[Complications and patency rate of portosystemic shunts in chronic liver diseases]

Cirrhosis is the most important etiology of portal hypertension worldwide. Even with improvements in noninvasive therapies, portosystemic shunts still remain one of the most important approaches after failure in medical treatment. Transjugular Intrahepatic Portosystemic shunt and liver transplantation are alternatively used in other countries. Evaluation of complications and patency rates can be a great help in choosing the best technique in patients. The aim of this study was to evaluate patency rate and complications of portosystemic shunts in patients with chronic hepatic diseases. In this cross sectional study, from summer 2000 to spring 2004, carried out at General and Vascular Surgery Departments 19 patients with portal hypertension underwent surgery. Patients with portosystemic shunts were followed up for at least one year after surgery, considering blood flow in anastomosis, using color Doppler ultrasonography and symptoms such as gastro intestinal bleeding, hepatic encephalopathy and etc. Data were analyzed using SPSS version 13 and descriptive statistics. Male to female ratio was 1:1.7. Portosystemic shunt was performed for 16 patients [2 distal splenorenal, 10 central splenorenal, 2 portocaval, 2 mesocaval] and 3 underwent splenectomy. Of patients 2 complicated with pneumonia after a week, and 2 with encephalopathy. After at least one year, 66.6% of shunts were patent, 8% were closed and in 25.4% doppler ultra sonography could not localize the shunt. One patient died under surgery. There was no death at the end of the first year; but during a 6 years follow up, 6 mortalities occurred. The major etiology of portal hypertension in these patients was cirrhosis secondary to hepatitis B. This finding is due to the cultural and religious differences with other countries. There was no relationship between pneumonia and splenectomy [p= 0.45]. Also, no significant difference observed between pre and post surgery encephalopathy [p =0.14]. Mortality rate did not depend on pre [p= 0.09] and post [p= 0.11] surgery encephalopathy. Survival rate of patients was 94.7% after one year and 73.7% after 2 years, demonstrating better results in comparison with other similar studies

application of thoracoscopic sympathectomy for the optimal management of hyperhidrosis and severe upper extremity ischemia

The thoracic sympathectomy is traditionally performed through open surgical thoracotomy. It is an extensive procedure associated with an unacceptable inconvenience. The present study describes a less morbid and minimally invasive thoracoscopy as the procedure of choice for thoracic sympathectomy. The present study, carried out during 2001 to 2005, was performed on 33 patients aged from 17 to 18, with a mean of 42.7 years and comprising 25 males and 8 females. They suffered from essential hyperhidrosis and severe upper extremity ischemia, which were unsuitable for revascularization. Of 33 patients, 15 had Buerger's disease, 3 emboli, 5 essential hyperhidrosis, 3 Raynaud's syndrome, 3 intra-arterial injections, 2 advanced arthrosclerosis, 1 acute thrombosis, and 1 patient post-traumatic ischemia. The patients were indicated to undergo a probable emergency thoracotomy. They were anaesthetized using one lung endobronchial intubations and underwent a two-port videothoracoscopy. Sympathetic chain resection was limited to T2-T3 and lower third of the stellate ganglion. The patients were kept under careful observation and comparisons were made between their preoperative and postoperative symptoms. Moreover, the early and late complications were carefully documented and analyzed. The presenting symptoms included 11, 4, 4 and 3 cases of ulcer and gangrene, rest pain, cyanosis and cold extremities, as well as excessive hand sweat respectively. The foregoing thoracic sympathectomy led to corresponding complete and partial recovery of 31 and 2 patients. Thoracoscopic sympathectomy is a simple, safe, reliable and cost effective therapy with surprisingly good results and low complications in patients with primary hyperhidrosis as well as limb threatening upper extremity ischemia, an entity unsuitable for revascularization. Additionally, the results of sympathectomy for ischemia of upper are much better than lower extremities, so the procedure could be advised liberally for such patients

One-year efficacy of expanded polytetrafluoroethylene vascular graft in eighty-three hemodialysis patients

To evaluate the patency and efficacy of expanded Polytetrafluoroethylene [ePTFE] vascular graft in hemodialysis patients. In a prospective study from January 1999 to January 2001 at Sina hospital 41 patients underwent implantation of 6-mm vascular grafts and 42 underwent implantation of 8-mm grafts in order to make vascular assess for hemodialysis. They were followed up to 12 months, observing the complications. Mean patients' age was 52.2 years. Thirty-seven of them were females and 46 were males. Over a 12 months period of follow-up, 12 cases of graft infection [14.5%], 21 cases of thrombosis [25.3%], 7 cases with both complications [8.4%], and 1 case of pseudoaneurism [1.2%] were observed. One-year patency rate was 34.9%. Diabetes was the only factor associated with lower patency rate [27% versus 57%, p<0.05]. ePTFE vascular graft seems to be an appropriate substitute for arteriovenous fistula as a vascular assess in hemodialysis patients. Educating patients and good care can decrease the rate of infection, thrombosis, and other complications, resulting in a better patency and lower morbidity rate