Summary Background Superficial inferior epigastric artery (SIEA) flap has a great advantage over other flaps of the area, that is, readily non-existent donor-site problems. The main reason why the ...SIEA flap has never been extensively used in breast reconstruction is the small diameter and variable anatomy of its donor artery. This study presents a possibility of enlarging the SIEA diameter using the delay-phenomenon mechanism. Methods A prospective clinical study of 26 patients was undertaken. Prior to surgery, ultrasound examinations were performed, measuring the diameter of SIEA and the velocity of blood flow in SIEA. The ipsilateral deep inferior epigastric artery (DIEA) was then ligated in all patients who had a measurable SIEA preoperatively. Two weeks later, measurements were repeated. The blood flow through SIEA was calculated and statistical analysis was applied. Results Twenty-one patients had an identifiable SIEA on preoperative measurements. On postoperative measurements, we confirmed ligation of DIEA in 19 patients, of these 17 patients had an augmentation in diameter (mean: 29%) and 18 in blood flow (mean: 127%). Conclusions This study shows that ligating a single of the three main arteries (DIEA, SIEA and superficial circumflex iliac artery) irrigating skin/soft tissue of the lower abdomen, although the dominant one, results in widening of diameter and enlarging of blood flow of another artery (SIEA) supplying the same angiosome. The results of the present study might be used in future to increase the diameter and flow in SIEA when the vessel diameter found on preoperative imaging was too small for clinical microsurgical transfer. The drawback of the proposed delay procedure is the sacrifice of ipsilateral DIEA and an added operative procedure. Statement The clinical trial is registered with Clinical Trials ( http://www.clinicaltrials.gov/ ). The clinical trial registration number is NCT01247129.
Summary
Background
Symptomatic patients with chronic mesenteric ischemia (CMI) should be treated without much delay because symptoms of CMI are present in 43 % patients who present with acute ...mesenteric ischemia. There are few reported series with large numbers of patients undergoing surgery for CMI, and many controversies persist regarding the optimal surgical treatment. These controversies include the type of surgical repair (antegrade vs. retrograde bypass), and the number of arteries that should be treated (single- vs. multiple-vessel reconstruction). It was the aim of presented study to report our experience and long-term results with single-vessel bypass grafting from infrarenal aorta to superior mesenteric artery.
Methods
Patients who were admitted because of mesenteric ischemia at the surgical clinics of University Clinical Center Maribor between January 1999 and January 2009 were identified with a computerized medical data registry. Patients who underwent revascularization for CMI with retrograde synthetic aortomesenteric bypass were included in the study. Demographics, clinical characteristics, imaging, and operative data were obtained from the medical records. Significant superior mesenteric artery stenosis (> 70 % diameter stenosis) was confirmed by spiral computed angiography. All patients underwent retrograde aortomesenteric arterial bypass with synthetic bypass graft originating from the infrarenal aorta. Doppler sonography combined with color Doppler was used to evaluate disease progression in patients at 3-month interval during the first year and from then at 6-month intervals. Endpoints of the study were occlusion of graft or death by any cause.
Results
Data are presented for a cohort of 19 women and 8 men with a mean age at admission 73 years (range 56–88 years). The mean duration of follow-up was 71 months (range 1–118 months). There was one early death (4 %). Four patients died during the follow-up period, and three were lost for follow-up. None of the deaths was connected with mesenteric ischemia. During follow-up period none of the patients developed restenosis, and no occlusions were observed. There were no reinterventions. Symptom improvements were noted in 25 patients (93 %). One patient (4 %) referred to persistent pain despite successful revascularization, although during follow-up period weight gain was observed. At 71 months, freedom from recurrent symptoms, restenosis, and reinterventions was 78 % ± 13.9 %.
Conclusions
Surgery for CMI can be safely performed with retrograde approach and single vessel anastomosis. Mortality rates and long-term survival compare favorably with other surgical approaches to treatment of CMI.
