wound healing effects of iloprost in patients with Buerger's disease: claudication and prevention of major amputations

This study analyzes the therapeutic effects of intravenous infusion of iloprost in wound healing, healing of the amputation stump wound, improvement in intermittent claudication and prevention of major amputation in patients with Buerger's disease. In a prospective study, 19 patients with known Buerger's disease, received intravenous iloprost infusion, 6 hours per day for 10 days. Iloprost with a dose of 0.5-2 ng/kg/min according to the patients' tolerance and using cardiac monitoring during the whole infusion period was administered for 6 hours/day using saline solution. Patients with larger wounds underwent simultaneous transmetatarsal or Ray amputation of the involved toe[s]. All patients were discharged after 10 days. Patients were followed to detect their healing changes. Nineteen patients, 19-55 years old received 0.5-2 ng/kg/min iloprost intravenously for 6 hours/day for 10 days. During this period, there was relative improvement in resting pain, but no significant amelioration was noticed in wound healing. In a 2 years follow-up, 14 patients showed a complete healing of the amputation stump and increased distance of walking without any pain. Some previous candidates of major amputation did not need amputation anymore. Five patients [26%] did not respond to therapy. Although Buerger's disease patients who were under iloprost therapy, may not show significant changes in wound healing during treatment and at discharge, late results have proved that iloprost infusion is promising in improving wound healing and claudication and preventing major amputations

[Evaluation of efficacy and complications of snuff box arterivenous fistulas in patients with chronic renal failure: ligation versus not ligation of distal vein]

Endogen arteriovenous fistulas [AVFs] are one of important hemodialysis access. According to current use of this technique, especially snuff box AVF, we compared the efficacy and complications of the two main techniques of snuff box AVFs, including with distal vein ligation and without ligation the vein. This double blind clinical trial was performed on 110 [11 to 83 years old] chronic renal failure [CRF] patients without evidence of proximal vein stenosis. Case and control group were matched regarding in age, sex, underlying disease and history of previous AVF. Vein distal to the site of AVF was ligated in case group and left open in control group. Patients were followed up in the days 1, 30, and 180 after the surgery to evaluate the efficacy and complications of two techniques. Short-term efficacy was 90% and 93.6% in case and control groups, respectively. Long-term efficacy was 90% in case group and 84.8% in control group [NS]. The most common complication in both groups was thrombosis followed by edema of the limb and venous hypertension. Venous hypertension was seen only in the control group [NS]. There are no statistical significant differences between two groups in efficacy and complications. Venous hypertension did not occur in any of the patients in case group. So, we recommend distal ligation of vein in snuff box AVFs

Studying the results of femoral artery ligation in 65 patients with infected pseudoaneurysm due to IV-drug abuse

Regarding the increasing numbers of IV drug addicts, the incidence of infected pseudoaneurysm is increasing. So far, different therapeutic strategies have been tried, but each method has its own drawbacks. Therefore, discovering an appropriate thera-peutic method is necessary. 65 patients with infected pseudoaneurysm due to drug injection referred to Shohada Medical Center from Feb 1994 till Oct 2003 were chosen. After obtaining proximal control of the external iliac artery, femoral artery ligation was performed in all patients. The patients were observed for signs and symptoms of ischemia.After primary ligation of the involved artery, acute ischemia occurred in only 6 patients who later underwent extra-anatomical bypass. Only 3 patients underwent amputation. One of them was performed after extra-anatomical bypass and two cases after arterial ligation, as ischemia and gangrene had been present on admission. During patient follow up [minimum 3 months, maximum 3 years and average 12 months], 8 cases of slight claudication [9.3%] and 3 cases of severe claudication were reported and the rest have been symptom-free.Various treatments have been used for infected pseudoaneurysm, but none of them are faultless. According to infection of the site and existence of extensive necrosis and inflammatory tissue, anatomical and even non-anatomical bypasses are almost im-probable. The results of this study indicate that arterial ligation could be the first and probably the best choice of treatment in such patients with less cost and also without mentionable morbidity or mortality. This procedure must be performed in a vascular surgery center to perform vascular bypass if needed

Assessment of notaras posterior meshrectopexy in treatment of rectalprolapse: a ten year experience

The aim of this study is to evaluate the long and short term postoperative results after the Notaras procedure as a surgical treatment of rectal prolapse in adults.Thirty-one patients suffering from rectal prolapse who were operated with Notaras posterior mesh rectopexy in Shohada-e-Tajrish hospital between 1991-2000 were followed up for results and complications and the results were compared with other surgical techniques for this disease.The mortality rate was zero which was ideal in comparison with other studies; short term complications were seen in 20% of cases which had the same prevalence as other abdominal surgeries.Sexual impotence and retrograde ejaculation as long term complications were seen in only one patient [3.22%].The recurrence rate was zero which stands above nearly all other procedures, also we had recuperation of fecal incontinence in all of our cases and gas incontinence in 92% of them. The constipation rate has not increased significantly postoperatively [p= 0.8]The Notaras procedure can be used in the management of rectal prolapse with low mortality and recurrence rate but although not contraindicated, may not be appropriate for young and sexually active male patients

case of actinomycotic mycetoma in hand treated successfully with co-trimoxazole and streptomycin

Mycetoma is a chronic infection involving cutaneous and subcutaneous tissues. We describe a 33-year old man who presented subcutaneous nodules with draining sinuses that extrude masses of the infecting organism. The etiologic agent of disease was identified as Nocardia asteroids by direct examination, culture of exudates and physiological tests. The lesions were completely eradicated by using combination of streptomycin and co-trimoxazole