Endoscopic versus open lumbar sympathectomy

There have been increasing reports of early experiences with endoscopic lumbar sympathectomy. Most of these reports mentioned a small number of cases and non compared this minimal invasive procedure to the standard open approach. Thirty-one patients with inoperable critical limb ischemia attended our hospital over 32 months, were randomized to either open or endoscopic approach for lumbar sympathectomy. We used the standard technique for the open approach and used the aid of two different purpose balloons for the endoscopic approach. Data regarding operative time, complications, operative success, operative wound pain control and hospital stay were compared in both groups. Operative time was initially longer in the endoscopic approach, but toward the end of the study, it was nearly the same in both groups. The aid of the dissecting and retracting balloons helps to have a safe endoscopic approach with no intraoperative complications. Patients who had endoscopic approach significantly required fewer painkillers for the operative wound and had shorter hospital stay than those who had the open approach. Endoscopic lumbar sympathectomy is a safe and feasible procedure. It has a better outcome when compared to the open approach

Early morbidity and mortality after retroperitoneal repair of the abdominal aorta with modification of the patient's position

Repair of the abdominal aorta is a major procedure that has a considerable morbidity and mortality. Efforts are exerted to reduce this operative risk, one of which is the surgical approach of the Aorta. This study was carried out to evaluate the retroperitoneal approach regarding morbidity and mortality during the operation and for 30 days afterward and to evaluate the accessibility of this approach while the patient in supine. Nineteen patients with a mean age of 65.5 years were admitted for the repair of Abdominal Aorta between March 2004 and March 2006. To repair the Aorta of these patients it was approached retroperitonealy, using the standard technique with modification of the patient's position. Operative and post-operative data were measured and compared to the literature. Mean operative time, intra-operative fluid replacement and ICU stays were less compared to the transperitoneal approach. Normal intestinal sounds were regained after 2 days in most of the patients. Mean hospital stay was 6.7 days with no mortality. This study supports that retroperitoneal approach has early morbidity and mortality that is comparable to the accepted rate of complications in literatures. This approach provides a convenient exposure to treat different anatomical lesion of the distal Aorta and iliac arteries, when we operate with the patient in the neutrally supine position

Prothrombin gene G 20210 a mutation in patients with acute deep venous thrombosis

Deep venous thrombosis [DVT] is an interaction between hereditary and acquired factors. Prothrombin gene mutation is one of these hereditary risk factors that may cause DVT through elevation of the Prothrombin level and therefore, requires special attention. In this study we tried to have an idea about frequency of this gene mutation in patients with DVT. Prothrombin gene mutation was looked for in forty Warfarin-Resistances DVT patients. The results were compared to another forty Warfarin-Sensitive DVT patients and thirty healthy blood donors. In addition blood samples were assessed for the levels of protein C, protein S, antithrombin III and anticardiolipin antibodies. Recurrent DVT and positive family history were more frequent in the Warfarin-Resistance group. Prothrombin gene mutation was found in DVT patients as well as healthy controls, but with different percentages. The higher frequency of this gene mutation in Warfarin-Resistance individuals may confirm its mechanism in causing DVT. This study supports that Prothrombin gene mutation is present in our population, especially DVT patients. The study also suggests that patients with Warfarin-Resistance should be tested for the presence of this gene mutation

Bone marrow micro-metastases in clinically stage I-III HER2/Neu positive breast cancer

Patients with breast cancer should have a favorable outcome when diagnosed early. Occult distant metastases, especially in the Bone Marrow [BM] was claimed to be responsible for tumor relapse in certain cases, especially in HER-2/neu expressing tumors. Such an occult metastases may be detected by PCR techniques for a BM aspirate, which is the aim of this study. Between May 2004 and May 2005, PCR technique was used to determine the tumor HER-2/neu status of 37 patients, attending Suez Canal University Hospital for the treatment of stage I-III breast cancer. BM and peripheral blood of those positive patients were examined by the same technique for the presence of micro-metastases. Correlation between tumor characteristics and the HER-2/neu status was done. Fifteen patients were tumor HER-2/neu positive, which correlated with stage and number of positive lymph nodes. BM micro-metastases were detected in 7 patients, with no correlation to the tumor characteristics. Additionally, HER-2/neu positive tumor cells were detected in the peripheral blood of 6 patients. BM micro-metastases can be detected in HER-2/neu positive non-metastatic breast cancer that may be predicted by the peripheral blood not the primary tumor characteristics

Retro-peritoneal versus trans-peritoneal approaches in elective abdominal aortic surgery in Suez Canal University Hospital

In the era of rapidly changing surgical techniques toward safety and more cost effectiveness, retroperitoneal approach for aortic surgery is gaining popularity. This study aimed at evaluating the antero-lateral retroperitoneal approach in elective aortic surgical procedures versus the standard trans-peritoneal approach in the setting of the Suez Canal University Hospital. Since 2001 the retroperitoneal approach for aortic surgery had been introduced in the Suez Canal University Hospital. The current retrospective study was conducted in the period between 1995 and 2005. All patients had elective aortic surgery either by retro or trans-peritoneal approaches were in the study. Preoperative parameters, intra and postoperative variables, morbidity and mortality were compared in between both groups. Ninety two patients were included in two study groups. Demographic and preoperative parameters were nearly matched. The only statistically significant differences between both groups were found in some of the intra and postoperative variables. No statistically significant differences were found regarding either fatal or non-fatal complications. Both trans-peritoneal and retroperitoneal approaches are comparable to each other according to surgical expertise of the operating surgical team. With increasing experience with the retroperitoneal approach, it would be a preferable option to be chosen for performing aortic procedures