Surgical correction of main stem reflux in the superficial venous system: does it improve the blood flow of incompetent perforating veins?

Fifty-seven limbs (33 patients) with chronic venous ulceration were selected for this study. The criterion for selection was the presence of isolated superficial venous reflux. Long saphenous vein reflux alone was observed in 39 (68.4%) limbs, short saphenous vein reflux alone in 4 (7.0%) limbs, and both long and short saphenous vein reflux in 14 (24.6%) limbs. Surgical correction of the refluxing saphenous system has allowed 46 (80.7%) ulcers to heal. The healing rates for all the ulcerated legs that had long saphenous vein reflux, short saphenous vein reflux, or a combination of the two were 85.4%, 75.0%, and 66.7%, respectively. Incompetent perforating veins (IPVs) were observed in 51 (89.5%) limbs; 74.5% of them regained their competence postoperatively (189 preoperatively vs. 59 postoperatively; p < 0.001), with a significant reduction in their mean diameter (p < 0.001). IPVs remained in 13 (25.5%) limbs: 3 limbs with persistent reflux in the tributaries of the saphenous system, 1 limb with a fixed ankle joint, and nine limbs with no evidence of macrovascular venous disease. In patients with a competent deep venous system, reflux in perforating veins is often abolished after eradication of saphenous reflux.

Accuracy of the "triple test" in the diagnosis of palpable breast masses in Saudi females.

BACKGROUND: For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. MATERIAL AND METHODS: During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. RESULTS: Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). CONCLUSION: The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

The role of laparoscopic cholecystectomy in the management of acute cholecystitis in patients with sickle cell disease.

BACKGROUND: As emergency surgery in sickle cell disease patients is associated with high morbidity, the aim of the study was to assess the safety of laparoscopic cholecystectomy in the acute state for these patients. METHODS: Over a 5-year period, April 1994 till December 1998, 35 sickle cell patients with acute cholecystitis had laparoscopic cholecystectomy within the first 5 days of presentation. A retrospective study of these was undertaken. RESULTS: Thirty-five patients were diagnosed as having acute cholecystitis with sickle cell disease. There were 26 female and 9 male patients; 5 patients needed preoperative and 1 patient needed postoperative endoscopic retrograde cholangiopancreatography. Twenty-seven patients needed simple transfusion and 8 needed partial exchange; conversion was necessary in two cases (5.7%). The mean hospital stay was 5.3 days and the complication rate was 17.5%. CONCLUSIONS: Because of the lack of significant complications, we believe that laparoscopic cholecystectomy for acute cholecystitis is safe and recommended in experienced hands with adequate preoperative preparation for patients with sickle cell disease.