Arteriovenous shunting for hemodialysis

Two hundred and forty six shunts were done in the last 5 years as vascular access for haemodialysis in 205 patients with end stage renal failure. These included 203 radio-cephalic fistulae done at the region or just above it [121 end-to-side and 82 side-to-side], 2 saphenous loops, 4 polytetrafluoroethylene [PTFE] Impra grafts, 26 brachio-basilic, 10 external Scribner shunts and in one case a new technique of shunting the brachial artery to accompanying deep vein and 2 mouths later superficializing the vein so it can be used for haemodialyses. Most failures occur in the early post-operative period [within 48 hours] and usually due to inadequate outflow through the venous side which will cause thrombosis of the fistula. Other detected complications include aneurysm [2 cases], infection [11 cases], later graft thrombosis [3 cases], secondary haemorrhage [1 case], oedema and swelling of the hand [2 cases]. Satisfactory patency rates are obtained so long as the fistula is handled well in the early usage by the nephrology staff. The arteriovenous fistulae had been repeated in 39 cases

Eradication of helicobacter pylori after surgical or medical treatment of duodenal ulcer and its relation to relapse

Forty four selected ulcer patients invariably positive for Helicobacter pylori were included in this this study, 14 patients were subjected to surgical treatment by truncal vagotomy and gastrojujenostomy. Eight of these 14 became H. Pylori negative postoperatively after healing of the ulcer. No single ulcer relapse was observed among those 8 patients during a 12 months follow up period, while the relapse rate was high in the 5 patients who remained H. Pylori positive postoperatively. The remaining 30 patients were treated medically using colloidal Bismuth Subcitrate [CBS] with or without antibiotics. It was observed that the patients who received amoxycillin and metronidazole in addition to CBS showed a higher cure rate [13/14]and no ulcer relapse. The results of this study indicate that eradication of H. pylori by antibioics may help to increase the cure rate and decrease ulcer recurrence. Thus it may be advisable to add one or more antibiotics to eradicate H. pylori whether medical or surgical regimen is used for management of duodenal ulcer