Endoscopic thoracic sympathectomy in the treatment of severe Raynaud's disease

To evaluate the results of endoscopic thoracic sympathectomy in severe cases of Raynaud's disease after medical treatment failure, with particular reference to the complications, safety and the effectiveness. We performed 22 endoscopic thoracic sympathectomies in 16 patients [12 males and 4 females] with severe Raynaud's disease after medical treatment failure. Their ages varies between 23 to 41 years. 10 patients underwent a unilateral endoscopic thoracic sympathectomy procedures, whereas 6 patients with bilateral symptoms underwent staged endoscopic thoracic procedures several weeks a part. Of the total 22 affected hands: 4 [18.18%] had severe intractable hand pain; 10 [45.45%] had trophic ulcers associated with terminal digital necrosis and 8 [36.36%] had gangrene of finger tips. All patients were evaluated clinically by history taking and physical examination as well as routine laboratory and radiological screening tests. All patients were carefully counseled on the potential complications of the procedure. We performed 22 endoscopic thoracic sympathectomy procedures [10 unilateral and 6 bilateral]. The mean post operative hospital stay was 1 day. The post-operative follow up ranged between 3 and 12 months with a mean of 6 months as regard to pain relief, healing of ulcers and spontaneous separation of gangrenous parts. There was no mortality and no serious morbidity detected in this study. The 4 hands [18.18%] with severe intractable hand pain were improved completely. Of the 10 hands [45.45%] with trophic ulcers associated with terminal digital necrosis, complete healing of ulcers as well as trophic lesions occurred in 8 of them [36.36%] while no healing detected in the remaining 2 hands [9%]. Of the 8 hands [36.36%] with gangrene of finger tips complete improvement of lesions and clear demarcation of the gangrenous parts occurred in 6 hands [27.27%] and the remaining 2 hands [9%] required later amputation at one or more distal inter-phalyngeal joint. Horner's syndrome occurred in 2 patients [12.5%] resolved in the first patient at 4 weeks and in the second patient at 4 months. Intercostal neuralgia detected in 2 patients. In one of them it appeared immediately after the operation, but in the 2nd it appeared 3 weeks later. The postoperative chest radiograms showed only a slight residual pneumothorax in one patient [6.25%] and non in the remaining cases. Endoscopic thoracic sympathectomy is safe-easy, reliable and effective way in the treatment of patients with severe Raynaud's disease after medical treatment failure

Outcome after distal revascularization and interval ligation [DRIL] for the tratment of dialysis-associated steal synrome

The purpose of this study was to determine the efficacy and durability of the distal revascularization and interval ligation [DRIL] procedure in relieving hand ischemia and in maintianing access patency in the setting of hemodialysis access-induced ischemia. The traditional operative treatment for ischemic steal intervention syndrome related to a functioning dialysis access arterio-venous fistula [A/V fistula] usually result in inconsistent limb salvage, loss of access function or both. This study describes the "DRIL" technique for correction of ischemic steal syndrome occurring as a complication of A/V fistulas. The study was conducted on 20 patients with a functioning upper extremity A/V fistulas associated with ischemic steal syndrome and treated by "DRIL" procedure at El Hussein University Hospital, Vascular Surgical Unit. The indications for surgery were ischemic hand pain in 9 patients [45%], tissue loss in 7 patients [35%], loss of neurologic function in 2 patients [10%] and pain during hemodialysis in 2 patients [10%]. The surgical technique used consisted of ligation of the brachial artery distal to the inflow anastomosis to the fistula and bypass graft from the brachial artery 5cm above the fistula by end to side anastomosis to a point just distal to the A/V anastomosis. The bypass material used in these patients was synthetic polytetrafluroethylene grafts [PTFE grafts] 6 mm in diameter. Of total 20 patients with ischemic steal syndrome affecting the upper extremities occurred after A/V fistulas treated by "DRIL" procedure, their ischemic symptoms improved immediately after surgery in 18 patients [90%]. The primary patency of the brachial artery bypass was 90% and the patency of A/V fistulas was 85% at 1 year. The "DRIL" technique is effective in alleviating symptoms of ischemic steal syndrome and preserving the hemodialysis access. It is considered as: the procedure of choice for correction of ischemic steal syndrome induced by A/V fistulas

Gastrointestinal complication of NSAIDs therapy: the safest choice, risk factors, and avoidance

