Operative hemorrhoidectomy versus cryodestruction.

Twenty-six patients were treated for hemorrhoids by a combination of cryodestruction and closed operative hemorrhoidectomy. Patients were able to draw their own conclusions about the efficacies of these treatments. They had no difficulty in distinguishing exactly which area was causing pain. The operative site was a source of greater pain until the second day after the procedure, when the pain resulting from cryodestruction equalled surgical pain; then cryodestruction associated pain continued longer. Cryodestruction was associated with production of a foul discharge. Residual hemorrhoids were present in 50 per cent of patients\u27 cryodestruction sites. Given the choice at the one year follow-up examination, 65 per cent preferred surgical treatment and 35 per cent preferred cryodestruction

Technique for thrombectomy of reversed saphenous vein arterial bypass grafts.

A technique for thrombectomy of saphenous vein arterial bypass grafts is described. The technique includes visual inspection of both anastomoses and avoids unnecessary trauma to the graft secondary to repeated attempts at passing a balloon catheter against the direction of the venous valves

Free-Tissue Transfers for Limb Salvage Utilizing in Situ Saphenous Vein Bypass Conduit as the Inflow.

Using vein grafts to bypass sclerotic and occluded arterial segments is a well-established technique in vascular surgery. For infrapopliteal bypass, autogenous veins have better patency rates than synthetic grafts. Although not resolved, in situ bypasses seem to be better than reversed bypasses, especially for far away segments. Although the etiology is not understood, it is a well-known clinical finding that sclerosis affects arteries more than the veins and, as a whole, is more advanced in lower extremities compared with the trunk and upper extremities. Our experience with eight patients in whom critical soft-tissue defects were covered with free-tissue transfers in severely compromised lower extremities utilizing the in situ saphenous vein bypass as the inflow is presented. Simultaneous bypass and free-tissue transfers were performed in seven and delayed free-tissue transfer was done in one. Follow-up ranged from 6 months to 3 years. To date, two patients underwent amputations. Five patients are able to maintain bipedal ambulation. One patient is wheelchair-bound with intact lower extremities. In well-selected patients, this procedure may offer an alternative treatment to amputation. However, because of the complexity of these combined procedures, we strongly urge careful patient selection

Efficacy of preoperative and postoperative bone scanning in the management of breast carcinoma.

With use of 99mtechnetium-labeled phosphates, we performed preoperative bone scans on 122 women with biopsy-proved breast carcinoma. Only two of the 110 patients with Stage I or II disease had scan abnormalities interpreted as bone metastases. Of 55 patients with normal preoperative scans, 20 later had changes suggesting bone metastases on the subsequent scans, most within 24 months of operation. In women with Stage I and II tumors, 13 of 48 (27 per cent) had scan evidence of bone metastasis of postoperative follow-up examination. Five of 23 with potential surgical cures (negative lymph nodes at operation) had bone metastasis within two years of operation. In Stage I and II patients, postoperative discovery of evolving metastases was most often (11 to 13) made by bone scan. Although the initial yield from preoperative bone scans is low, preoperative scanning combined with sequential postoperative scans constitutes one of the most sensitive indicators of evolving metastatic disease

Ankle pressure changes in distal bypass grafts during knee flexion.

Systolic ankle blood pressure was measured with the limb extended and then acutely flexed in four study groups. These included 11 normal individuals, 11 patients with below-knee autologous saphenous vein bypass grafts, 11 patients with polytetrafluoroethylene (PTFE) prosthetic below-knee bypass grafts, and 11 patients with femoropopliteal arterial occclusion who had not undergone bypass grafting. This study shows that normal limbs, limbs with saphenous vein bypass grafts, arteriosclerotic limbs, and those with PTFE bypass grafts all tolerate acute knee flexion without significant decrease in distal blood pressure