Acute limb ischemia: delayed presentation and outcome

Acute limb ischemia still represents an important dangerous situation in vascular surgery. Delayed presentation of acute ischemia usually leads to catastrophic outcome. Late ischemia represented 20.4% of all cases of acute limb ischemia admitted to our hospital during one year period. We were aiming to evaluate such cases with acute prolonged limb ischemia identifying causes of delayed presentation and its imprint on patients limb and life. Forty-five patients [45 limbs] were included in this study. There were 25 females and 20 males with ages ranged between 20 and 85 years [mean; 58 years]. The lower limbs were affected in 91.1% of cases while the upper limbs were involved in 8.9%. Sixty percent of cases had embolic ischemia while 40% suffered from thrombotic ischemia. The average ischemic interval was 6.8 days. Methods of treatment included medical and/or surgical intervention. Doctors of other specialties were responsible for delayed presentation in 62.2% of cases because of wrong diagnosis or treatment. Patients themselves were blamed in 31.1% of cases due to ignorance or low socioeconomic level. Long distance from the nearest specialty hospital was the cause of delay in 6.7% cases. Overall, a good outcome was recorded in 11.1% patients. Major amputation was ultimately required in 71.1% patients. Death occurred in 4.5% patients. Treatment of acute prolonged limb ischemia is difficult and results in high morbidity. Proper management of acute limb ischemia requires educational programs for genior doctors, patients and community to realize its causes, manifestations, methods of diagnosis, and importance of time factor and its imprint on patient's limb and life

Enoxaparin versus heparin for the prophylaxis of post-operative deep vein thrombosis in general surgery

Patients undergoing surgery with a prolonged general anesthesia or a period of a limited postoperative mobility, or both, face a high risk of thromboembolism. Surgical procedure is considered as the third most common risk factor for thromb oembolism after old age and obesity. To asses the value of enoxaparin in the prophylaxis of venous thromboembolism and the possible complications in comparison to heparin in high risk patients undergoing general surgery. In the period between March 2003 and May 2005, 200 patients admitted for different surgical procedures were randomized into 2 equal groups: [1] Group A where unfractionated heparin was used as a prophylactic anticoagulant drug, and [2] Group B where enoxaparin was utilized. Patients were obese with one or more risk factors for deep vein thrombosis. Clinical and laboratory assessment in addition to venous duplex scanning of the lower limbs were performed. The ages of the patients ranged from 40 to 82 years with a mean of 61 years. A mean preoperative hospitalization period of 6.1 days and a mean operative duration of 95 minutes was recorded. Postoperative deep venous thrombosis [DVT] occurred in 10 [5%] patients, 8 of them were asymptomatic [4 in each group] and diagnosed by duplex ultrasound. The 2 remaining patients had symptomatic DVT, both were in group A. Bleeding complications occurred in 30% and 16% patients of group A and group B, respectively. Low molecular weight heparin [enoxaparin] is more effective and safer than unfractionated heparin, but with higher costs in the prophylaxis of postoperative deep venous thrombosis

early experience with laser therapy of hemangiomas and vascular malformations

The purpose of this study is to examine the effects of Nd: YAC laser on treatment of hemangiomas [n=30] and vascular malformations [n = 4]. A series of 27 patients [6 males and 21 females] with an age ranged from 4 months to 22 years were included. Most of patients [70.3%] were in their first year of life. Of the 30 hemangiomas, 13 were classified as capillary, 12 as cavernous, and 5 as mixed hemangiomas. Of the 34 vascular anomalies, 27 [70.6%] were located in the head and neck region. The indications for laser therapy were cosmetic disfigurement in 26 [76.5%], functional problems such as visual field defects and feeding difficulties in 6 [17. 6%], and ulceration or bleeding in 2 [5.9%] lesions. Our patients were subjected to 132 laser treatments utilizing both non-contact and contact techniques of laser beam application. Results were as follows: 64.7% lesions showed good response while 26. 5% demonstrated fair response. Bad response had occurred in 8.8% of lesions. Complications of laser therapy included excessive scarring in 2 [5.9%], ulceration in 3 [8.8%] and bleeding in 1[2.9%] case. These findings demonstrated that Nd: YAC laser therapy is a safe and effective treatment of vascular skin lesions that give satisfactory cosmetic and functional results without major side effects