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Background The use of synthetic mesh is considered too high risk, and therefore, not an option when closing a contaminated abdominal fascial defect. This study evaluated the clinical outcomes when using synthetic mesh combined with vacuum-assisted closure (VAC) dressing to close these facial defects. Materials and methods From 2010 to 2016, a retrospective review was performed, including 34 patients in a single rural trauma center who underwent a damage control laparotomy in the presence of a contaminated or infected field. Definitive abdominal closure with a bridging polypropylene mesh along with the application of a VAC dressing was done in all cases. Data collection included baseline demographics, operative indication, postoperative complications, mortality and length of follow up. Results Median age of the patients was 67 y (IQR 40-87 y), with 22 (65%) being male at the time of operation. The median duration of clinical follow-up was 15.15 mo. The observed complications included three fistulas, two hernias, nine draining sinus tracts, and three mesh explanations with an overall complication rate of 41.1%. Although the absolute observed fistula rate was 8.8% (3 cases), the adjusted mesh-related fistulas formation rate after chart review was 0.0%. No mortalities were attributed directly to mesh-related complication. Conclusions This study found no mesh-related fistulas when using a synthetic mesh along with a VAC dressing for abdominal closure in a contaminated field. These results may provide a platform for further study regarding the safety of this technique.

Main aim To know the result of the Girdlestone resection arthroplasty (ARG) in the treatment of the infected hip arthroplasty. Secondary aims To analyze the effectiveness in the control of pain and infection, the functional outcome and to contrast factors correlated with the final result. Patients and methods Case series with a total of 17 patients. The control of the infection was assessed according to the presence or absence of sinus, and the clinical status using EuroQol 5D scale, residual pain and limb length discrepancy. Outcomes The most common infecting germ at the time of removal of the arthroplasty was Staphylococcus CN and one patient presented infection by Candida albicans. In 2 patients the draining sinus persisted. The residual dysmetria was 5.24 cm. In the EQ-5D scale, the most affected dimensions were mobility, need for help for self-care and ability to carry out activities of daily life. 8 patients maintained, pain levels worse than 4 in the VAS. The variables of dysmetria were correlated inversely with health index (−0.54) and self-perceived general health status (−0.45). Conclusions The Girdlestone resection arthroplasty is an alternative in the treatment of the infected hip arthroplasty. Patient perception is inversely corelated to residual dysmetria. The dysmetria is greater in women and in ages over 65 years.

The benefit of suppressive antibiotic treatment in inoperable patients with a chronic periprosthetic joint infection and a sinus tract is unknown. Some physicians prefer to just let the sinus drain, while others prefer antibiotic treatment. In this viewpoint article we discuss the advantages and disadvantages of suppressive antibiotic treatment in this particular patient group.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects the follicular portion of folliculopilosebaceous units. It causes painful nodules, abscesses, and draining sinus tracts throughout multiple regions of the body. HS primarily affects women; the overall HS prevalence in women is three times that in men. Although cutaneous disease itself causes substantial morbidity, recent evidence has shown that HS is a systemic inflammatory disease with multiple associated comorbidities. Objective: A review of the literature was conducted to elucidate existing information on this topic to assist in clinical decision-making for dermatologists. Methods: A review of the literature using the PubMed database was conducted with the search term “hidradenitis suppurativa comorbidities”. The search was conducted from March 3, 2019 to March 20, 2019, and yielded 55 articles, case reports, and reviews. Results: Metabolic and cardiovascular comorbidities were the most commonly associated with HS. HS has a significant comorbidity burden beyond the skin, including metabolic, cardiovascular, endocrine, gastrointestinal, rheumatologic, and psychiatric disorders, which collectively decrease the quality of life of patients. Conclusions: Dermatologists should be aware of these associations to encourage appropriate screening and referral for management of these disorders. Keywords: Hidradenitis suppurativa, comorbidities

