Day care surgery.

In recent years, day surgery rates have risen in many countries in the world. In 1998-99, 65% of elective surgery was performed as day procedures in the UK and about 70% in the USA. The future has the potential for an increase in day surgery as less well-performing countries and hospitals catch up with the best, and new surgical, anaesthetic and analgesic techniques are introduced.

Day surgery--the future.

Day surgery is a cost effective, quality approach to treatment which has expanded rapidly in recent years. Changes in attitude and the introduction of new technology will ensure its future growth as long as the purchasers of health care do not focus only on its cost savings aspect but equally concentrate on its quality benefits.

A prospective study of bilateral inguinal hernia repair.

A prospective study of outcome after inguinal hernia repair in patients undergoing simultaneous repair of bilateral hernias (n = 31), sequential repair of bilateral hernias (n = 5), and unilateral hernia repair (n = 75) is reported. There were no differences in wound complications, post-operative respiratory complications, or other adverse effects in the three groups. Operating time was similar in the unilateral and bilateral simultaneous repairs (median 55 min), but was longer (100 min) for the combination of two sequential repairs.

Admission to hospital after day case surgery.

This paper reports a 5-year experience of a surgical day case unit. Over 10,000 patients were treated in the three specialties of gynaecology, orthopaedics and general surgery. Seventy patients (0.

Effect of a surgical day unit on waiting lists.

The effect of a surgical day unit (SDU) on the waiting lists of a busy district general hospital is reported over a 4-year period. During this time, 18 (15%) of the general surgical beds were closed for financial reasons. A real saving rather than an apparent one is reported due to the work expansion in the SDU.

Recurrence rates following local anaesthetic day case inguinal hernia repair by junior surgeons in a district general hospital.

Four hundred and seventy one inguinal hernia repairs were performed by surgeons in training as day cases using local anaesthesia between September 1979 and December 1982. All patients were sent questionnaires relating to the possibility of a recurrence or an unsatisfactory outcome of the operation at a mean of 34 months after surgery. A 96.

Outpatient varicose vein surgery under local anaesthesia.

Local anaesthesia has been used for 186 varicose vein operations performed in a day surgical unit. The long saphenous vein was stripped in 87 legs using a femoral nerve block. All patients went home on the day of operation and none required readmission.

Variable symptomatology in idiopathic retroperitoneal fibrosis.

Idiopathic retroperitoneal fibrosis is uncommon enough to be placed low down on a list of differential diagnoses of any problem facing a general surgeon in a district hospital. In this paper, 4 cases of retroperitoneal fibrosis are described, all of whom presented within a 5-year period to the same surgeon; each described a different symptomatology. This paper serves to reiterate the diversity of presenting features in retroperitoneal fibrosis and to demonstrate that this condition may not be as rare as is widely believed.

The treatment of recurrent pulmonary embolism: experience with the Kimray Greenfield vena cava filter.

Clinical experience with the Kimray Greenfield vena cava filter in 24 patients, most of whom suffered recurrent pulmonary embolism despite heparin treatment, is presented. The advantages of this filter over previous trans-venous filters is discussed. Initial results show the filter to be both safe and effective.

Day case inguinal hernia repair under local anaesthetic.

Local anaesthetic day case inguinal hernia repair has been performed on 135 patients under the care of one surgeon in a nine month period. Results of a questionnaire answered by 129 patients (95.6%) and 31 of their general practitioners (85%) have been analysed.

Blood viscosity, Raynaud's phenomenon and the effect of fibrinolytic enhancement.

The whole blood and corrected blood viscosity of 17 patients with Raynaud's phenomenon (8 with idiopathic Raynaud's phenomenon and 9 with scleroderma-associated Raynaud's phenomenon) have been compared with 12 normal controls. Viscosity has been measured with a Contraves LSV1 rotating viscometer and the Wells-Brookfield microviscometer at 37 degrees C and 25 degrees C and shear rates ranging from 0.775 s-1 to 230 s-1.

Venous lipodermatosclerosis: treatment by fibrinolytic enhancement and elastic compression.

The value of fibrinolytic enhancement with an anabolic steroid (stanozolol) combined with elastic stockings in treating venous lipodermatosclerosis was assessed in a six-month double-blind cross-over trial. Thirty-four legs of 23 patients in whom other treatments had failed were studied. The patients were randomly divided into two groups who were treated with either stanozolol plus elastic stockings or placebo plus elastic stockings for three months, and then vice versa.

Treatment of Raynaud's phenomenon by fibrinolytic enhancement.

Twenty patients with advanced Raynaud's phenomenon, in 14 of whom it was secondary to scleroderma, were treated with stanozolol, an anabolic steroid that enhances natural fibrinolysis. All showed an increase in hand blood flow and a reduction in symptoms during treatment. This response may have been caused by the lysis of fibrin deposited in the digital arteries and the reduction of plasma viscosity.

Treatment of liposclerosis of the leg by fibrinolytic enhancement: a preliminary report.

Fourteen patients with longstanding lipodermatosclerosis of their lower legs, secondary to venous disease in 11, were treated for three months with stanozolol, a drug that enhances fibrinolytic activity. No other treatment was given and no change made in existing treatment. All the patients improved.

Idiopathic recurrent superficial thrombophlebitis: treatment with fibrinolytic enhancement.

Sixteen patients with idiopathic recurrent superficial thrombophlebitis were shown to have a defect of blood and tissue fibrinolytic activity. After six months' treatment with stanozolol their mean dilute blood clot lysis time and plasma fibrinogen fell significantly and the mean fibrin plate lysis area increased. Attacks of thrombophlebitis stopped completely in 13 patients, though five patients later suffered recurrences and phenformin had to be added to their treatment.

Blood and vein-wall fibrinolytic activity in health and vascular disease.

The resting blood fibrinolytic activity of 120 normal subjects and 294 patients with various forms of vascular disease was assessed by measuring the dilute blood clot lysis time and fibrin plate lysis area before and after 10 minutes of venous congestion. The tissue fibrinolytic activity of several of these subjects was assessed in vein biopsy specimens. The results suggested that there was a correlation between blood and tissue fibrinolytic activity and that certain venous diseases, particularly recurrent superficial thrombophlebitis and venous liposclerosis, were associated with a deficiency of blood and tissue fibrinolytic activity.