Ambulatory venous pressure revisited

PURPOSE: The purpose of this study was to describe a method for measuring the deep venous pressure changes in the lower extremity and compare it with those obtained in the dorsal foot vein. METHODS: After cannulation of the posterior tibial vein, a catheter with a pressure transducer in its tip was inserted and placed at the knee joint level. The dorsal foot vein was also cannulated. Pressures were recorded simultaneously at both sites during toe stands and repeated with the probe in the upper, middle, and lower calf. RESULTS: The study was performed in 45 patients with signs and symptoms of chronic venous insufficiency. Duplex Doppler scanning and ascending and descending venography performed before pressure measurements revealed saphenous vein incompetence in 11 lower extremities, incompetent perforators in 11 extremities (eight were combined with saphenous incompetence), and marked compression of popliteal vein with plantar flexion in 28 extremities. No significant deep axial reflux was observed on duplex Doppler examination or descending venography. No morphologic outflow obstruction was detected. The mean deep pressure at the knee joint level fell during toe stands, -15% +/- 27 (SD), and the mean dorsal foot vein pressure drop was even more marked, -75% +/- 22 (SD). Although the exercise pressure in the dorsal foot vein decreased in all patients (range, 13-90% drop), the popliteal vein pressure increased (4-72%) in nine limbs, decreased only marginally if at all in 15 limbs (0-15%), and fell more markedly in 21 extremities (22-65%). Deep vein recovery time was considerably shorter overall as compared with the findings by the dorsal vein measurement. In the comparison of limbs with and without superficial reflux, the recovery times in the deep system were significantly shorter in limbs with superficial incompetence. CONCLUSION: Ambulatory dorsal foot venous pressure is not always accurate in detecting changes in the pressure of the tibial and popliteal veins. Although dorsal foot venous pressure may be normal, deep venous pressure may decrease to a lesser degree or even increase.     

Ambulatory surgery in orthopedics

Growing importance is being assumed by orthopaedic outpatient surgery. An account is given in this paper of advantages, obstacles, prerequisites, surgical indications, preparations for surgical intervention, and anaesthesia. Close cooperation between the clinical and outpatient departments has proved to ensure smooth transition in patient care from one sector to another in the case of complications.     

Ambulatory surgery in Spain

In Spain, ambulatory surgery (AS) is a form of surgical care provision covered by the services delivered by the National Health System (NHS). In order to achieve an approximation of the organisation of AS, an anonymous questionnaire was sent to all Spanish hospitals (public and private) in 1995. AS surgery was carried out in 57% of the respondent hospitals (out of these, 62% were hospitals of the NHS). Of hospitals, 54% not performing day surgery were planning to set it up in the immediate future. The most common way of providing the service is by integrating the day patients with elective cases from the surgical department. Most of the ambulatory units are hospital-based; only one free-standing unit was identified. Lack of infrastructure was claimed as the main obstacle for initiating day surgery programmes. A wide expansion of AS in Spain needs more structural modifications of the traditional hospital organisation to allow the establishment of well designed units for the provision of high quality care.     

Ambulatory surgery update

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - Ambulatory surgery today represents a new challenge for the anaesthetist as the focus has shifted to the bottom line: cost...     

Ambulatory proctologic surgery

Outpatient surgical proctology is nowadays more and more frequently performed. Between 1986 and 1989, 65% of 1149 anal surgical procedures were performed in our institution on an outpatient basis. The various criteria used to select patients fit for ambulatory surgery seemed adequate, as no complications were observed and no patient required secondary hospitalization.