As, combination of misoprostol or PPIs plus NSAIDs or use of safer NSAIDs, including COX-2 inhibitors, may reduce the gastrointestinal complication associated with NSAIDs therapy. We aimed to demonstrate: the safest drug, risk factors, and plan of avoidance Fifty patients with rheumatological and cardiovascular indications for NSAIDs classified into: twenty patients treated by NSAIDs alone, fifteen patients treated by NSAIDs and proton pump inhibitors [used for a week every month of treatment course], and fifteen patients treated by anti COX2. Involved in this study, subjected to careful clinical examinations, upper endoscopies, with stress on the possible risk factors exaggerate gastrointestinal complication of NSAIDs. In hypertension, bronchospasm, and allergies there were no significant difference between patients treated by NSAIDs, NSAIDs plus PPIs, or Anti COX2. Heartburn was; 50%, 26.6%, and 33.3% in group 1, 2, and 3 respectively, GIT hemorrhage; 25%, 13%, and 6.6 for group 1, 2, and 3 respectively. With observation of higher percentage of heartburn, and GIT hemorrhage among patients treated by NSAIDs alone which was double this percentages observed among group treated by NSAIDs plus PPIs [addition of PPIs reduce GIT complications to the half]. However patients treated by Anti COX2 shown reduction in GIT manifestation by three folds. Only one case of death among group 1. In endoscopic examination there were noticed higher percentages of oesophagitis, gastritis, and peptic ulcer among patients treated by NSAIDs alone which were double this percentages noticed among group treated by NSAIDs plus PPIs [addition of PPIs reduce HCL related complications to the half]. However, deudenitis, cardiac incompetent, congestive gastropathy, and abnormal pylorus shown no significant difference between group 1, and 2. Patients treated by Anti COX2 shown reduction in GIT manifestation by three folds. Addition of PPIs with NSAIDs reduces GIT complications to the half as PPIs reduce HCL related complications. However, Patients treated by Anti COX2 shown reduction in GIT manifestation and HCL related complications by three folds. By further economical study for cost benefit from combined therapy versus Anti COX2

Effect of smoking on liver histological activity in chronic hepatitis C

Aims and methods: Toexaminetheassociation between smoking and histological liver lesions in chronic hepatitis C, we studied 50 patients [mean age 45.9 years] with laboratory proven chronic hepatitis C [HCV Ab. by ELISA]. Daily tobacco consumption before liver biopsy was recorded as the number of cigarettes smoked daily. The duration of tobacco consumption was recorded by years of smoking. Liver biopsy specimens were graded for histological activity and fibrosis according to the METAVIR scoring system

Results: the proportion of patients with mild, moderate ,and marked histological activity [,Al,A2,and A3] increased gradually with daily tobacco consumption: from 16 patients with marked histological activity grade A3 : '5[50% of heavey smokers >15 cig/day] comparing to, 7 [3 1. 9 % of 1-15 cig/days]and4[22.2% with no history of smoking] however, 17 patients of grade A2 moderate histological activity:6[33.3% non smokers],7[31.9% smoked 1 -15cig/day],and 4[40% smoked>15cig/day],lastly from 17patients of grade Al mild histological activity:8[44.'4%of non smokers],8[36.4% of 1-15 cig/day smokers],and l[10%of >15cig/day smokers][p<0.05].which mean ;a significance difference with smoking groups rather than other in grading of histological activity

Conclusion: This study suggests that smoking could aggravate the histological activity of chronic hepatitis C and that patients with chronic hepatitis C virus infection should be advised to stop smoking.Abbreviations: HCV, hepatitis C virus; CCL4; carbon tetrachloride; HBs Ag, Hepatitis B surface antigen

Effect of pectin, high bran, low bran bread and potato on weight loss and serum lipids in obese rats fed low fat low calorie diet

The effect of pectin, high bran bread [HBB], low bran bread [LBB] and cooked potato added to low fat restricted calorie diets on body weight, serum lipids, HDL-cholesterol and liver lipids were studied in adult male obese rats for 8 weeks. Results were compared with fiber depleted low calorie diet. The HBB group had the highest weight loss [77 g]. Pectin and potato groups had comparable weight loss [67 g]. Pectin group had the highest fat loss and the lowest protein loss. Pectin displayed the most hypocholesterolemic effect, increased HDL- cholesterol and decreased serum triglycerides. HBB, LBB and potato groups exerted a hypocholesterolemic effect and increased HDL- cholesterol. Potato lowered serum triglycerides. In addition, liver cholesterol and triglycerides were reduced significantly for the four groups. The four regimens used proved effective in weight reduction and serum lipids modification