Current management of popliteal fossa incompetent superficial venous systems

2007 ◽  
Vol 22 (4) ◽  
pp. 179-185 ◽  
Author(s):  
A Kambal ◽  
C Bicknell ◽  
M Najem ◽  
S Renton ◽  
S T Hussain
Keyword(s):  
Current Practice ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Popliteal Fossa ◽  
Duplex Scanning ◽  
Initial Assessment ◽  
Current Management ◽  
Skin Changes

Objectives: Controversy exists regarding the management of varicose veins at the level of the popliteal fossa. This questionnaire reviews the current practice of vascular surgeons. Methods: A postal questionnaire was sent to 440 consultant surgeon members of the Vascular Society of Great Britain and Ireland. Recipients were asked to indicate their current practice of investigation and management of small saphenous (SSV), gastrocnemius and Giacomini varicosities. Results: We have received 296 (67%) responses to the questionnaire. Duplex scanning is utilized by 275 (93%) for the initial assessment of patients. Preoperatively, 188 (64%) reuse duplex scanning to mark the saphenopopliteal junction (SPJ) site, 53 (18%) mark with handheld Doppler only and 24 (8%) do not mark the SPJ. At operation, 198 (67%) flush ligate the SPJ and 87 (29%) tie the SSV 2–3 cm from the junction. A total of 101 (34%) usually strip the SSV to various levels. In symptomatic patients, 158 (53%) ligate the SPJ when an incompetent segment of SSV with a competent SPJ exists. One hundred and sixty-nine (57%) disconnect incompetent gastrocnemius veins during SPJ surgery and 172 (58%) regularly look for the Giacomini vein. Routine follow-up after surgery is practised by 172 (58%), most commonly at six weeks. This is mostly (88%) by clinical examination, with 14 (8.1%) using duplex scanning and six (4.7%) using a nurse-run clinic for the follow-up. Conclusions: This review suggests marked variation in the management of popliteal fossa venous incompetence. There is a clear need for further research to clarify the role of ablation in the management of symptoms and skin changes.

Role of diagnostic imaging in diagnosis by Covid-19

2020 ◽  
Author(s):  
Coda Marco ◽  
Sica Federica ◽  
Finelli Mirko ◽  
Ungaro Gaetano ◽  
Sica Alfonso Marco
Keyword(s):  
Differential Diagnosis ◽  
Lung Parenchyma ◽  
Chest Ct ◽  
Initial Assessment ◽  
X Rays ◽  
Radiological Imaging ◽  
Laboratory Examinations ◽  
Clinical Conditions

The diagnosis from Covid-19 provides the set of several examinations such as: clinical examinations, laboratory examinations, radiographic examinations. Using radiological imaging, RX and chest CT, it is possible to evaluate the impairment of lung function and thanks to this aspect it is possible to define the severity and clinical conditions of the patient. In this way, it allows timely therapeutic intervention especially if the patient shows a mild condition in such a way as to avoid the onset of further complications. Chest X-rays allow both an initial assessment of patients and the possibility to perform a differential diagnosis towards other possible causes of lung parenchyma involvement. The CT scan, which highlights the peculiar characteristics of COVID pneumonia, is performed both as diagnostic confirmation and in the patient’s follow-up.

Evolving Role of Digital Subtraction Angiography in Neurosurgical Practice

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 430-438 ◽  
Author(s):  
Thomas A. Duff ◽  
Patrick A. Turski ◽  
Joseph F. Sackett ◽  
Charles M. Strother ◽  
Andrew B. Crummy
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Processing ◽  
Initial Assessment ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Pathological Conditions ◽  
Vascular Bypass ◽  
Intracranial Vasculature

Abstract Advances in digital subtraction angiography (DSA) have allowed the evaluation of a number of pathological conditions involving the extra-and intracranial vasculature. In addition to its role in diagnosis. DSA has been used for the postoperative assessment of endarterectomy, aneurysm clipping, and vascular bypass and for the follow-up of arteriovenous fistulas or malformations. This paper describes the theory and anticipated improvements in the digital processing of radiological information and presents our initial assessment of its clinical utility.

Clinical Relevance of Neovascularisation on Duplex Ultrasound in the Long-Term Follow-up after Varicose Vein Operation

1999 ◽  
Vol 14 (3) ◽  
pp. 118-122 ◽  
Author(s):  
M. G. De Maeseneer ◽  
I. F. Tielliu ◽  
P. E. Van Schil ◽  
S. G. De Hert ◽  
E. J. Eyskens
Keyword(s):  
Varicose Vein ◽  
Clinical Relevance ◽  
Varicose Veins ◽  
University Hospital ◽  
Duplex Scanning ◽  
Recurrent Varicose Veins ◽  
Varicose Vein Operation ◽  
Long Term Follow Up

