Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach.

BACKGROUND: Patients considered for arterial surgery, have been shown to have a high incidence of coexistent cardiac, vascular and other diseases, affecting operative risk and survival. We developed a systematic workup strategy for detecting these coexistent diseases in our vascular surgical patients, mainly based on non-invasive diagnostic techniques. METHODS: We evaluated 200 consecutive patients, admitted to the department of vascular surgery in an academic teaching hospital, in order to establish the total incidence of relevant concomitant disorders, the extent to which this screening yielded previously unknown diagnostic information, and the impact on short-term (one year) survival. RESULTS: Coronary artery disease was present in 46% of the patients; 22% had active ischaemia, newly diagnosed in 5.5%. Impaired cardiac function was found in 37%: severely impaired in 12%, newly diagnosed in 27%. Carotid artery disease was present in 32%: critical stenoses were found in 9%; new diagnoses in 29.9%. Aortic aneurysms were present in 7%, newly diagnosed in 5%. Severe renal artery stenosis was present in 5%, newly diagnosed in 3.5%. Sixteen % of the patients had chronic obstructive pulmonary disease, newly diagnosed in 3.5%, and 4.5% had unexpected disorders, which were all new diagnoses. Overall, new diagnoses were reached in 64.5% of the population, affecting therapeutic strategy immediately in 21% of the patients. The presence of coronary artery disease and of cardiac failure were clearly related to one year survival. CONCLUSIONS: We conclude that a systematic screening strategy, mainly based on noninvasive techniques, can detect the presence of concomitant diseases in the vascular surgical patient. Most important seem the newly diagnosed diseases altering surgical management in one out of every five patients; they also have important implications for patient prognosis.

Atlantoaxial rotatory fixation. A case report and proposal of a new classification system.

Atlantoaxial rotatory fixation (AARF) remains a relatively rare finding. A case of AARF is reported and the existing Fielding and Hawkins classification is reviewed. Furthermore a new classification system is proposed.

Operative treatment of carpal tunnel syndrome.

The results of surgical treatment of 100 carpal tunnel syndromes are discussed. With respect to paresthesias, pain, muscular weakness of the thumb and numbness, excellent or good results were obtained in 94%, 93%, 79% and 100% of the cases. There were complications (minor algodystrophy syndrome) in only 3% of the cases.