Talal Amer

Preoperative embolization of nasopharyngeal angiofibroma: a report of 34 cases

Abstract Preoperative embolization was performed in 34 patients with nasopharyngeal angiofibroma (NAF). Thirty-seven embolization procedures were done in those patients (three patients had tumor recurrence and repeated embolizations were performed). Embolization was done using Gelfoam (seven embolizations), contour particles (24 embolizations) and Ivelon (six embolizations). The internal maxillary artery (IMA) was embolized bilaterally in four patients (four embolizations), and unilaterally in 30 patients (33 embolizations). In 25 patients, intraoperative blood loss at primary surgery was insignificant (no blood transfusion was required) while in nine patients, the intraoperative blood loss ranged from 400 to 1500 ml (average 650 ml), and the average blood transfusion was 944.4 ml. Only three patients showed recurrence of the tumor after primary surgery (8.8%). Minor complications were seen in most of the patients in the form of mild to moderate local pain in the vascular territory of the embolized artery and slight temperature elevation. Other minor complications included nausea in three patients and local subcutaneous edema in only one patient. A major complication was encountered in only one patient who had left retinal artery occlusion and temporary visual loss due to embolization of the left ophthalmic artery. The results indicated that pre-operative embolization of the internal maxillary artery in patients with nasopharyngeal angiofibroma is a relatively safe technique, effective in reducing intraoperative blood loss and contributes to improving surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Prevalence of activated protein c resistance due to factor v leiden mutation in egyptian patients with chronic nonthrombotic venous ulcer

Background Chronic venous leg ulcers are major health problems with great financial burden on patients and health resources. They are either post-thrombotic or not. Factor V Leiden (FVL) mutation is the most commonly diagnosed inherited thrombophilia. The present study compared the prevalence of activated protein C resistance (APCR) due to FVL mutation in patients with chronic nonthrombotic venous ulcer with an age-matched and sex-matched control group. Patients and methods Over a period of 6 years, 64 patients with chronic venous (nonthrombotic) leg ulcers were compared with 64 controls regarding APCR and FVL mutation. Results In total, 17 patients out of 64 tested positive for APCR (26.6%) [15 of them (23.4%) were due to FVL mutation (13 heterozygous and two homozygous)], whereas among controls only four tested positive for APCR (6.25%), all of them due to FVL mutation (all were heterozygous). Conclusion Patients with chronic nonthrombotic venous ulcers had statistically significant prevalence of FVL mutation compared with age-matched and sex-matched controls. Our results (although with some limitations) showed that a special cohort of primary varicose veins with this thrombophilic abnormality needs further investigation to accurately elicit its possible role in their disease progression into venous ulcers.