Coagulation disorders in symptomatic deep vein thrombosis

The present study was carried on 25 patients with deep vein thrombosis and 10 healthy controls. The following laboratory investigations were performed for both patients and controls: platelet count and aggregation using ADP; prothrombin time and concentration; partial thromboplastin time; plasma plasminogen, alpha-2 antiplasmin and antithrombin III. The mean platelet count in patients [292.800/cu mm] was higher than in the control group [263,000/cu mm]. But the difference was not statistically significant. The maximum platelet aggregation in the patients [55.49%] was significantly lower than controls [95%]. Both the prothrombin and partial thromboplastin times in the patients were higher than the controls with a statistically significant difference. The plasminogen level in patients' plasma was slightly lower than in controls. No statiscally significant difference was detected between the alpha-2 antiplasmin activity in patients [113.8%] and the control group [95.45%]. The mean antithrombin III concentration in patients [29.34 mg/d] was significantly lower than controls [32.1 mg/d]

Thrombosed arterio-venous fistulae for hemodialysis

Patients with recurrent thrombosis of access arterio-venous fistulae were selected to clarify the cause of their shunt failure. Antithrombin III being the most important physiological normal circulating anticoagulant which causes progressive irreversible destruction of thrombin in plasma, has been estimated in 43 patients and 20 normal controls. Every patient was subjected to determination of Antithrombin III [ATIII] level by functional assay, 2 weeks course of 5 mg Warfarin/day, re-estimation of ATIII level and then to construction of a new A -V fistula under maintenance dose of 2 mg Warfarin/day. The ATIII time in the patients [25.67 +/- 12.05 sec] was significantly lower than in controls [31.27 +/- 7.66 sec]. After warfarin therapy it increased significantly [30.37 +/- 8 sec] as compared to that before therapy. Patients who had reduced ATIII time showed dramatic response to warfarin therapy and ATIII increased to become within normal or even higher, but no significant change was observed in patients with normal or high ATIII. After three months follow up the new fistulae were patent in all the 12 patients who had low ATIII time which was improved by warfarin in contrary to those with normal or high ATIII time only 15 new shunts were patent out of 31 cases

CT guided percutaneous drainage of hepatic abscess

Liver abscess is an infrequent surgical problem that carries high morbidity and mortality rates. The accepted method of treatment was surgical drainage and this has its potential difficulties and complications. With the advent of modern imaging techniques percutaneous drainage of hepatic abscess was introduced and popularized by many centres .We treated twelve patients with liver abscess by percutaneous indwelling catheter drainage using no. 12 or 14 F polyurethane abscess drainage tube with side holes. This was aided by the guide wire and image intensifier. We succeded to drain all patients with marked clinical improvement with no discernible complications and no mortality. Review of the literature and our experience suggest that percutaneous drainage should be the first line of management of liver abscess because of its low mortality and camplications and its high cure rate

Pneumatosis cystoides intestinalis: management of eight cases

Pneumatosis cystoides intestinalis is an uncommon condition characterised by the presence of cystic accumulation of gas in the submucosa or subserosa of the bowel. Though many aetiological factors are postulated, the exact pathogenesis is uncertain. The present work includes, in addition to a review of all aetiological factors, the management of 8 cases collected over five years. The clinical significance of the condition resides in the fact that familiarity with it can avoid unnecessary laparotomy [Thomson et al, 1977] Specific management by oxygen therapy and elemental diet are discussed in our reported cases

Peripheral vascular injuries

Recent refinements in the management of traumatic peripheral vascular injuries has led to marked improvement in patient survival and limb salvage. 43 patients who sustained such injuries were reviewed. Recent auxiliary investigations included conventional angiography, nuclear angiography, Doppler ultrasound flow detector and intra-operative angiography. Primary repair could be accomplished in all cases. Vein grafts were used in 86% and direct repair in 14%. No primary amputation was resorted to though 7% [3 cases] 'eventually had amputation