Graded pressure stockings in prevention of deep vein thrombosis following total hip replacement.

The occurrence and distribution of deep vein thrombosis after elective hip surgery were studied in 22 consecutive patients wearing graded pressure stockings as thromboprophylaxis. The frequency of thrombosis, as evidenced by leg-scan and phlebography, was 59%. Thirty-six per cent of the patients developed femoro-popliteal thrombosis. Thrombosis was unilateral and located in the operated limb, except for one patient who had concurrent leg-vein thrombosis in the non-operated limb. Two patients developed symptomatic lung embolism. Antithrombin III was determined pre- and postoperatively. There was no evidence of antithrombin III consumption due to postoperative thrombosis.

A clinical and phlebographic study of postoperative deep vein thrombosis following knee meniscus extirpation.

To evaluate the risk of deep vein thrombosis, a clinical and phlebographic examination was performed 7 to 16 days after a bloodless knee meniscus operation in 37 male patients aged 20 to 35 years. Anticoagulant prophylaxis was not administered. Phlebography revealed asymptomatic calf vein thrombosis in three patients and these were not treated. In two of these phlebography was repeated after six weeks, and complete regression of the thrombi was noted. The present study may underestimate the frequency of postoperative venous thrombosis, as some thrombi may already have lysed at the time of phlebography. However, our results indicate a low incidence of thrombosis after knee meniscus extirpation.

Tracheo-oesophageal fistula caused by cuffed tracheal tubes.

Two patients with tracheo-oesophageal fistula following endotracheal intubation and tracheostomy are reported. In both cases the fistulas were related to inflammation of the cuffs distal to the tracheostomy. Two kinds of surgical treatment were performed: (1) Resection of 3 cm of the cervical trachea, closure of the oesophageal fistula opening with absorbable sutures and interposing a muscle flap of the left sternohyoid muscle. (2) No resection of the trachea. Direct closure of the fistula openings, and interposition with fixation to the trachea of a vascularized intercostal muscle flap via a right-sided thoracotomy. For optimal results of surgery, the pre-operative requirements should include control of septicaemia and gastrobronchial regurgitation, establishment of spontaneous ventilation and correction of malnutrition. For these purposes, the gastrostomy and transgastric jejunostomy regime was important in our patients. The simultaneous use of tracheal and oesophagus tubes is considered a risk factor in development of tracheobronchial fistulas.

Reconstructive arterial surgery in peripheral obliterative atherosclerosis.

A series of 547 patients (678 extremities) subjected to reconstructive arterial surgery is presented, with a minimum observation period of 2 years. The incidence of associated diseases at the time of operation was high (39%) and accounted for an impressive mortality when the patients were observed for a longer period of time. The main indication for all types of reconstructions was intermittent claudication and the results are in accord with those reported in other larger series. In 244 patients subjected to open thrombendarterectomy the postopertive mortality was 10/244, with 55% of the reconstructions being open after a mean observation period of 76 months. In 158 patients undergoing femoro-popliteal vein bypass procedures, the postoperative mortality was 2/158, with 55% open grafts after a mean observation period of 61 months.

Spontaneous pneumothorax.

Patients with spontaneous pneumothorax, who were treated in this department during the period 1950-59, were reviewed in 1963. Since the treatment of this group of patients has changed radically towards a greater surgical activity in the form of suction drainage and thoracotomy, the patients from the next decade, comprising 229 episodes in 202 patients, have now been reviewed to evaluate the results of this attitude. The conclusion from the earlier review, that recidivating pneumothorax should be operated upon, is further supported, and in quite a few patients (9%) thoracotomy had to be performed to control the first attack. Pleural rubbing, as an additional procedure to resection of bullae, seems as safe as partial pleurectomy in prevention of relapse. There were few serious operative complications. A rather protracted suction drainage has been practised in this series. One consequence of the experiences from the present review is that this time has been shortened.