Vascular surgical complications of the acquired immunodeficiency syndrome

AbstractThe past twenty years has seen an explosive rise in the number of individuals infected with the Human Immunodeficiency Virus (HIV). In sub-Saharan Africa, the Acquired Immunodeficiency Syndrome (AIDS) is the leading cause of death among young adults with little sign of abating. Immunosuppression and opportunistic infections associated with HIV infection have been responsible for various unusual and unique surgical syndromes that have only recently been described. This review examines the vascular surgical complications of the disease with particular regard to HIV-associated vasculitides, aneurysms and occlusive disease and the implications for management

The influence of diabetes mellitus on early outcome following carotid endarterectomy

BACKGROUND. There are few studies that look at the influence of diabetes mellitus on early outcome following carotid endarterectomy (CEA). Those available have reported conflicting results, with some showing poor outcome and others similar outcome to those without diabetes mellitus. OBJECTIVE. To assess the influence of diabetes mellitus on early outcome following CEA. METHODS. Clinical data on patients who had CEA over a 5-year period were acquired from a prospectively maintained computerised database. They were divided into two groups, namely diabetics and non-diabetics. RESULTS. Two hundred and sixty-four charts were analysed. There were no significant differences in patient demographics and risk factors for atherosclerosis between the two groups. The majority (71%) of patients had CEA for symptomatic carotid disease. Carotid shunting was performed selectively, and significantly more diabetic patients had CEA under the protection of a carotid shunt (p=0.0469). Postoperative strokes, transient ischaemic attacks and deaths were not significantly different between the two groups. CONCLUSIONS. Diabetes mellitus had no influence on the early surgical outcome following carotid endarterectomy.http://www.sajs.org.za/index.php/sajsam201

Prevention of wound sepsis in amputations by peri-operative antibiotic cover with an amoxycillin-clavulanic acid combination

In a series of 44 patients with lower limb ischaemia requiring amputation for major limb sepsis, the performance of a new antibiotic combination with Blactamase- inhibiting properties, amoxycillin plus . clavulanic acid (A-CA) (Augmentin; Beecham), was compared with that of penicillin in the prevention of wound infection. The sepsis rate of ·12,9% in the group of patients receiving peri-operative A-CA was significantly lower than the 76,9% in the penicillin control group (x2 = 14,48; P<O,OO1).lt is concluded that there is a need for peri-operative antibiotic cover in this situation and that A-CA appears to be highly effective. No statistical difference was found as regards development of sepsis in wounds closed primarily or left open while under A-CA cover

The influence of diabetes mellitus on early outcome following carotid endarterectomy

BACKGROUND. There are few studies that look at the influence of diabetes mellitus on early outcome following carotid endarterectomy (CEA). Those available have reported conflicting results, with some showing poor outcome and others similar outcome to those without diabetes mellitus. OBJECTIVE. To assess the influence of diabetes mellitus on early outcome following CEA. METHODS. Clinical data on patients who had CEA over a 5-year period were acquired from a prospectively maintained computerised database. They were divided into two groups, namely diabetics and non-diabetics. RESULTS. Two hundred and sixty-four charts were analysed. There were no significant differences in patient demographics and risk factors for atherosclerosis between the two groups. The majority (71%) of patients had CEA for symptomatic carotid disease. Carotid shunting was performed selectively, and significantly more diabetic patients had CEA under the protection of a carotid shunt (p=0.0469). Postoperative strokes, transient ischaemic attacks and deaths were not significantly different between the two groups. CONCLUSIONS. Diabetes mellitus had no influence on the early surgical outcome following carotid endarterectomy.http://www.sajs.org.za/index.php/sajsam201