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

Impact of eversion technique in carotid endarterectomy: Mansoura experience

To review our experience in eversion technique in carotid enclarterectomy 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

High dose versus low dose streptokinase infusion in patients with submassive pulmonary embolism and echocardiographic right ventricular dysfunction

Pulmonary embolism [PE] remains a major cause of morbidity and mortality in the general population, the established treatment for PE is anticoagulation. It has previously been demonstrated that thrombolytic therapy can be lifesaving in patients with massive PE [haemodynamic instability and right heart failure]. However, the use of thrombolytic therapy in patients with submassive PE [haemodynamically stable] remains a controversial topic. Recent clinical studies, however, support evidence that thrombolysis may favorably affect the outcomes in a wider spectrum of high risk PE patients presenting with right ventricular dysfunction [RVD] as evidenced by decreased right ventricular end diastolic diameter [RVEDD], disappearance of paradoxical septal motion [PSM], and tricuspid regurge [TR] as well as decrease in the pulmonary artery pressure. The aim of this study was to evaluate the effect high dose streptokinase [SK] in 1 hour versus low dose SK in 24 hours in patients with submassive PE and RVD. The study included 50 patients [25 males and 25 females, mean age 45.5 y] with submassive PE [positive spiral CT chest] and RVD [proved by echocardiography]. Those without contraindications to SK were randomly assigned to receive either high dose [group 1] or low dose [group 2] of SK. Those with contraindication [s] to SK received anticoagulation [group 3]. Echocardiography was done before and 72 h after treatment. Right ventricular dysfunction [RVEDD, PSM, and TR] and mean pulmonary artery pressure [PAP] improved significantly 72 h after treatment in group 1 and 2, while a slight improvement in PAP was observed after treatment in group 3. No significant difference was noticed between group 1 and 2 regarding the effect of treatment on RVD or PAP. No significant difference was found between group 1 and 2 regarding the complications of SK. No significant difference was found between the 3 groups regarding the mortality. These data suggest that SK can rapidly reverse the pulmonary hypertension and RVD in contrast to anticoagulation. Both protocols of SK are equieffective in rapid reversal of RVD and pulmonary hypertension. Both protocols were safe as proved by absence of difference in mortality over anticoagulant group

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

External spermatic vein ligation improves the outcome of varicocele surgery: fact or fiction

Internal spermatic vein is the major route of testicular venous drainage However, Surgical failure after varicocelectomy is mostly due to persistent incompetent collaterals distal to the site of ligation of internal spermatic vein and the most important collaterals is the external spermatic vein. The aim of this study was to estimate the incidence of external spermatic vein in infertile patients and to evaluate the results of inguinal varicocelectomy with combined ligation of both internal and external spermatic veins. Eighty inguinal varicocelectomies were performed on 45 infertile patients with varicocele ranging in age from 20-40 years. There were 15 fertile control patients undergoing inguinal herniorrhaphy. There were 35 patients with bilateral varicocele and 10 patients with isolated left sided varicocele [Thirty-Seven patients with primary infertility and 8 patients with secondary infertility]. Grade 2 varicocele was the commonest one [52.5%]. External spermatic veins were detected in 57 varicocelectomies [71.25%]. Improvement in semen parameters was detected postoperatively. Pregnancy occurred in 14 cases [31%] on follow up period of one year after surgery. Subclinical recurrence of varicocele occurred in 3 patients [6.6%]. Vaginal hydrocele occurred in 2 patients [4.4%]. Among control group external spermatic vein was detected only in 2 patients [13.3%]. External spermatic vein is commonly found in patients with varicocele and its ligation during inguinal varicocelectomy improves the results of surgery. So, careful searching for this vein and its ligation is advised

