Non-randomized comparative study of three methods for great saphenous vein ablation associated with mini-phlebectomy; 48 months clinical and sonographic outcome.

Background: Varicose veins are one of the earliest clinical features of superficial venous insufficiency (SVI) of the lower limbs that affects around 20-40% of the population with a lot of burden on patients' quality of life (QoL) and health systems if left untreated. They are defined as subcutaneous veins in the lower extremities which are dilated to ≥3 mm in diameter in the upright position and retrograde flow of >0.5 s in duration. (VVs) could occur in the great saphenous vein (GSV) or small saphenous vein (SSV) and/or in any of their tributaries. Methods: A prospective non-randomized comparative study for three methods of treatment of varicose veins was conducted. All symptomatic varicose veins with Clinical, Etiological, Anatomical, Pathophysiological (CEAP) Clinical classes of 2 or greater and demonstrated venous reflux with a duration of 0.5 s or greater on duplex ultrasound imaging GSV larger than 10 mm in diameter by duplex ultrasound were included. Results: A total of 150 patients with 183 legs in all three groups are treated. The mean age of the patients in all groups was comparable (37.32) years, and a total of 87% were women. Demographic and preoperative clinical features, presentations, and anatomic characteristics were comparable in all groups. Disfigurement was the main presenting complaint in all. All postoperative complications were significantly higher in the group of surgery over 48 months of follow up the degree of satisfaction measured by VCSS score was highest among the RFA group followed by the EVLA group. Conclusion: The results of our study suggest that the long-term results of endovenous thermal ablation methods (EVLA, RFA) are superior to open surgery for the management of varicose veins, with the RFA group showing better results in terms of improvement in QoL based on VCSS compared to the EVLA group.

Metachronous recurrent pediatric primary spontaneous pneumothorax: A case presentation and literature review.

INTRODUCTION: Pediatric primary spontaneous pneumothorax (PSP) is defined as the presence of air in the pleural cavity without underlying lung disease or thoracic trauma. Metachronous recurrence of PSP whether ipsilateral or contralateral is rare. Apical bullae and sub-pleural blebs are found in the majority of PSP patients. As in adults, surgery is indicated in cases with prolonged air leak. Video-assisted thoracoscopic surgery (VATS) is increasingly performed in children and has been reported to be both safe and effective. PRESENTATION OF THE CASE: An 11-years-old girl had bilateral attacks of PSP, the second attack happened one after the first one and this later was associated with her menarche. Chest CT scan detected bilateral apical blebs. DISCUSSION: Contralateral recurrence in pediatric PSP is a low probability. The decision for surgery in the pediatric age group is a matter of controversy as there are no strict pediatric guidelines for management of PSP. Currently, VATS is superior to open surgery. Pediatric Catamenial pneumothorax is not well described in the literature. CONCLUSIONS: Contralateral recurrence of PSP in children is rarer. No guidelines exist for the management of these cases. The association of pediatric PSP with menarche is not well described in the current literature.

Diaphragmatic lipoma; A benign condition necessitating an aggressive management.

INTRODUCTION: Primary diaphragmatic lipoma (PDL) is a very rare condition. The aim of this paper is to report a case of diaphragmatic lipoma presenting as a case of diaphratmatic hernia with a brief literature review. A 73-year-old female presented with chronic dry cough for three month duration. The patient was stable, there was no significant finding on general, chest and abdominal examination. Chest-x-ray showed vague shadow above the left dome of the diaphragm. Computed tomography scan (CT scan) of the chest revealed a round mass with features consistent with either diaphragmatic hernia or malignancy. The patient underwent resection under general anesthesia and histopathological examination confirmed the diagnosis of PDL. CONCLUSION: Although PDL is a benign condition, in most of the time, it needs aggressive management because of the possibility of malignancy or other critical diseases.