True aneurysms of the profunda femoris artery are extremely rare in comparison to pseudoaneurysms of the same artery. In most cases they are accompanied by aneurysms of the abdominal aorta or ...peripheral vessels. The most common reason for aneurysmic dilatation of vessels is a generalized vascular degenerative process. An isolated true aneurysm of the profunda femoris artery due to atherosclerosis is markedly unusual. These aneurysms have a high incidence of complication; therefore surgical management is mandatory for all diagnosed cases regardless of whether they are symptomatic or not. We describe a case of a 73-year-old man with a large isolated atherosclerotic aneurysm of the profunda femoris artery. He presented with an enlarging, progressively debilitating mass in his upper thigh. Ultrasound and computed tomography-angiography demonstrated a 15 x 14 cm large aneurysm of the profunda femoris artery. The patient was successfully treated by aneurysm neck ligation and sac decompression.
During the 4-year military conflict in Croatia, we treated operatively 7,928 casualties. Of those casualties, 172 (2.2%) had penetrating liver injury, mostly sustained by explosive devices. Of these ...injuries, 90.7% were associated with the trauma of other abdominal and extra-abdominal organs. Seventy-five percent of injuries belonged to grades III and IV on the Liver Injury Scale. The main method of treatment was debridement with ligation of severed vessels and bile ducts. In 8.1% of cases with detrimental bleeding, we used liver packing. Fifty percent of these patients have survived but with a high incidence of septic complications. This method was proven salutary in the most detrimental injuries that could not be treated in any other way. Postoperative hemorrhage and intra-abdominal abscesses were complications that needed surgical and ultrasound-guided aspiration, respectively. Numerous heavy injuries of the liver combined with associated trauma of other vital organs are responsible for the high mortality rate of 28.5%.
Cytomegalovirus reactivation is a well described event occurring after intensive therapeutic suppression of the immune function in patients with latent infection. Treatment protocols for suppression ...of the immune response often include high-dose steroids. However, it is not known whether even a low-dose steroid treatment can reactivate latent cytomegalovirus in otherwise healthy persons. We documented cytomegalovirus reactivation after low-dose steroid treatment for autoimmune hemolytic anemia as a complication of Epstein-Barr virus mononucleosis in an immunocompetent 21-year-old man.
Colorectal war injuries Uravić, M
Military medicine,
03/2000, Letnik:
165, Številka:
3
Journal Article
Recenzirano
Odprti dostop
During the war in Croatia (1991-1995), 851 war casualties were treated by the surgical teams of Rijeka Clinical Hospital. Among them, 66 patients (7.8%) had colon and/or rectum injuries, usually ...combined with trauma of other abdominal organs, most often jejunum and ileum (24.2%). Regarding the site of injury, right and sigmoid colon were the most frequently traumatized areas (30.3% and 31.8%, respectively). All patients received surgical treatment within 3 hours from wounding. In 89% of patients, relieving colostomy was formed after the resection of the damaged part of the intestine; 11% of patients were treated with primary resection or sutures without colostomy. The mortality rate of 3% (2 patients) was caused by mutilating multiple organ abdominal trauma combined with massive brain injury.
Objective : A moderate increase in serum alanine aminotransferase (ALT) has been reported to be a helpful, low-cost tool for predicting viremia in anti-hepatitis C virus (HCV)-positive hemodialysis ...(HD) patients. This study focused on evaluating the effectiveness of a lowered normal serum ALT value as a screening method for HCV infection in HD patients. Material and Methods : Serum ALT levels were compared with HCV virologic status in 125 patients on maintenance HD. Results : The prevalence of HCV antibodies was 23%. A total of 3.7% of viremic HD patients did not have a detectable antibody response. Using the conventional upper limit of normal for ALT of 37 IU, there was no significant difference in the frequency of elevated ALT levels between HCV RNA-positive and -negative patients. However, if the upper limit of normal for ALT was lowered to 27 IU, the difference was significant. Nevertheless, 60% of viremic patients still fell within the normal range. Conclusion : Although inexpensive and widely available, the monitoring of serum ALT levels is not useful as a screening method for HCV infection in HD patients.
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