of pheochromocytoma involving hematemesis and epistaxis episodes with accompanying hypertensive attacks. Venous ectasia was detected in the esophagus. Abdominal magnetic resonance imaging revealed an adenoma in the left adrenal region. The present case illustrates that pheochromocytoma can mimic different clinical conditions.

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.

BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Prevalence of sacrococcygeal pilonidal disease in Turkey.

BACKGROUND: Pilonidal sinus disease is frequently observed in the producing population; despite it not being a malignant disease, attention of clinicians to this disease has increased. Studies on this disease have not clearly revealed its prevalence. We aimed to detect its dispersion characteristics in our country. MATERIALS AND METHODS: Our study was designed as a descriptive study involving a large number of patients. A total of 19,013 candidates, aged between 17 years and 28 years and coming from different regions of the country, who applied to be students or officials of the state's schools and institutions, were enrolled in the study. Examination was performed including the perineal region, the presence of any comorbid diseases was noted, and clinical types of pilonidal sinus disease were detected according to Tezel's classification and recorded. RESULTS: Pilonidal sinus was detected in a total of 1258 (6.6%) candidates, of whom 72 (0.37%) were female and 1186 (6.23%) male. Our clinical experience showed that pilonidal cysts had a higher incidence in the Turkish population than in other populations, and it was especially increased in individuals of military age. CONCLUSION: We believe that soldiers coming from different regions of Turkey and candidates applying for auxiliary staff positions provide a small sample group resembling a representation of the whole of Turkey.

A case report: Giant intra-abdominal liposarcoma presenting acute renal failure.

INTRODUCTION: Liposarcomas represent 20-30% of adult soft tissue tumors and its abdominal localization occurs only in 5% of cases. Most are asymptomatic, but few present with abdominal mass and pain, fatigue, nausea, vomiting. They infiltrate adjacent organs and cause intestinal obstruction, intestinal ischemia-perforation, hydronephrosis, ureteric fistula and even aortic rupture. Here we aimed to report a rare case of a giant liposarcoma which originated from mesentery. PRESENTATION OF CASE: A 45-year-old male presented with slightly abdomen distention, urinary retention, oliguria since fifteen days. There was no concomitant nausea, vomiting and lower extremity edema. We found renal function tests abnormal. Contrast-enhanced computed tomography (CT) demonstrated a 20 × 18 cm, well-circumscribed, lobulated, heterogeneous mass. Both ureters were compressed by the mass. The entire mass was totally excised. After the operation, the patient's renal function returned to normal levels dramatically. The tumor was diagnosed as dedifferentiated liposarcoma. DISCUSSION: In cases of intra-abdominal mass is detected, surely abdominal compartment syndrome (ACS) should be considered. If vital signs, pulmonary function tests (PFT) and value of the CVP are abnormal, intra-abdominal pressure should be measured. Our findings mentioned above were not observed. CONCLUSION: A detailed history should be obtained other abdominal solid organs should also be considered while performing a careful physical examination, the amount of urinary output in particular should be questioned and this sytemic questioning should be supported by specific laboratory tests.

Effects of Mastalgia in Young Women on Quality of Life, Depression, and Anxiety Levels.

The aims of this study are to evaluate whether or not there is a relationship between mastalgia with anxiety and depression in young women with mastalgia who do not have organic breast pathology and to examine the effect of pain on the quality of life. Forty female pre-menopausal patients between the ages of 20-40 years with mastalgia and 40 totally healthy volunteers with the same characteristics were investigated with the Short Form 36 (SF-36), Hamilton Depression Scale, and the Hamilton Anxiety Rating Scale prospectively following breast examination and radiological examination. Statistical assessments were performed using the SPSS 11.5. Anxiety levels were observed to be higher in the patient group (p = 0.04). The depression level was higher in the patient group; however, this was not statistically significant (p = 0.08). The quality of life of the mastalgia group was determined to be lower than that of the control group, and the sub-parameters of physical function (p = 0.04), body pain (p = 0.02), general health (p = 0.03), and energy (p = 0.008) were found to be significantly low. There may be a relationship between mastalgia and depression in young women with mastalgia; however, a closer relationship between anxiety and mastalgia is observed. Mastalgia affects the quality of life of an individual negatively at a significant degree.

