Iatrogenic bile duct injuries

Twenty-two patients with postcholecystectomy bile duct injuries were managed in the Surgical Unit in period from June 1989 to June 1992. They were 18 females and 4 males. Their ages ranged between 25-60 years with a mean of 43 years. The timing and mode of presenting manifestation varied. In only two patients injuries were recognized intraoperatively. Thirteen patients [59.1%] presented within one month POP. Recurrent cholangitis was the most frequent presenting manifestation [54.5%]. Preoperative diagnostic work up included US, PTC, ERCP and CT, and when added to operative findings, stricture level and type of injury could be demonstrated. Bismuth types 2 and 3 strictures were found in 16/22 [77.7%], while ligated bile duct was the most frequent type of injury 14/22 [63.6%]. End to side Roux en Y hepaticojejunostomy was performed in 14.22 [63.3%], while end-to-end anastomosis on a T-tube stent wasdone for 2 patients with intraoperative recognition of injury [9.1%]. Choledochoduodenostomy was performed in 2 patients [9%], Roux en Y choledochojejunostomy in 2 patients [9.1%] while, portojejunostomy was done for another 2 patients [9.1%]. The period of postoperative follow up ranged between 12-36 months with a mean of 20.5 months. Only one mortality [4.65%] was met with, while early specific morbidity were encountered in 6 patients. Five patients showed late specific morbidity [one restenosis and 4 mild recurrent cholangitis]

Structural changes in the veins in Arterio-Venous Fistulae [AVF] and primary varicose veins of the lower extremity histological and histochemicat studies

Histological and histochemical studies were carried out on 36 specimens taken from veins of the leg: Five normal, one from chronic traumatic AVE and 30 from primary varicose veins. The study showed that the structural changes in the wall of varicose veins were not unlike those found in traumatic AVF. In addition degenerative changes in the form of accumulation of acid mucopoIysaccharides and choesterol esters were also demonstrated. These degenerative changes seem to be responsible for venosclerosis characteristic of long-standing varicose veins