BACKGROUND: The development of venous outflow stenosis in cerebral arteriovenous malformation (AVM) is poorly understood. OBJECTIVE: The location of stenosis within the AVM-draining vein in relation to the adjacent venous sinus and the hypothesis that the ratio of draining vein to adjacent sinus diameter might predict the development of venous stenosis were explored. METHODS: Patients with supratentorial AVMs (1997–2018) were reviewed (n=290). AVM-draining vein and adjacent venous sinus diameters, degree of draining vein stenosis, and distance from the maximal stenotic point to the junction of the adjacent draining sinus were recorded. Correlation between percentage of AVM-draining vein stenosis and the ratio of AVM-draining vein to venous sinus diameters was analyzed. RESULTS: 360 draining veins in 243 AVM with complete angiographic data were measured. Venous stenosis (in 131 draining veins) was observed within 20mm of the junction to the adjacent draining sinus in 85% of our sample. The ratio of draining vein to adjacent sinus diameter correlated positively with the percentage of venous stenosis (P1.0 showed significant tighter stenosis compared to the ratio ≤0.5 (25.9% and 28.9% vs. 10.0% respectively, P0.5. This may be related to more turbulent flow at the junction of the draining vein and venous sinus, especially in larger draining veins, which causes venous stenosis to develop over time.

Background and purpose Dural arteriovenous fistulas (DAVFs) with direct antegrade sinus drainage have a benign natural history but bruit can be disabling. Disconnection of the draining sinus is considered curative. We present the treatment results of 14 patients with a dural arteriovenous fistula with antegrade sinus return with emphasis on functionality of the involved sinus and the need for sinus patency. Materials and methods Between January 2009 and January 2018, 14 patients with a DAVF with direct antegrade sinus drainage were treated in our institution. There were two men and 12 women (1: 6) with a mean age of 61 years (median 61, range 43–78). Clinical presentation was unbearable pulsatile bruit in all cases. Thirteen were draining in the sigmoid or transverse sinus and one drained into the inferior petrosal sinus. Results Twelve of 14 (86%) patients had a draining sinus non-functional for the brain. In ten of these 12 patients the sinus was occluded with liquid embolic or coils. In the two patients with a functional sinus, the fistula was successfully occluded without occluding the sinus. One patient with inferior petrosal sinus drainage required transvenous embolization. There were no permanent adverse events of treatment. Conclusions Patients with DAVFs with direct antegrade sinus drainage were cured using a strategy of endovascular transarterial and transvenous embolization. Most patients had a non-functional sinus that could be occluded for cure.

Little is known about the relationship between the virulence of pathogens in periprosthetic joint infection (PJI) and C-reactive protein (CRP) levels. In this context, we assessed the performance of CRP for PJI. We collected the following data from 987 cases of total joint revision due to PJI and 386 cases of aseptic revision: age, gender, comorbidities, values for serum CRP, leukocytes, microbiology for preoperatively taken aspirations and at least 2 intraoperative biopsies, and presence or absence of a draining sinus. The mean CRP value in the PJI group was 50.2 mg l−1 (sd=62.2), while a lower CRP value of 11.6 mg l−1 (sd=25.3) was found in the control group. There were no significant differences for the CRP values between patients with and without draining sinus (P=0.4423). The difference in CRP between high-virulence and low-virulence micro-organisms was significant for both the hip and the knee (P

Tuberculosis (TB) although a rare disease in the developed countries, is still a serious problem in developing countries. Incidence of tuberculous osteomyelitis of the jaw bones is very low. The rare incidence and its clinical presentation frequently leads to misdiagnosis during initially management. We report a case of a 36-year-old male who presented with a draining sinus over the right side mandible since 3 months which later proved to be tuberculous osteomyelitis in absence of a primary focus and which responded well to anti-tubercular treatment (ATT).

Here, we report the complete genome sequence of the multidrug-resistant (MDR) strain Pseudomonas aeruginosa NRD619, assembled via long- and short-read hybrid assembly. P. aeruginosa is a Gram-negative bacterial pathogen that is a significant public health burden. NRD619 was isolated from a left ventricular assist device (LVAD) draining sinus tract.

Branchial pouch cysts clinically mimic deep neck space infection and misdiagnosis leads to surgical drainage which can complicate into a persistently draining sinus or fistula. We present a unique case of infected third branchial pouch cyst in an infant who presented with acute stridor and our experience in its management.

