Intra-arterial drug injection: an effective treatment protocol

Intra-arterial drugs injection [IADI] either iatrogenic or self administered in drug abusers is a source of considerable morbidity. Most interventions are largely empirical. No prospective human studies have shown that any specific treatment is superior to another. The aim of this study was to evaluate the outcome of different modalities of treatments in patients with IADI. This study included 36 patients divided into 2 groups: Retrospective group [A] [from November 2002 to July 2004] enrolled 13 patients [10 males and 3 females] and prospective group [B] [from August 2004 to June 2008] enrolled 23 patients [19 males and 4 females]. Group A received systemic treatment only [heparin, dexamethazone, antiplatelet and prostaglandins] and group B received intra-arterial treatment [heparin and streptokinase] in addition to the systemic treatment Normal outcome [normal extremities] improved greatly in group B [52%] than in group A [23%] although, this failed to reach statistical significance. Intra-arterial cannulation and administration of heparin and streptokinase is a good option in treating accidental IADI resulting in better final outcome than systemic heparinization and early treatment is mandatory for a good outcome

Early outcome and follow up on 25 cases with vascular compression at thoracic outlet area

The aim of this study is to describe our experience with the surgical treatment of arterial and venous thoracic outlet syndrome. This prospective study included 25 patients with vascular compression manifestations at thoracic outlet area. They were admitted to Vascular Surgery Unit, Mansoura University Hospital during the period from July 2004 to December 2007. patients were classified into two main groups. Group I [arterial thoracic outlet syndrome, n=16]. Group II [venous thoracic outlet syndrome, n=9]. The operations for arterial reconstruction [n=13] were worthwhile for all patients with excellent results in 11 patients [84.6%], only 2 patients [15.4%] developed early postoperative thrombosis which was managed by transbrachial thrombectomy. The success rate of surgical interference for nonthrombotic venous patients [n=2] was 100% while that for thrombotic venous patients showed success in 4 patients [57%] and failed in 3 patients [43%]. In patients with vascular compression, resection of the first rib, resection of cervical rib, scalenectomy and neurolysis of the brachial plexus are recommended in addition to vascular reconstruction. Our experiences using the supraclavicular approach indicate that this is a safe route with good results and minimal risk to the patients health

Vascular thoracic outlet compression syndrome

The aim of this study was to describe our experience with the surgical treatment of arterial and venous thoracic outlet syndrome. This prospective study included 25 patients with vascular compression at thoracic outlet area. They were admitted to Vascular Surgery Unit, Mansoura University Hospital during the period from July 2004 to July 2007. Patients were classified into two main groups. Group I [arterial thoracic outlet syndrome, n = 16]. Group II [venous thoracic outlet syndrome, n = 9]. The operations of arterial reconstruction were worthwhile for all patients with excellent results in 11 patients [84.6%], only 2 patients [15.4%] developed early postoperative thrombosis which was managed by transbrachial thrombectomy. The success rate of surgical interference for venous non-thrombotic patients was 100% while conservative treatment of thrombotic patients showed success in 4 patients [57%] and failure in 3 patients [43%]. In patients with vascular compression, resection of the first rib, resection of cervical rib, scalenectomy and neurolysis of the brachial plexus are recommended in addition to vascular reconstruction. Our experience using the supraclauicular approach indicate that this is a safe route with good results and minimal risk to the patients health

T2 versus T2 and T3 endoscopic sympathetic ablation in primary palmar hyperhidrosis

Between June 2000 and April 2002, 112 sympathectomies were performed on 56 patients suffering from isolated palmar hyperhidrosis. Both sides were operated during the same surgical procedure using 5 mm 0-degree laparoscope. All patients were placed in a semi-sitting position under single lumen endotracheal anesthesia. Electrocute ablation of T2 ganglion and any Kuntz fibers was performed in 28 patients [group I] and similar procedure on T2 and T3 ganglion was performed in the other 28 patients [group II]. The procedure was accomplished within 12 minutes [range 7-20 minutes] for both sides. All patients were discharged within eight hours after conventional chest X-ray. Fifty-four patients were followed up for a mean of 17 months [2 patients lost the follow up]. The study concluded that the incidence of compensatory hyperhidrosis can be greatly decreased by limiting sympathetic ablation to T2 only in the treatment of primary palmar hyperhidrosis with a high subjective patient-satisfaction

Special tactics in repair of epigastric hernia

This study included 30 patients presented with epigastric hernias of different sizes. Careful clinical examination and preoperative investigations were done to evaluate the general conditions of the patients and to treat any correctable medical disease. After assuring that there was no contraindication to surgery, the elective surgically correction of the hernia was done by a special technique in all patients using three-layer repair [vest-over pants repair, gel foam packing and prolene mesh [hernioplasty]. A follow up of the patients was done for one year. The results were very satisfactory with no recurrence

Study of risk factors and different modalities of treatment in lower extremity vascular injuries

This study included 88 patients with lower extremity vascular injuries. They were assessed on presentation and resuscitation protocols were initiated if signs of shock were present. Arterial injuries were repaired by primary repair, resection and anastomosis, interposition graft, artery ligation, temporary shunts and extra- anatomical bypass. Venous injuries were repaired by the same techniques, but when the repair would be complex or the patient is hemodynamically unstable, simple ligation was done. Primary amputation was done for patients where limb salvage was impossible clinically. MESS score was applied on the cases to obtain a score, which predicted the eventual need for amputation

Peripheral vascular malformations: favorable outcome

In the period from May 1999 and January 2003, 45 patients were presented with arteriovenous malformations. All patients were subjected to thorough history taking, clinical examination and investigation with recent modalities techniques. A surgical excision was done in all cases; wide surgical excision of hemangioma and preliminary ligation of the feeding vessels was done in case of arteriovenous communication. Residual lesions were subjected to a further excision or injection sclerotherapy with ethanol. An excellent outcome was obtained in most of the patients, with only residual lesions in seven patients who were treated by a further excision or injection sclerotherapy with ethanol. There was no major complication in the postoperative period, e.g. DVT and PE. There was no recurrence in the study