fast track arterial duplex ultrasound performed by vascular surgeon. Is the now?

With the technologic advancement in vascular ultrasound imaging, surgeons are now encouraged to perform their own examinations. The vascular surgeons run the vascular laboratory in Suez Canal University hospital.The aim of this study to determine the efficiency and advantages of the arterial duplex scanning performed by the surgeon. A prospective comparative study between the results of colour duplex [performed by vascular surgeon], arteriogram and operative finding in 105 limbs [96 lower and 9 upper] from 63 patients, with chronic arterial occlusive disease or peripheral arterial emergencies, was performed. The arterial vessels were divided into 13 segments. A total of 858 segments were examined. Duplex scan was able to detect significant disease with sensitivity 83%, specificity 100% positive predictive index 100%, negative predicative index 93%, accuracy 95% and K value of 0.85. Accuracy for final therapeutic decision was 83% in arteriography, 80% in duplex and combination of both was 100%.Surgeon performed duplex is reliable and should be an integral part of vascular surgeon's practice. Our practice recommends performing arteriogram as well in the lower limb to maximize preoperative information. This paper is accepted for presentation in the first congress of the North African and Middle East chapter of the international union of angiology. Cairo, Egypt- October 2001

Early versus late excision and grafting in the treatment of second and third degree burns

One hundred seventy eight patients with second or third degree burns who attended the emergency department in Suez Canal University Hospital in whom the total body burned surface area [TBSA] ranged between 10- 50% were included in our study. They were allocated randomly into two equal groups using simple randomization technique. [n= 89 patients]. Patients of the first group were treated by early excision of eschars and auto grafting [EEG], after a mean period of 5.39 +/- 1.47 days while patients of the second group were treated by repeated eschar excision, wound dressing and late grafting [LEG] after a mean period of 39.12 +/- 18.26 days [P<0.0001]. The mean graft take was 95.38% +/- 7.70 in the EEG group while it was 94.37% +/- 6.81 in the EEG group. The difference was statistically insignificant. Hypertrophic scars were common among patients of EEG group [41.57%] compared to [26.96%] in LEG group. It declined to 35% in EEG group compared to 30% in LEG group when burned surface area was equal or below 20% of [TBSA]. Late contracture was less common among patients of EEG group [6.74%] compared to [24.71%] in LEG group [P<0.001]. It declined to 0% in EEG group compared to 25% in LEG group when burned surface area was equal or below 20% of [TBSA]. The overall mortality was 5.06% [9 patients]. All mortalities had a burned surface area of 40-50%, it was due to septicaemia in 6 patients [3.37%], acute renal failure in 2 patients [1.12%] and DIC in one patient [0.56%]. Five of them [5.62%] were in EEG group and 4 [4.49%] were in the LEG group [NS]. The mean hospital stay was shorter in the EEG group [22.75 +/- 22.58 days] compared to [61.43 +/- 22.01 days] in the LEG group [p=0.0002]. We recommend the use of EEG in the management of second and third degree burn

Radial forearm flap versus anterolateral thigh flap in the treatment of problematic wounds of the leg a clinical prospective study

Deep electrical and thermal burns and crushing injuries often result in exposure and devascularization of underlying structures. This study was done to evaluate the results of free flaps in reconstruction of these problematic wounds. Our study included 30 patients who were treated by free flap reconstruction. Twenty-three patients were males [76.67%] and 7 patients were females [23.33%]. Their mean age was 36.5 +/- 12.31 years. Problematic wounds were post-traumatic in 22 cases and post burn in 8 cases. The free flaps used were radial forearm flap [n=15] and anterolateral thigh flap [n=15]. Reconstruction was done using microsurgical technique by one team of surgeons. The total success rate was [90%]. The radial forearm flap succeeded in 14 cases [93.33%] and failed in 1 case [6.67%]. The anterolateral thigh flap succeeded in 13 cases [86.67%] and failed in 2 cases [13.33%]. Post-traumatic wounds were found to have a lower success rate compared to post-bum cases. We think that free flaps should be strongly considered in the management of problematic wounds for their advantages as better preservation of tissues, less number of operations and short hospitalization than other traditional techniques

