Evaluation of healing of varicose ulcers after endovenous laser ablation of great saphenous vein

Background: Varicose veins are permanently swollen, tortuous and elongated while standing due to back flow of blood caused by incompetent valve closure which result in venous congestion .they are of two types primary and secondary varicosities .The main symptoms are tingling, itching, pain, fatigue, a heavy feeling in the legs especially if one has to stand for a long time. Ulcers and thrombophlebitis are possible complications. The aim of this study is to assess the outcome of laser ablation of great saphenous vein on healing of varicose ulcers.Methods: A prospective study conducted at Suez Canal University Hospitals and Nasser Institute Hospital in Cairo on 20 patients complaining varicose ulcers due to incompetent saphenous femoral junction.Results: All patients had improvement in Abrdeen Varicose vein questionnaire after endovenous laser ablation (EVLA) during the first, second and third follow up visits when compared with preoperative scores. The Aberdeen Varicose vein questionnaire ranged from 8 to 18 before the procedure, with a mean of 12.11, ranged from 3 to 11 at the first follow up visit with a mean of 7.07, ranged from 2 to 10 at the second follow up visit with a mean of 4.89 and ranged from 2 to 10 at the third follow up visit with a mean of 3.85, p value is less than 0.001 compared to the pre-operative data. During the assessment of the patients of our study after 6 months of continuous follow up, we found that the healing rate of the patients who underwent laser ablation of great saphenous vein were (91.67) (p=0.769).Conclusions: EVLA of great saphenous vein leads to better wound healing rates in treating patients with varicose ulcers.

Prognostic roles of endostatin, matrix metalloproteinase-2 and 9 and tissue inhibitors of metalloproteinase-1 in advanced non-small cell lung cancer

Background and aim of the work: Previous studies verified that Endostatin, matrix metalloproteinase [MMP] -2 and -9, in addition to tissue inhibitors of metalloproteinase [TIMP] -1 may play a crucial role in prognosis of non-small cell lung cancer [NSCLC]. In this study we will investigate the changes in the pretreatment serum levels of these factors and to evaluate their clinical implication in patients with advanced non-small cell lung cancer [NSCLC]

Patients and methods: Pretreatment serum samples were collected from 25 patients and 10 control healthy individuals. The levels of Endostatin, MMP-2, MMP-9, and TIMP-1 were measured using a sandwich enzyme immunoassay kit

Results: The pretreatment serum levels of Endostatin and TIMP1 were significantly elevated and correlated with their stages and survival [P< 0.05], where, the serum level of Endostatin in healthy subjects was 81.20 +/- 23.99 ng/ml and in patients with NSCLC was 354.40 +/- 164.01 ng/ml. The serum level of TIMP1 in healthy subjects was 1.49 +/- 0.29 ng/ml and in patients with NSCLC was 2.96 +/- 0.58 ng/ml. The serum level of MMP2 and 9 were non-significantly decreased in serum of NSCLC patients [P > 0.05], where the serum activity of MMP2 in healthy subjects was 0.14 +/- 0.03 ng/ml and in patients with NSCLC was 0.09 +/- 0.03% and the serum activity of MMP9 in healthy subjects was 0.13 +/- 0.019 ng/ml and in patients with NSCLC was 0.10 +/- 0.03%

Conclusions: Our results indicated that the circulating levels of Endostatin, and TIMP-1 in patients with NSCLC may be valuable future tools for treatment planning and monitoring of treatment, however, these blood tests need to be standardized and validated in large-scale prospective clinical trials

Endoscopic thoracic sympathectomy: a comparative study of resection and electro-diathermy ablation in the treatment of primary palmar hyperhidrosis, Taif experience

