Role of arteriovenous shunting in venous ulcers--therapeutic implications

Although the presence of arteriovenous communications in patients with chronic venous ulcers has been confirmed in several studies, their role in the pathogenesis of venous ulcers is still uncertain. They possibly do play an important role in the aetiology of chronic venous insufficiency. There is also substantial evidence to suggest that arteriovenous communications develop as a result of chronic venous hypertension. The question raised in this pilot study was whether the importance of arteriovenous shunts in the genesis of venous ulcer disease is such that their obliteration might lead to long-term healing. This clinical study was also designed to determine whether therapeutic microembolization of nutritive arterial branches to arteriovenous fistulas, found in patients with venous ulcers, facilitates healing of venous ulcers resistant to previous conservative and/or classical surgical treatment. From 1997 to 1999, 34 patients (22 women and 14 men, mean age 51.3 years) with chronic venous ulcer resistant to classical treatment were included in the study. Arteriovenous shunting was demonstrated by digital subtraction angiography in 31 patients (31/34 = 91%). The embolization procedure of muscular arterial branches feeding the arteriovenous shunts with microspirals and microparticles led to ulcer healing in 13 patients (13/31). The results suggest that the role of arteriovenous shunting in chronic venous ulceration resistant to classical treatment is more important than previously suggested, and that their microembolization might lead to complete healing.     

Laparoscopic splenectomy--indications,specifics of surgical procedures and surgical technics

The surgical management of splenic disorders has changed considerably over past few years. The increased use of laparoscopic approach for general surgical problems has prompted surgeons to investigate feasibility of laparoscopic splenectomy. However, some unique anatomical features of disordered spleen may limit the application of laparoscopic techniques for this procedure. In this article we analyzed indications for laparoscopic a surgery of the spleen, some surgical particularities of laparoscopic splenectomy, as well as the techniques to accomplish this procedure.     

Splenic injuries and mortality in polytrauma

Severe trauma is the leading cause of death in the working population. Traffic accidents are the most frequent etiological factor, with substantially more male than female victims. In this paper we have analyzed 53 cases of dead patients, among 240 severe traumatized treated in Center of emergency surgery, Emergency Center, CCS from January, 2000-June 2002. Spleen is the most frequent injured abdominal organ. In 34% surviving period was less than 72 hours. One-third of patients required at least two surgeries, including laparotomy. The most preciously diagnosis were performed in the cases of spleen injuries. The most common cause of death was cariopulmonal insufficiency, according both clinical diagnosis and forensic findings.     

Use of fibrin glue in the prevention of leakage in pancreatico-jejunal anastomoses

The aim of this study was to test the protective effects of fibrin sealing on the pancreatico-jejunostomy (PJA), the high-risk anastomosis following pancreas head resection. Experimental study was performed on the mongrel dogs, divided in two groups (20 animals each): Experimental group-with end to end "dunking" PJA, protected by temporary occlusion of the pancreatic duct with fibrin sealant/Tissucol/Immuno Ag/, while control group was without any protective procedure. The animals were followed 5 months in order to study: protective effects of such procedure on the PJA quantified with the percent of anastomotic leakage, effects of the exocrine secretion and effects the endocrine function Results: PJA leakage occurred in 13.33% in control group. No leakage was registered in experimental group. Biochemical, histological and electron microscopic study showed slight transitory elevation of amylase levels. Fibrin glue plug was dissolved and pancreatic juice output was reestablished 12th days postoperatively. Long term follow-up showed no damages of the endocrine and exocrine pancreas. Pancreatic duct occlusion with fibrin glue appeared to be an useful method in the prevention of pancreatico-jejunostomy leakage, without negative effects on the exocrine and endocrine pancreas.     

Myeloma kidney: pathogenesis and treatment

Renal failure frequently complicates the course of multiple myeloma. Factors that determine the development of myeloma kidney include a high rate of light chain excretion, biochemical characteristics of light chain, and concurrent volume depletion. There are two main pathogenetic mechanisms; i.e. direct tubular toxicity and intratubular cast formation. Therapeutic measures include chemotherapy, bone marrow or peripheral blood stem cell transplantation, hyperhydration, plasmapheresis, dialysis, solving of hypercalcemia, treatment of anemia with erythropoietin, and avoidance of nephrotoxic drugs and radiocontrast agents. Experimental approach includes administration of colchicines and alkalinization of the urine.     

Hypokalemic metabolic alkalosis--three case reports

The two most common forms of inherited normotensive hypokalemic metabolic alkalosis are Bartter's and Gitelman's syndromes. Bartter's syndrome typically present with normal or increased calcium excretion. Hypomagnesemia occurs in only one third of affected individuals. In contrast, hypomagnesemia and hypocalciuria are considered hallmarks of Gitelman's syndrome. In most patients, the symptom of muscle weakness and polyuria occur early in life, which may be attributed to potassium depletion. Despite hyperaldosteronism, the patients tend to be normotensive, which is at least explained by vascular hyperresponsiveness to prostaglandins. Therapeutic approaches to Bartter's and Gitelman's syndromes include potassium supplementation, prostaglandin synthesis inhibitors (nonsteroid anti-inflammatory agents), aldosterone antagonists and converting enzyme inhibitors. Three patients with hypokalemia, normal blood pressure, metabolic alkalosis, hyperreninemia and hyperaldosteronism are described. Two patients had Bartter's syndrome and one patients had Gitelman's syndrome.