Hidradenitis suppurativa is characterized by lesions and draining sinus tracts in intimate locations. Although often overlooked, the selection of an effective, comfortable dressing can dramatically improve patients’ lives. We aimed to review dressings based on management of post-surgical and non-surgical wound dressings. We reviewed the characteristics and types of dressings used in patients with hidradenitis suppurativa and addressed recommendations for dressing post-surgical and non-surgical wounds. Available studies on dressings are few in number with small sample sizes. There were no studies comparing the efficacy of dressings in hidradenitis suppurativa patients. The types of dressings include superabsorbent/absorbent dressings, foam dressings, hydrofiber dressings, alginate dressings, silicone adherent dressings, non-adherent dressings, hydrocolloid dressings, silver-impregnated dressings, iodine-impregnated dressings, and honey-impregnated dressings, and platelet-rich plasma gel and hyaluronic acid scaffold dressings. Providers should consider the “TIME” acronym when assessing post-surgical and non-surgical wounds to select the appropriate dressing. As an important component of wound healing, large, randomized controlled trials that compare dressing options for the management of wounds in hidradenitis suppurativa patients are needed.

Cutaneous draining sinus tracts of odontogenic origin often are a diagnostic challenge. A delay in correctly diagnosing these types of lesions can result in unnecessary antibiotic therapy and surgical treatment. This case report presents the clinical course of two cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. These facial lesions were initially misdiagnosed as lesions of non-odontogenic origin. Later on an odontogenic cause was identified and endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis.

Tuberculous osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections and neoplastic diseases involving the mandible. Hereby we are reporting such type of case in a ten year old male, presented with draining sinus over right mandible since 3 months proved later as tuberculous osteomyelitis in absence of a primary focus and responded well to antitubercular treatment.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 59-62

AIM: Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly characterized by painful, deep dermal abscesses and chronic draining sinus tracts. Recently, laser and light-based therapies have become more commonly used in the management of HS.MATERIAL AND METHODS: We report 20 HS patients treated with a 1064 nm wavelength, emitted from a diode laser, launched in an optical fibre through intracavitary modalities.RESULTS: Each patient underwent four laser sessions, one every two weeks. we recorded a significative reduction (31%) of Sartorius score from 28.55 ± 13.04 to 19.75 ± 12.29 after 4 laser sessions (p < 0.05). No one has had a worsening of the disease.CONCLUSION: Intralesional diode laser 1064 nm can be a good treatment option for patients with moderate and localized hidradenitis suppurativa, because it is minimally invasive, doesn’t have significant complications and provides a rapid post-treatment recovery.

We report a novel case of a patient who had a draining sinus soon after a total hip arthroplasty that spontaneously resolved. The patient voluntarily discontinued antibiotic suppressive therapy (AST) after 10 years of treatment and paradoxically experienced full resolution of signs of chronic prosthetic joint infection (PJI), including recovery of his left-sided draining sinus tract. Now 8 years after discontinuing AST, the patient has no pain, good function, and no major or minor criteria of joint infection according to the Musculoskeletal Infection Society (MSIS) workgroup. The authors have not identified literature describing a similar resolution of draining sinus tracts from around a prosthetic joint after discontinuing AST. Despite the resolution of this patient’s sinus tract, the authors do not advocate for discontinuing AST in patients with a draining sinus tract. However, in spite of the fact that the MSIS consensus statement suggests that a draining sinus is a sure sign of PJI and that the assumption is that the infection will not go away until explant, this case was different.

Aims and objective To evaluate the surgical treatment given and do a regular follow up to study the recurrence rate and complications of ameloblastoma in our institution. Materials and methods A total of 31 cases of various subtypes of ameloblastoma, treated with different modalities, in the Department of OMFS, were recalled for a follow up & radiographs were taken along with the clinical examination for any recurrence or complications such as fracture/exposure of the reconstruction plate, loosening of the screw, infection of the graft, any draining sinus/signs of infection. Results Two of our patients had fractured reconstruction plate, one patient developed infection, one patient complained of screw exposure and two other patients had infection of the iliac graft. Conclusion We conclude that an adequate resection with a safe margin could be a treatment option and can be undertaken depending on the extent, location of the lesion and histopathologic variant.

