Amir Peer

Selection of patients with severe pelvic fracture for early angiography remains controversial

BackgroundPatients with severe pelvic fractures represent about 3% of all skeletal fractures. Hemodynamic compromise in unstable pelvic fractures is associated with arterial hemorrhage in less than 20% of patients. Angiography is an important tool in the management of severe pelvic injury, but indications and timing for its performance remain controversial.MethodsPatients with major pelvic fractures [Pelvic Abbreviated Injury Score (AIS) ≥ 3] admitted to two high volume Trauma Centers from January 2000 to June 2005 were identified and divided into two groups: Group I patients did not undergo angiography, Group II patients underwent angiography with/without embolization. Demographics, hemodynamic status on admission, concomitant injuries, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), pelvic AIS, blood requirement before and after angiography, arterial blood gases and mortality were evaluated. Patients with an additional reason for hemodynamic instability were excluded.ResultsCharts of 106 patients were retrospectively reviewed. Twenty nine patients (27.4%) underwent angiography. Bleeding vessel embolization was performed in 20 (18.9%) patients. Patients who underwent angiography had a significantly higher pelvic AIS and a lower Base Excess level on admission. A blood transfusion rate of greater than 0.5 unit/hour was found to be a reliable indicator for early angiography.ConclusionA high pelvic AIS, amount of blood transfusions and decreased BE level should be considered as an indicators for early angiography in patients with severe pelvic injury.

Buerger's disease presenting as acute small bowel ischemia.

The case of a young man with an unusual presentation of thromboangiitis obliterans with ischemia of the small bowel, 2 years before peripheral vascular disease of the extremities was clinically expressed, is reported.

Hypothenar hammer syndrome: apropos of six cases and review of the literature.

Hypothenar hammer syndrome (HHS) is a rather rare condition and is a term used to describe an aneurysm or thrombosis of the ulnar artery. It is considered an occupational or recreational injury and is usually a result of a repetitive trauma to the hypothenar region where the unique anatomy of the Guyon canal allows arterial injury. HHS is one of the less common causes of symptomatic ischemia of the upper extremity. The aim of this article is to describe our experience with six patients. Presenting signs, symptoms, differential diagnoses, and literature review of this probably underdiagnosed syndrome are described. There are two pathologic entities: the aneurysmal type and the thrombotic type. Although most authors recommend watchful observation for the thrombotic type, reconstructive surgery is the treatment of choice for the aneurysmal type.

Balloon catheter dilatation of focal colonic strictures following necrotizing enterocolitis

Two infants with severe colonic strictures secondary to necrotizing enterocolitis (NEC) were successfully dilated with balloon catheters. The procedures were performed under mild sedation, with fluoroscopic guidance. Results were sustained for more than 4 years follow-up. This procedure proved to be a safe and effective alternative to operative repair.

Effect of Timing of Thrombectomy on Survival of Thrombosed Arteriovenous Hemodialysis Grafts

Background: The use of an arteriovenous (AV) graft for hemodialysis is associated with a relatively high rate of thrombosis. Unfortunately, the urgent thrombectomy is not always readily available. Our aim was to investigate a possible association between the timing of thrombectomy and the patency rates of AV grafts. Methods: A retrospective single-center study on patients who underwent thrombectomy of clotted AV grafts was conducted. According to the time of thrombectomy, all patients were divided into 4 groups. Results: Primary graft patency at 6 months after thrombectomy was 28.3%, with no significant difference between the study groups (P = .161). Secondary graft patency at 6 months was significantly worse in the group that underwent thrombectomy between the third and fifth days than in the whole cohort: 15.4% versus 45.6% (P = .038). Conclusions: Timing of thrombectomy of a clotted AV graft may have a significant impact on the graft survival.

Solitary eosinophilic granuloma of sternum: case report with review of the literature

A solitary lesion in the distal sternum in a 30-year-old woman caused by eosinophilic granuloma (EG) is reported. Bone scan with 99Tcm was negative. Laboratory tests were completely normal. Although EG bone lesions have been discussed extensively in the literature only one similar case of solitary EG of the sternum has been published to date. A comprehensive summary of the literature is presented.

Long-term follow-up of patients after carotid stenting with or without distal protective device in a single tertiary medical center.

Objective: To evaluate the immediate and long-term clinical outcomes after carotid artery stenting (CAS) with and without protection devices (PDs), compared with carotid endarterectomy (CEA). Methods: A total of 116 patients with symptomatic carotid stenosis underwent CAS; 56 patients (48.3%) underwent CAS-PD; and 137 patients underwent CEA. Results: There were more ipsilateral transient ischemic attacks (TIAs) in the CEA group than in CAS-PD and CAS + PD (4 [3%] vs 1 [1.6%] and 0 respectively, P = 0.02). In the CAS-PD group there were more vertebrobasilar TIAs, ipsi- and contralateral strokes, myocardial infarctions, and death rates in the 30-day postprocedural period. After 8-year follow-up, there were 18 (30%) death cases in the CAS-PD group, 10 death cases (17%) in the CAS + PD patients, and 15 death cases (11%) in the CEA group of patients (P = .02). Conclusion: Our data show that CAS + PD was associated with lower rate of vascular complications and mortality compared with CAS-PD and CEA.

Lumbar Disk Replacement With the ProDisc Prosthesis

Twenty-two ProDisc II prostheses (Spine Solutions, New York, New York) were implanted in 21 patients with degenerative disk disease at L5-S1 (19 disks) and L4-L5 (3 disks). After mean follow-up of 3.1 years (range, 17-49 months), pain intensity in all but 3 patients had improved from an average of 7.7 preoperatively to 4.6 postoperatively (P< .001) on a visual analog scale. Average Oswestry Disability Index score improved from 61 to 35 (P< .001). Radiographic reconstruction of the disk space height was achieved in all cases. Previous diskectomy at the implanted level and disk degeneration adjacent to previous fusion negatively influenced the results.

Percutaneous catheter drainage of multiple pyogenic liver abscesses: a case report

Percutaneous drainage has become an accepted alternative to surgery in the management of patients with liver abscess [ 11. Multiple liver abscesses, as compared with single abscesses, are uncommon, have a poor prognosis, and complete drainage by percutaneous aspiration is less successful [2]. We report a case of three abscesses involving both lobes of the liver treated successfully by percutaneous drainage.