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

Chemical and biological investigations of the roots of sonchus oleraceus L. growing in Egypt

Phytochemical study of the roots of Sonchus oleraceus L [Astraceae] growing in Egypt, afforded loliolide 1 for the first time from the genus Sonchus in addition to 1 5-O-beta-glucopyranosyl-11beta, 13-dihydrourospermal A 2, ursolic acid 3, lupeol 4, and beta-sitosterol-3-O- beta-glucopyranoside 5 for the first time from the species. The biological evaluation of the isolated compounds showed cytotoxic activity of 1 and 2 against L5187Y cell line, while compound 2 showed activity against PCS 3 cell line. In addition to antibacterial activity of compounds 1 and 2 against S. aureus, B. subtilis, E. Coli, and N. gonorrhoea. The structures of the isolated compounds were elucidated using 1D [[1]H and [13]C], 2D [H-H COSY, HMQC and HMBC] NMR and MS spectroscopic data

Impact of eversion technique in carotid endarterectomy: Mansoura experience

To review our experience in eversion technique in carotid endarterectomy in patients with carotid artery stenosis with particular attention to restenosis, occlusion, recurrent stroke or TIA. This prospective study included 12 patients with symptoms of unilateral carotid artery stenosis who were investigated, operated and followed up in Vascular Surgery Unit of Mansoura University Hospital during the period from July 2004 to January 2008. Eversion carotid endarterectomy [ECEA] was carried out for all patients. Carotid restenosis rate [>50%] during follow up was [0%] after eversion CEA at the end of the study. The cumulative stroke free survival rate was 85.7% at the end of the study. ECEA is a feasible and safe alternative technique for management of extracranial carotid stenosis, an excellent technique for handling of the kink, spiral or redundant internal carotid artery. It can be performed while patients under local or general anesthesia according to the general condition and cooperation of the patient

Evaluation of different treatment modalities of neurovascular compression in thoracic outlet syndrome

Objective: The aim of this study is to evaluate the results of different modalities of treatment of neurovascular compression manifestations of thoracic outlet syndrome [TOS]

Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy

Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]

Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations

Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy

Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]

Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations

Carotid body tumors: challenging complexity of diagnosis and surgical management

The tumor of the carotid body tumor [CBT], is a rare tumor, only about 1000 cases had been reported in the literature. It's of obscure origin and misdiagnosed if it is suspected. CBT is usually benign and commonly presented as a non-painful cervical mass. The aim of this study was to analyze diagnostic and therapeutic aspects and complications of surgery of CBT in Mansoura University Hospitals. We present eight patients had 10 carotid body tumor. Male to female ratio was [1: 2], age ranged between 13-72 years in the period between May 2000 to December 2003. The aim of this study was to analyze diagnostic and therapeutic aspect and complications of surgery of CBT in Mansoura University Hospitals. All patients were identified and complete radiological study was done including CT, MRI, Doppler Ultrasound and Angiography. Clinically, there were no secreting tumors in these patients. Preoperative immobilization was done in seven cases 24hours before surgery. All patient were operated on for tumor resection. Result the blood loss for these patients was fewer than those without immobilization. Only one case needed resection of the carotid and interposition graft. One patient had preoperative nerve deficit. Neurological deficits were noted in three patients out of nine patients [33%] immediately after surgery and two patients out of seven had permanent deficit [29%]. One patient deceased in the postoperative period from pulmonary embolism [12.5%]. Our conclusion is: the diagnosis of CBT is depending on suspicious, radiology is essential. Embolization decreases blood loss and facilitates tumor removal. Observation is not recommended because of the progressive behavior of the tumor associated with increased risk of neurological deficit. Surgery is the treatment of choice with minimal morbidity and mortality

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