Abnormal Venous Dilatation other than Typical Varicose Vein, Rare Encounters.

Varicose vein, one of the common vascular illnesses is usually a disease in lower limb. This is due to reflux of blood from deep venous system to superficial venous system. Rarely, this disease can also happen in veins in different location. Four such rare encounters are mentioned in this case series.

Crural Bypass Surgery in Case of Critical Ischemia: Technical Aspects and Results.

Background Crural bypass surgery is one of the last options to salvage the leg. Compared to arterial reconstructions of more proximal localization patency rates are generally less good. The aim of this retrospective study was to answer the question if crural bypass surgery is justified. For that we focused on different technicalities, bypass material, recipient vessel and anticoagulation regimes. Objective To know outcome of crural bypass in terms of patency rates, survival rates, amputation. The difference in outcome is compared in different stages of peripheral arterial disease and various bypass materials and sites. Method Between 07/2013 and 06/2018 we performed 102 crural bypasses (27 female, 75 male; age 44-90 (70) years). Reasons for the bypasses were a critical peripheral arterial diseases (PAD) (stage III [pain at rest] and IV [necrosis/gangrene] according to Fontaine). End point of the study was major amputation or death. All patients were operated on in the same department by two experienced vascular surgeons. Result Amputation-free time was 78% after sixmonths and 70% after 24 and 60 months. Six, 12 and 40 months survival was 83%, 78% and 59%, respectively. Patency rates were affected by the severity of the disease (stage III vs. stage IV) and so was major amputation. Autologous bypasses were not associated with a better patency rate. Minor amputation or the anticoagulation scheme did not influence the long term results. Conclusion The long term survival after crural bypass is good and amputation rates are low, independent of the vessel of the lower leg used as recipient outflow. Accordingly, if a bypass is technically feasible, there is no limitation regarding the choice of the recipient vessel. If possible, autologous vein should be used, but a graft prosthesis can lead to equally good results. As patients with stage III PAD have better outcomes, early intervention is recommended in order to avoid deterioration to stage IV.

Initial Experience of Complex Peripheral Bypass Surgery at Dhulikhel Hospital, Kathmandu University Hospital.

Peripheral arterial disease is seemingly silent yet is a major pubic health problem with limb threatening and life threatening consequences. This condition can initially be asymptomatic and gradually may progress to intermittent claudication and finally to critical ischemia. When conservative management is not sufficient and there is option of surgical management, peripheral bypass surgery is an established modality of treatment of peripheral arterial disease. We present our initial cases of peripheral arterial bypass surgery all of which are technically demanding surgeries. All the cases have resulted into limb salvage until current follow-up.

[Therapy and course of disease in spontaneous esophageal perforations]. / Chirurgische Therapie und Verlauf nach spontaner Osophagusruptur.

INTRODUCTION: Esophageal perforations occur spontaneously or as a complication of endoscopic procedures. Especially in spontaneous perforation there is ongoing debate regarding the best treatment options. METHODS: 24 patients that were treated at two surgical centers (University Halle, City-hospital Bielefeld) after spontaneous esophageal perforations between 1996 and 2005 were analysed retrospectively. RESULTS: All patients but one underwent surgical treatment with in 2 cases additional stent implantation. Average stay in hospital was 53 days. In-hospital-lethality was 25% (overall lethality 37.5%). Concerning the therapeutic outcome there was no link between patients' age, localization or size of the perforation and the time interval between perforation and treatment. In 22 patients diagnosis was made > 12hrs after the event. CONCLUSIONS: Main problem of the Boerhaave-syndrome is the septic-toxic disease. Prognostic criteria are the patients' health-state and not factors like size of perforation, time of delay or localization of the perforation. Since in case of survival esophageal resection shows good long-term-results, in doubt a radical surgical procedure should be recommended as primary option. Implanting an esophageal stent might become a useful mean of treating patients with spontaneous perforations.

