Treatment of varicose veins. An update.

The modern injection-compression sclerotherapy, as described by Fegan of Ireland and Sigg of Switzerland, bears little resemblance to the injection treatment of varicose veins as used in the United States in the 1940s. Sotredecol (sodium tetradecyl sulfate) is the agent injected, and no more than 0.5 ml is used at any one site. The sites picked are those of the incompetent perforator veins which are found by careful physical examination. The injection is made into the emptied vein with the leg raised, and a firm compression dressing is applied as the injections are made from below cephalad. The compression bandage is worn for 3 weeks. Randomized studies that compared surgery and injection-compression sclerotherapy in the treatment of varicose veins have shown little difference in the end results. The overall cost, including hospitalization, work days lost, and complications, are greater with surgery. A series of 66 patients has been analyzed.

Surgical treatment of diverticulitis. Experience at a large Municipal Hospital.

In the past 5 1/2 years, 71 patients with diverticulitis were operated on--20.8% of all cases of diverticulitis admitted to the Bronx Municipal Hospital Center. Operative mortality was 22%, primarily because of delayed diagnosis, inadequate surgery, and a high incidence of associated disease. Only 20% of patients operated on had a previous history of diverticular disease. Hemorrhage was the indication for surgery in 16 cases; in this situation, a subtotal colectomy in one stage is the operation of choice. Perforation was the indication in 47 cases, eight of these being acute and with free air under the diaphragm. In cases with peritoneal contamination, a two-stage procedure (removing the diseased portion of colon at stage one) is advocated. Colostomy without drainage, or closure of a free perforation, is condemned.