Palmar Hyperhidrosis is an excessive and unpleasant sweating and it is under control of the thoracic sympathetic chain. At present, endoscopic upper thoracic Sympathectomy [ETS] offers a safe and durable solution of the condition. The operation includes excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic ganglia T2 and T3. The present study was done to compare the results achieved by excision and electro-diathermy ablation. This prospective randomized study was conducted in King Abdul Aziz Specialist Hospital and Al-Hada Armed Forces Hospital, Taif- Saudi Arabia, from January 2007 to August 2010 and included sixteen patients with primary palmar hyperhidrosis. They were randomized into 2 groups; each of 8 patients. In one group; the sympathetic chains with T2 and T3 ganglia were excised on both sides and in the other group, the sympathetic chains and ganglia were ablated bilaterally using electro-coagulation diathermy hook. There were 10 women and six men. The mean age of the ablation group was 23.6 +/- 7.6 years and in the resection group it was 22.5 +/- 8.4years. The mean operating time for bilateral Sympathectomy in the resection group was 74 +/- 18.6minutes; whilst in the thermal ablation group it was 32 +/- 7.8 minutes. The mean postoperative hospital stay in the excision group was 48 +/- 12 hours and in the ablation group, it was 24 +/- 6 hours. No deaths occurred and all patients are discharged with dry hands. The mean follow up was 24 +/- 18 months. Intraoperative intercostal venous bleeding occurred in 18.75% of sympathectomies in the excision group but not in the ablation group. Neuralgic pain of the chest wall developed in 31.25% of sympathectomies of the excision group and 6.25% of the sympathectomies of the ablation group. Horner's syndrome developed in 6.25% per cent of the sympathectomies in both groups. Compensatory hyperhidrosis of trunk and thighs occurred in 37.5% of both groups. Recurrence developed in 6.25% of ablation group but no recurrence in the excision group. The rate of recurrence after endoscopic thoracic sympathectomy for treatment of primary palmar hyperhydrosis, if ablation is used, may be higher than resection, however; it is practically accepted as the procedure is easier, has shorter operating time with less liability to develop neuralgic pain and intercostal venous bleeding

Prevalence, pattern of presentation, risk factors and outcome of acute mesenteric venous thrombosis in Taif province, Saudi Arabia, a single center study

Mesenteric venous thrombosis has a global incidence of 10-15% of all cases of mesenteric ischemia; however reports from high altitude provinces of Saudi Arabia as Taif and Aseer recorded an incidence above 60%. The aim of this study is to record the incidence, pattern of presentation, risk factors; diagnostic tools and outcome of treatment in a single center [King Abdul Aziz Specialist Hospital] Taif, Saudi Arabia. In this retrospective chart review study, we reviewed the records and data of all patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2009 to January 2013 and their final diagnosis were proved to be acute mesenteric venous thrombosis. Traumatic, postoperative and non occlusive cases were excluded from the study. Sixteen patients with final diagnosis of acute mesenteric venous thrombosis were included in this study, out of 26 patients [61.5%] presented and diagnosed as acute occlusive mesenteric ischemia. Males were more affected than females. The mean age of the patients was 55 +/- 13.4 years. The mean duration of symptoms was 4.9 +/- 1.4 days. The most common presenting symptoms were; abdominal pain followed by nausea, vomiting, anorexia, bloody diarrhea and fever. The most prevalent physical findings was tachycardia followed by ileus, 5 patients presented by marked peritoneal signs 3 of them were shocked. Multiple risk factors were detected in all patients. Laboratory findings were not conclusive and diagnosis was established by CT angiography in most of the patients. During operation, all patients were found to have a segment of infarction of the small intestine and in one of them the cecum was involved. Resection of the gangrenous parts was done for all patients. Second look operation was performed in 25% of patients. The total mortality was 18.75%. Acute mesenteric venous thrombosis is the most common cause of acute occlusive mesenteric ischemia in Taif province and this may be related to multiple risk factors. Being familiar with this disease is essential in making the correct diagnosis to be followed by prompt resuscitation with heparinization to be continued postoperatively to prevent recurrent thrombosis. Laparotomy should be performed as soon as metabolic and hemodynamic correction is done with resection of any infracted segment. A second look operation may be required. If these steps are followed strictly and without delay, the prognosis of mesenteric venous thrombosis is often favorable

Prevalence of cervical cellular abnormalities by liquid based cytology in Taif province: a hospital based study