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the hair follicles manifesting as painful nodules with draining sinus tracts. Due to protracted inflammation, cutaneous squamous ...

Hidradenitis Suppurativa is a chronic inflammatory disease often confused with an immune deficiency due to the chronic draining sinus tracts. Related conditions affect additional regions of skin. The pathophysiologic basis is over production of inflammatory mediators and the treatments are usually directed at restoring the balance of inflammatory pathways. Typically sporadic and episodic in nature, features of these syndromes can occur in association with inborn errors of immunity.

A young female sought treatment for a painful swelling in the right mandibular posterior region for the past 1 month with severe halitosis and paresthesia of right lower lip. Past history revealed that #46 was impacted due to an odontogenic tumor and an unsuccessful attempt was made to remove the impacted teeth and the tumor. A warm, tender, mild extra-oral diffuse swelling with right side cervical lymphadenopathy present. Intra-orally, there was a missing crown of 46 with a diffuse, tender buccal cortical expansion with a draining sinus. Imaging studies revealed a radiopaque lesion with a well-defined and rounded radiolucent halo. A provisional diagnosis of acute suppurative osteomyelitis was made and the remaining roots along with the radio-opaque material removed in toto via an open approach method and the entire area reconstructed with autograft harvested from rib. Histopathologically lesion was diagnosed to be a complex composite odontome. The challenges of diagnosis and the implication are discussed.

Sorafenib is a multi-kinase inhibitor approved for the treatment of renal cell and hepatocellular carcinoma. Adverse cutaneous reactions are a very common side effect of the medication. We report the development of hidradenitis suppurativa (HS) in a patient after initiation of treatment with sorafenib. HS is marked by recurrent deep painful nodules, fluctuant abscesses, and draining sinus tracts most frequently occurring in the groin and axilla. To our knowledge, sorafenib-induced HS in the axillary and inguinal skin folds has not been previously reported.

A longitudinal vaginal septum can be obstructive or nonobstructive. We report on an adult woman who presented with involuntary fluid loss per vagina and had a partially obstructive longitudinal vaginal septum. A 36-year-old nulliparous female presented with malodorous, clear, leakage per vagina that she described as “urinary incontinence.” Examination revealed a fluid-filled fluctuant anterior vaginal wall with a draining sinus. Imaging revealed a solitary right kidney with duplicated ectopic fluid-filled ureters inserting into a partially obstructed left hemivagina with a longitudinal vaginal septum. A longitudinal vaginal septum may present in adulthood with the complaint of urinary incontinence.

The festive season presents oral and maxillofacial surgery (OMFS) dental core trainees (DCTs) with the challenges of managing an eclectic mix of emergencies. We present three such patients in this case series. First, Patient A, a 39-year-old homeless male who presented with a maxillary extra-oral draining sinus. Secondly, Patient B, a 38-year-old intra-venous (IV) drug user who suffered pan-facial fractures following an alcohol-fuelled assault. Finally, Patient C, a 38-year-old male who sustained a left zygomatic complex fracture a week previously, in attendance for corrective surgery. Despite the hardship, there was still festive cheer to be had by these individuals. CPD/Clinical Relevance: Primary and secondary care practitioners should be aware of the advanced clinical presentation of dental and maxillofacial emergencies that occur over holiday periods.

Background Sacrococcygeal pilonidal disease is a chronic, well-recognized entity, characterized by the recurrent formation of an abscess or draining sinus over the sacrococcygeal area. It is one of the most common surgical problems. Rarely, chronic inflammation and recurrent disease leads to malignant transformation, most commonly to squamous cell carcinoma (SCC). Case presentation We describe an extremely unusual case of SCC developing in a 60-year-old patient with a chronic pilonidal sinus complicated by an anal fistula. After wide surgical excision of the pilonidal sinus and fistulas and because of the poor healing process 6 months later, colonoscopy and a percutaneous fistulography were performed, revealing an anal canal-pilonidal fistula. Patient was treated with a more radical surgical resection with a prophylactic loop colostomy, but healing was not accelerated. Multiple biopsies were then taken from the surgical site at the time, which revealed the development of SCC. CT and MRI imaging techniques revealed SCC partial invasion of the coccyx and sacrum. As a result, aggressive surgical approach was decided. Histological examination revealed moderately to poorly differentiated SCC, and the patient was treated with adjuvant radiation therapy postoperatively. Nine months later, recurrence was found in the sacrum and para-aorta lymph nodes and the patient died shortly after. We discuss the clinical features, pathogenesis, treatment options, and prognosis of this rare malignant transformation. Conclusions The development of SCC in chronic pilonidal disease is a rare but serious complication. Symptoms are usually attributed to the sacrococcygeal pilonidal disease (SPD), and diagnosis is often made late by histological examination of biopsies. Malignant transformation should be suspected in chronic SPD with recurrent episodes of inflammation, repeated purulent discharge, poor healing, and chronic complex fistulas.