Helicobacter pylori: does it play a role in pathogenesis of acute appendicitis

The exact aetiology of acute appendicitis remains uncertain but an infective origin has been proposed. It was postulated that helicobacter pylori infection could cause mucosa associated lymphoid tissue hypertrophy in the appendix to the extent that under certain conditions luminal obstruction and acute appendicitis might occur. This study was done to confirm whether helicobacter pylori forms part of the microenvironment of the appendix and whether it play a role in the pathogenesis of acute appendicitis. This study was performed on 62 patients with acute appendicitis ranging in age from 8 to 42 years. There were 39 females and 23 males. All patients subjected to open appendicectomy, fresh specimens from the appendix was taken and cultured on blood agar and subjected to urease test. Other specimens was subjected to histopathological examination. Pathological grading of the appendicitis was performed according to the depth of inflammatory infiltrate. 10 ml of blood was drawn from all patients for serological assessment of helicobacter pylori. Fifty patients had a pathological appendix [80.6%] with different grades of inflammation. The appendix was histologically normal in 12 patients [19.3%]. Forty-two cases [67.7%] were sero negative in whom the appendix was inflamed in 33 cases [78.6%]. Twenty cases [32.3%] were seropositive in whom the appendix was inflamed in 1 7 cases [85%]. Multiple organisms were grown on all plates and 7 biopsies were positive for urease activity. There was no evidence of helicobacter pylori in any sample on histological examination. We have concluded that helicobater pylori does not colonize the appendix and is unlikely to be a pathogenic stimulus for appendicitis. However, downstream effect of gastroduodenal infestation might induce immunological effect

Peripheral aneurysms in Behcet's disease

Behcet's disease is a multisystem inflammatory disorder which may involve the vascular system. In this report, 14 patients with Behcet's disease with a total of 16 periphral aneurysms are presented. All patients were male, ranging in age from 23-50 years. The most common site of aneurysm formation was the femoral artery in 10 patients [71%]. Others include: 2 brachial, 1 popliteal, 1 external iliac, 1 peroneal, 1 posterior tibial. Only two patients with known previous history of venous thrombosis and under treatment of Behcet's disease In the other patients [86%] the first presentation was peripheral aneurysm and recurrent scrotal ulceration +/- oral ulceration. Synchronous multiple presentation in one patient and dis-synchronous presentation in other patient We performed interposition vein grafts for11 [8 femoral, 2 brachial and 1 popliteal] and 3 interposition PTFE graft [2 femoral and 1 external iliac]. Simple ligation as initial procedure was done for two [1 peroneal and 1 posterior tibial]. Anastomotic aneurysm developed in 2 patients [14%], secondary haemorrhage ended with A.k amputation in one patient [7%]. Relapse as new aneurysm formation in the aorta in 3 patients [21%] with mortality in two of them [14%]. Behcet's .disease should be considered in the differential diagnosis of periphral arterial aneurysm in young person in our population. A combination of corticosteroids and immune-suppression should be considered to control relapses responsible for new aneurysm formation especially in patients presented with multiple aneurysms

Platelet aggregation index and femoropopliteal graft patency

Platelet aggregation index [PAI], based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 femoropopliteal bypasses with 6-mm, externally-supported, knitted Dacron grafts from 1982 to1992 mean follow up 50 months]. This index was found to be stable both pre-and postoperatively. The PAI value, the patient's age, history of hypertension atherosclerotic heart disease, diabetes, and/or smoking, the site of the distal anastomosis, previous ipsilateral bypass and state of runoff determined by preoperative angiography were analyzed for predicting closure, using the Cox proportional hazards regression model. Of the studied risk factors, the PAI was the most highly predictive variable for graft closure [P < 0.0001]. An increase of 10 units was associated with an increased relative risk of 2.02. Throughout the follow up period, 15 of l6 grafts remained patent in patients with an PAI < 15, whereas only 2 grafts out of 17 remained patent in patients with a PAI > 30. These data suggest that the PAI is an accurate predictor of the Outcome of femoropopliteal bypass using externally-supported, knitted Dacron grafts