Effects of platelet rich plasma on fascial healing in rats with fecal peritonitis

PURPOSE: To evaluate the effects of platelet rich plasma (PRP) on the healing of fascia wherein peritonitis has been created. METHODS: Twenty eight Wistar Albino rats were divided into four groups. Only a primary fascial repair following laparotomy was performed on Group 1, a primary fascial repair performed and PRP treatment applied following laparotomy on Group 2, and a fecal peritonitis created following laparotomy and a primary fascial repair carried out on Group 3. A fecal peritonitis was created following laparotomy and primary fascial repair and PRP treatment on the fascia was carried out on Group 4. RESULTS: TNF-α was found to be significantly lower in the control group (Group 1). It was detected at the highest level in the group in which fecal peritonitis was created and PRP applied (Group 4). TGF-ß was determined as being significantly higher only in Group 4. Histopathologically, the differences between the groups in terms of cell infiltration and collagen deposition were not found to be significant. CONCLUSION: When platelet rich plasma was given histologically and biochemicaly as wound healing parameters cellular infiltration, collagen accumulation, and tissue hydroxyiproline levels were not increased but neovascularization, fibroblast activation and TNF Alfa levels were increased and PRP accelerated wound healing.

Effects of platelet rich plasma on fascial healing in rats with fecal peritonitis

ABSTRACT PURPOSE : To evaluate the effects of platelet rich plasma (PRP) on the healing of fascia wherein peritonitis has been created. METHODS: Twenty eight Wistar Albino rats were divided into four groups. Only a primary fascial repair following laparotomy was performed on Group 1, a primary fascial repair performed and PRP treatment applied following laparotomy on Group 2, and a fecal peritonitis created following laparotomy and a primary fascial repair carried out on Group 3. A fecal peritonitis was created following laparotomy and primary fascial repair and PRP treatment on the fascia was carried out on Group 4. RESULTS: TNF-α was found to be significantly lower in the control group (Group 1). It was detected at the highest level in the group in which fecal peritonitis was created and PRP applied (Group 4). TGF-β was determined as being significantly higher only in Group 4. Histopathologically, the differences between the groups in terms of cell infiltration and collagen deposition were not found to be significant. CONCLUSION: When platelet rich plasma was given histologically and biochemicaly as wound healing parameters cellular infiltration, collagen accumulation, and tissue hydroxyiproline levels were not increased but neovascularization, fibroblast activation and TNF Alfa levels were increased and PRP accelerated wound healing.

Effects of Copper, Zinc, and Vitamin Complex (Cernevit®) on Hepatic Healing in Rats Experimentally Subjected to Blunt Hepatic Trauma.

Solid organ injuries following blunt trauma are frequently encountered. The use of non-operative approach is gradually increasing. Thus, research on the methods that could enhance healing in solid organ injuries is in progress. Agents known to have antioxidant property were used after an experimentally induced blunt hepatic trauma. Thirty-two Wistar albino rats weighing 200 g were dropped from a height of 40 cm on to the right upper abdominal quadrant to produce a grade II-III hepatic injury. Rats were divided into control, Zn-administered, Cu-administered, and vitamin complex-administered groups, with eight rats in each. Aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were measured in the blood samples. The percentage of cells displaying Ki-67 nuclear staining was estimated. The sections were stained with hematoxylin and eosin and the degree of inflammation in the samples was semi-quantitatively assessed. Treatment with zinc, copper, and Cernevit® caused varying levels of decrease in AST, ALT, and LDH levels compared to the control group. Ki-67 positivity was significantly lower in group I compared with groups II and III (p = 0.002). Ki-67 positivity was significantly higher in group II compared to the other groups (p < 0.05). A marked improvement was observed in inflammation in group II. Copper and zinc treatment decreased inflammation as well as blood levels of AST and ALT, and enhanced the healing of traumatized hepatic tissue. However, Cernevit® reduced only the degree of inflammation.

