Aneurysms of the popliteal artery: management strategy and study of outcome

This study summarizes our experience in the management of popliteal aneurysms in 23 limbs [21 patients] during a 3-year period. The aim being to provide what constitutes our strategy of management and to determine the factors that influence the outcome. The data of 21 patients with 23 aneurysms were reviewed. There were 20 males and only one female, age ranging between 28 and 70 years, 18 aneurysms were atherosclerotic and 5 were arteritic. Patients were classified into group 1, the acutely ischaemic, group II with no evidence of acute ischaemia and group Ill, the asymptomatic cases. All patients brad colour coded duplex assessment, arteriograpgy was done in cases presenting with, ischaemia whether acute or chronic. 21 aneurysms were managed by operative repair while only one small asymptomatic aneurysm with no mural thrombus was managed conservatively. Also, one limb was treated by primary amputation because of irreversible ischaemia. The overall limb salvage rate in this series was 82.6%. All lost limbs belonged to group I i.e. those presenting with acute ischaemia. There was no hospital mortality and a follow up period ranging from 6 to 18 months brought forth neither mortality nor complications. Operative repair is the ideal treatment for all popliteal aneurysms. Exclusion and bypass, is the recommended procedure. Resection being particularly indicated when compression symptoms are conspicuous. There is a place to conserve in small asymptomatic aneurysms with no mural thrombi as well as in symptomatic aneurysms in non- threatened limbs with poor outflow vessels. In the latter situation, ill-advised surgery may end in limb loss. The results of this study also confirm that the outcome is strongly related to the initial presentation, being worse in time acutely ischaemic cases and hence elective repair is recommended

Carotid body tumours: surgical management and predictors of operative risk

In spite of a low but constant incidence of neurologic complications, resection of carotid body tumours of all sizes in appropriate surgical candidates has been advocated as the sole line of treatment of these rare lesions. This study summarizes our experience in the diagnosis and treatment of these lesions trying to identify the factors that predict the magnitude of operative risk.22 patients with 23 non-familial carotid body tumours presenting to the Cairo and Alexandria University Hospitals over a 4-year period were reviewed. There were 10 females and 12 males and the mean age was 42 years. A preoperative diagnosis, of being carotid body tumour, was not reached in 7 patients. In the remaining 16 tumours, duplex scanning, angiography, CT scanning and MRA clenched the diagnosis preoperatively, one tumour had FNAB and another open biopsy. 21 tumours were resected and the remaining 2 were irradiated. Internal carotid artery reconstruction employing great saphenous vein was required in 7 cases, end to end anastomosis in one case and lateral repair in another. A temporary shunt was used in 5 instances. Three patients suffered a transient hemiparesis while another 3 suffered a transient hypoglossal nerve palsy .It was concluded that surgical resection remains an effective form of treatment but is not without risk. The predictors of operative difficulty and hence increased risk include lack of preoperative diagnosis, mid and large sized tumours, Shamblin classes 2 and 3, use of FNAB as well as previous surgery

Upper thoracic sympathectomy "thoracoscopic versus supraclavicular approach''

With the outburst of the use of video-endoscopic assisted techniques in the early nineties, thoracoscopy was one of the most privileged domains. This is due to the already formed cavity maintained by the bony framework. This encouraged the performance of many of the "open sky" surgeries in the thoracic cavity to be included in a minimal invasive approach. In this study, we compared the results of upper thoracic sympathectomy that had been done either by the supraclavicular approach or by video-assisted thoracoscopic surgery. It was found that the thoracoscopic approach was easier to perform and less painful than the supraclavicular approach. Exposure was better, operative time and hospital stay were also reduced. The long-term success rate [one-year follow-up] was inure than 90% in both groups. As thoracoscopic sympathectomy resulted in achieving similar long-term results as the supraclavicular approach, thus the endoscopic approach is the operation of choice when upper thoracic sympathectomy is contemplated

Analysis of the possible causes of dyspepsia in Egyptian cirrhotics

Fifty three cirrhotic patients with oesophageal varices were included in this study and carefully analysed for dyspeptic manifestations. Dyspepsia was evident in 90.5% of patients [92.8% of nonbleeders and 89.7% of bleeders]. An attempt is made to correlate these dyspeptic symptoms to the size of the spleen [as a reflection of portal congestion], presence of gastric mucosal lesions, gastric activity and gastric mucosal blood flow rates and to the degree of alternation of liver function. None of the above parameters was statistically significantly altered in those studied so as to be the cause of dyspepsia. We therefore, differ with the other authors who previously attributed the dyspeptic symptoms to any or all of the above factors without solid evidence of their involvement