RESUMEN
The incidence of varicose veins and the need for treatment has shown a tremendous increase over the years. Debilitating venous ulcers and dragging edemas of the lower limb with overall improvement in cosmetic results and availability of endovenous procedures has brought many patients forward for treatment. Continuous-wave handheld Doppler usage is limited by its diagnostic capabilities, thus the need to determine its real effectiveness. Benefits of using hand-held dopplers lies in its rapidity in assessment of patients, it's low running cost and short learning curve. This is important as duplex ultrasounds are not readily available in district hospitals. This study aims to determine the clinical effectiveness of hand-held continuous wave dopplers in the local setting especially in primary uncomplicated varicose articles veins. All electively referred patients with primary uncomplicated varicose veins who were referred to the Varicose Vein Clinic were evaluated with continuous-wave handheld Doppler (CWD) and duplex ultrasound (DUS) examination. The study duration was from the 1st of July to 31st of August 2013 (2 months). All patients in the study were independently evaluated with CWD and DUS in the clinic on the same day after adequate rest time. DUS was taken as the gold standard for evaluation of CWD specificity and sensitivity. The Chi-square and T-test was used to test for statistical significance. A total of 41 patients were evaluated in this study. The specificity of CWD when compared to DUS for diagnosing Sapheno-femoral junction (SFJ) was 100% and at the Sapheno-popliteal junction (SPJ) was 87%. Meanwhile sensitivity of CWD for SFJ was 75% and SPJ was 60%. The examination time with CWD was significantly faster than when compared with DUS examination with significant faster tracing times that can be achieved with CWD. CWD also significantly shorter reflux times when compared to DUS. Continuous-wave handheld doppler proves to be an indispensable clinical tool in the evaluation of SFJ and SPJ reflux in varicose veins. CWD assessment in this study was shown to be equal if not better for evaluating reflux when compared to DUS assessment for SFJ reflux. Main advantages for CWD also lie in its low running cost, rapidity in assessment and short learning curve when compared to duplex ultrasound examinations.
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The diagnosis of aortic dissection in a young adult in the absence of atherosclerosis or prior history of trauma is extremely rare. The presence of more than one arterial dissection site in such a patient is even more unheard of. We highlight a case of spontaneous multiple acute arterial dissections occurring in a 32-year-old male. Stanford B aortic dissection and a separate dissection extending from the bifurcation of the right common iliac artery to the right common femoral artery was noted on computed tomographic angiography (CTA). A small aneurysm of the right subclavian artery was also noted. A two-stage hybrid procedure involving a combination of open and endovascular surgery was employed. The rarity and lethality of this condition warrants a high index of suspicion for early diagnosis and prompt intervention.
Asunto(s)
Aneurisma de la AortaRESUMEN
Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.
Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Implantes Absorbibles , Estética , Humanos , Tiempo de Internación/estadística & datos numéricos , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Recurrencia , Mallas Quirúrgicas , Técnicas de SuturaRESUMEN
Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.
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Arteriolas/anomalías , Embolización Terapéutica , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/terapia , Estómago/irrigación sanguínea , Adulto , Angiografía/métodos , Embolización Terapéutica/métodos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hematemesis/etiología , Humanos , Hipertensión/complicaciones , Masculino , Melena/etiología , Factores de Riesgo , Estómago/diagnóstico por imagen , Estómago/patología , Resultado del Tratamiento , Ureterolitiasis/complicacionesRESUMEN
Arteriovenous malformation (AVM) are commonly congenital in origin. We hereby describe the case of a 24-year-old male who was diagnosed of left thigh intramuscular AVM at the time of 14 years old. The computerized tomography (CT) scan confirmed a large deep seated intramuscular AVM with the size of 20 x 15 cm, with dilated and distended feeding vessel from profunda femoris artery (PFA) and superficial femoral artery (SFA). He also had another AVM near the left supracondylar region adherent to the sciatic nerve. The main AVM lesion was earlier treated with surgical resection and it remained for asymptomatic for next seven years. Following this, the patient presented again to the clinic with recurring swelling, pain and occasional paraesthesia on the same site. He was then managed with a series of embolization (total of 6 attempts) with histoacryl glue. These attempts of embolization were successful. The interesting case of pulmonary embolism due histoacryl glue following embolization of an AVM is described.
