royal medical services experience in vascular injuries during the Palestinian uprising

This report summarizes the experience of two vascular surgeons in dealing with vascular injuries at Rafidia surgical hospital- Nablus during the bloody conflict between the Palestinians and Israel. Between January 2000 and June 2001 thirty-nine Palestinians with vascular injuries were received alive at Rafidia Hospital in the city of Nablus. All patients were received in profound shock and underwent emergency surgery. Massive blood transfusion was given almost to all patients. We retrospectively evaluated the outcome and the surgical results. There was one operative death in a patient with injury to the vertebral artery. There were serious complications in 14 patients related to other injuries but all of them were discharged alive from Hospital with no limb loss. War vascular injuries are lethal. However, the presence of an experienced vascular surgeon and anesthesiologist, unlimited supply of blood and blood products combined with the young age of patients who tolerate the state of shock better can tremendously improve the outcome

simple method of bonding rifampin to dacron grafts and its value in preventing early vascular graft sepsis

The graft was impregnated by soaking it for 15 minutes in rifampin after preclotting and was used for bypass for symptomatic lower ischemia in 15 patients [part I]. In part II patients, grafting using knitted Dacron prosthesis was applied in comparable group of 20 patients in the same center and under the same circumstances. In both groups, patients were followed up for early wound infection, gross graft infection and early graft thrombosis at 1, 3, 6 and 12 months. In group I patients, there was zero% incidence of graft infection even when groin wound infections occurred in the immediate postoperative period. The graft was resistant and wounds healed by secondary intention with no complications around the graft. In group II patients gross graft infection occurred in two patients and extra anatomical bypass was done after excision of the graft in one patient and the other patient died of intraabdominal hemorrhage due to aortic suture line disruption. The simple method of impregnation of preclotted graft in rifampin resulted in antibiotic retention and prevented serious prosthetic infection and should therefore be used in prophylaxis against vascular graft sepsis

Injertos vasculares biológicos para microcirurgía / Biological vascular grafts for microsurgery

En este estudio se revisó el comportamiento de la arteria umbilical humana (AUH), tratada con glutaraldehído, en un calibre de 1.5 mm de diâmetro, substituyendo un segmento de 20 mm de longitud de la aorta abdominal de la rata. Se utilizaron 48 ratas Wistar machos de 250 a 300 g de peso, las cuales fueron divididas en grupos. Fuerojn sacrificadas a diferentes intervalos de tiempo, entre los 12 a 315 días. En el Grupo I (AUH lisa) se observó una permeabilidad del 75%. En el grupo II (AUH corrugada) se obtuvo una permeabilidad del 50%. En el grupo III (AUH lisa + glutaraldehído) se encontró una permeabilidad del 75%. Finalmente, en el grupo IV (AUH corrugada + glutaraldehído se observó una permeabilidad del 66.6%. Aunque la permeabilidad del Grupo III es del 75%, las dilataciones aneurismáticas y clacificaciones importantes (25% y 41.6% respectivamente) que se presentaron no permiten recomendar este tipo de microinjertos para substituir segmentos vasculares en el humano

Trauma vascular / Vascular trauma

La cirugia, para condiciones derivadas del trauma, adquiere cada dia proporciones mayores a medida que las sociedades se tornan mas violentas y las indicaciones de aquella se hacen mas precisas gracias a los avances en las tecnicas de atencion de emergencias y desastres. La cirugia del trauma vascular no es excepcion a lo anterior. En el presente trabajo se presenta una revision de los casos de trauma vascular que recibieron tratamiento quirurgico en el Hospital San Ignacio, en un lapso de 10 anos. Se exponen los hallazgos de la revision de 76 pacientes con 97 lesiones vasculares asociadas, determinando las variedades de estas, los territorios vasculares afectados, el cuadro clinico y el tratamiento quirurgico. El porcentaje de amputaciones ocasionadas por el trauma periferico fue del 5.6% y la mortalidad general, del 1.3% (1 caso).