Objective: To evaluate the clinical relevance of neovascularisation at the saphenous ligation site. Design: Long-term follow-up after previous varicose vein surgery in a single patient group. Setting: Vascular clinic of a university hospital. Patients: Eighty-two patients (106 limbs) with a mean follow-up period of 56 months after correct saphenous ligation were submitted to duplex scanning. Intervention: Clinical assessment and colour duplex scanning of all the operated limbs. Reintervention in 15 limbs with perioperative evaluation of recurrent veins. Main outcome measures: Limbs with and without recurrent varicose veins were classified according to the degree of neovascularisation: grade 0 = no new communicating veins, grade 1 = tiny new vein with diameter <4 mm, grade 2 = new communicating vein with diameter >4 mm and pathological reflux. On reintervention the presence of neovascular veins at the site of the previous ligation was checked. Results: In 68 limbs without recurrent varicose veins, grade 0 was observed in 50 limbs (74%), grade 1 in 12 limbs (18%) and grade 2 in six limbs (9%). In 38 limbs with recurrent varicose veins, grade 0 was diagnosed in eight limbs (21%), grade 1 in four limbs (11%) and grade 2 in 26 limbs (68%). In 15 limbs with recurrent varicose veins and grade 2 neovascularisation, reintervention confirmed the duplex findings. Conclusions: The presence of grade 2 neovascularisation was associated with the recurrence of varicose veins, suggesting a causal relationship.

scholarly journals Treating the boxer's fracture in Wales: a postal survey

2010 ◽  
Vol 92 (3) ◽  
pp. 236-239 ◽  
Author(s):  
Rhidian Jones ◽  
Sadie Burdett ◽  
Matthew Jefferies ◽  
Abhijit R Guha
Keyword(s):  
Best Practice ◽  
Current Practice ◽  
Response Rate ◽  
Plaster Cast ◽  
Postal Questionnaire ◽  
Postal Survey ◽  
Outcome Study ◽  
Best Practice Guidelines ◽  
Boxer’S Fracture

INTRODUCTION There is no standardised treatment for fifth metacarpal neck fractures. Treatment of this common fracture can vary from immediate mobilisation to immobilisation in a plaster cast for 3 weeks. There is no literature identifying current practice amongst surgeons. SUBJECTS AND METHODS This survey's aim was to reveal current practice in Wales by means of a postal questionnaire sent to all Welsh orthopaedic consultants. RESULTS The questionnaire had a 60% response rate. Results demonstrated varied opinion regarding the degree of displacement warranting reduction. Overall, 10% of surgeons reduce the fracture at 30° of displacement, 29% at 40°, 18% at 50° and 20% at 60° of displacement. The treatment was also very varied. Most surgeons preferred to treat these fractures with neighbour strapping (43%,) while others preferred plaster immobilisation (39%) or immediate mobilisation (10%.) Only 22% of surgeons discharge these patients back to the community after their first visit to out-patients while 13% offer two follow-up appointments. CONCLUSIONS The treatment being offered for this common fracture in Wales is inconsistent. There is a need to develop evidence- based best practice guidelines which should standardise the treatment of this common injury. Perhaps, a large multicentre outcome study may enable this to be drawn up in the future.

The Role of Imaging in Advanced Endometrial Carcinoma

2009 ◽  
Vol 05 (01) ◽  
pp. 68
Author(s):  
Helen Addley ◽  
Evis Sala ◽  
◽  
Keyword(s):  
Endometrial Carcinoma ◽  
Treatment Planning ◽  
Endometrial Thickness ◽  
Imaging Techniques ◽  
Treatment Selection ◽  
Histological Diagnosis ◽  
Initial Assessment ◽  
Oncological Treatment

Imaging in endometrial carcinoma has many roles. It is used in the initial assessment of symptomatic patients for demonstration of abnormal endometrial thickness. Once the histological diagnosis of endometrial carcinoma is confirmed, imaging can accurately stage the tumour, facilitating surgical and oncological treatment planning. This article will review the different imaging techniques available and their roles in staging, treatment selection and follow-up of patients with endometrial carcinoma.

Compression regimes after endovenous ablation for superficial venous insufficiency – A survey of members of the Vascular Society of Great Britain and Ireland

2015 ◽  
Vol 31 (1) ◽  
pp. 16-22 ◽  
Author(s):  
J El-Sheikha ◽  
S Nandhra ◽  
D Carradice ◽  
C Acey ◽  
GE Smith ◽  
...  
Keyword(s):  
Great Britain ◽  
Venous Insufficiency ◽  
Current Practice ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Compression Stockings ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Endovenous Ablation ◽  
Superficial Venous Insufficiency

Introduction The optimal compression regime following ultrasound guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) for varicose veins is not known. The aim of this study was to document current practice. Methods Postal questionnaire sent to 348 consultant members of the Vascular Society of Great Britain and Ireland. Results Valid replies were received from 41% ( n = 141) surgeons representing at least 68 (61%) vascular units. UGFS was used by 74% surgeons, RFA by 70% and EVLA by 32%, but fewer patients received UGFS (median 30) annually, than endothermal treatment (median 50) – P = 0.019. All surgeons prescribed compression: following UGFS for median seven days (range two days to three months) and after endothermal ablation for 10 days (range two days to six weeks) – P = 0.298. Seven different combinations of bandages, pads and compression stockings were reported following UGFS and four after endothermal ablation. Some surgeons advised changing from bandages to stockings from five days (range 1–14) after UGFS. Following endothermal ablation, 71% used bandages only, followed by compression stockings after two days (range 1–14). The majority of surgeons (87%) also treated varicose tributaries: 65% used phlebectomy, the majority (65%) synchronously with endothermal ablation. Concordance of compression regimes between surgeons within vascular units was uncommon. Only seven units using UGFS and six units using endothermal ablation had consistent compression regimes. Conclusion Compression regimes after treatments for varicose veins vary significantly: more evidence is needed to guide practice.

