Critical limb ischemia: Revascularization options and clinical outcome

To study the various options of revascularization, mainly the role of Percutaneous Transluminal Angioplasty [PTA] in the treatment of Critical Limb Ischemia [CL1] and to assess the clinical outcome. A retrospective study was performed involving 109 consecutive patients [75 men and 34 women; mean age 59 years, range 45-87]. Fifty-nine patients were diabetic, and sixty-four smokers. Balloon angioplasty for critical limb ischemia was performed in 78 limbs, while Percutaneous Transluminal Angioplasty [PTA] and/or surgery in 34 limbs. Immediate and at one year outcome was examined by case note review to determine survival, amputation-free survival, and limb salvage. In the angioplasty, technical success was achieved in 66 [84%] out of 78 limbs, while in the combined PTA and/or surgery it was 22 limbs [65%] out of 34 limbs. The overall amputation rate was 22%. The follow-up period was 12 months. The overall in-hospital mortality was five patients [4.6%]. Eighty patients [74%] had their feet spared from major amputation as a result of revascularization. Only sixty-tow patients were available for follow-up which revealed that 84% of them were doing well 12 months after their revascularizations. Patients with an initially successful angioplasty had a good outcome. The results of this study justify the use of PTA as a first-line treatment for critical limb ischemia; technical failure does not preclude conventional surgery. CLI is highly prevalent among diabetes. CLI was significantly associated with diabetes, smoking, and gangrene. Educational programs and aggressive approach are highly needed to reduce the risk of amputations

Iatrogenic Gastric Dilatation: A Rare and Transient Cause of Hepatic-portal Venous Gas

Gas in the portal veins is rare and in most cases is associated with serious diseases and poor clinical outcome. A case of gas in the hepatic-portal veins with gastric dilatation, as shown by CT-scanning for abdominal trauma, is reported. The condition was clinically benign and resolved spontaneously. An abdominal CT scan documented the findings.

clinical and epidemiological features of hydatid disease in Northern Jordan

To elaborate on the epidemiology of hydatid disease in Jordan as a model for the Middle East, and highlight the obstacles that face disease control in the region. The clinical and epidemiological data for 65 patients with the diagnosis of hydatid cyst [who were treated in the Department of Surgery, Jordan University of Science and Technology, Irbid and its affiliated hospitals, between January 1994 through to September 2003] were analyzed. Fifty-five patients were interviewed for details of life style. Forty-six% of patients were below 40- years of age. Fifty-seven% were females. All interviewed patients gave history of contact with dogs and history of ingestion of raw vegetable food. The latter in addition to a high zoonotic infection rate and uncontrolled animal movement were factors contributing to the high prevalence. Optimization of control programs in the Middle East requires the establishment of a regional center. Wide traveling has made it essential for physicians practicing in non-endemic areas to be aware of the diverse presentations of this disease when dealing with immigrants from endemic areas

Effort thrombosis of the subclavian-axillary vein

The aim of this study is to outline the clinical patterns, diagnosis and the outcome of patients with 'effort' subclavian-axillary vein thrombosis. The medical records of 7 patients diagnosed with 'effort' subclavian-axillary vein thrombosis between 1992 and 2000 at the Princess Basma Teaching Hospital, Irbid, Jordan were reviewed. Patients with secondary subclavian-axillary vein thrombosis [catheter related or secondary to thoracic outlet compression] were excluded. The clinical presentations of this condition were swelling, pain, and cyanosis of the upper limbs. The presence of dilated superficial vein is a late sign. All patients were treated by non-fractionated heparin continued with warfarin with a favorable outcome. Effort thrombosis of subclavian-axillary vein [Paget-Von Schroetter syndrome] is less reported in the literature contrary to secondary subclavian-axillary vein thrombosis. Early and effective anticoagulation constitutes the base of curative treatment. Prevention of recurrence is mandatory