Surgical treatment of vasculo-Behcet's disease - A review of patients with concomitant multiple aneurysms and venous lesions

Background: Vascular complications can be seen inpatients with Behcet's disease. Arterial and venous complications may be found separately or concomitantly in patients.BACKGROUND:Vascular complications can be seen in patients with Behçet's disease. Arterial and venous complications may be found separately or concomitantly in patients.PATIENTS AND METHODS:Out of 29 patients with vasculo-Behçet's disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 +/- 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes.RESULTS:We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed in two patients who had anastomotic aneurysms and graft occlusion without disabling ischemia. Venous pathologies were treated by medical therapy. The patients were followed up between 1 to 8 years. One of the patients with iliac artery aneurysm died due to gastrointestinal bleeding 15 months after the operation.CONCLUSIONS:In conclusion, when an aneurysm has been found in a patient with Behçet's disease, the patient should be scanned for possible multiple aneurysms and venous lesions since they might be found together. Surgical treatment, when feasible, should be performed in cases with Behçet aneurysms because of a high risk of rupture. However, the possibility of an anastomotic aneurysm developing after surgery should also be kept in mind

Videothoracoscopy versus intrapleural streptokinase for management of post traumatic retained haemothorax: a retrospective study of 65 cases

Background: Post traumatic retained haemothorax (PRH) may cause pulmonary restrictions or septic pleural complications. Currently, minimally invasive procedures such as videothoracoscopy or intrapleural fibrinotysis have replaced open surgery in an effort to avoid these complications.BACKGROUND:Post traumatic retained haemothorax (PRH) may cause pulmonary restrictions or septic pleural complications. Currently, minimally invasive procedures such as videothoracoscopy or intrapleural fibrinolysis have replaced open surgery in an effort to avoid these complications.OBJECTIVE:We have reviewed retrospectively our use of videothoracoscopy versus intrapleural streptokinase for the management of PRH over the last 10 years.PATIENTS AND METHOD:There were 56 males and nine females in the study. Thirty-one cases had been managed by intrapleural streptokinase (group I), and videothoracoscopy was performed on 34 cases (group II). Therapeutic results for both groups were determined by chest radiographs.RESULTS:In the population from which we drew our study group, retained haemothoraces occurred in 10.9% of 596 cases with traumatic haemothorax. In group I, 22 patients had radiological improvement; the others underwent thoracotomy. In this group, mean hospitalisation time was 14.5(+/-4.2) days, and three cases were complicated by empyema. In group II, all patients except four had complete radiological improvement; two of them required a decortication. In this group, mean hospital stay was 9.8(+/-3.7) days. There were no deaths in either group. The differences between group I and group II for length of hospital stay and number of thoracotomies was statistically significant.CONCLUSION:Videothoracoscopy is therefore a more effective procedure than intrapleural streptokinase for the management of PRH

Benefits of early aggressive management of empyema thoracis

Bckground: The end-target of the management of thoracic empyema is to obtain early rehabilitation by re-expansion of the trapped lung resulting from intrapleural infected material. Our aim was to shorten the hospitalization time and to prevent a possible thoracotomy by using video-assisted thoracoscopy initially.BACKGROUND:The end-target of the management of thoracic empyema is to obtain early rehabilitation by re-expansion of the trapped lung resulting from intrapleural infected material. Our aim was to shorten the hospitalization time and to prevent a possible thoracotomy by using video-assisted thoracoscopy initially.METHODS:Seventy patients with parapneumonic empyema were prospectively studied between January 1997 and June 2004. The patients were randomly divided into two groups. In group I (n = 35 patients), a chest tube was inserted into the patients after pleural content was evacuated and fibrins were debrided using video-assisted thoracoscopy. In group II (n = 35 patients), tube thoracostomy was carried out without using a video-assisted thoracoscope. Both groups were compared in terms of hospitalization time, open surgery for decortication and complications.RESULTS:There was no statistically significant difference between the groups from the point of view of age and sex (P > 0.05). In group I, 17.1% of the patients underwent open decortication, whereas in group II, 37.1% of the patients underwent the same procedure (P < 0.05). Whereas average hospital stay in group I was 8.3 days (range, 7-11 days), it was 12.8 days in group II (range, 10-18 days; P < 0.05). There was one bronchopleural fistula in group I, and there was one bronchopleural fistula and one death in group II.CONCLUSION:Video-assisted thoracoscopic evacuation and chest tube insertion in situ is a new therapeutic approach for pleural empyema that shortens hospital stay and reduces the necessity of open decortication

Extrapleural regional versus systemic analgesia for relieving postthoracotomy pain: A clinical study of bupivacaine compared with metamizol

Background: The effects of a local anesthetic delivered through a catheter inserted in the extrapleural region by a surgeon and an analgesic agent given systemically on pain after thoracotomy were assessed.BACKGROUND:The effects of a local anesthetic delivered through a catheter inserted in the extrapleural region by a surgeon and an analgesic agent given systemically on pain after thoracotomy were assessed.METHODS:The patients in group I (n = 25) had a catheter inserted between the parietal pleura and the endothoracic fascia by a surgeon, and 0.5% bupivacaine was given through this catheter. Another 25 patients (group II) had metamizol given intravenously. Respiratory function tests, arterial blood gases, range of shoulder motion, and postoperative pain were evaluated for each group. Bupivacaine and metamizol were given just before finishing the thoracotomy and then repeated every 4 hours for 3 days.RESULTS:There was no statistical difference in arterial blood gases between the groups (P >.05). There were statistically significant differences in the respiratory function tests, range of shoulder motion, and visual analogue scale (P <.05) between the groups. Group I had fewer complications than group II. There was no mortality in either group.CONCLUSIONS:Bupivacaine given through a catheter to the extrapleural region before finishing thoracotomy is substantially beneficial for the prevention of postoperative pain and reduction of postoperative complications

Is capitonnage unnecessary in the surgery of intact pulmonary hydatic cyst?