value of splenic vicryl mesh repair in cases of rupture spleen

Twenty-three patients [15 males and 8 females] with rupture spleen; grade II in 3 cases [13.04%], grade IIl in 12 cases [52.17%] and grade IV in 8 cases [34.78%] had been managed with splenic preservation and vicryl mesh application. Splenic salvage with mesh was done in 20 cases [86.96%] while in the remaining 3 cases [13.04%] partial splenectomy was done followed by mesh application. The vicryl mesh was successful in controlling splenic bleeding in all cases [100%]. However, re-exploration was performed in two cases for causes other than bleeding. The first case was explored due to peritonitis from disrupted gastric tear and splenectomy was performed. The second case was explored due to small bowel gangrene and resection anastomosis was done with preservation of the mesh and the patient was discharged after 10 days. One patient died in the first post-operative day suffering from cerebral laceration. One week after the operation duplex scanning demonstrated normal flow in the splenic vessels in the surviving 22 cases and IgG, IgA and IgM were found to be within normal limits. The application of splenic mesh for preservation of injured spleen is a safe and reliable method for splenic salvage and maintenance of splenic function

Excision versus excision and closure by transposition rhomboid flap in the treatment of chronic pilonidal sinus

This study is a r and omized clinical prospective study done on thirty-six patients with chronic pilonidal sinus who attended the outpatient clinic of surgery. Suez Canal University during the period between June 1998 and February 2000. Patients were allocated by balanced r and omization into two equal groups. Preoperatively patients characteristics were similar in the two groups. Patients of group-1 [n=18] were treated by open excision technique and their healing by second intention while patients of group-2 [n=18] were treated by excision and transposition rhomboid flap technique and their healing by first intention. Patients of the two groups were followed up for a mean period of 15.3 +/- 4.9 months [range 6-21months]. The mean operative time was shorter in the open excision group [32 +/- 6.11 minutes] compared to that in transposition rhomboid flap group [82.3 +/- 7.37 minutes]. The difference was statistically significant. Post-operative wound infection occurred in one patient [5.56%] in the transposition rhomboid flap group, it was mild and controlled by repeated dressings and broad-spectrum antibiotic. In the open excision group, it occurred in 10 patients [55.56%] with variable degree. The difference between the two groups was statistically highly significant. The mean hospital stay was 1.8 +/- 2.13 days in the open excision group while in transposition rhomboid flap group it was 3 +/- 8.89 days. The difference between the two groups was statistically significant. Healing of wound in the open excision group occurred after a mean period of 63 +/- 12.13 days while in transposition rhomboid flap group it occurred after a mean period of 11 +/- 2.16 days. The difference between the two groups was statistically highly significant. Patients returned back to work in the open excision group after a mean period of 35 +/- 5.33 days before complete healing of their wounds while in transposition rhomboid flap group it was 17 +/- 2.32 days. The difference between the two groups was statistically highly significant. No recurrence had been recorded during follow up in patients of the two groups

Upper gastrointestinal bleeding in Ismailia: agreement between clinical and endoscopic diagnosis

Thorough detailed history and clinical examinations were obtained, and early upper gastrointestinal endoscopy was performed to 632 patients presenting with upper gastrointestinal bleeding to determine the bleeding source. The Chi-square test, the student t test and Mannwitney test were used where appropriate. A "p" value less than 0.05 was considered to be significant. The statistic Kappa was computed to quantify the extent of agreement beyond chance between the clinical and endoscopic diagnosis of the bleeding source. Esophageal varices was found to be the most common source of bleeding. Duodenal ulcer and gastric ulcer occurred with decreasing frequencies. 32% of patients had more than one potential bleeding site, emphasizing the need to anticipate more than one lesion at endoscopy in patients with upper gastrointestinal bleeding and the importance of early endoscopy to identify the bleeding source. No source of bleeding was apparent in 6.7% of cases. Kappa was only 0.58 emphasising that clinical system is not able to discriminate well between the disease categories. Patients with bleeding esophageal varices were significantly younger than non variceal bleeders [36.8 +/- 12 years and 51.8 +/- 18 years, respectively]. About 86% of patients with bleeding varices and 39% of those with non-variceal source of bleeding were rural [p < 0.05]. There was a tendency for upper gastrointestinal bleeding to occur more often in the winter months regardless of the cause. The overall mortality rate was 21.4%. It was higher [29.4%] in patients with varices compared with non variceal bleeders [6.4%]. Liver status, mode of presentation and severity and activity of bleeding at presentation were fount to be predictors to the hospital outcome