A 7-year-old girl presented with a small fistula in the right lateral orbital region since birth. Bacteremia developed from a local infection of the region at the age of 6 years and 10 months. The blind end of the fistula was a cyst located slightly cranial to the right frontozygomatic suture, and the region was accompanied by osseous concavity. Based on the present case and our literature search of reported cases, when this defect is suspected, it is important to identify its location and morphology using imaging techniques and perform early excision of the cyst. Keywords: Dermoid cyst, Sinus, Lateral orbital region

Odontogenic cutaneous sinus tract is a rare but well-documented condition. A common manifestation of pulp necrosis is draining sinus tract or fistula, which could be intra-oral or extra-oral. The microbiologically induced inflammation spreads along the path of least resistance by penetrating the alveolar bone. Ultimately, to form a path of drainage, the inflammatory process can reach the surrounding tissues. These conditions are often misdiagnosed as other non-pulp pathologies. So misdiagnosed as a local skin lesion and maltreated by systemic antibiotics, we came across a 13-year-old girl patient who presented with a cutaneous lesion of dental etiology in the sub-mental region with frequent purulent discharge which was not responding to systemic antibiotics. The management of this condition using endodontic therapy of the involved tooth followed by surgical excision of sinus tract so as to minimize the residual scar formation are presented here.

Orbitofacial dermoid cysts in children are treated using surgical excision. Dermoid cysts of the frontotemporal region usually present as superficial, slow-growing masses without deep extension. We report a rare case wherein a frontotemporal dermoid in a 21-month-old girl presented with a draining sinus tract to the skin and extended intracranially through the sphenoid bone. It was removed surgically and a dermoid cyst was removed from the frontotemporal region, extending superficially from the skin sinus tract through the sphenoid bone and attaching to the dura of the anterior temporal lobe. In addition to our case presentation, a literature review was performed to identify the few reported similar cases in the published literature, the combination of which suggests that frontotemporal dermoid cysts with associated draining sinus tracts may require preoperative imaging with computed tomography or magnetic resonance imaging before surgical intervention because of the high likelihood of intracranial extension.

We report a case of retained wooden foreign body in the zygomatic region which posed a considerable diagnostic difficulty and was the source of persistent draining sinus and other distressing symptoms. The patient was not aware of the foreign body in the maxillofacial region. In such cases a thorough history of the patient is of utmost importance. The case has been described to highlight the problems associated in managing unlikely foreign bodies at unusual facial sites when there is a possibility that radiolucent material is embedded in the wound.

Aims: Pacemaker and implantable-cardioverter defibrillator lead infections widely increased with consequent need to accurately recognize responsible bacteria. Methods: Between May 2003 and December 2007, we extracted 118 leads, 104 (87.3%) due to infections (sepsis, lead-associated endocarditis, pocket infection) or chronic draining sinus (with negative local bacteriological analyses). Swabs and tissue specimens from pocket and fragments of pin and tip of each extracted lead were obtained during extraction and sent for bacteriological examination. Results: Cultures from explanted lead pins returned positive results in 100% of the cases presenting with local infections and in 92.5% of those with chronic draining sinus. In cases of sepsis, positive results of blood samples are less common than lead samples (58.3 vs 86.7, P = 0.02), the latter being more sensitive for infection diagnosis. Concordance between bacterial isolates from pocket and lead is quite low, approaching 45%, seemingly due to contamination effect. Concordance between isolates within the lead (pin and tip) is quite high, close to 70%, reflecting a more accurate expression of the real infection. In cases of sepsis, concordance between lead and blood samples, and mainly from tip and blood, is very high, resembling 80–85%; consequently bacterial isolates from the lead, particularly from lead tip, are clearly associated with clinical infections. Conclusions: Our results strongly support the hypothesis that chronic draining sinus is often sustained by infection. Moreover, diagnostic accuracy of lead samples is higher not only than swabs and tissue samples, but also than blood samples to confirm an infection and to guide effective therapy.

