Surgical, histopathological and electron microscopic research aspects of hepatic regeneration following major hepatic resection using halothane

Twenty dogs had major hepatic resection and were re-explored two- eighteen months later were included in this study. Biopsies were taken for histopathological and electron microscopic studies which showed that the hepatocytes pass into a state of hyperactivity after resection which returns to normal when the liver reached its full original size. Mortality rate following the initial surgery was 15%. The liver resumed its full pre-resection size in fifteen dogs of the seventeen which survived the initial resection. It could be also postulated that what is known as hepatic regeneration is in fact a state of hypertrophy and hyperplasia of liver cells rather than re- growth from the line of resection. All the research data were analyzed to obtain a better understanding of this unique phenomenon

Diagnosis and management of failing infrainguinal grafts

A surveillance program was done in the period between January, 1984 to December 1995 on 74 patients [79 limbs] in which infrainguinal graft bypass was performed in Al-Azhar University and Therapeutic Establishment Hospitals. Patients were followed up for a period from 6 to 36 months; by clinical, doppler flowmetry, systolic ankle brachial pressure indices, duplex scan, and conventional or digital subtraction angiography. In 23 limbs [19 patients], a patent but hemodynamically failing grafts were identified. Different methods of correction of the failing graft were used according to the cause of hemodynamic defect. The primary patency was 71.1%, the associated primary patency was 85% and the secondary patency was 94%. This study stressed on the importance of the surveillance program for early detection and management of the failing graft before complete occlusion and limb threatening ischemia

Vascular trauma in civilian practice

Twenty patients suffered iatrogenic trauma [Median age 61 years], including cardiac intervention [7], radiological intervention [7], laparoscopy [2], surgical operations [3] and intra arterial injection [1]. Twelve patients had accidental trauma [Median age 23 years]. Eight patients sustained blunt trauma; road traffic accident [6], fall from height [2] and four penetrating injuries [stabbing to axilla, femoral triangle, popliteal fossa, left iliac fossa]. Three of eight patients with blunt trauma were referred for vascular assessment before orthopedic intervention. In four cases, an initial orthopedic operation was performed before recognition that vascular problem existed, one case postoperative after orthopedic operation had failed to improve limb perfusion. A variety of vascular techniques were used to treat the injuries, one patient died postoperatively and one underwent major limb amputation. From this study, it can be concluded that iatrogenic vascular injuries represented about [60%] and accidental trauma [40%] and most of iatrogenic injuries as a result of invasive diagnostic or therapeutic vascular procedure and cardiac catheter injuries were more extensive than other injuries

Vascular trauma in civilian practice

A retrospective study of 32 patients requiring operative intervention for vascular trauma was undertaken. From the results obtained it was concluded that a successful outcome of vascular trauma depends on early diagnosis and intervention and vascular surgeons should be involved at an early stage. As specialized vascular services round the clock are limited in any hospitals, the techniques of vessel repair involved should be included in general surgical training program

Risk factors in repair of vascular injuries in war circumstances [Afghanistan war]

Repair of vascular injuries was done in 24 patients [Mojahdens]. The mode and type of injuries were studied the outcome of the risk factors on our results was discussed. The ischaemic period, the contamination site of injury, associated injuries, combined arterial and venous injuries and other risk factors were insufficient to preclude direct repair. Direct primary vascular repair after minimal mobilization was preferable, otherwise placement of an interposition autogenous veingraft was the procedure of choice. Aggressive wound debridment covering with viable tissues, i.v. antibiotics and open fasciotomy if compartment syndrome developed. All this improve our results markedly and reduce the rate of limb loses among the afgan Mojahden