Early results of femoro popliteal cutting balloon angioplasty

This study was conducted to evaluate the early result of Cutting Balloon Angioplasty [CBA] for the management of femoro-popliteal disease. Twenty patients with symptomatic lower limb ischemia due to femoro popliteal disease [15 stenoses and 5 occlusions], diagnosed clinically, by Doppler, duplex and angiography. Percutneaus Transluminal Angiogrphy [PTA] with the cutting balloon was done for every patient. Patients were followed up for 1 year. Initial outcome of angioplasty revealed that eighteen cases [90%] were technically successful with no distal dissections, iatrogenic vessel perforations, or surgical target vessel revascularizations. Out of 14 patients available for follow-up, the limb salvage rate was 92.5% [13 cases] and CBA sites were still widely patent [mean follow-up, 12 months], This study proved that Cutting Balloon Angioplasty [CBA] is safe and feasible for electively performed femoropopliteal chronic occlusive disease with acceptable success rates on short-term follow-up

Surgical management of post endoscopic retrograde cholangiopancreatography [ERCP] duodenal perforation

Traditionally post ERCP duodenal perforations have been managed surgically; however, in the last decade, management has shifted toward a more selective approach. Those who favor a selective approach have not elaborated distinct management guidelines. To evaluate the authors experiences in management of post ERCP duodenal perforations to define the criteria for operative management and a systematic management approach. A retrospective review of consecutive cases of ERCP related perforation [from May 2000 to May 2004] was carried out. Seventy-four out of 3050 ERCP performed [2.4%] were complicated by duodenal perforations and were included in the study. Forty-two perforations [56.8%] were discovered at ERCP while 32 cases [43.2%] required additional radiological assistance. Twenty-nine patients [39.2%] were operated early within 6 hours whereas 45 patients [60.8%] were initially treated conservatively. Fifteen patients had surgery after failure of medical treatment. Four cases [8.9%] died under conservative treatment and 14 cases [31.8%] died after surgical intervention. Pyloric exclusion procedure [PE] was done for 33 patients [75%]. Early diagnosis is important but difficult especially for retroperitoneal perforations. Clinical and radiographic features of ERCP - related duodenal perforations can be used to stratify patients into surgical or non-surgical cohorts. A selective management scheme is proposed based on the features of each type. Pyloric exclusion procedure is the operation of choice when the diagnosis is delayed and when the perforation is not detected or can't be repaired

Prognostic classification and management of local complications of severe acute pancreatitis

Recently, an international symposium on acute pancreatitis developed a clinically based classification system for acute pancreatitis that classifies its local complications into three groups [sterile necrosis [SN], infected necrosis [IV] and pancreatic abscess [PA]]. The aim of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification to a group of surgical patients with local complications from acute pancreatitis. Twenty-two patients with locally complicated pancreatitis were managed and classified into three groups [sterile necrosis [SN], infected necrosis [IN] and pancreatic abscess]. Ranson's score, APACHE-II score and computed tomography [CT] grading were calculated within the first 48 hours of admission. Information about the patients' demographics, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days and morbidity and mortality were also reviewed and analyzed. It was found that the clinical classification had both therapeutic and prognostic utility. The adoption of this system should allow for a standardization of interinstitutional data and provide a framework for more accurate and precise communication between clinicians