Ultrasound-guided compression of iatrogenic femoral artery pseudoaneurysms

From March 2002 to May 2004, forty-two patients with iatrogenic pseudoaneuiysm after diagnostic and interventional procedures were identified by clinical and duplex examination. Data of the patients were collected regarding, clinical picture, catheterization procedure, size of sheath, coagulation parameters, pseudoaneurysm size and location, time to compression, and number of attempts at compression. Patients who had successful ultrasound guided compression underwent follow-up duplex scanning. Forty-two patients with iatrogenic pseudoaneurysms were treated with UGC over a 26-months period. UGC was successful at obliterating the false aneurysm cavity with the initial attempt in 37 [88.1%] patients, in two of these patients [4.8%] recurrence of false aneurysm occurred 3 and 9 days after initially successful UGC. Obliteration of three additional pseudoaneurysms [7.1%] was achieved on subsequent UGC attempts after failure of the initial attempts of UGC. This account for an overall success rate of [95.3%]. Surgical repair was attempted in two [4.8%] patients where UGC was not successful. There were no episodes of thromboembolism or skin necrosis. Follow-up was available for thirty-six patients, for whom physical examination and follow-up duplex was done 1 to 12 months after compression. There was no evidence of late recurrence of pseudoaneurysm, or residual thrombus. Pseudoaneuiysms after iatrogenic arteriographic and interventional procedures can often be successfully compressed with an ultrasound-guided technique. The precise role of this technique would appear to be a valuable method for management of uncomplicated iatrogenic femoral artery pseudoaneurysms

role of total mesorectal excision and short term preoperative radiotherapy in improving the outcome of rectal cancer surgery

Colorectal cancer is the most common gastrointestinal cancer. One of the main problems in the treatment of rectal cancer is the development of local recurrence. Recurrences of rectal cancer are often confined to the pelvis without distant metastases and considered as a loco-regional failure. Total mesorectal excision [TME] was described 25 years ago and is now being established as the therapeutic gold standard for rectal cancer surgery in a number of countries worldwide. The analysis of this study which included 54 patients who underwent potentially curative radical surgery for rectal cancer showed that the introduction of TME has led to substantial lower loco-regional recurrence rate within the first 2 years postoperatively from 66.6% in group A [20 patients] to 33.3% in group B [34 patients]. Further improvement was recognized in group B2 who underwent TME + short course of preoperative radiotherapy. However the risk of anastomotic leak was higher among the low anterior resection+ TME group [5 patients] 25%, specifically in those who received a short term preoperative radiotherapy, in comparison with patients among [group A] who underwent curative low anterior resection without TME. Despite the initial controversy. TME + preoperative short term adjuvant radiotherapy is now a feasible, reproducible, adjunctive therapy in the management of rectal cancer

Different surgical modalities in management of extracranial internal carotid artery aneurysm

Aim: the purpose of this study was to analyze the etiology, the mode of presentation; surgical management of a series of extracranial internal carotid artery aneurysms [EICAA]

Patients and methods: this study includes 20 patients 8 men and 2 females with aneurysms involving the extracranial internal carotid artery presenting to Kasr El-Eini hospital during the period from January 2000 to December 2003

Results: the etiology was trauma in 4 patients [40%], atherosclerosis in 4 patients [40%], Behcet's disease in 1[l0%] patient and mycotic aneurysm in 2 patient [10%]. As regards the management interposition grafting was applied in 8 [80%] of the 10 cases saphenous interposition graft was applied in 5 cases [50%] and in 3 [30%] cases polytetrafluoroethylene [PTFE] graft was used. Two cases were treated by ligation [20%]. Clinical results showed minimal complications in two patients one with haematoma, and other with hypoglossal nerve affection. Follow up Duplex was done for 8 cases within the 2 years following surgery and proved no stenosis or occlusion in the repaired artery

Conclusion: EICAA are rare and have variable causes. Safety and long-term reliability of appropriate surgical approach warrant broad surgical indications, because of the risk of embolization and rupture of these aneurysms

Laparoscopic vertical banded gastroplasty versus laparoscopic adjustable gastric banding in morbidlty obese patients: a comparative study

To compare between laparoscopic vertical banded gastroplasty and laparoscopic adjustable gastric banding as regard the operative procedure, efficiency, clinical results and complications, in the treatment of morbid obesity A total of 40 morbidly obese patients, with body mass index [BMl] 40 to 50 kg/m[2] were selected to either laparoscopic adjustable silicone banding [LASGB] [n = 21 cases] or laparoscopic vertical banding gastroplasty [LVBG] [n 19 cases]. The patients were operated upon during the period between February 2000 to November 2001 with a follow up period of 24 months postoperatively There were no deaths in both groups but conversions to open surgery in one case in [LVBG]. Mean operative time was 94.2 minutes in [LVBG] versus 65.4 minutes in [LASGB] [P < 0.05] Early morbidity rate was lower in LASGB [6.1%] versus LVBG [9.8%]. Mean hospital stay was shorter in LASGB [3 days] versus LVBG [6 days [P < 0.05,]. Late complications in LVBG was 14% and in LASGB was 32.7% [P < 0.05]. The most frequent complication was slippage of the band [18%]. Late reoperations rate in LVBG was 0% versus 24.5% in LASGB [P < 0.001]. Weight loss in LVBG after 2 years was [63.5%], versus 41.4% in LASGB. BMI in L VBG at 2 years was 29.7 kg/m[2] versus 34.8kg/m[2] in LASGB. This study demonstrates that, in patients with BMI 40 to 50 kg/m[2], LASGB requires shorter operative time and hospital stay but LVGB is more effective in terms of late complications reoperations and weight loss