INDICATIONS FOR ANGIOCARDIOGRAPHY

Angiocardiography is indicated in selected cases of heart disease in which a definite diagnosis cannot be made by ordinary methods or in which there is reasonable expectation that the information so obtained may influence the treatment of the patient. Whenever possible, angiocardiography should be done in conjunction with cardiac catheterization. The main indication for angiocardiography is cyanotic congenital heart disease; primarily those cases in which there is a right-to-left shunt. Angiocardiography is occasionally of value in diagnosis of other types of congenital heart disease and in acquired heart disease.     

INDICATIONS FOR LUMBOSACRAL FUSION

In cases in which operation is indicated, the author advocates routine fusion of the lumbosacral joint in all cases of protrusion of the 5th lumbar disc, providing the spine above that level is considered essentially normal.He would do spinal fusion in all cases—provided operation were indicated—in which the primary complaint was that of low back pain and in which sciatic pain was absent or minimal. In such cases, the fusion area should extend as far as necessary to include the portion of the spine involved in pathologic change. Only in exceptional cases would spinal fusion be done in patients more than 50 years of age.With the exceptions noted, all patients requiring reoperation should have the benefits of lumbosacral fusion.     

INDICATIONS FOR OPERATION IN GLAUCOMA

Prompt surgical operation is indicated in angle-closure glaucoma and in infantile glaucoma. Open-angle glaucoma is properly considered a disease for which conservative treatment should be tried.Operation is indicated in open-angle glaucoma when, despite maximal medical therapy, the intraocular pressure reaches a level at which the optic nerve is going to be damaged. Many factors must be considered in making a decision as to whether or not to operate in such circumstances, among them the condition of the eye, the result of previous operation if one has been done, the reliability of the patient with regard to carrying out a prescribed regimen, the age and physical condition of the patient, perhaps the race of the patient, the presence of cataracts and the attitude of both patient and surgeon toward surgical treatment.     

INDICATIONS FOR OPERATION IN LARYNGEAL CANCER

Improvements in the surgical treatment of laryngeal cancer by combined laryngectomy and radical neck dissection have given new importance to selection of the mode of treatment for various stages of disease at that site. To cast light on the subject, the cases of 63 patients with cancer of the larynx were reviewed. Twenty-one of them were operated on for recurrence after radiation therapy; and 42 were treated surgically at the outset, 36 of them having combined laryngectomy and radical neck dissection. In almost 80 per cent of the patients the lesion was extrinsic.In the entire series, 51 patients had combined operations, and in 41 of them the cervical lymph nodes were positive for metastasis.Reports in the literature also make note of a very high incidence of cervical node metastasis not only in cases of extrinsic cancer, but also in those in which the lesion is intrinsic.Because of the frequency of cervical node spread, and its occult nature, choice between radiation and surgical operation must be made after candid, critical appraisal of the individual condition in each patient.     

INDICATIONS FOR DIFFERENT APPROACHES TO PROSTATECTOMY

Most urologists are definite and positive in their conviction as to which approach to prostatectomy is indicated in a given case. Their views are often so widely divergent that other physicians may be confused as to the best advice to give patients who need prostatic operation. Urologists who extol one approach or technique and deride another only add to the confusion and prejudice.The most important indication for the use of any approach or technique is the ability of the surgeon to carry it out.