ABSTRACT
Chronic occlusive arterial diseases form a single largest entity amongst the peripheral vascular diseases. Current operative methods available for improving circulation often elicit poor results and the patient has to undergo an amputation. The technique of pedicled omental transfer has given hope of saving such unsalvageable limbs. Although symptomatic and clinical improvement has been reported by this method of "biological by-pass revascularisation", there are no simple, objective and easily reproducible tests to assess improvement in circulation. In this study pulse oximetry and stress testing have been used to assess revascularisation. This study comprised 56 patients (78 limbs) suffering from chronic occlusive arterial disease, spanning a period of 5 years. Patients were investigated and subjected to pedicled omental transplantation (omentopexy). Symptomatological assessment showed improvement in intermittent claudication in about 85% of patients, relief from rest pain in 86% and healing of chronic ulcers in 73% of patients. Objective tests of stress testing and pulse oximetry also showed improvement in circulation. Relief from ischaemia was more in cases of Buerger's disease (TAO) than in cases of atherosclerosis obliterans (ASO).
Subject(s)
Adult , Aged , Arterial Occlusive Diseases/surgery , Humans , India , Intermittent Claudication/surgery , Ischemia/surgery , Leg/blood supply , Male , Middle Aged , Omentum/transplantation , Surgical Flaps , Treatment OutcomeABSTRACT
Fifty-four patients with civilian vascular injuries of the extremities caused by blunt trauma in 41 patients and by penetrating trauma in 13 patients were evaluated. Twenty-nine patients (53.7%) had associated fractures/dislocations and 19 sustained concomitant venous injuries. Twenty-nine patients (53.7%) came with a lagging period of more than 12 hours. Vascular injuries were diagnosed both clinically and by Doppler examination. In patients with equivocal findings, arteriography was performed. Arterial repair was done in 19 patients and saphenous vein interposition grafting was done in 2 patients. Fifteen patients required fasciotomy. Amputation was done in 13 patients (24.07%). It is concluded that the time lag, incorrect and incomplete assessment, and the reluctance to perform fasciotomy early and completely are some of the factors responsible for poor results.
Subject(s)
Adolescent , Adult , Aged , Amputation, Surgical , Arteries/injuries , Child , Child, Preschool , Extremities/blood supply , Fascia/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multiple Trauma/complications , Saphenous Vein/transplantation , Time Factors , Veins/injuries , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgeryABSTRACT
Sigmoido-rectal intussusception is the least common type of intussusception seen in infants and children and is therefore usually misdiagnosed as rectal prolapse. Delay in diagnosis and treatment is due to lack of its awareness amongst surgeons, incomplete assessment of the prolapsed bowel at the anal orifice, and absence of classical traid of intussusception i.e. palpable abdominal mass, colicky abdominal pain, and bleeding per rectum.
Subject(s)
Child , Humans , Intussusception/diagnosis , Male , Rectal Prolapse/diagnosis , Sigmoid Diseases/diagnosisABSTRACT
Concentrations of serum calcium and inorganic phosphate and serum alkaline phosphatase activity have been determined in 75 males over the age of 60 years and 40 young adult controls. Serum calcium and inorganic phosphate levels were significantly lower in the elderly group. Serum calcium-inorganic phosphate product was below 30 in 36% of the aged individuals. Serum alkaline phosphatase activity was elevated in one subject only. These results indicate the existence of mild vitamin D deficiency in the elderly males in this region.