Antroscopy: current practice—a survey of UK otolaryngologists

1989 ◽  
Vol 103 (8) ◽  
pp. 747-749 ◽  
Author(s):  
E. W. Fisher ◽  
C. B. Croft
Keyword(s):  
Clinical Practice ◽  
Cost Effectiveness ◽  
Current Practice ◽  
Postal Questionnaire ◽  
General Anaesthetic ◽  
Clinical Role ◽  
Inferior Meatus ◽  
The Uk ◽  
The Cost

AbstractThe use of antroscopy by otolaryngologists in the UK was assessed by means of a postal questionnaire. A response of 70 per cent was obtained. Thirty-three per cent of otolaryngologists currently perform antroscopy; the principal reason for not using the technique being lack of suitable equipment. Twenty-four per cent of non-users believed that antroscopy would not alter their management of patients, and 19 per cent of all responders thought that antroscopy had no proven clinical role. Few surgeons recognized a role for antroscopy in the treatment of antral disease.Antroscopists preferred to operate on in-patients (73 per cent), under a general anaesthetic (60 per cent) and via the inferior meatus (66 per cent); 76 per cent consider that morbidity is insignificant.There is clearly a need for studies clarifying the role of antroscopy in clinical practice and to establish the cost-effectiveness of the technique.

TP3-9 Assessment of seizures in over 75-year olds: a clinical audit

2019 ◽  
Vol 90 (3) ◽  
pp. e20.3-e21
Author(s):  
ZT Ahmed ◽  
A Rather
Keyword(s):  
Current Practice ◽  
Clinical Audit ◽  
Data Entry ◽  
Integrated Approach ◽  
Initial Assessment ◽  
National Audit ◽  
Retrospective Audit ◽  
Specialist Referral ◽  
Nice Guidance

ObjectivesThis audit evaluates the assessment of first seizures in over 75-year-olds within our centre using NICE guidance (CG137) as our standard. This is in response to the National Audit of Seizure management in Hospitals which revealed significant deficits in current practice.DesignA retrospective audit design was used.SubjectsWe reviewed patient records of 74 patients over the age of 75 who presented to A+E with their first seizure between 1 st January and 30th April 2017.MethodsData entry took place between 14th November and 22nd January when follow-up information should have been available. A proforma based on current NICE guidance was used to evaluate initial assessment, investigations and specialist review.Results38 females and 36 males were assessed with an average age of 83 years (range 76–95). NICE recommends that all patients are seen by a specialist within 2 weeks, however only 38% of our patients met this standard. Only 65% of patients indicated for an EEG had one and 34% waited longer than the recommended 4 weeks. Neuroimaging was optimal with 95% of patients receiving an MRI within 4 weeks. In contrast, blood glucose was only measured in 47% of patients and only 51% had a 12-lead ECG despite recommendations that these investigations should be performed routinely.ConclusionsThere is a lack of comprehensive A+E assessments and specialist referral for older people both within our centre and nationally. A more thorough and integrated approach is needed to improve outcomes and optimise care.

Assessment and Treatment of Varicose Veins in the Northern Region

1995 ◽  
Vol 10 (2) ◽  
pp. 56-61 ◽  
Author(s):  
T. A. Lees ◽  
J. D. Holdsworth
Keyword(s):  
Saphenous Vein ◽  
Current Practice ◽  
Varicose Veins ◽  
Northern Region ◽  
Initial Assessment ◽  
Doppler Examination ◽  
Long Saphenous Vein ◽  
Saphenous Veins ◽  
Assessment And Treatment ◽  
General Surgeons

Objective: To identify the current practice of surgeons and variations between these surgeons in the investigation and treatment of varicose veins. Design: Questionnaire submitted to all surgeons treating varicose veins. Setting: All general surgeons in the Northern Region of England. Results: The response was 83% with 60 surgeons (85% of responders) treating varicose veins. Thirty-five per cent have a vascular specialist interest and treat 58% of all the varicose veins; 37% of surgeons complement initial assessment by clinical examination with hand-held Doppler examination. For long saphenous vein incompetence all surgeons perform high saphenous ligation, with 67% stripping the vein to the knee and 23% to the ankle. For short saphenous incompetence, 28% localize the saphenopopliteal junction by investigation prior to treatment, 92% perform saphenopopliteal ligation and 13% strip the vein. Conclusions: The extent of investigation and the nature of treatment of varicose veins vary considerably between consultants. Relatively few surgeons use hand-held Doppler and surgeons remain divided on the use and extent of stripping of the saphenous veins.

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