Polyethylene-induced pes anserinus bursitis after total knee arthroplasty (TKA) with the clinical manifestations mimicking an infected TKA is a very rare occurrence. We report such a case in a 74-year-old woman. She developed recurrent draining papules on the anterolateral aspect of the knee because of polyethylene-induced chronic pes anserinus bursitis 8 years after TKA. The diagnosis was established with a sinography study and confirmed by histopathologic examination of the surgical specimen. The symptoms were resolved after surgical excision of the lesion. Pes anserinus bursitis should be included in the differential diagnosis in knees with a draining sinus after TKA, and sinogram is considered the best method to establish the diagnosis.

Cutaneous sinus tracts of dental origin have been well-documented in the medical literature. However, these lesions continue to be a diagnostic dilemma. A review of several reported cases reveals that patients have had multiple surgical excisions, radiotherapy, multiple biopsies, and multiple antibiotic regimens, all of which have failed, with a recurrence of the cutaneous sinus tract, as the primary etiology was dental that was never correctly diagnosed or addressed. This case report demonstrates the healing of an extraoral draining sinus by means of conventional nonsurgical root canal treatment.

Case: We report a case of a sterile abscess with subsequent sinus tract formation mimicking infection 3 years after uncomplicated distal biceps brachii tendon repair with FiberWire suture in a 42-year-old man. The preoperative workup for infection was unremarkable. Intraoperative culture specimens confirmed the absence of infection. Excision of the sinus tract and FiberWire-ENDOBUTTON construct was curative. At the 1-year follow-up, there had been no recurrence of symptoms. Conclusion: Foreign-body inflammatory reactions should be considered in the differential diagnosis of patients with apparent infection with a history of FiberWire suture fixation and negative serologic workup.

Branchial cleft anomalies are a common cause of congenital neck masses and can present as a cyst, sinus, or fistula. A comprehensive understanding of the embryologic basis of these anomalies aids in diagnosis and surgical excision. Fistulas tend to present at an earlier age than sinuses or cysts, with most lesions presenting as either a neck mass, draining sinus, or recurrent infections. The eventual management of each is complete surgical excision, which is curative. A history of recurrent preoperative infections leads to a higher rate of recurrence.

Skeletal deformities do occur after conservative or operative fracture treatment, as a consequence of congenital growth disturbance and as sequlae after posttraumatic and haematogenous osteomyelitis. In postinfectious deformities the course of the bone and soft tissue infection plays a decisive role when choosing the appropriate operative technique. Even in non active situations with a closed soft tissues envelope and no draining sinus persistence of germs within the bone has to be anticipated. The biological quality of the bone and the soft tissue envelope is often reduced because of local changes and as a result of multiple local revisions. Consequently wide areas of scar tissue and sclerotic bone are often encountered. The apex of the deformity is in most cases identical with the focus of the active or non active infection. The correction of the deformity at the apex can therefore only be accomplished if the infectious bone is also resected. If a correction is not possible at the apex of the deformity, translation at the osteotomy site is necessary to achieve a correct mechanical axis. The later rather complex operative procedure necessitates intensive preoperative planning and an extensive experience with deformity corrections by external fixators.

BACKGROUND: Synthetic materials are being used increasingly in reconstructive pelvic surgery. Multifilament polypropylene mesh in particular has been associated with healing abnormalities and other postoperative complications. This article describes an atypical infection presenting as a draining sinus tract to the lower extremity after intravaginal slingplasty. CASE: An otherwise healthy 75-year-old-woman presented with recurrent leg cellulitis 18 months after posterior intravaginal slingplasty for vaginal vault prolapse. A 35-cm fistulous tract draining from the pelvis to the lower thigh was identified. The patient underwent surgical debridement and was treated with 12 weeks of intravenous antibiotics with complete healing and no recurrence of symptoms. CONCLUSION: Complications associated with the multifilament mesh used in the intravaginal slingplasty tunneler device include pain, erosion, localized abscess, and genitourinary fistula.

