Aug 242013
 

Pilonidal Cyst / Sinus is found in the intergluteal cleft on the posterior surface of the lower sacrum polonidal cyst Latin meaning ‘hair nest’ is a blanket term for any type of skin infection near the tail bone (coccyx).

Incidence;

  • More in men
  • Normally happen in early adulthood
  • Usually found near tail bone
  • Other – navel, armpit

 Causes:
Pilonidal Cyst results from local trauma that causes the penetration of hairs into the epithelium and subcutaneous tissue. Formed congenitally by an infoling of epithelial tissue beneath the skin which may communicate with the skin surface through one or several small sinus opening.

Controversy:

  • Cause idiopathic
  • Old, theory –> a small and harmless cyst has always been present at birth and that for some reasons, it has become irritated and formed a painful abscess.
  • Another explanation –> It is an in grown air that has formed an abscess.

 Note:


Condition was wide spread in US army during world war II. More than eighty thousands soldiers having the condition required hospitalization. It was termed ‘Jeep Siders disease’, because a large portion of people who were being hospitalized for it rode in jeeps and it was theorized that prolonged sides in the bumpy vehicles caused the condition.

Clinical features:

  • Irritating drainage.
  • Abscess
  • Pain

 Diagnosis: Physical examination

Management

  • Antibiotic therapy, hot compress, application of deplilatory creams.
  • After the acute process resolves, further surgery is performed to excise the cyst and the secondary sinus tract. The wound is allowed to heal by granulation. Gauze dressings are placed in the wound to keep its edge separated while healing occurs.

Complication: Death because of septicemia.

 Posted by at 12:18 pm
Aug 232013
 

Colo-rectal cancer is a malignant neoplasm that affects the layer, lower portion of the intestinal tract. Also called colon cancer or bowel cancer, includes cancerous growth in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of cancer related death in the western countries.

2/3 of Colo-rectal cancer occurs in the colon, sigmoid colon.

1/3 of Colo-rectal cancer occur in the rectum or at the recto sigmoid colon (junction)

  • Colo-rectal cancer has recently declined among white person in the US.
  • 50% higher, arising among African, Americans.
  • Hispanics – one half the mortality rate of non-Hispanic white persons.

Risk Factor:

  • Age after 50 years.
  • Family history of Colo-rectal cancer.
  • Chronic inflammatory bowel disease.
  • Benign polyp, edematous polyps.
  • Physical inactivity.
  • A diet high in fat.
  • Energy intake greater than requirement.
  • Low vegetable fiber intake.
  • High content of refined carbohydrate.
  • Smoking (40%)
  • High intake of red meat, low selenium.
  • Decreased intake of protective micro nutrients.
  • Physical inactivity, virus (Human Papilloma Virus).

Note: Diet likely contributes to risk in these sporadic cancers, although causality is not proved; above diets may promote mucosal exposure to bile acids and bacterial degradative by products.

Genes, some genes that signal a hereditary predisposition to colon cancer have been identified. For e.g. mutation in either of 2 genes MSHZ and MLHI can predispose a person to HHPCC.

Alcohol intake (heavy alcohol) use may also increase the risk of Colo-rectal cancer (NCI). One study found that “people, who drink more than 30 grams of alcohol per day and especially those who drink more than 4.5 gm per day, appear to have slightly higher risk of Colo-rectal cancer.

 Posted by at 9:08 pm