Subfascial endoscopic perforator vein surgery using balloon dissector and saphenous vein surgery in chronic venous insufficiency

Objectives: Subfascial endoscopic perforator vein surgery (SEPS) has recently been a popular alternative to classical surgical methods in the treatment of severe venous insufficiency of the lower extremity. Yet, there are not many reports concerning this less invasive operation, and many modified methods are applied. We would like to report the clinical results of our country's first SEPS operations performed by using balloon dissector.

Methods: The SEPS via two ports and using balloon dissector with saphenous vein stripping and phlebectomy in patients with severe venous insufficiency. Pneumatic tourniquet has never been applied.

Results: Twenty-eight operations were performed on 28 patients (13 female, 15 male). Active open ulcers were present in four legs, ulcer scars were present in two patients, skin changes were present in 12 legs and severe oedema was present in 10 legs. An improvement in all clinical findings and complaints was determined following the operations. A significant drop was determined in chronic venous insufficiency scores. No serious complication requiring rehospitalization of the patients was observed. All the patients were followed up for six months, and none presented again with any complaints.

Conclusion: SEPS using balloon dissector with saphenous vein surgery we performed is an effective, reliable and promising method.

Short-term graft patency of sequential and Y-graft in open heart surgery with transit time flow measurement

AIM

In this prospective study, we aimed to compare flow characteristics and the short term patency of sequential and y-grafts by intraoperative transit time flow measurement.

METHODS

Sixty patients were selected from 1374 isolated coronary bypass operations. Group 1 (N.=36) consisted of sequential grafted, Group 2 (N.=24) consisted of y-grafted patients. Intraoperative graft flow measurement was done with a transit time flow meter at stable hemodynamic conditions. We follow up the groups at the 30th day of the operation.

RESULTS

The mean flows at measurement set up were 43.2±19.7 mL/min in Group 1 and 43.6±21.7 mL/min in Group 2. After distal graft clamp removal the same values were 63.4±20.9 mL/min in Group 1 and 67.3±35.3 ml/mins in Group 2. At the 30th day of the operation no patients died, and none of them had an acute myocardial infarction.

CONCLUSION

The percent of flow increase in sequential graft group was higher but the difference of the percent of flow increase between groups was not statistically significant.

Surgical treatment of peripheral aneurysms in patients with Behcet's disease

INTRODUCTION

Our aim was to report our experience with 23 patients presenting with 32 peripheral aneurysms secondary to Behcet's disease (BD) and their outcome after vascular surgery.

METHODS

The study was retrospective in nature. Except for those presenting with aneurysm rupture, patients underwent surgery after treatment of acute inflammatory lesions. All aneurysms appeared to be pseudo-aneurysms. Graft interposition with polytetrafluoroethylene or saphenous vein was most commonly employed. Postoperatively, all patients were put on immunosuppressive and antiplatelet therapy. Follow-up was done every 6-12 months, complications recorded and managed appropriately.

RESULTS

All the patients were males. The mean age at diagnosis of a peripheral aneurysm was 41.0 ± 9 years. There were 17 (53%) femoral, 8 (25%) popliteal, two carotid, two external iliac, two brachial and one internal iliac aneurysms. Fourteen (61%) patients had a single peripheral aneurysm while nine had two. Surgery was performed for all initially presenting 23 aneurysms. Six patients with multiple peripheral aneurysms had surgery for their second asymptomatic aneurysm. The mean follow-up period was 84 ± 62 months. Of 29 aneurysms operated on, 7 (24%) anastomotic pseudo-aneurysms and 11 (38%) graft occlusions developed. Five (22%) patients underwent major lower extremity amputations. Six (26%) mortalities were recorded.

CONCLUSION

Surgery for peripheral aneurysms in BD is warranted in many instances. Results of operation can be improved by prolonged monitoring. However, despite all efforts, peripheral aneurysm involvement in BD worsens the prognosis.

