Surgical treatment of peripheral aneurysms in patients with Behcet's disease.

INTRODUCTION: Our aim was to report our experience with 23 patients presenting with 32 peripheral aneurysms secondary to Behcet's disease (BD) and their outcome after vascular surgery. METHODS: The study was retrospective in nature. Except for those presenting with aneurysm rupture, patients underwent surgery after treatment of acute inflammatory lesions. All aneurysms appeared to be pseudo-aneurysms. Graft interposition with polytetrafluoroethylene or saphenous vein was most commonly employed. Postoperatively, all patients were put on immunosuppressive and antiplatelet therapy. Follow-up was done every 6-12 months, complications recorded and managed appropriately. RESULTS: All the patients were males. The mean age at diagnosis of a peripheral aneurysm was 41.0 ± 9 years. There were 17 (53%) femoral, 8 (25%) popliteal, two carotid, two external iliac, two brachial and one internal iliac aneurysms. Fourteen (61%) patients had a single peripheral aneurysm while nine had two. Surgery was performed for all initially presenting 23 aneurysms. Six patients with multiple peripheral aneurysms had surgery for their second asymptomatic aneurysm. The mean follow-up period was 84 ± 62 months. Of 29 aneurysms operated on, 7 (24%) anastomotic pseudo-aneurysms and 11 (38%) graft occlusions developed. Five (22%) patients underwent major lower extremity amputations. Six (26%) mortalities were recorded. CONCLUSION: Surgery for peripheral aneurysms in BD is warranted in many instances. Results of operation can be improved by prolonged monitoring. However, despite all efforts, peripheral aneurysm involvement in BD worsens the prognosis.

Accessibility of calf perforating veins from the superficial posterior compartment: an anatomic dissection study.

OBJECTIVES: to determine the anatomic location of medial perforating veins (PVs) and their course within the compartments of the leg. MATERIALS AND METHODS: the lower extremity veins of 15 cadavers were filled with coloured latex solution. Medial PVs between the ankle and the knee were dissected out. RESULTS: in total 95 direct PVs (mean 6.3 per extremity, range 3-9) were identified and classifed as Cockett I, II, or III, proximal and distal paratibial and Boyd. Cockett PVs were present in more than half of the cases, of which the majority (except Cockett I) were located in the superficial posterior compartment. Whereas the vast majority of Cockett PVs originate from the posterior arch vein, the other perforators originate from the greater saphenous vein. CONCLUSIONS: only 62% of all PVs pass through the superficial posterior compartment. As a result, during subfascial endoscopic perforating vein surgery (SEPS), at least one third of patients require a paratibial fasciotomy in order to reach and ligate the PVs.

Laparoscopic hepatic wedge resection of hemangioma: report of two cases.

INTRODUCTION: Cavernous hemangiomas are the most frequent type of benign liver tumor. A large proportion are discovered unexpectedly. The widespread use of ultrasound (US) and computerized tomography (CT) scanning has made diagnosis more common. Laparoscopic liver surgery has, however, developed more slowly. There have been only a few anecdotal reports of hepatic laparoscopic resections, most of which are limited to wedge resections. Laparoscopic anatomical liver resections are still at an early stage of development. DISCUSSION: This paper describes two cases of hepatic cavernous hemangiomas, both of which were removed laparoscopically. No blood transfusion was necessary. No surgical complications occurred and the patients were discharged on the second postoperative day. We conclude that, depending on the size and location of the tumor, laparoscopic resection of liver hemangiomas can be performed safely.

Fascioliasis observed during laparoscopic cholecystectomy.

Fascioliasis is an uncommon zoonotic disease caused by Fasciola hepatica, a liver fluke, for which humans act as an accidental host, infected by the ingestion of water or raw aquatic vegetables contaminated with the metacercaria. We report the case of a patient who presented to our clinic with right upper abdominal pain and nausea. Physical examination and abdominal ultrasonography revealed cholelithiasis. Peripheral blood eosinophilia was the only positive sign observed during routine laboratory tests. We therefore decided to perform laparoscopic cholecystectomy. During laparoscopy peritoneal implants approximately 0.5-1 cm diameter were detected which gave an impression of peritoneal carcinomatosa. Laparoscopic cholecystectomy was performed, and biopsies were taken from the peritoneal implants which were examined histopathologically, and fascioliasis was determined.

Surgical treatment of advanced alveolar hydatid disease of the liver: a report of five cases.

We report herein the cases of five patients with alveolar hydatid disease (AHD) of the liver who were diagnosed and underwent surgery at the Department of Surgery of Ankara University between 1989 and 1994. In all five patients, the final diagnosis was established by frozen section of the lesion during laparotomy. Lesions of AHD were found only in the liver. Hepatic resections including right lobectomy and segmentectomy were performed in three patients while palliative procedures were carried out in the remaining two patients with unresectable disease. There was no operative mortality, and only one late death occurred 3 years after the hepatic resection. In this paper, we present the clinical and operative findings of these five patients and their outcomes, followed by a review of the surgical treatment of AHD.

Simultaneous manifestation of an aortocaval and aortoduodenal fistula.

An unusual case of traumatic aortocaval and aortoduodenal fistula is presented in which the two conditions occurred simultaneously. A 19-year-old man was admitted with acute upper gastrointestinal bleeding and a pulsatile abdominal mass. An aortography revelead an aortocaval fistula and at the operation an aortocaval and aortoduodenal fistula was found. An aortocaval fistula can be discovered when a patient presents with an abdominal bruit or cardiomegaly with or without heart failure. The diagnosis of an aortoenteric fistula is difficult because of the subtleties in manifestation. The presence of an abdominal pulsatile mass and acute gastrointestinal bleeding should indicate that an aortoenteric fistula is possible.