Int Surg
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Spinal cord stimulation (SCS) improves microcirculatory blood flow, relieves ischemic pain and reduces amputation rate in patients with severe peripheral arterial occlusive disease. ⋯ In patients with failed conservative and surgical treatment for severe critical lower limb ischemia, the SCS increases the skin blood flow, is associated with a significant pain relief and could prove an excellent alternative therapy that improves the quality of life. We also demonstrate that TcPO2 increase within a test period of 2 weeks, is a predictive index of SCS therapy success and should be considered in terms of cost effect before the final decision for permanent implantation.
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The Johannesburg hospitals see large numbers of gunshot wounds and there is, therefore, considerable experience in their management. Historically, management has been dictated by experimental theories of wounding mechanisms. More modern work has indicated that some of these theories have been somewhat misleading, and some traditional means of management have changed. ⋯ It is the wound as encountered which is managed, irrespective or the theoretical velocity of the bullet. The Johannesburg practice is outlined with regard to regions of the body, with discussion of, among others, the conservative management of gunshot wounds of the abdomen, primary repair of the colon, non operative management of certain limb wounds. The practice is summarised, based on considerable experience and the logistic implications of large numbers and may be useful to surgeons less experienced in gunshot wound management.
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Despite indomethacin therapy, many premature infants require surgical closure of their patent ductus arteriosus (PDA). Between January 1985 and December 1997, 176 premature infants underwent surgical closure of PDA by vascular clip after failure of medical treatment. The median gestational age and birth weight were 26 weeks (range 23-36 weeks) and 847.5 g (range 400-2300 g), respectively. ⋯ Three infants (1.7%) developed vocal cord paralysis directly related to the position of the vascular clip. Echocardiography confirmed PDA closure in 43 infants (24.4%) while the remaining 133 had no clinical signs of PDA. Surgical closure of PDA by vascular clip carries a very low morbidity in premature infants.
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Postoperative iliac and popliteal arteriovenous fistulas are extremely rare. This article describes the percutaneous endovascular treatment of iatrogenically induced arteriovenous fistula in two patients with simultaneous use of intravascular ultrasound. In a 61-year-old woman, a fistula between popliteal artery and vein, inadvertently created during implantation of a prosthetic knee joint, was treated with a novel polytetrafluorethylene (PTFE) stent graft. ⋯ Congestive heart failure induced by the arteriovenous communication was reduced rapidly. Our results indicate that percutaneous treatment in conjunction with intravascular ultrasound is a useful therapeutic option for vascular lesions. It is less invasive than open vascular reconstruction and has a comparably high success rate.
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We studied patients who underwent a coronary artery bypass grafting (CABG) procedure with previous percutaneous transluminal coronary angioplasty (PTCA). Forty patients had undergone successful PTCA, and required subsequent CABG, between January 1993 and June 1996 (Group I). These patients were matched with 40 patients surgically revascularized without previous PTCA at the same term (Group II). ⋯ Survival rates for three years were 92.5% and 95% in Group I and in Group II, respectively. In conclusion, the method of initial revascularization procedure should be considered carefully, as markers of more severe disease may indicate primary CABG and avoidance of an initial PTCA. The initial PTCA may complicate the operation and may increase postoperative morbidity and mortality.