Hemodynamic assessment of high-compression hosiery in chronic venous disease.

Graded high-compression support hosiery have long been recognized as a physiologically significant mode of therapy for chronic venous disease because of their effects on the hemodynamics of venous return. Photoplethysmography (PPG) in the noninvasive vascular laboratory is now recognized as a quick, simple, and noninvasive measurement technique, which correlates well with ambulatory venous pressure in the postphlebitic limb with chronic venous insufficiency. The purpose of this study was to evaluate the hemodynamic effects, as measured by PPG, of 40 mm Hg graded compression support hosiery in the treatment of patients with a documented history of hospital-treated thrombophlebitis. Fifty lower extremities among 38 patients with a documented history of deep vein thrombosis and chronic venous insufficiency were matched against 50 control extremities among patients without disease. All 50 lower extremities in the study group had abnormal noninvasive venous studies, including Doppler ultrasound examination, phleborheography, and PPG (mean, 5.9. seconds). Thus these patients were ascertained to have incompetent deep venous systems, but with normal arterial flow as documented by ankle:brachial ratios. After application of 40 mm Hg gradient compression stockings to the study group, PPG measurements in all 50 limbs initially converted to normal (20.6 seconds). Abnormal PPG measurements were converted to normal in postphlebitic limbs with the application of graded compression stockings in the 29 patients who wore the prescribed hosiery; 21 patients did not wear the gradient stockings after the initial evaluation(s) and were not found to have improved PPG measurements. It can be concluded that such gradient stockings should be associated with a reduction in ambulatory venous pressure, which may, in turn, lead to clinical prevention or improvement of the various sequelae associated with chronic venous hypertension.

Panendoscopy with arteriography versus mandatory exploration of penetrating wounds of the neck.

Of 193 patients with penetrating wounds of the neck, 76 had only surgical exploration; 57 had only nonsurgical exploration including one or more of the following: arteriography, bronchoscopy, laryngoscopy, esophagoscopy, and contrast-swallow esophagogram; and 60 had both surgical and nonsurgical exploration. Eighty-six patients were wounded by gunshot, 108 by stabbing. Presenting signs and symptoms were an unreliable method of predicting presence or absence of injury. Overall negative rate of surgical exploration was 50% (54% of the stabbings and 45% of the gunshots). Accuracy of nonsurgical exploration was assessed by comparing to surgery. Arteriography was 100% accurate, a combination of bronchoscopy and laryngoscopy was 100% accurate, contrast-swallow esophagogram was 90% accurate, and esophagoscopy was 86% accurate. The literature was reviewed regarding the accuracy of nonsurgical as well as surgical exploration. The one complication attributed to nonsurgical exploration was a symptomatic anemia, while there were two wound infections resulting in increased length of stay associated with negative surgical exploration. Overall mortality rate was 5.6%. The average length of stay for nonsurgical exploration only was 2.8 days, for negative surgical exploration was 4.2 days, and for positive surgical exploration was 9.5 days. Financial cost of a negative surgical exploration was $3185, while for four-vessel cerebral arteriography with panendoscopy it was $3492. More studies need to be done, particularly concerning venography and esophagoscopy. However, considering the fact that surgical exploration should by no means be considered 100% accurate, the data in this study support the fact that arteriography with panendoscopy represents an equally safe and acceptable method of exploration of penetrating wounds of the neck for stable patients without specific signs and symptoms of injury and can be expected to result in a reduced number of negative surgical explorations and their associated morbidity as well as a reduced length of hospital stay, although at a slightly higher financial cost when compared to mandatory surgical exploration.

Septic complications associated with the use of peritoneal drains in liver trauma.

This study reviewed all 164 cases of liver trauma seen at the Charity Hospital of New Orleans from 1980 through 1984, in 12 of whom intra-abdominal abscesses formed. Thirty four per cent of the patients had no peritoneal drainage and an abscess rate of 1.8%, 18% had only closed suction drainage and 0% abscess rate, 15% had only open sump drainage and a rate of 8.3%, 14% had only open Penrose drainage with a rate of 8.7%, and 19% had a combination of both open Penrose and sump drainage with a rate of 22.5%. Certain findings or conditions were related to the development of postoperative sepsis. Gunshot wounds were associated with a 9.9% abscess rate, blunt trauma with 3.8%, and stabbings with 0%. Patients who presented in shock were at a threefold increased risk for intra-abdominal abscess formation, those who needed blood transfusions of greater than 6 units were at a tenfold increased risk, those with major liver injuries were at a sixfold increased risk, and those with a total of three or more abdominal organs injured were at a threefold increased risk for abscess formation. There was no significant relation between presence of gastrointestinal perforation and subsequent abscess formation. For patients without the specific risk factors mentioned above, the probability of developing an intra-abdominal abscess is low. This group of patients would therefore benefit little from the presence of a drain, but might very well be harmed by the introduction of external contaminant bacteria into the peritoneal cavity by the drain itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient compliance with fitted compression hosiery monitored by photoplethysmography.

This study assessed the compliance useage and impact by monitoring of graded compression hosiery in chronic venous disease. Diagnostic methods, such as qualitative photoplethysmography (PPG), have enabled the physician to assess deep-vein valvular incompetence earlier and begin specific treatment measures to slow the progression of symptoms. This study group, comprised of 100 patients, was diagnosed initially with deep-venous thrombophlebitis and evaluated by phleborrheography and PPG at three-month intervals for one year. The patients were instructed to wear fitted, graded compression hosiery after hospital discharge; compliance was 37% at one year. The primary reason for noncompliance was socioeconomic. The price of the ideal graded compression hosiery was not easily within reach of this population and insurance reimbursement was difficult or impossible to obtain. Complaint patients felt better while wearing the compression hosiery. Increasing deterioration of qualitative PPG values of deep-valve assessment was found in both compliant and noncompliant patients at each testing interval. The PPG value deteriorated as time increased with or without the compression hose, although symptoms lessened when the prescribed hosiery was worn. The long-term sequelae of wearing or not wearing the hosiery are yet to be determined, but PPG assessment is normalized with the hosiery in place.