Significance of appetite hormone ghrelin and obestatin levels in the assessment of the severity of acute pancreatitis.

BACKGROUND/AIMS: Due to risk of morbidity and mortality, various tests and scoring systems used in the assessment of the diagnosis and severity of acute pancreatitis disease are gaining more importance every day. Most of the current scoring systems, validated by various parameters, have a sophisticated and complex structure. Research is ongoing to establish a method to diagnose the disease and determine the severity by using different and simple parameters. In this trial, we aimed to investigate the role of the orexigenic "ghrelin" and anorexigenic "obestatin" hormones, if any, on the diagnosis and assessment of the severity of acute pancreatitis. MATERIALS AND METHODS: A total of 30 patients hospitalized between September 2009 and September 2010 with a diagnosis of acute pancreatitis (AP) and 25 healthy volunteers were enrolled in the trial with a prospective and randomized design. The patients were classified in two groups, mild (Ranson ≤3 and / or Apache II ≤8) and severe (Ranson >3 and/or Apache II >8) cases, as per the Ranson and Apache-II criteria; the ghrelin and obestatin levels in blood samples obtained from the patients were measured using the ELISA method. RESULTS: Twenty-two of the 30 patients (73%) were regarded as mild pancreatitis cases, while 8 cases (27%) were diagnosed as severe pancreatitis. Comparison of the mild and severe pancreatitis groups did not reveal a statistical difference between the two groups in terms of acylated and de-acylated ghrelin values on presentation and following the initiation of oral feeding. Similarly, no significant difference was found in the comparison of the patient and the control groups in terms of acylated and de-acylated ghrelin values on presentation (p=0.863). On the other hand, acylated and de-acylated ghrelin values after initiation of oral feeding were observed to be higher in the patient group (p=0.001, p=0.000). Comparison of these two groups revealed a significant difference in obestatin values, both on presentation and after initiation of oral feeding (p=0.002 and p=0.000). CONCLUSION: Consistently high serum ghrelin values during pancreatic inflammation suggest that ghrelin may be used as an adjunctive parameter in the monitoring of the course of the disease. On the other hand, high obestatin values in patients on presentation indicate that this hormone is a more significant parameter in terms of diagnosis. However, no correlation was established between these two peptide hormones and the severity of AP.

Inguinal Hernia Repair via Application of Mesh in Front of and behind the Fascia Transversalis.

The aim of this study was to compare mesh placement in front of the fascia transversalis and behid the fascia transversalis via inguinal incision. We evaluated the results of 106 inguinal hernia cases treated with polypropylene mesh applied via the anterior approach between December 2004 and January 2010. Using the anterior approach, the mesh was placed preperitoneally behind the fascia transversalis in 51 of the patients, whereas in the other 55 patients the mesh was placed in front of the fascia transversalis. Mean duration of surgery was shorter in the patients in which the mesh was placed behind the fascia transversalis (60 min vs. 75 min) (P < 0.05). In all, 8 patients (7.5%) had postoperative complications, including hematoma (n = 4), seroma (n = 2), scrotal edema (n = 1), and orchitis (n = 1). There weren't any significant differences in the complication rate between the 2 groups of patients (P > 0.05). During a mean 44-month follow-up period (range: 12-72 months), no recurrence was observed. In conclusion, there weren't any significant differences between the 2 methods of inguinal hernia repair, other than the duration of surgery.

The results of a one-time crystallized phenol application for pilonidal sinus disease.

The aim of this study was to investigate the cure rate after a one-time phenol application for pilonidal sinus disease. Forty-eight patients diagnosed with pilonidal sinus from May 2006 to September 2009 were retrospectively reviewed. They were all managed under the same polyclinic conditions in different hospitals by the same surgeon under local anesthesia. Crystallized phenol was applied a total of 97 times on 48 patients. The median follow-up was 22 months (range, six to 38 months). Two patients (4 %) could not participate in the follow-up. One of these patients had 12 sinuses and didn't continue treatment after eight applications of phenol, and the other had nine sinuses and didn't continue treatment after five applications of phenol. The one-time application cure rate was 64.5 %, and the rate of success was 95 % with two or more applications. Recurrence did not occur during this period. A one-time phenol application is an effective treatment for pilonidal sinus disease. Hence, it can be an alternative to surgical treatment.