Sclerotherapy: a study comparing polidocanol in foam and liquid form

Objectives

Compression sclerotherapy has been satisfactorily used for half a century for the treatment of varicose veins of the lower extremities. The effect of sclerosing solutions is that of making endofibrosis and vascular damage via producing endothelial injury. Different sclerosing agents were used by applying many different sclerotherapy methods. In recent years, sclerosing foam has been introduced in sclerotherapy with the goal of increasing the efficacy in the treatment of varicose veins. It is still uncertain whether foam or liquid form is superior. The aim of this study is to determine the efficacy and safety of the sclerosant polidocanol – which is a well-known detergent-type sclerosing agent – in foam form compared with liquid form.

Methods

A total of 100 women patients with telengiectases and small varicose veins of less than 4 mm were included in this study. The patients were divided into two groups according to presenting dates. Fifty patients who presented first were classified as the first group. They were treated with Tessari's foam sclerotherapy method. The second fifty patients who presented later were placed in the second group. They were treated with the liquid form of polidocanol. Extremity veins that did not have insufficiency at the saphenofemoral junction were divided into three groups as <1 mm, 1–2 mm and >2 but <4 mm, and the veins were treated with 0.25%, 0.5% or 1% of polidocanol, respectively. Clinical improvement, patients' complaints and side-effects were determined after treatment.

Results

Complete disappearance was determined in 84% of patients in the foam form group and in 72% in the liquid form group. Although polidocanol in foam form's success rate was higher than the liquid form of polidocanol to clear the vessels, this result did not reach statistical significance ( P = 0.148). There was no significant difference also in the side effects between each group.

Conclusion

Compression sclerotherapy is an effective and useful method for treating small varicose veins and telengiectases. Both polidocanol foam and polidocanol liquid forms are effective and safe sclerosing agents. The rates of side-effects were similar for both sclerotherapy methods. Although efficacy to clear the small varicose veins and telengiectases with foam polidocanol seems to be more successful than with liquid polidocanol, it is early to declare the superiority of the foam sclerotherapy method.

A comparison of low-molecular-weight heparin and combined therapy of low-molecular-weight heparin with an anti-inflammatory agent in the treatment of superficial vein thrombosis

OBJECTIVES

The optimal treatment of superficial vein thrombosis (SVT) of the leg has not been determined yet. The aim of this study is to evaluate the efficacy of low-molecular-weight heparin (LMWH) as compared with combined therapy of LMWH with an anti-inflammatory agent in treatment of SVT.

METHODS

Fifty patients with SVT of the greater saphenous vein were randomly assigned to be treated with Ca-nadroparin 190 IUAxa/kg in a single dose or with same dose of Ca-nadroparin and 60 mg oral acemetacine twice daily for 10 days. The efficacy of the two treatments to relieve symptoms and signs was evaluated by using visual analogue scale.

RESULTS

Significant improvements were achieved for both groups after the treatment in terms of all four symptoms (P < 0.001). Treatment scores were in favour of LMWH with anti-inflammatory agent treatment group to relieve all four symptoms. The most significant and remarkable results obtained were for the reduction of pain and local tenderness (P < 0.05). No patient experienced major complications or mortality in either group.

CONCLUSION

The results of this study suggest that the combined therapy of LMWH with an anti-inflammatory agent is more effective than LMWH. It may be an important option in the standard treatment of SVT.

Hydatid cyst of the breast

Cystic hydatid disease is caused by the Echinococcus granulosus parasite. Most frequently, cysts develop in liver and lung. The breast is rarely a primary site of the hydatid cyst. A case of hydatid cyst of the breast is presented, the diagnosis of which was missed both pre-operatively and intra-operatively.

