Role of superficial venous surgery in the long term treatment of venous ultration in patients with isolated superficial venous incompetence

The aim of this study was to determine the ability of superficial venous surgery to heal venous ulcers in the lower parts of the legs with isolated superficial venous incompetence. This study was done on patients attending Vascular Clinic in El-Hussein Hospital and Sayed Galal Hospital. Ulcers were considered venous if the ankle: Brachial pressure index were more than 0.8 and duplex imaging showed venous reflux. Patients with isolated superficial venous incompetence were not offered sapheno-femoral and/or sapheno-popliteal surgery. Neither perforator surgery, skin grafting nor postoperative compression bandaging were used. The results showed that 60 legs with normal deep veins underwent superficial venous surgery. Fifty-four procedures [90%] were done under epidural anesthesia and six procedures [10%] were done under general anesthesia. The median time healing was 18 weeks [95% confidence interval 14-21w] and the cumulative 6, 12, 18 months healing rates were 57%, 74% and 82%, respectively

Evaluation of low molecular weight heparin administration in longterm treatment of deep venous thrombassis

The purpose of this study was to evaluate whether low molecular weight heparin [LMWH] could be equal or more effective than conventional oral coagulants [COAs] in long term treatment of deep venous thrombosis [DVT]. In this study, 100 patients with symptomatic DVT of lower limbs diagnosed clinically and confirmed by duplex scan were randomized to receive 3 to 6 months treatment with LMWH of OAs. Duplex scan scoring was used to study the evolution of thrombosis in both groups at 1, 3, 6 and 12 months. The results showed that during the 12-month surveillance period, one [2%] of 50 patients who received LMWH and 4 [8%] of 50 patients who received OAs had recurrence of venous thrombosis. In LMWH group no cases of major bleeding were found, and four cases [8%] occurred in the OAs group. The quantitative mean duplex scan examinations had statistical significance after long term LMWH therapy on ilio femoral DVT [1, 3, 6 and 12 months], femoropopliteal DVT [1-3 months] and infrapopliteal DVT [1st month]. Duplex scan evaluation showed that the rate of venous recanalization significantly increased in the common femoral vein at 6 and 12 months and during each point of follow-up in superficial and popliteal veins in the LMWH group. Reflux was significantly less frequent in communicating veins after LMWH treatment [17.9% vs 32.2% in OA group]. The reflux rates were 22.4% in LMWH group, 30.6% in OA group in the superficial and deep [13.4% vs 17.7%]

Endoscopic Trans-thoracic sympathectomy in the treatment of primary palmar hyperhidrosis: results and complications

This study aimed to evaluate the results of primary palmer hyperhidrosis by using endoscope transthoracic sympathectomy with particular reference to the complication, the immediate and long term effectiveness of treatment and patient satisfaction with the endoscope results. Twenty patients with bilateral primary hyperhidrosis were treated by endoscopic transthoracic sympathectomy on both sides. When the stellate ganglion is uniquely identified by a pad of fat covering it above the head of the first rib, a diathermy hook used to confirm identification by palpating the sympathetic chain and rolling the nerves over the ribs. The 2nd, 3rd and 4th ganglia were cut and preserved for histopathological examination. All patients were relieved of their symptoms except the left side of a female patient [aged 26 years and treated by open surgical method]. Compensatory hyperhidrosis was the only significant side effect and reported in sixty five%. There was no mortality or major complications. Endoscopic transthoracic sympathectomy is safe-easy, reliable and effective way in the treatment of patients with primary palmer hyperhidrosis