Keloidectomy with core fillet flap and intralesional verapamil injection for recurrent earlobe keloids.

Background: Earlobe keloids are usually recalcitrant to treatment and have a high rate of recurrence. Verapamil is a calcium channel antagonist that has been shown to inhibit the synthesis/secretion of extracellular matrix molecules and increase collagenase. Objectives: This prospective study was designed to evaluate the results of treatment of recurrent earlobe keloids using keloidectomy with core fillet flap and intralesional verapamil injection. Methods: Nineteen keloids in 16 patients were treated using this technique with intralesional verapamil injection given intraoperatively, then every 2 weeks for 3 months, with postoperative follow‑up for 18 months. Results: Fourteen patients completed the study. Ten patients (71.4%) showed response to treatment. Four (28.6%) cases showed recurrence, two (14.2%) at the wound bed and another two (14. 2%) at the incision line. Eighty percent of responders were highly satisfied with their treatment. Conclusion: Keloidectomy with core fillet flap and intralesional verapamil injection is a reliable and cost‑effective method in the treatment of recurrent earlobe keloids with a low rate of recurrence and high patient satisfaction.

Early postoperative outcome in diffusely diseased left anterior descending artery comparative study between endarterectomy and mammary arterial patch reconstruction

The problem of diffusely diseased LAD represents one of the surgical challenges with very few alternative solutions. Some my leave this diffusely diseased vessel without grafting and keep such patients on lifelong anticoagulation with the acceptance of some residual symptoms, others my do surgical grafting of this vessel using either extensive endarterectoy or creating a newly constructed LAD by the use of a long mammary artery graft patch. In this short prospective study we used both techniques in grafting the diffusely diseased LAD and we evaluated the early outcomes in the immediate post operative period [3 months]. This prospective shortterm study was done at Kasr Eleini teaching hospitals in the period between January 2006 and April 2009, 100 patients with severely and diffusely diseased LAD underwent bypass grafting. We used two techniques of LAD grafting. In group "A" [50 patients] we used the internal mammary artery for grafting after conventional endarterectomy [excision of the entire atheromata] while in the other group "B" [50 patients] we employed long mammary patch grafting of the LAD without coronary endarterectomy. In both groups selection of the technique was the surgeon's preference and there was no significant differences in the preoperative and operative criteria of patients. The preoperative data was not significantly different in both groups. The average length of endarterectomy in group A was 2.4 +/- 0.75 cm while the average length of mammary artery patch in group B was 3.2 +/- 0.8 cm. The duration of aortic cross clamp was 68.2 +/- 6.4 mm in group A and 78 +/- 8.5 mm in group B. there was higher postoperative mortality in group A [22%]. and only [8%] mortality in group B. ICU stay was 8.5 +/- 2.8 days in group A and 6.3 +/- 2.6 days in group B. postoperative myocardial infarction was higher in group A [32%] than that in group B [12%]. Also there was 4 cases in group A who needed additional saphenous vein grafting to the distal LAD, while no one needed additional LAD grafting in group B. postoperative bleeding was 540 +/- 86cm2 in group A and 830 +/- 116 cm2 in group B. long mammary arterial patch grafting of the LAD can be used as a surgical technique for grafting the diffusely diseased LAD. This technique provides better early postoperative outcome than that of LAD grafting after endarterectomy, however this study still needs longer evaluation of the graft patency in both groups. Pathological Q wave and positive cardiac biomarkers are predictors for worse prognosis among patients having myocardial infarction post-CABG

Repair of aortic coarctation with hypoplastic distal aortic arch in neonates and infants

The surgical repair of aortic coarctation with hypoplastic distal aortic arch has evolved over time. Some changes came from technique refinements and anatomical variations while other changes came from high rate of residual, recurrence or other complications. We report our experience with performing repair of aortic coarctation with hypoplastic distal aortic arch without prosthetic material to enlarge all areas of distal aortic arch in neonates and infanty. From March 2003 to March 2005, 17 patients ranging in age from 10 days to 8 months with aortic coarctation and hypoplastic distal aortic arch underwent repair.8 paticnts underwent extended end-to-end anastomosis with reversed subclairan flap.5 patients underwent extended end-to-end anastumosis.2 patients underwent extended end-to-end anastomosis with subclavian augmentation.2 patients underwent extended end to-end anastomosis with combined carotid- subclavian arch augmentation. There was no operative mortality. Residual gradients were as follows: 7 patients had no residual gradient, 8 patients had low residual gradient [< 20 mmHg] and 2 patients had gradients between 20 and 35 mmHg. There was no paraplegia, recurrent laryngeal nerve injury, Horner's syndrome, phrenic nerve injury or stroke. There was no left arm ischemia, hemorrhage, aneurysm, chylothorax, recoarctation or paradoxical hypertension. Performing repair of aortic coarctation with hypoplastic distal aortic arch in neonates and infants is safe, effective, and reproducible and avoids use of prosthetic materials. It has low residual gradient and complication rate

Peri- anal and peri- prostatic local infilterating aneasthesia before transrectal ultrasound [TRUS] guided biopsy in patients with or without painful anal disorders

TRUS guided biopsies is painfull and uncomfortable procedure; which could cause many complications up-to vasovagal attacks. Some patients can not sustain the procedure to complete his required biopsies either due to presence of anal disorders [fissures, piles. stenosis .. ] or untolerable pain during biopsy. The objective of this study was to evaluate the use of peri-anal and peri-prostatiic local infilterating aneasthesia prior to TRUS biopsy in patients with or without painful anal conditions. Five hundred patients who are subjected for TRUS biopsy were included in this study of them 150 patients were found to have painful anal problems [fissure, piles. tight anal canal]. Peri-anal infilterating aneasthesi were used only in [n=150] patients who complaining of anal problems while. periprostatic aneasthesia were performed in all included patients [n=500] of this study. DRE was routinly performed prior to TRUS 10 assess the presence of anal disorders and to evaluate the prostate. Local injection of xylocain 0.5% in perianal rectal muscle before the introduction or TRUS probe followed by peri-prostatic injection of the same anesthetic material which were injected in sagital axis started from the seminal vesicle base of each side or the prostate till the prostatic apex. Then TRUS evaluation of the prostate and its measures, presence of focal lesion and capsular integrity were done to give the proper time for aneasthia. Biopises were taken according to TRUS finding using the standard sixtant or the extended biopsy technique+/- lesion directed. Most of the patients [90%] were comfortable using this procedure without significant pain during TRUS guided biopsies. Only 3% of the patient feel mild pain during mid-zonal biopsy because of repeat biopsy. Patients with painful anal problems were comfortable without prior treatment or delay in the procedure. Some of this painful anal problems improved after the procedure [anal dilatation]

On conclusion: Peri-anal local infilterating aneasthesia solve the problem of TRUS biobsy in patients with painful anal problems without delay or the procedure. Peri-prostatic local infiltrating aneasthesia was safe and effective prior to TRUS guided biopsies for all patients