Major surgery in leukemic patients.

During the last ten years, 15 major operations have been performed in our ward on 14 patients with leukemia. Nine had an uncomplicated postoperative course, two succumbed to overwhelming postoperative infections, another two died from cardiovascular complications and one from carcinomatous spread. There were no wound-related complications and no granulocyte or platelet transfusions were necessary. It is concluded that major surgery should not be avoided in patients solely because of the presence of a leukemic process.

Sapheno-femoral valve insufficiency in varicose veins of the lower limb.

SFV competence was investigated in 100 patients (189 legs) suffering from varicose veins. The incidence was found to depend on the method used. The simpler clinical methods such as the cough test, percussion test, Trendelenburg test, revealed SFV insufficiency to be between 15.4-21.6%. Using the Doppler ultrasound the incidence increased to 47.6%; by using the MABP, SFV insufficiency was found to be increased 20%. The SFV competence was indicated as playing an important role in the pathogenesis of varicose veins. The phlebologist's decision to carry out high ligation and stripping of the saphena magna in patients with varicose veins should be considered only for those cases where the extent of incompetence has been established beyond doubt.

Varicosities of uncommon sites: therapeutic aspects.

Five cases of varicosities of uncommon sites-suprapubic (2), abdominal and lower thoracic wall (1), gluteal region (1), and vulva (1)-are reported. The treatment given consisted of sclerotherapy and compressive bandaging. In order to obtain adequate compression in the inguinal and pubic regions it was necessary to resort to various improvisations (using wide elastic bandages and sheets of firm foamy material).

Immunodiagnostic test for the early detection of carcinoma of the breast.

A cytotoxic assay for the identification of circulating lymphocytes bearing surface ferritin was performed on 100 patients with malignant disease of the breast and in 50 healthy women. Forty-five patients were found to have a subpopulation of ferritin bearing lymphocytes, and all of them proved to have Stages I and II carcinoma of the breast. No such lymphocytes were identified in normal women, and in the remaining 55 patients, 33 had benign disease of the breast, 20 had Stage III carcinoma of the breast and two had Stages I and II carc-noma of the breast. It appears that this immunodiagnostic test may provide an additional tool for the early detection of carcinoma of the breast and may have a prognostic implication.

Restoration of muscle-pump function in chronic venous insufficiency.

The direct venous pressure profile was recorded before and after treatment in 15 patients suffering from chronic venous insufficiency. Patients were treated conservatively, first by tight elastic support and walking exercises, then by eliminating the points of blood shunting by sclerotherapy of the incompetent perforators. The average venous pressure drop during tiptoeing was increased from 31.6% to 50.9% (P less tan 0.01), and the time required for return to the resting venous pressure level increased from an average 6 seconds to 12.9 seconds (P = 0.01). These values indicate a significant improvement in the functioning of the muscle pump of the calf, and are paralleled by clinical and subjective improvement. Wr recommend this method of treatment in cases of chronic venous insufficiency. We also wish to point out the importance of repeated direct venous pressure profile recording as a means of assessing the effectiveness of treatment in cases of venous disorders.

Conservative treatment of stasis ulcer of the lower limbs.

Our conservative method of treating stasis ulcers of the leg, which is based on counteracting causal factors, was tested in 100 patients. Ninety-one percent of the ulcers healed within 12 months of treatment, and 71% within 6 months. No recurrences have been reported, although the follow-up is still only short-term. Because of these results, we think surgical treatment of stasis ulcers should be undertaken only when the conservative method fails. If surgery is to be done, it should consist of excision and ligation of varices and incompetent perforators, in order to eliminate recurrences.

Urine xanthine oxidase activity in urinary tract infection.

Xanthine oxidase (XO) activity was found to be negligible in sterile human urines (less than 480 units, as presently defined, per litre). Significant XO activity was found in all urines containing more than 10(5) bacteria/ml, except for urines infected with Staphylococcus aureus, in which XO activity ranged from 347 to 714 units per litre. Plasma XO is not transferred to the urine, as demonstrated by the negligible XO activity found in sterile urines from patients with raised plasma XO activity. Determination of urinary XO activity is a suitable procedure for the detection of urinary tract infection.