Venous thrombosis in the lower limbs: Its relation to pulmonary embolism

378

THE

AMERICAN

HEART

JOURNAL

surgical procedures on varicose veins have a much higher mortality. Westerborn found that 6,994 operations on varicose veins were followed by 18 deaths from embolism. In America McPheeters found that 6,671 operations on varicose veins were followed by 36 deat.hs from embolism-a mortality from embolism of 0.54 per cent. MONTGOMERY.

Homans, John : Venous Thrombosis in the Lower monary Embolism. Am. J. Surg. 38: 316, 1937.

Limbs:

Its Relation

to Pul-

The influences, anatomic and related to life in bed, consequent upon many diseases, injuries, and operations, which lead to thrombosis in the lower half of the body, are fairly well recognized today. Many of them are unavoidabIe, but most of them can be relieved of some of their bad effects by prophylactic treatment. Thrombosis once established should no longer be treated by the familiar ice bag and immobilization but by real elevation followed early by gradually increasing exercise. Embolism is more likely to be prevented by forestalling the formation of the dangerous propagating thrombus than by apprehensive immobilization. A further study of deep peripheral thrombophlebitis should be made by both the physicians and pathologists. By such means the apparent tendency today to increase in the incidence of thrombophlebitis may be reversed. AIJTHOR.

Barnes, A. R.:

Pulmonary

Embolism.

J. A. M.

A.

109: 1347, 1937.

Death from pulmonary embolism is a much greater menace in both medical and surgical cases t,han is generally realized. Although its cause is not known, some of the factors that predispose to its occurrence are known. Mild premonitory attacks frequently precede the fatal seizure, and it is important that they be recognized. The picture of shock, noted as much as or more commonly than marked dyspnea and The eleetrocyanosis, may constitute the clinical symptoms of pulmonary embolism. cardiogram may furnish invaluable aid in the diagnosis of this condition and especially in its differential diagnosis from acute coronary thrombosis. Whatever the cause of pulmonary embolism, the most promising avenue of attack is the attempt to improve the rate of circulation and particularly the velocity of venous A comprehensive program looking to that end return from the lower extremities. should be applied, if not to all patients, then to those patients whose condition presents circumstances which are known to predispose to the occurrence of pulmonary emCertain results to date encourage one to believe that if such a program bolism. were carried out with uncompromising zeal a very high percentage of deaths from at least following surgical procedures, pulmonary embolism could be eliminated, during the puerperium, and following sprains and fractures. In no aspect of surgery is there such a promising field for lowering surgical mortality. The medical profession is challenged to use at least such measures as are available in the effort to combat the tragic situation presented by pulmonary embolism. AUTHOR.

Johnston, C. II.: Combined Ligation and Injection Treatment Great Saphenous Vein. J. A. M. A. 109: 1359, 1937. Recurrence in cases presenting incompetent by injection alone or by ligation alone is far femoral junction, dissecting out, and se&ion injection of the distal end of the saphenous

of the Varicosed

saphenofemoral valves when treated too common. Ligation at the saphenoof all five branches at that level, and vein, is the treatment of choice. AI1