Background Cutaneous draining sinus tracts of dental origin often are a diagnostic challenge. A delay in correctly diagnosing these types of lesions can result in ineffective and inappropriate treatment. Case Description The authors present five cases of facial lesions that were initially misdiagnosed as lesions of nonodontogenic origin. The correct diagnosis in each case was cutaneous sinus tract secondary to pulpal necrosis and suppurative apical periodontitis. All facial sinus tracts resolved after the patients received nonsurgical root canal therapy. Clinical Implications As patients with cutaneous facial sinus tracts of dental origin often do not have obvious dental symptoms, possible dental etiology may be overlooked. Early correct diagnosis and treatment of these lesions can help prevent unnecessary and ineffective antibiotic therapy or surgical treatment.

Background: Recurrent inguinal hernias can be repaired efficaciously by mesh plug techniques, which have had better results than traditional tissue-based repairs in several small studies. This report provides a detailed description and assessment of the anterior, tension-free, “umbrella” mesh plug method for recurrent groin herniorrhaphy. Methods: We performed a retrospective analysis of 407 patients with recurrent inguinal and femoral hernias treated with an umbrella mesh plug repair since 1989. Information was recorded about postoperative recovery and complications, and patients were examined for rerecurrences 1 week after operation and annually thereafter. Results: Of the 320 patients with a first-time recurrence, 6 (2%) had a rerecurrence after placement of a mesh plug. Of the 87 patients who had undergone 2 or more prior repairs, 8 (9%) had a rerecurrence subsequent to a mesh plug hernioplasty. Nine (64%) of the 14 rerecurrences were noted within 1 year of operation; 4 (29%) were found 2 years after operation and 1 (7%) during postoperative year 3. During the 9 years of follow-up study, a mesh plug has not been involved in any infectious process requiring removal. There have been no instances of draining sinus tracts, ischemic orchitis, long-term pain, vascular and embolic phenomena, or plug erosion and migration. Two hundred fifteen (53%) of the patients took no pain medication. One hundred fifty-nine patients (39%) used nothing more than nonprescription pain medicine. Three hundred seventy-five patients (92%) returned to normal daily activities within 4 days of the herniorrhaphy. Conclusions: Patients with recurrent groin hernias, who undergo a minimal-dissection umbrella mesh plug repair, have a rapid recovery and few postoperative complications. (Surgery 1998;124:844-7.)

Actinomycetous infections typically involve either the head and neck or the extremities following a traumatic implantation. Classic clinical associations are draining sinus tracts. This case report describes the pathologic and MR findings of a relatively acute mycetomatous process involving the soft tissues. Pathologic findings in this case included an occasional granule composed of gram positive, thin branching elements. These and other findings were consistent with actinomycetes bacterium infection. The discussion centers around the use of MR, both with and without gadolinium, in evaluating this type of granulomatous infection. Infiltration of the adjacent subcutaneous tissues was easier to appreciate on both the T1-weighted images without gadolinium and the T1-weighted images with gadolinium when compared to the T2-weighted images. Signal characteristics as described in this case report may suggest a granulomatous process.

Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in good systemic health.

A 29-year-old Thai women had draining sinus tracts, tumefaction, and granules on the plantar aspect of the foot. Phialophora verrucosa was isolated from the lesion. P. verrucosa is a major agent of chromoblastomycosis, which is known to rarely cause subcutaneous phaeohyphomycosis. This dematiaceous fungus has not been previously reported to cause mycetoma. This case illustrates the clinical spectrum of disease of this fungus. The salient features of mycetoma and management options are presented.

