Venous claudication successfully treated by distal superficial femoral-to-greater saphenous venous bypass.

Chronic venous disease of the lower extremities is a clinical entity that is commonly encountered by practicing physicians. The problem is usually a direct consequence of a previous episode of deep venous thrombosis. Patients so afflicted suffer from a distinct series of symptoms that are grouped under the term "postthrombotic" or "postphlebitic" syndrome. These consist of leg edema, stasis dermatitis, ulceration, and sometimes claudication. The causative pathophysiologic features consist of either valvular incompetence and/or main channel obstruction. This report offers a new method of relieving symptoms caused by a superficial femoral vein obstruction.

Factors influencing the morbidity of colostomy closure.

In a series of 80 colostomy closures, a total complication rate of 26 per cent was found, with a wound infection rate of 14 per cent and an anastomotic leak rate of four per cent. Patients having preoperative systemic antibiotics had fewer wound infections than those who did not (eight per cent versus 19 per cent). Delayed primary skin closure or closure by secondary intention was associated with less wound morbidity than was primary closure (ten per cent versus 17 per cent). However, the use of preoperative systemic antibiotics decreased the incidence of wound infection in those having primary skin closure (five per cent versus 27 per cent). Patients having diverticular disease had more wound infections (40 per cent) and greater overall morbidity (70 per cent). Older patients had a higher incidence of complications (24 per cent if less than 40 years and 45 per cent if greater than 50 years). Closure of left-sided colostomies was associated with a higher infectious complication rate (26 per cent versus 13 per cent). The time interval to colostomy closure was found to alter subsequent morbidity with a waiting period of one to two months associated with zero complications.