Mucormycosis presenting with painful ophthalmoplegia

Mucormycosis is a rare fungal infection that can involve the sino-orbito-cerebral region. Sino-orbito-cerebral mucormycosis is most common in patients who are immunocompromised or have diabetes mellitus, severe malnutrition or burns. This condition can be fatal if it is not diagnosed early and treated aggressively. This article presents 4 cases of mucormycosis, including 2 with orbital apex syndrome, 1 with cavernous sinus syndrome, and 1 with multiple cranial nerve involvement. All of the patients were presented with painful ophthalmoplegia. The predisposing factors for mucormycosis included diabetes mellitus (three patients) and chronic leukemia (one patient). In all cases, mucormycosis was diagnosed by examining endoscopic sinus drainage material and was treated with surgical debridement and amphotericin B. Two patients with central nervous system involvement died. The others have survived, but still exhibiting various neurologic abnormalities after aggressive treatment. Patients with mucormycosis rarely present with orbital apex syndrome. The possibility of mucormycosis should be investigated in any patient with painful ophthalmoplegia, and prompt otorhinolaryngologic examination is recommended to ensure rapid diagnosis and treatment.

Epithelioid leiomyosarcoma of the gastrocolic ligament

We present the case of a 56-year old man who presented with a large, well circumscribed cystic mass in the gastrocolic ligament. The histopathological study revealed an epithelioid leiomyosarcoma. Epithelioid leiomyosarcomas are generally solid tumours of the stomach. It is uncommon in the gastrocolic ligament and in a cystic formation. Preoperative diagnosis with ultrasound, computerized tomography and endoscopy was not made. Complete surgical resection of the mass was performed. Histopathological study confirmed the diagnosis of epithelial leiomyosarcoma. Two years after surgery, clinical and radiological examinations of the patient were normal.

Primary malignant lymphoma of the appendix (a case report and review of the literature)

Authors report a case of a 29-year-old male with primary malignant lymphoma of the appendix with involvement of lymph nodes in the mesenteries. Surgical intervention was performed, adjuvant chemotherapy was applied. No recurrences, metastases or complaints occurred after one year of follow-up. The case is of interest due to the clinical and histopathological diagnostic problems as well as the dimension of the metastatic lymph node in the ileal mesentery.

Coronary sinus retroperfusion during acute experimental coronary artery occlusion

BACKGROUND

This study was planned to show the effect of retroperfusion and cardiopulmonary bypass on myocardial hemodynamic recovery.

METHODS

Eighteen dogs entered this study. After, left anterior descending artery (LAD) was dissected and occluded, the animals were divided into three equal groups; Group I: retrograde coronary sinus perfusion, group II: cardiopulmonary bypass and retrograde coronary sinus perfusion, Group III: control group, left anterior descending artery occlusion only.

RESULTS

In Group III, deterioration of the hemodynamic values progressed parallel with the degree of ischemic damage but in Group I, hemodynamic parameters were better because of the retrograde coronary sinus perfusion and minimally affected by the reperfusion. In Group II, at the end of the cardiopulmonary bypass minimal myocardial damage was observed.

CONCLUSIONS

There is no statistical difference between Group I and II if we examine the data that was taken after reperfusion although myocardial performance was better in Group II.

Lymphangiomas of the ileum: a report of two cases and a review of the literature

Lymphangiomas of the gastrointestinal tract are seen very rarely, especially in adults. We herein present two cases of ileal lymphangioma which were found during surgery. One case was a 43-year-old man with a palpable mass, and the other was a 19-year-old man who presented with symptoms of pyloric stenosis. Although radiologic studies helped us, we could only be certain about the diagnosis after both the operation and histopathologic studies. We performed a total excision with ileal resection in both cases.

A case of Behçet's disease with an abdominal aortic aneurysm and two aneurysms in the common carotid artery. A case report

A sixteen-year-old boy presented with varied symptoms to the hospital. After he had been diagnosed as having Behçet's disease, investigations revealed two carotid aneurysms in the right common carotid artery and one abdominal aortic aneurysm. The aneurysms were resected, medical therapy was started, and the patient recovered well. Although multiple aneurysms have been reported previously, the authors believe this is the first reported case involving both the carotid and the aorta.