Mullerian inhibiting substance expression in papillary thyroid cancer.

OBJECTIVE: To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer. MATERIALS AND METHODS: The MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records (n = 23). RESULTS: In all the cases studied, 50% (n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining. CONCLUSION: The MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis.

Effects of trimetazidine in acute pancreatitis induced by L-arginine.

BACKGROUND: In acute pancreatitis, oxygen free radicals (OFRs) and cytokines have been shown to play a role in the failure of pancreatic microcirculation and the development of local tissue damage. We studied the effects of trimetazidine (TMZ), a potent antioxidant and anti-ischemic agent, on acute pancreatitis. METHODS: Rats were randomized into 3 groups: a control group (n = 15), a study group (n = 15) in which acute pancreatitis was induced with with L-arginine, and a treatment group (n = 15) in which pancreatitis was induced and treated with TMZ intraperitoneally. The rats were followed for 24 hours. At the 24th hour we determined serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lactate dehydrogenase (LDH), interleukin 1-β (IL-1β), interleukin 6 (IL-6) and tumour necrosis factor-α (TNF-α), and the pancreatic tissues were analyzed histopathologically. RESULTS: The AST (p < 0.001), ALT (p < 0.01), amylase (p < 0.001), LDH (p < 0.01), TNF-α (p < 0.01), IL-1ß (p < 0.001) and IL-6 (p < 0.001) levels, and pancreatic tissue edema (p < 0.01), hemorrhage (p < 0.05), acinar cell necrosis (p < 0.001) and level of perivascular inflammation (p < 0.01), were significantly lower in the treatment group than the study group. CONCLUSION: Trimetazidine markedly decreases biochemical and histopathologic changes during the early stages of acute pancreatitis, thus preserving the pancreas histologically.

CONTEXTE: Dans la pancréatite aiguë, les radicaux libres de l'oxygène et les cytokines contribuent à l'insuffisance de la microcirculation pancréatique et à l'endommagement des tissus localement. Nous avons étudié les effets de la trimétazidine (TMZ), un puissant agent antioxydant et anti-ischémique, sur la pancréatite aiguë. MÉTHODES: Des rats ont été assignés aléatoirement à 1 de 3 groupes : un groupe témoin (n = 15), un groupe (n = 15) dans lequel la pancréatite aiguë a été induite au moyen de L-arginine et un groupe (n = 15) dans lequel la pancréatite a été induite, puis traitée par TMZ par voie intrapéritonéale. Les rats ont été suivis pendant 24 heures. À la 24e heure, nous avons mesuré les taux sériques d'aspartate aminotransférase (AST), d'alanine aminotransférase (ALT), d'amylase, de lacticodéshydrogénase (LDH), d'interleukine 1-ß (IL-1ß), d'interleukine 6 (IL-6) et de facteur de nécrose tumorale α (TNF-α), et les tissus pancréatiques ont été soumis à un examen histopathologique. RÉSULTANTS: Les taux d'AST (p < 0,001), d'ALT (p < 0,01), d'amylase (p < 0,001), de LDH (p < 0,01), de TNF-α (p < 0,01), d'IL-1ß (p < 0,001) et d'IL-6 (p < 0,001), de même que l'oedème tissulaire (p < 0,01), les saignements (p < 0,05), la nécrose des cellules acineuses (p < 0,001) et le degré d'inflammation périvasculaire (p < 0,01) pancréatiques,étaient significativement moindres dans le groupe traité que dans le groupe non traité. CONCLUSIONS: La trimétazidine atténue nettement les modifications biochimiques et histopathologiques qui accompagnent les premiers stades d'une pancréatite aiguë, ce qui permet de préserver le pancréas au plan histologique.