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Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/efectos adversos , Enbucrilato/efectos adversos , Embolia Pulmonar/etiología , Muslo/irrigación sanguínea , Malformaciones Arteriovenosas/patología , Humanos , Masculino , Adulto JovenRESUMEN
Mycotic descending thoracic aneurysm with aortobronchial fistula is a rare condition which is associated with high mortality. Treatment in the era of minimally invasive procedure can often be controversial. The risk of graft infection should be considered as well as the unknown long term behavior of the endovascular stent. Here, we describe our initial experience of performing emergency thoracic endovascular aneurysm repair in an unstable patient presenting with haemoptysis.
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Aneurisma Infectado/cirugía , Aneurisma de la Aorta Torácica/cirugía , Procedimientos Endovasculares , Stents , Anciano de 80 o más Años , Humanos , MasculinoRESUMEN
The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.
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Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Estreptocócicas/microbiología , Estreptococos Viridans/aislamiento & purificación , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Disección Aórtica/complicaciones , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Torácica/complicaciones , Bacteriemia/microbiología , Procedimientos Endovasculares , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/etiología , Fístula Esofágica/microbiología , Fiebre/etiología , Humanos , Isquemia/etiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Paraplejía/etiología , Penicilinas/uso terapéutico , Complicaciones Posoperatorias , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Radiografía , Médula Espinal/irrigación sanguínea , Infecciones Estreptocócicas/diagnóstico por imagen , Infecciones Estreptocócicas/tratamiento farmacológico , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/microbiologíaRESUMEN
The availability of multiple investigating modalities should be utilized to arrive at the correct diagnosis of the spinal arteriovenous malformation (AVM). We hereby report the case of a 21-year-old, obese female, who presented with paraplegia and impaired bowel control two years after an episode of the fall. The Magnetic Resonance Imaging (MRI) of her spine not only revealed disc prolapse at T11-T12, but also tortuous dilated spinal veins and cord oedema. A diagnosis of a spinal arterio-venous fistula was confirmed after a spinal angiogram. The dilemma of treating the right pathology for the clinical signs and symptoms are being discussed.
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Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico , Desplazamiento del Disco Intervertebral/etiología , Vértebras Lumbares , Médula Espinal/irrigación sanguínea , Vértebras Torácicas , Femenino , Humanos , Adulto JovenRESUMEN
Patients with Falciparum malaria may present with peripheral gangrene as a rare complication. In this report we describe two adult Sudanese patients with high grade fever for 10 days, jaundice, alteration consciousness and hypovolaemic shock. Both patients had blackish discolouration of the fore foot and the toes, bilaterally. Blood smears showed hyperparacitaemia with Plasmodium falciparum. They were diagnosed as having severe malaria with peripheral gangrene; they were treated with quinine infusion and the foot lesions recovered spontaneously without surgical intervention.
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Refractory ascites is difficult to treat by restriction of salt and repeated paracentesis which have been the mainstay of treating it for a long time. Sapheno-peritoneal shunts have been performed in patients with refractory ascites . Here, we evaluated the use of saphenous vein to be anastomosed to the peritoneam to drain the refractory ascites. Nine patients (7 male, median age 45 years, range 17 - 69) with tense refractory ascites associated with liver cirrhosis, perioprtal fibrosis and end stage renal diseases underwent sapheno-peritoneal anastomosis by mobilizing and rotating the proximal vein in order to be anastomosed to peritoneum in the lower abdomen . All procedures were performed under local anaesthesia. Thirty-day mortality was 22% (2) patient. Morbidity included fluid leakage in 1 (11%), and wound infection in 1 (11%). Hospital stay (median) was 16 days (range 11 to 23). In the short term (median of 2 months) significant reduction in body weight and abdominal girth was seen in 9 (90%), 6 (60%) were not on diuretics while 3 (30%) continued to remain on reduced doses of diuretic. Furthermore, 7 (70%) did not require paracentesis. At 2-year follow-up, 5 (45%) patients died and 3 succumbed during follow-up. The remaining 3 were all in active employment, 1 was off diuretics, and 2 were on reduced doses. All 3 patients maintained reduced body weights and abdominal girths compared with preoperative values. Saphenous-peritoneal shunt appears a simple, safe, and cost effective method of achieving long-term control of refractory ascites. The use of autogenous shunt is an added advantage over prosthetic shunts for drainage of ascitic fluid.
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An internal hernia through the mesosalpinx is a rare condition which is often overlooked. We report the case of a 65-year-old lady who presented with features of small bowel obstruction. At laparotomy, a gangrenous ileum was found to have herniated through a defect in the right mesosalpinx. We discuss this rare cause of a small bowel obstruction and its diagnostic dilemma.