Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort

Techniques in Coloproctology - The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. All adult patients treated with SiLaT in our...     

Human Leukocyte Antigen Sensitization in Solid Organ Transplantation: A Primer on Terminology,Testing, and Clinical Significance for the Apheresis Practitioner

The human leukocyte antigen (HLA) system is an important immunologic barrier that must be considered for successful solid organ transplantation. Formation of donor‐specific HLA antibodies in solid organ transplantation is an important cause of allograft injury and may contribute to recipient morbidity and mortality. Therapeutic plasma exchange is often requested to lower HLA antibody levels prior to or after transplantation and for management of HLA antibodies in the context of organ rejection. In this review, we summarize the current terminology, laboratory testing, and clinical significance of HLA sensitization in the solid organ transplant population. Furthermore, to illustrate applications of HLA testing in clinical practice, we summarize our own lung and kidney institutional protocols for managing HLA antibodies in the peri‐transplant setting.     

Primary mammary focus of malignant non-Hodgkin's lymphoma. Apropos of 10 cases

The authors describe 10 cases of malignant non-Hodgkin's lymphoma in a mammary site in women aged 38 to 82 years. The clinical examination and the sometimes suggest an adenocarcinomatous lesion, thus leading to a useless surgical exeresis. An initial histological study provides the diagnosis. A complete assessment of extension allows an accurate staging and the refinement of the therapeutic schedule. Exclusive radiation therapy seems to be justified in low-malignancy forms remaining strictly confined to the breast. For the high- and medium-malignancy forms, the essential weapon is chemotherapy, which seems to improve the duration and rate of remission.     

Total perineal reconstruction after abdominoperineal excision for rectal cancer: long‐term results of dynamic graciloplasty with Malone appendicostomy

Aim This study aimed to assess long‐term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer. Method From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28–55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement ‘WPASR’ scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer ‘EORTC’ QLQ‐C30 and QLQ‐CR38 questionnaires). Results There was no procedure‐related mortality. One patient required intra‐abdominal re‐operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease‐free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time. Conclusion In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long‐term function and QoL.     

Techniques chirurgicales de traitement du carcinome ��pidermo?de de l��anus: amputation abdominop��rin��ale, colostomie p��rin��ale, reconstruction p��rin��ale par lambeaux

Although the treatment of anal squamous carcinoma is primarily medical, abdomino-perineal resection remains the only alternative treatment if primary chemoradiotherapy is contraindicated or is unsuccessful. Salvage surgery for anal squamous carcinoma requires wide excision of the anal sphincter and permanent abdominal colostomy. Such major surgery in an irradiated field is associated with significant morbidity from delayed wound healingm, but this can be reduced by the use of myocutaneous flaps, whilst perineal colostomy allows a permanent abdominal stoma to be avoided. These techniques have been employed in the management of low rectal cancer with good oncological and functional results. However, there is little data on perineal colostomy and its feasibility in squamous carcinoma is limited by the extent of the perineal surgical resection.