Internal iliac artery aneurysms.

Information on 10 patients who presented because of aneurysms of the aorto-iliac segment of the arterial tree has been reviewed. Problems caused by aneurysmal dilatation of the internal iliac artery are discussed and a technique for the management of aneurysm at this site is described.

Deep vein thrombosis after femoropopliteal bypass grafting with observations on the incidence of complications following the use of dextran 70.

Radiological thrombosis was demonstrated on six occasions in the leg veins in 66 patients following the placement of 71 femoropopliteal bypass grafts. All patients received dextran 70 as prophylaxis postoperatively. The incidence was similar for grafts with the lower anastomosis either above or below the knee joint. No predisposing factors to venous thrombosis were apparent other than blood dyscrasias. A further group of patients who had arterial reconstructive procedures were examined to determine the incidence of the complications of bleeding and heart failure which might be attributed to the routine use of dextran 70. The incidence of complications in this larger group indicates that the routine use of dextran 70 is not a significant factor in their occurrence in the postoperative period.

Carotid endarterectomy at Wellington Hospital.

AIM: To evaluate the morbidity and mortality of carotid endarterectomy at Wellington Hospital. METHOD: A retrospective study of all patients undergoing carotid endarterectomy at Wellington Hospital in the four year period from June 1987 to June 1991 was performed. Data was collected from chart review. A general practitioner questionnaire was sent to assess posthospitalisation outcome. RESULTS: One hundred and one carotid endarterectomies were performed in 89 patients. The overall combined 30 day mortality and disabling stroke rate in symptomatic patients was 5.1%. CONCLUSIONS: Carotid endarterectomy is performed at Wellington Hospital with an acceptable 30 day mortality and disabling stroke rate.

The use of a ureteric nipple alone for reflux prevention.

In the re-implantation of a ureter into the bladder, vesico-ureteric reflux can be prevented by a ureteric nipple alone, provided the nipple is at least 1.5 cm long. This eliminates the need for an oblique ureteric entry or a submucosal tunnel. Longer nipples may be used although they may lead to difficulties with catheterisation. Reduction in the length of the nipple frequently occurs later.

Postoperative infection in arterial surgery: a review of the incidence and distribution in 386 patients.

The clinical records of 386 patients undergoing surgery for peripheral arterial disease during the period 1958 to 1974 were examined for patterns of wound infection. The incidence of infection in arterial reconstructive procedures was 7.4%, of which infections 2.2% were major. A high incidence of minor wound infection was found not to be of significance with regard to patient morbidity. The greater risk of wound infection occurring when there was an ischaemic skin lesion present distally in the limb was confirmed. An incision in the groin was not clearly identified as a significant factor in the development of wound infection. The prophylactic use of antibiotics has not resulted in a lower incidence of infection, when compared with those results reported from centres where antibiotic prophylaxis has not been routine. Analysis by year has demonstrated a lower incidence of infection in the more recent years 1969 to 1974.

An appraisal of the role of the PTFE graft in lower limb arterial reconstruction.

In the period between April 1977 and April 1981, 105 femoropopliteal bypass grafts were performed for atherosclerotic occlusive arterial disease below the inguinal ligament. Forty-six of these were done using polytetrafluoroethylene (PTFE) and the remaining 59 using autogenous saphenous vein. In April 1982 a retrospective evaluation of the efficacy of the PTFE graft was undertaken. Patency rates between the two groups were found to be comparable when disabling claudication was the indication for surgery. No difference in patency rates was found between the PTFE graft inserted above or below the knee irrespective of whether the graft was undertaken for claudication or limb salvage.

Clinical and radiologic lacrimal testing in patients with epiphora.

OBJECTIVE: The purpose of the study is to assess the strengths and weaknesses of selected clinical and radiologic lacrimal tests in patients with epiphora. DESIGN: The study design was a prospective clinical trial. PARTICIPANTS: Fifteen patients with epiphora (N = 27 eyes) were studied. METHODS: All patients underwent Jones testing, the dye disappearance test, canalicular probing, lacrimal scintigraphy, and macrodacryocystography. MAIN OUTCOME MEASURES: The dye disappearance test was graded individually by three ophthalmologists. Lacrimal scintigraphy and macrodacryocystography were evaluated by a nuclear medicine specialist and a radiologist, respectively. A panel of three ophthalmologists evaluated the data using a scoring system that relied on the preponderance of evidence to arrive at a final assessment. RESULTS: When the Jones I test results were negative (dye recovered from the nose), the epiphora was always from hypersecretion. When the Jones I test results were positive (no dye recovered from the nose), obstruction was not always present. When the dye disappearance test results were strongly abnormal, obstruction was always present. In contrast, when the dye disappearance test results were normal, the lacrimal drainage system was not always patent. Canalicular probing was more reliable than scintigraphy in identifying canalicular obstruction. Marked stenosis of the sac or duct on dacryocystography essentially confirmed nasolacrimal outflow obstruction; however, with the authors' technique, a normal study was found in some patients with functional or partial obstruction. CONCLUSIONS: More than one lacrimal test may be required for a definitive diagnosis in patients with epiphora due to partial or functional nasolacrimal outflow obstruction.