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Conservative treatment of occlusive arterial disease
124
THE
lated to cardiac syndromes might in the production
AMERICAN
tone. Competent study possibly throw further of angina pectoris.
HEART
JOURNAL,
of certain antagonistic factors light on the precise mechanism
in these involved AUTHORS.
Wright, Burg.
Irving: 40:
163,
Conservative
Treatment
of Occlusive
Arterial
Disease.
Arch.
1940.
An attempt has been made to review and evaluate the more important of the methods used in conservative treatment of occlusive peripheral vascular disease, especially arteriosclerosis obliterans and thromboangiitis obliterans. The more general use of the conservative approach definitely affects the statistics on amputations. It should be recognized that it is far better surgery to take meticulous care of small lesions and produce healing than to perform major amputations. In a series of 100 consecutive cases of thromboangiitis obliterans studied since 1931 by Littauer and me, only three major amputations were performed, all on persons who would not stop smoking. Most of the patients have been followed for from two to eight years. The incidence of amputation in this group may be expected to rise with the trauma and other factor’s incident to the passage of time, but it is extremely doubtful that the former amputation rate of from 40 to 50 per cent will again be observed. For arteriosclerosis obliterans, our figures are not so encouraging. We have not yet oompiled statistics on this condition, but we have been impressed by its more hesitant response to therapy. On the other hand, an increasing number of patients who have been advised to submit to amputation are today walking on the condemned leg as a result of conservative therapy. Continued study may result in greater success in this regard. Amputation must be regarded as an admission of defeat, an acknowledgment of the physician’s inability to solve the problem with which he is confronted. * It is important that the recent trend in certain quarters toward submitting all patients with vascular disease to the same form of therapy, whether it be use of the pressure suction boot, administration of hypertonic saline solution, or intravenous administration of typhoid vaccine, be discouraged. The problems presented by different diseases and by different patients with the same disease are more frequently unlike than identical. Each should be given individual consideration before the therapeutic regimen is instituted. It is also of vital importance that the conception that peripheral vascular disease is purely local, invoIving only the extremities, be overcome. Each patient should be submitted to a complete study in order that evidences of vascular damage anywhere in the body may be discovered and proper therapy instituted. For example, it is not yet generally recog nized that thromboangiitis obliterans may affect any artery in the body. AUTHOR.
Homans, John:
Lymphedema
of the Limbs.
Arch.
Surg.
40:
232,
1940.
An attempt has been made to sort out and describe the lymphedemas, especialIy of the lower limbs, which are due to local causes. The elephantiases, that is, those associated with a total disappearance of the lymph vessels, are unexplainable, and, as one might suppose, they are really incurable; that is to say, there is no way of restoring drainage of the tissue fluids. To do away with the swelling, one must remove the tissue in which fluid collects. This need not, as a rule, be done for the thigh. It is enough to reduce the size of the leg below the knee. None originate
of the other in femoroiliae
lymphedemas are thrombophlebitis
wholly of lymphatic are certainly due
in
origin. part
Those which to involvement
THE
lated to cardiac syndromes might in the production
AMERICAN
tone. Competent study possibly throw further of angina pectoris.
HEART
JOURNAL,
of certain antagonistic factors light on the precise mechanism
in these involved AUTHORS.
Wright, Burg.
Irving: 40:
163,
Conservative
Treatment
of Occlusive
Arterial
Disease.
Arch.
1940.
An attempt has been made to review and evaluate the more important of the methods used in conservative treatment of occlusive peripheral vascular disease, especially arteriosclerosis obliterans and thromboangiitis obliterans. The more general use of the conservative approach definitely affects the statistics on amputations. It should be recognized that it is far better surgery to take meticulous care of small lesions and produce healing than to perform major amputations. In a series of 100 consecutive cases of thromboangiitis obliterans studied since 1931 by Littauer and me, only three major amputations were performed, all on persons who would not stop smoking. Most of the patients have been followed for from two to eight years. The incidence of amputation in this group may be expected to rise with the trauma and other factor’s incident to the passage of time, but it is extremely doubtful that the former amputation rate of from 40 to 50 per cent will again be observed. For arteriosclerosis obliterans, our figures are not so encouraging. We have not yet oompiled statistics on this condition, but we have been impressed by its more hesitant response to therapy. On the other hand, an increasing number of patients who have been advised to submit to amputation are today walking on the condemned leg as a result of conservative therapy. Continued study may result in greater success in this regard. Amputation must be regarded as an admission of defeat, an acknowledgment of the physician’s inability to solve the problem with which he is confronted. * It is important that the recent trend in certain quarters toward submitting all patients with vascular disease to the same form of therapy, whether it be use of the pressure suction boot, administration of hypertonic saline solution, or intravenous administration of typhoid vaccine, be discouraged. The problems presented by different diseases and by different patients with the same disease are more frequently unlike than identical. Each should be given individual consideration before the therapeutic regimen is instituted. It is also of vital importance that the conception that peripheral vascular disease is purely local, invoIving only the extremities, be overcome. Each patient should be submitted to a complete study in order that evidences of vascular damage anywhere in the body may be discovered and proper therapy instituted. For example, it is not yet generally recog nized that thromboangiitis obliterans may affect any artery in the body. AUTHOR.
Homans, John:
Lymphedema
of the Limbs.
Arch.
Surg.
40:
232,
1940.
An attempt has been made to sort out and describe the lymphedemas, especialIy of the lower limbs, which are due to local causes. The elephantiases, that is, those associated with a total disappearance of the lymph vessels, are unexplainable, and, as one might suppose, they are really incurable; that is to say, there is no way of restoring drainage of the tissue fluids. To do away with the swelling, one must remove the tissue in which fluid collects. This need not, as a rule, be done for the thigh. It is enough to reduce the size of the leg below the knee. None originate
of the other in femoroiliae
lymphedemas are thrombophlebitis
wholly of lymphatic are certainly due
in
origin. part
Those which to involvement