Vascular injuries caused by orthopaedic screws

To describe 3 cases of vascular injuries due to orthopaedic procedures. Clinical Presentation and Intervention: Of 242 vascular injuries, 3 were due to orthopaedic screws. The 1st patient presented with a late complication [after 3 years] of an orthopaedic screw placed in close proximity to the axillary artery that with time got eroded and leaked to form a false aneurysm which later caused embolisation to the arm and limb ischaemia. The 2nd and 3rd cases were due acute ischaemia following the orthopaedic procedures. Both were injuries to the popliteal artery, one after a long screw and the other after drilling the tibia. The aneurysm of the 1st case was resected, the screw was removed and a reversed segment of the right long saphenous vein was used to repair the axillary artery. In the 2nd patient, a bypass of the left popliteal artery to the tibio-peroneal trunk was performed using a reversed 12-cm-long saphenous vein graft retrieved from the right thigh. In the 3rd patient, the right popliteal vein was ligated, and a reversed 25-cm-long saphenous vein graft retrieved from the left thigh was used for a femoro-popliteal bypass. For the 3 patients, postoperative recovery was unremarkable. Pulses were present within 6-10 months of follow-up. Conclusions: Whenever limb vascularity is compromised after an orthopaedic procedure, a high index of suspicion for an arterial injury should be exercised and prompt referral to the vascular service is mandatory. Repair of injured vessels with a saphenous vein graft provides excellent long-term results

Tension free mesh repair of inguinal hernia under local anesthesia as a day case surgery

In this study, 211 adult patients underwent open tension-free inguinal hernioplasty under local infiltration anesthesia as a day case surgery. Inguinal neuralgia and testicular atrophy could be reduced and hydrocele disappeared completely as a postoperative complication. Limited and controlled superficial wound infection was 1% as a postoperative sequel. Mean operation time reached 50 minutes. It was feasible to perform the repair as a day care surgery with comparable results of modern approaches, however the complications and recurrence rates were significantly less

Occult malignancy in patients with idiopathic deep venous thrombosis

The relationship between deep venous thrombosis [DVT] and malignancy has long been recognized and documented, patients diagnosed with malignancy are clearly at risk for the development of venous thromboembolism and conversely some patients with deep venous thrombosis have subsequently been discovered to harbor an occult malignancy. This is a prospective study of 51 DVT patients who presented to Ain Shams University Hospitals between January 1997 and December 2000. These patients were chosen out of 188 DVT cases because of absence of any major thrombotic risk factor, their ages were over 40 years, and non were previously diagnosed with any form of malignancy. All patients were screened for any signs of occult cancer, which included careful history taking, thorough physical examination, laboratory screening including tumor markers, and abdominal ultrasonographic examinations. After the first level of screening; suspicious cases were subjected to the second level of specific laboratory, radiological, or endoscopic tests to reach a final diagnosis. Malignant neoplasms were detected in 11 cases [21.5%]. Carcino-embryonic antigen [CEA] and endoscopy were key in diagnosing 2 cases of early colon cancer and 2 cases of adenomatous colonic polypi. Cystoscopy followed by biopsy detected 2 cases of early urinary bladder cancer, and high levels prostate specific antigen, transrectal ultrasound and biopsy were used to diagnose cancer prostate in one patient. Biopsy of palpable axillary and cervical lymph nodes attracted our attention to one case of cancer breast, and one case of non-Hodgkin lymphoma. Oncofeotal proteins and scrotal ultrasound led to diagnosing one case of early testicular tumor. Computerized tomography scans of the abdomen discovered one case of cancer body of the pancreas. The most striking finding was that most of these cases were in the early stages of malignancy. These findings underscore the importance of screening for occult malignancy in idiopathic DVT patients especially in the elderly population and regardless of the cost, since we are sometimes rewarded by finding cancer at an early stage, giving the patient the best chance for survival

On the diagnosis and management of loin pain nephroptosis syndrome [LPNPS]: the results of renal sympathectomy and nephropexy on 29 cases

In this study, 29 patients suffering from intractable recurrent loin pain due to loin pain nephroptosis syndrome underwent 29 renal sympathetic denervation and nephropexy operations. It aimed to introduce a new clinical signs and tests for diagnosis and assessment of such painful condition and to report the results of renal sympathetic denervation and nephropexy in the treatment of nephroptosis. The success rate was 82.5% which was higher than the previous published results. The study also rendered the importance of erect radiological examination by KUB, IVU and ultrasound to clinch the diagnosis

Laparoscopic management of acute abdomen

This study included 76 patients of acute abdomen with unclear clinical evidence of urgent operation and without definite diagnosis by available investigations. Laparoscopy has been undergone within three days after admission. The main objective was to remove the great burden of unclear diagnosis and decision and to lower the morbidity of long hospital stay due to the concept of wait and see or to avoid unnecessary operation with possibility of postoperative complications in negative laparotomy cases. Diagnostic laparoscopy stated only eighteen cases needing further surgical procedures which were accomplished by laparoscopic further intervention in eight cases. Also, videoscopic assessed histopathology was diagnostic in eleven cases