Limb salvage in critical ischaemia

125 patients with critical limb threating ischaemia are reviewed. The majority were male smokers. 92% involved the lower extremity. Thirty primary amputations were done as these presented with fixed and extensive gangrene with an operative mortality of 36.8%. 23% had acute onset of ischaemia while 77% presented with chronic ischaemia. Thromboembolectomy salvaged 80% of the acute ischaemia cases. The chronic ischaemia groups was predominantly secondary to atherosclerotic arterial occlusive disease and not Thrombo Angitis obliterans contrary to the local belief. Femeropopliteal [13] was the most common bypass procedure performed. Aorto-Bilateral femoral [4], popliteo tibial [4] and extra anatomic bypasses [4] were the next common procedures. Overall in the bypass procedures there was 88% immediate graft patency and 84% limb salvage. Aggressive attempts towards limb salvage is recommended

Swallowed sewing needle in the gastrointestinal tract

In a four year period three female patients who had swallowed a sewing needle presented for treatment. All had upper abdominal colicky pain. A straight X-ray of the abdomen was the single most useful investigation. Endoscopic retrieval was attempted in one patients. The needle had penetrated the wall of stomach or duodenum and entered into the pancreas in all three patients. Following surgical removal the patients recovered completely

Endogenous hyperinsulinism from islet cell adenomatosis

In a 50 year old male sudden loss of consciousness resulted in a dislocated elbow. Under observation, repeated unconscious episodes were initially thought to be post traumatic epilepsy but led to a blood glucose which was low. Although fasting Insulin/Glucose ratios were not diagnostic there was a marked abnormality of serum Insulin/Glucose and Glucose/Insulin rations during a glucose tolerance test. Serum C-peptide levels were also elevated after glucose ingestion but not before. Although the diagnostic significance of these findings is not known, the suspicion of endogenous hyperinsulism was strong. Selective angiography was inconclusive. On September 17, 1986 a 75% distal pancreatectomy was done. Permanent section microscopy consistently showed islet cell adenomatosis with some uninvolved areas of the pancreas. Post operative recovery was smooth; there have been no further attacks and until now no post-operative medications have been required. Determination of fasting Insulin/Glucose ratios is planned at the patient's next visit

Carotid endarterectomy

This is the first reported series of carotid endarterectomies from Pakistan. Of the 68 patients that presented with symptoms suggestive of cerebro-vascular insufficiency, 59 were evaluated noninvasive using bi-directional Doppler and photo-plethysmography. Accuracy of non invasive testing was 75%. Six carotid endarterectomies were performed with no operative mortality and a single minor residual neurologic deficit suggesting that the procedure can be performed locally with a reasonable degree of safety

Isolated aneurysm of the iliac artery

Iliac artery aneurysms are one tenth as common as abdominal aortic aneurysms. When present they are usually atherosclerotic, and occur in associated with abdominal aortic aneurysms [AAA]. Isolated mycotic iliac artery aneurysms are even more uncommon. One such case of an Isolated Mycotic right iliac artery aneurysm is presented with a brief review of the literature

Abdominal wall defects: use of internal supporting materials

The Use of Internal Supporting Material as a strengthening device in case of abdominal wall defects is reported in 19 cases, spread over a period of 6 years. Marlex Mesh was used in 14 cases, Teflon Mesh in 2, Mersilene Mesh in 2 and Prolene Mesh in one. The criterion chosen for mesh repair are [a] multiple previous failed herniorrhaphies [b] two defects in the linear alba existing simultaneously with relatively normal aponeurosis in between or [c] any incisional hernia more than 2cms in transverse diameter. The operative technique is presented. The mean follow up is 28 months with success rate of 88%. There were two failures in this series. The causes of failures are discussed

Endoscopic sphinctero papillotomy

The first case of Endoscopic Sphincteropapillotomy in Pakistan [in a patients with Retained Common Bile duct stones] is presented with a brief review of the subject