Evaluation of pain during endovenous laser ablation of the great saphenous vein with ultrasound-guided femoral nerve block.

BACKGROUND: Endoluminal laser ablation is now considered the method of choice for treating greater saphenous vein insufficiency. General anesthesia and peripheral nerve blocks with sedation have the risk of post-procedural delay in discharge and prolonged immobilization with the risk of deep vein thrombosis. The main pain experienced by patients during the procedure is during the laser ablation and the multiple needle punctures given along and around the great saphenous vein. The aim of our study was to evaluate the safety and efficacy of blocking the femoral nerve only under ultrasound-guidance without sedation, to reduce or prevent pain during injectable tumescent anesthesia in endovenous laser ablation of the greater saphenous vein. METHODS: Sixty patients in two groups underwent endovenous laser ablation for the greater saphenous vein insufficiency at an outpatient clinic. All patients received tumescent anesthesia. However, one group received a femoral nerve block (FNB) under ultrasound guidance before the procedure. All patients were asked to record the pain or discomfort, using the visual analog score, from the start of the procedure until the end of the great saphenous vein laser ablation. The length of the great saphenous vein and duration of the procedure were also recorded. The results were analyzed using statistical methods. RESULTS: No complications from FNB were observed. The pain associated with application of tumescent anesthesia and laser ablation was more intense in the group without an FNB (P < 0.001). There was no significant difference between the two groups in the length of the great saphenous vein or procedure duration. CONCLUSION: Ultrasound-guided FNB (without other peripheral nerve blocks) is a safe, adequate, and effective option to decrease and/or eliminate the intraoperative discomfort associated with tumescent anesthesia injections and laser ablation during endoluminal laser ablation of the greater saphenous vein.

Isolated large vulvar varicose veins in a non-pregnant woman.

Vulvar varicosities are often asymptomatic, and they may be associated with varicose veins of the lower extremity. Also, they may be a part of pelvic congestion syndrome and usually occur during pregnancy. We present a case of a huge isolated and disfiguring vulvar varicosities in a non-pregnant women managed successfully by combination of surgery and sclerotherapy.

Leg ischemia post-varicocelectomy.

Varicocelectomy is the most commonly performed operation for the treatment of male infertility. Many surgical approaches are used as each of them has advantages over the other and is preferred by surgeons. Vascular injury has never been reported as a complication of varicocelectomy apart from testicular artery injury. We present a 36-year-old male who developed leg ischemia post-varicocelectomy due to common femoral artery injury. He was successfully treated by using a vein graft.

Barriers to feedback in undergraduate medical education. Male students' perspective in Central Saudi Arabia.

OBJECTIVE: To explore the views of undergraduate medical students regarding the presence and sources of barriers to effective feedback in their setting. METHODS: This cross-sectional study was conducted at the College of Medicine, Department of Medical Education, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia from April to June 2010. A self-administered questionnaire was used to explore the objectives of the study. RESULTS: One hundred and eighty-six male undergraduate medical students participated in this study. Approximately 45% indicated presence of barriers to effective feedback. These include: absence of a clear system of feedback; inadequate skills of teachers for provision-effective feedback; and to a lesser extent, students' fear of insult due to feedback. Most participants showed their interest and readiness to receive more professional feedback in the future. CONCLUSION: This study has showed the presence of barriers as perceived by medical students, which could significantly minimize utilization of feedback in medical education. The reported barriers should be addressed to utilize the vital role of feedback in the learning process of undergraduate medical students.

Giant celiac artery aneurysm: Treatment by transcatheter coil embolization.

Celiac artery aneurysms (CAA) are one of the rarest forms of visceral artery aneurysms. Most patients are a symptomatic at the time of diagnosis and aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 42-year-old man who had an asymptomatic giant CAA detected incidentally by an abdominal ultrasound investigating an abdominal pain. A contrast enhanced computed tomography angiogram (CTA) revealed a large CAA measuring 7.1 cm × 4.3 cm with extensive collaterals from the superior mesenteric artery (SMA). The aneurysm sac was mostly filled with thrombus with the celiac artery branches occluded. Pre-procedural angiography and transcatheter embolization procedures were performed at the same session. Endovascular exclusion was performed by transcatheter coil embolization and packing of the aneurysm sack. Technical success was achieved by the absence of flow in the aneurysm, and preservation of the native circulation on angiograms obtained just after the transcatheter coil embolization procedure. One week postembolization, a CTA confirmed thrombosis of the aneurysm. The patient returned for a follow-up CTA 3, 6, 12 and 48 months after embolization. The aneurysm was thrombosed and the patient remained a symptomatic. The surgical mode of treatment of CAA is increasingly being replaced by endovascular embolization because of the lower morbidity and mortality and high success rate. The accepted endovascular approach is by coil embolization of the aneurysmal lumen, the proximal and distal aneurysmal neck, or both.

Impact of a diabetic foot care education program on lower limb amputation rate.

BACKGROUND: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program's impact on the rate of lower extremity amputation due to diabetic foot complications. METHOD: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a "before" group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an "after group" having had foot ulcers managed between 2002 and 2004, in the program's initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis. RESULTS: The before group contained 20 patients (17 males) and the after group contained 21 patients (16 males). There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant. CONCLUSION: The program, although evaluated at an early stage, has increased the awareness of both patients and health care staff about the prevention and management of diabetic foot disease, and decreased the rate of lower extremity amputation. We believe that the statistical proof of its impact will be evident in the final evaluation.

The diabetic foot. In the Arab world.

The literature is replete with diabetic foot problems throughout the world, but few has been written about the problem in the Middle East and even in the Arab world. After reviewing these discussions, we realized that the magnitude of the problem is not yet appreciated for many reasons. In this paper, we explained why it is more prevalent, less managed and has been associated with worse health outcomes in diabetic patients in the Arab world. We believe that the leading problems are preventable, and this cancer can be controlled in a simple cost-effective way.