The aim of this study was to determine the prevalence of the cervical cellular Abnormalities using liquid based thin-layer preparations as screening test for women who attended the gynaecology outpatient clinic at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. In this retrospective chart review study, we reviewed the records and data of all women for whom liquid base cytological studies were performed as screening test to detect the cervical cellular abnormalities at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from June 2010 to June 2012. The total number of women for whom liquid base, thin-layer cytological studies were performedwas 2168 patients 79.9% of them were symptomatic. The mean age was 38.6 years. Liquid based thin-layer preparations were used for all patients. Cervical abnormality was seen in 25.6% of the patients, of which 6.5% were malignant or premalignant and 19.1% were of benign nature. Liquid-based, thin-layer cytology reduces sampling and preparation errors of the conventional smear; however, screening should include human papilloma virus [HPV], DNA testing to increase the sensitivity and specificity of primary screening

Acute occlusive mesenteric ischemia in Taif province, Saudi Arabia

Mesenteric ischemia is relatively a rare disorder seen in the emergency department [ED]. Due to the effect of hypobaric hypoxia and higher liability for thrombosis encountered in high altitude areas, acute occlusive mesenteric ischemia [AOMI] would represent an actual challenge in Taif and related districts. Another risk factor is that about twenty-five percent of Saudis are victims of diabetes due to the changes in lifestyle and diet leading to increasing levels of obesity. Vague nonspecific clinical findings and limitations of diagnostic studies in addition to cultural and social factors, may lead to late presentation making the diagnosis a significant challenge and in turn higher morbidity and mortality are expected. In this study, we review type of AOMI, pattern of presentation, laboratory, radiological, Intraoperative findings and results of treatment in 36 patients who were admitted to King Abdul Aziz Specialist Hospital and King Faisal Hospital, Al Taif, Saudi Arabia from January 2009 to January 2012. 36 patients with final diagnosis of AOMI were included in this retrospective study by means of review of their files and medical records. The disease was more common in men than women [23 male and 13 females]. The mean age of patients was 54 years. The mean time of presentation was 2.4 days after occurrence of symptoms. Abdominal pain was the most common symptom of patients followed by nausea, vomiting, constipation and bloody diarrhea. On physical examination; tachycardia was prevalent, Oliguria was seen in approximately 69.4% of patients, 11.1% of patients were in shock status. All patients had abdominal tenderness and 61.1% of patients had marked peritoneal signs [rebound tenderness with guarding or/and rigidity]. Twenty one/36 [58.3%] patients were diabetics, 17/36 patients [47.2%] were hypertensive and 8/36 patients [22.2%] with associated cardiac disorders. In laboratory tests, Leukocytosis was present in all patients. Secondary polycythemia was seen in 38.9% of patients. D-Dimer level was high in all patients. In 61.1% of patients, exploratory laparotomies were done based on clinical, laboratory, abdominal ultrasound and plain x-ray findings without performing CT angiography due to presentation with marked peritoneal signs. In all patients gangrenous lesions were detected during surgery and resection of these parts was done. Gangrene and in turn resection, was extensive in 14/36 patients [38.9%] and they developed short bowel syndrome. There were 22/36 patients [61.1%] with superior or/and inferior mesenteric vein thrombosis, 10/36 patients [27.8%] with superior mesenteric artery thrombosis, in one of them there is associated focal thrombosis of aorta and renal arteries and 4/36 patients [11.1%] with superior mesenteric artery embolism. All patients received postoperative anticoagulant therapy. Patients with short bowel syndrome were prepared to receive total parental nutrition [TPN] for life. Intra-operative deaths were 3/36 [8.3%].There were 5/36 deaths [13.9%] accruing within one month after surgery and all died secondary to sepsis and its sequalae with total deaths of 8/36 patients [22.2%]. Acute occlusive mesenteric ischemia [AOMI] especially of venous type will represent a challenging problem in Taif and related districts. The surgeon must pay intensive attention to patients presented by unexplained central abdominal pain and he has to be with high index of suspicion especially if it meets with the classic teaching of "pain out of proportion to physical findings ". Early diagnosis, aggressive approach to early resuscitation of the patients, correction of metabolic and hemodynamic derangements, and performing laparotomy as soon as these derangements were corrected would decrease morbidity and mortality. In some patients it is necessary to perform second look operation for re-evaluation of the viability of the intestine