Venous disease: how to heal and prevent chronic leg ulcers.

Venous disease accounts for up to 90% of all cases of chronic leg ulcers. Patients with venous disease have relatively unhealthy, ischemic tissue in the lower legs, and slight trauma often initiates an ulcer. Symptoms include leg swelling, which is often unilateral and persistent, and a dull ache that worsens with standing, walking, or sitting with the legs down. Approximately 50% of patients have a history of deep vein thrombosis. A careful history and examination can rule out other causes and guide appropriate therapy as well as prophylaxis against progressive disease. Elevation, compression, occlusion, and debridement are the mainstays of treatment. Ulcer healing is gradual, often requiring weeks to months of therapy. Preventing recurrence requires careful attention to compression; surgery may be indicated.

The role of serum amylase in the diagnosis of acute pelvic inflammatory disease.

The use of serum amylase levels in the diagnosis of acute pelvic inflammatory disease (PID) was investigated prospectively. Eighty-five women presenting with the chief complaint of lower abdominal pain were entered into the study; all patients were examined by one of the principal investigators. In addition to the usual laboratory studies, a serum amylase level was obtained on all patients; the investigators were blinded to the results. Patients were diagnosed with PID if they fulfilled previously published clinical criteria. Forty-eight patients met the criteria for the diagnosis of PID (PID group); 37 patients were diagnosed with other disease processes (non-PID group). The average serum amylase level for the PID group was 62 U/L, with a standard deviation (STD) of 24; for the non-PID group, the average was 76 U/L with an STD of 32. Although there was a statistical difference between the two groups (P < .05), there was no clinically significant difference because both values fell within the normal range of serum amylase. The routine use of serum amylase in the diagnosis of acute PID seems to be of no value.

Double-blind randomised crossover trial of moderate sodium restriction in essential hypertension.

Nineteen unselected patients with mild to moderate essential hypertension, whose average supine blood pressure after two months' observation on no treatment was 156/98 mm Hg, were advised not to add salt to food and to avoid sodium-laden foods. After 2 weeks of sodium restriction patients were entered into an 8-week double-blind randomised crossover study of 'Slow Sodium' (Ciba) versus slow sodium placebo. The mean supine blood pressure was 7.1 mm Hg (6.1%) lower in the fourth week of placebo than that in the fourth week of slow sodium (p less than 0.001). Urinary sodium excretion in the fourth week of slow sodium was 162 +/- 9 mmol/24 h and that in the fourth week of placebo was 86 mmol +/- 9 mmol/24 h (p less than 0.001). There was no difference in potassium excretion. These results suggest that moderate sodium restriction achieved by not adding salt and avoiding sodium-laden foods should, if not already, become part of the management of essential hypertension.