[Primary operative gastrostomy or percutaneous endoscopic gastrostomy (PEG) in progressive oesophageal carcinomas? A case report on abdominal wall metastases following PEG]. / Primäre operative Gastrostomie oder perkutane endoskopische Gastrostomie (PEG) beim fortgeschrittenen inoperablen Osophaguskarzinom? Zwei Fallberichte mit Bauchwandmetastase als Folge einer PEG-Anlage.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a safe and easy procedure used to provide enteric nourishment in patients with non-operable, constricting, malignant tumors of the oropharynx or esophagus. However, as a late complication, the development of abdominal wall metastases have been described, the mechanism of which is controversially. PATIENTS AND METHODS: We describe two cases in which abdominal wall metastases developed 9 and 14 months, respectively, following PEG. Both patients suffered from an advanced esophageal carcinoma. One patient had to undergo surgery because of the size of the metastasis. This was followed by several weeks of hospital treatment. The second patient was already in a prefinal condition so that no surgical procedure was performed. Reviewing the current literature, we discuss the question of whether, in certain cases, an operative gastrostomy should be preferred to a PEG. RESULTS: As in our opinion the reason for abdominal wall metastases is direct tumor seeding, we suggest that in certain cases, in order to avoid a possible metastasis resection, an operative gastrostomy should be discussed. This is particularly relevant if the tumor is constricting with a high risk of losing tumor cells. If possible, a minimal-invasive method is to be preferred.

[Therapeutic results after papilloduodenal injuries following ERCP]. / Behandlungsergebnisse nach papilloduodenalen ERCP-Verletzungen.

INTRODUCTION: Our goal was to compare operative vs. conservative therapeutic strategies after injuries following ERCP. METHODS: Eight patients with ERCP-induced injuries were surveyed retrospectively. Four of them were treated operatively, four conservatively. Criteria for an operative therapy were clinical and radiological findings and laboratory data. RESULTS: The four patients that were treated conservatively had an uncomplicated course whereas three of four patients treated operatively had long and complicated stays. In these patients the operation was performed more than 24 hours after injury. All of them showed advanced biliary peritonitis. One patient was operated on within 24 hours. He was discharged after a short stay without complications. All injuries were located in the retroperitoneum. Five patients showed anatomical abnormality of either duodenum, papilla or common bile duct. In five cases the duodenum was involved in the injury. CONCLUSIONS: The course of disease of the operated patients was longer and more complicated compared to those treated conservatively. According to our data the timing of the operation seems to be an important criterion with respect to the prognosis. Due to the small number of patients, whether conservative therapy should be preferred cannot be determined. The role of the location of injury is also not clarified.

Comparison of questionnaire-based and serological screening for natural latex allergy in children with neurogenic bladder dysfunction.

OBJECTIVE: We evaluated the prevalence of sensitization to natural latex in children with congenital neurogenic bladder dysfunction by patient history and serological examinations. METHOD: 50 consecutive children aged from 6 months to 17 years were included into the study which comprised questionnaires of patient and family histories, serological screening tests for common inhalational allergens (CAP SX1), and determination of total serum immunoglobulin E (IgE) and of latex-specific serum IgE by solid-phase immunoassays. RESULTS: 5 children had a history of allergic reactions to natural latex; a history of atopic disposition or allergic reactions other than to latex was present in 16 children. In 10 children, latex-specific IgE levels were elevated: > 0.35 kU/l; 6 out of these 10 children had no history of allergic reactions to latex. Elevated latex-specific IgE values were statistically correlated with the number of past operations (p < 0.006) and a history of atopic or allergic reactions (p < 0.0067). Clean intermittent catheterization, however, was not associated with an increased risk of latex allergy (p = 0.408). CONCLUSION: When screening children with congenital neurogenic bladder dysfunction for sensitization to natural latex, serological examinations of latex-specific IgE in addition to patient history may better identify patients at risk.