A retrospective review of all patients presenting to a tertiary referral center with acute nontraumatic upper limb ischemia between January 1992 and June 1997 was undertaken to examine the role of intraarterial thrombolysis in the management of such cases. Twenty-one patients were identified in the radiology and vascular surgery departments' registers. Twenty (95%) underwent angiography, demonstrating subclavian artery occlusion in four, axillary in two, brachial in 13, and one at the digital level. Intraarterial thrombolysis was attempted in 12 patients. There were three technical failures, all requiring embolectomy. Six had complete lysis and resolution of their symptoms. One patient had partial lysis but experienced no further rest pain. Thrombolysis was unsuccessful in two cases with one subsequently requiring embolectomy and the other surgical bypass. Three patients had surgical intervention as their primary procedure with two favorable outcomes and one ending in above-elbow amputation. Five patients were treated conservatively with heparin, resulting in three partial and two full recoveries. One patient experienced complete resolution of symptoms with an intravenous prostacyclin infusion. Both electrocardiograms (ECG) and echocardiograms (ECHO) were of limited diagnostic aid, and long-term warfarin anticoagulation was prescribed to all patients. There was no recurrence of upper limb ischemia at a median follow up of 18 months. Intraarterial thrombolysis is an effective first line treatment for acute nontraumatic upper limb ischemia in selected cases.

Size of tumour, lymph node involvement and Ki-67 were independent prognostic factors for relapse after potentially curative surgery in NET.

No abstract

Healing of purely ischaemic ulcers is characterised by vasculogenesis associated with increased presence of the proangiogenic cytokines PDGF and TGFbeta3. These findings show promise for the use of growth factor manipulation to aid healing in ischaemic ulcers.

Objective: Wound dehiscence with nonhealing of the perineum is a significant morbidity associated with radical abdominoperineal resection (APR). Myocutaneous flaps have been used to facilitate primary wound healing. The purpose of this study is to evaluate the results of myocutaneous flap reconstruction of the perineum following radical APR. Method: The clinical records of patients who had myocutaneous flap reconstruction of the perineum between 2000 and 2005 were reviewed. Details of wound healing and complications related to the flaps were recorded.Results: Seventeen patients with a median age of 59 (range 29-77) years had primary reconstruction of the perineum with gracilis (10), rectus abdominis (6) and gluteal (1) myocutaneous flaps. Malignancy of the anus (12) and rectum (4) was the primary pathology and one patient had chronic perianal Crohn's fistulae. An 11 patients had preoperative radiotherapy in this group. Complete healing of the perineum was achieved in 16 (94.2%) of the 17 patients. There were 8 (47%) minor wound dehiscence and 2 (11%) skin necrosis all of which healed completely and 1 (5.8%) total flap necrosis.Discussion: Myocutaneous flaps improve wound healing with only minor morbidity in majority of patients and should be considered routinely to close perineal defects following radical APR particularly in irradiated perineum.