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Arterial combat injuries of the upper extremity.

The results of treatment of 101 combat injuries of the upper extremities are reported. There were 84 acute injuries and 17 late complications. There was a high incidence of associated fractures (35%) and nerve lesions (51%). Over half the injuries were repaired by saphenous vein graft replacement. There were seven early amputations related to a long delay before treatment, extensive tissue damage, and sepsis with delayed hemorrhage. There were no late amputations, but residual neurologic damage gave a less than perfect result in 32 extremities. Two injuries resulted in Volkmann's contracture. Fracture specific to the management of upper-extremity arterial injuries are outlined.

Amputation, Surgical↗

[Air embolism].

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Arteries↗

Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients.

Between the years 1968-1992, 475 patients underwent simultaneous bilateral upper dorsal sympathectomy by the supraclavicular approach for severe palmar hyperhidrosis. For the purpose of comparing outcomes of the open surgical method with the increasingly used thoracoscopic procedure, we reviewed the clinical data of our patients. The incidence of severe palmar hyperhidrosis in the young population in Israel is 1-2/1,000. Surgical excision of the T2 and T3 ganglia was effective in drying the hands of all patients, who had frozen section confirmation of removal of a ganglion. At follow-up, hyperhidrosis recurred in 5.3% of limbs. Mild transient Horner's syndrome occurred in 12% of procedures, but only in 5 patients was it permanent. The main drawback of the open surgical approach lies in the postoperative complications. The effectiveness of the thoracoscopic approach will be judged by immediate and late results, and by the expected reduction in postoperative morbidity.

Hand↗

Carotid endarterectomy for symptom-free stenosis: the patient's point of view.

Determining the indication for carotid endarterectomy in a given patient with a totally symptom-free internal carotid artery stenosis depends on objectively assessing the risk of non-operative versus operative treatment, as well as on the patient's attitude towards immediate versus long-term risk. In order to study patients' attitudes and preferences, four groups of subjects were asked to complete two questionnaires: the first examined people's perceived deterioration in their quality of life if they sustained a stroke of a defined severity. The second checked the attitude towards risk of operative versus non-operative treatment at different levels of an expected annual stroke rate without surgery. This preliminary study showed the feasibility of studying these subjective elements, and also pointed to problem areas in this type of research. The existence of individual as well as group differences in patients' values and preferences should be considered in the decision-making process.

Adult↗