Background: Endovenous, open surgery or hybrid treatment are commonly performed methods of treatment for varicose veins. Comparative study between triple saphenectomy, Endovenous laser ablation (EVLA) and Endovenous Chemical Ablation with Trendelenburg's operation (eCAT) for treatment of primary varicose veins as regard, the return to daily activity, residual varicosities, complications, GSV caliber and, recurrence after one year. Patient and methods: Seventy five patients with primary varicose veins presented at AL-Azhar University hospital of New Damietta city during the period from November 2016 to December 2018. All patients were randomized into three equal groups each included 25 patients. Group I was treated by triple saphenectomy, group II was treated by EVLA, while group III was treated by eCAT. Results: Return to daily activity was more rapid in group II than that of group I and group III. Statistically significant results had been detected in patients with group III as regard reduced incidence of saphenous nerve injury, residual varicosities, recurrence together with early ecchymosis and hematoma formation. Saphenous nerve injury had been detected in 5 and 2 patients for group I, II respectively but not in group III. Residual varicosities were detected in 10,15,5 patients for group I, II and III respectively. Conclusion: Endovenous chemical ablation with Trendelenburg's operation had better results than endovenous laser ablation and triple saphenectomy as regard saphenous nerve injury, residual varicosities and recurrence with lower incidence of postoperative ecchymosis and hematoma formation.

Background and aim Diabetic patients with foot ulcer and peripheral ischemia were shown to be associated with hypercoagulation and dysfunction in the fibrinolytic system that in turn would affect the healing of the ulcer. The authors aimed to investigate the role of rivaroxaban in improving the microcirculation of the skin and peripheral tissues and how it can improve ischemic diabetic foot ulcers. Patient and methods The authors conducted an observational retrospective case–control study at Al-Azhar University Hospital, New Damietta, from January 2015 till December 2020. Diabetic patients with foot ulcer and peripheral limb ischemia who received rivaroxaban till ulcer healing were considered as the case group, whereas patients who did not receive rivaroxaban were considered as the control group. Clinical assessment and pulse oximeter were used for the assessment of transcutaneous microcirculation. Results Throughout the 5 years of the study, 172 patients were included; the case group included 87 patients and the control group included 85 patients. There was a significant difference between the two groups regarding the improvement of limb ischemia, tissue plasminogen activator antigen, and transcutaneous microcirculation (P<0.05). Before the treatment, there was a significant correlation between both permeability coefficient and plasma fibrinogen and transcutaneous microcirculation. Conclusion The oxygenation of the ulcer and the microcirculation were found to be improved in the case group and accelerate wound healing in the ischemic diabetic foot.

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Article informationBackground: It has been shown that an arteriovenous fistula [AVF] is better for hemodialysis patients than central venous catheters and arteriovenous grafts in terms of morbidity and death. Aim of the work:This study aims to compare the safety and effectiveness of the anatomical snuffbox AV fistula versus the usual radio cephalic fistula at the wrist for hemodialysis. Patients and Methods: Our study is a prospective interventional study that included 40 patients on hemodialysis scheduled for A-V fistula formation. Patients were classified into two groups; Group [A]: 20 patients who underwent standard Wrist Arterio Venous Fistula, [WAVF], and Group [B]; 20 patients who underwent AV fistula at the anatomical snuffbox [SB].Results: Clinical data, and demographics of the two groups were similar [p-value > 0.05]. After six weeks of intervention the AVF was found to be patent in 85.7% of the patients in WAVF group, and in 88.6 % of the patients in SBAVF group with no significant difference between the two groups [P value = 0.7]. In WAVF group showed one case of mild steel syndrome, and ecchymosis, and three cases of edema which resolved spontaneously. Two cases of infection responded to systemic and local management. While in the SBAVF group there was one case of ecchymosis and edema which resolved without intervention. Also, two cases of infection responded to systemic and local management. Conclusion:When a cephalic vein is anatomically inaccessible, or if a secondary surgery requires access to the wrist, the SBAVF can be used to preserve those vessels.

Background: Diagnosis of acute appendicitis depends mainly on clinical diagnosis. However, the high negative rate remains a challenge and different aids for diagnosis had been proposed. The aim of the work: The current work aimed to assess the sensitivity of Modified Alvarado Score [MAS] in diagnosis of acute appendicitis. Patients and Methods: One hundred children with clinical manifestations of acute appendicitis were included. Patients were categorized into two groups according to MAS: [group A] included 50 patients with [MAS] ≥ 7 regardless of sonography results. The second group [group B] included another 50 patients with MAS <7 and abdominal ultrasound study suggestive for appendicitis. Intraoperative diagnosis had been performed for 100 patients with postoperative histopathological study for all cases.Results: Tenderness in right iliac fossa was the most frequent sign in the study population [98%]. Histopathology revealed positive results among 49 patients [47 in group A and 2 in group B] with significant difference between groups A and B. The overall sensitivity and specificity of ultrasonography were 89.4% and 33.3% respectively and were 96.0% and 20.0% respectively of MAS score. Conclusion:In acute appendicitis, MAS is a good diagnostic [sensitive] tool. Sensitivity increased when combined with ultrasound, as the number of negative appendectomies was reduced.