Embolectomy For Acute Lower Limb Ischemia

In this prospective descriptive study, all patients with acute lower limb ischemia who presented to Shohada Tajrish Hospital (STH) between July 2001 and July 2003 were analyzed and followed for 6 months. The total population of 109 patients, with no significant difference in sexual distribution had a mean age of 64±16 years. 23% had AF and 31% had a history of MI, but in the ECG of 30%, no pathologic finding had been detected. Pain and coolness were the two most prevalent symptoms. Only one-third of the patients had normal sensory and motor examination in their limb and the rest had different degrees of impairment. More than 70% of the patients arrived here after 12 hours from the onset of the symptoms. Fasciotomy was done in 29%, and amputation in 23.5%. The mortality rate was 12.2%. Surgical site infection occurred in 11% and 14.1% underwent re-embolectomy. There was no pseudoaneurysms. The time interval from the onset, sensory and motor findings, and calf tenderness a! ffected the prognosis. Prognosis was better in smokers. The iatrogenic group which consisted of 13.7% of our patient population had the best prognosis (no mortality or morbidity). 4% of the patients who had first undergone embolectomy in other centers, all lost their limbs. In cases of late embolectomies, venotomy and heparin flush has lowered the amputation level without increasing mortality. Early referral by a cardiologist, receiving heparin rapidly and smoking are among the factors which improve prognosis

Evidence-Based Assignment of Diagnostic Peritoneal Lavage (DPL) Sensitivity in Penetrating Abdominal Trauma

Background:There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence. Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned. Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy; 2 had a positive DPL and negative laparotomy; 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy. Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate

Cosmetic Surgical Repair of Contaminated Wounds Versus Traditional Loose Approximation: Does It Increase the Rate of Wound Infections?

Background:The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction.On the other hand,there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth. Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis,we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.Results:There was no significant difference in the rate of wound infection between these two groups.Conclusions:This study shows that perfect closure of the wound with subcuticular closure,which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection

Effectiveness of Intravenous Ilomedin Infusion and Smoking Cessation in the Treatment of Acutely Symptomatic Buerger Disease

We assessed the effectiveness of iloprost treatment in the management of symptomatic Buerger disease (BD) and assessed smoking cessation compliance, based on a single-center experience. Thirteen patients with BD were treated with sessions of intravenous (IV) Ilomedin infusion. At 1-year follow-up, pain status alteration, number of analgesics required, ankle-brachial index (ABI) change, compliance with supervised smoking cessation, and amputation-free rate were recorded. The pain status improved considerably according to a visual analog scale, the number of analgesics required was significantly reduced, and all patients improved their pain-free walking distance, the ABI, and their self-reported quality of life. Only 2 patients required minor amputations. Combination of IV Ilomedin infusion, supervised smoking cessation, and a specific follow-up protocol may lead to improvement in pain-free walking distance, pain status, quality of life, and substantial reduction in amputation risk