Outcome of non surgical hepatic decompression procedures in Egyptian patients with Budd-Chiari

AIM: To evaluate outcome of patients with Budd-Chiari syndrome after balloon angioplasty ± stenting or transjugular intrahepatic portosystemic shunt (TIPS). METHODS: Twenty five patients with Budd-Chiari syndrome admitted to Ain Shams University Hospitals, Tropical Medicine Department were included. Twelve patients (48%) with short segment occlusion were candidates for angioplasty; with stenting in ten cases and without stenting in two. Thirteen patients (52%) had Transjugular Intrahepatic Portosystemic Shunt. Patients were followed up for 12-32 mo. RESULTS: Patency rate in patients who underwent angioplasty ± stenting was 83.3% at one year and at end of follow up. The need of revision was 41.6% with one year survival of 100%, dropped to 91.6% at end of follow up. In patients who had Transjugular Intrahepatic Portosystemic Shunt, patency rate was 92.3% at one year, dropped to 84.6% at end of follow up. The need of revision was 38.4% with one year and end of follow up survival of 100%. Patients with patent shunts showed marked improvement compared to those with occluded shunts. CONCLUSION: Morbidity and mortality following angioplasty ± stenting and TIPS are low with satisfactory outcome. Proper patient selection and management of shunt dysfunction are crucial in improvement.

The effect of BMI and age on the outcomes of microsurgical vasoepididymostomy: a retrospective analysis of 181 patients operated by a single surgeon

To design a treatment plan for patients with epididymal obstruction,we explored the potential impact of factors such as body mass index(BMI)and age on the surgical outcomes of vasoepididymostomy(VE).In this retrospective study,181 patients diagnosed with obstructive azoospermia(OA)due to epididymal obstruction between September 2014 and September 2017 were reviewed.All patients underwent single-armed microsurgical intussusception VEs with longitudinal two-suture placement performed by a single surgeon(KH)in a single hospital(Peking University Third Hospital,Beijing,China).Six factors that could possibly influence the patency rates were analyzed,including BMI,age,mode of anastomosis,site of anastomosis,and sperm motility and quantity in the intraoperative epididymal fluid.Single-factor outcome analysis was performed via Chi-square test and multivariable analysis was performed using logistic regression.A total of 159(87.8%,159/181)patients were followed up.The follow-up time(mean±standard deviation[s.d.])was 27.7±9.3 months,ranging from 12 months to 48 months.The overall patency rate was 73.0%(116/159).The multivariable analysis revealed that BMI and age significantly influenced the patency rate(P=0.008 and 0.028,respectively).Younger age(≤28 years;odds ratio[OR]=3.531,95%confidence interval[95%CI]:1.397–8.924)and lower BMI score(<26.0 kg m−2;OR=2.352,95%CI:1.095–5.054)appeared to be associated with a higher patency rate.BMI and age were independent factors affecting the outcomes of microsurgical VEs depending on surgical expertise and the use of advanced technology.

Influence of Junction Angle Changed Models on Hemodynamic of Coronary Artery Bypass Graft

The restenosis after coronary artery bypass graft(CABG) is attributed to the formation of intimal hyperplasia(IH) at the anastomosis,which is closely related to hemodynamic depend on the geometric model. In order to give a reasonable assessment of the surgery effect and judge the long-term patency rate,the hemodynamic of CABG surgery program is compared with that of surgery design of the junction angle changed.Based on in-vivo CT coronary angiography datasets,the individual geometric model of CABG reconstructed instead of idealized geometric models are applied to simulate the real physiological blood flow utilizing pulsatile flow boundary waveforms in the present study. The simulation results show that the maximum wall shear rate(WSS) value is at the bottom of anastomosis. Moreover,the stagnation zone growing gradually with the greater angle downstream the anastomosis is prone to form the IH,which is consistent with clinical observation. It is proved that the surgery being better suited to maintain graft patency is successful.