The assessment of skin blood flow in peripheral vascular disease by laser Doppler velocimetry.

The helium-neon laser Doppler (LD) is designed to measure skin blood flow velocity (SBFV). Flow velocity and pulse wave amplitude are expressed in millivolts (mv) relative to a zero-flow reference. The authors have reviewed their initial experience in ten persons (20 limbs) without peripheral vascular disease (PVD, group I) and nine patients (12 limbs) with severe PVD (group II). The finger, palm, great toe, and forehead had a significantly (P less than 0.05) greater flow velocity than the plantar and dorsal foot, distal and proximal leg, thigh, chest, arm, and forearm. Baseline and hyperemic SBFV, measured at the great toe, were compared in groups I and II. In group I, the baseline SBFV (mv, mean +/- standard error of the mean (SEM] in the great toe was 197 +/- 38 compared with 67 +/- 12 in group-II patients (P less than 0.05). The pulse wave amplitude (mv, mean +/- SEM) was 77 +/- 14 in group I and 5.4 +/- 1.1 in group II (P less than 0.05). The time to maximal hyperemic response (seconds, mean +/- SEM) in group I was 18 +/- 1.5 compared with 150 +/- 14 in group II (P less than 0.05). LD is a sensitive indicator of changes in SBFV, allowing differentiation between normal persons and patients with PVD. The LD tracing in patients with PVD is characterized by a baseline SBFV that is significantly less than normal and also by the attenuation or absence of pulse waves. The diagnostic accuracy is enhanced by the use of reactive hyperemia.

Management of nonpenetrating stab and gunshot wounds of the chest.

Records of 102 patients with gunshot and stab wounds to the chest but with normal roentgenogram of the chest upon admission were reviewed. There were no delayed hemothoraces or pneumothoraces. The three complications probably resulted from admission to the hospital and would not have occurred if the patients had maintained their normal daily activities. The cost of these admissions was $104,319, and no benefit resulted from them. A significant number of routine studies were done with an extremely low yield. These patients need not be admitted to the hospital unless there is some other compelling clinical factor.