Objective: To review the treatment and outcome of patients with nontuberculous mycobacterial infections of the head and neck. Design: Retrospective examination of the medical records of patients treated by several surgeons during a 5-year period with a minimum 6-month follow-up. Setting: Large teaching children's hospital. Patients: Twenty-six children hospitalized for treatment of nontuberculous mycobacterial infections of the head and neck. Main Outcome Measures: Resolution of infection, recurrence, and need for additional surgical intervention for cure. Results: Eleven patients initially were treated by incisional biopsy or incision and drainage procedures; eight patients developed recurrence or a draining sinus tract, necessitating a second surgical procedure. In contrast, 15 patients initially underwent complete excision; only one developed a recurrence ( P Conclusions: Excisional biopsy is both the diagnostic procedure and treatment of choice for nontuberculous mycobacterial adenitis. (Arch Otolaryngol Head Neck Surg. 1994;120:873-876)

We report a case of congenital heterotopic salivary gland with draining sinus in the lower neck on the right side of a 10-year-old female, which we initially thought to be a branchial fistula. Heterotopic salivary glands are rare lesions in the neck and when present appear very similar to branchial cleft sinus or fistula. This congenital lesion is rare. This is probably the first report from India. It is important to report this case to raise the awareness of this condition.

Salivary tissue can be present in the head and neck outside the usual locations of the major and minor salivary glands. This can be in the form of accessory salivary glands, in association with branchial cleft anomalies, or, less commonly, as heterotopic salivary gland tissue (HSGT). Heterotopic salivary gland tissue is defined as salivary tissue outside of the expected locations of major, minor, and accessory salivary glands with absence of clinical or histologic features of branchial cleft anomalies. Here we present the case of a 13-year-old girl who presented with a draining sinus of the lower neck, which was excised and, on histologic analysis, was consistent with HSGT. We include photographs and histologic images. A review of the literature on heterotopic salivary tissue in the neck is then presented including discussion of the presentation, clinical features, important considerations, and recommendations for management.

A 34-year-old woman presented with a history of a previous laparoscopic cholecystectomy, followed within a few days by a formal laparotomy for a suspected bile duct injury. Approximately one week after the laparotomy, she developed a sinus on the anterior abdominal wall that was draining bile. She was then referred to our institution for further management. The earlier surgery was done at another hospital, and these details were not clear. A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts. A week later, an endoscopic retrograde cholangiopancreatography (ERCP) examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts. These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy. This duct now drained into the gallbladder fossa, causing the collection and draining sinus.

A cutaneous draining sinus tract of dental origin is often a diagnostic challenge, because of its uncommon occurrence and absence of dental symptoms. Proper diagnosis, treatment, and the elimination of the source of infection are a must; otherwise, it can result in ineffective and inappropriate outcome of treatment. This article presents 4 cases of facial lesions misdiagnosed as being of nonodontogenic origin. The correct diagnosis in each case was cutaneous sinus tract secondary to pulpal necrosis, suppurative apical periodontitis, and osteomyelitis. In all cases, facial sinus tracts of dental origin were excised and the source of infection eliminated. The purpose of this paper is to provide diagnostic guidelines and examination protocols for differential diagnosis of cutaneous facial sinus tracts of dental origin.

Fifteen cases of mycetomas from four locations in northern Yemen were studied. On the basis of morphologic characteristics and staining properties of the granules in discharges from the draining sinus tracts (a narrow elongated cavity that extends from a focus of suppuration or other inflammatory softening to a free surface and through which pus discharges) in the affected appendages and in tissue sections, three causative organisms were identified: Streptomyces somaliensis, Actinomadura madurae, and Madurella mycetomatis. Because of the similarity in the climate and the causative organisms, northern Yemen can be considered as being in the same endemic area for mycetomas as eastern Africa.

Background Surgical resection remains the gold standard for the treatment of localized adenocarcinoma of the extrahepatic bile ducts. Yet, treatment of loco-regional recurrences is not well defined. Case Presentation We present an unusual case of distal adenocarcinoma of the extrahepatic bile ducts that was treated with surgery and relapsed two years later with a solitary recurrence on the tract of a previous Redon drain. In addition, a review of the literature on management of loco regional relapses is presented. Conclusions The ideal management of these patients still remains undefined. Decisions are made based on clinical parameters from retrospective series, such as tumor grade, surgical margins or lymph node involvement. Prospective studies, that include molecular and genetic markers, are needed to improve patient selection and outcomes on this population.