Background: Hydatid disease, a parasitosis, is still an important health problem in Turkey. Surgery is the choice of treatment for pulmonary hydatid cyst. In this study, cystotomy and capitonnage were compared to cystotomy.BACKGROUND:Hydatid disease, a parasitosis, is still an important health problem in Turkey. Surgery is the choice of treatment for pulmonary hydatid cyst. In this study, cystotomy and capitonnage were compared to cystotomy.METHODS:Fifty-nine patients with 70 pulmonary intact hydatid cysts were surgically treated between 1993 and 1999. There were 11 females and 48 males (range 4-58 years). Cystotomy and closure of bronchial openings were performed in all patients. The patients were divided into two groups. In Group A (n = 32 patients, n = 38 cysts), the cavity was closed (capitonnage), and in Group B (n = 27 patients, n = 32 cysts) capitonnage was not performed. The patients treated by other surgical methods (pericystectomy, lobectomy, and others) were not included in this study.RESULTS:Prolonged air leak (> 5 days) was found in one patient in Group A, and in four patients in Group B. Atelectasis developed in one patient in Group A, and in three patients in Group B. Additionally, in Group B pseudocystic appearance occurred in two patients and empyema in one patient. The duration of hospitalization was 9.8 +/- 2.1 days for Group A, and 12.4 +/- 3.2 days for Group B. There was a significant difference between the groups for hospital time (p < 0.01). There was no mortality in either group.CONCLUSION:This study shows that capitonnage is a procedure that should not be easily abandoned, despite the current contrary opinions, because of its low complication rate

The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters

Background. Different alternative approaches to thoracotomy have been developed because of the considerable morbidity associated with the standard posterolateral incision.BACKGROUND:Different alternative approaches to thoracotomy have been developed because of the considerable morbidity associated with the standard posterolateral incision.METHODS:We studied a prospective, randomized, blinded study of 60 consecutive patients to compare surgical approach time, postoperative pain (quantitated by narcotic requirements and the visual analogue scale), pulmonary function, shoulder strength, and range of motion between standard posterolateral (group I) and muscle-sparing (group II) thoracotomy techniques.RESULTS:There were no differences in postoperative surgical time, pulmonary function, shoulder range of motion, mortality, or hospitalization time. There was significantly less postoperative pain in group II. In this group, narcotic requirement was less in the first 24 hours, and visual analogue scale scores were significantly lower (p < 0.05) throughout the first postoperative week. Muscle strength had returned to preoperative levels by 1 month in both groups. Morbidity was identical in the two groups with the exception of postoperative seromas. The prevalence of seroma was 16.6% in the muscle-sparing group.CONCLUSIONS:We conclude that the muscle-sparing incision may be a sensible alternative to a standard posterolateral thoracotomy

Endovascular treatment of lower limb penetrating arterial traumas

Purpose: The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.PURPOSE:The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.MATERIALS AND METHODS:Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients.RESULTS:On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient.CONCLUSIONS:We conclude that embolization-particularly n-butyl cyanoacrylate embolization-is technically feasible in patients with penetrating peripheral arterial trauma

Modified pudendal thigh flap for perineoscrotal reconstruction: A case of Leriche syndrome with rapidly progressing Fournier's gangrene

We present the first report of Leriche syndrome associated with Fournier's gangrene. We used a modified pudendal thigh flap in the treatment of an extensive perineoscrotal soft-tissue defect successfully. We propose this new robust flap as an addition to the existing reconstructive armamentarium and draw attention to the coexistence of Leriche syndrome and Fournier's gangrene. (C) 2004 Elsevier Inc.We present the first report of Leriche syndrome associated with Fournier's gangrene. We used a modified pudendal thigh flap in the treatment of an extensive perineoscrotal soft-tissue defect successfully. We propose this new robust flap as an addition to the existing reconstructive armamentarium and draw attention to the coexistence of Leriche syndrome and Fournier's gangrene

Pericardioperitoneal Fenestration for Chylopericardium

Two patients were given a pericardial-peritoneal window (PPW) using a subxiphoid approach for chylous pericardial effusion. Complete drainage without recurrence was achieved with PPW in a 22-year-old female patient who had recurrent chylopericardium associated with Klippel-Trenaunay syndrome and in an 11-year-old girl with tricuspid atresia who had undergone the Fontan procedure. PPW is a simple, easy-to-learn, safe, and effective procedure. It creates a communication between the pericardial and peritoneal cavities and is applicable in most patients with noninfectious benign pericardial effusion without serious complications and where adequate drainage can be obtained without the need for external draining systems. We describe the technique, its clinical characteristics, and the results of patients undergoing this treatment