Endovascular versus open surgical reconstruction in long segment superficial femoral artery occlusive disease

Background: The concept of endovascular intervention has been well supported by the continuous advance in technology in long segment [superficial femoral artery] SFA occlusions. The rapid evolution of stent design, deployment approaches and adjunctive therapy made the practice of [percutaneous transluminal angioplasty] PTA safer and more predictable and has reduced superficial femoral artey surgery

Objectives: To compare the safety and effectiveness of endovascular treatment versus open surgical bypass in treatment of superficial femoral artery occlusive disease

Patients and Methods: This prospective study included 30 patients presenting to the Vascular Department in Cairo University Hospitals with femoropopliteal occlusive disease for whom percutaneous transluminal angioplasty with or without stenting was done for 15 cases. Femoropopliteal bypass surgery with saphenous or synthetic graft was done for 15 cases between March 2017 and January 2018. The procedure, possible complications, benefits, risks and other alternative interventions were all explained to the patients and an informed consent was obtained

Results: In endovascular cases: 1/15[6.66%] cases, developed small haematoma at the site of puncture which resolved by conservative management. After 6 months follow up,6/15 cases [40%] had intact pedal pulsation, 6/15 cases [40%] had popliteal pulsation with marked improvement of their complaints [disappearance of rest pain in 3 cases, the other 3 cases which had gangrene, line of demarcation appeared]. 1/15 case [6.66%] showed popliteal pulse at 3 months follow up which disappeared at 6 months but the patient had good circulation with improvement of rest pain. So, successful cases were 13/15[86.66%] at 6 months follow up. 2 /15 cases[13.33%] showed occlusion, by Duplex 1 case of them showed occlusion of stent and 1 case showed return to original occlusion. In open surgical cases: Postoperative wound infection at groin incision developed in 3/15[20%] cases, 2 cases of them were managed conservatively by IV antibiotic and repeated dressing, and one developed secondary haemorrhage in which ligation of femoral artery was done and the limb became gangrenous and Above knee amputation was done. After 6 months follow up, 5/15 cases [33.33%] had intact pedal pulsation, 7/15 cases [46.66%] had popliteal pulsation with marked improvement of their complaints. Disappearance of rest pain occurred in 3 cases, while 3 cases which had gangrene, line of demarcation appeared and 1 case which had non healing ulcer, healing of ulcer started to occur. So successful cases 12/15[80%] at 6 months follow up. Thus, 3/15 cases [20%] failed, 1 case developed wound infection at groin incision followed by secondary haemorrhage in which ligation of the graft was done, the limb was worsen ended in above knee amputation. The other 2 cases showed occlusion of graft, 1 case ended in above knee amputation, the other below knee amputation was done in which the stump became gangrenous followed by above knee amputation

Conclusion: Percutaneous transluminal angioplasty [PTA] has obtained a definite place in the management of peripheral arterial occlusive disease of the lower limb. It was widely accepted as a first line of treatment for many patients with SFA occlusive disease. The low complication rate and relatively non-invasive nature of PTA made it an increasing popular intervention

prospective study of the latero-central glandular pedicle technique as an oncoplastic procedure for medial quadrants breast masses:oncological safety and clinical outcomes

Background: breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. For many women with stage 1 or 2 breast cancer, the combination of partial mastectomy and radiation therapy - together referred to as breast- conserving therapy is preferable to total mastectomy because breast conserving surgery survival rates is equivalent to those after mastectomy while preserving the breast

Aim of the work: this study aimed to focus on the latero-central glandular pedicle technique as an oncoplastic procedure for management of medial breast cancer and to assess the technique clinically regarding oncological safety, surgical outcomes and patient satisfaction

Methods: this was a prospective analytical study that included 15 patients aiming to clinically assess the centro-lateral oncoplastic technique for both inner quadrants of breast cancer regarding oncological safety and patient satisfaction. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained

Results: in our study we were able to conduct an excellent cosmetic outcome for a relatively large tumor excisions with 66% of the cases [10 patients] falling in excellent and very good score groups with mean cosmetic outcome score 4.26. Another 20% [3 cases] which fall in good and fair score groups as those two patients noticed asymmetry of the two breasts in front of the mirror as they refused bilateral breast reduction mastopexy. None of our cases have had a poor or an ugly score

Conclusion: the combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. This approach has enabled us to increase the number and extend the indications of breast conserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome

Insitu liver autotransplantation in dogs without venovenous bypass, novel technique for training on liver transplantation

Introduction: Living-related liver transplantation is gaining increasing acceptance in Egypt and is the only available liver transplantation technique as cadaveric grafts are not approved by law. However it needs high surgical skills regarding hepatic surgery, micro vascular anastomosis and training on small biliary anastomosis

Aim: Provide surgical team responsible for living-related liver transplantation with frequent training on a model very similar to that in human. The aim is to acquire the required surgical skills

Methodology: This technique was done in 9 adult mongrel dogs of both sexes weighing between 85-15 kg, in experimental animal house in Urology nephrology center. General anesthesia is used in all dogs with intubation. Through midline incision and insertion of ring retractor. Dissection of hepatic artery, portal vein. common bile duct and hepatic veins is done with preservation of IVC and isolated dissection of LHV and RHV. Division of HA, PV. CBD is then carried out followed by clamping RHV and LHV and anterior venotomy of LHV. Infusion of PV with cold ringer's solution at 4 C degree with drainage from LHV venotomy. Reanastomosis of HA, PV, CBD and closure of venotomy is done at the end with revascularization of the graft. Wedge liver biopsy was taken before portal clamping, at 30 min ischemia, after portal reperfusion and after arterial reperfusion. Postoperative fluids and antibiotics are given. Follow up for survival up toe months is done with scarification of living dogs for assessment

Results: All dogs survived the operation and up to 24 hours. One dog survived up to 6 months and scarified to assess success of technique. Biliary leak occurred in one dog and discovered after 2 weeks. Average survival in other dogs is 2 weeks. Minimal focal necrosis of the liver was noted after 30 min ischemia. Reperfusion changes are minimal mainly neutrophil infiltration and mild vacular degeneration

Conclusion: Liver transplantation in dogs is an excellent model for training surgical team responsible for liver transplantation as the number of cases is not enough to reach the high level of surgical experience required. It will be also valuable as research tool, to study ischemia and reperfusion injury

Temporary defunctioning stomas: a randomized clinical trial comparing loop ileostomy with loop transverse colostomy following low anterior resection with total mesorectal excision

Patients undergoing low anterior resection with total mesorectal excision who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy [n=13] [group A] or a loop transverse colostomy [n=14] [group B]. Postoperative morbidity following closure were compared. From May 1999 to May 2002, 13 patients had a loop ileostomy and 14 had a loop colostomy following low anterior resection. There were no significant differences in the difficulty of formation or closure, or in the postoperative recovery between the groups. However, the ileostomy was associated with significantly less appliance changes. Wound infection was also significantly more common after closure of colostomy compared with the ileostomy. Furthermore, four complications directly related to the stoma in the loop transverse colostomy group have been seen [prolapse [two] and incisional hernia during follow-up [two]]. None of these complications occurred in the loop ileostomy group