The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition.

Recurrence of pilonidal sinus disease after surgical intervention is not a very rare problem although sophisticated reconstruction procedures have been developed. Recurrence is thought to be related to the anatomical status of the patients, i.e., depth of the intergluteal groove. Obese patients have deeper intergluteal grooves. The aim of this study was to use body mass index (BMI) as an objective indicator of obesity to determine whether there is a relationship between BMI and recurrence of pilonidal sinus disease. BMI was calculated preoperatively in 114 patients with pilonidal sinus disease who were treated by excision and Limberg flap transposition between 1996-1999 in general surgery departments of two university hospital clinics. Fifteen patients were referred to our clinics after surgical intervention carried out at other institutions. Their average BMI was calculated by using their hospital records. The mean follow-up period was 24 months (range 10-36). Six of the 114 patients (5%) had recurrence. The mean BMI of patients with and without recurrence was 29.35 and 27.415, respectively (P<0.05). The mean BMI of 15 patients referred to us because of recurrent disease was 29.41; however, that of patients with primary pilonidal sinus disease was 27.212 (P<0.05). Their BMI before their first operation was 29.30. This was also significantly higher than patients with primary disease (P<0.05). We conclude that obese patients with high BMI have a higher risk of recurrence of pilonidal sinus disease after surgical intervention.

Theoretical model for an MRI radio frequency resonator.

A theoretical model is described for a magnetic resonance imaging (MRI) radio-frequency resonator (an MRI "coil") that is useful at ultrahigh frequencies. The device is a "TEM resonator," which is based on a concept originally proposed by Röschmann (1988). The coil comprises a circular cavity-like structure containing several coaxial transmission lines operating in a transverse electromagnetic (TEM) mode. The model developed herein treats the empty coil and is based on multiconductor transmission line theory. This work generalizes and extends similar analyses of the device by Röschmann (1995) and Chingas and Zhang (1996). The model employs explicit calculation of per-unit-length parameters for TEM lines having arbitrary geometries. Calculations of the resonator's frequency response are found to compare well with measurements. Fields produced by linear (single-point) and quadrature drive are also computed and compared to images of low-permittivity phantoms.

Persistent müllerian duct syndrome. A case report.

BACKGROUND: Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism in which well-developed müllerian structures are present in an otherwise normal male with XY chromosomes. The syndrome was first described by Nilson in 1939, and almost 100 cases have been reported. CASE: A 22-year-old man presented with mild, right-sided inguinal pain and heaviness in his scrotum. He underwent right-sided inguinal exploration because of having a palpable right-sided, irreducible inguinal hernia. Two testicles with surface nodularity and a bicornuate uterus with rudimentary fallopian tubes were detected and removed as one specimen, and the hernia was repaired. CONCLUSION: Management of this syndrome is difficult because of the limited number of cases. If the diagnosis can be made before surgery, karyotyping can be useful to decide on orchiopexy or orchioectomy. In suspected cases, laparoscopy and ultrasonographic evaluation of all crytorchidic cases may be helpful for diagnosing this condition before surgery. All patients with this syndrome have a male phenotype; therefore, it is essential to preserve secondary sex characteristics. Androgen replacement therapy should be given to patients who have undergone gonadectomy and to those with low levels of testosterone.