[Incidentally diagnosed liver and right iliac muscle hydatid disease]. / Rastlantisal Olarak Tani Konulmus Karaciger ve Sag Iliak Kas Kist Hidatigi.

Hydatid cyst disease is localized in the liver and lungs in most of the cases, but also can exist throughout the body. In this article, we present a 20-year-old male patient who was diagnosed with hydatid cyst of the liver and iliac muscle, who presented because of respiratory problems. Especially in endemic areas, in patients who are detected as having hydatid cyst in the liver, systemic examinations must be cattied out and investigated regarding any involvement of other organs.

Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation.

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.

The effects of intraperitoneal sildenafil administration on healing of left colonic anastomoses and intra-abdominal adhesion formation in the presence of intra-abdominal infection.

PURPOSE: The objective of this pilot study was to establish an animal model for intra-abdominal infection and to examine the effect of sildenafil on anastomotic healing of the left colon and intra-abdominal adhesion formation. METHODS: Fourteen Winstar rats underwent colonic transsection and primary anastomosis after performing intra-abdominal infection. Rats were divided into two groups: Group 1 (n = 7): intra-abdominal infection, resection, and anastomoses; Group 2 (n = 7): intra-abdominal infection, resection, anastomoses, and sildenafil. Anastomotic bursting pressures, hydroxyproline levels, histopathologic grading, and abdominal adhesions were accessed on the postoperative Day 7. RESULTS: Anastomotic healing was found to be improved in terms of a bursting pressure (P = 0.02). Histopathological examination revealed an increase in angiogenesis (P = 0.007). Moreover, intra-abdominal adhesions were significantly less in rats given sildenafil (P = 0.03). CONCLUSION: Sildenafil may improve anastomotic healing of the left colon and diminishes peritoneal adhesion formation in the presense of abdominal infection.

Comparison of Kugel and Lichtenstein operations for inguinal hernia repair: results of a prospective randomized study.

INTRODUCTION: The aim of this prospective randomized clinical study was to compare the Lichtenstein hernia repair with Kugel's patch hernia repair. METHODS: From September 1999 to August 2002, adult patients with inguinal hernia were randomized into two groups. Group I included patients with the Lichtenstein hernioplasty, and group II included patients with the Kugel hernioplasty. The duration of the operation, surgical findings, and postoperative complications were recorded for the patients in both groups. RESULTS: A total of 139 patients (134 men, 5 women) were randomized to either group I or group II. No significant differences were observed for the duration of the operation or the complication rates between the groups during the same follow-up time (53.06 +/- 5.6 months vs. 53.41 +/- 7.11 months in groups I and II, respectively). CONCLUSIONS: Kugel herniorraphy is a minimally invasive method and as safe as the Lichtenstein hernia repair technique, with similar complication rates.

Pilonidal sinus treated with crystallized phenol: an eight-year experience.

PURPOSE: The aim of this study was to determine the impact of crystallized phenol on the outpatient treatment of pilonidal disease. PATIENTS AND METHODS: A retrospective analysis was undertaken of patients seen in the outpatient surgery clinic of the University Hospital, Elazlg, Turkey. Age, gender, body mass index, characteristics of sinuses at initial presentation, and the recovery time of 41 patients were analyzed. The relationship between recovery time and the number of sinus openings, presence of abscess, and status of the sinuses (acute vs. chronic) were noted. RESULTS: Crystallized phenol was applied a total of 107 times on 41 patients. Seventy percent of the patients had two to three applications. Mean recovery time was 42.7 (+/- standard deviation of 24) days with a range of 13 to 120 days. Recurrences were observed in only two patients at the fifth and eighth months following recovery. The success rate was 95.1 percent. Median follow-up was 24 (range, 6-98) months. The status of sinuses (acute vs. chronic and presence or absence of abscess) and the number of sinus opening had no effect on recovery time (P > 0.005). CONCLUSION: Crystallized phenol treatment is a simple and inexpensive method that can be readily applied on an outpatient basis, decreasing both the recurrence rate and lost work time. We suggest that this method be considered the first-line treatment of any type of pilonidal sinus.