Saphenofemoral ligation as a safe and effective alternative for the treatment of chronic venous leg ulcer

To evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure. Thirty six patients [28 men and 8 women] with mean age of 42.3 +/- 8.7, presented with a venous leg ulcer. After taking a full history, they underwent examination for presence of edema, cellulitis or local ulcer infection. The site and size of ulceration were recorded and ankle-brachial pressure index [ABPI] was measured. Venous color Doppler ultrasonography was performed and venous valvular incompetence was assessed using Valsalva test and calf compression. Patients were divided into 2 groups. Group I, [n=10] assigned for long saphenous stripping, while group II, [n=26] assigned for saphenofemoral ligation and divided combined with ligation of major tributaries under local infiltration anesthesia. Mean operative time, postoperative complications and hospital stay were recorded. The study was carried out in Benha University Hospital, Egypt and Armed Forces Hospital, Khamis Mushayt, Southern Region, Kingdom of Saudi Arabia, between January 2000 and December 2001. The mean operative time and the hospital stay were significantly [p<0.05] reduced in group II compared to group I. The postoperative complications were significantly [x2=7.5, p<0.05] reduced in group II. Ulcer healing started after 3 months in group II and 6 months in group I, but, by 12 months, group II had a significant [x2=6.7, p<0.05] number of healed ulcers [n=22, 84.6%], compared to group I [n=7, 70%]. The isolated ligation of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer, and being easily performed under local anesthesia and considered to be a satisfactory procedure for treatment of leg ulcer in patients who are unfit for general anesthesia

Haemorrhoidectomy for advanced haemorrhoidal disease, comparative study between the conventional and modern techniques

Surgical excision is considered the ideal treatment for the third and fourth degree haemorrhoids. Inspite of being safe, surgical excision is liable to some complications as postoperative bleeding, pain, discharge, stenosis and recurrence So, a wide variety of techniques had been developed to avoid these complications. This study was performed for two hundred patients complaining of third or fourth degree haemorrhoidal disease. Their ages ranged between 18 and 66 years, [mean 40.28 +/- 11.84 years]. The patients were divided into four groups. Group I, [50 patients], for whom stapler haemorrhoidectomy was done. Group II, [50 patients], for whom rubber band ligation was performed. Group III, [50 patients], for whom Good-Sall's stitch technique was done. Group IV [50 patients], for whom conventional haemorrhodectomy was performed. The aim of this study was evaluation of the four techniques regarding, the operative time, hospital slay, time off work, postoperative pain, bleeding and post operative complications: For each technique the study concluded that: The shortest mean operative time was in group II, [5.7 +/- 2.14 mins.]. The shortest hospital slay and shortest time-off work was in group II, [1.60 +/- 0.91 days] and [3.12 +/- 1.39 days] respectively. Minimal post operative pain was in group I. The highest incidence of postoperative minor bleeding pruritis and wound discharge was recorded in group IV. The highest incidence of recurrence was recorded in group II. The results seen with stapler haembrrhoidectomy are very promising and actually superior to that of conventional haemorrhoidectomy in treatment of third and fourth degrees haemorrhoidal disease. Cost which remains high, seems to be balanced by the superior results obtained and the significant rapid return to normal activities and patient satisfaction

Diagnostic accuracy of total leucocytic count and C-reactive protein in acute appendicitis

Early and accurate diagnosis of acute appendicitis [AAp] is still a difficult problem especially in patients with questionable symptoms and signs. The current study was designed to determine the accuracy of repeated total leucocytic counting [TLC] and measurement of serum C-reactive protein [CRP] level in the diagnosis of suspicious Ap and to compare this with the surgical clinical diagnosis. The study comprised 83 patients with acute abdominal pain, after clinical examination with special respect to localization of pain to right iliac fossa, and the presence of rebound tenderness and abdominal wall guarding, two blood samples were taken; the first [SI] at admission and the second one 4 hours later [32], for TLC and estimation of serum concentration of CRP. Histopathologic examination of the resected appendices disclosed normal appendix [NAp group] in 13 patients with 16% negative laparotomy rate while 66 patients had acute appendicitis [AAp group]. Abdominal wall guarding is the most specific clinicalfindingforAAp with a 95.2% sensitivity, 61.1% specificity and 88.6% accuracy rate. Ttiere was a significant increase in TLC and CRP value in AAp group compared to NAp group and in S2 sample versus SI. TLC of S2 sample was specific for AAp with a 98.5% sensitivity, 92.3% specificity and 97.5% accuracy rate. However, CRP showed a higher sensitivity and specificity in the presence of gangrenous or perforated appendix [Ap] There was a positive significant correlation between diagnosis of AAp and TLC S2 sample, [r=0.956, P<0.001]. Moreover, there was positive significant correlation CRP value in S2 sample and pain localization, and abdominal wall guarding [r=l, P<0.001] and the presence of rebound tenderness [r=0.937, <0.00l]. In conclusion, the increase in TLC is an early marker for appendiceal inflammation and its persistent elevation indicating AAp, whereas CRP level usually increases markedly only with complicated Ap. AAp seems to very unlikely in patients with a normal TLC and CRP value, even if clinical symptoms and signs indicated AAp